Effects Of Patient Characteristics Research Articles

Effect of Patient Characteristics, Including Cardiothoracic Ratio, on Vessel Enhancement in Coronary Computed Tomography Angiography

Effect of Patient Characteristics, Including Cardiothoracic Ratio, on Vessel Enhancement in Coronary Computed Tomography Angiography

Efficacy and Safety of Anti-calcitonin Gene-Related Peptide (CGRP) Monoclonal Antibodies in Preventing Migraines: A Systematic Review.

The neuropeptide calcitonin gene-related peptide (CGRP) is an essential pathophysiological treatment for migraines. A unique class of medications called CGRP monoclonal antibodies target CGRP and its receptor and have demonstrated promising benefits in the treatment and prevention of migraines. This study sought to identify and assess the quality of existing systematic reviews about the effectiveness of CGRP antibodies for preventing migraines, as well as systematically review and synthesize the evidence on these topics. This included the four Food and Drug Administration (FDA)-approved medications erenumab, galcanezumab, fremanezumab, and eptinezumab. The effectiveness and safety of these monoclonal antibodies in preventing migraines should also be examined in light of patient characteristics, and any gaps in the body of knowledge should be noted in order to suggest new lines of investigation. Data gathering included a thorough search of internet databases (PubMed, Cochrane Library, Web of Science, and Scopus) for relevant research released between 2018 and 2023. The findings imply that CGRP monoclonal antibodies are efficient and secure for preventing migraines and may be considered a first-line alternative for treating migraines and drug misuse. The results further imply that combination treatment with CGRP antibodies and onabotulinumtoxinA may enhance the prevention of migraine in adults. With suggestions for more studies to find and address these variables, the significance of genetic and epigenetic factors in the progression of pediatric patients' acute postoperative pain to chronic postsurgical pain is underlined. All four anti-CGRP monoclonal antibodies, erenumab, fremanezumab, galcanezumab, and eptinezumab, were shown to be safe and effective for the prevention of migraine when the research additionally looked at their individual effectiveness and safety. Additionally, the study discovered considerable variances in effectiveness amongst various groups. However, further investigation is required to establish the best time and dosage and the effect of patient characteristics on the effectiveness and safety of these medications.

225. PREDICTORS OF ANASTOMOTIC LEAK AMONG PATIENTS UNDERGOING ESOPHAGECTOMY: A RETROSPECTIVE COHORT OF 6669 PATIENTS

Abstract Background Despite advances in operative techniques, anastomotic leak (AL) after esophagectomy remains a dreaded complication associated with a relatively high morbidity and mortality. Identification of patient and surgical factors associated with AL are useful for risk stratification to improve patient and procedure selection. Furthermore, an adequately powered analysis for the incidence of AL after minimally invasive esophagectomy is lacking. Methods The ACS-NSQIP database was used to extract patients who underwent esophagectomy between 2016 and 2021. Categorical variables were analyzed using chi-squared tests and continuous variables were evaluated using ANOVA tests. Using a hypothesis driven purposeful selection methodology, a multivariable logistic regression model was created with the primary outcome of interest being the odds of AL. Statistical analysis was completed with StataSE 17 (STATACorp, LP, College Station, TX). The primary outcome of interest was the effect of minimally invasive surgery on AL. Secondary outcomes were the effect of patient characteristics and surgeon specialty on AL. Results Of the 6669 esophagectomies, the leak rates were 14.6% (open; 360/2451), 13.4% (MIS-abdominal; 64/478), 21.1% (MIS-chest; 69/326), 14.3% (MIS-total; 369/2590), and 20.1% (Robotic; 166/824), respectively. On multivariate analysis, positive margin (OR 1.37, 95% CI 1.01–1.85, p = 0.043), MIS-chest (OR 1.40, 95% CI 1.01–1.96, p = 0.047), MIS-total (OR 0.95, 95% CI 0.78–1.15, p = 0.595), MIS-robotic (OR 1.37, 95% CI 1.07–1.77, p = 0.014), transhiatal esophagectomy (OR 1.28, 95% CI 1.01–1.62, p = 0.040), and three-hole esophagectomy (OR 1.38, 95% CI 1.12–1.77, p = 0.014) were surgical factors associated with increased odds of AL (Table 1). Conclusion Anastomoses that were performed by certain types of minimally invasive surgery and those performed in the cervical region were associated with increased odds of AL. Consideration of this increased risk needs to be weighed against the established benefits of minimally invasive surgery when selecting the appropriate procedure for each patient. Identifying patients who are high-risk for an AL pre-operatively may prevent delay in the diagnosis and treatment of ALs in this patient population.

