Compare Treatment Outcomes Research Articles

Time to Treatment and Outcomes of Hemorrhagic Stroke, Comparing Patients Entering Surgery before and after 120 Minutes Upon Arrival at the Emergency Department Pattani Hospital

Background: The duration between a patient’s hospital arrival and the point at which they enter surgery for hemorrhagic stroke affects survival, length of stay, health care costs, and outcome (Glasgow Outcome Scale). Therefore, a study to explore the effects of time on these outcomes is warranted. Objective: To compare treatment outcomes of patients with hemorrhagic stroke having entered surgery before and after 120 minutes upon arrival at the emergency department. Materials and Methods: A therapeutic and interventional study with a retrospective observational cohort design at Pattani Hospital in patients with hemorrhagic stroke who received treatment between October 2018 and April 2023. A retrospective review of medical records, which collected clinical characteristics and the time to treatment. Glasgow Outcome Scale was evaluated at 72 hours, two weeks, one month, and date of hospital discharge. Length of stay, health care costs, and survival status at date of hospital discharge were analyzed. Comparative analysis was performed by Fisher’s exact probability test and t-test, and prognostic analysis was performed by risk ratio. Results: Of all the patients in the present study, 49 and 182 received treatment before and after 120 minutes, respectively, upon arrival at the emergency department. Clinical characteristics of gender, age, underlying conditions, regular medications, and level of consciousness were not significantly different between the two groups. Patients who entered surgery within 120 minutes of arrival had more occurrences of basal ganglia hemorrhage compared with those who received surgery thereafter. Furthermore, patients who received surgery within 120 minutes had a 11.4% increased chance of survival. The number needed to treat (NNT) hemorrhagic stroke patients with a time to treatment of under 120 minutes is 9. However, there was an associated increase in complications, health care cost, and length of stay. The Glasgow Outcome Scale improvement was greater only in the two-week follow-up period. These results were similar when subarachnoid hemorrhage and anticoagulating medication used were excluded. Conclusion: Patients with hemorrhagic stroke who receive early surgical treatment have lower mortality rates. Adequate provision of personnel and facilities for delivering prompt care should be made available. Measures should be taken to reduce the complications of patients who receive surgical treatment after 120 minutes upon arrival at the emergency department.

Treatment outcomes of mild to moderate Clostridioides difficile infection in inflammatory bowel disease: an Australian experience.

The incidence of Clostridioides difficile infection (CDI) in inflammatory bowel disease (IBD) is rising and associated with adverse outcomes. Optimal treatment for CDI in IBD remains unknown, with various organisations suggesting vancomycin as first-line therapy. To compare treatment outcomes for metronidazole versus vancomycin in mild to moderate CDI in IBD. A retrospective analysis of IBD patients with CDI between January 2015 and December 2019 was conducted. Laboratory data and clinical outcomes were examined. Forty-seven discrete episodes of CDI in 34 patients occurred during the study period. Fifty-three per cent (18) had Crohn's disease, 44% (15) ulcerative colitis and 3% (1) IBD unclassified. Six per cent (3/47) of CDI cases were severe and excluded. In 68% (30/44) of mild to moderate CDI, metronidazole was prescribed, with treatment failure in 20% (6/30), CDI recurrence in 13% (4/30) and 20% (6/30) experiencing a further CDI episode. Comparatively, vancomycin was prescribed in 23% (10/44) without any treatment failures; however, 10% (1/10) had CDI recurrence and 40% (4/10) experienced another CDI episode. No statistically significant difference was noted between metronidazole and vancomycin therapy for treatment failure (P = 0.31), CDI recurrence (P = 1.0) or further CDI episodes (P = 0.23). Proton-pump inhibitor therapy was the only risk factor associated with a higher rate of the composite outcome and remained significant on multivariate logistic regression (odds ratio 12.99 (95% confidence interval = 1.21-139.97), P = 0.03). Metronidazole compared to vancomycin for treatment of mild to moderate CDI in IBD is effective however may be associated with higher rates of treatment failure.

