Columbia University Medical Center Research Articles

Use of Recommended Neurodiagnostic Evaluation Among Patients With Drug-Resistant Epilepsy

Interdisciplinary practice parameters recommend that patients with drug-resistant epilepsy (DRE) undergo comprehensive neurodiagnostic evaluation, including presurgical assessment. Reporting from specialized centers suggests long delays to referral and underuse of surgery; however, longitudinal data are limited to characterize neurodiagnostic evaluation among patients with DRE in more diverse US settings and populations. To examine the rate and factors associated with neurodiagnostic studies and comprehensive evaluation among patients with DRE within 3 US cohorts. A retrospective cross-sectional study was conducted using the Observational Medical Outcomes Partnership Common Data Model including US multistate Medicaid data, commercial claims data, and Columbia University Medical Center (CUMC) electronic health record data. Patients meeting a validated computable phenotype algorithm for DRE between January 1, 2015, and April 1, 2020, were included. No eligible participants were excluded. Demographic and clinical variables were queried. The proportion of patients receiving a composite proxy for comprehensive neurodiagnostic evaluation, including (1) magnetic resonance or other advanced brain imaging, (2) video electroencephalography, and (3) neuropsychological evaluation within 2 years of meeting the inclusion criteria. A total of 33 542 patients with DRE were included in the Medicaid cohort, 22 496 in the commercial insurance cohort, and 2741 in the CUMC database. A total of 31 516 patients (53.6%) were women. The proportion of patients meeting the comprehensive evaluation main outcome in the Medicaid cohort was 4.5% (n = 1520); in the commercial insurance cohort, 8.0% (n = 1796); and in the CUMC cohort, 14.3% (n = 393). Video electroencephalography (24.9% Medicaid, 28.4% commercial, 63.2% CUMC) and magnetic resonance imaging of the brain (35.6% Medicaid, 43.4% commercial, 52.6% CUMC) were performed more regularly than neuropsychological evaluation (13.0% Medicaid, 16.6% commercial, 19.2% CUMC) or advanced imaging (3.2% Medicaid, 5.4% commercial, 13.1% CUMC). Factors independently associated with greater odds of evaluation across all 3 data sets included the number of inpatient and outpatient nonemergency epilepsy visits and focal rather than generalized epilepsy. The findings of this study suggest there is a gap in the use of diagnostic studies to evaluate patients with DRE. Care setting, insurance type, frequency of nonemergency visits, and epilepsy type are all associated with evaluation. A common data model can be used to measure adherence with best practices across a variety of observational data sources.

Abstract 4827: Financial toxicity among cancer survivors during the COVID-19 pandemic

Abstract Background: Financial toxicity (FT), the financial impact of cancer and its treatments on patients’ employment, income, and health insurance, can have significant short- and long-term consequences for cancer survivors. With significant increases in cancer survivorship and the changing demographics of the United States, a need exists to identify those most susceptible to FT. This study evaluated FT prevalence during the COVID-19 pandemic and identified factors associated with greater FT risk. Methods: Data were collected from 1,147 cancer survivors recruited from previous National Cancer Institute-funded studies, from electronic health record searches for patients with cancer diagnoses at University of California, San Francisco (UCSF) and Mount Sinai Medical Center and Columbia University Medical Center in New York City, and the Dr. Susan Love Foundation for Breast Cancer Research. Adults, diagnosed with cancer and proficient in English, completed an online survey via the Research Electronic Data Capture (REDCap) system between May 27, 2020 and February 21, 2021. FT was assessed for the past 14 days using the validated 11-item COmprehensive Score for financial Toxicity (COST) measure. Patients were categorized by score: no FT (COST scores >25), mild FT (14-25), and moderate/severe FT (0-13). Using Pearson’s chi-square test of independence, and univariate ordinal logistic regression, the study evaluated sociodemographic and clinical characteristics associated with FT, including age, race and ethnicity, gender, household income, education, marital status, health insurance status, and cancer site. Results: The COST measure had excellent reliability for the sample (Cronbach’s alpha = 0.911). Overall, 9% of respondents reported moderate/severe FT (MSFT), 16% mild. Race/ethnicity, education level, annual household income, cancer site, and years from diagnosis (p-values ≤ 0.035) were associated with FT. Current health insurance coverage was not associated with FT (p=0.456). 18% Black, 13% Asian American, 17% mixed, and 20% other races/ethnicities reported MSFT, while 8% non-Hispanic White and 5% Hispanic respondents reported the same. 31% of survivors with annual household income <$40,000 reported MSFT vs. 7% with ≥$40,000 income. 14% of survivors with less than a college degree reported MSFT vs. 8% amongst those with a college degree or higher. For men, the odds of having FT (mild or MSFT) were 0.60 (95% CI 0.40, 0.90) times that of women. Survivors <50 years old at diagnosis had 7.53 (95% CI 4.09, 13.83) times the odds of FT (mild or MSFT) vs. those aged ≥75 years. Conclusions: These preliminary analyses from this cross-sectional study characterizes the prevalence and determinants of FT experienced by cancer survivors during the COVID-19 pandemic. The next steps will include multivariable analysis and comparison with pre-pandemic data, to identify those at greatest risk and inform interventions. Citation Format: Tanvi Srivastava, Salma Shariff-Marco, Samuel L. Washington, Christine Miaskowski, June M. Chan. Financial toxicity among cancer survivors during the COVID-19 pandemic [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4827.

