Difference In Duration Of Treatment Research Articles

Does Implementation of Office Based Addiction Treatment by a Nurse Care Manager Increase the Duration of OUD Treatment in Primary Care? A Secondary Analysis of the PROUD Randomized Control Trial

BackgroundImplementation of office-based addiction treatment (OBAT) by nurse care managers increases overall use of OUD medication, but it is unknown whether it increases treatment duration among treated patients. MethodsThe Primary Care Opioid Use Disorders Treatment (PROUD) trial was a pragmatic, cluster-randomized trial testing whether implementation of OBAT increased OUD treatment in 12 primary care clinics in 6 systems. One of 2 clinics per system was randomized to implement OBAT (intervention), the other, usual care (UC). We evaluated treatment duration for the 3 years after nurses began seeing patients at clinics randomized to intervention vs. UC. The primary sample included patients newly initiating OUD medication; the secondary sample included patients with ongoing OUD medication. The primary outcome was percentage of days with OUD medications after treatment initiation, modeled using linear generalized estimating equations (GEE). Modified Poisson GEE models assessed secondary outcomes (≥80% of days covered, ≥6 months on treatment). ResultsIn adjusted analyses, the mean difference between intervention and UC in percent days treated was 6.3% (95% CI -9.6%, 22.1%) in the primary sample and 2.3% (95% CI -36.4%, 31.8%) in the secondary sample. There was no significant difference in treatment duration between intervention and UC patients in either primary or secondary outcomes. ConclusionsImplementation of OBAT in this trial did not measurably increase duration of medication treatment among those treated for OUD compared to UC, suggesting that benefits of OBAT, at least in this trial, largely reflect increases in treatment access.

Impact of causative organism identification on clinical outcomes after minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis: multicenter retrospective cohort study.

This study aimed to evaluate the difference in treatment duration and unplanned additional surgeries between patients with unidentified causative organisms on empiric antibiotics and those with identified organisms on selective antibiotics in treating thoracolumbar pyogenic spondylitis with minimally invasive posterior fixation. This multicenter retrospective cohort study included patients with thoracolumbar pyogenic spondylitis refractory to conservative treatment who underwent minimally invasive posterior fixation. Patients were divided into the identified (known causative organism) and unidentified groups (unknown causative organism). We analyzed data on demographics, antibiotic use, surgical outcomes, and infection control indicators. We included 74 patients, with 52 (70%) and 22 (30%) in the identified and unidentified groups, respectively. On admission, the identified group had higher C-reactive protein (CRP) levels and more iliopsoas abscesses. The duration to postoperative CRP negative was similar in the identified and unidentified groups (7.13 vs. 6.48 weeks, p = 0.74). Only the identified group had unplanned additional surgeries due to poor infection control, affecting 6 of 52 patients (12%). Advanced age and causative organism identification increased the additional surgery odds (odds ratio [OR], 8.25; p = 0.033 and OR, 6.83; p = 0.034, respectively). The use of empiric antibiotics in minimally invasive posterior fixation was effective without identifying the causative organism and did not prolong treatment duration. In patients with identified organisms, 12% required unplanned additional surgery, indicating a more challenging infection control. Causative organism identification was associated with the need for additional surgery, suggesting a more cautious treatment strategy for these patients.

Long-term Outcomes of Traditional Braces versus Invisalign in Orthodontic Treatment

ABSTRACT Objective: This research targets to compare the longstanding outcomes of traditional braces versus Invisalign in orthodontic treatment, focusing on dental alignment, occlusal stability, patient satisfaction, and treatment duration. Methods: A retrospective cohort research with 200 subjects was piloted. One hundred subjects received traditional braces, while the other 100 received Invisalign. Dental models, cephalometric radiographs, and intraoral photographs were obtained at baseline, post-treatment, and at 1, 2, and 5 years follow-up. Patient satisfaction surveys were administered at each follow-up visit. Results: Both traditional braces and Invisalign effectively improved dental alignment and occlusal stability over the 5-year follow-up period. Patient satisfaction scores were consistently higher in the Invisalign group compared to the traditional braces group. However, there were no significant differences in treatment duration between the two groups. Conclusion: Invisalign may offer comparable or superior longstanding outcomes compared to traditional braces in orthodontic treatment, with higher patient satisfaction levels. These findings support the use of Invisalign as a viable alternative to traditional braces, particularly for subjects seeking esthetic and convenient orthodontic solutions.