Comparative Efficacy of Biodentine® and Calcium Hydroxide in Pulp Capping Treatment

Background: This study is focused on — Assessing Biodentine and Calcium hydroxide in indirect pulp capping procedures. Various materials have been used in indirect pulp capping but this comparative study may help appreciate which material produces better results: Biodentine or Calcium hydroxide. Objective: To compare treatment outcomes post indirect pulp capping treatment using Biodentine® and Calcium hydroxide (Ca(OH)2) . Materials and Methods: A blinded, randomized clinical control trial involving 50 consenting subjects, comparing Biodentine® (test) and Ca(OH)2 (control). Cavity preparation was done and the cavity was dressed with either Biodentine® or Ca(OH)2 and then restored with Glass ionomer cement. The subjects’ teeth were later examined clinically and radiographically at 3, 6, and 9 months post treatment. The indicators of clinical success were absence of pain, swellings, sinus, fistula, abscess, mobility, tenderness to percussion, normal response to electric pulp tester, and Endo-ice cold test. The indicator of radiographic success was absence of periapical pathosis. The probability level of p<0.05 was considered significant. Results: The success rate at three months was 100% for both groups; at six months, it was 92% for both groups and at nine months, 92% of subjects were successful in the Biodentine® group while the Ca(OH)2 group recorded 88% which was statistically insignificant (P=0.74). Conclusion: Biodentine® and Calcium hydroxide have shown comparable effectiveness in improving treatment outcomes, thus, contributing to the longevity of the teeth, and the period of optimum efficaciousness of the pulp capping materials in this study was three months.

Treatment outcomes and esophageal cancer incidence by disease type in achalasia patients undergoing peroral endoscopic myotomy: Retrospective study.

This retrospective study aimed to compare treatment outcomes and postoperative courses, including the incidence of esophageal cancer (EC), according to disease types, in 450 achalasia patients who underwent peroral endoscopic myotomy (POEM). Data from consecutive POEM procedures performed from September 2011 to January 2023 at a single institution were reviewed. Achalasia was classified into straight (St), sigmoid (S1), and advanced sigmoid (S2) types using esophagography findings. Regarding efficacy, POEM was considered successful if the Eckardt score was ≤3. A statistical examination of the incidence and trend of EC occurrence across the disease type of achalasia was conducted using propensity score matching. Of the 450 patients, 349 were diagnosed with St, 80 with S1, and 21 with S2. POEM efficacy was 97.9% at 1 year and 94.2% at 2 years postprocedure, with no statistical difference between disease types. Using propensity score matching, the incidence of EC in each disease type was as follows: St, 1% (1/98); S1, 2.5% (2/77); S2, 10% (2/18). While no statistical significance was observed between St (1.0%: 1/98) and all sigmoid types (4.0%, 4/95; P = 0.3686). However, a trend test revealed a tendency for EC to occur more frequently in the order of S2, S1, and St type with a statistically significant difference (P = 0.0413). Outcomes of POEM are favorable for all disease types. After POEM, it is important not only to monitor the improvement of achalasia symptoms but also to pay attention to the occurrence of EC, especially in patients with sigmoid-type achalasia.

Comparison of treatment outcomes between slow coagulation transscleral cyclophotocoagulation and micropulse transscleral laser treatment

This study compared treatment outcomes of slow coagulation transscleral cyclophotocoagulation (SC-CPC, 65 eyes) and micropulse transscleral laser treatment (MPL, 134 eyes) in patients with medically uncontrolled glaucoma. Success was defined as achieving an intraocular pressure (IOP) of 6–21 mmHg with a ≥ 20% reduction from baseline, no reoperation for glaucoma, and no loss of light-perception vision. Visual acuity, number of glaucoma medication, corneal endothelial cell count, aqueous flare values, and complications were analyzed. At 12 months, mean IOP decreased from 32.2 ± 13.4 to 17.9 ± 8.3 mmHg in the SC-CPC group and from 26.4 ± 10.8 to 16.5 ± 6.8 mmHg in the MPL group. No significant changes were observed in visual acuity, medication count, or corneal endothelial cell count. Aqueous flare values increased immediately after the procedure and gradually decreased in both groups, with greater changes at 1 week significantly associated with greater IOP reduction (p < 0.05). Pupillary abnormalities were found in 5 eyes (4.5%) of the MPL group, with no severe complications. The 12-month success rates were 50.1% for SC-CPC and 38.2% for MPL (p = 0.131). Both SC-CPC and MPL effectively controlled IOP, with early postoperative aqueous flare values predicting treatment outcomes.