The Effects of Patient Characteristics on the Management of Subclinical Hypothyroidism: A Survey of Faculty and Trainees

ObjectiveThere is no universal approach to the management of subclinical hypothyroidism (SCH). This study was designed to determine the impact of patient characteristics on management decisions in SCH amongst physician faculty members and trainees. MethodsAn online survey was distributed to faculty members and medical trainees (ie, interns, residents, and fellows) at multiple academic medical centers. The survey included 9 clinical scenarios describing women with SCH with 5 management options sequenced from most “conservative” (no further treatment or monitoring) to most “aggressive” (treatment with levothyroxine). ResultsOf the 194 survey respondents, 95 (49.0%) were faculty members and 99 (51.0%) were trainees. Faculty members were more likely to report being “confident” or “very confident” in making the diagnosis of SCH compared to trainees (95.8% vs 46.5%, P < .001). Faculty members were also more likely to consider patient preference for treatment (60.0% vs 32.3%, P < .001). Among all respondents, the clinical factors that resulted in the highest predicted probability of treatment were hypothyroid symptoms (predicted probability [PP] 68.8%, 95% CI [65.7%-71.9%]), thyroid stimulating hormone >10 mIU/L in a 31-year-old (PP 63.9%, 95% CI [60.3%-67.3%]), and the desire for fertility (PP 52.2%, 95% CI [48.6%-56.0%]). In general, faculty members favored more aggressive treatment across all clinical scenarios. ConclusionThe presence of symptoms, thyroid stimulating hormone >10 mIU/L, and desire for fertility were most predictive of the decision to treat in SCH. In several clinical scenarios, both trainee and faculty decision-making demonstrated discordance with general SCH management principles.

Effect of patient characteristics on the efficacy and safety of imeglimin monotherapy in Japanese patients with type 2 diabetes mellitus: A post-hoc analysis of two randomized, placebo-controlled trials.

Substantial variability in demographic and clinical characteristics exists among patients with type 2 diabetes mellitus, which may impact treatment. This post-hoc analysis evaluated the efficacy and safety of imeglimin 1,000 mg twice daily (BID) monotherapy in type 2 diabetes mellitus patients according to demographic and clinical characteristics. Data were pooled from two placebo-controlled, 24 week, randomized, double-blind studies in adults with type 2 diabetes mellitus. Outcomes (least squares mean [LSM] change in HbA1c from baseline to week 24, and safety) were analyzed according to subgroups based on demographics, clinical characteristics, and comorbidities. The difference in LSM change in HbA1c from baseline to week 24 was statistically significant for imeglimin vs placebo in all patient subgroups analyzed (P < 0.05 each), including demographics (age, body mass index), clinical characteristics (duration of type 2 diabetes mellitus, chronic kidney disease [CKD] stage, and prior medication use) and comorbidities (hypertension, dyslipidemia, risk of hepatic fibrosis and liver function parameter status). A statistically significant separation from placebo in HbA1c was observed at week 4 and maintained through week 24. No new safety concerns were identified with imeglimin in any patient subpopulations. The efficacy and safety of imeglimin was demonstrated across patient subgroups, irrespective of baseline demographic and clinical characteristics. Our findings confirm the efficacy and safety of imeglimin across a broad spectrum of patients with type 2 diabetes mellitus.

Anastomotic leaks and the relationship with anastomotic strictures after esophageal atresia surgery; effects of patient characteristics

Background This study aimed to evaluate the link between anastomotic leaks (AL) and anastomotic strictures (AS) after esophageal atresia surgery and the influence of patient demographics. Materials and methods The clinical data of neonates who underwent surgical repair for esophageal atresia were retrospectively reviewed. The results of AL treatment and the relationship with AS, also the effects of patient characteristics were examined with logistic regression analysis. Results Primary repair was performed on 122 of 125 patients who underwent surgery for esophageal atresia. AL occurred in 25 patients and 21 were treated non-operatively. While 4 patients were re-operated, AL recurred in 3 and led to the death of one. There was no correlation between the development of AL and sex or the presence of additional anomalies. The gestational age and birth weight of patients with AL were significantly higher than those of patients without. AS developed in 45 patients. The mean gestational age was significantly higher in patients who developed AS (p < .001). While the development of AS was significantly higher in patients with AL (p = .001), the number of dilatation sessions needed was also significantly higher in these patients (p = .026). Complications related to anastomosis were less common in patients whose gestational age was ≤33 weeks. Conclusion Non-operative treatment remains effective for AL after esophageal atresia surgery. AL increases the risk of developing AS and significantly increases the number of dilatation sessions needed. Anastomotic complications are less common in patients with lower gestational age. NOVEL ASPECTS Gestational age and birth weight were found to be significantly higher in patients with anastomotic leaks than in those without and fewer anastomotic complications were encountered in patients whose gestational age was ≤ 33 weeks. Anastomotic stricture development was significantly higher in patients with anastomotic leaks and the number of dilatation sessions needed for treatment was also significantly higher in these patients.

