Diverse Patient Populations Research Articles

First comparison between artificial intelligence-guided coronary computed tomography angiography versus single-photon emission computed tomography testing for ischemia in clinical practice.

Noninvasive cardiac testing with coronary computed tomography angiography (CCTA) and single-photon emission computed tomography (SPECT) are becoming alternatives to invasive angiography for the evaluation of obstructive coronary artery disease. We aimed to evaluate whether a novel artificial intelligence (AI)-assisted CCTA program is comparable to SPECT imaging for ischemic testing. CCTA images were analyzed using an artificial intelligence convolutional neural network machine-learning-based model, atherosclerosis imaging-quantitative computed tomography (AI-QCT)ISCHEMIA. A total of 183 patients (75 females and 108 males, with an average age of 60.8 years ± 12.3 years) were selected. All patients underwent AI-QCTISCHEMIA-augmented CCTA, with 60 undergoing concurrent SPECT and 16 having invasive coronary angiograms. Eight studies were excluded from analysis due to incomplete data or coronary anomalies. A total of 175 patients (95%) had CCTA performed, deemed acceptable for AI-QCTISCHEMIA interpretation. Compared to invasive angiography, AI-QCTISCHEMIA-driven CCTA showed a sensitivity of 75% and specificity of 70% for predicting coronary ischemia, versus 70% and 53%, respectively for SPECT. The negative predictive value was high for female patients when using AI-QCTISCHEMIA compared to SPECT (91% vs. 68%, P = 0.042). Area under the receiver operating characteristic curves were similar between both modalities (0.81 for AI-CCTA, 0.75 for SPECT, P = 0.526). When comparing both modalities, the correlation coefficient was r = 0.71 (P < 0.04). AI-powered CCTA is a viable alternative to SPECT for detecting myocardial ischemia in patients with low- to intermediate-risk coronary artery disease, with significant positive and negative correlation in results. For patients who underwent confirmatory invasive angiography, the results of AI-CCTA and SPECT imaging were comparable. Future research focusing on prospective studies involving larger and more diverse patient populations is warranted to further investigate the benefits offered by AI-driven CCTA.

Access to Primary Care Telemedicine and Visit Characterization in a Pediatric, Low-Income, Primarily Latino Population: Retrospective Study.

Since the COVID-19 pandemic, telemedicine has been widely integrated into primary care pediatrics. While initial studies showed some concern for disparities in telemedicine use, telemedicine uptake for pediatric patients in a low-income, primarily Latino community over a sustained period has yet to be described. We aimed to assess the relationship between demographics, patient portal activation, and telemedicine visits, as well as characterize diagnoses addressed in telemedicine, in a low-income, primarily Latino population over time. A multidisciplinary team conducted outreach for telemedicine and patient portal activation with the adoption of a new electronic health record. Data were collected on all in-person and telemedicine visits from February 2020 through April 2021 for 4 community-based pediatric practices. The outcomes included patient portal activation, telemedicine use, and reason for telemedicine visits. Bivariate tests and multivariate regression analyses were conducted to assess the independent effects of demographics on the likelihood of portal activation and having a telemedicine visit. Telemedicine diagnoses were categorized, and subanalyses were conducted to explore variations by age and month. There were 12,377 unique patients and 7127 telemedicine visits. Latino patients made up 83.4% (n=8959) of the population. Nearly all patients (n=10,830, 87.5%) had an activated portal, and 33.8% (n=4169) had at least 1 telemedicine visit. Portal activation decreased with age >2 years (2-4 years: adjusted odds ratio [aOR] 0.62, 95% CI 0.51-0.76; 5-11 years: aOR 0.28, 95% CI 0.23-0.32; 12-14 years: aOR 0.29, 95% CI 0.23-0.35; and 15-17 years: aOR 0.46, 95% CI 0.36-0.58). Spanish-speaking (aOR 0.52, 95% CI 0.45-0.59) and non-Latino patients (aOR 0.64, 95% CI 0.54-0.76) had decreased odds of activation and having a telemedicine visit (aOR 0.81, 95% CI 0.74-0.89 and aOR 0.71, 95% CI 0.62-0.81, respectively). The top 5 diagnostic categories for telemedicine were infectious disease (n=1749, 26.1%), dermatology (n=1287, 19.5%), gastrointestinal (n=771, 11.7%), well and follow-up care (n=459, 7%), and other specialty-related care (n=415, 6.3%). Infectious disease showed the most variation over time. Age-based patterns included a decrease in the proportion of infectious disease diagnoses by increasing age group and a higher proportion of well and follow-up care in older ages. Additional telemedicine diagnoses included common infant concerns for patients younger than 2 years of age; pulmonary, asthma, and allergy concerns for toddler or school-age children; behavioral health concerns for younger adolescents; and genitourinary and gynecologic concerns for older adolescents. The high engagement across demographics suggests feasibility and interest in telemedicine in this low-income, primarily Latino population, which may be attributable to the strength of outreach. Language-based disparities were still present. Telemedicine was used for a wide range of diagnoses. As telemedicine remains a vital component of pediatric health care, targeted interventions may enhance engagement to serve diverse pediatric patient populations.