Complementary Therapies For Mild to Moderate Neonatal Opioid Withdrawal Syndrome: A Mini-review

Introduction: Neonatal Opioid Withdrawal Syndrome, resulting from prenatal opioid exposure, is rising in prevalence and presents substantial health and developmental challenges for neonates. While standard treatments of opioids such as morphine have been traditionally employed for treatment, concerns about their long-term effects on neonatal development have spurred interest in alternative therapeutic strategies. This review seeks to highlight emerging non-opioid interventions for Neonatal Opioid Withdrawal Syndrome and their potential benefits. Methods: Utilizing the PRISMA framework, the database PubMed was systematically searched for complementary therapies for neonatal opioid withdrawal syndrome. The search was conducted on September 27th, 2023, and employed a combination of keywords targeting the condition and the treatment modalities. Cochrane risk of bias tool was utilized to evaluate study quality and classify studies based on their risk of bias. Data captured from these studies encompassed parameters such as study design, intervention, and outcomes, including length of stay and length of pharmacotherapy. Results: Among 71 identified articles, only five met the inclusion criteria. Three were randomized controlled trials, and two were quasi-experimental studies. Among the 5 included trials, 3 demonstrated potential benefits, while two revealed no differences in treatment duration or reliance on pharmacological support. The "Eat-Sleep-Console" method, acupuncture, and vibrating mattresses were associated with reduced morphine dosages and shorter hospital stays. Most trials showed moderate to high risk using the Cochrane RoB-2 tool. Discussion: This review underlines the growing concern of Neonatal Opioid Withdrawal Syndrome stemming from increased opioid use during pregnancy. While severe cases necessitate pharmaceutical treatments, there’s a pressing need for safer alternatives. "Eat-Sleep-Console" method and transcutaneous auricular neuromodulation might offer mild relief. Future efforts should adopt a multifaceted strategy, emphasizing further research to optimize treatments and outcomes. Conclusion: Although complementary therapies show promise, with limited evidence from three RCTs, their efficacy remains uncertain. Additional studies might clarify the role while combining it with pharmacological methods could enhance outcomes. Comprehensive research is essential to optimize treatments for NOWS-affected infants. Complementary therapies in mild to moderate cases of Neonatal Opioid Withdrawal Syndrome show promising results. So far, not enough data has been obtained to support the efficacy of observed therapies.

Duration of orthodontic treatment with clear aligners versus fixed appliances in crowding cases: a systematic review.

To critically appraise and assess the currently observed evidence about the difference in orthodontic treatment duration between clear aligners and fixed appliances in crowding cases. An electronic search without limitations was conducted from inception to June 2023 covering nine databases: The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Scopus, Web of Science, Google Scholar, Trip, CINAHL via EBSCO, EMBASE via OVID and ProQuest. Randomized controlled trials (RCTs) and matched non-randomized studies were included in this systematic review. Risk of Bias was assessed via Cochrane's tool (RoB 2) for RCTs and ROBINS-I tool for non-randomized studies. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was employed to evaluate the overall quality of evidence. Out of the 3537 articles initially identified, ten eligible studies were included in this systematic review; six were RCTs. Only one study offered extraction-based treatment, while the other nine adopted non-extraction treatments. According to the GRADE, there is low evidence that treatment duration in mild to moderate crowding cases with clear aligners is similar to that in fixed orthodontic appliances. Meta-analysis was not administered due to high inconsistency. Based on currently available information, there was no significant difference in the treatment duration between the CA and FA groups in mild to moderate crowding cases. Further well-performed RCTs, especially in severe cases, are required. Time efficiency is an essential outcome measure for clinical orthodontic practice. While the type of appliance used is a critical determinant of treatment duration, orthodontists should be aware of other factors that can significantly impact treatment time, such as patient and treatment-related factors.

Home nursing and self-administered outpatient parenteral antimicrobial treatment: a comparison of demographics and outcomes from a large regional hospital in Queensland, Australia.

Outpatient parenteral antimicrobial treatment (OPAT) is a safe and effective therapy used in several settings across Australia. As OPAT services expand their inclusion criteria to include complex patient populations, there is an increased need for selecting appropriate patients to receive either healthcare-administered OPAT (H-OPAT) or self-administered OPAT (S-OPAT). To describe patient demographics, diagnosis, microbiology and outcomes of patients treated by H-OPAT and S-OPAT within the Sunshine Coast Hospital and Health Service, Australia. Data on demographics, diagnoses, treatment and outcomes on all patients treated by H-OPAT and S-OPAT from March 2017 to December 2019 were collected retrospectively. One hundred and sixty-five patients (62.26%) were enrolled in H-OPAT and 100 patients (37.74%) in S-OPAT. S-OPAT patients were significantly younger. H-OPAT patients were more comorbid. Bone and joint infections were the most treated infections and were more likely to be treated by S-OPAT. There was no difference in treatment duration, cure and complication rates between S-OPAT and H-OPAT. Longer duration of therapy was associated with more complications. Treatment failure was associated with infections due to multiple organisms, number of comorbidities and treatment of surgical site, skin and soft tissue infections. There were significant differences in demographics between H-OPAT and S-OPAT without any difference in outcomes. Overall failure and complication rates were low. Higher rates of treatment failure were predicted by the diagnosis, number of comorbidities and number of organisms treated.

