Follow-up In Clinical Practice Research Articles

Pediatric Intensive Care Unit follow-up: thinking before acting

ObjectiveIt is now well established that post-intensive care syndrome is frequent in critically ill children after discharge from the Pediatric Intensive Care Unit (PICU). Nevertheless, post-intensive care follow-up is highly heterogenous worldwide and is not considered routine care in many countries. The purpose of this viewpoint was to report the reflections of the French PICU society working group on how to implement post-PICU follow-up. MethodsA working group was set up within the Groupe Francophone de Reanimation et d’Urgences Pédiatriques (GFRUP) to provide conceptual and practical guidance for developing post-PICU follow-up. The working group included psychologists, PICU physicians, physiotherapists, and nurses, from different French PICUs. Five virtual meetings have been held. ResultsFirst, we described in this work the objectives of the follow-up program and the population to be targeted. We also provided a framework to implement post-PICU follow-up in clinical practice. Finally, we detailed the potential obstacles and challenges to consider. ConclusionAlthough implementing a post-PICU follow-up program is a challenge, the benefits could be significant for both patient and relatives, as well as for the health care professionals involved.

Loa loa and Mansonella perstans infections in non-endemic countries: a narrative review

Abstract Purpose of Review Loiasis and mansonellosis are filarial infections potentially causing a relevant impact on morbidity and mortality. In non-endemic countries, there is poor awareness on these conditions, and clinical management is not standardized. Aim of this work is to review current evidence on cases diagnosed in non-endemic areas, in order to guide clinical management. Recent Findings In non-endemic areas, a wider range of symptoms and signs have been reported for both infections, compared to endemic areas. Diagnostic tools include parasitological tests, serology and molecular methods, each one potentially playing a different role (i.e. for screening, determination of microfilarial load, etc). Treatment is not standardized, and first-line drugs might not be available everywhere. Summary Loiasis and mansonellosis can be diagnosed in non-endemic countries; here we comment on strategies for screening, diagnosis, treatment and follow-up in clinical practice.

Exploring Biomarkers in Breast Cancer: Hallmarks of Diagnosis, Treatment, and Follow-Up in Clinical Practice.

Breast cancer is a prevalent malignancy in the present day, particularly affecting women as one of the most common forms of cancer. A significant portion of patients initially present with localized disease, for which curative treatments are pursued. Conversely, another substantial segment is diagnosed with metastatic disease, which has a worse prognosis. Recent years have witnessed a profound transformation in the prognosis for this latter group, primarily due to the discovery of various biomarkers and the emergence of targeted therapies. These biomarkers, encompassing serological, histological, and genetic indicators, have demonstrated their value across multiple aspects of breast cancer management. They play crucial roles in initial diagnosis, aiding in the detection of relapses during follow-up, guiding the application of targeted treatments, and offering valuable insights for prognostic stratification, especially for highly aggressive tumor types. Molecular markers have now become the keystone of metastatic breast cancer diagnosis, given the diverse array of chemotherapy options and treatment modalities available. These markers signify a transformative shift in the arsenal of therapeutic options against breast cancer. Their diagnostic precision enables the categorization of tumors with elevated risks of recurrence, increased aggressiveness, and heightened mortality. Furthermore, the existence of therapies tailored to target specific molecular anomalies triggers a cascade of changes in tumor behavior. Therefore, the primary objective of this article is to offer a comprehensive review of the clinical, diagnostic, prognostic, and therapeutic utility of the principal biomarkers currently in use, as well as of their clinical impact on metastatic breast cancer. In doing so, our goal is to contribute to a more profound comprehension of this complex disease and, ultimately, to enhance patient outcomes through more precise and effective treatment strategies.

Screening and risk of hepatocellular carcinoma in patients with advanced fibrosis after hepatitis C virus eradication.

The risk of hepatocellular carcinoma (HCC) after eradication of the hepatitis C virus (HCV) is highly variable in patients with advanced fibrosis (F3). Long-term surveillance for HCC after sustained virological response (SVR) is controversial in these patients. Our objective is to describe the post-SVR follow-up in clinical practice in patients with F3 and determine the predictive factors for the development of HCC. a multicenter, observational, and retrospective study, which included HCV-monoinfected patients with F3 fibrosis determined by transient elastography who achieved SVR between 2015 and 2022 and with follow-up until May 2023. Clinical-demographic, laboratory, elastography, and ultrasound variables were recorded before and after treatment. A descriptive and inferential analysis, Cox regression analysis, and survival analysis were carried out with the R statistical software. 219 patients were included (65.3% men, median age 57 years). 175 (79.9%) received ultrasound screening after SVR for 62 [6-90] months. The prescribing service was the only independent variable related to performing ultrasound surveillance (p=0.004). Eight patients developed HCC. In multivariate analysis adjusted for sex, age, presence of diabetes, and alcohol consumption, a post-SVR FIB-4 ≥ 3.25 was associated with a 12-fold increase in HCC risk. The cumulative probability of HCC was higher in the group of patients with FIB-4 ≥ 3.25 after SVR (p<0.001). post-SVR follow-up of patients with F3 fibrosis is variable in clinical practice. Using the FIB-4 after SVR allows us to identify those patients with a higher risk of HCC who benefit from biannual ultrasound screening.