Information Mode-Dependent Success Rates of Obtaining German Medical Informatics Initiative-Compliant Broad Consent in the Emergency Department: Single-Center Prospective Observational Study.

The broad consent (BC) developed by the German Medical Informatics Initiative is a pivotal national strategy for obtaining patient consent to use routinely collected data from electronic health records, insurance companies, contact information, and biomaterials for research. Emergency departments (EDs) are ideal for enrolling diverse patient populations in research activities. Despite regulatory and ethical challenges, obtaining BC from patients in ED with varying demographic, socioeconomic, and disease characteristics presents a promising opportunity to expand the availability of ED data. This study aimed to evaluate the success rate of obtaining BC through different consenting approaches in a tertiary ED and to explore factors influencing consent and dropout rates. A single-center prospective observational study was conducted in a German tertiary ED from September to December 2022. Every 30th patient was screened for eligibility. Eligible patients were informed via one of three modalities: (1) directly in the ED, (2) during their inpatient stay on the ward, or (3) via telephone after discharge. The primary outcome was the success rate of obtaining BC within 30 days of ED presentation. Secondary outcomes included analyzing potential influences on the success and dropout rates based on patient characteristics, information mode, and the interaction time required for patients to make an informed decision. Of 11,842 ED visits, 419 patients were screened for BC eligibility, with 151 meeting the inclusion criteria. Of these, 68 (45%) consented to at least 1 BC module, while 24 (15.9%) refused participation. The dropout rate was 39.1% (n=59) and was highest in the telephone-based group (57/109, 52.3%) and lowest in the ED group (1/14, 7.1%). Patients informed face-to-face during their inpatient stay following the ED treatment had the highest consent rate (23/27, 85.2%), while those approached in the ED or by telephone had consent rates of 69.2% (9/13 and 36/52). Logistic regression analysis indicated that longer interaction time significantly improved consent rates (P=.03), while female sex was associated with higher dropout rates (P=.02). Age, triage category, billing details (inpatient treatment), or diagnosis did not significantly influence the primary outcome (all P>.05). Obtaining BC in an ED environment is feasible, enabling representative inclusion of ED populations. However, discharge from the ED and female sex negatively affected consent rates to the BC. Face-to-face interaction proved most effective, particularly for inpatients, while telephone-based approaches resulted in higher dropout rates despite comparable consent rates to direct consenting in the ED. The findings underscore the importance of tailored consent strategies and maintaining consenting staff in EDs and on the wards to enhance BC information delivery and consent processes for eligible patients. German Clinical Trials Register DRKS00028753; https://drks.de/search/de/trial/DRKS00028753.

IMPACT OF THE ARIS MODULE (ANXIETY AND DEPRESSION REDUCTION THROUGH ISLAMIC SPIRITUAL CARE) ON PATIENTS WITH CORONARY HEART DISEASE

Background: Coronary heart disease (CHD) is a significant health issue that causes both physical and psychological distress, including heightened anxiety and depression. Islamic-based spiritual care practices may improve mental well-being in CHD patients. Objectives: This study aims to evaluate the effectiveness of the ARIS Module (Anxiety and Depression Reduction through Islamic Spiritual Care) in reducing anxiety and depression among CHD patients. Methods: Conducted from September to October 2024 at Siti Khadijah Islamic Hospital in Palembang, the study included 84 CHD patients, divided into an intervention group (42) and a control group (42), selected through purposive sampling. A pre- and post-intervention design was used to assess anxiety and depression levels before and after the ARIS Module, which incorporates Islamic spiritual practices such as guided prayer, reflection, and recitation. Results: The intervention group showed a statistically significant reduction in anxiety and depression levels. Patients also reported increased peace, spiritual connection, and emotional stability, enhancing their coping abilities and overall quality of life. Conclusions: The ARIS Module effectively reduced anxiety and depression in CHD patients, highlighting the value of integrating spiritual care into CHD treatment for mental and emotional health. Suggestions: It is recommended to incorporate programs like ARIS module into healthcare settings, with further research to explore its impact across diverse patient populations.