Psychiatric Features of Children with Chronic Functional Constipation: Focusing on Individuals with Autism Spectrum Disorder.

The present study aimed to assess the psychiatric characteristics of children with chronic functional constipation using the Aberrant Behavior Checklist-Japanese version and the Pervasive Developmental Disorders/Autism Society Japan Rating Scale, and to examine the frequency of autism spectrum disorder in children with chronic functional constipation. We also investigated differences in treatment duration between children with and without autism spectrum disorder. Treatment outcomes were examined retrospectively for 55 participants (chronic functional constipation group: n = 30, mean age 3.4 years; control group: n = 25, mean age, 4.5 years). The association between chronic functional constipation and autism spectrum disorder was evaluated using multivariable logistic regression analysis. The mean Aberrant Behavior Checklist score and frequency of individuals with autism spectrum disorder were significantly higher in the chronic functional constipation group. After adjusting for age and sex, chronic functional constipation was significantly associated with autism spectrum disorder. In the chronic functional constipation group, the frequency of onset was significantly higher in children with autism spectrum disorder under 1 year of age. When treated, the mean duration of constipation was significantly longer in children with autism spectrum disorder. Pediatricians, pediatric surgeons, and child psychiatrists should work closely to ensure appropriate treatment of chronic functional constipation in children with autism spectrum disorder.

Oral Antibiotics for Treatment of Gram-Negative Bacteremia in Solid Organ Transplant Recipients: A Propensity Score Weighted Retrospective Observational Study.

We assessed the safety and efficacy of oral antibiotic step-down therapy for uncomplicated gram-negative blood stream infections in solid-organ transplant recipients. We identified all solid-organ transplant recipients within the Massachusetts General and Brigham and Women's Hospital systems from 2016 to 2021 with uncomplicated gram-negative bacteremia involving an organism susceptible to an acceptably bioavailable oral antibiotic agent. Using inverse probability of treatment-weighted models based on propensity scores adjusting for potential clinical confounders, we compared outcomes of those transitioned to oral antibiotics with those who continued intravenous (IV) therapy for the duration of treatment. Primary endpoints were mortality, bacteremia recurrence, and reinitiation of IV antibiotics. Secondary endpoints included length of stay, Clostridioides difficile infection, treatment-associated complications, and tunneled central venous catheter placement. A total of 120 bacteremia events from 107 patients met inclusion criteria in the oral group and 42 events from 40 patients in the IV group. There were no significant differences in mortality, bacteremia recurrence, or reinitiation of IV antibiotics between groups. Patients transitioned to oral antibiotics had an average length of stay that was 1.97 days shorter (95% confidence interval [CI], -.39 to 3.56 days; P = .005). Odds of developing C. difficile and other treatment-associated complications were 8.4 times higher (95% CI, 1.5-46.6; P = .015) and 6.4 times higher (95% CI, 1.9-20.9; P = .002), respectively, in the IV group. Fifty-five percent of patients in the IV group required tunneled catheter placement. There was no difference in treatment duration between groups. Oral step-down therapy was effective and associated with fewer treatment-related adverse events.

Analysis of the Differences in Length of Stay of Covid-19 Patients with a History of Comorbids and Without a History of Comorbids on the Impact of Hospital Financing in Central Sulawesi Province in 2023

