Completion Of Treatment Research Articles

Quality of Life of Children After Completion of Surgical Treatment for Anorectal Malformation: A Single-centre Cross-sectional Study in South-Western Uganda

BackgroundAnorectal malformations (ARMs) range from abnormalities such as imperforate anus to complex forms such as cloaca and are often associated with other anomalies and residual functional stooling problems. The present study aimed to evaluate the quality of life (QoL) of children after surgical treatment for ARMs at Mbarara Regional Referral Hospital (MRRH) in South-Western Uganda. MethodsIn this cross-sectional study, we enrolled children who had completed surgical treatment for ARMs between 2014 and 2021 at MRRH. A 23-item PedsQL 4.0 inventory was used to evaluate health-related QoL in children using a multidimensional parent proxy reporting for children aged 3 years to 7 years and child self-reporting for children aged 8–17 years. Regression analysis was used to determine the association between sociodemographic and clinical variables and QoL. Crude and adjusted coefficients and their corresponding 95% confidence intervals (CI) were calculated. The significance level was set to a p-value <0.05. ResultsA total of 88 participants (F:M ratio = 1.15:1) aged 3 years–18 years with a median age of 4.5 years (IQR 3–7) were enrolled. The median age at diagnosis of ARM and preliminary diverting colostomy was 3 days (range: 2–30 days) and 3 days (range: 2–60 days) respectively. Rectovestibular fistulas, 47 (53.4%), were the most prevalent subtype of ARMs, and 5.7% of children had associated anomalies. Over one-third of the participants (38.6%) had definitive surgery after 3 years of age, and PSARP was the most common procedure. The average PedsQL score was 94 out of a maximum score of 100. The mean physical functioning score was 96.7 in males and 98.9 in females. The overall mean emotional functioning score was 91 ± 2. The mean social functioning score was 92 ± 3.0. The mean school functioning score was 95.7 in males and 98.5 in females. Associated anomalies and reoperation significantly predicted poor QoL. ConclusionThe overall QoL of the participants was good. Increasing years after completion of surgery was significantly associated with good QoL scores in all dormains. Associated anomalies and reoperation were associated with poor QoL, while years after definitive surgery was associated with good QoL. There is a need for increased awareness and utilization of QoL assessments as an outcome measure after definitive surgery for ARM. Level of evidence4. Type of studyCross sectional clinical study.

“Tell me I’m okay”: A cross-sectional quality-of-life assessment of patients in a breast cancer survivorship program.

213 Background: The number of breast cancer survivors is increasing due to improvements in care and an aging population, leading to an increased need for care that addresses the physical and psychological needs of patients after completion of active treatment. The Sunnybrook Breast Cancer Survivorship Program was established to provide comprehensive evidence-based survivorship care and facilitate the transition to family doctors. Despite rising interest in dedicated survivorship care, there is little consensus regarding which individuals are likely to suffer the most long-term impacts of breast cancer treatment. Factors as varied as age, ethnicity, socioeconomic status, and treatment type can influence Quality-of-Life (QoL) outcomes. This cross-sectional assessment uses mixed methods to evaluate QoL trends in the patient cohort. Methods: Current patients of the Sunnybrook Breast Cancer Survivorship Program were asked to complete a baseline information form, as well as the EORTC QLQ-30 and BR-45, two validated measures of QoL for breast cancer patients and survivors. QoL, functional, and symptom domains were calculated from these responses accordingly and analyzed statistically. Patients reported their most bothersome QoL concerns through an open-ended questionnaire, which was analyzed and organized thematically. 99 patients have been recruited to date, of a planned 200. Results: We find that sexual health is of importance for this population, with 50 (50.5%) participants reporting sexual activity. Patients under 50 have poorer sexual functioning scores (p&lt;0.01) as well as more issues with body image (p&lt;0.05) than older survivors. Both married and under-50 patients are significantly more likely to have poorer outlooks on the future (p&lt;0.05; p&lt;0.01). Younger patients also tended to have worse role functioning, cognitive functioning, emotional functioning, and social functioning scores, though these differences were not statistically significant. Thematic analysis of qualitative data showed that patients’ chief concerns were the impact that ongoing side effects had on their daily functioning, impact of treatment on body image, disruptions to work and personal relationships, and strong anxiety about potential recurrence. Conclusions: While it is understood that younger BC survivors face unique challenges, our findings indicate that these obstacles persist into older age groups. In addition to physical side effects, such concerns as body image issues, social strain, and emotional functioning can drive QoL scores for these patients. Notably, many patients endorsed strong anxiety regarding potential recurrence that affected QoL, and identified dedicated survivorship follow-up as an ameliorating factor. Further research should be conducted into the unique needs of under-50 survivors, as well as the role of recurrence anxiety in impacting QoL.

