Patient Clinical Factors Research Articles

BIOS-06. MACHINE LEARNING MODEL INDEPENDENTLY IDENTIFIES CLINICAL FEATURES ASSOCIATED WITH WILD-TYPE GLIOBLASTOMA VERSUS MUTANT GRADE 4 ASTROCYTOMA

Abstract BACKGROUND Glioblastoma (GBM), the most common and aggressive primary brain tumor in adults, presents significant clinical challenges due to its invasive nature and high recurrence rates. Understanding the clinical demographic factors associated with IDH wild-type (IDH-wt) versus mutant grade 4 astrocytoma (IDH-Mut) is critical for prognosis and treatment strategies. This study aimed to utilize a novel machine learning method to identify key clinical and demographic factors linked to IDH status. METHODS The Cancer Imaging Archive dataset included 617 patients but required preprocessing and cleaning. The cleaning process ensured data completeness and consistency by removing non-relevant variables like date and time, resulting in 20 potential predictors and 317 observations. A random forest model using Gini impurity score was built to classify patient IDH status. The dataset was split into a training set (two-thirds) and a test set (one-third). A variable importance plot identified significant variables based on the mean decrease in the Gini index. RESULTS Our machine learning model achieved 98% accuracy on the test set, outperforming the previously published model of 80% accuracy. A variable importance plot identified age at diagnosis, gender, ethnicity, and race as key predictors of IDH status, with age being the most important. Age was the most important predictor, but race (Caucasian) and ethnicity (not Hispanic or Latino) were also significant. CONCLUSIONS We present a highly accurate machine learning model for differentiating glioma IDH molecular status based only on patient clinical and demographic factors; improving upon prior published models. Future work will use a generalized logistic model to explore variable interactions and predict IDH-wt versus IDH-Mut status. These steps are vital for enhancing predictive accuracy and supporting personalized treatment strategies. Furthermore, we will define associations and interactions between these variables with other biological and therapeutic variables in predicting clinical outcome.

Diversity, geographical distribution and predictive factors of Hepatitis C virus genotypes and subtypes in Rwanda

BackgroundExisting data on the prevalence of hepatitis C virus (HCV) genotypes and subtypes in Rwanda need to be strengthened. The aim of this study was to identify HCV genotypes and subtypes among HCV-infected patients, as well as their geographical distribution in Rwanda, and to identify the social and economic factors that could influence HCV epidemiology which would make it possible to target national preventive and management actions for infected patients. MethodsThis study included 560 patients with confirmed chronic HCV infection. Patients were recruited from various health facilities in the four provinces of Rwanda as well as in the City of Kigali and had never received treatment with direct-acting antiviral (DAAs). HCV viral loads were measured using Cobas® AmpliPrep/Cobas® TaqMan® HCV Quantitative Test, version 2.0. HCV genotyping was performed using an in-house sequencing protocol targeting the NS5B central region. Genotypic HCV prevalence was correlated with patient geographic location, sociodemographic, behavioral, lifestyle, and clinical factors. ResultsHCV genotype 4 was detected in 99.3% of the patients, while genotype 3 was identified in 0.7%. A total of eight (8) HCV subtypes were detected, with 4k being the predominant subtype nationwide (49.5%), followed by subtypes 4r (21.2%), 4q (16.2%), 4v (7.9%), 4b (2.0%), 4l (1.8%), 4c and 3h represent 0.7% each. Our findings reveal subtype distribution variations among provinces. Subtype 4k was prevalent across regions, particularly in Kigali (64.0%) and the Eastern Province (61.6%). Subtype 4q was more common in the northern province (40.7%), 4r in the southern (43.9%) and western provinces (37.1%), and 4v in the eastern province (17.8%). Farmers exhibit a distinct infection profile compared to other occupations, showing a lower prevalence of subtype 4k but a higher prevalence of subtype 4r. ConclusionsOur study revealed that HCV infection is unevenly distributed in Rwanda, dominated by HCV genotype 4, with considerable heterogeneity in the repartition of the different subtypes. We found potential associations between rural/urban lifestyles and HCV subtype profiles. Determined HCV distribution and diversity can serve as basis not only for HCV infection awareness and prevention campaigns, but also success and guidance for personalized treatment.

Factors Predicting the Ability to Perform Activities of Daily Living among Stroke Patients in Rural Community Southern Thailand.