The Role of Plastic Stents in the Management of Pseudocysts: Cost-Effective Solutions and Clinical Advantages of Dual Stenting

Dear Editor, Pancreatic cysts represent a significant clinical entity in gastroenterology, frequently arising as sequelae of acute or chronic pancreatitis. These cysts are categorized based on the presence of necrotic material, which can be effectively identified through cross-sectional imaging techniques. Fluid-filled collections encapsulated by fibrous or granulation tissue are classified as pseudocysts, whereas collections with necrotic content are termed walled-off necrosis (WON). Clinical management becomes particularly critical when these cysts are symptomatic—manifesting as intractable pain, nausea, or vomiting—or when complications such as antimicrobial-resistant infections or mass effects on surrounding structures, including the biliary tract, are present. Endoscopic drainage is the cornerstone of treatment, with plastic and metallic stents serving as the primary tools. Economic constraints and clinical considerations often dictate the choice of stents, with plastic stents being the preferred option in resource-limited settings due to their cost-effectiveness and favorable clinical outcomes. Although metallic stents, such as lumen-apposing metal stents (LAMS), provide technical advantages—primarily their larger diameter for drainage—plastic stents have demonstrated comparable efficacy in many scenarios, particularly when the number of stents is optimized. Advantages of Dual Plastic Stenting Recent studies have underscored the advantages of dual plastic stent placement over single stenting for managing pancreatic pseudocysts [1]. Dual stenting offers several distinct benefits that enhance clinical outcomes and procedural safety. The primary advantage is the reduction of additional endoscopic interventions. When one stent becomes occluded by necrotic debris or viscous fluid, the second stent serves as a safeguard, maintaining drainage and reducing the need for repeated procedures [2]. A second notable benefit of dual stent placement is the stabilization of the newly formed fistulotomy tract in cases of stent migration. Larger pseudocysts, due to their size and intraluminal pressures, are particularly prone to this issue when managed with a single stent. If migration occurs, re-accessing the endoscopically created fistula tract for re-stenting can be challenging and may require a new puncture. Dual stent placement significantly reduces migration risk, enhances tract stability, and minimizes the need for unnecessary interventions [1]. Supporting Evidence Ghoneem et al. demonstrated the technical and clinical success of single wide-caliber plastic stents for pseudocyst drainage, albeit with stent occlusion as a potential limitation [2]. Similarly, Giri et al. reported superior drainage efficiency and a lower incidence of complications with dual stent placement [1]. Furthermore, a meta-analysis by Saunders et al. comparing plastic and metallic stents for pancreatic fluid collections revealed that while metallic stents offer certain advantages, plastic stents remain highly effective, especially in resource-constrained settings [3]. Although LAMS is gaining traction due to its ease of placement and larger luminal diameter, randomized trials have not consistently demonstrated its superiority over plastic stents [4]. These findings highlight the importance of cost-effectiveness and accessibility in stent selection, particularly in resource-limited environments where dual plastic stenting is a practical yet effective enhancement of standard techniques. Practical Considerations While dual stenting offers clear advantages, the procedure demands technical expertise. Ensuring proper positioning of the first stent before placing the second is crucial, as inadvertent migration during the procedure can complicate the intervention. This emphasizes the need for specialized training and experience among endoscopists managing pancreatic pseudocysts. CONCLUSION We advocate for the judicious use of plastic stents in managing pseudocysts, with dual stenting providing enhanced clinical outcomes and procedural safety. Further research comparing single and dual stenting strategies in diverse patient populations, along with randomized trials evaluating the long-term efficacy of plastic versus metallic stents, would offer invaluable insights.

Dermatology in Student-Run Clinics in the United States: Scoping Review.

Student-run clinics (SRCs) for dermatology hold potential to significantly advance skin-related health equity, and a comprehensive analysis of these clinics may inform strategies for optimizing program effectiveness. We aimed to perform a scoping review of the literature about dermatology SRCs across the United States. We conducted systematic literature searches of Ovid MEDLINE, Ovid Embase, and Scopus on March 1, 2023, and June 19, 2024. No date, language, or paper-type restrictions were included in the search strategy. A total of 229 references were uploaded to Covidence for screening by 2 independent reviewers (SK and LL), and 23 full-text documents were assessed for eligibility. After an additional 8 documents were identified through a gray literature search, a total of 31 studies were included in the final analysis. Inclusion criteria were as follows: (1) studies set in an SRC, which was operationally led by medical students and could render condition-relevant treatments to patients, with dermatology care; (2) published in English; (3) within the United States; (4) included characterization of any of the following: logistics, care, patients, or design; and (5) included all study or document types, including gray literature that was not peer reviewed (eg, conference abstracts, preprints, and letters to the editor). Exclusion criteria were (1) papers not published in English and (2) those with duplicated data or that were limited in scope or not generalizable. Data were extracted qualitatively using Microsoft Excel to categorize the studies by several domains, including clinic location, demographics, services offered, and barriers to care. There are at least 19 dermatology SRCs across the United States. The most common conditions encountered included atopic dermatitis; acne; fungal infections; benign nevi; psoriasis; and neoplasms, such as basal cell carcinoma, squamous cell carcinoma, and melanoma. Key facilitators for the clinics included faculty oversight, attending physician participation for biopsy histopathology, and dedicated program coordinators. Major barriers included lack of follow-up, medication nonadherence, and patient no-shows. Dermatology SRCs serve a diverse patient population, many of whom are underrepresented in traditional dermatology settings. This scoping review provides insights to help build stronger program foundations that better address community dermatologic health needs.

