Adaptation of a stoma care pathway and use of telephone clinics during the pandemic: patient experience survey

With the arrival of the COVID-19 pandemic, outpatient clinics had to adjust and reduce the number of face-to-face appointments. The Cambridge stoma service has a recognised pathway of stoma care but needed to adjust this in line with government guidelines. The team took the opportunity to audit the current pathway and complete a patient experience survey to determine the future of the service and potential adaptations to the pathway in the future. Aim: To determine the need for adaptation and improvement of the standard stoma clinics pathway. Method: A survey was conducted using a postal questionnaire to all patients who attended stoma clinics between April and June 2020. Findings: 160 questionnaires were sent and 72 responses returned (45%). All elements of the virtual clinic were rated positive by more than 80% of respondents, with nearly 90% of them feeling that all their stoma care needs were met. When asked to indicate their preferred consultation methods (patients were allowed to choose more than one), face to face received 50 votes, telephone 32 votes and video clinic 5 votes. Conclusion: There is a need to adapt the standard clinic pathway to be able to offer standardised care but with flexibility to adjust to circumstances and patients' preferences.

Recent Advances in the Inhibition of the IL-4 Cytokine Pathway for the Treatment of Allergen-Induced Asthma

The IL-4 and IL-13 cytokine pathways play integral roles in stimulating IgE inflammation, with the IL-4 cytokine being a major cytokine in the etiology of thunderstorm asthma, atopic dermatitis, and allergic rhinitis. The increasing prevalence of thunderstorm asthma in the younger population and the lessening efficacy of corticosteroids and other anti-inflammatories has created a need for more effective pharmaceuticals. This review summarizes the IL-4 and IL-13 pathways while highlighting and discussing the current pathway inhibitors aimed at treating thunderstorm asthma and atopic dermatitis, as well as the potential efficacy of peptide therapeutics in this field.

646 A Review of The Urodynamic Referral Pathway and The Accuracy of Urodynamic Study Requests

Aim Urodynamic studies (UDS) are physiological measurements of voiding and storage function of the lower urinary tract that are commonly performed in clinical practice to investigate bothersome lower urinary tract symptoms. Despite considerable efforts to improve UDS, standardisation of the practice remains to be challenging. This audit thus, presents a review the current UDS referral process and analysis of the clinical details included on urodynamic requests. Method This audit included retrospective data from 112 patients between March and Oct 2020, 98 of which had UDS performed. Patient electronic records, referral forms and clinic letters were all used for data collection. Results Data shows that 47% of patients were females with average age of 56 years, range (16-86) years. The reason of UDS was clearly stated in 8 referrals only and the clinical examination findings were clearly mentioned in 31% only. More than three quarters of patients (i.e., 77%) had assessment of post void residual prior to UDS, but half of the proportion had no history of relevant medications. In 98 patients who had UDS done, the main findings showed that 4 patients had normal studies, 3 with dysfunctional voiding, 7 had bladder outflow obstruction, 32 patients were diagnosed with detrusor overactivity, 12 had stress incontinence and 7 showed detrusor underactivity. Conclusions Finding of this audit clearly suggest a level of unclarity in the great majority of referrals. Evidently, key history of relevant medication is overlooked in half of the referrals. Improvements to the current pathway to UDS is therefore pivotal.

Analysing the meta-interaction between pathways by gene set topological impact analysis

Background Pathway analysis is widely applied in transcriptome analysis. Given certain transcriptomic changes, current pathway analysis tools tend to search for the most impacted pathways, which provides insight into underlying biological mechanisms. Further refining of the enriched pathways and extracting functional modules by “crosstalk” analysis have been proposed. However, the upstream/downstream relationships between the modules, which may provide extra biological insights such as the coordination of different functional modules and the signal transduction flow have been ignored. Results To quantitatively analyse the upstream/downstream relationships between functional modules, we developed a novel GEne Set Topological Impact Analysis (GESTIA), which could be used to assemble the enriched pathways and functional modules into a super-module with a topological structure. We showed the advantages of this analysis in the exploration of extra biological insight in addition to the individual enriched pathways and functional modules. Conclusions GESTIA can be applied to a broad range of pathway/module analysis result. We hope that GESTIA may help researchers to get one additional step closer to understanding the molecular mechanism from the pathway/module analysis results.

