Antibiotic Guidance for OMFS inpatients

Introduction/Aims: Implementation of local antimicrobial guidelines is essential for optimal use of antibiotics and reduction of antibiotic resistance. The aims are: * To assess current antibiotic use for inpatients. * To assess which antibiotics are commonly prescribed in OMFS. * To assess dose/duration of antibiotics. * To assess second line antibiotic options for allergies. Material(s) and Method(s): Retrospective data was collected for elective and emergency admissions from October 2018 - October 2019. Data collection included: Antibiotic prescribed, clinical reason for antibiotics, dose, duration, administration method, discharge antibiotics, alternatives for penicillin allergic patients and microbiology swab results if applicable. Results/Statistics: Elective procedures included osteotomies, salivary gland surgery, TMJ surgery, cysts and major resections. 92% of osteotomies received prophylactic IV co-amoxiclav. 26% of salivary gland patients received antibiotics, majority co-amoxiclav. 58% of cyst patients received IV co-amoxiclav (43%), amoxicillin (43%) or amoxicillin and metronidazole (14%) and all major resection patients received IV antibiotics, majority amoxicillin and metronidazole (45%) 70 dental abscesses received IV antibiotics. 30% received amoxicillin and meronidazole, 22% received benzylpenicillin and metronidazole and the remaining 48% were prescribed a variety of combinations. 65% of abscesses had a microbiology pus swab taken. 48% were sensitive to penicillin, metronidazole or both. 33% had no growth. 91% of fractured mandibles received IV antibiotics, with co-amoxiclav and metronidazole the most common (30%). Conclusions/Clinical Relevance: Current practice was extremely varied. A guidance document was created for the department by a multidisciplinary team. A further round of data collection will be completed in due course following lifting covid restrictions to assess compliance. Copyright © 2022

Smoking and OMFS – How well are we recording tobacco use and referring to smoking cessation services?

smoking. Evidence shows that smokers who develop oral cancer have poorer outcomes than non-smokers. Additionally, smoking incidence is reported to be increased because of the COVID pandemic.We have a duty to discuss smoking with our patients and offer appropriate advice or referrals. Objectives are as follows: - To assess department compliance with the recording of smoking and tobacco history at initial consultation appointments - To aim for 100% compliance with the recording of smoking and tobacco quantity and duration - To increase number of successful referrals to smoking cessation services. Materials and Methods: Retrospective data collectionwas completed from 20 initial new patient consultations. Notes were assessed for the presence of the following: Smoking status and history, duration of smoking history, number of cigarettes smoked daily, and whether smoking cessation advice was given and/or a smoking cessation referral offered. Results of first round data collectionwere presented to the department and a ‘help to stop smoking’ referral form for smoking cessation services made readily available in the department. A second round of data collection was subsequently completed. Results: 60% of initial consultations recorded patient smoking status. Of this group, 42% are confirmed smokers. When smoking history has been recorded, the quantity of cigarettes was always recorded. The duration of smoking history was only successfully recorded in 60% of cases. No referrals were made to the smoking cessation service;however 60% of the confirmed smokers declined a referral offer. After intervention, a vast improvement is noted – 85% of clinical notes recorded patient status, with 25% confirmed smokers. There was an increase in referrals to smoking cessation referral services. Conclusions: All patients should be asked about smoking status and evidence recorded in clinical notes. Furthermore, smoking cessation advice should be given to all patients and referrals to smoking cessation services offered. Collaborative projects with the smoking cessation service have begun to further improve our patient care and oral health improvement.

Exploring Self-directed Learning Among Engineering Undergraduates in the Extensive Online Instruction Environment During the COVID-19 Pandemic

The COVID-19 pandemic brought about unprecedented academic disruptions to postsecondary education, including engineering education. A considerable decrease in student motivation became a major issue for online learning during the pandemic. This paper attempts to address these questions: How did the online instruction environment affect engineering students' motivation and self-directed learning? How did these changes, in turn, affect their learning outcomes? We used survey data collected from a large Canadian engineering school and conceptualized self-directed learning from a social cognitive perspective to address these questions. Our findings revealed that students' self-directed learning capabilities mediated the effects of learning environment factors on estimated grades and perceived gains in competency development;and student motivation had both direct and indirect effects on these learning outcomes. In their comments, students ascribed lack of motivation to multiple aspects of the online learning environment and felt that decreased motivation affected their learning. Our analysis demonstrated the significant role of student motivation in an online environment and suggested that the decrease in motivation became a major affective barrier to learning. Thus, the extensive online instruction during the pandemic offered both challenges and opportunities for producing self-directed learners. We recommend that engineering schools implement more interventions to help engineering students enhance their self-directed learning capabilities. © American Society for Engineering Education, 2021