The aim of this study was to explore the factors associated with the ability to perform activities of daily living (ADL) among post-stroke patients participating in outpatient physical rehabilitation programmes in community hospital in southern Thailand. In this cross-sectional study, data were collected from 258 patients diagnosed with stroke through the HOSxP programme from 2018 to 2022. Patients' ADL were assessed using the Barthel Index measurement. Characteristics were described by percentages and medians (IOR). Associations of categorical variables were examined using the chi-squared test, and multiple logistic regressions were employed to identify factors predicting Barthel Index scores among stroke patients. Patients' capacity levels were categorised based on Barthel Index scores and rehabilitation criteria, and unadjusted and adjusted odds ratios (OR/AOR) were presented, with a significance level of 0.05. Of the 258 stroke patients, 59.30% were male, with a median age of 67 years old. Significant differences in Barthel Index scores were found with respect to gender, age, marital status, comorbidities and duration of rehabilitation (P < 0.05). Binary logistic regression analysis indicated that male stroke patients (AOR = 1.89; 95% confidence interval [CI]: 1.10, 3.26), individuals with single marital status (AOR = 4.62; 95% CI: 1.58, 13.49), absence of comorbidities (AOR = 0.53; 95% CI: 0.29, 0.98), and rehabilitation duration of less than five days (AOR = 4.38; 95% CI: 2.14, 8.96) were more likely to achieve independence in ADL with higher Barthel Index scores (P < 0.05). Several factors contribute to the effective planning of care and rehabilitation for stroke patients in rural area. Stroke rehabilitation programmes in this region should consider various elements, including patient characteristics, family involvement and clinical factors, to improve ADL performance.

Patient factors associated with early vs late referral to supportive oncology.

202 Background: ASCO guidelines recommend early palliative care (PC) for patients with advanced cancer, defined as referral within 8 weeks of diagnosis. Early referral has been associated with improved quality of life, survival and a reduction in healthcare utilization at the end of life. We sought to determine the role of sociodemographic and clinical patient factors on timing of referral to an embedded supportive oncology (SO) practice and impact on utilization. Methods: Patients ≥18 years with advanced cancer who first received a SO visit between 01/01/2021-06/30/2023 were included. Data on patient demographics, cancer treatment and mortality were extracted from the electronic health record. Early referral to SO was defined as a visit &lt;3 months after diagnosis of advanced cancer. We used descriptive statistics to summarize patients’ sociodemographics, clinical characteristics, and healthcare utilization, and multivariable linear regression analysis to identify factors associated with the timing of referrals. Results: Of the 782 patients, 39.1% were referred early. Poorer functional status (p&lt;0.001) and certain cancer types (p&lt;0.01) were associated with earlier referrals. There were significant differences in timing of referral by cancer type with highest early rates among Head and Neck (53%,) GI (48%), Lung (46%) and GYN (43%) and lowest among GU (29%) and Breast (11%; p &lt; 0.001). Those with Medicare as the primary insurance had an increase in referral time (138 days) compared to Medicaid patients (p&lt;0.001). Patients whose primary symptom was pain were referred earlier than patients with other non-pain symptoms although this did not reach statistical significance (p=0.084). Patients with an earlier referral had more ED visits and hospitalizations both before (p=0.001 and p&lt; 0.001, respectively) and after (p=0.186 and p=0.007, respectively) referral compared to those referred later. Overall, there was no difference in mean referral times between 2021 (483d) and 2023 (533d). Conclusions: There remains significant disparities in the timing of referrals to SO based on sociodemographic and clinical factors. While early SO referral is associated with several benefits, the variability in referral timing underscores the need for targeted strategies to promote timely access to PC. Moving forward, efforts should focus on developing standardized referral protocols and addressing barriers to early PC access to ensure equitable and optimal patient outcomes. Patient demographics and characteristics. Category Overall N=782 Early N=306 Late N=476 p-value Age (mean] 63.3 63.6 63.1 0.689 Race (%) 0.736 Asian 88 (11) 39 (13) 49 (10) Black or African-American 194 (25) 72 (24) 122 (26) Hispanic 192 (25) 80 (26) 112 (24) White 260 (33) 95 (31) 165 (35) Other/Patient Declined 48 (6) 20 (7) 28 (6) Insurance (%) 0.080 Commercial 197 (28) 73 (26) 124 (29) Medicaid 175 (25) 83 (27) 92 (19) Medicare 330 (47) 123 (40) 207 (44) Other 6 (0) 1 (0) 5 (1)

Analysis of hospitalization costs in adult inguinal hernia: based on quantile regression model.