Effects of optimal versus suboptimal median household income on the surgically treated traumatic brain injury population at a level I trauma center in the Boston metropolitan area: a propensity score-matched analysis.

The median household income is a useful metric for healthcare disparity assessment. New England holds the highly diverse, densely populated Boston metropolitan area, which is known for having one of the highest living wages in the US. To the authors' knowledge, there is no published data on the effects of optimal versus suboptimal median household income on the surgical treatment of patients with traumatic brain injury (TBI). The authors sought to evaluate the disparities of an optimal versus suboptimal median household income-stratified population of patients with TBI who underwent surgical treatment at a single level I trauma center with a high safety-net burden in a major US metropolitan area. Demographic, clinical, and outcome data of patients who underwent surgery for TBI between 2015 and 2021 were collected and stratified based on optimal (≥ $80,000) and suboptimal (< $80,000) median residential household income. One-to-one tight caliper (0.01) propensity score matching was performed to balance the groups for comparative analysis. From the initial 144 patients in the optimal and 140 patients in the suboptimal income groups, 53 patients were included in each group after propensity matching. The suboptimal income group was significantly more ethnically diverse (p = 0.02), with significantly more ethnic minority patients (p = 0.05). Significantly more patients in the optimal income group presented as transfers from other hospitals (p < 0.001). Insurance status, injury mechanism, type and location, imaging features, length of ICU stay, and distribution of disposition destinations, as well as the follow-up time and outcome measures were not significantly different between the two groups after propensity matching. Although the suboptimal income group is significantly more ethnically diverse, median household income does not seem to affect TBI outcomes and discharge disposition. Patients in the optimal income group more frequently presented as transfers from other facilities, potentially indicating fair high-level care at a specialized trauma center with a high safety-net burden adapted to a diverse patient population.

Abstract IA002: Leveraging synthetic lethality for the development of novel cancer therapies

Abstract The concept of synthetic lethality has long held promise for the next generation of genetically targeted cancer therapies to follow the success of PARP inhibitors in the treatment of BRCA-mutant cancers. The classical definition of synthetic lethality arose in Drosophila with the observation that loss of either of two genes independently had little effect on cell viability but loss of both led to cell death. This definition has now been expanded to capture pairs of genes in which genetic alteration of one gene and pharmacological inhibition of the other leads to death of cancer cells while sparing the normal cells which lack the genetic alteration, leading to a broad therapeutic index. Functional genomics screening (using unbiased RNAi or CRISPR-based technology) has enabled the systematic discovery of novel synthetic lethal targets for drug discovery. The selective dependence of MTAP-deleted cells on PRMT5 is one of the strongest genetic interactions observed in early RNAi screens. Approximately 10-15% of all human cancer is MTAP-deleted, providing a large and diverse patient population. MTA-cooperative PRMT5 inhibitors, which bind preferentially in the presence of MTA, have been developed by scientists at Tango Therapeutics and elsewhere to leverage the synthetic lethal relationship between PRMT5 and MTAP loss. MTA-cooperative PRMT5 inhibitors inhibit PRMT5 in MTAP-deleted cancer cells and spare MTAP-expressing normal cells leading to clinically well-tolerated and efficacious therapies. MTA-cooperative PRMT5 inhibitors have broad therapeutic potential both as single agent and in combination with other therapies. Citation Format: Kimberly Briggs.Leveraging synthetic lethality for the development of novel cancer therapies. [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Optimizing Therapeutic Efficacy and Tolerability through Cancer Chemistry; 2024 Dec 9-11; Toronto, Ontario, Canada. Philadelphia (PA): AACR; Mol Cancer Ther 2024;23(12_Suppl):Abstract nr IA002.

A Prostate Imaging-Reporting and Data System version 2.1-based predictive model for clinically significant prostate cancer diagnosis.