A Statewide Surgical Quality Improvement Collaborative's Opioid Data Collection

Introduction: Our statewide surgical quality improvement (QI) collaborative began collecting opioid data to better understand our patients’ pain management and discharge opioid prescriptions. During our pilot there was invalid data requiring variable revision. Collection resumed in 1/2020 and was encouraged during COVID-19, acknowledging that we faced reduced and highly selective operative case volumes with reduced resources. Methods: Institutions from a statewide surgical QI collaborative participated in the revised custom variable opioid data collection. Utilizing the National Surgical Quality Improvement Program (NSQIP) platform, seven custom variable data were collected for 13 general surgery procedures. Variables were abstracted by Surgical Clinical Reviewers from 1/2020-12/2020. Results: 722 cases were performed. 460 (64%) cases had all variable data submitted, 102 (14%) had at least one and 160 (22%) cases had no variables submitted. Postoperative/in-patient opioids and non-opioids administered were the most likely to be submitted (73% and 73%). 489 cases (68%) had submitted data on use of an opioid sparing strategy. 483 (67%) cases had some discharge opioid prescription data, but only 357 cases (49%) had adequate data to standardize for comparison. Conclusion: A significant decrease in collection of the three minimally revised variables was observed. However, from revising the discharge opioid prescription variable from free text to a pre-populated selection, the quality of data improved significantly. This will allow the collaborative to standardize discharge opioid prescribing. Custom variable opioid data collection is feasible and can be utilized to inform collaborative opioid prescribing practices.

Mobile-Health Tool to Improve Care of Patients with Hematological Malignancies

INTRODUCTION Adverse effects are common during treatment of hematological malignancies. Treatment toxicities can impact quality of life [1], impose financial hardship and cause cancer related distress[2]. Symptom monitoring using electronic technology can facilitate early detection of complications[3], reduce symptom burden[4], cost of care[5] and improve survival[6]. Cancer treatment also increases risk of mortality from infections such as coronavirus disease 2019 (COVID-19) and routine screening has been recommended[7]. METHODS We developed an application that periodically delivers toxicity questionnaires to patients during treatment. Based on NCI- PRO-CTCAE™, the questions are delivered through SMS or e-mail. Patient responses crossing prespecified thresholds trigger automated alerts on a dashboard, resulting in additional interventions as needed. Nature and time to intervention is tracked. Patient experience is measured using a Likert-scale and free-text box. Centers for Disease Control recommended COVID-19 screening questions were incorporated. Finally, a distress thermometer for cancer distress screening has been recently added. The app was offered to patients with hematological cancers in a community-based cancer center. RESULTS Since introduction in April 2020, we have enrolled 37 patients. 9 patients had chronic lymphocytic leukemia, 6 diffuse large B cell, 5 mantle cell, 4 Hodgkin's and 3 follicular lymphoma. 2 each had chronic myelogenous, multiple myeloma and Richter's syndrome. 1 each had hairy cell leukemia, acute myelogenous leukemia and T Cell lymphoma. Median age was 64 years (range 24-85). Patient experience has been favorable. On a scale of 1-5, 85.5% rated the experience as 3 or higher. Median patient engagement, calculated by dividing the number of forms completions by number of days enrolled was 34.2% (0.9-66.2 %). Symptom tracker captured 536 responses. Fatigue (153), no symptoms (152), shortness of breath (57), nausea/vomiting, diarrhea (46) and numbness/tingling (28) were the most common response categories. Of 1107 completed check ins, 75 triggered flags. There were 2 hospitalizations for neutropenic fever with the remainder managed as outpatients. Average time between patient generated response and provider intervention was 90.9 minutes. 88% follow-ups were completed within 1 business day. COVID-19 screening module captured 1096 responses. 988 were no symptoms. All positive responses (44 diarrhea, 39 cough, 23 shortness of breath and 2 fever) were false positives. Distress thermometer implemented a week before data cut-off captured 2 responses, 1 in the physical and 1 in the psychological domain. CONCLUSION We demonstrate feasibility of electronic capture of treatment toxicities and offer proof of concept that a mobile app can be used for infection screening. Additionally, the quick response time by care team indicated a high adoption rate. REFERENCES 1. Doorduijn J, B.I., Holt B, Steijaert M, Uyl-de Groot C, Sonneveld P., Self-reported quality of life in elderly patients with aggressive non-Hodgkin's lymphoma treated with CHOP chemotherapy. European Journal of Hemtology 2005. 75(2): p. 116-123. 2. Troy JD, L.S., Samsa GP, Feliciano J, Richhariya A, LeBlanc TW., Patient-reported distress in Hodgkin lymphoma across the survivorship continuum. Supportive Care Cancer, 2019. 27(7): p. 2453-2462. 3. Stover A M, H.S., Deal A M, Stricker C T, Bennett A V, Carr P M, Jansen J, Kottschade L A, Dueck A C, Basch E M, Methods for alerting clinicians to concerning symptom questionnaire responses during cancer care: Approaches from two randomized trials (STAR, AFT-39 PRO-TECT). Journal of Clinical Oncology 2018. 36(30 supplement): p. 158. 4. Mooney KH, B.S., Wong B, Whisenant M, Donaldson G, Automated home monitoring and management of patient-reported symptoms during chemotherapy: results of the symptom care at home RCT. Cancer Medicine, 2017. 6(3): p. 537-546. 5. Barkley R, S.M.-J., Wang J, Blau S, Page RD, Reducing Cancer Costs Through Symptom Management and Triage Pathways. Journal of Oncology Prac ice, 2019. 15(2): p. e91-e97. 6. Denis F, B.E., Septans AL, Urban T, Dueck AC, Letellier C., Two-Year Survival Comparing Web-Based Symptom Monitoring vs Routine Surveillance Following Treatment for Lung Cancer. JAMA, 2019. 321(3): p. 306-307. 7. ASCO Special Report: A guide to cancer care delivery during COVID-19 pandemic. 2020, ASCO: Alexandria, VA. Disclosures: Janssen: wellbe Inc.: Current Employment.