Case is a health problem experienced throughout the world. The increasing spread of the Covid virus in Indonesia has resulted in hospitals designated by the Ministry of Health being unable to accommodate patients infected with Covid. Analysis of the differences in treatment duration for Covid-19 patients with comorbidities and without comorbidities is important to know so that the prognosis of patients with comorbidities can be predicted, so that Covid-19 patients with comorbidities can receive more optimal special health services so that the death rate due to Covid-19 can be maximally prevented. and can reduce costs for treating Covid-19 patients. The aim of this research is to analyze the difference in length of stay for Covid-19 patients with and without a history of comorbidities in Central Sulawesi Province in 2023. This research uses a cross sectional type of research . The population in this study was 9 6 samples. The sampling technique used was Accidental Sampling, data analysis used was bivariate analysis with the Mann Whitney test. The results of the study showed that the highest length of stay was for Covid patients who underwent short-term treatment with a proportion of 88.5% and those with a history of comorbidities had the most comorbidities with a proportion of 63.5%. The results of the Mann Whitnay statistical test show that there is no difference in the average frequency of length of stay for Covid-19 patients with a history of comorbidities and without comorbidities. with the value ρ Value 0.512. The advice in this research is that it is hoped that the hospital, especially the Health Promotion section, will always disseminate health education about the factors that influence the length of stay and treatment of Covid-19 patients with and without comorbidities. Covid cases accompanied by comorbidities are mostly age. Furthermore, it is necessary to provide education on Covid prevention through leaflets and Covid pocket books at Posyandu for the elderly

The Effects of Methylphenidate on Ventricular Repolarization Parameters in Children with Attention-Deficit Hyperactivity Disorder.

Long-acting methylphenidate (MPH), a psychostimulant agent, is widely used in the treatment of attention-deficit hyperactivity disorder (ADHD). Methylphenidate might cause an increment in the risk of lethal arrhythmias by deteriorating ventricular repolarization. QT intervals, the corrected QT (QTc), QT dispersion, T-peak to T-end (TpTe), and the TpTe/QTc ratio are the most utilized indicators of ventricular repolarization in electrocardiogram (ECG). The present study was conducted to examine the effects of long-term MPH use on the ECG in pediatric patients. A total of 52 children with ADHD and 51 age- and gender-matched controls were enrolled in the study. The children had been using MPH regularly for at least 6 months. Comparisons were made regarding ECG parameters, including the mean intervals of QT, QTc, QTc dispersion interval duration, TpTe intervals, TpTe/QT, and TpTe/QTc ratio. The median duration of treatment with MPH was 30 months (minimum-maximum: 6-120), and the median MPH dose was 30 mg/day (minimum-maximum: 18-54). The main findings showed significantly prolonged P-wave dispersion, TpTe interval, TpTe dispersion, and TpTe/QT and TpTe/QTc ratios in the ADHD group compared to the healthy controls (P < .001). These parameters were not associated with MPH dose or treatment duration. Additionally, nearly half of the patients had QTc values of 460 ms or higher, but there were no significant differences in treatment duration and dose compared to the remaining group (P = .792 and P = .126). Methylphenidate may have proarrhythmogenic effects in children with ADHD, which may not be adversely affected by long-term use and treatment dose. Considering the extensive use of MPH, cardiac monitoring of these children is important.

Abstract P2-03-22: Assessment of the relationship between duration of treatment with hormonal therapy and the detection of ESR1 mutations in hormone-receptor positive, HER2 negative, breast cancer

