A clean environment is critical to prevent hospital-acquired infections (HAIs) through organism transfer. A previous study at our hospital indicated that UV-C effectively eliminated pathogens and commonly seen organisms from patient rooms. Subsequently, our facility purchased a UV-C device and incorporated it into our terminal cleaning practices. The patient room may play a role in the transfer of multi-drug resistant organism (MDRO), if the previous occupant was colonized or infected with an MDRO. We hypothesized that the incorporation of UV-C technology into our terminal cleaning practices would decrease the number of organisms potentially acquired by patients during hospitalization. After IRB approval, four high-volume rooms were selected for data collection. Electronic medical record reports generated a chronological list of patients that occupied each of the designated rooms. Microbiology organism reports were generated for each patient during his or her hospital stay. The reports were further delineated to identify which organisms were present on admission and those that were acquired during the hospital stay. The data were de-identified and collated in spreadsheets retaining only the organism list and the chronological order. Each room’s data was compared independently. Organisms acquired during a patient’s hospital stay that had also been recovered from the previous patient were considered a potential transfer from the environment. Reports were generated for 2015, 2017 and 2018. Total number of pathogens was compared by the Wilcoxon rank sum test, and specific pathogens were compared by Fisher’s exact test. Statistically significant decreases in total number of pathogens were found between 2015 and 2017 (p<0.0001) and between 2015 and the combination of 2017 and 2018 (p<0.0001). There was no significant pathogen difference between 2017 and 2018. Significant differences for specific pathogens between 2015 and 2017 and those between 2015 and the combination of 2017 and 2018 are shown in Table 1. None of the specific pathogens showed any differences between 2017 and 2018. Implementation of UV-C technology as an integrated part of terminal cleaning processes significantly reduces the number of potential transferred organisms. Fewer pathogens present reduces risk for acquiring HAIs. Reducing environmental contamination through effective touch - free technology reduces risk for acquiring HAIs. Table 1 Table 1

Changes in burn care over the past 50 years have included early excision and grafting, the introduction of enteral tube feeding and the development of skin substitutes for grafting. Additionally, flame-retardant clothing, the use of smoke detectors, and burn prevention measures have resulted in fewer children burned. Nonetheless, large pediatric burns still result in morbidity and mortality. This hospital opened in 1968, and basic information on all acute patients was collected into a de-identified database. Age, sex, %TBSA burn, % full thickness (FT) burn, post-burn day of admission, inhalation injury, hospital length of stay, as well as survival/death, were tracked on 8489 patients. Descriptive statistics on these variables were determined, and demographic variables, as well as their interaction, were put into a multiple logistic regression (MLR) analysis to determine significant predictors of mortality. Mean patient age was 6.4 ± 5.3 years and mean %TBSA was 16.4 ± 19.3, while mean % FT was 9.8 ± 17.1. Of the 8489 patients, 65% were male, 7.5% had sustained an inhalation injury, and 3.2% died. During the first decade inhalation injury was not tracked, so only 5940 patients were used in the MLR. Those results indicated that %FT burn and the interaction term were only marginally predictive of the probability of mortality. Percent TBSA burn (p<.0001) and inhalation injury (p<.0001), as well as age (p=. 0005) and sex (p=.0101), were statistically predictive of the probability of mortality. That is, higher burn size, inhalation injury, lower age and female sex increased the probability of mortality. Table 1 indicates coefficients of predictors and their p-values, as well as odds ratios and their 95% confidence intervals. Burn size and inhalation injury strongly contribute to a predictive model of mortality. Additionally young age and female sex increase the risk of mortality. A pediatric burn patient with a large burn, especially one accompanied by an inhalation injury, is more likely to die. MLR Results MLR Results