Patient characteristics and clinical factors affecting lumpectomy cavity volume: implications for partial breast irradiation.

Partial breast irradiation (PBI) has increased in utilization, with the postoperative lumpectomy cavity and clips used to guide target volumes. The ideal timing to perform computed tomography (CT)-based treatment planning for this technique is unclear. Prior studies have examined change in volume over time from surgery but not the effect of patient characteristics on lumpectomy cavity volume. We sought to investigate patient and clinical factors that may contribute to larger postsurgical lumpectomy cavities and therefore predict for larger PBI volumes. A total of 351 consecutive women with invasive or in situ breast cancer underwent planning CT after breast-conserving surgery at a single institution during 2019 and 2020. Lumpectomy cavities were contoured, and volume was retrospectively computed using the treatment planning system. Univariate and multivariate analyses were performed to evaluate the associations between lumpectomy cavity volume and patient and clinical factors. Median age was 61.0 years (range, 30-91), 23.9% of patients were Black people, 52.1% had hypertension, the median body mass index (BMI) was 30.4 kg/m², 11.4% received neoadjuvant chemotherapy, 32.5% were treated prone, mean interval from surgery to CT simulation was 54.1 days ± 45.9, and mean lumpectomy cavity volume was 42.2 cm3 ± 52.0. Longer interval from surgery was significantly associated with smaller lumpectomy cavity volume on univariate analysis, p = 0.048. Race, hypertension, BMI, the receipt of neoadjuvant chemotherapy, and prone position remained significant on multivariate analysis (p < 0.05 for all). Prone position vs. supine, higher BMI, the receipt of neoadjuvant chemotherapy, the presence of hypertension, and race (Black people vs. White people) were associated with larger mean lumpectomy cavity volume. These data may be used to select patients for which longer time to simulation may result in smaller lumpectomy cavity volumes and therefore smaller PBI target volumes. Racial disparity in cavity size is not explained by known confounders and may reflect unmeasured systemic determinants of health. Larger datasets and prospective evaluation would be ideal to confirm these hypotheses.

Risk of relapse and readmission among hospitalized adults with carbapenem non-susceptible gram-negative infections

Background Infections caused by carbapenem-nonsusceptible gram-negative (C-NS) pathogens are associated with increased mortality and high treatment costs. Identification of potentially modifiable factors that may improve patient outcomes is important for better management of C-NS GN infections. Methods This was a retrospective study of hospitalized adults with electronic health record evidence of complicated urinary tract infection (cUTI), bacterial pneumonia (BP), complicated intra-abdominal infection (cIAI), or bacteremia (BAC) due to C-NS GN organisms from January 2013 to March 2018. Treatment patterns and clinical characteristics during the index hospitalization were analyzed descriptively and stratified by infection site(s). The effect of patient characteristics on index infection relapse during the postdischarge period and on readmission with 30 days was modeled using logistic regression. Results The study included 2,862 hospitalized patients with C-NS GN infections. Index infection sites were 38.4% cUTI ± BAC, 21.5% BP ± BAC, 18.7% cUTI + BP ± BAC, 14.7% any cIAI, and 6.7% BAC only. The majority of patients (83.6%) received an antibiotic during their index hospitalization; among these, the most common classes given were penicillins (52.9%), fluoroquinolones (50.7%), and carbapenems (38.9%). During the postdischarge period, 21.7% of patients had a relapse of the index infection and 63.9% of patients were readmitted to the hospital. Factors associated with increased adjusted odds ratio (OR) for relapse or readmission included Charlson comorbidity score of ≥3 relative to 0 (relapse: OR [95% CI] = 1.34 [1.01–1.76], p = .040; readmission: OR [95% CI] 1.92 [1.50–2.46], p < .001), preindex immunocompromised status (relapse: OR [95% CI] 1.37 [1.05–1.79], p = .019; readmission: OR [95% CI] = 1.60 [1.27–2.02], p < .001), and preindex carbapenem use (relapse: OR [95% CI] = 1.35 [1.07–1.72], p = .013; readmission: OR [95% CI] = 1.25 [1.00–1.57], p = .048). Conclusions Adverse postdischarge outcomes were common among hospitalized patients with C-NS GN infections and were significantly associated with previous carbapenem use and patient clinical characteristics such as higher comorbidity burden and immunocompromised status. Adoption of antimicrobial stewardship and consideration of individual patient risk factors in making treatment decisions may help improve clinical outcomes.