Inguinal hernia repair is a common surgical procedure with significant variability in hospitalization costs. Traditional cost analysis methods often overlook the distribution of costs across patient demographics and clinical factors. This study employs a quantile regression model to explore the determinants of hospitalization costs for adult inguinal hernia surgery, providing a detailed understanding of cost variations across different quantiles. We analyzed data from adult patients who underwent inguinal hernia surgery at Beijing Chaoyang Hospital from January 2015 to June 2023. The study included patient demographics, hernia-related information, surgery-related details, and cost-related data. A quantile regression model was used to assess the impact of various factors on hospitalization costs at different quantiles (10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%). Data were processed using StataSE 15.0 software. Our study included 16,602 patients, predominantly male (91.86%) and Han Chinese (96.48%), with the 51-64 years age group being the largest (26.80%). The quantile regression analysis revealed significant cost variations across different quantiles. Younger patients incurred higher costs, with age coefficients ranging from -40.541 at the 90th quantile to -3.082 at the 10th quantile. Uninsured patients faced higher costs, with coefficients from 214.747 at the 80th quantile to 501.78 at the 10th quantile. Longer hospital stays correlated with increased costs, with coefficients from 342.15 at the 80th quantile to 405.613 at the 90th quantile. Patients hospitalized multiple times(≥3) had lower costs, with coefficients from-767.353 at the 40th quantile to -311.575 at the 80th quantile. Comorbidities significantly raised costs, with coefficients for three or more comorbidities ranging from806.122 at the80th quantile to1,456.02 at the40th quantile. Laparoscopic surgery was more expensive than open surgery, with coefficients from 1,834.206 at the 80th quantile to 2,805.281 at the 10th quantile. Bilateral surgeries and the use of biological mesh also resulted in higher costs, with coefficients for bilateral surgeries ranging from 1,067.708 at the 10th quantile to 2,871.126 at the 90th quantile and for biological mesh from 3,221.216 at the 40th quantile to 6,117.598 at the 90th quantile. Hospitalization costs for inguinal hernia surgery are influenced by multiple factors, with significant variations across different patient groups. Strategies to control costs should be tailored to address the specific needs of patients, optimize surgical methods, and improve perioperative care. Future research should extend these findings across different healthcare settings and consider the latest advancements in medical technology and policy changes.

Predictive factors associated with health-related quality of life in patients with colorectal cancer in Iran: a cross-sectional study

ObjectivesThis study aims to identify the primary factors influencing health-related quality of life (HRQoL) in patients with colorectal cancer (CRC), hypothesising that specific patient characteristics and clinical factors significantly impact...

Local excision vs. proctectomy in patients with ypT0–1 rectal cancer following neoadjuvant therapy: a propensity score matched analysis of the National Cancer Database

BackgroundWe aimed to evaluate outcomes of organ preservation by local excision (LE) compared to proctectomy following neoadjuvant therapy for rectal cancer.MethodsThis retrospective observational study using the National Cancer Database (NCDB) included patients with locally advanced non-metastatic rectal cancer (ypT0–1 tumors) treated with neoadjuvant therapy between 2004 and 2019. Outcomes of patients who underwent LE or proctectomy were compared. 1:1 propensity score matching including patient demographics, clinical and therapeutic factors was used to minimize selection bias. Main outcome was overall survival (OS).Results11,256 of 318,548 patients were included, 526 (4.6%) of whom underwent LE. After matching, mean 5-year OS was similar between the groups (54.1 vs. 54.2 months; p = 0.881). Positive resection margins (1.2% vs. 0.6%; p = 0.45), pathologic T stage (p = 0.07), 30-day mortality (0.6% vs. 0.6%; p = 1), and 90-day mortality (1.5% vs. 1.2%; p = 0.75) were comparable between the groups. Length of stay (1 vs. 6 days; p < 0.001) and 30-day readmission rate (5.3% vs. 10.3%; p = 0.02) were lower in LE patients. Multivariate analysis of predictors of OS demonstrated male sex (HR 1.38, 95% CI 1.08–1.77; p = 0.009), higher Charlson score (HR 1.52, 95% CI 1.29–1.79; p < 0.001), poorly differentiated carcinoma (HR 1.61, 95% CI 1.08–2.39; p = 0.02), mucinous carcinoma (HR 3.53, 95% CI 1.72–7.24; p < 0.001), and pathological T1 (HR 1.45, 95% CI 1.14–1.84; p = 0.002) were independent predictors of increased mortality. LE did not correlate with worse OS (HR 0.91, 95% CI 0.42–1.97; p = 0.82).ConclusionOur findings show no overall significant survival difference between LE and total mesorectal excision, including ypT1 tumors. Moreover, patients with poorly differentiated or mucinous adenocarcinomas generally had poorer outcomes, regardless of surgical method.