Healing Touch (HT), credentialed by the National Commission of Certifying Agencies, is a professional, holistic, non-pharmacological therapy purported to promote relaxation, pain management and reduce stress. Since April 2013, 279 HT treatments were provided to three groups of recipients experiencing discomfort: pediatric patients, their guardians and employees. The purpose of this evaluation was to assess the satisfaction and clinical improvements this service provides. IRB exempt review and approval was obtained for a prospective de-identified survey evaluation of data from 105 HT recipients, guardians and clinicians who observed their patients, from 2015–2017. Guardian and recipient surveys consisted of questions to evaluate calmness, relaxation, interest in repeat sessions and whether HT had a positive effect. Clinicians who observed their patients documented changes in heart rate, blood pressure and respiratory rate. A validated observational pain assessment scale (OPAS) was used to compare pre- and post- treatment pain status and was analyzed by the nonparametric Wilcoxon signed rank test. Practitioners were HT certified or level 1–5 trained staff. For the recipient survey findings, 96% (n=29) of responders indicated that HT was beneficial, 100% said they would return for additional sessions, and 100% reported improved relaxation and calmness. Ninety-four percent of guardians (n=32) found HT to be beneficial by documenting that they strongly agree or agree that HT had a positive effect. The clinician survey (n=44) revealed that heart rate either decreased or was neutral 100% of the time as did blood pressure, O2 saturation and respiratory rate most of the time for whom it was assessed. Eighty-two percent of clinicians found HT to be beneficial. There were statistically significant differences in OPAS scores from pre-HT to post-HT for both the clinician (p<.0001) and HT practitioner (p<.0001). No adverse effects were reported. HT provided by a well-organized program and an interdisciplinary team of credentialed providers represents an effective means to improve clinical and satisfaction measures for patients, guardians and employees, especially when applied during times of anxiety and pain. This HT evaluation forms the basis for continuing the use of HT in a burn and surgery hospital for children. HT is a helpful modality to enhance patient and guardian satisfaction.

Drug-gene testing or pharmacogenetics is used to detect how genes impact a patient’s response to drugs. Its use may improve outcomes of psychopharmacological therapy by using genotype, phenotype and drug metabolism information to improve the safety and effectiveness of psychotropic medications, analgesics and medications used to treat ADHD. The tests give recommendations about which drugs are most effective and safest to prescribe. The resulting report categorizes medications into 3 possible color-coded groupings: Use as Directed; Moderate Gene-Drug Interaction; or Significant Gene-Drug Monitoring. Application of this test in the medical management of the pediatric burn population was evaluated. A retrospective, IRB-approved chart review was performed for pediatric burn patients who underwent drug-gene testing from 2015–2016. Demographic data collected included age, gender, % total body surface area (TBSA) burn, behavioral diagnoses and decisional factor to testing. The test results and the outcomes of the testing also were tracked. Drug-gene tests were obtained on 7 patients. Five were male, with mean age 9 years (range 4–12) and with a mean burn TBSA of 51%. Six of 7 patients had at least one psychological and/or behavioral diagnosis prior to the burn injury. Decisional factors for testing included significant active or preexisting behavioral/ psychiatric issues. Results showed only 14% of patients were prescribed a “Use as Directed” medication prior to drug-gene testing, with 86% of patients being prescribed a drug coded as “Moderate or Significant Drug-Gene Monitoring.” 71% of patients had a medication change and 86% a dosage change based on the drug-gene testing. In addition, in 57% of the patients, paroxetine, duloxetine, fluvoxamine, clozapine, and olanzapine demonstrated moderate to severe gene-drug interactions; while 100% of the drug-gene tests indicated desvenlafaxine, vilazodone HCl, selegiline, levomilnacipran, paliperidone, and ziprasidone could be “used as directed”. This finding suggested that not all antipsychotic and antidepressant medications may be effective in select patients. Drug-gene testing may be important for pediatric burn patients whose care is compromised by pre-burn behavioral or psychiatric issues and may require medication changes to control pain, anxiety and behavior. Further prospective studies will clarify the role of drug-gene testing for these patients. Role of drug-gene testing in pediatric burn care.