Abstract Background Hormonal therapeutic agents such as the selective estrogen receptor modulator, tamoxifen, as well as the aromatase inhibitors (AIs), anastrozole, exemestane, and letrozole, are a mainstay in the treatment of patients with hormone-receptor positive (HR+) breast cancer. Despite the effectiveness of hormonal therapy in the treatment of patients with HR+ breast cancer, acquired resistance to both AIs and tamoxifen does occur, often associated with mutations of the estrogen receptor 1 (ESR1). Although the acquisition of ESR1 mutations in patients with HR+ breast cancer treated with hormonal therapy has been established as a mechanism of resistance, there is a paucity of data on the relationship between the duration of treatment with hormonal therapies and the development of ESR1 mutations. Using a cohort of patients with HR+ breast cancer who underwent next generation sequencing (NGS) as part of routine clinical care, we aim to assess the relationship between the duration of exposure to aromatase inhibitors and the detection of ESR1 mutations. The results of this study will further our understanding of ESR1-mutations and provide insight into strategies to optimize therapy for patients with HR+ breast cancers. Methods This is a retrospective analysis of patients 18 years of age or older treated at a single academic cancer center in the USA, diagnosed with HR+, HER2-negative breast cancer and who have received somatic NGS as part of clinical care over a six-year period through July 2019. Demographic, disease-related, and treatment related variables were collected along with genomic testing variables (ie. ESR1-mutation status) for each patient who met the inclusion criteria. Two patient groups were formed on the basis of ESR1-mutation status (present vs. absent) and compared on the basis of duration of treatment with AI, and other clinical and demographic categories. Results A total of 247 patients who were diagnosed with HR-positive, HER2-negative breast cancer and received NGS were identified and are included in this analysis. A total of 138 (56%) patients were assessed via tissue based NGS and 109 (44%) by liquid biopsy. The median age at time of sequencing was 58 years [57 years (ESR1-absent) vs. 60 years (ESR1-present); p =0.009]. The majority of patients were white (83%) and post-menopausal (57%). Invasive ductal carcinoma was the most common histological type (82%). Nearly all (96%) patients had stage IV disease at time of sequencing and ESR1 mutations were found exclusively in those with stage IV disease. ESR1 mutations were identified in 62 patients (25%). The median duration of treatment with aromatase inhibitors prior to testing was 19.3 months in both groups (ESR1 mutations absent vs. detected). There was no difference in prior tamoxifen use between groups (absent 43%, present 48%; p=0.48). In patients tested by tissue based NGS, ESR1 mutations were more frequently detected in metastatic sites (28% vs. 13%; p=0.03). Twenty-two patients for whom NGS did not identify an ESR1 mutation prior to July 2019 received subsequent NGS testing. Of these 22 patients, six (27%) had ESR1 mutations detected by subsequent NGS. In these six patients, ESR1-mutations were detected by NGS a median of 2.2 years (range 1.7 years to 2.6 years) after prior NGS. Conclusion There was no difference in duration of treatment with aromatase inhibitor therapy in patients with ESR1 mutations vs. those without ESR1 mutations detected by NGS. Patients with ESR1 mutations tended to be older. Although the detection of ESR1 mutations is associated with acquired therapy resistance and progression on treatment, a longer duration of treatment may make the emergence of ESR1 mutations more likely. These counterbalancing factors may have contributed to the results reported here. Citation Format: Hannah Ayettey-Anie, Kamran A. Ahmed, Iman Washington, Kosj Yamoah, Todd Knepper. Assessment of the relationship between duration of treatment with hormonal therapy and the detection of ESR1 mutations in hormone-receptor positive, HER2 negative, breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-03-22.

The impact of benzodiazepine exposure on treatment retention in an open-access methadone program: A retrospective cohort study

BackgroundOpen-access opioid treatment programs (OTP) offer same-day access to methadone without an appointment and aim to minimize treatment barriers that often reduce admission and/or retention. We explored whether patients with benzodiazepine exposure at treatment entry would have similar 12-month retention compared to those without benzodiazepine exposure. MethodsWe conducted a retrospective cohort study of 2968 patients consecutively initiated on methadone between January 2015 and February 2017 at an open-access OTP. The sample was stratified into benzodiazepine-exposed and nonexposed groups based on intake urine toxicology. Group comparison of 12-month retention was conducted. Kaplan Meier analysis compared time to methadone treatment discontinuation between groups with a log-rank test. Multivariable Cox regression was performed to compare retention by baseline benzodiazepine exposure with adjustment for confounders. ResultsOverall, 31% of patients with benzodiazepine exposure (n = 171) and 31% without exposure (n = 2423) were retained at 12 months (p = 0.95). Median treatment duration was 182 days (95% CI, 152–239) and 175 days (95% CI, 156–196) for patients with and without benzodiazepine exposure, respectively. Kaplan-Meier analysis showed no significant difference in treatment duration between groups (log-rank test p = 0.73). Cox regression found no difference in treatment retention between groups (adjusted Hazard Ratio= 1.03, 95% CI, 0.91–1.16). ConclusionsIn this cohort of patients receiving methadone at an open-access OTP, benzodiazepine exposure at intake was not observed to impact 12-month treatment retention or duration. These findings support U.S. Food and Drug Administration (FDA) recommendations to not withhold medications for opioid use disorder from patients taking benzodiazepines.

How Does Treatment Intolerance Affect Survival in Patients with Multiple Myeloma (MM)?