Artists' satisfaction with telerehabilitation in physiotherapy during the COVID-19 pandemic: A cross-sectional study.

To our knowledge, there is currently no research on telerehabilitation concerning artists. This study aims to assess the feasibility, acceptability, and effectiveness of utilizing video-based telerehabilitation in physiotherapy among artists during the COVID-19 pandemic. Fifty-one artists who accessed virtual physiotherapy between November 2020 and February 2022 at a healthcare center that provides specialized healthcare services to artists of all disciplines who reside or work in Ontario, Canada were asked to complete a 26-item online questionnaire about their experience with virtual physiotherapy. The 51 respondents were from a range of artistic disciplines, with the largest portion being musicians (n=22; 43%). Of the respondents, 86% (n=44) felt the virtual physiotherapy met their expectations in therapeutic benefits, 78% (n=40) were confident in performing all the exercises that the physiotherapist demonstrated on the virtual platform, 80% (n=41) did not run into many technological challenges when booking or attending virtual sessions, and 54% (n=20) reported similar treatment outcomes between virtual and in-person sessions. Although artists liked the convenience of accessing physiotherapy from home, 53% (n=17) of respondents rated the lack of physical contact as a major limitation in telerehabilitation. Telerehabilitation for artists during the COVID-19 pandemic has shown potential to be an effective and viable alternative to in-person physiotherapy, as demonstrated by high satisfaction levels and comparable treatment outcomes, especially when public health restrictions were in place. Future research can explore hybrid models (mix of in-person and virtual sessions) in physiotherapy to meet the needs for physical contact during sessions.

Defining ideal middle cerebral artery bifurcation aneurysm size for Woven EndoBridge embolization.

The Woven EndoBridge (WEB) device was approved to treat wide-necked bifurcation aneurysms. The device is designed as an intrasaccular flow disruptor covering aneurysm widths up to 10 mm. Although prior studies combined all aneurysm sizes, it is known that aneurysms behave differently in response to endovascular treatment based on their size. Therefore, the authors' objective was to identify ideal middle cerebral artery (MCA) aneurysm width and neck sizes most suitable for WEB treatment. The WorldWideWEB consortium is a large multicenter retrospective database that analyzes intracranial aneurysms treated with the WEB device. In this study, all unruptured MCA bifurcation aneurysms with available measurements were included. Cutoff values based on aneurysm width and neck in relation to aneurysm occlusion status were measured using the receiver operating characteristic (ROC) curve. Propensity score matching (PSM) was then used to compare treatment outcomes between aneurysms smaller and larger than the cutoff value for both width and neck size. The ideal cutoff values for MCA bifurcation aneurysm width and neck were 6.1 mm and 4.6 mm, respectively. On PSM, 87 matched pairs were compared based on width size (≤ 6.1 mm and > 6.1 mm), and 77 matched pairs were compared based on neck size (≤ 4.6 mm and > 4.6 mm). There was a significant difference in adequate aneurysm occlusion between aneurysms smaller and larger than those cutoff values for both widths (93% vs 76%, p = 0.0017) and neck sizes (90% vs 70%, p = 0.0026). The retreatment rate was also significantly higher for larger aneurysms in both parameters. This study shows that MCA bifurcation aneurysms ≤ 6.1 mm in width and ≤ 4.6 mm in neck size are significantly better candidates for WEB treatment, leading to improved occlusion status and reduced retreatment rate, which are important considerations when using WEB devices.