Healing Touch (HT) is a credentialed, energy-based therapy believed to improve sleep and to reduce pain, stress and anxiety. Sleep deprivation occurs often in hospitalized pediatric patients and may persist for years. A previous study at this hospital found HT significantly enhanced total sleep time and REM. The purpose of this study was to determine if HT improves sleep, anxiety, anesthesia emergence and post-op nausea and pain. This IRB-approved study stratified patients undergoing elective surgery into 2 age groups (5–11, >11 yrs of age) and 2 acuity levels of surgery (same-day surgery and observation, surgical procedure with admission for ≥ 24 hours). Patients were randomly assigned to HT, HT sham, control/presence (CP) and control/no presence (CNP). HT used self-centering exercises at the patient’s bedside, creating an atmosphere devoid of anxiety and with goals of mind clearing and full body (chakra) connection. HT sham intervention involved an aide’s mimicking of HT technique, CP group had a research aide with no HT familiarity, and CNP group had no study aide. All patients underwent polysomnography (PSG) with soft music playing during the first hour. The Yale Preoperative Anxiety Scale (YPAS) score was obtained pre-op before medications were given and in the pre-op surgery area. Sedation score, anesthesia emergence score, vital signs and occurrence of post-op nausea and vomiting were recorded. Pain scores were determined by the Observation Pain Assessment Scale (OPAS) post-op and at time of discharge. Pre-op laboratory blood was drawn for C-reactive protein (CRP), glucose, cortisol and vitamin D25 levels for detection of stress and anxiety, and a HT satisfaction survey was given. Thirty-nine patients consented to participate and were randomized as follows: 9 to HT, 12 to HT sham, 7 to CP and 11 to CNP. Mean patient age was 13.0 years, and no significant difference in age group or acuity level was found among the groups. There were no significant group differences in age, sex, race or patient procedure, categorized as laser, burn reconstruction and plastic surgery reconstruction. No significant group differences were detected for any of the PSG parameters, YPAS scores, OPAS scores, medications, anesthesia emergence score, bloodwork or satisfaction survey score. CRP, glucose and cortisol levels were higher in the CNP group, possibly indicating that pediatric patients undergoing elective surgeries may benefit from more pre-op support, possibly by HT. HT is safe and patients were satisfied. Although no tracked parameters showed statistically significant findings, anecdotal HT benefits included enhanced relaxation and sounder sleep. HT produced no significant outcomes other than patient satisfaction.

5586 Background: Chemoradiation (CRT) is the standard of care for locally advanced cervical cancer but survival is poor among women with large tumours, advanced stage, or positive nodes. Neoadjuvant chemotherapy (NACT) prior to CRT to down-stage tumours and lengthen the exposure to systemic treatment is designed to improve outcome. Methods: Patients (pts) with locally advanced cervical cancer received dose-dense carboplatin (AUC2) and paclitaxel (80 mg/m2) weekly, for 6 cycles, followed by CRT (external and brachytherapy) in week 7 with weekly cisplatin (40 mg/m2). The primary end-point was complete and partial response rate (RR) 12 weeks post CRT. Secondary objectives were RR for NACT at 6 weeks, toxicity and survival. The target RRs were 50% and 85% for NACT and post CRT (12-weeks) respectively. Results: Baseline characteristics were: median age at diagnosis 43 yrs (23–71); 74% squamous-, 20% adeno- and 6% adenosquamous carcinomas; FIGO stage IB2 (11%), II (50%), III (33%), IV (6%). The trial closed in Oct 08 with 46 pts. Of the first 36 pts enrolled 9 failed to complete protocol therapy (7 did not complete 6 NACT cycles, 2 did not complete the pre-specified minimum of 4 cycles of concomitant cisplatin). Using data currently available, the RR associated with NACT is 72% (95% CI 53–86%), and 81% at 12 weeks (95% CI 63–92%). Nonhaematological grade 3/4 toxicity was rare (<5%). There was grade 2 alopecia in 25% pts. Grade 3 and 4 haematological toxicity was seen in 10% and <3% of pts respectively. Updated results, including survival, will be presented for all pts. Conclusions: Dose-dense weekly NACT chemotherapy with carboplatin and paclitaxel followed by radical CRT is associated with a high response rate and is feasible. This approach merits further investigation in a phase III trial. [Table: see text]