Abstract TMP67: Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy May Affect Large Cerebral Arteries

Introduction: CADASIL is the most common monogenic small-vessel disease (SVD) form. Large and small brain arteries are intimately related, but it is unclear whether people with CADASIL have changes in their large arteries as a result. We hypothesized that CADASIL patients have affected large arteries compared to controls. Methods: We conducted a comparative analysis by matching 37 CADASIL patients with 104 lacunar stroke patients from the NYP/ Columbia University Medical Center Stroke Registry Study matched by age +/-3 and sex. We measured the basilar and intracranial carotid artery diameters in both groups in T2 MRI images. We rated cervical artery tortuosity as 0 for no tortuosity, 1 for 45-90°, and 2 for >90°. We ran generalized linear models to compare cases and controls, adjusting for demographics and clinical variables. Results: Patients with CADASIL were less likely Hispanic\Latino (10.8% vs. 51.9%, p=<0.001), hypertensive (27% vs. 73.1%, p=<0.001), current smokers (5.4%vs. 22.1%, p=0.024), but more likely to have a prior stroke (56.8% vs. 24%, p=<0.001) than controls—Table 1. In the adjusted model, patients with CADASIL had larger basilar artery diameters (p=0.007) and a statistical trend for greater cervical carotid artery tortuosity—Table 2. Conclusions: Although traditionally considered an example of pure SVD, patients with CADASIL have a higher prevalence of cervical tortuosity and intracranial artery dilatation. Whether changes in large arteries result from small artery disease or part of the NOTCH3 mutation phenotype is uncertain. Further investigation is needed to determine if large artery involvement influences the clinical manifestations of CADASIL.

Psychosocial support among adults living with metastatic breast cancer: Perspectives from providers across four New York-Presbyterian hospitals.

Key Points We conducted semi‐structured interviews with providers at four New York‐Presbyterian (NYP) hospitals: Weill Cornell Medicine (WCM), NYP‐Queens, NYP‐Brooklyn Methodist Hospital, and Columbia University Medical Center. Emergent themes identified factors that influenced healthcare delivery at the institutional, provider, and patient levels. Most frequently reported barriers included a lack of formal protocols for communicating and offering psychosocial resources to patients (institutional), lack of vital staff such as, social workers and patient navigators (institutional), time constraints (provider), and stigma regarding mental health care (patient). Most frequently cited facilitators to delivering psychosocial care included having a trained social worker on staff (institutional), awareness of psychosocial needs (provider), and engagement (patient). Our findings highlight opportunities to improve the provision of psychosocial care for adults with metastatic breast cancer (mBC) at multiple levels.

Contralateral prophylactic mastectomy: Weighing the risks of delayed chemotherapy, radiotherapy, and hormonal therapy