Mobile health tool for monitoring cancer treatment complications

Background: Side effects after cancer treatment are ubiquitous, seen in up to 98.3% of patients in one Phase III lymphoma trial. Additionally, cancer patients are at a greater risk of mortality from infections such as coronavirus disease 2019 (COVID-19), prompting recommendations for routine screening. Current care delivery model, reliant on self-triaging of symptoms by patients results in delayed management and avoidable emergency room visits and hospitalizations.Technology based symptom monitoring allows early identification of complications, reduces symptom burden, cost of care and enables early detection of relapse. We studied utility of a mobile-health tool for toxicity monitoring and COVID-19 screening. Methods: We developed an application that periodically delivers disease specific toxicity questionnaires to patients following cancer treatment. Based on NCI-PROCTCAE form builder, the questions are delivered through SMS or e-mail. Responses crossing prespecified thresholds are flagged for manual careteam follow-up. Patient and staff experience as well as medical interventions are captured. Results: Currently, 68 patients with different malignancies are enrolled. Median age 60 years (range 24-85), 35 males, 31 females. 72.35% patients rated user experience at 4 or higher (1-5 scale, 5 highest). Aggregate provider rating was 3.25 (1-5 scale, 5 highest). Of 639 captured responses, 157 reported fatigue, 145 no symptoms, 57 nausea/vomiting or diarrhea, 52 numbness/tingling and 48 shortness of breath. 76 responses were flagged for nurse follow-up calls. These resulted in 72 successful outpatient symptom management, 2 hospitalizations for neutropenic fever, 1 MRI diagnosis of radiation necrosis and 1 diagnosis of lymphoma progression. 92% of patients received a follow up within one business day. Median time between response recorded and follow up completed was 55 minutes. Of 1299 responses recorded by COVID-19 screening, 1175 reported no symptoms. All positive responses (47 cough, 52 diarrhea, 5 fever and 20 dyspnea) were false positives. Study is ongoing with recent implementation of a distress screening and survivorship modules. Conclusions: Electronic capture of symptoms using connected technology is feasible and can be used to screen cancer patients for treatment related complications as well as pandemic related illnesses.