Endovascular treatment for proximal middle cerebral artery occlusion due to underlying intracranial atherosclerotic disease: A retrospective single-center case series

ObjectiveTo compare treatment outcomes between patients who received a front-line stent-retriever thrombectomy (SRT) or first stenting without retrieval (FRESH) for treating proximal M1 occlusion due to underlying intracranial atherosclerotic disease (ICAD). MethodsWe retrospectively reviewed consecutive acute ischemic stroke (AIS) patients with intracranial large vessel occlusion (LVO) in the anterior circulation who underwent endovascular treatment (EVT) between January 2017 and August 2021 at Yeungnam University Medical Center. LVO in the anterior circulation was classified according to etiology as follows: Embolic group and ICAD group. Occlusion of the proximal M1 due to ICAD were enrolled in this study. The ICAD group was divided into SRT and FRESH groups according to the treatment method. ResultsAmong the 72 patients in the ICAD group, 55 patients had occlusion of the M1, and 27 had occlusion of the proximal M1 (27/55, 49.1 %). Among the 27 patients, 11 (40.7 %) underwent SRT and 16 (59.3 %) underwent FRESH. The puncture-to-recanalization time was significantly shorter in the FRESH group (28 min vs. 52 min, p = 0.023). Symptomatic ICH tended to occur more frequently in the SRT group than in the FRESH group (27.3 % vs. 0.0 %, p=0.056). There was a nonsignificant trend towards a good functional outcome in the FRESH group compared to the SRT group (81.3 % vs. 45.5 %, p=0.097). ConclusionIn the FRESH group, the puncture-to-recanalization time was significantly shorter, symptomatic ICH tended to occur less frequently, and good functional outcomes were more common.

Comparative clinical study of Mist Amen Fevermix and Edhec Malacure: two polyherbal products used for the treatment of uncomplicated malaria in Ghana against Artemether/Lumefantrine

The use of herbal products for the treatment of malaria, has increased globally. However, inadequate scientific studies about the safety and effectiveness of such herbal products have been raised. Also, the reduced sensitivity of the malaria parasites to artemisinin-based combination therapies is of concern. There is therefore the need for new antimalarial medications including those from alternative sources such as herbal medicinal products. In this study, a prospective, comparative parallel group randomized, clinical study was done to assess the safety and effectiveness of Mist Amen Fevermix and Mist Edhec Malacure with Artemether/Lumefantrine as control at the Tafo Government Hospital, Kumasi between July and November 2019, after Committee on Human Research, Publication and Ethics approval (CHRPE/AP/424/19). The study was conducted in accordance with Good Clinical and Laboratory Practice (GCLP) and registered with the Pan African Clinical Trials Registry with trial number PACTR202109664146698. Participant completed an informed consent form. Randomization was based on a single sequence to allocate participants to a group. SPSS version 19. One-way ANOVA test and exploratory statistics was used for data analysis. Total sample size was 150 participants with 50 on each arm of the group. Male and female patients aged 15–45 years and meet inclusion criteria with clinically established malaria were treated with Mist Amen Fevermix and Mist Edhec Malacure, at the specified doses of 45 mls (0.1063 g) and 30 mls (0.0521 g) three times daily after meals for three days. Artemether/Lumefantrine was administered at a dose of 80/480 mg/kg twice daily after meals for three days. Baseline data was taken on day 0. Patients were then followed up on Day 3, 7 and 28 to establish treatment outcomes and any side effect using a checklist for signs and symptoms and Karnofsky’s scale to assess the quality of life. Mist Amen Fevermix was effective with a cure rate of 95.89%. Mist Edhec Malacure was also effective with a cure rate of 91.87%. The cure rate of Artemether/Lumefantrine was 97.25%. Kidney and liver panels were within normal reference range at the end of the 28-day study. This study supports the use of Mist Amen Fevermix and Mist Edhec Malacure, two multi-component products as safe and effective for the treatment of uncomplicated malaria. Both products achieved a comparable clinical treatment outcome with Artemether/Lumefantrine.