The impact of anti-tuberculosis treatment on respiratory tract microbiome in pulmonary tuberculosis

The growing evidence has underscored the significance of interactions between the host and microbiota in respiratory health, presenting a novel perspective on disease management. Yet, comprehension of the respiratory microbiome shifts before and after anti-tuberculosis treatment is limited. This study compares respiratory microbiome profiles in untreated tuberculosis (UTB) and completed TB treatment (CTB) cases with healthy controls, using 16S rRNA sequencing on sputum samples. Significant reduction in sputum microbial alpha diversity was observed in both TB groups when compared to healthy controls (P < 0.05). Beta diversity analysis showed distinct clustering (P < 0.05). Linear discriminant analysis revealed an abundance of potentially pathogenic bacterial genera like Haemophilus, Pseudomonas, and Mycobacterium in the UTB group, while Streptococcus, Rothia, and Neisseria dominated in CTB samples. Healthy sputum microbiomes were enriched with Prevotella, Fusobacterium, Porphyromonadaceae_unclassified,andPeptostreptococcus. Moreover, predicted bacterial functional pathways showed significant differences among the three groups, mainly related to nutrient metabolism.These findings indicated significant microbial dysbiosis in sputum samples recovered from patients with pulmonary TB with an elevated presence of potentially pathogenic bacteria, depletion of beneficial genera, and downregulation of several essential metabolic pathways. Further exploration of respiratory microbiome-based diagnostic biomarkers and their role in targeted treatment strategies in tuberculosis is warranted.

Exploring gender as a sociocultural construct among cancer caregivers enrolling in a dyadic resiliency trial.

186 Background: Caregiving relations are essential for navigating cancer care among cancer curvivors (i.e., completed curative-intent treatment) and metavivors (i.e., living with incurable illness). Caregiving is associated with poor health outcomes, but little work explicates gender differences in specific sociocultural constructs that drive caregivers’ health outcomes. This study explores gender differences in caregiving relationship type (e.g., partner, friend) and psychosocial variables theorized to be impacted by caregiving stress, such as preventative health behaviors, self-compassion, depression/anxiety, informational/emotional social support and perceived caregiving relationship quality among caregivers of cancer curvivors and metavivors. Methods: 47 survivor-caregiver dyads (64% metavivors) enrolled in a pilot clinical trial of simultaneous remotely-delivered dyadic stress management groups at a tertiary care academic center. Eligible caregivers were those supporting survivors who had completed initial treatment for cancer with curative intent 3 months- 5 years ago OR were diagnosed with metastatic illness at least 3 months before enrollment. Data were collected via brief self-report baseline surveys measuring depression (PHQ-2), anxiety (GAD-2), self-compassion (SCS-12), informational/emotional support (PROMIS short forms-4a), including assessments of sex-specific cancer screening behavior (i.e., recommended breast, cervical, prostate, and colorectal screening) and relationship quality created for this study. Bivariate statistics compared caregivers based on self-reported gender identity (two-tailed p &lt; .05) with Cohen’s D used to characterize strength of between-group differences (0.2 = small, 0.5 = medium, 0.8 = large). Results: Most caregivers ( M age = 56.9) were White (87%) women (64%) caring for men (53%). Women (79% partners, 17% family, 4% friends) and men (64% partners, 36% family) caregivers did not significantly differ in caregiving relationship type ( p = .33). Most caregivers were up-to-date with sex-specific screening recommendations for breast (83%), cervical (80%), and prostate (85%) cancer, though women vs. men were significantly less adherent to colon cancer screening (60% vs. 100%, p = .003). Significant gender differences emerged in (anxiety D = -0.69, p =.03) but not depression (D = -0.47, p = .14 or self-compassion (D = .58, p = .07), such that women experienced great distress. Finally, women reported not significantly greater informational/emotional support (Ds = -0.30 and -0.25, p s &gt; .40) and relationship quality (D = -0.63, p = .05). Conclusions: When comparing the experiences of women and men currently in caregiving roles, gendered traits such as anxious emotional expression, as well as gender norms around self-focused preventative health behaviors may place women at increased risk for poor health outcomes. Clinical trial information: NCT05702723 .