Impact of Disease Factors of Patients with Psoriasis and Psoriatic Arthritis on Biologic Therapy Switching: Real-World Evidence from the CorEvitas Psoriasis Registry.

Patients with psoriasis (PSO) and psoriatic arthritis (PsA) may frequently switch biologic therapies over the course of treatment because of symptom variability and individual responses. Real-world studies analyzing patient characteristics and clinical factors associated with biologic switching are limited. This longitudinal cohort study used real-world data from the CorEvitas Psoriasis Registry to evaluate the relationship between associated disease factors and biologic switching among patients with PSO and PsA in the United States (US) and Canada following initiation of a biologic. Patients were evaluated between April 2015-August 2022. Combinations of disease severity (as measured by Psoriasis Area Severity Index [PASI]) and Dermatology Life Quality Index (DLQI) as a measure of health-related quality of life (HRQoL) were assessed, and the association with time to switching was calculated using Cox proportional hazards regression modeling. Among 2580 patient-initiations (instances of patients initiating a biologic), 504 (19.5%) switched biologics within 30months of initiation. Switching was more frequent when either PASI > 10 or DLQI > 5 compared with PASI ≤ 10 or DLQI ≤ 5 at follow-up. Patients with higher skin involvement (PASI > 10) and impact on HRQoL (DLQI > 5) were 14 times more likely to switch (hazard ratio = 14.2, 95% confidence interval: 10.7, 18.9) than those with lower skin involvement (PASI ≤ 10) and HRQoL (DLQI ≤ 5). Patients with PSO and PsA treated in a real-world dermatology setting with substantial disease factors following biologic initiation were more likely to switch therapies. Those with PASI > 10 and DLQI > 5 switched more frequently than those with PASI ≤ 10 and DLQI ≤ 5.

Anti-interleukin-17 therapies for moderate/severe psoriasis in clinical practice: effectiveness, safety and association with clinical patient factors

ObjectivesInterleukin-17 (IL-17) contributes to the pathogenesis of psoriasis. Secukinumab, ixekizumab, and brodalumab are monoclonal antibodies anti-IL-17 antibodies, approved for the treatment of moderate/severe plaque psoriasis.The aim of the study was...

Could Obesity Be Related to the Increasing Incidence of Warthin Tumors?

Background: The number of patients diagnosed with Warthin tumors (WTs) has increased significantly in recent years. The association of obesity as measured by body mass index (BMI) with the incidence of WTs remains unclear. This retrospective study aims to compare the BMI and other clinical factors of patients diagnosed with WTs to those with other benign epithelial parotid gland tumors. Methods: Over a 24-year period, 465 cases of benign epithelial parotid gland tumors were treated in our department. Of these, 155 (33.3%) were diagnosed as WTs. The results of the WT group were compared with those of another benign epithelial parotid gland tumor. Results: The mean BMI of WT patients was 27.3, which was significantly higher than in other benign tumors (25.52; p < 0.001). Furthermore, statistically significant correlations were observed, including a higher incidence of WT in males (p < 0.001), in the elderly (p < 0.001), and in cigarette smokers (p < 0.001). Additionally, a higher prevalence of other head and neck cancers was confirmed in patients with WTs (p = 0.004); Conclusions: This study supports the multifactorial etiology of WT development. Among these factors, smoking, advanced age, and obesity have been identified as factors associated with the development of WT, which might be due to chronic inflammation linked to obesity.

Performance of calf circumference in identifying sarcopenia in older patients with chronic low back pain: a retrospective cross-sectional study

