Difference In Overall Rate Research Articles

The relationship between asymmetrical grip strength criteria and fall incidence among middle-aged and older Chinese adults.

Current handgrip strength (HGS) protocols employ a variety of criteria, affecting the assessment of asymmetric HGS. The impact of these different criteria on fall prediction is understudied. This study was devised to compare the relative performance of average and maximum HGS asymmetry criteria as tools to predict fall incidence among middle-aged or older adults in China. 9627 Chinese adults 50 + years of age who were participants in the China Health and Retirement Longitudinal Study (2013-2015 waves) were evaluated. The measurement of HGS was achieved based on either the maximum recorded value (HGSmax) or the average (HGSave), and these values were employed for the calculation of HGS asymmetry. Fall incidence over a 2-year period was evaluated based on self-reported data. Logistic regression analyses were utilized to determine the predictive performance of HGSmax asymmetry or HGSave asymmetry when gaging 2-year fall risk. Significant differences in overall rates of HGS asymmetry and the rates of subdivisions thereof were observed when comparing the HGSmax and HGSave criteria, with moderate consistency (kappa = 0.599, p < 0.001). Over the 2-year follow-up period, 1743 fall incidents were recorded. Adjusted logistic regression models indicated that only HGSmax asymmetry > 30.0% was significantly related to fall risk (p = 0.034, odds ratio = 1.36, 95% confidence interval: 1.02-1.81). These findings highlight the importance of HGS criteria in detecting HGS asymmetry, and suggest that HGSmax is a more robust criterion for predicting fall risk among Chinese adults 50 + years of age.

Arrhythmia and Time of Day in Maintenance Hemodialysis: Secondary Analysis of the Monitoring in Dialysis Study

Rationale & ObjectiveThe incidence of arrhythmia varies by time of day. How this impacts individuals on maintenance dialysis is uncertain. Our objective was to quantify the relationship of arrhythmia with the time of day and the timing of dialysis. Study DesignSecondary analysis of Monitoring in Dialysis study- a multicenter prospective cohort study. Settings & ParticipantsLoop recorders were implanted for continuous cardiac monitoring in 66 participants on maintenance dialysis with a follow up of 6 months. ExposureTime of day based on 6-hour intervals OutcomesEvent rates of clinically significant arrhythmia Analytical ApproachNegative binomial mixed effects regression models for repeated measures were used to evaluate data from the Monitoring in Dialysis study for differences in diurnal patterns of clinically significant arrhythmia among those with end stage kidney disease with heart failure and end stage kidney disease alone. We additionally analyzed rates according to presence of heart failure, time of dialysis shift, and dialysis vs. non dialysis day. ResultsRates of clinically significant arrhythmia peaked between 0:00 AM-<6:00 AM and were more than 1.5-fold as frequent during this interval compared with the rest of the day. In contrast, variations in atrial fibrillation peaked between 6:00 AM-<12: PM, but variations across the day were qualitatively small. Clinically significant arrhythmia occurred at numerically higher rate in individuals with end stage kidney disease and heart failure (5.9 events/month, 95% CI: 1.3-26.8) than those without heart failure (4.0 events/month, 95% CI: 0.9-17.9). Although differences in overall rate were not significant, their periodicity was significantly different (P<0.001) with a peak between 0:00 AM-6:00 AM with kidney failure alone and between 6:00 AM-<12:00 PM in those with heart failure. Although the overall clinically significant arrhythmia rate was similar with morning compared with evening dialysis shifts (P=0.43), their periodicity differed with a peak between 0:00 AM-<6:00 AM in those with AM dialysis and a later peak between 6:00 AM-<12:00 PM in those with PM shifts LimitationsPost hoc analysis, unable to account for unmeasured confounders ConclusionClinically significant arrhythmias showed strong diurnal patterns with a maximal peak between 0:00-<6:00 AM and noon. Although overall arrhythmia rates were similar the peak rate occurred overnight in individuals without heart failure and during the morning in individuals with heart failure. Further exploration of the influence of circadian rhythm on arrhythmia in the setting of hemodialysis is needed.

Fewer severe infections with tranexamic acid in patients with hematologic malignancies

BackgroundTranexamic acid (TXA) is an antifibrinolytic agent that reduces bleeding in a multitude of clinical settings from postpartum hemorrhage to trauma. TXA may have clinical effects unrelated to bleeding; plasminogen, the target of TXA, alters immune responses, and TXA appears to decrease the risk of infection in patients undergoing cardiac surgery, as well as joint arthroplasty. ObjectivesTo address whether TXA alters rates of infection and inflammatory outcomes in patients with hematologic malignancies. MethodsWe performed a post hoc analysis of outcomes of patients randomized to receive either TXA or placebo in the double-blinded, multicenter American Trial to Evaluate Tranexamic Acid Therapy in Thrombocytopenia (Clinicaltrials.gov identifier: NCT02578901). ResultsTXA did not change the overall rate of infections, but the rate of severe infections (Common Toxicology Criteria for Adverse Events grade 3+) was lower in patients who received TXA compared with the placebo group. Patients who experienced grade 3+ infections had higher rates of World Health Organization grade 2+ bleeding and red blood cell transfusion requirements than patients who did not experience a grade 3+ infection, irrespective of treatment group. TXA did not impact other inflammatory outcomes such as mucositis, rash, or graft vs host disease. ConclusionPatients with hematologic malignancies who received TXA had less severe infections than those who received placebo with no difference in overall rate of infection or other inflammatory outcomes. Further investigation is needed on the impact of TXA on infections in this population.