To develop and validate a Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1 (v2.1)-based predictive model for diagnosis of clinically significant prostate cancer (csPCa), integrating clinical and multiparametric magnetic resonance imaging (mpMRI) data, and compare its performance with existing models. We retrospectively analysed data from patients who underwent prospective mpMRI assessment using the PI-RADS v2.1 scoring system and biopsy at our institution between April 2019 and December 2023. A 'Clinical Baseline' model using patient demographics and laboratory results and an 'MRI Added' model additionally incorporating PI-RADS v2.1 scores and prostate volumes were created and validated on internal and external patients. Both models were compared against two previously published MRI-based algorithms for csPCa using area under the receiver operating characteristic curve (AUC) and decision curve analysis. A total of 1319 patients across internal and external cohorts were included. Our 'MRI Added' model demonstrated significantly improved discriminative ability (AUCinternal 0.88, AUCexternal 0.79) compared to our 'Clinical Baseline' model (AUCinternal 0.75, AUCexternal 0.68) (P < 0.001). The 'MRI Added' model also showed higher net benefits across various clinical threshold probabilities and compared to a 'biopsy all' approach, it reduced unnecessary biopsies (defined as biopsies without Gleason Grade Group ≥2 csPCa) by 27% in the internal cohort and 10% in the external cohort at a risk threshold of 25%. However, there was no significant difference in predictive ability and reduction in unnecessary biopsies between our model and comparative ones developed for PI-RADS v2 and v1. Our PI-RADS v2.1-based mpMRI model significantly enhances csPCa prediction, outperforming the traditional clinical model in accuracy and reduction of unnecessary biopsies. It proves promising across diverse patient populations, establishing an updated, integrated approach for detection and management of prostate cancer.

Retinal Vascular Changes in Vitiligo: A Novel Approach Using OCTA

ABSTRACT Purpose This study aimed to the detect of structural and functional changes in the retina and choroid in patients with vitiligo using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Materials and Methods Thirty patients with vitiligo and 30 healthy participants were enrolled in the study. Central macular thickness (CMT), retina nerve fiber layer (RNFL) thickness, choroidal thickness (CT), foveal avascular zone (FAZ) area, and superficial and deep vascular density (VD) ratios were compared between the groups. Results The mean age was 43.32 ± 12.13 and 45.90 ± 7.50 years, respectively (p = 0.435). CMT, RNFL thicknesses (except temporal quadrant), CT, superficial and deep VD, and FAZ area were similar between the two groups (p > 0.05 for all). Temporal RNFL thicknesses were lower in vitiligo patients than in control groups (p = 0.005). There was a moderate negative correlation between the duration of vitiligo disease and the mean RNFL thickness, inferior RNFL thickness, superficial total, superior, superior inner, outer, and superior outer VD values. No correlation was found between the VASI (Vitiligo area scoring index) score in vitiligo patients and OCT and OCTA values. Conclusion Although it is known that vitiligo causes melanocyte loss in ocular tissues, there was no significant effect of vitiligo on superficial and deep retinal VD. Further comprehensive studies with a larger and more diverse population of vitiligo patients are needed to explore this further.

Quantitative proteomics analysis reveals the pathogenesis of obstructed defecation syndrome caused by abnormal expression of dystrophin.

Obstructed defecation syndrome (ODS) represents the most prevalent form of chronic constipation, affecting a diverse patient population, leading to numerous complications, and imposing a significant burden on healthcare resources. Most ODS patients have insufficient rectal propulsion, but the exact mechanism underlying the pathogenesis of ODS remains unclear. To explore the molecular mechanism underlying the pathogenesis of ODS. A total of 30 pairs of rectal samples were collected from patients with ODS (ODS group) or grade IV prolapsed hemorrhoids without constipation (control group) for quantitative proteomic and bioinformatic analysis. Subsequently, 50 pairs of paraffin-embedded rectal specimens were selected for immunohistochemistry and immunofluorescence studies to validate the analysis results. Human intestinal smooth cell contractile function experiments and electrophysiological experiments were conducted to verify the physiological functions of target proteins. Cellular ultrastructure was detected using transmission electron microscopy. In comparison to the control group, the expression level of dystrophin (DMD) in rectal specimens from ODS patients was markedly reduced. This finding was corroborated using immunohistochemistry and immunofluorescence techniques. The diminished expression of DMD compromised the contractile function of intestinal smooth muscle cells. At the molecular level, nucleoporin protein 153 and L-type voltage-gated calcium channel were found to be overexpressed in intestinal smooth muscle cells exhibiting downregulated DMD expression. Electrophysiological experiments confirmed an excessive influx of calcium ions into these cells. Moreover, vacuolar-like structures which may be associated with excessive calcium influx were observed in the cells by transmission electron microscopy. Decreased DMD expression in intestinal smooth muscle may upregulate L-type voltage-gated calcium channel expression, leading to excessive calcium influx which may cause a decrease in rectal propulsion, thereby contributing to the pathogenesis of ODS.