Evaluating the Impact of Posterior Edentulism on Temporomandibular Disorder-Related Bruxism, Tinnitus, and Depression

Purpose: The impact of posterior edentulism on the management of temporomandibular disorders (TMD) remains unclear, with a paucity of studies examining the influence of posterior edentulism on TMD symptoms. The objective of this study is to investigate the relationship between posterior edentulism and bruxism, tinnitus, and depression in TMD patients and to compare treatment outcomes in two groups with and without posterior edentulism. Material and methods: In a quasi-experimental controlled trial, 26 patients with TMD participated in a six-week intervention, including manual therapy, massage, postural exercises and kinesio taping. The patients were divided into 13 in the posterior edentulous group and 13 in the full dentate group. The participants attended 12 physiotherapy sessions, twice a week, over six weeks. Outcome measures, including bruxism, tinnitus, joint clicking, Beck Depression Inventory, and cervical range of motion, were evaluated at baseline and the end of the six weeks. Results: The six-week physiotherapy program significantly improved bruxism, tinnitus, cervical range of motion, and depression (p

The Odyssey of HOMER: Comparative Effectiveness Research on Medication for Opioid Use Disorder During the COVID-19 Pandemic.

The usual challenges of conducting primary care research, including randomized trials, have been exacerbated, and new ones identified, during the COVID-19 pandemic. HOMER (Home versus Office for Medication Enhanced Recovery; subsequently, Comparing Home, Office, and Telehealth Induction for Medication Enhanced Recovery) is a pragmatic, comparative-effectiveness research trial that aims to answer a key question from patients and clinicians: What is the best setting in which to start treatment with buprenorphine for opioid use disorder for this patient at this time? In this article, we describe the difficult journey to find the answer. The HOMER study began as a randomized trial comparing treatment outcomes in patients starting treatment with buprenorphine via induction at home (unobserved) vs in the office (observed, synchronous). The study aimed to enroll 1,000 participants from 100 diverse primary care practices associated with the State Networks of Colorado Ambulatory Practices and Partners and the American Academy of Family Physicians National Research Network. The research team faced unexpected challenges related to the COVID-19 pandemic and dramatic changes in the opioid epidemic. These challenges required changes to the study design, protocol, recruitment intensity, and funding conversations, as well as patience. As this is a participatory research study, we sought, documented, and responded to practice and patient requests for adaptations. Changes included adding a third study arm using telehealth induction (observed via telephone or video, synchronous) and switching to a comprehensive cohort design to answer meaningful patient-centered research questions. Using a narrative approach based on the Greek myth of Homer, we describe here the challenges and adaptations that have provided the opportunity for HOMER to thrive and find the way home. These clinical trial strategies may apply to other studies faced with similar cultural and extreme circumstances.

Effect of ear cleaning on treatment outcome for canine otitis externa.

Ear cleaning is often recommended for management of canine otitis externa (OE). Few invivo studies evaluate how ear cleaning affects treatment outcome. To determine the effect of ear cleaning on canine OE by comparing treatment outcome in cleaned versus noncleaned ears. Twenty-three client-owned dogs with ceruminous or purulent OE. Forty ears were randomised to one of two groups: 20 ears were wiped with dry or saline-moistened gauze (grp1), and 20 external ear canals received manual cleaning (grp2) with a commercial product. One millilitre of a commercial otic suspension containing hydrocortisone aceponate, miconazole nitrate and gentamicin sulfate was applied to affected ears every 24 h for five days. Cytological scores, modified otitis index score (OTIS3), pruritus Visual Analog Scale (PVAS), modified PVAS and client questionnaire were compared on Day (D)0 and D7. There were no statistical differences between cytological scores, modified OTIS3, PVAS, modified PVAS or client assessments between groups at D7. Both groups had significant reduction in all treatment parameters from D0 to D7 with the exception of cytological rod scores that were only significantly decreased in cleaned ears. There was a significant difference in OTIS3 before and after cleaning on D0. Both groups achieved successful outcome regardless of cleaning. Ear cleaning may be more important when rod-shaped bacteria are present.

Financing decisions following negative shocks in the product market: A matrix-completion study of the U.S. pharmaceutical industry

We investigate whether firms adjust their financing policies in response to a negative shock affecting their product market. Focusing on the pharmaceutical industry, we leverage the U.S. Inflation Reduction Act (IRA) of 2022 as an exogenous shock, marking the government's inaugural authority to negotiate drug prices. Using a matrix completion approach, a supervised machine-learning methodology that allows to compare treatment outcomes against predicted counterfactual values in absence of the treatment, our analysis reveals that pharmaceutical firms react to this regulatory intervention by issuing more equity. This finding suggests that firms raise fresh capital to mitigate the adverse impact of IRA on the product market.