Many patients with unilateral breast cancer opt for contralateral prophylactic mastectomy (CPM) at the time of therapeutic mastectomy (immediate CPM) or following completion of adjuvant therapy. Studies show that immediate CPM increases the risk of surgical complications related to unilateral mastectomy (UM) alone, which may lead to delays in adjuvant therapy initiation. However, it is unclear if these complications cause clinically significant delays in initiating adjuvant chemotherapy, radiotherapy, or hormonal therapy. A retrospective chart review was conducted on patients with breast cancer who underwent immediate CPM versus UM alone at Columbia University Medical Center from January 2000 to December 2020. Patient demographic and oncologic characteristics; complications; and timing of adjuvant chemotherapy, radiotherapy, and/or hormonal therapy relative to therapeutic mastectomy were collected. In this study, 239 UM alone patients were propensity score matched to 239 immediate CPM patients. No significant difference in complication rates was found between the index and contralateral breasts in CPM patients. A similar percentage of CPM and UM patients experienced postoperative complications (19% vs. 17%, p = 0.64). No significant difference in time to adjuvant chemotherapy, radiotherapy, or hormonal therapy was found between CPM patients with complications and all CPM patients or all UM patients. There is a lack of clear guidance for clinical decision-making regarding timing of CPM relative to adjuvant therapy. Our study suggests that immediate CPM does not significantly increase the risks of postoperative complications or complication-related delays in the initiation of adjuvant chemotherapy, radiotherapy, or hormonal therapy. This information may help patients and providers to plan, select, and schedule breast cancer treatment options.

Abstract 17197: Team-Based Care for Uncontrolled Hypertension in Accountable Care Organizations: A Simulation Study

Background and Objectives: Team-based care (TBC) is associated with greater blood pressure (BP) reductions than usual care, particularly when non-physicians titrate antihypertensive medications, but has yet to be widely adopted. This analysis projected the effectiveness of TBC among patients with uncontrolled hypertension from three accountable care organizations (ACOs): Columbia University Medical Center (New York), Cedars-Sinai Medical Center (California), and Ochsner Accountable Care Network (Louisiana). Methods: The Cardiovascular Disease (CVD) Policy Model is a computer model that simulates modifiable hypertension care processes (i.e., office visit frequency, BP measurement accuracy, medication intensification, and patient medication adherence) and has been validated to reproduce TBC outcomes. We used the CVD Policy Model to simulate the ACO population aged >=65 years with BP >=140/90 mmHg at two outpatient visits in 2015, and project BP and CVD outcomes out to 10 years with usual care alone vs. one year of TBC followed by a return to usual care. Hypertension usual care processes were derived from national sources and published literature. The model was calibrated to reproduce systolic BP reductions with TBC at one year vs. usual care from a published meta-analysis, which were stratified by the team member responsible for antihypertensive medication titration: -5.0 (95%CI -7.9, -2.2) mmHg with physician titration and -10.5 (95%CI -16.2, -4.8) mmHg with non-physician titration. Results: The ACO population with uncontrolled BP (N=9,788) had a mean (SD) age of 76.3 (7.8) years; 66.6% were white and 59.8% female. The mean BP (SD) at baseline was 151.1 (13.0)/78.1 (10.6) mmHg and 39.1% had a history of CVD. Compared with usual care at 10 years, TBC with non-physician titration was projected to increase the proportion with BP <140/90 mmHg by 16.0% and TBC with physician titration by 4.2%. Relative to usual care, TBC with non-physician titration was projected to prevent 20.8 CVD events per 1000 individuals and TBC with physician titration to prevent 6.6 CVD events. Conclusion: Universal adoption of TBC, especially with non-physician titration, could improve achievement of quality benchmark BP control goals and prevent CVD events in ACO populations.

Abstract 286: Assessing the Needs of Caregivers of Cardiac Arrest Survivors: A Qualitative Study

Background: Interventions addressing highly prevalent psychological distress in caregivers of cardiac arrest (CA) survivors are lacking.We conducted a prospective study to confirm our previous findings of information-based needs as the highest priority in a cross-sectionalsurvey of caregivers of CA survivors. Methods: Adult caregivers of CA survivors hospitalized at Columbia University Medical Center were eligible for recruitment.Caregivers completed an interview after transfer from the intensive care unit (ICU) to inpatient floors and a follow-up interview 1-monthpost-discharge. Interviews allowed for initial free response, followed by prompts for opinions on eight potential interventions addressingpatient-centered needs (i.e., CA education, information on neurological recovery or rehabilitation, having a designated member of thecare team) and caregiver-centered needs (i.e., peer-to-peer support, hospital-based resources, formal psychotherapy, self-care). Interviewtranscripts were used to identify top-ranked needs and temporal changes between post-ICU and 1-month post-discharge. Results: Of 33 caregivers who participated in post-ICU interviews between August 2021-July 2022, 22 who also completed 1-monthinterviews were analyzed. The highest ranked need during acute care (n=10; 45.5%) and 1-month post-discharge (n=8; 36.4%) wasaccess to a designated member of the patient’s medical care team to answer the caregiver’s questions throughout hospitalization and thetransition home. Patient-centered needs accounted for 81.8% (n=18) of caregiver desire for interventions at both time points. 37% (n=8)of caregivers shifted focus between patient- and caregiver-centered needs, observed in both directions, between the two interviews. Conclusions: Caregivers of CA survivors self-reported their greatest need during hospitalization and a month after hospital dischargeas access to trusted resources about their loved one’s medical condition. Studies with a longer follow-up to understand caregivers’journeys and timing of the switch from patient-to caregiver-centered needs are warranted.