Are large language models valid tools for patient information on lumbar disc herniation? The spine surgeons' perspective

IntroductionGenerative AI is revolutionizing patient education in healthcare, particularly through chatbots that offer personalized, clear medical information. Reliability and accuracy are vital in AI-driven patient education. Research questionHow effective are Large Language Models (LLM), such as ChatGPT and Google Bard, in delivering accurate and understandable patient education on lumbar disc herniation? Material and methodsTen Frequently Asked Questions about lumbar disc herniation were selected from 133 questions and were submitted to three LLMs. Six experienced spine surgeons rated the responses on a scale from “excellent” to “unsatisfactory,” and evaluated the answers for exhaustiveness, clarity, empathy, and length. Statistical analysis involved Fleiss Kappa, Chi-square, and Friedman tests. ResultsOut of the responses, 27.2% were excellent, 43.9% satisfactory with minimal clarification, 18.3% satisfactory with moderate clarification, and 10.6% unsatisfactory. There were no significant differences in overall ratings among the LLMs (p = 0.90); however, inter-rater reliability was not achieved, and large differences among raters were detected in the distribution of answer frequencies. Overall, ratings varied among the 10 answers (p = 0.043). The average ratings for exhaustiveness, clarity, empathy, and length were above 3.5/5. Discussion and conclusionLLMs show potential in patient education for lumbar spine surgery, with generally positive feedback from evaluators. The new EU AI Act, enforcing strict regulation on AI systems, highlights the need for rigorous oversight in medical contexts. In the current study, the variability in evaluations and occasional inaccuracies underline the need for continuous improvement. Future research should involve more advanced models to enhance patient-physician communication.

Safety/booster seats in pediatric motor vehicle crashes: Public health concern

IntroductionThe American Academy of Pediatrics (AAP) guidelines recommend that children ≤12-years-old with height < 145 cm should use safety/booster seats. However, national adherence and clinical outcomes for eligible children involved in motor vehicle collisions (MVCs) are unknown. We hypothesized that children recommended to use safety/booster seats involved in MVCs have a lower rate of serious injuries if a safety/booster seat is used, compared to children without safety/booster seat. MethodsThis retrospective cohort study queried the 2017–2019 Trauma Quality Improvement Program database for patients ≤12-years-old and <145 cm (recommendation for use of safety/booster seat per American Academy of Pediatrics) presenting after MVC. Serious injury was defined by abbreviated injury scale grade ≥3 for any body-region. High-risk MVC was defined by authors in conjunction with definitions provided by the Centers for Disease Control and Prevention and the American College of Surgeons Committee on Trauma. ResultsFrom 8259 cases, 41% used a safety/booster seat. There was no difference in overall rate of serious traumatic injuries or mortality (both p > 0.05) between the safety/booster seat and no safety/booster seat groups. In a subset analysis of high-risk MVCs, the overall use of safety/booster seats was 56%. The rate of serious traumatic injury (53.6% vs. 62.1%, p = 0.017) and operative intervention (15.8% vs. 21.6%, p = 0.039) was lower in the safety/booster seat group compared to the no safety/booster seat group. ConclusionsDespite AAP guidelines, less than half of recommended children in our study population presenting to a trauma center after MVC used safety/booster seats. Pediatric patients involved in a high-risk MVC suffered more serious injuries and were more likely to require surgical intervention without a safety/booster seat. A public health program to increase adherence to safety/booster seat use within this population appears warranted.

Does brace treatment following closed reduction of developmental dysplasia of the hip improve acetabular coverage?