Group-Delivered Trauma-Focused CBT Integrating Racial Socialization: A Multiple Case Study

In addition to disparities in interpersonal trauma exposures, Black youth in the U.S. experience the compounding stress of racial trauma, both of which are associated with a disproportionate mental health burden. Black youth also face barriers to engaging with trauma-specific therapies to address trauma-related mental health problems, with research suggesting that they are less likely to complete trauma-specific treatment. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based therapy for trauma-related mental health problems in youth ages 3 to 18. Metzger and colleagues (2021) proposed a set of cultural considerations for Black families to address racial stressors and enhance engagement in TF-CBT. The aim of the current multiple case study was to demonstrate the utility of group-delivered TF-CBT integrating these considerations for a single telehealth group of Black adolescents and their caregivers. We describe the intervention, patient engagement and clinical outcomes, and feedback from families regarding their experience with the group model. We also outline clinical and implementation challenges and highlight directions for future research and clinical practice.

Neoadjuvant radiotherapy and endocrine therapy for oestrogen receptor positive breast cancers: the Neo-RT feasibility study

AimsTo establish safety and feasibility of delivering neoadjuvant radiotherapy and endocrine therapy for oestrogen receptor positive breast cancers with palpable size 20mm or greater, for which radiotherapy might facilitate more conservative surgery. Materials and MethodsA single arm feasibility study was conducted. Patients received whole breast radiotherapy with or without radiotherapy to nodal areas. Dose/fractionation was 40Gy in 15 fractions over 3 weeks, with or without either simultaneous integrated boost to 48Gy, or sequential boost, to the tumour bed. This was followed by endocrine treatment for 20 weeks, then surgery. The primary endpoint of the study was proportion of patients successfully completing neo-adjuvant radiotherapy and endocrine treatment followed by breast surgery. Response and toxicity endpoints including mastectomy rate, peri/postoperative complications, and pathological response were also evaluated.The primary analysis is descriptive. The study regimen would be considered feasible if more than 70% of patients completed treatment, while it might not be considered feasible if less than 50% did so. With a one sided 5% significance level and 80% power, a maximum of 43 patients would be required to detect a rate of ≤50% vs ≥70%. Results14 patients were recruited of the planned 43. Due to slow recruitment particularly during the COVID-19 pandemic, the decision was made to stop the trial in October 2021. One registered patient was found to be ineligible before starting treatment. 13/13 patients (100%, 90% CI: 75.3%, 100%) who received any trial treatment successfully completed all trial treatments. The lower bound of the Clopper-Pearson (exact) 90% confidence interval was 79%, indicating that the primary endpoint would have been met if the planned recruitment had been achieved. 3/13 patients underwent mastectomy. 7/13 had more conservative surgery than had been planned at baseline. 4/13 patients experienced any peri/postoperative complication. The only acute radiotherapy toxicities reported were grade 1/2 dermatitis and grade 1 fatigue. Long term breast outcomes were clinician assessed as none/mild at all timepoints in 12/13 patients. All tumours showed evidence of some pathological response to treatment, but none had pathological complete response. ConclusionsThis treatment schedule is likely feasible. It is difficult to draw strong conclusions on safety/toxicity given the small numbers, but these seem in keeping with other recent reports of neoadjuvant breast radiotherapy.

Dedicated OAM Oncology Navigation program to improve access to medication education, ePRO enrollment, and physician treatment plan completion adherence.

234 Background: Effective coordination of oncology care is essential for optimizing patient outcomes and ensuring adherence to treatment plans. When an Oncology Navigation program is implemented specifically related to patients on Oral Anticancer Medications (OAMs), it directly improves patient access to medication education and treatment adherence through enrollment in ePRO (electronic patient reported outcomes) tracking systems. Currently, there is limited evidence published related to the quantitative impact of dedicated OAM Navigation programs on patient treatment review and coordination visits, and provider completion adherence to treatment plans. Methods: This quality improvement initiative aimed to evaluate the impact of implementing an OAM Navigation program. Data were collected over a 90-day pilot period from a single geographic region within a community oncology practice. The patients’ medical records were reviewed to assess completion of treatment review and coordination visits by an APP or Physician, ePRO enrollment, and provider adherence to completion of treatment plans. Results: Analysis of the data revealed a significant increase in completed treatment review and coordination visits following the implementation of the OAM Navigation program, with a 28% increase observed compared to pre-implementation levels. Enrollment to ePRO system increased from 46 patients’ pre-pilot to 272 patients within the pilot period, a 491% increase in enrollment. Additionally, provider adherence to completion of treatment plans showed a marked improvement, increasing by 50% post-implementation. These findings suggest that the OAM Navigation program effectively facilitated enhanced quality and safety of care provided. Conclusions: Dedicated OAM Navigation programs play a crucial role in improving patient outcomes and optimizing oncology care delivery. Our findings demonstrate the significant positive impact of an OAM Navigation program on increasing patient education, ePRO enrollment, and improving provider adherence to completion of treatment plans. Incorporating OAM Navigation programs into ambulatory oncology practices can lead to more efficient and effective care coordination, ultimately enhancing the quality and safety of care. As we continue to expand and refine this program, we look forward to sharing our research findings and insights with the broader oncology healthcare community.