Effect of patient characteristics on vessel enhancement on arterio-venous fistula CT angiography in a retrospective cohort study.

To evaluate the effects of various patient characteristics on vessel enhancement on arterio-venous fistula (AVF) computed tomography (CT) angiography (AVF-CT angiography). A total of 127 patients with suspected or confirmed shunt stenosis and internal AVF complications were considered for inclusion in a retrospective cohort study. The tube voltage was 120 kVp, and the tube current was changed from 300 to 770 mA to maintain the image quality (noise index: 14) using automatic tube current modulation. To evaluate the effects of age, sex, body size, and scan delay on the CT number of the brachial artery or vein, we used correlation coefficients and multivariate regression analyses. There was a significant positive correlation between the CT number of the brachial artery or vein and age (R = 0.21 or 0.23, P < .01). The correlations were inverse with the height (r = -0.45 or -0.42), total body weight (r = -0.52 or -0.50), body mass index (r = -0.21 or -0.23), body surface area (body surface area [BSA]; r = -0.56 or -0.54), and lean body weight (r = -0.55 or -0.53) in linear regression analysis (P < .01 for all). There was a significant correlation between the CT number of the brachial artery or vein and scan delay (R = 0.19 or 01.9, P < .01). Only the BSA had significant effects on the CT number in multivariate regression analysis (P < .01). The BSA was significantly correlated with the CT number of the brachial artery or vein on AVF-CT angiography.

Effect of Patient Characteristics on Uptake of Screening Using a Mailed Human Papillomavirus Self-sampling Kit

Mailing human papillomavirus (HPV) self-sampling kits increases cervical cancer screening participation, but effects may differ across subpopulations. Subpopulation data can inform US health care system implementation. To identify patient characteristics that modify effectiveness of a mailed kit intervention at increasing screening. This was a secondary analysis of data from the Home-Based Options to Make Cervical Cancer Screening Easy (HOME) randomized clinical trial conducted from 2014 to 2018 at Kaiser Permanente Washington. Data analysis was performed from March 2018 to May 2022. Individuals aged 30 to 64 years with female sex, health plan enrollment longer than 3 years and 5 months, a current primary care clinician, and no Papanicolaou test within the prior 3 years and 5 months were identified through electronic medical records and randomized (1:1) to the control or intervention group. The control group received usual care Papanicolaou screening reminders and outreach. The intervention group received usual care plus an unsolicited mailed HPV self-sampling kit. Screening uptake was captured within 6 months after randomization. Baseline patient characteristics (age, race, ethnicity, travel time to clinic, income, body mass index, tobacco use, health plan enrollment duration, time since last Papanicolaou test, mammography, comorbidities, and colorectal cancer screening adherence) were extracted from the electronic medical record. Of 19 734 individuals (mean [SD] age, 50.1 [9.5] years; 14 129 [71.6%] White), 9843 were randomized to the intervention group, and 9891 were randomized to the control group. Screening uptake was 26.3% (2592 of 9843 individuals) in the intervention group vs 17.4% (1719 of 9891 individuals) in the control group (relative risk [RR], 1.51; 95% CI, 1.43-1.60). Although absolute differences in uptake by group varied little by screening history, relative effects were greater with longer vs shorter time since last Papanicolaou test (no prior Papanicolaou test: RRs, 1.85-3.25; ≥10 years: RR, 2.78; 5-10 years: RRs, 1.69-1.86; <5 years: RRs 1.29-1.37). Relative effects were greater in participants overdue (RR, 2.03; 95% CI, 1.73-2.38) vs up-to-date with mammography (RR, 1.53; 95% CI, 1.41-1.67), although absolute difference was greater in the up-to-date group. Differences by age were not significant, with RRs of 1.33 to 1.48 across 5-year age groups in participants 30 to 54, vs 1.60 (95% CI, 1.40-1.82) in participants 55 to 59 and 1.77 (95% CI, 1.56-2.01) in participants 60 to 64 years. Among those mailed kits, there were differences in kit use vs in-clinic screening by age, race, plan enrollment duration, underscreening duration, and colorectal cancer screening adherence. In this secondary analysis of a randomized clinical trial, clinically important improvements in screening uptake were observed for all subgroups. Differences in magnitude of intervention effect and kit use highlighted opportunities to optimize HPV self-sampling for priority groups. ClinicalTrials.gov Identifier: NCT02005510.