Abduction bracing is commonly used to treat developmental dysplasia of the hip (DDH) following closed reduction and spica casting, with little evidence to support or refute this practice. The purpose of this study was to determine the efficacy of abduction bracing after closed reduction in improving acetabular index (AI) and reducing secondary surgery for residual hip dysplasia. We performed a retrospective review of patients treated with closed reduction for DDH at a single tertiary referral centre. Demographic data were obtained including severity of dislocation based on the International Hip Dysplasia Institute (IHDI) classification, age at reduction, and casting duration. Patients were prescribed no abduction bracing, part-time, or full-time wear post-reduction and casting. AI measurements were obtained immediately upon cast removal and from two- and four-year follow-up radiographs. A total of 243 hips underwent closed reduction and 82% (199/243) were treated with abduction bracing. There was no difference between those treated with or without bracing with regard to sex, age at reduction, severity of dislocation, spica duration, or immediate post-casting AI (all p > 0.05). There was no difference in hips treated with or without abduction brace with regard to AI at two years post-reduction (32.4° (SD 5.3°) vs 30.9° (SD 4.6°), respectively; p = 0.099) or at four years post-reduction (26.4° (SD 5.2°) vs 25.4° (SD 5.1°), respectively; p = 0.231). Multivariate analysis revealed only IHDI grade predicted AI at two years post-reduction (p = 0.004). There was no difference in overall rate of secondary surgery for residual dysplasia between hips treated with or without bracing (32% vs 39%, respectively; p = 0.372). However, there was an increased risk of early secondary surgery (< two years post-reduction) in the non-braced group (11.4% vs 2.5%; p = 0.019). Abduction bracing following closed reduction for DDH treatment is not associated with decreased residual dysplasia at two or four years post-reduction but may reduce rates of early secondary surgery. A prospective study is indicated to provide more definitive recommendations.

A comparison of clinical outcomes of acellular dermal matrix with and without radiation sterilization process in immediate prepectoral direct-to-implant breast reconstruction

Although there are many acellular dermal matrix (ADM) products, the sterilization process varies for each product. We compared the clinical outcomes of immediate prepectoral direct-to-implant (DTI) breast reconstruction with and without sterilization products. This was a retrospective study of immediate prepectoral DTI breast reconstructions performed between 2018 and 2020. We classified patients depending on whether the used ADM products had undergone radiation sterilization and compared the patient demographics and surgical outcomes, including seroma, infection, mastectomy flap necrosis, capsular contracture, and implant failure. The study included 357 patients, 182 in the no-sterilization group and 179 in the sterilization group. The ADM size differed significantly between the no-sterilization and sterilization groups (122.7cm2 vs. 145.4cm2, respectively, P=0.01). There were no significant differences in overall rates of complications between the two groups, including seroma (P=0.28), infection (P=0.63), mastectomy flap necrosis (P=0.76), and capsular contracture (P=0.76). However, implant failure from infection (0% vs. 3.4%, P=0.01) and drainage amount (690.3mL vs. 779.36mL, P=0.04) with similar removal days were significantly higher in the sterilization group. The authors demonstrated similar complication rates for seroma, infection, mastectomy flap necrosis, and capsular contracture. Whereas a bigger size of ADM was needed to cover a similar implant volume, and drain amount was higher in the sterilization group, the salvage rate from infection was higher in the no-sterilization group with a significant difference.

Differences in Functional and Survival Outcomes Between Patients Receiving Primary Surgery vs Chemoradiation Therapy for Treatment of T1-T2 Oropharyngeal Squamous Cell Carcinoma

Due to lack of data from high-powered randomized clinical trials, the differences in functional and survival outcomes for patients with oropharyngeal squamous cell carcinoma (OPSCC) undergoing primary transoral robotic surgery (TORS) vs primary radiation therapy and/or chemoradiation therapy (RT/CRT) are unclear. To compare 5-year functional (dysphagia, tracheostomy dependence, and gastrostomy tube dependence) and survivorship outcomes in patients with T1-T2 OPSCC receiving primary TORS vs RT/CRT. This national multicenter cohort study used data from a global health network (TriNetX) to identify differences in functional and survival outcomes among patients with OPSCC who underwent primary TORS or RT/CRT in 2002 to 2022. After propensity matching, 726 patients with OPSCC met inclusion criteria. In the TORS group, 363 (50%) patients had undergone primary surgery, and in the RT/CRT group, 363 (50%) patients had received primary RT/CRT. Data analyses were performed from December 2022 to January 2023 using the TriNetX platform. Primary surgery with TORS or primary treatment with radiation therapy and/or chemoradiation therapy. Propensity score matching was used to balance the 2 groups. Functional outcomes were measured at 6 months, 1 year, 3 years, 5 years, and more than 5 years posttreatment and included dysphagia, gastrostomy tube dependence, and tracheostomy dependence according to standard medical codes. Five-year overall survivorship was compared between patients undergoing primary TORS vs RT/CRT. Propensity score matching allowed a study sample with 2 cohorts comprising statistically similar parameters with 363 (50%) patients in each. Patients in the TORS cohort had a mean (SD) age of 68.5 (9.9) vs 68.8 (9.7) years in RT/CRT cohort; 86% and 88% were White individuals, respectively; 79% of patients were men in both cohorts. Primary TORS was associated with clinically meaningful increased risk of dysphagia at 6 months (OR, 1.37; 95% CI, 1.01-1.84) and 1 year posttreatment (OR, 1.71; 95% CI, 1.22-2.39) compared with primary RT/CRT. Patients receiving surgery were less likely to be gastrostomy tube dependent at 6 months (OR, 0.46; 95% CI, 0.21-1.00) and 5 years posttreatment (risk difference, -0.05; 95% CI, -0.07 to -0.02). Differences in overall rates of tracheostomy dependence (OR, 0.97; 95% CI, 0.51-1.82) between groups were not clinically meaningful. Patients with OPSCC, unmatched for cancer stage or human papillomavirus status, who received RT/CRT had worse 5-year overall survival than those who underwent primary surgery (70.2% vs 58.4%; hazard ratio, 0.56; 95% CI, 0.40-0.79). This national multicenter cohort study of patients undergoing primary TORS vs primary RT/CRT for T1-T2 OPSCC found that primary TORS was associated with a clinically meaningful increased risk of short-term dysphagia. Patients treated with primary RT/CRT had an increased risk of short- and long-term gastrostomy tube dependence and worse 5-year overall survival than those who underwent surgery.