News from the European Journal of Therapeutics: A new issue and a new editorial board

News from the European Journal of Therapeutics: A new issue and a new editorial board

Is It Cheating to Use Chat GPT-4 in the Clinical Practice of Psychiatry?

Back to table of contents Previous article Next article ViewpointsFull AccessIs It Cheating to Use Chat GPT-4 in the Clinical Practice of Psychiatry?Steven Hyler, M.D.Steven HylerSearch for more papers by this author, M.D.Published Online:8 Jun 2023https://doi.org/10.1176/appi.pn.2023.07.7.27As an enthusiastic admirer of technological advancements, I have always been fascinated by novel innovations, especially their potential implications in psychiatry. OpenAI's latest offering, Chat GPT-4, intrigued me due to its exceptional ability to provide a wealth of both personal and professional information. However, it's noteworthy to mention that this technology occasionally produces fictitious answers, or as known in AI parlance, "hallucinates," prompting questions about its reliability in patient care.In an endeavor to assess its applicability in psychiatry, my team at Columbia University Medical Center and I embarked on a project to compare Chat GPT-4's responses to a “gold standard” of psychiatric questions and answers readily available online. Our findings indicated that Chat GPT-4 delivered accurate responses about 70% to 80% of the time, a success rate parallel to studies conducted using the MCAT and USMLE. This outcome implies that Chat GPT-4 holds potential as a valuable asset in psychiatric practice.Nevertheless, the specter of “cheating” looms large when contemplating the deployment of AI technology in a professional setting. It's pivotal to distinguish between academic testing—where outside assistance is traditionally prohibited—and real-life medical practice, where physicians might significantly profit from harnessing all accessible resources for their patients' welfare. In 1983, Robert Spitzer, M.D., proposed the LEAD standard, which is an acronym for Longitudinal Evaluation conducted by expert clinicians, leveraging All Data available—family members' inputs, hospital records, psychological evaluations, and laboratory results included. Therefore, it begs the question: Why insist that our trainees rely solely on memory? Why not empower them with all available tools, teaching them how to optimally use these resources during their training?Consider a hypothetical study utilizing exam questions from the PRITE or ABPN. One group is instructed to refrain from using technology while answering the questions, under the threat of severe repercussions. In contrast, the other group is informed of no such limitations. Who would score higher? Which group would eventually morph into better physicians? It might be worth seeking the patients' perspective. Would they prefer their physicians to base their assessments, diagnoses, and treatment plans on memory alone? Or would they favor their physicians using all tech aids at their disposal for better patient care?In the realm of clinical psychiatry, I contend that using Chat GPT-4 should not be stigmatized as "cheating." Rather, it should be perceived as an additional instrument in the ever-growing arsenal of technology available to health care professionals. As physicians, we are tasked with the responsibility of setting boundaries when assimilating AI technology into patient care. It goes without saying that physicians should maintain accountability for their patients' care, not solely relying on AI-generated responses.Endorsing this viewpoint, I argue for the enablement and encouragement of trainees to harness all accessible resources, including Chat GPT-4, during their education. This approach could potentially enhance their clinical acumen and proficiency in integrating technology into patient care. I eagerly anticipate engaging in further discussions on this subject with other professionals who might hold divergent views. ■Steven Hyler, M.D., is professor emeritus of psychiatry at Columbia University Medical Center. He has a longstanding interest in education and technology. ISSUES NewArchived

Physician Family Conflict Following Cardiac Arrest: A Qualitative Study.

Comatose survivors of cardiac arrest may die following withdrawal of life-sustaining therapy (WLST) due to poor neurologic prognosis. Family members, acting as surrogate decision makers, are frequently asked to decide whether the patient should continue to receive ongoing life-sustaining therapy such as mechanical ventilation in this context of risk of death following removal. Sometimes, physicians and family members disagree about what is in the patient's best interest, and this conflict causes distress for both families and medical personnel.This article examines themes recorded in the medical records of 24 cardiac arrest patients at Columbia University Medical Center (CUMC) whose families chose to pursue continued life support despite physician recommendations for withdrawal. In documented conversations between patients' families and their providers, the most prominent themes included faith in miracles, the inappropriateness of "playing God," the value of more time with the patient, and differences in how providers and family members perceived the patient's status.