Background MM is the second most frequent hematological neoplastic disease. Management of MM is moving toward long-term continuous regimens , but this approach is sometimes difficult to implement due to multiple factors including intolerance to treatment. In this study, we aim to identify the factors associated with treatment intolerance and assess it impact on MM patient's outcome . Method We analyzed data from the Australian and New Zealand (ANZ) and Asia-Pacific (APAC) Myeloma and Related Diseases Registry (MRDR). Newly diagnosed MM patients that have stopped their treatment were included. The patients are further classified according to whether they stopped the treatment due to intolerances or other reasons. Categorical variables are compared using a chi-squared test, whilst for continuous variables a rank-sum test was used. Survival analyses we performed using the Kaplan-Meier method and statistical comparisons performed using a log-rank test. Results 4454 patients diagnosed MM in the registry. Of these, 2753 ceased treatment. 313 stopped due to intolerance, 2313 stopped due to other reasons and 127 were not classified and therefore excluded from the analysis. Compared to others, patients who stopped treatment due to intolerance were older (Median age 74.7 years vs 64.3 years, p<0.001), tended to have advanced disease (38.9% ISS3 vs 30.4%, p=0.009), had poorer performance status (33.6% ECOG2-4 vs 17.3% ECOG2-4), and more co-morbidities such as moderate to severe cardiac disease (16.8% vs 8.2%, p=0.001), pulmonary disease (7.7% vs 3.7%. p<0.001) and diabetes requiring treatment (18.8% vs 11.2%, p<0.001). Consistent with the patient profile, a lower proportion of the intolerant patients underwent stem cell transplantation and bortezomib based treatment whereas more patients in the intolerant group had lenamidomide based treatment. Importantly, there was no clinically relevant difference in duration of treatment between the intolerant and tolerant group, although there was a lower proportion patients achieving a partial response or deeper in the intolerant group (74% vs 88.8%, p<0.001) . On multivariate analysis, age was the predominant factor associated with intolerance, with the odds ratio increasing with age, whereas the use of velcade was relatively protective with an odds ratio of 0.33 (p<0.001). Patients who ceased treatment due to intolerance to treatment had shorter PFS (median PFS 36.8 months compared to 47.7 months, p<0.001) and OS (Median OS 47.5 months compared to 80.9 months, p<0.001). On multivariate analysis, intolerance to treatment itself was an independent prognostic factor. To remove the immortal time bias inherent in analyzing the effect of treatment duration on survival, we measured survival from the cessation of treatment. This analysis showed a shorter survival in the intolerant group (35.3 months compared to 68.4 months, p<0.001). When we added duration of treatment and depth of response to the multivariate model of survival, intolerance was no longer a significant prognostic factor, whereas depth of response was. Duration of treatment was also not significant [show table] Conclusion Intolerance to chemotherapy is associated with inferior survival, independent of potential confounding baseline variables associated with intolerance, in particular age and performance as well as chemotherapy regimen (ISS stage is not independently associated with an intolerant response once adjusted for age and performance status). The main reason for this appears to be reduced depth of response achieved. Optimizing treatment to achieve better tolerance and to increase chance of deeper response especially in the elderly, and those with comorbidities and poorer performance status, would be important in improving outcomes of MM patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Tumoral PD-L1 does not impact time to treatment discontinuation in EGFR mutated non-small cell lung cancer patients treated with EGFR tyrosine kinase inhibitor-a Danish cohort study.

BackgroundNot all non-small cell lung cancer (NSCLC) patients harboring epidermal growth factor receptor (EGFR) mutations respond equally to therapy with tyrosine kinase inhibitors (TKIs). Programmed death ligand-1 (PD-L1) has previously been speculated as a possible biomarker for treatment outcome because of its positive correlation with these mutations in cell lines, but clinical studies have yielded conflicting results. We investigate the predictive potential of this surface protein in relation to clinical benefit in patients as measured by time to treatment discontinuation (TTD).MethodsWe screened 516 Danish patients with EGFR mutations for inclusion based on a history of TKI treatment and a PD-L1 status that was assessed no earlier than three months prior to treatment initiation. Patients were stratified according to their expression of the potential biomarker as either negative (0%), low (1–49%) or high (≥50%). We employed the Kaplan-Meier method and the log rank test to test for a difference in treatment duration according to PD-L1 expression.ResultsWe included 111 Danish patients. The median follow-up time from inclusion until death or censoring at the end of the study was 670 days (range, 32–1,664 days, 95% CI: 502–897 days). Fifty-seven patients (51%) categorized as PD-L1 expression negative, 32 (29%) as low and 22 (20%) as high. We tested for differences in treatment duration between the three groups. Our tests did not yield statistically significant P values.ConclusionsIn our cohort of 111 Danish patients with NSCLC harboring mutations in the epidermal growth factor receptor gene, expression levels of PD-L1 did not significantly impact the duration of clinical benefit from tyrosine kinase treatment.