Race/ethnicity, negative peer support, and polyvictimization among college women

Advances in social scientific understandings of female racial/ethnic minority college students’ experiences of woman abuse have not kept pace with the amount of theoretical and empirical work on the plight of their White counterparts. What is especially needed is a study that examines racial/ethnic variations in negative peer support for various types of victimization in institutions of higher learning. Using the Campus Quality of Life Survey, results show (1) no significant differences between White and racial/ethnic minority women students in polyvictimization within types of abuse (i.e., stalking, harassment, sexual assault, and intimate partner violence), but some differences in overall rates of victimization and polyvictimization, and (2) negative peer support is strongly related to woman abuse and polyvictimization. Implications are discussed.

A phase II randomized clinical trial to assess toxicity and quality of life of breast cancer patients with hypofractionated versus conventional fractionation radiotherapy with regional nodal irradiation in the context of COVID-19 crisis.

This study, conducted during the COVID-19 crisis, primarily aimed to compare the acute toxicity between conventional fractionated radiation therapy (CF-RT) with hypofractionated radiation therapy (HF-RT) among patients who underwent breast-conserving surgery or mastectomy in whom breast or chest wall and regional nodal irradiation (RNI) were indicated. The secondary endpoints were both acute and subacute toxicity, cosmesis, quality of life, and lymphedema features. In this open and non-inferiority randomized trial, patients (n = 86) were randomly allocated 2:1 in the CF-RT arm (n = 33; 50 Gy/25 fractions ± sequential boost [10 Gy/5 fractions]) versus the HF-RT arm (n = 53; 40 Gy/15 fractions ± concomitant boost [8 Gy/15 fractions]). Toxic effects and cosmesis evaluation used the Common Terminology Criteria for Adverse Events, version 4.03 (CTCAE) and the Harvard/National Surgical Adjuvant Breast and Bowel Project (NSABP)/Radiation Therapy Oncology Group (RTOG) scale. For the patient-reported quality of life (QoL), the European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30) and the breast cancer-specific supplementary questionnaire (QLQ-BR23) were used. Lymphedema was assessed by comparing volume differences between the affected and contralateral arms using the Casley-Smith formula. Grade 2 and grade 3 dermatitis were lower with HF-RT than with CF-RT (28% vs. 52%, and 0% vs. 6%, respectively; p = 0.022). HF-RT had a lower rate of grade 2 hyperpigmentation (23% vs. 55%; p = 0.005), compared to CF-RT. No other differences in overall rates of physician-assessed grade 2 or higher and grade 3 or higher acute toxicity between HF-RT and CF-RT were registered. There was no statistical difference between groups regarding cosmesis, lymphedema rate (13% vs. 12% HF-RT vs. CF-RT; p = 1.000), and functional and symptom scales, during both the irradiation period and after 6 months of the end of treatment. The results revealed that the subset of patients up to 65 years or older did not show a statistical difference between both arm fractionation schedules (p > 0.05) regarding skin rash, fibrosis, and lymphedema. HF-RT was non-inferior to CF-RT, and moderate hypofractionation showed lower rates of acute toxicity, with no changes in quality-of-life outcomes. ClinicalTrials.gov, identifier NCT40155531.

A phase II randomized clinical trial to assess toxicity and quality of life of patients with breast cancer with hypofractionated versus conventional fractionation radiotherapy with regional nodal irradiation.