BackgroundCalf circumference is currently recommended as a case-finding marker for sarcopenia, but its usefulness has not been determined in chronic pain conditions. Therefore, the present study aimed to evaluate the predictive performance of calf circumference in diagnosing sarcopenia in older patients with chronic low back pain.MethodsAmbulatory adult patients aged ≥ 65 years with chronic low back pain were enrolled. A diagnosis of sarcopenia was established based on the criteria outlined by the Asian Working Group for Sarcopenia in 2019. Patient demographics, pain-related factors, clinical factors, and sarcopenia-related measurements were compared between non-sarcopenic and sarcopenic patients. Linear regression analysis was used to evaluate the correlation of calf circumference with muscle mass, strength, and physical performance. Also, a receiver operating characteristic curve analysis for calf circumference in predicting sarcopenia was conducted; and area under the curve (AUC) values, along with their corresponding 95% confidence intervals (CI), were calculated.ResultsData from 592 patients were included in the analysis. Eighty-five patients were diagnosed with sarcopenia (14.3%), 71 of whom had severe sarcopenia (11.9%). A higher prevalence of sarcopenia was observed in female patients (9.0% vs. 16.7%, p = 0.016). After adjusting for age, BMI, and comorbidities, calf circumference correlated positively with muscle mass but not with muscle strength and physical performance. The AUC values for sarcopenia were 0.754 (95% CI = 0.636–0.871, p = 0.001) in males and 0.721 (95% CI = 0.657–0.786, p < 0.001) in females. The cut-offs for calf circumference in predicting sarcopenia were 34 cm (sensitivity 67.1%, specificity 70.6%) in males, and 31 cm (sensitivity 82.5%, specificity 51.5%) in females.ConclusionsEven though sex differences in its predictive value for sarcopenia should be considered, our findings suggest that calf circumference can be used as an indicator for predicting muscle mass and may serve as a potential marker for identifying sarcopenia in older patients with chronic low back pain.

Patient socio-demographics and clinical factors associated with malaria mortality: a case control study in the northern region of Ghana

BackgroundGhana is a malaria-endemic country with the entire population at risk. The Northern region of the country recorded the highest malaria case fatality rate (CFR) for two consecutive years: 1.11% in 2013 and 1.07% in 2014. Even though the National Malaria Elimination Programme (NMEP) has achieved a reduction in malaria mortality, the existence of high case fatality in the Northern region was alarming. This study, therefore, aimed to determine the factors associated with malaria mortality in the northern region of Ghana to institute control measures.MethodsAn unmatched case control study was conducted from July 2015 to August 2015. The study population consisted of patients admitted to health facilities for severe malaria in the Northern region of Ghana. A case was defined as a patient diagnosed with severe malaria at an eligible health facility who died as a result of malaria. A control was a patient diagnosed with severe malaria admitted to an eligible health facility who did not die. Health facilities that recorded CFRs of 1.0% and above were randomly sampled for this study, after which, 10 cases and 20 controls were recruited from each health facility. Information on cases and controls was then abstracted from hospital records using an electronically deployed abstraction tool. Continuous variables were expressed as means and medians, and categorical variables as frequencies and proportions. Multivariable logistic regression was used to assess the strength of the association between malaria mortality and factors predictive of malaria mortality. A p-value of < 0.05 was considered statistically significant.ResultsIn all, a total of 95 cases and 190 controls participated in this study. The median ages of cases and controls were 4.1 years (IQR = 21.6) and 5.7 years (IQR = 18.2), respectively. Fifty-four (56.8%) cases were females, while 93 (49.0%) of the controls were females. Factors associated with malaria mortality included: duration of hospital stay less than 24 h [aOR: 12.0, 95% CI (5.9–24.6)], severe pallor [aOR: 2.3, 95% CI (1.1–4.6)], children under 5 years [aOR: 2.8, 95% CI (1.4–5.6)], oral Artesunate/Amodiaquine administration [aOR: 0.4, 95% CI (0.2–0.9)] and sepsis as an additional diagnosis [aOR: 4.1, 95% CI (1.8–9.5)].ConclusionPredictors of malaria mortality in the Northern region include children under 5 years, severe pallor, sepsis as an additional diagnosis, and use of oral anti-malarial. Patients with severe pallor and sepsis as co-morbidities should receive proactive management. The NMEP and its partners should implement measures to strengthen the referral system, anaemia prevention and management, and retrain health workers on malaria case management. Malaria control interventions targeted at under five children in the region should be reviewed and enhanced.