The efficacy of cuff-shaving combined with negative pressure wound therapy in refractory exit-site and tunnel infections: a single center experience

BackgroundRefractory exit-site infections (ESIs) and tunnel infections (TIs) are challenging complications for patients undergoing peritoneal dialysis (PD). This study compared the outcomes of surgical intervention, notably the cuff-shaving (CS) procedure coupled with negative-pressure wound therapy (NPWT), and conservative management strategies for patients with refractory ESI and TI.MethodsWe retrospectively reviewed patients who underwent PD at our center, focusing on the incidence and management of ESI and TI. We evaluated and compared treatment outcomes, including ESI scores, frequency of ESI and/or TI, identification of causative microorganisms, and duration of catheter survival or time until removal.ResultsWe identified 97 episodes of catheter-related ESI and/or TI across 71 patients with an incidence rate of 0.15 episodes per patient-year. Of the 23 patients with refractory ESI and/or TI, surgical intervention was performed in 8, while 15 chose conservative management. In the one-month follow-up, patients who underwent CS combined with NPWT showed no complications such as leakage, and their local symptoms resolved completely. The mean PD catheter survival time was significantly longer in the surgical group (29.38 ± 7.25 months) than in the conservative group (7.86 ± 2.13 months). Surgical intervention demonstrated a significantly higher therapeutic efficacy and extended catheter survival.ConclusionsThe combination of CS and NPWT as a surgical approach is crucial for eradicating infectious foci and significantly improving the longevity of PD catheter function. This integrated surgical strategy offers a promising solution for the management of refractory ESI and TI in patients undergoing PD.

Agent-Based Modeling of Virtual Tumors Reveals the Critical Influence of Microenvironmental Complexity on Immunotherapy Efficacy.

Since the introduction of the first immune checkpoint inhibitor (ICI), immunotherapy has changed the landscape of molecular therapeutics for cancers. However, ICIs do not work equally well on all cancers and for all patients. There has been a growing interest in using mathematical and computational models to optimize clinical responses. Ordinary differential equations (ODEs) have been widely used for mechanistic modeling in immuno-oncology and immunotherapy. They allow rapid simulations of temporal changes in the cellular and molecular populations involved. Nonetheless, ODEs cannot describe the spatial structure in the tumor microenvironment or quantify the influence of spatially-dependent characteristics of tumor-immune dynamics. For these reasons, agent-based models (ABMs) have gained popularity because they can model more detailed phenotypic and spatial heterogeneity that better reflect the complexity seen in vivo. In the context of anti-PD-1 ICIs, we compare treatment outcomes simulated from an ODE model and an ABM to show the importance of including spatial components in computational models of cancer immunotherapy. We consider tumor cells of high and low antigenicity and two distinct cytotoxic T lymphocyte (CTL) killing mechanisms. The preferred mechanism differs based on the antigenicity of tumor cells. Our ABM reveals varied phenotypic shifts within the tumor and spatial organization of tumor and CTLs despite similarities in key immune parameters, initial simulation conditions, and early temporal trajectories of the cell populations.

Treatment Outcomes of PED for Unruptured Aneurysms of Internal Carotid Artery: Comparison of PED-Flex and PED-Shield.