Absolute oral bioavailability of milvexian spray-dried dispersion formulation under fasted and fed conditions in healthy adult participants: An intravenous microtracer approach.

Milvexian is an oral, small-molecule factor XIa inhibitor being developed to prevent thromboembolic events. This study assessed the absolute bioavailability (F) of milvexian following single doses of milvexian spray-dried dispersion (SDD) formulation under fed and fasted conditions, and milvexian solution, in healthy adult participants using an intravenous microtracer approach. This was a phase I, open-label, partially randomized, 4-sequence, 5-period crossover study. After fasting for ≥10 h, participants received milvexian 200-mg oral solution with a 100-μg 14C milvexian intravenous microtracer at the time of maximum observed plasma concentration. Following a 3-day washout, participants were randomized to 1 of 4 milvexian SDD treatment sequences in a crossover fashion: 25 mg fasted, 25 mg fed, 200 mg fasted, or 200 mg fed. Pharmacokinetic data were collected up to 72 h postdose. Seventeen participants were dosed, and 14 completed treatment. Under fasted conditions, milvexian F was ~100%, 58.2%, and 54.2% following administration of the oral solution, 25 mg SDD, and 200 mg SDD, respectively. Under fed conditions, milvexian F following 25 mg and 200 mg SDD was 44.3% and 75.6%, respectively. The milvexian SDD formulation at 25 mg and 200 mg resulted in similar F in a fasted state; under fed conditions, milvexian F decreased at 25 mg and increased at 200 mg. These findings clarify pharmacokinetic-related gaps observed in previous studies.

Addressing Latinx cancer care equity program for long-term united skills building (ALCANCE-PLUS): Updated results from an ongoing implementation.

151 Background: Addressing Latinx Cancer Care Equity - Program for Long-term United Skills Building (ALCANCE-PLUS) is an ongoing community-academic partnership between the Stanford University School of Medicine Partnerships to Advance Care and Pacific Cancer Care (PCC). The partnership began in 2019 and is comprised of several community-identified multi-level interventions to improve cancer health equity in an undeserved, rural migrant farm-working community. The intervention components are delivered by trained community health workers to low-income and racial and ethnic minoritized patients receiving active cancer treatment and include: 1) precision medicine education using literacy- and language-concordant educational tools; 2) food insecurity screening and intervention with plans to cross-train &gt; 150 CHW's across the county to expand cancer screening and care delivery in the county. Here, we describe the characteristics of participants and the program's impact to date on metrics identified by the community. Methods: ALCANCE-PLUS eligibility includes: all patients with cancer actively receiving cancer-directed treatment at PCC who are ≥ 18 years old and speak English or Spanish. Community identified metrics of success include: % treatment adherence (completion), no-show rate, days from diagnosis to treatment, and % who received clinical trials education as compared to baseline (prior to program start). We used descriptive statistics and chi-squared tests to compare metrics of participants in the program to baseline. Results: At baseline, 62% of low-income and racial and ethnic minoritized patients in the county completed treatment, 35% had no-shows to clinic or infusion appointments with an average of 82.7 days from diagnosis to treatment and only 15% received clinical trial education. From July 2022 to May 2024, a total of 164 patients participated in the program. Mean ages were 60.88 ± 14.55, 68 (41.5%) identified as male, 104 (63.4%) as Hispanic or Latino, 2 (1.2%) African American or Black, 12 (7.3%) Asian American, 2 (1.2%) Native Hawaiian or Other Pacific Islanders, and 60 (36.6%) White. Insurance types included 63 (25.6%) patients with Medicaid, 56 (22.6) with Medicare, 13 (5.2%) with both, 72 (29%) with private insurance, and 7 (2.8%) with other insurance or uninsured. As of January 2024, treatment adherence was 100% for the 157 program participants, the average time from diagnosis to treatment dropped from 82.7 days county-wide pre-program to 30 days among enrolled participants, all participants received clinical trial education, and 38 (24.2%) were actively participating in a clinical trial. Conclusions: Community-academic partnerships to co-design and implement approaches to overcome community-identified needs for marginalized populations are essential to achieve cancer health equity.