Analisis Pemeriksaan Laboratorium pada Penyakit Tiroid

Penyakit tiroid merupakan salah satu masalah kesehatan yang umum ditemui di masyarakat. Gangguan pada kelenjar tiroid dapat menyebabkan berbagai kondisi kesehatan serius. Pemeriksaan laboratorium memainkan peran penting dalam diagnosis dan manajemen penyakit tiroid. Penelitian ini bertujuan untuk mendeskripsikan berbagai jenis pemeriksaan laboratorium yang digunakan untuk mendiagnosis penyakit tiroid. Penelitian ini menggunakan metode tinjauan pustaka dengan menganalisis data dari berbagai sumber, seperti jurnal ilmiah, buku teks, dan pedoman klinis. Teknik pengumpulan data pada penelitian ini yakni dengan studi literatur. Setelah data terkumpul, analisis dilakukan dengan melalui tiga tahapan seperti penyaringan data, data disajikan, serta membuat kesimpulan. Temuan penelitian menunjukan bahwa beberapa jenis pemeriksaan laboratorium yang biasanya dilakukan untuk penyakit tiroid adalah Hormon Thyroid Stimulating Hormone (TSH), Hormon Tiroid (T3 dan T4), Tiroglobulin (Tg), dan Antibodi tiroid. Pemeriksaan laboratorium tiroid merupakan alat yang penting untuk mendiagnosis dan memantau penyakit tiroid. Interpretasi hasil pemeriksaan laboratorium tiroid harus dilakukan dengan mempertimbangkan faktor klinis pasien.

Understanding risk factors for revision surgery after cubital tunnel release: Analysis of patient selection, surgeon, and clinical factors

PurposeThe purpose of this study was to identify and characterize factors that may contribute to revision surgery following primary cubital tunnel release (CuTR) surgery. MethodsA retrospective study was performed by reviewing all patients who underwent CuTR at a single institution between 2014 and 2021. Only primary in situ CuTR surgeries were included. Exclusion criteria were any case of primary ulnar nerve transpositions or ulnar nerve decompression surgery related to pathology other than isolated ulnar neuropathy (ie. elbow fracture repair, medial epicondylitis debridement, etc.). Revision surgery was defined as return to the operating room by the index surgeon or another surgeon within the same practice for repeat ulnar nerve decompression and/or transposition. Patient demographics and surgical information was analyzed to determine factors that may be associated with revision surgery following primary in situ ulnar nerve decompression. ResultsA total of 1367 patients met inclusion criteria. Revision rate following primary CuTR was 1.2 ​% (n ​= ​16). Of the factors evaluated, younger age (46.6 vs 57.0 years) and a history of cervical stenosis had a higher correlation with undergoing a revision. Patients who had revision surgery were more likely to have negative electrodiagnostic studies versus those who did not. Otherwise, there was no association between sex, race, tobacco use, medical comorbidities, symptom severity, bilateral symptoms, or concurrent surgery and the subsequent need for revision ulnar nerve decompression. ConclusionsFollowing primary in situ CuTR, younger age or a history of cervical stenosis may be at higher risk of undergoing revision surgery. Additionally, patients without electrodiagnostic evidence of ulnar neuropathy may have less reliable outcomes versus those who have a positive nerve study. Given the unpredictable nature of ulnar nerve surgery, further prospective data including diagnostic imaging and biomechanical evaluation of patients following ulnar nerve release may help provide a deeper understanding of this unique patient population. Level of evidencePrognostic, level IV.

Risk factors for Gleason score upgrade from prostate biopsy to radical prostatectomy.

Accurate identification of prostate cancer Gleason grade group remains an important component of the initial management of clinically localized disease. However, Gleason score upgrading (GSU) from biopsy to radical prostatectomy can occur in up to a third of patients treated with surgery. Concern for disease undergrading remains a source of diagnostic uncertainty, contributing to both over-treatment of low-risk disease as well as under-treatment of higher-risk prostate cancer. This review examines the published literature concerning risk factors for GSU from time of biopsy to prostatectomy final pathology. Risk factors identified for Gleason upgrading include patient demographic and clinical factors including age, body mass index, race, prostate volume, and biomarker based assays, including prostate-specific antigen (PSA) density, and testosterone values. In addition, prostate magnetic resonance imaging (MRI) findings have also been associated with GSU. Biopsy-specific characteristics associated with GSU include lower number of biopsy cores and lack of targeted methodology, and possibly increasing percent biopsy core positivity. Recognition of risk factors for disease undergrading may prompt confirmatory testing including repeat sampling or imaging. Continued refinements in imaging guided biopsy techniques may also reduce sampling error contributing to undergrading.