Identifying factors associated with disparities in accessing an Integrative Oncology program

Introduction: Integrative oncology (IO) programs provide patients with evidence-based complementary medicine therapies within a supportive and palliative cancer care setting. This study retrospectively examined characteristics of patients with lung cancer predicting utilization of a freely-provided IO consultation at two medical centers in Israel. Methods: Electronic medical files of 832 patients with lung cancer attending/not attending the IO consultation were searched for socio-demographic (age, gender, country of birth, place of residence, primary language spoken) and personal health (Body Mass Index; smoking; disability) characteristics; cancer-related parameters (primary tumor site, localized vs. metastatic); and reported pain- and emotional-related concerns. Results: Only 120 (14.4%) of eligible patients attended the IO consultation, with multivariate analysis finding a significantly lower likelihood of attendance among patients who were older (OR: 0.98, 95%CI=0.96-0.99; p=0.02); male (OR: 0.53, 95%CI=0.34-0.83; p=0.005); primarily non Hebrew-speaking (i.e., primarily Arabic or Russian speakers; OR: 0.34, 95%CI=0.14-0.82; p=0.016); without disability (OR: 0.52, 95%CI=0.33-0.92; p=0.025); and not reporting pain (OR=0.40,95%CI=0.17-0.98-; p=0.046). Conclusions: The present study suggests that age, gender and culture-related factors (reflected by the patient's primary language) may contribute to disparities in accessing a freely-provided IO consultation, as shown in a diverse population of patients with lung cancer from two medical centers in Israel. Further research is needed to better understand the role of these programs within a diverse, equitable and inclusive setting of effective and safe integrative care of oncology patients.

Psychometric Properties of the Chinese Version of Aberdeen Varicose Veins Questionnaire (AVVQ) in Patients With Varicose Veins of Lower Extremity: A Cross-Sectional Study.

Varicose veins in the lower extremities significantly impairs patients' quality of life, highlighting the importance of targeted quality of life assessments for specific diseases. The Aberdeen Varicose Vein Questionnaire (AVVQ) was specifically designed to assess the impact of lower extremity varicose veins on quality of life. This study comprised two phases: in the first phase, the AVVQ was translated and culturally adapted, and the second phase was an evaluation of the psychometric characteristics of the Chinese version of AVVQ in 328 patients with varicose veins of lower extremities. Confirmatory factor analysis revealed that the Chinese AVVQ comprises 13 items distributed across four dimensions, accounting for a total variance of 61.74%, with a Cronbach's α of 0.745 and a content validity index of 0.908. Furthermore, there was a negative correlation between the AVVQ scores and the SF-36. In addition, the difference in AVVQ scores by CEAP classification was statistically significant. These findings affirmed the Chinese version of the AVVQ as both reliable and valid, making it a valid tool for evaluating the quality of life in Chinese patients with varicose veins and applicable across various international contexts and diverse patient populations.

Aotearoa New Zealand Tongan residents’ attitudes to chronic cough and access to healthcare

Little is known about the unique attitudes of Aotearoa New Zealand Tongan residents to chronic cough and healthcare access. Chronic cough is synonymous with respiratory conditions and delayed assessment and management may result in detrimental effects on quality of life, hospital admission, and mortality. Talanoa were undertaken with seven Tongan adults to explore attitudes to chronic cough and healthcare access that may facilitate or inhibit diagnosis and management. Three key themes were constructed representing disruption to dimensions of the Fonua model of health and an imbalance between the interconnectivity of life’s dimensions: (1) “feeling the cold” and the “warmth of remedies”; (2) the multidimensional impact of cough and action/inaction taken; and (3) discrepancies between understanding and accessing cough care, including respiratory physiotherapy. Study findings highlight the importance of increased community understanding of chronic cough and why and how to better access care pathways. Appreciation of the unique cultural nuances and health models of diverse patient populations, including Tongan, is essential to enhance engagement and ensure culturally responsive practice is provided. The promotion and marketing of respiratory physiotherapy in cough management is also required so that people understand, access, and engage with therapies to optimise their respiratory health.

Apixaban versus enoxaparin to prevent venous thromboembolism in post-operative patients with gynecologic cancers at an urban academic medical center

ObjectiveA recent clinical trial demonstrated that the use of apixaban was safe and equal to enoxaparin (LMWH) in post-operative gynecologic oncology patients. This study aimed to determine if these findings are applicable in a diverse patient population at a single site urban academic medical center. MethodsThis was a retrospective cohort study of patients who underwent an exploratory laparotomy for confirmed or presumed gynecologic cancer from the years 2017–2023 at a single-site urban academic medical center. Venous thromboembolism (VTE) prophylaxis with LMWH was standard practice at our institution up until January 2021 after which apixaban became standard for post-operative prophylaxis in our division. Baseline demographic and clinical characteristics of patients receiving apixaban post-operatively were compared to the population previously receiving enoxaparin. The primary outcome was a VTE event within 90days of surgery. Secondary outcomes included major and minor bleeding events. ResultsTwo hundred fifteen patients met inclusion criteria, of which 65 were discharged on enoxaparin and 150 were discharged on apixaban. Baseline characteristics in terms of age, race/ethnicity and BMI found no significant difference between the two groups. Rates of any VTE event within 90 days of surgery were similar for apixaban and LMWH (3.33 % vs. 4.61 %, p = 0.6). Secondary outcomes demonstrated that the rate of a major bleeding event in apixaban group was 1.31 % and LMWH group was 3.08 %, (p = 0.38). Minor bleeding events in the apixaban group were comparable to the LMWH group (10.60 % vs 10.16 %, p = 0.5). ConclusionsIn this real world, urban setting, for women undergoing laparotomy for gynecologic cancer, apixaban as post-operative VTE prophylaxis showed no increase in VTE events and appeared safe with no increase in bleeding events compared to LMWH. This study adds to the literature demonstrating that apixaban is safe and effective for VTE prophylaxis in our gynecologic oncology patients.