Methylation-based prediction of myelodysplastic syndrome survival outcomes.

7058 Background: Myelodysplastic syndromes (MDS) are a heterogeneous group of myeloid malignancies associated with a myriad of deleterious outcomes and a 5-year relative survival of 37%. MDS risk stratification is key for optimal treatment decisions. DNA methylation is associated with MDS biology due to frequent somatic mutations in genes (i.e. TET2, DNMT3A, IDH1, IDH2, and WT1) that affect DNA methylation. We hypothesized that methylation-based markers may help stratify risk and improve IPSS-R (the Revised International Prognostic Scoring System). Here, we evaluated the potential of both Bone Marrow (BM) Whole-genome Bisulfite Sequencing (WGBS) and Serum-based Targeted Methylation (TM) Sequencing to predict survival of MDS patients. Methods: We conducted paired BM WGBS and Serum-based TM sequencing on a cohort of 127 patients with MDS (N = 104) and secondary AML (N = 23) treated at the Columbia University Medical Center. We categorized patients based on an overall survival of > 3 (“long”, N = 50) or < 3 years (“short”, N = 77). We then identified differentially methylated regions (DMRs) differing between long and short survivor groups, and analyzed the biological pathways and functions enriched in these regions. To assess survival association, we trained a random forest classifier on principal components (“methylation classifier”) on the methylation fractions from a subset of 96 Serum and 98 BM MDS patient samples to predict long vs. short survival, and compared this against a logistic regression IPSS-R model. We optimized the hyperparameters and assessed classifier performance using six-fold nested cross-validation. Finally, we conducted a multivariable cox regression with predicted scores from the methylation classifier, IPSS-R scores (recalculated at sample collection), age, and gender. Results: We identified a total of 7,742 DMRs in the BM WGBS and 14,093 DMRs in the Serum TM as significantly different between long and short survivor groups. Signaling pathways for calcium, cAMP, MAPK, Rap1, and PI3K-Akt were significantly enriched in DMRs. We also identified a previously-reported CpG island hypermethylation signature associated with AML progression in BM and Serum. The methylation classifier achieved a comparable AUROC compared to IPSS-R logistic regression for both BM WGBS (0.80 vs 0.78) and Serum TM (0.77 vs 0.73) samples. Multivariable Cox regression demonstrated that both predicted scores from the methylation classifier (Serum p =0.002; BM p =0.016) and IPSS-R scores (Serum p =0.003; BM p =0.004) are significant predictors of survival. Conclusions: We demonstrated methylation-based sequencing represents a promising new tool for MDS patient risk stratification. As IPSS-R relies on bone marrow aspirates, the Serum-based TM assay offers a less-invasive method for MDS risk stratification.

Financial Behaviors and Experiences of Financial Loss in those with Alzheimer’s disease and Frontotemporal Dementia: Preliminary findings from a survey

AbstractBackgroundOlder adults are increasingly experiencing financial loss, with annual costs estimated to be about $2.9 billion. The risk of experiencing financial loss is magnified in those with neurodegenerative conditions, including Alzheimer’s disease (AD) and Frontotemporal Dementia (FTD). However, limited information exists on the frequency and amount of money lost, and the behaviors that contribute to such loss in these conditions. The current study sought to characterize the nature of financial losses in AD and FTD, and to identify risk factors in an effort to prevent or mitigate financial loss.MethodSurvey data were collected from ten caregivers of individuals clinically diagnosed with AD or FTD recruited via the Neurodegeneration‐Associated Psychiatric Syndromes study and caregiver support groups at Columbia University Medical Center. Survey items queried demographic information, details of financial loss, level of concerns experienced by care partners and patients, and financial behaviors resulting in financial losses (Table 1).ResultCaregivers had known the patients on average for 46 years. Out of 10 patients, 6 experienced financial loss. See Table 2 for detailed results. While the same number of patients with AD and FTD lost money, those with FTD lost money more frequently and to a larger amount than those with AD. Caregivers of FTD patients expressed a higher degree of concern relative to those with AD. Moreover, most AD patients were described as being concerned about their financial ability, as compared to none of the FTD patients having concern for their financial ability. Additionally, 3 of 5 FTD patients were reported to have engaged in repetitive spending as compared to none of the AD patients.ConclusionPreliminary data indicate a high prevalence of financial loss (60%) in AD and FTD. The intensity of financial loss and related caregiver burden appears higher in FTD, with caregivers describing repetitive spending and less concern about difficulties, likely tied to the lack of insight which is a core feature of this disease. These findings can guide caregiver supervision and interventions to preserve family funds.