Hospitals with decreasing cost-to-charge ratios bill greater surgical charges for similar outcomes

BackgroundThe cost-to-charge ratio reflects the markup of hospital services. A lower cost-to-charge ratio indicates lower costs and/or greater charges. This study examines factors associated with cost-to-charge ratio trends to determine whether decreasing cost-to-charge ratio is associated with worse surgical outcomes. MethodsThe Florida Agency for Healthcare Administration Inpatient database (2018–2020) was queried for common surgical procedures and linked to the Distressed Communities Index, RAND Corporation Hospital data, Center for Medicare Services Cost Reports, and American Hospital Association data. Only hospitals with monotonically increasing or decreasing cost-to-charge ratio were included in the study. Univariable analysis compared these hospitals. Using patient-level data, interpretable machine learning predicted cost-to-charge ratio trend while identifying influential factors. ResultsThe cohort had 67 hospitals (27 increasing cost-to-charge ratio and 40 decreasing cost-to-charge ratio) with 35,661 surgeries. Decreasing cost-to-charge ratio hospitals were more often proprietarily owned (78% vs 33%, P = .01) and had greater mean total charges ($134,349 ± $114,510 vs $77,185 ± $82,027, P < .01) with marginally greater mean estimated costs ($14,863 ± $12,343 vs $14,458 ± $15,440, P < .01). Patients from decreasing cost-to-charge ratio hospitals had greater rates of most comorbidities (P < .05) but no difference in mortality or overall complications. Machine-learning models revealed charges rather than clinical factors as most influential in cost-to-charge ratio trend prediction. ConclusionsDecreasing cost-to-charge ratio hospitals charge vastly more despite minimally greater estimated costs and no difference in outcomes. Although differences in case-mix existed, charges were the predominant differentiators. Patient clinical factors had far less of an impact.

Gut community structure as a risk factor for infection in Klebsiella pneumoniae-colonized patients.

The primary risk factor for infection with members of the Klebsiella pneumoniae species complex is prior gut colonization, and infection is often caused by the colonizing strain. Despite the importance of the gut as a reservoir for infectious K. pneumoniae, little is known about the association between the gut microbiome and infection. To explore this relationship, we undertook a case-control study comparing the gut community structure of K. pneumoniae-colonized intensive care and hematology/oncology patients. Cases were K. pneumoniae-colonized patients infected by their colonizing strain (N = 83). Controls were K. pneumoniae-colonized patients who remained asymptomatic (N = 149). First, we characterized the gut community structure of K. pneumoniae-colonized patients agnostic to case status. Next, we determined that gut community data is useful for classifying cases and controls using machine learning models and that the gut community structure differed between cases and controls. K. pneumoniae relative abundance, a known risk factor for infection, had the greatest feature importance, but other gut microbes were also informative. Finally, we show that integration of gut community structure with bacterial genotype data enhanced the ability of machine learning models to discriminate cases and controls. Interestingly, inclusion of patient clinical variables failed to improve the ability of machine learning models to discriminate cases and controls. This study demonstrates that including gut community data with K. pneumoniae-derived biomarkers improves our ability to classify infection in K. pneumoniae-colonized patients.IMPORTANCEColonization is generally the first step in pathogenesis for bacteria with pathogenic potential. This step provides a unique window for intervention since a given potential pathogen has yet to cause damage to its host. Moreover, intervention during the colonization stage may help alleviate the burden of therapy failure as antimicrobial resistance rises. Yet, to understand the therapeutic potential of interventions that target colonization, we must first understand the biology of colonization and if biomarkers at the colonization stage can be used to stratify infection risk. The bacterial genus Klebsiella includes many species with varying degrees of pathogenic potential. Members of the K. pneumoniae species complex have the highest pathogenic potential. Patients colonized in their gut by these bacteria are at higher risk of subsequent infection with their colonizing strain. However, we do not understand if other members of the gut microbiota can be used as a biomarker to predict infection risk. In this study, we show that the gut microbiota differs between colonized patients who develop an infection versus those who do not. Additionally, we show that integrating gut microbiota data with bacterial factors improves the ability to classify infections. Surprisingly, patient clinical factors were not useful for classifying infections alone or when added to microbiota-based models. This indicates that the bacterial genotype and the microbial community in which it exists may determine the progression to infection. As we continue to explore colonization as an intervention point to prevent infections in individuals colonized by potential pathogens, we must develop effective means for predicting and stratifying infection risk.