Comparable Skeletal and Dental Movements Achieved Using Conventional and Surgery-First Techniques in Class III Patients

The surgery-first (SF) approach to orthognathic surgery has been proposed as a more efficient method to correct the dentofacial deformity. This study aimed to evaluate if the magnitude of skeletal and dental changes achieved in Class III patients treated with either conventional orthognathic surgery (COS) or SF techniques differ. A retrospective cohort study of Class III orthognathic surgery patients between January 2006 and May 2020 with available pre- and post-treatment lateral cephalograms was conducted at an academic institution. The primary predictor variable was surgery technique: COS or SF. Assessed outcome variables included cephalometric skeletal parameters: SNA, SNB, ANB, Wits Appraisal, Sn-GoGn, and FMA; and dental parameters: U1-SN, U1-NA (°), U1-NA (mm), L1-NB (°), L1-NB (mm), and overjet. Within-group posttreatment parameters were analyzed with paired t tests. Pretreatment, posttreatment, and between-group parameter changes were analyzed by 2-sided 2-sample independent t tests. Potential covariates, including gender, surgical procedure, previous conventional treatment, extractions (excluding 3rd molars), crowding, and midline discrepancy, were analyzed using Fisher exact tests. Thirty-nine subjects were included in this study: 1) 21 COS (age: 20.9±8.7years) and 2) 18 SF (age: 19.6±5.0years). Cohorts were comparable (P>.05) for all analyzed covariates. COS showed statistically significant increases in L1-GoGn (3.31±6.23°; P=.024), overjet (4.26±3.99mm; P<.001), ANB (3.5±2.79°; P<.001), SNA (3.5±1.85°; P<.001), and Wits Appraisal (3.78±4.97mm; P=.002). SF showed statistically significant increases in L1-GoGn (4.19±4.85°; P=.002), L1-NB (3.08±4.13°; P=.006), L1-NB (0.79±1.35mm; P=.023), overjet (5.82±2.96mm; P<.001), ANB (5.51±3°; P<.001), SNA (4.13±2.38°; P<.001), and Wits Appraisal (5.92±3.42mm; P<.001) and statistically significant decreases in U1-NA (-3.69±7.35°; P=.048) and SNB (-1.38±2.14°; P=.014). There were no statistically significant differences in skeletal or dental parameters between groups when adjusted for pretreatment levels of that parameter. The mean treatment duration was 38months (standard deviation=12.7) in COS and 17.6months (standard deviation=5.2) in SF. The results show that skeletal and dental changes between groups were not statistically different, despite an average 20-month difference in treatment duration. This suggests that either technique can be used to achieve comparable degrees of skeletal and dental movement in Class III patients.

Trends in primary treatment of advanced ovarian cancer: A real world national database analysis (336)

Trends in primary treatment of advanced ovarian cancer: A real world national database analysis (336)

Soft tissue changes with skeletal anchorage in comparison to conventional anchorage protocols in the treatment of bimaxillary proclination patients treated with premolar extraction : Asystematic review.

This review systematically evaluates the evidence related to comparisons between skeletal and conventional anchorage protocols in the treatment of bimaxillary proclination patients who underwent premolars extraction with respect to soft tissue profile changes, treatment duration and three-dimensional (3D) soft tissue changes. Electronic database search and hand search with no language limitations were conducted in the Cochrane Library, PubMed, Ovid, Web of Science, Scopus and ClinicalTrials.gov. The selection criteria were set to include studies with patients aged 13years and above requiring extractions of upper and lower first premolars to treat bimaxillary proclination with high anchorage demand. Risk of bias assessment was undertaken with Cochrane's Risk Of Bias tool 2.0 (ROB 2.0) for randomised controlled trials (RCTs) and ROBINS‑I tool for nonrandomised prospective studies. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used for quality assessment. Results were summarised qualitatively; no meta-analysis was conducted. Two RCTs and two nonrandomised prospective studies were included. According to the GRADE approach, there is low to very low quality of evidence that treatment using mini-implant anchorage may significantly change nasolabial angle, upper and lower lip procumbence, and facial convexity angle compared to treatment with conventional anchorage. Similarly, very low quality evidence exists showing no differences in treatment duration between treatments with skeletal or conventional anchorage. The overall existing evidence regarding the effect of anchorage protocols on soft tissue changes in patients with bimaxillary protrusion and premolar extraction treatment plans is of low quality. PROSPERO CRD42020216684.