The effect of patient characteristics on illness perception and sun protection behaviors in melasma.

Melasma, a significant cosmetic problem, has been accepted by some authors as a photoaging illness in recent times. There is no published study evaluating the effects of the clinical and sociodemographic findings on illness perception and sun protection behaviors (SPBs) in patients with melasma. Sociodemographic data, personal characteristics, and clinical features of 150 patients with melasma were recorded in this cross-sectional study. They were analyzed for their SPBs in three groups as "never," "rarely/sometimes," and "often/always." Patients completed the Melasma Quality of Life (QoL) Scale and Revised-Illness Perception Questionnaire. Melasma patients with higher clinical severity and Qol scores, lower education level, concomitant chronic illness, and a history of previous melasma treatment thought more frequently that melasma had negative serious consequences. Majority of the patients blamed sun exposure as the cause of the melasma. However, SPBs were more frequent only in patients with higher socioeconomic and educational levels, a previous history of melasma treatment, and evaluating their disease as a chronic condition. Neither Qol nor clinical severity score had a significant effect on sun exposure causal attribution or SPBs. No significant effect of patients' perception of melasma was determined on the use of sunscreen or protective hat. Being aware of the factors affecting the perception of melasma and QoL of patients might be helpful in making persistent individual recommendations for the regulation of SPBs.

Testosterone Recovery after Neoadjuvant Gonadotropin-Releasing Hormone Antagonist versus Agonist on Permanent Iodine-125 Seed Brachytherapy in Prostate Cancer Patients: A Propensity Score Analysis.

Optimal neoadjuvant hormone therapy (NHT) for reducing prostate cancer (PC) patients' prostate volume pre-brachytherapy is controversial. We evaluated the differential impact of neoadjuvant gonadotropin-releasing hormone (GnRH) antagonist versus agonist on post-brachytherapy testosterone recovery in 112 patients treated pre-brachytherapy with NHT (GnRH antagonist, n=32; GnRH agonists, n=80) (Jan. 2007-June 2019). We assessed the effects of patient characteristics and a GnRH analogue on testosterone recovery with logistic regression and a propensity score analysis (PSA). There was no significant difference in the rate of testosterone recovery to normal levels (> 300 ng/dL) between the GnRH antagonist and agonists (p=0.07). The GnRH agonists induced a significantly more rapid testosterone recovery rate at 3 months post-brachytherapy versus the GnRH antagonist (p<0.0001); there was no difference in testosterone recovery at 12 months between the GnRH antagonist/agonists (p=0.8). In the multivariate analysis, no actor was associated with testosterone recovery. In the PSA, older age and higher body mass index (BMI) were significantly associated with longer testosterone recovery. Post-brachytherapy testosterone recovery was quicker with the neoadjuvant GnRH agonists than the antagonist, and the testosterone recovery rate was significantly associated with older age and higher BMI. Long-term follow-ups are needed to determine any differential effects of GnRH analogues on the quality of life of brachytherapy-treated PC patients.

Effect of patient characteristics on posttraumatic stress disorder treatment retention among veterans: A systematic review.

To identify baseline patient characteristics (i.e., demographic and psychological factors, military background) associated with better posttraumatic stress disorder (PTSD) treatment retention among veterans, we conducted a systematic review. After an electronic database search for studies of PTSD treatment in veterans, two reviewers independently screened the literature for eligibility, abstracted study-level information, and assessed risk of bias. As most studies used multivariate models to assess multiple potential predictors of retention simultaneously, the results were described narratively. The GRADE approach, adapted for prognostic literature, was used to assess the overall quality of evidence (QoE). In total, 19 studies reported in 25 publications met the inclusion criteria (n=6 good quality, n=9 fair quality, n=4 poor quality). Definitions of treatment completion and dropout varied, and some studies lumped different therapy approaches together. Older age and higher treatment expectations were associated with better retention (moderate QoE). In 5 of 6 studies, baseline PTSD severity was not associated with retention, and the remaining study reported an association between better retention and more severe PTSD symptoms; the presence of more co-occurring psychiatric disorders was associated with better retention (moderate QoE). QoE was low or insufficient to support conclusions for any other characteristics due to inconsistent results, imprecision, potential publication bias, possible study population overlap, study limitations, or lack of studies. More research is needed regarding the associations between modifiable factors (e.g., motivation, barriers, expectations) and retention, and consistent definitions of treatment completion and minimally adequate treatment should be adopted throughout the field.