588 Background: The primary aim was comparing acute toxicity between conventional fractionated radiation therapy (CF-RT) and hypofractionated radiation therapy (HF-RT) for patients undergoing breast-conserving surgery or mastectomy with breast or chest wall and regional nodal irradiation (RNI). The secondary endpoints were acute and subacute toxicity, cosmesis, quality of life, and lymphedema features. Methods: Unblinded randomized trial with total of 86 patients treated with CF-RT (n = 33; 50 Gy/25 fractions ± sequential boost [10 Gy/5 fractions]) versus HF-RT (n = 53; 40 Gy/15 fractions ± concomitant boost [8 Gy/15 fractions]). Toxic effects and cosmesis evaluation used the Common Terminology Criteria for Adverse Events version 4.03 (CTCAE) and the Harvard/NSABP/RTOG scale. Patients-reported QoL was determined using European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30) and the breast cancer-specific supplementary questionnaire (QLQ-BR23). Lymphedema determination compared volume differences between the affected and contralateral arms using the Casley-Smith volume formula. Results: Grade 2 and grade 3 skin rash dermatitis were lower with HF-RT than with CF-RT (28% vs. 52%, 0% vs. 6%; p = 0.022, respectively). HF-RT vs. CF-RT had lower rate of grade 2 hyperpigmentation (23% vs. 55%; p = 0.005). No differences in overall rates of any physician-assessed grade 2 or higher and grade 3 or higher acute toxicity between HF-RT vs. CF-RT were registered. There was no statistical difference between the CF-RT and the HF-RT regarding cosmesis, lymphedema rate (13% vs. 12% HF-RT vs. CF-RT; p = 1.000, respectively), and functional and symptom scales during irradiation and after six months of treatment. Conclusions: HF-RT showed lower rates of acute toxicity, with no changes in quality-of-life outcomes. Clinical trial information: NCT04015531 .

Comparing lengths and inclusion of information in storytelling videos: Implications for Hepatitis B education.

This study examined whether adding disease-specific facts into storytelling videos and altering video length would lead to differences in overall ratings of the video and the storyteller, as well as hepatitis B prevention beliefs, among Asian American and Pacific Islander adults. A sample of Asian American and Pacific Islander adults (N = 409) completed an online survey. Each participant was randomly assigned to 1 of 4 conditions that varied in video length and use of additional hepatitis B facts. Linear regressions were used to examine differences in outcomes (i.e., video rating, speaker rating, perceived effectiveness, hepatitis B prevention beliefs) by conditions. Condition 2, which added facts to the original full-length video, was significantly related to higher speaker ratings (i.e., the storyteller's rating) compared to Condition 1, the original full-length video with no added facts, p = 0.016. Condition 3, which added facts to the shortened video, was significantly related to lower overall video ratings (i.e., how much participants liked the videos overall) compared to Condition 1, p = 0.001. There were no significant differences in higher positive hepatitis B prevention beliefs across conditions. Results suggest that adding disease-specific facts to storytelling for patient education may improve initial perceptions of storytelling videos; however, more research is needed to examine long-term effects. Aspects of storytelling videos such as length and additional information have been rarely explored in storytelling research. This study provides evidence that exploring these aspects is informative to future storytelling campaigns and disease-specific prevention.

Neural distinctiveness and reinstatement of hippocampal representations support unitization for associations

The medial temporal lobe (MTL) is critical to associative memory success, yet not all types of associations may be processed in a similar manner within MTL subregions. In particular, previous work suggests intra- and inter-item associations not only exhibit differences in overall rates of recollection, but also recruit different MTL subregions. Whereas intra-item associations, akin to unitization, take advantage of associations between within-item features, inter-item associations form links across discrete items. The current work examines the neural differences between these two types of associations using fMRI and multivoxel analyses. Specifically, the current study examines differences across face-occupation as a function of whether the pairing was viewed as a person performing the given job (intra-item binding) or a person saying they knew someone who had a particular job (inter-item binding). The results show that at encoding, successfully recollected neural patterns related to intra- and inter-item associations are distinct from one another in the hippocampus, parahippocampal and perirhinal cortex. Additionally, the two trial types are reinstated distinctly such that inter-item trials have higher neural reinstatement from encoding to retrieval compared to intra-item trials in the hippocampus. We conclude that intra- and inter- associative pairs may utilize similar neural regions that represent patterns of activation differentially at encoding. However, to reinstate information to the same degree (i.e., subsequently successfully recollected) inter-item associations, that are all encoded in the same manner, may be reinstated more similarly compared to intra-item associations that are encoded by imagining pairs differently and occupation specific. This may indicate that intra-item associations promote more efficient reinstatement.

Is It Safe to Prep the External Fixator in Situ During Staged ORIF of Pilon Fractures? A Retrospective Comparative Cohort Study