There is a lack of data regarding the safety and effectiveness of implanting the Pipeline Embolization Device with Shield technology (PED-Shield) compared with the previous generation of Pipeline (PED-Flex). This retrospective single-center study aimed to compare treatment outcomes between the PED-Shield and PED-Flex for treating unruptured internal carotid artery aneurysms. The PED-Flex was used in 62 procedures (67 aneurysms, 59 patients) and the PED-Shield in 53 procedures (59 aneurysms, 58 patients). The mean aneurysm diameter was significantly lower in the PED-Shield group than in the PED-Flex group (11.9 ± 7.0 mm vs. 15.2 ± 6.9 mm, p < 0.001). At the 12-month follow-up, the complete angiographic occlusion rate was 72.1% and 72.3% in the PED-Flex and PED-Shield groups, respectively (p = 0.9808). Limited to aneurysms larger than 10 mm, 70.6% and 68.0%, respectively (p = 0.8175). The incidence of more than three high signal intensity areas on diffusion-weighted imaging after treatment was significantly lower in the PED-Shield group than in the PED-Flex group (27.7% vs. 67.7%; p < 0.001). Limited to aneurysms larger than 10 mm, 41.1% and 69.6%, respectively (p < 0.0117). Symptomatic ischemic complications occurred within 30 days of four PED-Flex procedures (6.5%) and one PED-Shield procedure (2.0%) (p = 0.2315). Limited to aneurysms larger than 10 mm, 1.8% and 3.2%, respectively (p = 0.6677). The incidence of mRS score worsening at 6 months was 3.2% and 1.9% in the PED-Flex and PED-Shield groups, respectively (p = 0.6534). The PED-Shield can achieve outcomes equivalent to or better than the PED-Flex. Further large-scale studies are warranted to confirm our findings.

Direct Oral Anticoagulants in Older and Frail Patients with Atrial Fibrillation: A Decade of Experience.

Both the prevalence of atrial fibrillation (AF) and its subsequent use of direct oral anticoagulants (DOACs) are rapidly increasing in patients of older age. In the absence of contra-indications, guidelines advocate anticoagulation based on the CHA2DS2-VASc score for all AF patients aged 75 and above. However, some practitioners are hesitant to prescribe anticoagulants to older and frail patients due to perceived elevated bleeding risks. This review delves into the comparative treatment outcomes of DOACs versus vitamin K antagonists (VKAs) in older patients with AF, particularly focusing on those of advanced age, frailty, increased risk of falling, chronic kidney disease (CKD), or with a history of major bleeding. Additionally, considerations on the use of off-label DOAC doses, the role of left atrial appendage (LAA) closure and future developments in factor XIa-inhibitors will be discussed. While strong evidence supports the use of DOACs in the vital older patients with nonvalvular AF, it remains scant in frail patient groups. There is some evidence from non-randomized studies suggesting that the effect of DOACs compared with VKAs is consistent between frail and nonfrail patients. However, recent findings from a single randomized trial showed increased bleeding risks but comparable thromboembolic outcomes in frail individuals switching from VKAs to DOACs. In patients with an increased risk of falling, data suggest no relevant interaction of increased risk of falling on the effectiveness and safety of DOACs compared with warfarin. Resuming oral anticoagulants in patients with Af after major bleeding seems to be beneficial. Off-label low-dose DOAC is often prescribed to patients who were underrepresented in larger randomized trails because of an elevated risk of bleeding or overexposure to DOACs, but its effect on clinical outcomes remains uncertain. DOACs are the recommended oral anticoagulant for vital older patients with AF. The scarcity of data backing DOAC use in frail individuals, those with renal impairments, or significant bleeding history underscores the necessity for further investigation. However, existing evidence suggests at least similar effectiveness and safety and potential benefits for DOACs in these patient subsets. Therefore, there is no reason to suggest these patients should be treated differently than the established guidelines regarding anticoagulation.

Acceptability and feasibility of implementing thermal ablation as a preventive cervical cancer treatment and the comparison of treatment outcome with cryotherapy in Zimbabwe.

Thermal ablation, a technique that destroys precancerous cervical cells by extreme heat or cold, is predominantly used as a preventive cervical cancer treatment modality in high-income countries. Compared to other treatment methods thermal ablation has numerous advantages in its portability, minimal electricity use and comparable treatment rates, which is convenient for use in low- and middle-income countries (LMICs). Therefore, it is important to understand acceptability among providers and clients and the feasibility of achieving comparable treatment outcomes with other methods in LMICs. We conducted a prospective longitudinal, open-label two-arm study from June 2021 to April 2022 at seven health delivery points. In this study, 182 clients were enrolled to receive preventive cancer treatment at baseline and followed up 6 months later to measure treatment outcomes and experiences on the procedure. Eligible consented clients were elected to a preferred method (either thermal ablation as an intervention or cryotherapy as a control group). We also conducted qualitative interviews with 14 service providers in either static or outreach settings. At the 6-month follow-up, the efficacy was comparable among the two groups, 96.5% (95% CI 86.7%-99.1%) clients in the intervention group had successful lesion treatment rate compared to 80.8% (95% CI 69.9%-99.1%) of the control group. Furthermore, 99% of clients in the intervention group would recommend thermal ablation to their family members or peers. Service providers preferred thermal ablation due to its ease of use, lower costs, portability and lower likelihood of adverse events compared to cryotherapy. The study showed the feasibility of implementing thermal ablation as a new preventive cervical cancer treatment modality in Zimbabwe. Furthermore, service providers indicated their preference for thermal ablation due to its ease of use, portability at static settings and lower likelihood of adverse events occurrence. Therefore, we recommend scaling up thermal ablation both at static and outreach sites.