Patient Characteristics and Clinical Factors Affecting Seroma Volume

Partial breast irradiation (PBI) has increased in utilization recently, with the postoperative seroma and clips used to guide target volumes. The ideal post-surgical timing to perform computed tomography (CT)-based treatment planning for this technique is unclear. Prior studies have examined change in volume over time from surgery, however, the effect of patient characteristics on seroma volume has not been previously reported. We sought to investigate patient and clinical factors that may contribute to larger post-surgical seromas, and therefore would predict for larger PBI volumes.212 consecutive women with invasive or in situ breast cancer underwent planning CT after breast-conserving surgery at a single institution with four radiation centers during the year 2020. 215 total lumpectomy cavities were contoured per institutional standard. Contoured volume was computed using the treatment planning system. Generalized estimating equation methods were used to analyze the combined data, using treatment center as the cluster effect. Univariate and multivariate analyses (MVA) were performed to evaluate the associations between the seroma volume and patient and clinical factors.Distribution among sites were 61 patients (28.4%), 24 patients (11.2%), 57 patients (26.5%), and 73 patients (34.0%). Patient characteristics included median age 61.0 years (range, 30-85) and median BMI 30.1 kg/m² (17.3-53.9). 94% of patients did not receive neoadjuvant hormone therapy, 47.9% did not have hypertension, 93.5% of patients did not have coronary artery disease, 34.4% were treated in prone position, mean interval from surgery to CT simulation was 58.0 days ± 49.1, and mean seroma volume was 43.3 cm3 ± 46.1. Longer interval from surgery was significantly associated with smaller seroma volume, P = 0.0360. Age, BMI, hypertension, position, coronary artery disease, and use of neoadjuvant hormone therapy remained significant on MVA (P < 0.05 for all), and thus were independently associated with seroma volume. Increased age, BMI, and prone position vs. supine were associated with larger mean seroma volume; absence of hypertension, absence of coronary artery disease, and absence of neoadjuvant hormone therapy were associated with decreased seroma volume. Surgical re-excision, oncoplastic reduction, prior breast surgery, receipt of chemotherapy, race, diabetes, smoking status, and presence of clips were not significantly associated.Increased age, higher BMI, hypertension, coronary artery disease, and prone position were associated with larger seroma volume, and longer interval from surgery to simulation was associated with smaller seroma volume. Especially relevant for patients planned to receive PBI, these data may be used to select patients for which longer time to simulation may result in smaller seroma volumes and therefore smaller PBI target volumes. Larger datasets and prospective evaluation would be ideal to confirm these hypotheses.

Effect of Patient Characteristics on Clinical Outcomes More Than 12 Months Following Dorsal Root Ganglion Stimulation Implantation: A Retrospective Review

IntroductionDorsal root ganglion (DRG) stimulation is an effective treatment option for lower extremity complex regional pain syndrome and other focal pain conditions. However, the patient characteristics that may predict long-term outcomes have not been defined. Materials and MethodsThis was a retrospective observational study that included 93 patients who were implanted with a DRG stimulator at a single private practice institution. A variety of demographic data was collected. Follow-up results were reviewed from multiple time points more than 12 months. Patients were classified as either “responder” or “nonresponder” status using two different thresholds, “greater than or equal to 50% pain relief” and “greater than or equal to 80% pain relief.”Results: A history of prior chronic opioid use was associated with significantly lower rates of responder status based on both a 50% pain relief threshold and 80% pain relief threshold at the one week to one month, three months, and 12-months visits. ConclusionsThis single-center retrospective study found patients prescribed chronic opioids at the time of DRG stimulator implantation had a higher likelihood of less than 50% pain relief and 80% pain relief at one month, three months, and 12 months follow-up visits.