958 Prostatic Artery Embolisation vs. Transurethral Resection for Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis

Abstract Background This systematic review and meta-analysis aimed to comprehensively compare these two therapeutic approaches regarding peri-operative and post-operative outcomes. Method Studies reporting on peri-operative and post-operative outcomes of PAE and TURP in BPH patients were included. Meta-analyses were performed to assess differences in outcomes such as IPSS, post-void residual (PVR), maximum urinary flow rate (Qmax), Prostate volume, procedural time, and Quality of Life (QoL) scores using RevMan 5.4.Methodological assessment was done by using the Newcastle-Ottawa Scale (NOS) for observational studies. Results Our analysis included a total of 9 studies involving 1138 patients. The postoperative subgroup analysis revealed significant differences in IPSS (HR of 1.37 (95% CI: -2.27 to 5.01, p = 0.00001; I2 = 98%), PVR (HR 43.29 (95% CI: -10.38 to 96.96, p = 0.00001; I2 = 99%). In the comprehensive analysis, substantial heterogeneity (98%) was noted, yielding an HR of -9.58 (95% CI: -48.20 to 29.30; p = 0.00001), Prostate volume 13.94 (with a 95% CI: 9.34 to 18.54, resulting in a highly significant p-value of 0.0001 and an I2 statistic indicating 83% heterogeneity), procedural time and QoL, with an HR (54.70) CI: 23-86.39, p&amp;lt;0.00001, I2=96%, and HR (0.27) CI: -0.39-0.93, p&amp;lt;0.00001 and I2=97%, respectively, these all outcomes favoured TURP over PAE. However, post-operative Qmax, (HR -8.48 (95% CI: -13.89 to -3.07, p=0.00001 and an I2 =99%) favoring PAE over TURP. Conversely, PAE exhibited a slower but sustained improvement in QoL scores over time. Complication rates were almost same between the two groups. Conclusions TURP may offer a quicker improvement in BPH; however, PAE also provides a viable alternative with sustained QoL improvements and a potentially lower risk of post-operative complications. Individualized treatment decisions should consider patient preferences and clinical factors.

Assessing patient perception and preferences for outcomes in lung cancer resection surgery: a cross-sectional study.

Surgical resection is the primary treatment for early-stage lung cancer, but little is known about the outcomes that truly matter to patients. This aim of our study was to identify the aspects of postoperative outcomes that matter most to patients undergoing lung cancer surgery and explore the influence of clinical and demographic factors on their importance ratings. We performed a cross-sectional study of patients undergoing lung resection for non-small cell lung cancer at our institution from November 2021 to May 2022. Patients were surveyed using a self-developed questionnaire and the European Organisation for Research and Treatment of Cancer core health-related quality of life questionnaire (EORTC QLQ-C30) prior to surgery. Ordinal logistic regression was performed to determine associations between individual patient factors and outcome importance ratings. Forty patients completed the survey during the study period. Patients prioritized oncologic outcomes, with 95% rating R0 resection and cancer recurrence as "very important". Other important factors included overall survival (90%), postoperative complications (e.g., myocardial infarction: 92.5%, infection: 87.5%), and the need for reoperation (82.5%). Health-related quality of life factors, such as chronic pain (77.5%) and the ability to return to normal physical and exercise levels (75%), were also highly valued. Certain patient clinical and demographic factors demonstrated significant associations with importance placed on certain outcomes. Preoperative health-related quality of life scores did not influence outcome importance ratings. This study provides insights into the outcomes that matter most to patients undergoing lung cancer surgery. Oncologic outcomes and postoperative complications were prioritized, while scar-related factors were less important. Patient preferences varied based on demographic and clinical factors. Understanding these preferences can enhance shared decision-making and improve patient-centered care in thoracic surgical oncology.

Mediating role of care partner burden among dementia care partners during post-hospital transition

Objectives This study examined the mediating role of care partner burden on the relationship between patient clinical factors (i.e. cognition, physical function, and behavioral and psychological symptoms of dementia [BPSD]) and care partner mental health (i.e. anxiety and depression) among dementia care partners at hospital discharge. Method The sample consisted of 431 patient and care partner dyads enrolled in the Family centered Function-focused Care (Fam-FFC) study; ClinicalTrials.gov identifier NCT03046121. Mediation analyses were conducted to test the role of care partner burden on the associations between patient clinical factors, and care partner anxiety and depression. Results Mediation models demonstrated that care partner burden partially mediated the relationship between patient physical function and care partner anxiety and depression, as well as patient BPSD and care partner anxiety and depression. Conclusion Findings highlight the need for clinicians and service providers to implement comprehensive strategies that address both patient clinical factors (i.e. physical function and BPSD) and care partner burden, to optimize care partner mental health outcomes during post-hospital transition.