Analysis of long-term results of conservative and surgical treatment in patients with locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinuses

Introduction. Surgical intervention with subsequent chemoradiation therapy is one of the treatment standards in squamous cell carcinoma of the nasal cavity and paranasal sinuses. However, the question of the optimal therapy for this pathology remains open.Aim. To compare treatment results in patients with locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinuses after conservative and surgical treatment.Materials and methods. The study included 86 patients with squamous cell carcinoma of the nasal cavity and paranasal sinuses, stages III–Iva, who between 2000 and 2020 received treatment at the N.N. Blokhin National medical Research Oncology Center. Surgical treatment with subsequent radiation or chemoradiation therapy was performed in 31 patients, conservative treatment (radiation or chemoradiation therapy) was performed in 55 patients.Results. Five-year overall survival in the conservative treatment group was 46.2 %, in the surgical treatment group – 59.7 % (р = 0.081); 5-year progression-free survival was 17 and 50.5 %, respectively (p = 0.002). In patients with Т3N0 tumor who received surgical treatment, 5-year progression-free survival was significantly higher than in patients who received conservative treatment (p &lt;0,05). Comparison of overall survival and progression-free survival of patients who achieved objective response (complete response + partial response) after conservative treatment (n =36) and after surgical treatment (n = 31) did not show statistically significant differences (р = 0.469 and р = 0.183, respectively). The overall 5-year survival rate in the salvage surgery treatment group (24/55) was 63.1 % compared with 59.7 % in the surgical treatment group (n = 31), there were also no significant differences (p = 0.95). In patients with T3 tumor who received conservative treatment in this study, higher risk of progression was observed compared to patients who underwent surgical treatment.Conclusion. Surgical intervention remains an important treatment method for patients with locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinuses, especially in cases of smaller tumor extent. Conservative therapy seems promising but large-scale prospective controlled randomized clinical trials are necessary to confirm its effectiveness and safety in various patient groups.

Effect of Providing Evidence-Based Mental Health Treatment on Retention in Care Among Medicaid-Enrolled Youths.

Youths who start behavioral health treatment often stop before completing a therapeutic course of care. To increase treatment engagement and quality of care, the Evidence-Based Practice and Innovation Center in Philadelphia has incentivized use of evidence-based practices (EBPs) for mental health care of youths. The authors aimed to compare treatment outcomes between youths who received EBP care and those who did not. Using EBP-specific billing codes and propensity score matching, the authors compared treatment retention among youths who received trauma-focused cognitive-behavioral therapy (TF-CBT; N=413) or parent-child interaction therapy (PCIT; N=90) relative to matched samples of youths in standard outpatient therapy (N=503). Youths with a minimum of one session of TF-CBT or PCIT attended a second session at higher rates than did youths in the matched control group (TF-CBT: 96% vs. 68%, p<0.01; PCIT: 94% vs. 69%, respectively, p<0.01). On average, these returning youths attended more sessions in the EBP groups than in the control group (TF-CBT: 15.9 vs. 11.5 sessions, p<0.01; PCIT: 11.2 vs. 6.9 sessions, p<0.01). These findings indicate that, in addition to improving quality of care, EBP implementation helps address the major challenge that most youths who engage with treatment are not retained long enough for care to have therapeutic effects. Future research should examine the mechanisms through which EBPs can improve treatment retention.