Metabolic Syndrome Parameters, Determinants, and Biomarkers in Adult Survivors of Childhood Cancer: Protocol for the Dutch Childhood Cancer Survivor Study on Metabolic Syndrome (Dutch LATER METS)

BackgroundPotential late effects of treatment for childhood cancer include adiposity, insulin resistance, dyslipidemia, and hypertension. These risk factors cluster together as metabolic syndrome and increase the risk for development of diabetes mellitus and cardio- and cerebrovascular disease. Knowledge on risk factors, timely diagnosis, and preventive strategies is of importance to prevent cardio- and cerebrovascular complications and improve quality of life. Currently, no national cohort studies on the prevalence and determinants of metabolic syndrome in childhood cancer survivors, including biomarkers and genetic predisposition, are available.ObjectiveThe objectives of the Dutch LATER METS study are to assess 1) the prevalence and risk factors of metabolic syndrome and its separate components, and 2) the potential diagnostic and predictive value of additional biomarkers for surveillance of metabolic syndrome in the national cohort of adult long-term survivors of childhood cancer.MethodsThis is a cross-sectional study based on recruitment of all survivors treated in the Netherlands between 1963 and 2002. Metabolic syndrome will be classified according to the definitions of the third Adult Treatment Panel Report of the National Cholesterol Education Program as well as the Joint Interim Statement and compared to reference data. Dual-energy x-ray absorptiometry scans were performed to assess body composition in more detail. The effect of patient characteristics, previous treatment, and genetic variation on the risk of metabolic syndrome will be assessed. The diagnostic and predictive value of novel biomarkers will be tested.ResultsPatient accrual started in 2016 and lasted until April 2020. A total of 2380 survivors from 7 pediatric oncology hospitals have participated. From July 2020, biomarker testing, single nucleotide polymorphism analysis, and data analysis will be performed.ConclusionsThe Dutch LATER METS study will provide knowledge on clinical and genetic determinants of metabolic syndrome and the diagnostic value of biomarkers in childhood cancer survivors. The results of this study will be used to optimize surveillance guidelines for metabolic syndrome in survivors based on enhanced risk stratification and screening strategies. This will improve diagnosis of metabolic syndrome and prevent complications.International Registered Report Identifier (IRRID)DERR1-10.2196/21256

Effects of Patient Characteristics on Diagnostic Performance of Self-Collected Samples for SARS-CoV-2 Testing.

We evaluated the performance of self-collected anterior nasal swab (ANS) and saliva samples compared with healthcare worker–collected nasopharyngeal swab specimens used to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We used the same PCR diagnostic panel to test all self-collected and healthcare worker–collected samples from participants at a public hospital in Atlanta, Georgia, USA. Among 1,076 participants, 51.9% were men, 57.1% were >50 years of age, 81.2% were Black (non-Hispanic), and 74.9% reported >1 chronic medical condition. In total, 8.0% tested positive for SARS-CoV-2. Compared with nasopharyngeal swab samples, ANS samples had a sensitivity of 59% and saliva samples a sensitivity of 68%. Among participants tested 3–7 days after symptom onset, ANS samples had a sensitivity of 80% and saliva samples a sensitivity of 85%. Sensitivity varied by specimen type and patient characteristics. These findings can help physicians interpret PCR results for SARS-CoV-2.

Effects of patient characteristics and comorbidities on temporal trends of low-flow, low-gradient aortic stenosis phenotypes

Abstract Background Aortic stenosis (AS) is a common primary heart valve disease in the elderly. Low-flow, low-gradient (LFLG) AS is an increasingly important phenotype. Purpose To evaluate the temporal changes in incidence of severe AS phenotypes: paradoxical LFLG, classical LFLG and non-LFLG and explore risk factors that contribute to temporal trends. Methods We analyzed 25,507 consecutive transthoracic echocardiograms over 6½ years between 2013 and 2019 divided into deciles. LFLG-AS was defined as mean transvalvular pressure gradient &amp;lt;40 mmHg and stroke volume index (SVi) &amp;lt;35 mL/m2, aortic valve area (AVA) &amp;lt;1 cm2 or indexed AVA &amp;lt;0.6 cm2/m2, with either normal (paradoxical LFLG) or decreased (&amp;lt;40%; classical LFLG) left ventricular ejection fraction. Trends and associations with patients characteristics and comorbidities were assessed over time in deciles. Results Of 891 cases that fulfilled severe AS criteria, there were 536 cases of LFLG-AS (85 classical and 451 paradoxical LFLG-AS). There was a statistically significant increase in incidence of paradoxical LFLG-AS between each time interval (p&amp;lt;0.0001), while significant reduction in incidence of non-LFLG-AS (p=0.009) that was not seen with classical LFLG-AS (p=0.7) (Figure). More comprehensive echocardiographic assessment of relevant parameters over time assisted with identification of LFLG-AS cases. Intrinsic patient factors such as age and E/e' contributed towards the increasing trend of paradoxical LFLG-AS. There was a rising population aged over 70 years (p=0.01). Multivariate logistic regression analysis showed that age, sex, E/e', obesity, atrial fibrillation and heart rate were potential risk factors responsible for temporal trend towards rising paradoxical LFLG-AS incidence. There was also a gradual increase in number of patients with low transvalvular flow rate (&amp;lt;200mL/s) over time (p=0.04). Conclusion The incidence of paradoxical LFLG-AS is rising in a hospital echocardiogram service. The parallel increase in LV filling pressure and age in AS patients suggests the increment in LFLG-AS is related to changes to the LV myocardium. Subtypes of aortic stenosis over time Funding Acknowledgement Type of funding source: None