Category: Trauma; Ankle Introduction/Purpose: Pilon fractures usually result from high energy mechanisms and are associated with signifcant soft tissue injuries in addition to complex fracture patterns. Treatment typically involves staged management with initial placement of an external fixator and subsequent definitive internal fixation once soft tissues are amenable. The purpose of this study was to compare the risk of fracture-related infection (FRI) and unplanned re-operation after staged open reduction and internal fixation (ORIF) of pilon fractures between cases in which elements of the temporizing external fixator (ex-fix) were prepped into the surgical field and cases in which it was completely removed prior to definitive fixation. Methods: This was a multi-surgeon retrospective comparative cohort study on patients 18 years and older with pilon fractures who underwent operative treatment over a ten-year period between January 1, 2010 to January 1, 2020 at an academic-level 1 trauma center. Medical records and radiographic images were reviewed for each patient to assess demographics, clinical characteristics and surgical outcomes. The primary outcome measures were FRI and unplanned re-operation, including arthrodesis and amputation. All analyses were completed using JMP Software (Version 15.0, SAS Institute Inc., Cary, NC), and an alpha of 0.05 was used for statistical significance. Results: 133 patients underwent staged ORIF, 47 with retained elements of the ex-fix prepped in situ for definitive ORIF and 86 with the ex-fix entirely removed. The overall rate of FRI was 23.3% while the overall rate of unplanned re-operation was 11.3% (4.5% rate of arthrodesis and 6.8% rate of amputation). There was no difference in FRI between the group in which ex-fix was prepped in versus the group in which it was completely removed (23.4% vs 23.3%, p=0.985) and no difference in overall rate of unplanned re-operation (10.6% vs 11.6%, p=0.863). Assessing the subset of patients with FRI, those with ex-fix prepped in had a higher prevalence of infection with MRSA and MSSA (81.8% vs 40%, p=0.021). Using alpha=0.05, and power=0.8, a sample size of 42 patients with FRI post-ORIF (27 with ex-fix prepped in, and 15 with ex-fix removed) would be needed to detect a difference in MRSA/MSSA bacteriology. Conclusion: Although there were relatively high complication rates in this cohort of pilon fractures treated with staged ORIF, prepping in elements of the external fixator did not lead to a significant increase in rates of fracture-related infection nor unplanned re-operation, including arthrodesis and amputation. This study offers clinical support regarding a common practice used to assist in reduction and definitive fixation of distal tibial pilon fractures.

MP52-17 RACIAL AND REGIONAL DISPARITIES AND SURGICAL INTERVENTION FOR URINARY INCONTINENCE AFTER PROSTATE CANCER THERAPY: A SEER-MEDICARE STUDY

You have accessJournal of UrologyCME1 May 2022MP52-17 RACIAL AND REGIONAL DISPARITIES AND SURGICAL INTERVENTION FOR URINARY INCONTINENCE AFTER PROSTATE CANCER THERAPY: A SEER-MEDICARE STUDY Nishant Garg, Alexandra Muise, Michael Pan, Michael Witthaus, Brent Rose, and Jill Buckley Nishant GargNishant Garg More articles by this author , Alexandra MuiseAlexandra Muise More articles by this author , Michael PanMichael Pan More articles by this author , Michael WitthausMichael Witthaus More articles by this author , Brent RoseBrent Rose More articles by this author , and Jill BuckleyJill Buckley More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002627.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary incontinence after prostate cancer therapy can significantly affect quality of life, with some men eligible for corrective surgery. Our objective is to evaluate the potential racial disparities for surgical management of urinary incontinence in patients who have undergone prior prostate cancer therapy. METHODS: Medicare claims from 2004-2013 were used to identify men aged 66 years or older who met inclusion criteria and underwent either prostatectomy (RP) or radiation (RT). Medicare Part A and B claims for incontinence were captured using HCPCS and ICD-9-CM codes along with the associated codes for the therapeutic surgeries. Differences in the covariates between treatment groups were evaluated using pairwise Chi-Square tests, and time to event analyses for surgery were calculated using Kruskal-Wallis tests. Outcomes were reported as hazard ratios with 95% confidence intervals, with statistical significance being reported as p < 0.05 on SASTM. RESULTS: A total of 63,158 men were identified in the cohort of which 15,143 men underwent RP and 44,694 underwent RT. There was no statistically significant difference in rates of incontinence surgery such as artificial urinary sphincter (AUS) and male sling (MS) between white and black men after either RT or RP. Black men had delayed treatment for incontinence compared to white men (27 vs 25 months for AUS and 27.5 vs 22 months for male sling). Men in the east were more likely to have incontinence after both RP and RT compared to men in the west but were not more likely to have any corrective surgery for this (Table 1). Men from the south were not more likely to have incontinence after RP compared to men from the west, but were more likely to get a MS (1.356 (1.086-1.692), p <0.0071). CONCLUSIONS: There was no difference in overall rates of surgical treatment for incontinence after either RT or RP between white and black men. There was a difference between men in the east vs west. These results may help improve counseling for men eligible for incontinence surgery, including based on region of the country but not stratified by race. Future research is needed in identifying the systems that may be associated with delayed surgical care. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e893 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nishant Garg More articles by this author Alexandra Muise More articles by this author Michael Pan More articles by this author Michael Witthaus More articles by this author Brent Rose More articles by this author Jill Buckley More articles by this author Expand All Advertisement PDF DownloadLoading ...