Is There a Role for Adjuvant Therapy in Patients with Large Juvenile Nasopharyngeal Angiofibromas?

The LaryngoscopeEarly View Triological Society Best Practice Is There a Role for Adjuvant Therapy in Patients with Large Juvenile Nasopharyngeal Angiofibromas? Charles A. Riley MD, Corresponding Author Charles A. Riley MD [email protected] orcid.org/0000-0002-1993-7018 Department of Otolaryngology—Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA Send correspondence to Charles A. Riley, MD, Department of Otolaryngology—Head and Neck Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA. Email: [email protected]Search for more papers by this authorDavid A. Gudis MD, David A. Gudis MD orcid.org/0000-0002-1938-9349 Department of Otolaryngology – Head and Neck Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York City, New York, USASearch for more papers by this author Charles A. Riley MD, Corresponding Author Charles A. Riley MD [email protected] orcid.org/0000-0002-1993-7018 Department of Otolaryngology—Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA Send correspondence to Charles A. Riley, MD, Department of Otolaryngology—Head and Neck Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA. Email: [email protected]Search for more papers by this authorDavid A. Gudis MD, David A. Gudis MD orcid.org/0000-0002-1938-9349 Department of Otolaryngology – Head and Neck Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York City, New York, USASearch for more papers by this author First published: 30 May 2023 https://doi.org/10.1002/lary.30797 Editor's Note: This Manuscript was accepted for publication on May 18, 2023 The authors have no other funding, or financial relationships to disclose. The authors whose names are listed above certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. The contents of this publication are the sole responsibility of the author(s) and do not necessarily reflect the views, opinions, or policies of Uniformed Services University of the Health Sciences (USUHS), the Department of Defense (DoD), the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. BIBLIOGRAPHY 1McAfee WJ, Morris CG, Amdur RJ, Werning JW, Mendenhall WM. Definitive radiotherapy for juvenile nasopahryngeal angiofibroma. Am J Clin Oncol. 2006; 29(2): 168- 170. 2Mallick S, Benson R, Bhasker S, Mohanti BK. Long-term treatment outcomes of juvenile nasopharyngeal angiofibroma treated with radiotherapy. Acta Otorhinolaryngol Ital. 2015; 35(2): 75- 79. 3Amdur RJ, Yeung AR, Fitzgerald BM, Mancuso AA, Werning JW, Mendenhal WM. Radiotherapy for juvenile nasopharyngeal angiofibroma. Pract Radiot Oncol. 2011; 1(4): 271- 278. 4Thakar A, Gupta G, Bhalla AS, et al. Adjuvant therapy with flutamide for presurgical volume reduction in JNA. Head Neck. 2011; 33(12): 1747- 1753. 5Labra A, Chavolla-Magana R, Lopez-Ugalde A, Alanis-Calderon J, Huerta-Delgado A. Flutamide as a preoperative treatment in juvenile angiofibroma (JA) with intracranial invasion: report of 7 cases. Otolaryngol Head Neck Surg. 2004; 130(4): 466- 469. Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Frailty Among Total Hip and Knee Arthroplasty Recipients: Epidemiology and Propensity Score-Weighted Analysis of Effect on In-Hospital Postoperative Outcomes.

From the Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, MI (Zalikha), and the Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY (El-Othmani). Correspondence to Abdul K Zalikha, MD, Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, MI; email: [email protected].

L-Strut Division Technique for Correction of Anterocaudal Septal Deviation: Functional and Cosmetic Outcomes.