Retrospective analysis of hemophilia B in Turkey: identifying main characteristics and treatment options

BackgroundHemophilia B (HB), an X-linked recessive inherited bleeding disorder, exhibits a high prevalence among males. ObjectivesTo present the first national cohort of persons with HB to define the demographics, clinical characteristics, and treatment patterns in Turkey. MethodsThis multicenter, retrospective study included 433 alive persons with HB registered in 35 centers between 1961 and 2018. Analyses were performed by age subgroups (0-17 years, 18-64 years, and ≥65 years), disease severity by factor levels (severe, <1 IU/dL; moderate, 1-5 IU/dL; mild, >5 IU/dL). Additionally, patients were stratified based on the initiation year of follow-up at the relevant study center, creating 2 periods: 1993-2006 (referred to as period A) and 2007-2018 (referred to as period B). ResultsPredominantly male (98.6%), the median age at data entry was 22.1 years (n = 429). The majority (49.0%) had moderate HB, followed by severe (30.0%) and mild (15.7%) disease. Of the 377 patients with complete treatment details, 209 (55.4%) were under prophylaxis from their diagnosis onwards, while 79 patients (21.0%) only received on-demand treatment. Additionally, 89 patients (23.6%) initially underwent on-demand treatment and later were switched to prophylaxis. Knees were the primary site of bleeding and the most frequently intervened joints. Most of the major (47.5%) and minor (53.3%) orthopedic procedures were carried out in persons with severe HB, while half of radioactive synovectomy procedures were performed on persons with moderate HB. ConclusionThis paper describes the demographics, clinical characteristics, and treatments patterns of a large cohort of alive persons with HB on a national scale.

Cost Effectiveness of Definitive Treatment Strategies for Autonomously Functioning Thyroid Nodules.

Autonomously functioning thyroid nodules (AFTN) can be treated with antithyroid drugs, radioactive iodine (RAI), thyroid lobectomy or radiofrequency ablation (RFA). Although surgery is most definitive, some patients require lifelong hormone supplementation. RFA avoids this sequela, but its efficacy depends on nodule size. This study aims to compare the relative cost-effectiveness of RAI, RFA and lobectomy for treatment of AFTNs. A Markov analysis model was created to simulate clinical outcomes, costs and utilities for three AFTN treatments: (1) thyroid lobectomy, (2) RAI, and (3) RFA. This mathematical model was created using published literature and modeling. Transition probabilities, utilities and costs were extracted from published literature, Medicare, and RedBook. The willingness to pay threshold was set to $100,000 per quality-adjusted life year. The model simulated 2-year outcomes, reflecting RFA literature. Sensitivity analyses were conducted to account for uncertainty in model variables. In the base model, RAI dominated both lobectomy and RFA, with lower estimated cost ($2000 vs. $9452 and $10,087) and higher cumulative utility (1.89 vs. 1.82 and 1.78 quality-adjusted life years). One-way sensitivity analyses demonstrated that relative cost-effectiveness between surgery and RFA was driven by the probability of euthyroidism after RFA and hypothyroidism after lobectomy. RFA becomes more cost-effective than surgery if the rate of euthyroidism after ablation is higher than 69% (baseline 54%). Based on published data, RAI is most cost-effective in treating most AFTN. Surgery is more cost-effective than RFA in most scenarios, but RFA may be more resource-efficient for smaller nodules with a high likelihood of complete treatment.

From twilight to starlight? Debating the role of chemoradiotherapy in gastric cancer in the D2 dissection era.

Patients affected by resectable locally advanced gastric cancer (GC) should receive perioperative chemotherapy as a standard of care. However, an additional benefit of adjuvant chemoradiation (CRT) has been negated by modern trials in the era of extended surgical dissection, and CRT is currently only considered on an individual basis in case of suboptimal resection. However, the dismal prognosis of GC and the modest treatment completion rates of perioperative chemotherapy have pushed to reconsider CRT, particularly as a preoperative treatment, in light of modern treatment techniques, advances in the understanding of the immune landscape and development of targeted agents. The aim of this review is to critically assess the historical role of CRT, the limitations of current evidence and to debate its potential role in an integrated neoadjuvant strategy for patients with resectable GC.