Real-life study on the effectiveness and safety of sofosbuvir/velpatasvir-based antiviral agents for HCV eradication in Chinese patients

BackgroundHepatitis C virus (HCV) eradication with Sofosbuvir/velpatasvir (SOF/VEL) represents a significant advancement, offering hope for eliminating the virus in diverse patient populations. But real-world data on its effectiveness and safety remains scarce for patients with chronic hepatitis C (CHC) in China, especially those with HCV GT3b, cirrhosis, HCC, or HCV/HBV, HCV/HIV, or HCV/HBV/HIV coinfection. MethodsIn this real-world prospective observational study, we recruited patients from West China Hospital and Public Health Clinical Center of Chengdu in China. Patients included adults chronically infected with any HCV genotype, either with or without cirrhosis, HCC, HCV/HBV, HCV/HIV, or HCV/HBV/HIV coinfection. Patients were administered with SOF/VEL (400/100 mg) ± ribavirin (RBV) once daily for 12 weeks. The primary effectiveness endpoint was sustained virological response at post-treatment Week 12 (SVR12). Adverse events (AEs) were evaluated during treatment. ResultsThe study included 483 patients, with HCV genotypes 1, 2, 3, 6 and uncertain. Among them, 35.4% (171/483, ITT) and 36.7% (166/452, mITT) received SOF/VEL + RBV. At EOT, 99.2% (ITT, 479/483) and 99.1% (mITT, 448/452) of patients had undetectable HCV RNA. The SVR12 rates were 92.8% (ITT, 448/483) and 99.1% (mITT, 448/452). In mITT analysis, the SVR12 for patients infected with HCV GT3b, patients with cirrhosis or HCC, and patients coinfected with HBV/HIV was 99.2% (130/131), 99.4% (168/169), and 97.6% (40/41), respectively. ALBI (-3.01 vs. -3.18 P<0.001), FIB4 (2.53 vs. 1.88, P=0.004) and APRI (0.99 vs. 0.44, P<0.001) showed a significant decrease from baseline to SVR12. None of the involved patients experienced grade 3-5 AEs. ConclusionsAlthough included a high proportion of patients with HCV GT3b, cirrhosis, HCC, or HCV/HBV, HCV/HIV, or HCV/HBV/HIV coinfection, SOF/VEL ± RBV was highly effective and well tolerated in patients with CHC in China.

“Developing a manual clinical trials screening process in a diverse southern gynecologic oncology practice”

ObjectiveThere is no standard clinical trial screening process in gynecologic oncology. In our low resource, highly diverse gynecologic oncology patient population, we sought to create an equitable, adaptable, manual screening process. MethodsOur objective is to describe our clinical trial screening process and success in improving trial enrollment. An Institutional Review Board (IRB) approved quality improvement (QI) project was implemented in July 2022 to evaluate trial access. Screenable events were defined. Potential patients were those with a screenable event: new patients or diagnoses, regimen changes, progressions, and recurrences. Events were categorized into screen positive or screened no trial available. Screen positives were further categorized as screen positive, enrollment failure events or enrollments. Data about patients were collected via weekly research team meetings. Monthly meetings occurred to review progress. The data were compared to trials available, number of patients with trail available, and those that enrolled. Reasons for enrollment fails were tracked. ResultsOver time, “screen no trial available” (SNTA) rates stayed stable, but enrollment rates increased. Patient preference accounted for 32.8 % of enrollment failures (n = 42), pre-existing symptoms 23.4 % (n = 30), and location 21.1 % (n = 27). During increased employee turnover, there was a rise in enrollment fails due to staffing (n = 6, 4.7 %). We describe an effective process of clearly defining and tracking our patient population and ‘screenable events’ for which all patients are screened and offered trial participation if eligible. ConclusionsWe show that we improved understanding of the patient population, built a clinical trial portfolio better matched to population served, exceeded national averages for enrolling patients on trials, and are improving number eligible.