Background: The potential of gemcitabine to interact with carboplatin was explored in a phase II trial in platinum-resistant ovarian cancer. Peripheral blood lymphocytes were sampled after drug administration to measure DNA interstrand cross-link formation and repair.Patients and Methods: Forty patients received carboplatin target area under concentration-time curve (AUC 4) followed by gemcitabine 1,000 mg/m(2) with a second dose of gemcitabine on day 8. Peripheral blood lymphocytes were obtained in 12 patients before and at intervals during the first cycle of chemotherapy. DNA cross-link formation and repair (unhooking) were measured by the single-cell gel electrophoresis (comet) assay following ex vivo incubation.Results: The global response rate was 47% (Response Evaluation Criteria in Solid Tumors rate, 29%; CA125 rate, 63%). Delays in treatment were seen in 24% of cycles largely due to myelosuppression; 15% of day 8 administration was omitted. Peak carboplatin-induced DNA cross-linking was seen by 24 hours. Significant reduction was seen in the repair of in vivo carboplatin-induced DNA cross-links following administration of gemcitabine.Conclusion: An enhanced activity of carboplatin in platinum-resistant ovarian cancer may be due to synergy with gemcitabine through inhibition of repair of DNA cross-links. Future studies should explore coadministration of these drugs, as this may be a more effective schedule. Clin Cancer Res; 16(19); 4899-905. (C) 2010 AACR.

5501 Background: BIBF 1120 is a new targeted therapeutic agent for maintenance therapy in OC. It is a unique triple angiokinase inhibitor, targeting 3 receptor classes involved in the formation of blood vessels (VEGFR, PDGFR, and FGFR). Methods: Continuous BIBF 1120 (250 mg, oral, twice daily) for up to 9 months (mo) was compared with placebo in a novel application of a randomized double-blind trial in pts who responded to their last (at least second line) chemotherapy. The primary endpoint, progression-free survival at 36 weeks, was confirmed by CT assessment, performed at 12-week intervals. Results: 84 pts were randomized (44 BIBF 1120; 40 placebo), mean age 60y (range 27–76). All had responded according to GCIG criteria. Treatment-free interval before prior chemotherapy was <6 mo for 41% and 6–12 mo for 59% of pts. Median treatment duration was 116 days (d), range, 2–281d (BIBF 1120) and 101 d, 2–239d (placebo). Five BIBF 1120 pts completed 9 mo of treatment vs 0 placebo pts. The 36-wk PFS rates (95% confidence interval [CI]) were 15.6% (3.8, 27.3) for BIBF 1120 and 2.9% (0.0, 8.4) for placebo. Although the trial was not powered for a direct comparison, the PFS hazard ratio was 0.68 (95% CI: 0.42, 1.09). Median time to RECIST progression (mo) was 4.8 for BIBF 1120, and 2.8 for placebo. There were no deaths during treatment. Grade 3 and 4 adverse events (AE) were seen in 54 and 7% (BIBF 1120) and 25 and 3% (placebo) of pts. Expected gastrointestinal toxicities occurred slightly more frequently in the BIBF 1120 arm (16 vs 10%, all gd 3; no gd 4 events). Elevated liver enzymes occurred in 43% (BIBF 1120) vs. 6.3% (placebo). Conclusions: Our trial suggests that maintenance BIBF 1120 could delay disease progression in OC pts who had previously responded to chemotherapy. A large phase III trial is needed to confirm the efficacy of this drug. [Table: see text]