Closing the referral loop on health-related social needs.

184 Background: Additional clinical challenges arise by way of health-related social needs (HRSNs) presenting barriers outside of clinic walls. Taking a person-centered approach by assessing and addressing HRSNs to overcome barriers can be practiced through resource referrals to community-based organizations offering specialized social services. Using closed-loop referral (CLR) technology, HRSNs can be addressed resulting in higher treatment completion rates and on-time visits contributing to positive health outcomes, quality of life, and improved business outcomes. HRSNs are categorized in major groups such as transit, food, housing, money, health (i.e. mental health, dental care, nutrition counseling, etc.), and care (i.e. daycare, end-of-life care, physical safety, etc.). In this study, we seek to substantiate CLR technology to address common HRSNs impacting cancer patients through real-time data sharing and resource facilitation showing reportable evidence that the HRSNs have been addressed. Methods: On June 5 th , 2023, The US Oncology Network (The Network) launched Findhelp’s CLR platform onboarding users in over 600 clinical service sites nationwide. Implementation and change management began with a pilot group and deployment to remaining clinical sites in a sequence of three waves. Methods used to measure engagement came through onboarding analytics and click rates tracked through the Findhelp CLR platform. For training and support job aides, new user workflows, promo materials and weekly office hours were held to catalyze engagement. Results: Within an eleven-month measurement period, 75% of practices in The Network showed navigation activities within the referral platform. The top five resource searches by need included health (21.7%), transit (20.8%), food (19.9%), housing (18.9%), and care (6.5%). Over 2,000 referrals were made with 1,306 being CLRs for nearly 500 patients receiving help to meet identified HRSNs through the CLR technology. Conclusions: In this study, over 50% of patients referred to social care services were captured as successfully receiving help meeting identified HRSNs. This study opens doors to further research on what HRSNs were not met, and to identify distressed demographics by location and geographical resource deserts with unmet HRSNs.

Enhancing Latent Tuberculosis Infection Treatment Adherence with Mobile Health Intervention: A Quasi-Experimental Study

Introduction: While detecting active TB is central to public health efforts, modelling indicates that reducing latent TB through preventive therapy is crucial. Current regimens mitigate risk but are lengthy and have side effects, necessitating support for uninterrupted treatment. This paper presents the development and evaluation of a digital health platform designed to enhance adherence among LTBI patients. Methods: A Quasi-experimental study was conducted among LTBI patients in Delhi. A total of 163 participants were allocated to intervention (n=82) and control (n=81) groups. Participants were followed up for 6 months post recruitment. Effectiveness of mobile application was evaluated through quantitative tools. Results: Intervention group participants showed slightly higher treatment completion rates (65.91%), in comparison to participants in control group (63%). The analysis demonstrated no co-relation of gender, age, education and employment with treatment completion rates in intervention group. While text and video-based interventions have shown success, there remains a need for more user-centric digital health interventions in this area, given the limited number of studies to date. Conclusion: The mobile health applications can be useful for LTBI care. However, there is a need of involving users during development so that continued interest of users can be ensured.

Group cognitive remediation therapy for adolescents with anorexia nervosa: Outcomes before, after, and during follow-up in a real-world setting in Japan.

Objective: Cognitive remediation therapy (CRT) can be used as an adjunct treatment for adolescents with severe and complex anorexia nervosa (AN) requiring inpatient treatment. However, there has been only one study on CRT for adolescents with AN in Japan. This study explored group CRT as an adjunct to inpatient treatment for Japanese adolescents with severe and complex AN requiring inpatient care. Methods: Thirty-one adolescents with AN underwent group CRT. Neuropsychological (set-shifting and central coherence) and psychological assessments (motivation, self-esteem, and depressive symptoms) were measured before and after the intervention. Weight and AN symptoms were measured before and after the intervention and at follow-up, and the adolescents completed post-intervention and follow-up questionnaires. Results: Set-shifting led to medium to large effect size improvements. Medium effect size improvements in central coherence and depressive symptoms were also observed. The feedback from the adolescents was mainly positive, and the treatment completion rate was high. The patients also reported that the skills learned through group CRT could be applied in daily life. Conclusion: Group CRT may be beneficial for adolescents with severe and complex AN who require inpatient care.

United States Provider Experiences With Telemedicine for Hepatitis C Treatment: A Nationwide Survey.