A Preliminary Study on Effectiveness of Varying Dose of Paretic Upper Limb Training with Visual Deprivation in Poststroke Patients: A Randomised Clinical Tria

Introduction: Poststroke Upper Limb (UL) rehabilitation with visual deprivation has shown potential in enhancing motor recovery through neural plasticity. However, the optimal dosage remains unclear. Aim: To evaluate the effectiveness of varying doses of paretic UL training with visual deprivation in stroke patients. Materials and Methods: This single-centre, parallel-group, single-blinded, randomised clinical trial involved 36 stroke patients who were randomly distributed into three groups varying in treatment frequency: Group A (n=12) received two sessions per week, Group B (n=12) received three sessions per week, and Group C (n=12) received five sessions per week for four weeks. Each session lasted 40 minutes of visual deprivation training for the paretic UL. A trained physiotherapist, who was blinded to group allocation, conducted pre- and postevaluations. The Wolf Motor Function Test was the principal outcome measure. This study utilised Analysis of Variance (ANOVA) for between group comparisons and independent sample t-tests for within group pre-post comparisons, with a significance level of 5%. Results: Out of the 36 study participants, three dropouts were recorded by the completion of the study: one from Group A and two from Group B. The average age of participants was 54.75±8.06 years, and the duration of stroke was 10.08±4.35 months, with 69.4% experiencing left-sided involvement. All groups showed significant improvement. Group C exhibited the highest improvement in the Wolf Motor Function Test score, with an F value of 42.86 (p-value=0.001). Post-hoc analysis revealed a significant difference in motor score improvement in Group C, (p-value=0.001). Additionally, Group C demonstrated greater improvements in the Wolf Motor Functional Ability Score (WMFAS), with a mean improvement of 15.00±0.82 (F=158.00, p-value=0.001). Conclusion: Visual deprivation training with higher intensity (five sessions per week) was effective in improving UL motor function in poststroke patients, proving superior to lower intensity (two or three sessions per week). These results highlight the importance of frequent training. Future research with larger and more diverse stroke patient populations, as well as long-term follow-up studies, is needed to validate these findings.

Recognizing and Advancing Leadership in Dermatology: Promoting the Health Care Administration, Leadership, and Management Subspecialty.

The recognition and development of leadership training within dermatology has taken on new importance in recent years. In Spring 2023, the American Board of Medical Specialties announced the launch of the Health Care Administration Leadership and Management (HALM) subspecialty, co-sponsored by multiple American Boards, including the American Board of Dermatology. The skills and credentials earned through HALM can enhance career opportunities for dermatologists seeking to achieve executive positions in large practice groups and industries while fostering interprofessional partnerships. Dermatologists are uniquely poised to integrate health care leadership and health systems approaches into clinical practice given broad exposure to diverse patient populations, care delivery settings, and payer contexts. Two pathways have been proposed for achieving HALM certification: a "practice-only" pathway and a fellowship pathway that provides a specialized post-residency curriculum. A HALM certification examination will be the final requirement for certification under both pathways. The HALM certification represents a valuable opportunity for dermatologists to enhance their ability to be physician leaders within the health care landscape. HALM also offers an institutionalized and structured avenue with protected time for physicians to develop leadership skills. Dermatologists taking on management roles within health care can both shape the current system from their unique vantage points and elevate the specialty's presence. Leadership training such as HALM can not only foster individual career prospects - including qualifying for executive roles in larger practices and industry - but also boost intersectoral collaborations between dermatologists and providers, payers, industry, and policymakers broadly. J Drugs Dermatol. 2024;23(12):e191-e194. doi:10.36849/JDD.8482e.

A Review on Knowledge of Diabetes, Medication Adherence, and Factors associated with Non- adherence among Diabetes Mellitus Type 2 Patients

Background: This review paper addresses the critical issue of medication adherence among patients with Type 2 Diabetes Mellitus (T2DM). This review paper aims to evaluates the current literature on prevalence of medication adherence among patients with Type 2 Diabetes Mellitus, assesses the level of knowledge regarding diabetes mellitus and its association with medication adherence. In addition, to identify and analyse the factors contributing to non-adherence to medication among individuals with Type 2 Diabetes Mellitus. Methods: The authors conducted a thorough literature review using databases such as ProQuest, PubMed, ScienceDirect, and Google Scholar. They focused on peer-reviewed articles published between 2019 and 2024, employing keywords related to medication adherence, knowledge, and sociodemographic factors. A total 25 studies selected for inclusion, utilizing various methodologies including quantitative, qualitative, and interventional approaches. Results: The findings revealed significant variability in medication adherence rates among T2DM patients, ranging from 35.8% to 67.5%. Key factors influencing adherence included sociodemographic characteristics such as age, gender, ethnicity, education level, and economic status. Higher levels of diabetes knowledge were associated with better adherence, although the relationship was not universally significant, indicating that other factors also play a role. Conclusion: The review concludes that enhancing medication adherence among T2DM patients requires targeted interventions that address identified barriers, including educational deficits and socioeconomic challenges. Further research is recommended to develop effective educational strategies tailored to diverse patient populations, ultimately aiming to improve health outcomes and adherence rates in this critical area of public health.