Trend analysis of effect of COVID-19 pandemic on breast cancer staging.

e18682 Background: COVID-19 Pandemic has impacted the diagnosis and treatment of breast cancer and has been shown to increase the late stage cancer at presentation. Most of studies has made year-wise comparison with 2019 for this conclusion. Same studies have also concluded that there was no difference in treatment duration after the diagnosis. Methods: We conducted an IRB-approved retrospective chart review of 505 (255 in 2018 and 250 in 2019) patients diagnosed with Breast Cancer from January 2018 to December 2019 for pre-COVID era and 206 patients diagnosed from March to December 2020 i.e. COVID era. We compared the race, histology, and stage at presentation. Patients from COVID era were compared with newly diagnosed breast cancer in 2018, 2019 patients individually and together. All the above characteristics. were compared between COVID and Pre-COVID era. Continuous variable was compared by T-test and Categorical variable were compared with details were recorded. Descriptive statistics were used in the analysis. Results: Median age of diagnosis for 2018, 2019, and COVID era was 62 (38-83), 59 (37-80) and 64(39-97) respectively. The proportion of white Race during pre-COVID era was 87.52% compared to 89.32% during the COVID era without any significant difference between all 3 years. For Histology, there was significant difference between proportion of histology between 2019 and 2020 (p-value 0.003) whereas no difference between 2018 and 2020 (p-value – 0.21) or combined pre-COVID and COVID era. Incase of staging, significantly more late stage cancer was seen in the COVID era compared to 2019 but there was no significant difference (p-value – 0.225). Same finding was seen between combined pre-COVID and COVID era (p-value - 0.94). Conclusions: Findings from our study suggest that a longer-term trend analysis is required for to find out the accurate impact of COVID-19 pandemic on breast cancer and cancer in general. A population-based study incorporating data from multicenter and multiple year should be done to assess the real effect of COVDI pandemic.[Table: see text]

The Effect of Race in the Palliative Treatment of Bone Metastases

PurposePrior studies demonstrated that single and multiple-fraction radiation therapy (RT) provide comparable pain relief in palliative-care patients. In addition, unconscious racial biases may affect practice patterns in oncology. In this study, we examined the effect of race on the duration of RT for palliative treatment of bone metastases. Methods and MaterialsThis is a retrospective study of 707 patients treated for bone metastases between 2013 and 2020 (1348 treatments). Patient race, demographics, RT dose, number of fractions, use of stereotactic radiosurgery (SRS), and performance score were collected. A short-course was defined as a single fraction, whereas a long-course was defined as more than one fraction. SRS cases were analyzed separately. ResultsOf all nonradiosurgery RT treatments delivered, 28.9% were single fraction and 71.1% were multiple fraction. In total, 76% of the patients were White and 24% were non-White. With regard to race, the number of White patients receiving short- and long-course RT was 256 (27.9%) and 663 (72.1%), respectively. The number of non-White patients receiving short- and long-course RT was 97 (31.9%) and 207 (68.1%), respectively. There was no difference in treatment duration based on patient race (P = .20). The use of SRS did not vary based on race (P = .79). There was no statistically significant difference in Karnofsky Performance Status Scale score between White and non-White patients (P = .44). ConclusionsAnalysis of patient and physician characteristics revealed that race did not influence treatment decisions such as duration of palliative RT regimen or use of SRS. Although palliative-care regimens must be individualized for each patient, such investigations can identify potential biases in treatment decisions.

The effect of proton pump inhibitors and vonoprazan on the development of 'gastric mucosal redness'.

The safety of long-term proton pump inhibitor (PPI) and vonoprazan (VPZ) use is a relatively recent concern. Gastric mucosal redness was reported as a VPZ-associated lesion in a previous study. The aim of this study was to investigate the prevalence and risk factors for gastric mucosal redness. Between December 2020 and November 2021, 1,101 patients who underwent esophagogastroduodenoscopy were reviewed. The cohort was divided into four groups: Control (n=580), histamine-2 receptor antagonist (H2RA) (n=65), PPI (n=146) and VPZ groups (n=310). Gastric mucosal redness was present in 48/1,101 patients (4%). The prevalence in controls, H2RA, PPI and VPZ groups was 1.9% (11/580), 1.5% (1/65), 6.2% (9/146) and 8.7% (27/310), respectively. Both the PPI and VPZ groups had a significantly higher prevalence of gastric mucosal redness compared with the control group (P<0.001). In the multivariate analysis, PPI and VPZ use were significantly associated with gastric mucosal redness. Fundic gland polyps, gastric hyperplastic polyps, multiple white and flat elevated lesions, cobblestone-like mucosa, and stardust gastric mucosa were also significantly associated with PPI and VPZ use in the multivariate analysis. Back-to-back analysis showed that gastric mucosal redness was not seen before starting PPI/VPZ in most patients. The duration of treatment with VPZ was investigated to determine if it affected the prevalence of gastric mucosal redness. There were no significant differences in treatment duration among patients with and without gastric mucosal redness (mean ± standard deviation: 3.0±1.5 vs. 2.5±1.4 years, P=0.077). In conclusion, the prevalence of gastric mucosal redness was low but was associated with PPI and VPZ use.