Hepatitis C virus (HCV) elimination requires treatment access expansion, especially for underserved populations. Telehealth has the potential to improve HCV treatment access, although data are limited on its incorporation into standard clinical practice. We conducted a cross-sectional, email survey of 598 US HCV treatment providers who had valid email addresses and (1) were located in urban areas and had written ≥ 20 prescriptions for HCV treatment to US Medicare beneficiaries in 2019-2020 or (2) were located in non-urban areas and wrote any HCV prescriptions in 2019-2020. Through email, we notified providers of a self-administered electronic 28-item survey of clinical strategies and attitudes about telemedicine for HCV. We received 86 responses (14% response rate), of which 75 used telemedicine for HCV in 2022. Of those 75, 24% were gastroenterologists/hepatologists, 23% general medicine, 17% infectious diseases and 32% non-physicians. Most (82%) referred patients to commercial laboratories, and 85% had medications delivered directly to patients. Overwhelmingly, respondents (92%) felt that telehealth increases healthcare access, and 76% reported that it promotes or is neutral for treatment completion. Factors believed to be 'extremely' or 'very' important for telehealth use included patient access to technology (86%); patients' internet access (74%); laboratory access (76%); reimbursement for video visits (74%) and audio-only visits (66%). Non-physician licensing and liability statutes were rated 'extremely' or 'very' important by 43% and 44%, respectively. Providers felt that telehealth increases HCV treatment access. Major limitations were technological requirements, reimbursement, and access to ancillary services. These findings support the importance of digital equity and literacy to achieve HCV elimination goals.

Treatment outcomes among patients with isoniazid mono-resistant tuberculosis in Mumbai, India: A retrospective cohort study

BackgroundTuberculosis (TB) remains a significant cause of mortality globally, with India accounting for 27% of the estimated number of people with TB. Multidrug-resistant TB (MDR-TB) and isoniazid (INH) resistance pose additional challenges to effective treatment. We aimed to describe treatment outcomes of INH mono-resistant TB patients under programmatic conditions in Mumbai, India. MethodsThis retrospective cohort study was conducted at Shatabdi Hospital in Mumbai between 2019–2021.We described the clinical and demographic characteristics, treatment outcomes, and risk factors for unfavourable outcomes among patients with INH mono-resistant TB treated with rifampicin, ethambutol, pyrazinamide, and levofloxacin (LfxREZ) for a duration of 6 months. ResultsAmong 3105 patients with drug-resistant TB initiated on treatment, 217 (7 %) had INH mono-resistant TB. Of these, 54 % (117/217) were female, with a median age of 26 years (interquartile range: 20–40). The majority (88 %; 191/217) presented with pulmonary TB, and most (87 %; 188/217) had favourable treatment outcomes, including treatment completion (52 %; 112/217) and cure (35 %; 76/217). Unfavourable outcomes, including treatment failure (2.3 %; 5/217), loss to follow-up (9.2 %; 20/217), or death (1.8 %; 4/217), were observed in 13 % (29/217) of patients. A total of ten (5 %) patients experienced at least one non-severe adverse drug reaction. Factors associated with unfavourable outcomes included severe thinness (p = 0.019) and male gender (p = 0.012). ConclusionTreating INH mono-resistant patients with LfxREZ resulted in satisfactory outcomes and low toxicity. It is important to rule out drug resistance to INH while determining the treatment regimen.

Variability of Hepatitis C Treatment Cascade Outcomes among People Who Inject Drugs across Geographically Diverse Clinics in the US: The HERO Study.