Hypoalbuminemia Increased the Length of Stay in the Treatment of Postoperative Acute Surgical Site Infection in Spinal Surgery.

Multicenter retrospective study. The aim of this study was to identify specific risk factors for increased length of stay (LOS) in the management of acute surgical site infection (SSI) following spinal surgery. Postoperative SSI is a serious complication of spinal surgery and is known to be associated with increased LOS and additional cost. Although many risk factors contribute to the development of SSI following spinal surgery, little is known about risk factors associated with the treatment of SSI that contribute to increased LOS. Patients at two institutions experiencing deep SSI following spinal surgery between January 2009 and December 2016 were identified. The patients were divided into two groups depending upon the median LOS attributable to SSI. The effects of patient characteristics, comorbidities, disease history, and invasiveness of the elective surgery on the risk of increased LOS were determined using univariate analyses and multivariate logistic regression. Of the 1656 spinal surgery cases, 40 (2.4%) experienced deep SSI. The median LOS was 67 days. Multivariate logistic regression analysis revealed that hypoalbuminemia during hospitalization was associated with increased LOS (odds ratio 0.042, confidence interval 0.005-0.342; P = 0.003). We determined the appropriate diagnostic cutoff of hypoalbuminemia during hospitalization using receiver-operating characteristic curves. A serum albumin level <3.1 g/dL (sensitivity, 86.4%; specificity, 75.0%; area under the curve, 0.84) was indicative of a longer hospital stay. Low serum albumin level during hospitalization was an independent risk factor for increased LOS in the treatment of SSI following spinal surgery. When the serum albumin level is <3.1 g/dL in patients with SSI, we should consider interventions aimed at correcting this hypoalbuminemia. 4.

Effect of Patient Characteristics on Reported Outcomes Over 12 Months Following Lumbar Radiofrequency Ablation: A Retrospective Review of 500 Patients.

Low back pain is the leading cause of years lost to disability worldwide. Approximately 15% to 45% of chronic low back pain is due to facet joint arthropathy. Currently, no large-scale retrospective studies have investigated long-term clinical predictors of success in individuals receiving radiofrequency ablation (RFA) of the medial branches for facet joint arthropathy. To determine the clinical factors associated with success and failure of RFA of lumbar facet joints at 1-year follow-up. Clinical data were gathered from 500 consecutive patients with an International Classification of Diseases (ICD)-10 diagnosis of lumbar spondylosis. VAS pain scores for patients undergoing lumbar medial branch RFA procedures were recorded at multiple time points, up to the 1-year follow-up visit. A responder was defined ashaving ≥30% improvement in VAS score from the pre-procedural VAS score. For our primary analysis, regression analysis was conducted to identify associations between responder status and patient characteristics, including age, gender, body mass index (BMI), hormone use, opiate dose, and smoking history at multiple time points, up to the 1-year follow-up visit. A total of 500 patients were included in the study. At the 1-year post-RFA follow-up visit, responder status was associated with a lower rate of prior opioid use (43.22% vs. 55.76%, odds ratio 0.60 [95% confidence interval (CI) 0.40 to 0.92], P=0.018), lower pre-procedural opioid consumption in oral morphine equivalents (10.16±16.02 vs. 14.67±20.65, β -4.50 [95% CI -8.57 to -0.44], P=0.030), and a higher pre-VAS pain score (6.36±2.17 vs. 5.85±2.17, β 0.50 [95% CI 0.06 to 0.95], P=0.028). There were no significant associations between responder status and age, gender, BMI, hormone use, and smoking history at the 1-year follow-up visit. Our results suggest that patients prescribed opioids, particularly at higher dosages, may find less pain relief 1 year following RFA for facetogenic pain. Additionally, patients with higher pre-procedural VAS pain scores may be more likely to have a positive response at 1 year.