Background For many people living with HIV (PLWH), taking antiretroviral therapy (ARV) every day is difficult. Methods Average adherence (Av-Adh) and log-transformed treatment interruption (TI) to ARV were prospectively measured over 6 months using electronic drug monitoring (EDM) in several cohorts of PLWH. Multivariate linear regression models including baseline confounders explored the influence of EDM-defined adherence (R 2) on 6-month Log10 HIV-RNA. Multivariate logistic regression models were used to compare the risk of HIV-RNA detection within subgroups stratified by lower (≤95%) and higher (>95%) Av-Adh. Results Three hundred ninety nine PLWH were analyzed with different ARV: dolutegravir (n=102), raltegravir (n=90), boosted PI (bPI; n=107), and NNRTI (n=100). In the dolutegravir group, the influence of adherence pattern measures on R 2 for HIV-RNA levels was marginal (+2%). Av-Adh, TI and Av-Adh x TI increased the R 2 for HIV-RNA levels by 54% and 40% in the raltegravir and bPI treatment groups, respectively. TI increased the R 2 for HIV-RNA levels by 36% in the NNRTI treatment group. Compared to dolutegravir-based regimen, the risk of VR was significantly increased for: raltegravir (adjusted OR (aOR), 45.6; 95% confidence interval (CI) [4.5 - 462.1], p=0.001); NNRTIs (aOR, 24.8; 95% CI [2.7 - 228.4], p=0.005) and bPIs (aOR, 28.3; 95%CI [3.4 - 239.4], p=0.002) in PLWH with Av-Adh ≤95%. Among PLWH with >95% Av-Adh, there were no significant differences on the risk of VR among the different ARV. Conclusion These findings support the concept that dolutegravir in combination with two other active ARVs achieves a greater virological suppression than older ARV, including raltegravir, NNRTI and bPI among PLWH with lower adherence.

IntroductionMany bowel problems following low anterior resection (LAR) for rectal cancer considerably impair the quality of life (QoL) of patients. The LAR syndrome (LARS) scale is a self-report questionnaire to identify and assess bowel dysfunction after rectal cancer surgery. It has been translated and validated in several languages but not in French (metropolitan French). The primary objective is to adapt the LARS scale to the French language (called French-LARS score) and to assess its psychometric properties. Secondary objectives are to assess both the prevalence and severity of LARS and to measure their impact on QoL.Methods and analysisA French multicentre observational cohort study has been designed. The validation study will include translation of the LARS scale following the current international recommendations, assessment of its reliability, convergent and discriminant validities, sensitivity, internal consistency, internal validity and confirmatory analyses. One thousand patients will be enrolled for the analyses. The questionnaire will be initially administered to the first 100 patients to verify the adequacy and degree of comprehension of the questions. Then reproducibility will be investigated by a test–retest procedure in the following 400 patients.An analysis will be conducted to determine the correlation between the LARS score and the Quality of Life Questionnaire (QLQ; European Organization for Treatment and Research of Cancer’s QLQ-C30, QLQ-CR29). Risk factors linked to QoL deterioration will be identified and their impact will be measured. This study will meet the need for a validated tool to improve patient care and QoL.Ethics and disseminationThe institutional review board of the University Hospital of Caen and the ethics committee (CPP Nord Ouest I, 25 January 2019) approved the study.Trial registration numberNCT03569488.

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A283surgical procedures, but also the administration of medicines to control lipids, blood pressure, antidepressants and even hypoglycemia, and even then those expenditures does not consider the indirect expenses such as transportation and escort the patient to the hospital and absence from work.

Objectives: Few studies have attempted to quantify the costs of operating room (OR) time. The purpose of this study is to quantify the variable cost per OR minute in isolated non-robotic valvular procedures -aortic valve replacement (AVR), mitral valve replacement (MVR), and mitral valve repair (MVRepair). MethOds:The Premier database, one of the most comprehensive hospital databases, was queried from 2007 to 2011 for patients undergoing AVR, MVR, or MVRepair. This database contains complete billing, hospital cost, and coding data from > 600 US facilities. Patients were identified using the following International Classification of Diseases 9 th Revision (ICD-9) procedure codes: AVR 35. 21, 35.22; MVR 35.23, 35.24; and MVRepair 35.12. Patients having coronary artery bypass grafting were excluded. The surgical approaches, right thoracotomy (RT) and any sternal incision, were identified for each patient with expert clinical assistance. Patients with right thoracotomy were then propensity score matched to patients with any sternal incision, adjusting for patient differences. Premier classified variable costs of the OR into three categories; staff for the surgery room, anesthesia, and recovery room. Outliers were identified based on the cost per minute of the procedure. The top and bottom five percent were removed. All costs were adjusted to 2012 dollars using the Medical Care Component of the Consumer Price Index. Results: There were 2,657 valvular procedures -1,604 AVR, 434 MVR, and 619 MVRepair -that met the inclusion criteria. The average cost per OR minute