Concurrent Cetuximab-based bioradiotherapy versus Cisplatin-based Chemoradiotherapy in the Definitive Management of Favourable Biology Human Papillomavirus-associated Oropharyngeal Squamous Cell Carcinoma: Systematic Review and Meta-analysis

Replacing cisplatin with cetuximab concurrently during radiotherapy has been one of the strategies of treatment de-escalation in human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). However, until recently, there were limited data on the efficacy and safety of such an approach. A systematic search of the literature was carried out to identify prospective randomised controlled trials comparing definitive cisplatin-based chemoradiotherapy (CT-RT) versus cetuximab-based bioradiotherapy (BRT) in HPV-positive OPSCC. Overall survival and locoregional control were primary outcomes of interest; rates of acute and late toxicities (≥grade 3) were secondary end points. Outcome data were aggregated using a random-effects model as per Cochrane methodology including risk of bias assessment and expressed as hazard ratio or risk ratio as appropriate with respective 95% confidence intervals. Data from five randomised controlled trials involving 1560 patients with HPV-positive OPSCC were aggregated in the meta-analysis. Cetuximab-based BRT was associated with a significantly increased risk of death (hazard ratio = 2.83, 95% confidence interval 1.22–6.57; P = 0.02) and locoregional relapse (hazard ratio = 2.78, 95% confidence interval 1.77–4.39; P < 0.0001) compared with cisplatin-based CT-RT. Cisplatin was associated with higher rates of acute ≥grade 3 toxicity in terms of acute kidney injury, dry mouth, febrile neutropenia, hearing impairment, nausea and vomiting, whereas dermatitis and acneiform rash were more common with cetuximab. There were no significant differences in overall rates of late ≥grade 3 toxicity (risk ratio = 0.63, 95% confidence interval = 0.36–1.10; P = 0.10). In conclusion, there is moderate-certainty evidence that cetuximab-based BRT leads to inferior efficacy outcomes compared with cisplatin-based CT-RT in the definitive curative-intent management of HPV-associated OPSCC.

Rates of Low-Value Service in Australian Public Hospitals and the Association With Patient Insurance Status

Low-value services have limited or no benefit to patients. Rates of low-value service in public hospitals may vary by patient insurance status, given that there may be different financial incentives for treatment of privately insured patients. To assess the variation in rates of 5 low-value services performed in Australian public hospitals according to patient funding status (ie, private or public). This retrospective cross-sectional study analyzed New South Wales public hospital data from January 2013 to June 2018. Patients included in the sample were over age 18 years and eligible to receive low-value services based on diagnoses and concomitant procedures. Data analysis was conducted from June to December 2020. Hospital-specific rates of low-value knee arthroscopic debridement, vertebroplasty for osteoporotic spinal fractures, hyperbaric oxygen therapy, oophorectomy with hysterectomy, and laparoscopic uterine nerve ablation for chronic pelvic pain were measured. For each measure, rates within each public hospital were compared by patient funding status descriptively and using multilevel models. A total of 219 862 inpatients were included in analysis from 58 public hospitals across the 5 measures. A total of 38 365 (22 904 [59.7%] women; 12 448 [32.4%] aged 71-80 years) were eligible for knee arthroscopic debridement for osteoarthritis; 2520 (1924 [76.3%] women; 662 [26.3%] aged 71-80 years), vertebroplasty for osteoporotic spinal fractures; 162 285 (82 046 [50.6%] women; 28 255 [17.4%] aged 61-70 years), hyperbaric oxygen therapy; 15 916 (7126 [44.8%] aged 41-50 years), oophorectomy with hysterectomy; and 776 (327 [42.1%] aged 18-30 years), uterine nerve ablation for chronic pelvic pain. Overall rates of low-value services varied considerably between measures, with the lowest rate for hyperbaric oxygen therapy (0.3 procedures per 1000 inpatients [47 of 158 220 eligible inpatients]) and the highest for vertebroplasty (30.8 procedures per 1000 eligible patients [77 of 2501 eligible inpatients]). There was significant variation in rates between hospitals, with a few outlying hospitals (ie, <10), particularly for knee arthroscopy (range from 1.8 to 21.0 per 1000 eligible patients) and vertebroplasty (range from 13.1 to 70.4 per 1000 eligible patients), with higher numerical rates of low-value services among patients with private insurance than for those without. However, there was no association overall between patient insurance status and low-value services. Overall differences in rates among those with and without private insurance by individual procedure type were not statistically significant. There was significant variation in rates of low-value services in public hospitals. While there was no overall association between private insurance and rate of low-value services, private insurance may be associated with low-value service rates in some hospitals. Further exploration of factors specific to local hospitals and practices are needed to reduce this unnecessary care.