BACKGROUND:The combination of cisplatin and etoposide (PE) has been a standard treatment for patients with poor-prognosis small cell lung cancer (SCLC). This non-inferiority design trial aimed to determine whether the combination of gemcitabine and carboplatin (GC) results in similar survival but is less toxic with better quality of life. METHODS:Previously untreated patients with SCLC with extensive disease or limited stage with poor prognostic factors were randomly assigned to six 3-weekly cycles of GC or PE. RESULTS:241 patients (121 GC, 120 PE) were recruited, of which 216 (90%) had died. There was no difference in overall survival (HR 1.01, 95% CI 0.77 to 1.32). Median survival with GC and PE was 8.0 and 8.1 months, respectively. Median progression-free survival was 5.9 months with GC and 6.3 months with PE. Grade 3 or 4 myelosuppressions were more frequent with GC (anaemia: 14% GC vs 2% PE; leucopenia: 32% GC vs 13% PE; thrombocytopenia: 22% GC vs 4% PE), but these were not associated with increased hospital admissions, infections or fatalities. Grade 2-3 alopecia (68% PE vs 17% GC) and nausea (43% PE vs 26% GC) were more frequent with PE. Patients given GC received more chemotherapy as outpatients (89% GC vs 66% PE of treatment cycles). In QoL questionnaires, more patients receiving PE reported being upset by hair loss (p = 0.004) and impaired cognitive functioning (p = 0.04). CONCLUSIONS:GC is as effective as PE in terms of overall survival and progression-free survival and has a toxicity profile more acceptable to patients. TRIAL REGISTRATION NUMBER:ISRCTN 39679215.

The preschool years are a critical time in the development of hand function. At this juncture children develop hand preference and learn complex bimanual tasks. These skills lay the groundwork for independence with activities of daily living (ADLs), and for proficiency in both play and work. Hand burns are a leading cause of hand injury in children, yet little is known about the long-term consequences of hand burn injury on their health-related quality of life (QoL). The purpose of this study is to analyze the effects of hand burn severity on QoL in children 0–4 years of age. A validated burn outcomes questionnaire assessing QoL in children aged 0–4 years was administered at the first clinic appointment post-discharge and at 3, 6, 12, 18, and 24 months thereafter to patients treated at two pediatric burn centers. Extent of burn injury was evaluated by burn size and depth, location, number of...

The location of a burn injury may impact the psychosocial recovery of burn injured patients. Limited data exist on the health-related quality of life (QoL) for children who sustain burn injuries involving the face. The purpose of this study was to analyze the effects of facial burn injuries on the QoL of children 5–18 years of age. Two validated Burn Outcomes Questionnaires, one completed by the parent and the other by the child (11–18) were administered at two regional pediatric burn centers at the first clinic appointment post discharge and at 3, 6, 12, 18, and 24 months thereafter. Comparisons were made between children who did and did not sustain facial burns, as well as between children with facial burns who did and did not wear pressure garments or masks. The location of the facial burn was included in the analysis. Statistical significance was determined by Student's t-test. Fifty-four parents...

BACKGROUND:Prognosis after resection of colorectal liver metastases is influenced by various factors. A positive margin of resection (MOR) has been shown to adversely influence prognosis. Although a 1-cm MOR has been accepted as adequate, the data to support this guideline are sparse. METHODS:Our hepatobiliary database was queried for patients who underwent liver resection for colorectal metastases between January 1992 and July 2003. All patients were divided into three groups: MOR <.5 cm (group A), .5 to 1 cm (group B), and >1 cm (group C). Operative reports from each hepatic resection were analyzed to determine local factors that may have contributed to a subcentimeter MOR. RESULTS:A total of 112 patients (67 men and 45 women) underwent liver resection for colorectal metastases with negative margins. Fifty-three patients were in group A, 26 patients were in group B, and 33 patients were in group C. Group C demonstrated decreased local recurrence (LR; P = .003), distant recurrence (DR; P = .008), and disease-free recurrence (P = .002). A significant difference in the overall time to LR (P = .003), time to DR (P = .003), and disease-free survival (P = .002) was also demonstrated. Factors associated with a subcentimeter MOR included nonanatomical resection (P = .043), proximity to a major vessel (P = .003), and central location (P = .002). CONCLUSIONS:A <1-cm resection for colorectal liver metastases is associated with increased LR and DR, as well as decreased disease-free survival. When a nonanatomical resection is performed, a MOR >1 cm should be attempted, because an adequate margin is often underestimated. Considerations should be made for extended resections when tumors are centrally located or near major vessels.