Facial Plastic Surgery & Aesthetic MedicineAhead of Print L-Strut Division Technique for Correction of Anterocaudal Septal Deviation: Functional and Cosmetic OutcomesSonam Dodhia, Ade Obayemi, Kevin Kuonqui, and Oscar TrujilloSonam Dodhia*Address correspondence to: Sonam Dodhia, MD, Department of Otolaryngology/Head and Neck Surgery, New York Presbyterian Hospital, Columbia University Medical Center, 180 Fort Washington Avenue 8th Floor, New York, NY 10032, USA. E-mail Address: snd7005@nyp.orghttps://orcid.org/0000-0002-8195-0475Department of Otolaryngology/Head and Neck Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.Search for more papers by this author, Ade ObayemiDepartment of Otolaryngology/Head and Neck Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.Search for more papers by this author, Kevin KuonquiDepartment of Otolaryngology/Head and Neck Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.Search for more papers by this author, and Oscar TrujilloDepartment of Otolaryngology/Head and Neck Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.Search for more papers by this authorPublished Online:5 May 2023https://doi.org/10.1089/fpsam.2022.0396AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"L-Strut Division Technique for Correction of Anterocaudal Septal Deviation: Functional and Cosmetic Outcomes." Facial Plastic Surgery & Aesthetic Medicine, , pp. FiguresReferencesRelatedDetails Volume 0Issue 0 InformationCopyright 2023, American Academy of Facial Plastic and Reconstructive Surgery, Inc.To cite this article:Sonam Dodhia, Ade Obayemi, Kevin Kuonqui, and Oscar Trujillo.L-Strut Division Technique for Correction of Anterocaudal Septal Deviation: Functional and Cosmetic Outcomes.Facial Plastic Surgery & Aesthetic Medicine.ahead of printhttp://doi.org/10.1089/fpsam.2022.0396Online Ahead of Print:May 5, 2023PDF download

Spheno-Orbital Meningioma - Treatment Outcomes and Factors Influencing Recurrence.

To determine treatment outcomes, recurrence rates, and predictors of recurrence, to inform future therapeutic approaches for spheno-orbital meningiomas (SOM). A retrospective single-center study of SOM treated from 1990 to 2021 was conducted with comprehensive neuro-ophthalmologic follow-up at Columbia University Medical Center (CUMC). Recurrence requiring reintervention was defined clinically as worsening of visual acuity, visual field defect, or ocular motility after an initial period of stabilization or 6 months of improvement following treatment, or radiologically as either a regrowth with an increase in tumor size by 20% at the site of previous growth or a new region of tumor growth. In total 46 patients met the inclusion criteria. The mean follow-up was 106 months (range 1-303). Dictated by the phenotype of the disease, patients underwent either gross- (50%), near- (17%), or subtotal resection (26%). Removal of the anterior clinoid process (ACP) was performed in 52% of patients. Nine patients (20%) required an enucleation or exenteration. Radiotherapy was employed at some point of treatment in 50% of cases. Inherited cases (24%) were referred to CUMC for treatment following 1 or more recurrences. The total recurrence rate, including inherited cases, was 54%, occurring at a mean interval of 43 months. The recurrence rate of patients treated solely at CUMC was 40%, occurring at a mean interval of 41 months. A subset of patients (32%) had 2 or more recurrences. Histopathology at the first surgery was WHO grade I (87%) and II (13%) and at the final surgery was WHO grade I (74%), II (21%), and III (4%). A subset of grade I tumors that received radiotherapy (35%) evolved to a higher grade or developed multiple recurrences without a change in histologic grade I. Grade II tumors and treatment with radiotherapy increased the odds of recurrence. Removal of the ACP and gross total resection decreased the odds of recurrence. Due to the routinely long interval to tumor recurrence, lifelong surveillance of patients with SOM is prudent. ACP resection and gross total resection, where possible, reduce tumor recurrence and the need for further treatment. Radiotherapy should be reserved for higher-grade meningiomas and select grade I tumors.

Being a Proctologist.

Division of Colorectal Surgery, Department of Surgery, Columbia University Medical Center, New York, New York Funding/Support: None reported. Financial Disclosures: None reported. Correspondence: James Church, MB ChB., M.Med.Sci., F.R.A.C.S., Columbia University Medical Center, Herbert Irving Pavilion, 161 Ft. Washington Ave., 8th Floor, Room 8-836, New York, New York 10032. Email: [email protected]

PD08-11 ACTIVE SURVEILLANCE VERSUS PRIMARY INTERVENTION FOR CLINICAL T1a KIDNEY TUMORS: TWELVE-YEAR EXPERIENCE OF THE DISSRM PROSPECTIVE COMPARATIVE STUDY