The impact of COVID-19 on hotel customer satisfaction: evidence from Beijing and Shanghai in China

PurposeThe purpose of this study is to provide better service to hotel customers during the COVID-19 era. Specifically, this study focuses on understanding the changes in hotel customer satisfaction during the epidemic and formulating effective marketing strategies to satisfy and attract guests.Design/methodology/approachAs the first victim of the COVID-19 virus, China’s hotel industry has been profoundly affected and customer satisfaction and needs have also changed. Taking 105,635 hotel reviews obtained from Tripadvisor.com in Beijing and Shanghai as samples, this study explores the changes in consumer satisfaction by using text-mining methods.FindingsThe results suggest that there are significant differences in overall ratings, spatial distribution and ratings of different traveller types before and after the epidemic. Generally, customers have higher “tolerance” and are more inclined to give higher ratings and pay more attention to hotel prevention and control measures to reduce health risks after the COVID-19.Research limitations/implicationsThis paper proves the changes in customer satisfaction before and after the COVID-19 at the theoretical level and reveals the changes in customer attention through the topic model and provides a basis for guiding hotel managers to reduce the impact of the COVID-19 crisis.Practical implicationsEmpirical findings would provide useful insights into tourism management and improve hotel service quality during the COVID-19 epidemic era.Originality/valueThis research explores the hotel customer satisfaction in the field of hotel management before COVID-19 and after COVID-19, by using text mining to analyse mandarin online reviews. The results of this study will suggest that the hotel industry should continuously adjust its products and services based on the effective information obtained from customer reviews, so as to realize the activation and revitalization of the hotel industry in the epidemic era.

Infusion of Allogeneic Mesenchymal Stromal Cells After Liver Transplantation: A 5-Year Follow-Up.

Various properties of mesenchymal stromal cells (MSCs) might be particularly of interest after liver transplantation (LT). In this article, we report the long-term results of a prospective, controlled, and first-in-human phase 1 study evaluating the safety of a single MSC infusion after LT. A total of 10 LT recipients treated with standard immunosuppression received 1.5 to 3×106 /kg third-party unrelated MSCs on postoperative day 3and were prospectively compared with a control group of 10 LT recipients. Primary endpoints were set to prospectively detect potentially delayed adverse effects of MSC infusion, particularly the occurrence of infections and cancers. Secondary endpoints of liver graft and patient survival, graft rejection and function, occurrence of bile duct complications, and development of donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA) against liver or MSC donors were studied. The median follow-up was 85months. There was no difference in overall rates of infection or cancer at 5years of follow-up between the 2 groups. There was also no difference in secondary endpoints. The prevalence of de novo liver DSAs related to HLA mismatches was twice as high in the MSC group compared with the control group. All of the de novo class II HLA antibodies against MSCs were linked to a shared HLA mismatch between the liver and MSCs. This study confirms the safety of a single MSC infusion after LT. The potential benefits of MSC injections in the context of organ transplantation have yet to be demonstrated by larger prospective studies. The development of anti-HLA antibodies against an MSC donor should be further evaluated, especially in cases of shared HLA mismatches between graft and MSC donors, despite the fact that no deleterious effect has been detected.

S202 Clinical Impact of Multiplex Polymerase Chain Reaction Pathogen Testing in Management of Outpatient Gastroenteritis

Introduction: Multiplex gastrointestinal pathogen panels (GI PCR) for the detection of enteric infection offer advantages in turnaround time and sensitivity compared to conventional modalities of stool testing. Previous research on GI PCR has focused almost exclusively on hospitalized patients, however, most cases of gastroenteritis are managed in the outpatient setting. Our aim was to compare GI PCR to conventional stool testing in outpatients with gastroenteritis and evaluate the impact on clinical decision-making and management. Methods: We performed a retrospective study of outpatients presenting with acute gastrointestinal symptoms at an academic medical center from September 2015 to April 2019 who received stool testing with GI PCR, and from February 2009 to April 2012 who received stool culture and ova and parasite exam (“conventional testing”). Patients who received GI PCR were matched by age and sex to patients who received conventional testing. We recorded pathogens isolated, demographic data, presenting symptoms, risk factors, antibiotic therapy, and downstream associated healthcare utilization including abdominal imaging, endoscopy, emergency room visits, hospitalizations, and abdominal surgeries. Univariate and multivariate linear regression was used to estimate the effect of testing on empiric antibiotic therapy. Results: We identified 1,018 outpatients who received GI PCR or conventional stool testing. (n = 509 each). A pathogen was isolated in 208 (41%) patients with GI PCR and 49 (10%, P < 0.01, Table 1) with conventional culture. There were no significant differences in overall rates of antibiotic therapy or average duration of therapy, but GI PCR was associated with less empiric therapy (47% vs 70%, P < 0.01), and higher rates of narrowing (13 vs 4%) and discontinuation (3 vs 0%, P < 0.01) of empiric antibiotics after the initial visit, with a 1.6-fold lower likelihood (95% CI 1.04-2.57, P = 0.04) of initiating empiric antibiotics on multivariable analysis. There were no significant differences in other outcomes. Conclusion: GI PCR testing detected more pathogens compared to conventional stool testing, without a significant increase in antibiotics prescribed. PCR testing was associated with changes in prescribing patterns for antibiotics, with a shift towards less empiric therapy.Table 1.: Characteristics of 1,018 patients stratified by modality of stool testing