Heterogeneity of outcomes across different clinical trial study sites is often inevitable. Understanding how outcomes differ by site is important for planning future programs and studies. We examined the extent of heterogeneity of hepatitis C virus (HCV) treatment cascade outcomes among persons who inject drugs (PWIDs) across sixteen clinical sites utilized in the HERO Study-a pragmatic randomized trial of HCV treatment support. Treatment cascade outcomes included averages of overall treatment adherence and proportions of treatment initiation, treatment completion, sustained virologic response (SVR) test completion, and SVR achievement. The HERO study utilized 16 clinical sites across the United States (US): eight opioid treatment programs (OTPs) and eight community health centers (CHCs). Variability of the outcomes across the 16 clinical sites was assessed using ranges and intraclass correlation coefficients (ICC) estimated from mixed-effects linear or logistic regression models. Treatment initiation was analyzed in the intention-to-treat (ITT) sample (N = 755); treatment completion, adherence, and SVR test completion in the modified ITT (mITT) sample, which is the sample that initiated treatment (N = 623); and SVR achievement in the mITT and per-protocol (PP, N = 501) samples. Across the 16 clinical sites, the range observed in the averages of overall treatment adherence was from 68% to 81% [ICC = 0.026 (0.005, 0.054)], and the ranges of proportions observed were from 68% to 96% for treatment initiation [ICC (95% CI) = 0.086 (0.051, 0.155)], 60% to 100% for treatment completion [ICC = 0.049 (0.008, 0.215)], 54% to 95% for SVR test completion [ICC = 0.096 (0.006, 0.177)], 46% to 90% for SVR achievement in the mITT sample [ICC = 0.070 (0.014, 0.122)], and 76% to 100% for SVR achievement in the PP sample [ICC = 0.143 (0.021, 0.422)]. The variability of the outcomes across 16 US sites treating HCV among PWIDs appears to be substantial in view of the ranges and ICC values of the outcomes. It is imperative to develop tailored interventions to target the sources of variability and reduce barriers at the patient, provider, clinic, and state policy levels to facilitate more equitable access to HCV treatment and reduce heterogeneity in treatment outcomes.

The role of hyperbaric oxygen treatment in the management of spondylodiscitis.

This study analysed treatment outcomes in a patient cohort diagnosed with spondylodiscitis, who received adjunct hyperbaric oxygen treatment (HBOT) in addition to antibiotic therapy at our clinic. Important considerations included the timing of HBOT initiation on treatment success, and recurrence rates. We retrospectively reviewed the records of all patients diagnosed with spondylodiscitis who received HBOT at the Underwater and Hyperbaric Medicine Clinic in Gulhane Training and Research Hospital, between 1 November 2016 and 25 October 2022. The patients received HBOT at 243.2 kPa for a total of 120 minutes per session, once daily for five days a week for a total of 30 sessions. Twenty-five patients with spondylodiscitis were evaluated before and after combination HBOT and targeted antibiotic treatment. After treatment, patients had lower median (range) visual analogue pain scores (8 [4-10] vs 3 [0-7], P < 0.001) and C-reactive protein (22.3 [4.3-79.9] mg·L⁻¹ vs 6.8 [0.1-96.0] mg·L⁻¹, P = 0.002) and lower mean (standard deviation) white blood cell counts (8.8 [3.5] x 109·L⁻¹ vs 6.1 [1.6] x 109·L⁻¹, P = 0.002). When patients were examined (median) 48 months (2-156 months) after the completion of treatment, there were no persistent cases of spondylodiscitis. Combination HBOT with targeted antibiotic therapy effectively managed our cohort of patients diagnosed with spondylodiscitis. Hyperbaric oxygen treatment was safe, with no complications experienced. Moreover, HBOT may have helped to eliminate persistence and recurrence of symptoms with long term follow-up. A randomised controlled study with a larger number of patients is needed for more definitive conclusions.

Image-Guided Superficial Radiation Therapy for Basal and Squamous Cell Carcinomas Produces Excellent Freedom from Recurrence Independent of Risk Factors

Background/Objectives: Basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) are non-melanoma skin cancers (NMSCs) and the most prevalent cancers in the United States. Image-guided superficial radiotherapy (IGSRT) is a relatively new treatment option that uses high-resolution dermal ultrasound integrated with superficial radiotherapy to improve tumor visualization. IGSRT is a clinically equivalent non-surgical alternative to Mohs micrographic surgery at 2 years of follow-up in early-stage NMSC, but larger cohort studies with longer follow-up periods that allow for analysis of patient outcomes by demographic and disease characteristics are needed. Methods: This large, retrospective cohort study was conducted to determine the effect of risk factors (tumor location, tumor stage, and sex) on 2-, 4-, and 6-year freedom from recurrence rates in 19,988 NMSC lesions treated with IGSRT, including lesions with complete treatment courses. Results: Overall freedom from recurrence rates were 99.68% at 2 years, 99.54% at 4 years, and 99.54% at 6 years; rates did not differ significantly by tumor location (head/neck versus other locations, p = 0.9) or sex (male versus female, p = 0.4). In contrast, there was a significant difference in freedom from recurrence rates when analyzed by tumor stage (p = 0.004). Conclusions: There was no significant effect of tumor location or sex on freedom from recurrence in IGSRT-treated NMSC. Although there was a significant difference according to tumor stage, freedom from recurrence rates exceeded 99% at all stages.