The purpose of this study was to evaluate foot arch types of obese children and adolescents aged 9-16.5 years using both indirect and direct measures. Fifty-eight obese children/adolescents attending the paediatric endocrinology unit of the University Hospital "Lozano Blesa" in Zaragoza were selected as experimental subjects. Fifty-eight gender and age matched, normal-weight children/adolescents were selected as control subjects. To assess the medial longitudinal arch (MLA) height, which is used as a main reference for the diagnosis of flatfoot, footprints from both feet were collected (in both groups) and lateral weight-bearing radiographs of both feet were taken (of 49 of the 58 obese children). Footprint angle (FA) and the Chippaux-Smirak index (CSI) were calculated from the footprints. Talus-first metatarsal (TFMA) and calcaneal inclination angles (CIA) were obtained from lateral feet radiographs. In the normal-weight group, mean values of FA and CSI indicated a normal MLA. In the obese group, morphological flatfoot was identified. Comparison between both groups, by side and gender, showed a decrease of FA (p<0.001) and an increase of CSI (p<0.001) in obese subjects. Mean values of TFMA and CIA in the obese group indicated a lowering of the MLA. Obese children/adolescents between 9 and 16.5 years of age had significantly lower values of FA and higher CSI, related to a lower MLA. Radiographic parameters supported these findings and mean values were associated with a fall of this arch.

OBJECTIVE. To analyse the association between overweight and obesity and foot structure in children older than 9 years of age, whose longitudinal medial arch (MLA) should be practically established. DESIGN, SETTING AND SUBJECT. A cross-sectional study of 245 children (age: 13.22±1.8 years) from four randomly selected schools (Zaragoza, Spain). Body mass index (BMI) was calculated and normal-weight, overweight and obese groups were defined. Footprints for both feet were collected. MEASUREMENTS. Foot angle (FA) and Chippaux-Smirak index (CSI) were calculated from the footprints. Height and body mass were measured to calculate the BMI. RESULTS. Mean values of FA and CSI in the normal-weight group indicated the presence of a normal MLA; however, in the overweight they indicated an intermediary MLA and in the obese group, a low MLA. Comparison among the groups showed a decrease of FA (p<0.01) and an increase of CSI (p<0.01) with increasing weight associated with a lower MLA. A low but significant correlation (p<0.0001) was found between the z-score BMI and footprint parameters. CONCLUSIONS. In children aged 9 to 16.5 years, the increase of body mass is related to a lower MLA. The MLA is lower in these obese children than in the younger ones studied in previous works probably due to the continuous bearing of excessive mass from childhood. A lower MLA could cause health problems. An assessment of foot structure in these children is recommended as the classification of the foot arch type can help decide if treatment to avoid these problems is necessary.

6553 Background: Clinical decision-support systems (CDSS) such as Watson for Oncology (WFO) may reduce treatment variation in oncology, provided options offered by the system are at least as acceptable as expert, evidence-based options. Deviation from expert consensus in practice is not well documented. In this blinded study, WFO therapeutic options and treatment decisions made by individual oncologists at Bumrungrad International Hospital (BIH) were evaluated by expert panel. Methods: Treatments selected by BIH that were labeled as either “for consideration” or “not recommended” by WFO were evaluated by a panel of 3 oncologists in 2018. The panel evaluated WFO options and previous BIH treatments for prospective cases from 2016-2018, blinded to the source of treatment option. Consensus of panel rated treatment pairs as: identical; both acceptable and roughly equivalent; both acceptable, but one preferred; one is acceptable and the other, unacceptable; neither is acceptable. The results of 321 treatment choices for breast, lung, colon and rectal cancers were analyzed, and McNemar’s test, a modified pairwise chi-square, was applied to identify differences between BIH and WFO. Results: 71% of both BIH and WFO treatments across all 4 cancer types were considered acceptable or identical by the panel. In 18 cases (5.6%), WFO treatments were preferred; in 14 cases (4.4%), BIH cases were preferred. Unacceptable treatments by either BIH or WFO were identified in 15% and 23% of treatments, respectively. Statistical analysis of treatment pairs revealed no significant difference between BIH and WFO treatments for breast, colon and rectal cancer. Treatment for lung cancer differed significantly ( p = 0.004); in 6% of cases, WFO was unacceptable and BIH acceptable; in 1% of cases, BIH was unacceptable and WfO was acceptable. Conclusions: This study is one of the first to compare therapeutic options from CDSS to treatment decisions made in practice, evaluated in a blinded fashion by an expert panel. 71% of treatments suggested by WFO CDSS were as acceptable as those selected by clinicians at the point of care, and some were considered superior. Decisions made in practice were unacceptable to the panel in 15% of cases, suggesting a role for CDSS.

No abstract

e14114 Background: Watson for Oncology (WfO) is an artificial intelligence-based clinical decision-support system which provides therapeutic options and associated scientific evidence to cancer-treating physicians. Oncologists at Bumrungrad International Hospital (BIH) have used WfO since 2015. We examined the association between concordance of WfO therapeutic options and BIH treatment decisions with short-term clinical outcomes for lung cancer patients. Methods: This study included lung cancer patients seen at BIH for treatment and follow-up care and for whom WfO was used from 2015 to 2018. Charts were reviewed for concordance with WfO, documentation of disease progression, response to treatment, and survival. We evaluated concordance between oncologists’ treatments and therapeutic options listed as “recommended” by WfO. We evaluated association between WfO concordance and partial or complete response rates over a 24-month period by comparison of proportions with odds ratio. Progression-free survival (PFS, time from diagnosis until progression or death) was evaluated by Kaplan-Meier log-rank test. Results: Seventy-nine lung cancer patients were included. We identified a trend towards higher response rates in concordant cases (59.2%, N = 32), as compared to discordant (48.0%, N = 12), with an odds ratio of 1.56 (see table). There was not a significant difference in PFS between concordant and discordant cohorts. Conclusions: In this small-cohort, retrospective study, lung cancer patients receiving treatments that are concordant with WfO recommended therapeutic options trended towards higher response rates than patients with discordant treatments. Use of a clinical decision-support system may help support cancer-treating physicians in delivering best practice and evidence-based care that may improve short-term outcomes. Prospective studies with larger samples and other cancer types are underway. [Table: see text]