Implementing Electronic Patient-Reported Outcomes for Patients With New Oral Chemotherapy Prescriptions at an Academic Site and a Community Site.

PURPOSE: Oral chemotherapy challenges providers' abilities to safely monitor patients' symptoms, adherence, and financial toxicity. COVID-19 has increased the urgency of caring for patients remotely. Collection of electronic patient-reported outcomes (ePROs) has demonstrated efficacy for patients on intravenous chemotherapy, but limited data support their use in oral chemotherapy. We undertook a pilot project to assess the feasibility of implementing an ePRO system for patients starting oral chemotherapy at our cancer center, which includes both an academic site and a community site. METHODS: Patients initiating oral chemotherapy were asked to participate. A five-question tool was built in REDCap. Concerning responses triggered outreach within one business day. The primary outcome was time to first symptom assessment. For comparison, we used a historical cohort of patients who had been prescribed oral chemotherapies by providers in the same disease groups at the cancer center. RESULTS: Twenty-five of 62 (40%) patients completed ePRO assessments. Fifty historical charts were reviewed. Time to first symptom assessment was 7 days (IQR, 4-14 days) in the historical group compared with 3 days (IQR, 2-4 days) in the ePRO group. Time to clinical action was 14 days (7-35 days) in the historical group compared with 8 days (4-19 days) in the ePRO group. No statistically significant differences were detected in 30-day emergency department visit or hospitalization (12% for both groups) or 90-day emergency department visit or hospitalization rates (historical 28% and ePRO 20%). CONCLUSION: An ePRO tool monitoring patient concerns about adherence, cost, and toxicities for patients with new oral chemotherapy regimens is feasible and improves time to symptom assessment. Further investigation is needed to improve patient engagement with ePROs and evaluate the long-term impacts for patients on oral chemotherapy.

A national survey of approaches to manage the ICU patient with opioid use disorder.

PURPOSE: Opioid associated admissions to the Intensive Care Unit (ICU) are increasing, but how institutions manage the care of these patients is unknown. We studied the availability of protocols and guidelines in Intensive Care Units (ICUs) for the management of the critically ill patient with opioid use disorder. MATERIALS AND METHODS: A survey was sent to a random sampling of ICU clinicians at acute care hospitals in the United States. RESULTS: Of the 300 hospitals contacted, 118 agreed to participate and 58 submitted surveys (49%, 58/118 response rate). While a majority of ICUs has a guideline to titrate sedative analgesics, only 7% reported a guideline that addresses the sedation needs of patients with opioid use disorder. Only one respondent identified a guideline for the continuation of medication-assisted treatment such as methadone. Most respondents did not have, or were unaware of, a guideline to manage opioid withdrawal or to prevent over-reversal with naloxone. Outpatient resources were offered to patients by 36% of institutions, while even fewer reported the use of a dedicated addiction care team. CONCLUSIONS: Few institutional guidelines exist to provide clinicians with the tools necessary to prevent harm and promote recovery for this growing and vulnerable ICU population.

Risk factors associated with self-reported injury history in female youth soccer players.

BACKGROUND: studies that investigate risk factors for musculoskeletal injuries in female youth athletes are limited, especially related to training attributes and position status. OBJECTIVE: to determine risk factors including training attributes and position status for a self-reported musculoskeletal injury history in female youth soccer players. METHODS: we conducted a cross-sectional study of young female soccer players (mean age: 13.6 ± 2.3 years). we asked about their history of musculoskeletal injuries using an electronic questionnaire. the proportion of young female soccer players with and without a history of soccer-related musculoskeletal injuries were compared based on physical characteristics, training attributes, position status (single vs. multiple), lower extremity strength, and joint laxity. a binary logistic regression analysis was used to generate, and adjusted odds ratios adjusted for potential co-variates (aor). a 95% confidence interval (95%ci) that did not cross one or p < 0.05 were considered statistically significant. RESULTS: a total of 160 young female soccer players (mean age: 13.6 ± 2.3 years) participated in the study. an independent association was found between prior musculoskeletal injuries and older ages (aor: 1.60, 95%ci: 1.17, 2.20, p = 0.004), higher weight (aor: 1.10, 95%ci: 1.01, 1.20, p = 0.026), and greater bmi (aor: 1.43, 95%ci: 1.07, 1.90, p = 0.014). CONCLUSIONS: musculoskeletal injuries were associated with age, weight, and bmi in female youth players. the current study indicates that maintaining proper body composition may be beneficial to reduce musculoskeletal injuries among female youth soccer players.

The Effect of Stride Length and Lateral Pelvic Tilt on Elbow Torque in Youth Baseball Pitchers.

High elbow torque during a pitch may contribute to injury risk. Our objective was to determine the pitch mechanics associated with elbow varus torque in youth baseball pitchers. Eighteen male youth pitchers (age = 15.5 ± 1.6 years) threw 3 fastballs and 3 change-ups from a windup position while undergoing 3-dimensional kinematic analysis. Independent variables included ball release point distance, stride length, lateral pelvic tilt, and ball velocity. Two multiple regression models, separated by pitch type (fastball, change-up) were used to determine the association of independent variables with peak varus torque at the elbow. Fastball and change-up regression models indicated that stride length (ß = 0.301, p = .015; ß = 0.46, p < .001, respectively) and lateral pelvic tilt (ß = -0.50, p < .001; ß = -0.25, p = .04, respectively) were significantly associated with peak elbow varus torque. During fastballs, pitch velocity was significantly associated with peak elbow varus torque (ß = 0.38, p = .002), while release point distance was significantly associated with peak elbow varus torque during change-ups (ß = -0.33, p = .015). Youth pitchers with longer strides and less lateral pelvic tilt demonstrated greater elbow torque regardless of pitch type, while the association of ball velocity and release point to elbow varus torque was dependent on pitch type.