You have accessJournal of UrologyCME1 Apr 2023PD08-11 ACTIVE SURVEILLANCE VERSUS PRIMARY INTERVENTION FOR CLINICAL T1a KIDNEY TUMORS: TWELVE-YEAR EXPERIENCE OF THE DISSRM PROSPECTIVE COMPARATIVE STUDY Khalid Y. Alkhatib, Joseph Cheaib, Nirmish Singla, Peter Chang, Andrew A. Wagner, Christian P. Pavlovich, James M. Mckiernan, Thomas J. Guzzo, Mohamad E. Allaf, and Phillip M. Pierorazio Khalid Y. AlkhatibKhalid Y. Alkhatib More articles by this author , Joseph CheaibJoseph Cheaib More articles by this author , Nirmish SinglaNirmish Singla More articles by this author , Peter ChangPeter Chang More articles by this author , Andrew A. WagnerAndrew A. Wagner More articles by this author , Christian P. PavlovichChristian P. Pavlovich More articles by this author , James M. MckiernanJames M. Mckiernan More articles by this author , Thomas J. GuzzoThomas J. Guzzo More articles by this author , Mohamad E. AllafMohamad E. Allaf More articles by this author , and Phillip M. PierorazioPhillip M. Pierorazio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003239.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) is an alternative to primary intervention (PI) in the management of small renal masses (SRMs; clinical stage T1a). However, AS remains underutilized due to the lack of strong, prospective data. We herein report mature outcomes after a twelve-year experience with the Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) Registry. METHODS: the DISSRM Registry has prospectively enrolled patients between 2009 to 2021, this multi-institutional comparative study that includes Johns Hopkins Medical Institution, Beth Israel Deaconess Medical Center, and Columbia University Medical Center. All patients with SRM in the registry chose to either undergo AS or PI. Primary outcomes were cancer-specific survival (CSS) and overall survival (OS); secondary outcomes were progression-free survival (PFS) and recurrence-free survival (RFS). Outcomes were evaluated using Kaplan-Meier survival analysis and log-rank test. RESULTS: A total of 964 patients were enrolled, 785 patients had available follow-up data. Of these 785 patients, 585 (60.68%) chose AS and 379 (39.32%) chose PI. Ultimately, 88 of 585 AS patients (15.04%) crossed over to delayed intervention (DI). Median follow-up time for the registry was 3.39 years (IQR 1.71-6.88), with 331 patients (34.3%) followed for ≥5 years. There was no difference in CSS between AS and PI (p=0.6). However, AS patients demonstrated worse OS compared to those who underwent PI (p<0.001). In the AS cohort, PFS was 62.1% at 7 years; 76.4% of progressions were due to growth rate >0.5 cm/year. RFS was not different between PI and DI (p=0.7). Unadjusted analysis demonstrated AS was associated with increased all-cause mortality Differences in all-cause mortality between the AS and PI cohorts were attributable to increased age and Charlson Comorbidity Index (CCI)in the AS group (p=0.02). CONCLUSIONS: AS is not inferior to PI for carefully selected patients with SRM suspicious for renal cell carcinoma. The difference in OS between AS and PI is mostly attributable to the increased risk of death from competing causes among AS patients. A priori definitions of progression, including growth rate, should be re-considered given high rates of progression with few adverse oncologic outcomes. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e237 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Khalid Y. Alkhatib More articles by this author Joseph Cheaib More articles by this author Nirmish Singla More articles by this author Peter Chang More articles by this author Andrew A. Wagner More articles by this author Christian P. Pavlovich More articles by this author James M. Mckiernan More articles by this author Thomas J. Guzzo More articles by this author Mohamad E. Allaf More articles by this author Phillip M. Pierorazio More articles by this author Expand All Advertisement PDF downloadLoading ...

Phenotypic Variability of Retinal Disease Among a Cohort of Patients With Variants in the CLN Genes.

To describe the phenotype of CLN-associated retinal dystrophy in a subset of patients at the Columbia University Medical Center, United States, and the Hospital das Clínicas de Pernambuco, Brazil, in comparison to the published literature. Eleven patients with confirmed biallelic variants in the CLN genes were evaluated via dilated fundus examination, clinical imaging, and full-field electroretinogram. A thorough literature search was conducted to determine previously published variants and associated phenotypes. Genetic testing confirmed the presence of variants in CLN3, CLN7/MFSD8, CLN8, and GRN/CLN11. Five novel variants were identified, and four novel phenotypes of previously published alleles were described. The phenotype differed among patients with variants in the same gene and sometimes among patients with the same allele. Substantial phenotypic variability among variants in the CLN genes makes identification of genotype-phenotype or allele-phenotype correlations challenging. Further study is required to establish an extensive database for adequate patient counseling.

Psychedelic Renaissance: Clinical Health Justice, Patient Safety, and Equity Need to Be Put First

Psychedelic Renaissance: Clinical Health Justice, Patient Safety, and Equity Need to Be Put First