38. INNOVATIVE USE OF A CUSTOM MOBILE APPLICATION (APP) BY A BRAIN METASTASES PROGRAM FACILITATES MULTIDISCIPLINARY MANAGEMENT OF PATIENTS AND DECREASED LENGTH OF HOSPITAL STAY (LOS)

INTRODUCTION Patients with Brain Metastases (BM) are complex, mandating multidisciplinary care. Our BM patients are discussed at in-person, weekly Brain Tumor Boards (BTB). However, BM patients diagnosed outside weekly BTBs wait several days for the next BTB, causing delays in generating multidisciplinary plans-of-care, prolonging LOS. We created a custom mobile app for our Brain Metastases Program to have a ‘Brain Metastases Virtual Tumor Board’ (BMVTB) discussion, in real-time, resulting in faster plans-of-care, decreasing LOS. METHODS The current pathway for navigating multidisciplinary discussions for patients with BM was examined by members of our Brain Metastases Program. We identified the need for all disciplines to participate in a BMVTB, outside of our in-person, weekly BTB. We developed a secure app that can be downloaded on any provider’s mobile device. The app includes a digital BM treatment algorithm for providers to understand comprehensive, data-driven, BM management. The app also gives our multidisciplinary Brain Metastases Program access to a BMVTB messenging tool to securely communicate and generate real-time consensus plans-of-care. Using a Vizient Clinical Database, we retrospectively calculated LOS index (observed LOS/expected LOS) for 184 BM patients over 21 months, creating a baseline. After launching our app and BMVTB workflow we prospectively evaluated LOS index in 45 BM patients over 6 months. RESULTS Over 21-months, 184 patients demonstrated baseline LOS index of 1.073. After launching our mobile app and BMVTB workflow, 45 patient admissions over 6-months demonstrated LOS index of 0.850. Using Levene’s test for equal variances, LOS variance with the app and BMVTB was lower than LOS variance at baseline (p = 0.049). This demonstrates a 38% reduction in LOS when the app and BMVTB generated real-time plans-of-care. CONCLUSION We demonstrated utility of a custom BM app coupled with a BMVTB to generate real-time plans-of-care for BM patients, reducing LOS.

Establishing Synthesis Pathway-Host Compatibility via Enzyme Solubility

Current pathway synthesis tools identify possible pathways that can be added to a host to produce a desired target molecule through the exploration of abstract metabolic and reaction network space. However, not many of these tools do explore gene-level information required to physically realize the identified synthesis pathways, and none explore enzyme-host compatibility. Developing tools that address this disconnect between abstract reactions/metabolic design space and physical genetic sequence design space will enable expedited experimental efforts that avoid exploring unprofitable synthesis pathways. This work describes a workflow, termed Probabilistic Pathway Assembly with Solubility Scores (ProPASS), which links synthesis pathway construction with the exploration of the physical design space as imposed by the availability of enzymes with characterized activities within the host. Predicted protein solubility propensity scores are used as a confidence level to quantify the compatibility of each pathway enzyme with the host (E. coli). This work also presents a database, termed Protein Solubility Database (ProSol DB), which provides solubility confidence scores inE. colifor 240,016 characterized enzymes obtained fromUniProtKB/Swiss-Prot. The utility ofProPASSis demonstrated by generating genetic implementations of heterologous synthesis pathways inE. colithat target several commercially useful biomolecules.AvailabilityProSol DBdata and code forProPASSare available for download fromhttps://github.com/HassounLab/

Analysing the structure of pathways and its influence on the interpretation of biomedical datasets

SummaryBiochemical pathways are commonly used as a reference to conduct functional analysis on biomedical omics datasets, where experimental results are mapped to knowledgebases comprising known molecular interactions collected from the literature. Due to their central role, the content of the functional knowledgebases directly influences the outcome of pathway analyses. In this study, we investigate the structure of the current pathway knowledge, as exemplified by Reactome, discuss the consequences for biological interpretation, and outline possible improvements in the use of pathway knowledgebases. By providing a view of the underlying network structure, we aim to help pathway analysis users manage their expectations and better identify possible artefacts in the results.