HSD38 From Unpersonalized to Personalized Breast Follow-up in Clinical Practice in the Netherlands: Will Artificial Intelligence Make a Difference?

HSD38 From Unpersonalized to Personalized Breast Follow-up in Clinical Practice in the Netherlands: Will Artificial Intelligence Make a Difference?

Implementation of a hybrid healthcare model in rheumatic musculoskeletal diseases: 6-months results of the multicenter Digireuma study

ObjectivesRheumatic and musculoskeletal diseases (RMDs) require a tailored follow-up that can be enhanced by the implementation of innovative tools. The Digireuma study aimed to test the feasibility of a hybrid follow-up utilizing an electronic patient reported outcomes (ePROs)-based monitoring strategy in patients with RMDs.MethodsAdult patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) were recruited for a 6-month bicentric prospective follow-up consisting of face-to-face and digital assessments. Patients were asked to report disease-specific ePROs on a pre-established basis, and could also report flares, medication changes, and recent infections at any time. Four rheumatologists monitored these outcomes and contacted patients for interventions when deemed necessary. Results from face-to-face and digital assessments were described.ResultsOf 56 recruited patients, 47 (84%) submitted any ePROs to the digital platform. Most patients with RA were female (74%, median age of 47 years), while 48% of patients with SpA were female (median age 40.4 years). A total of 3,800 platform visits were completed, with a median of 57 and 29 visits in patients with RA and SpA, respectively. Among 52 reported alerts, 47 (90%) needed contact, of which 36 (77%) were managed remotely. Adherence rates declined throughout the study, with around half of patients dropping out during the 6 months follow-up.ConclusionThe implementation of a hybrid follow-up in clinical practice is feasible. Digital health solutions can provide granular knowledge of disease evolution and enable more informed clinical decision making, leading to improved patient outcomes. Further research is needed to identify target patient populations and engagement strategies.

Remote support during cardiac implantable electrical device follow-up: preliminary experience in clinical practice

Abstract Funding Acknowledgements Type of funding sources: None. Background Industry employed allied professionals (IEAPs) traditionally provide technical assistance to physicians during cardiac implantable electrical device (CIED) implantation, programming, troubleshooting, and follow-up, by operating the programmers under the supervision of the physician. The Heart Connect™ application is a data-sharing system intended to provide physicians with the means to establish an online meeting and share the display of the LATITUDE™ Programmer (Boston Scientific) with IEAPs in a remote location. Purpose We describe the preliminary experience of remote IEAP support during CIED follow-up in clinical practice. Methods The Heart Connect™ software was downloaded on the programmer and network connection was established and tested using both Wi-Fi and a 4G cellular adapter at 3 Italian medical centers. External headset and webcam have been connected to the programmer. After system setup, the staff was trained on how to use the application, and online meetings were established with IEAPs of the Remote Clinical Support team during consecutive CIED follow-up visits. Data and users’ feedback were collected on the training provided, the quality of the remote connection, the support at each meeting. Results All the professionals trained in the use of the system judged the information received to be clear and adequate, and felt confident in using the system. Online meetings were established during 34 follow-up visits (12 pacemakers and CRT-P, 13 single- or dual-chamber ICD, 9 CRT-D). The remote connection was successfully established in all cases. In all cases the communication remained stable for the entire duration of the visit, except for 2 cases (connected via 4G) in which a loss of connection occurred (not restored in 1 case). The sound and video quality during two-way communication were rated good or excellent in 31 (91%) cases. The mean duration of the online meeting was 7±3 minutes. Routine CIED checks were performed during the visits: battery status, pacing and sensing thresholds, impedances, current rhythm diagnosis, arrhythmias detected and therapies delivered, device counters and review of programmed parameters, alerts and clinical diagnostics. Programming changes were done during 7 (21%) visits: pacing and sensing parameters, tachycardia detection and therapies. The remote support allowed to successfully complete the visit in 33 (97%) cases, without requiring additional medical or technical support. In all these cases, the support was judged to be equally effective compared to the on-site support, without causing delays or organizational difficulties. Conclusions Remote support during CIED follow-up using Heart Connect™ seems feasible, effective and well accepted. Additional tests are ongoing to demonstrate the potential usefulness of this solution in standard clinical practice, and in the context of restrictions on access to healthcare facilities due to COVID-19 pandemic.

Anticoagulation therapy during pulmonary embolism follow-up in clinical practice

Patients with pulmonary embolism are a heterogeneous population and, after the acute phase and the first 3-6 months, the main issue is whether to continue, and hence how long and at what dose, or to stop anticoagulation therapy. In patients with venous thromboembolism (VTE), direct oral anticoagulants (DOACs) are the recommended treatment (class I, level of evidence B in the latest European guidelines), and in most cases, an "extended" or "long-term" low-dose therapy is warranted. This paper aims to provide a practical management tool to the clinician dealing with pulmonary embolism follow-up: from the evidence behind the most used exams (D-dimer, ultrasound Doppler of the lower limbs, imaging tests, recurrence and bleeding risk scores), and the use of DOACs in the extended phase, to six real clinical scenarios with the relative management in the acute phase and at follow-up. Lastly, a practical algorithm is shown to deal with anticoagulation therapy in the follow-up of VTE patients in a simple, schematic, and pragmatic way.

Development and validation of a nomogram model for predicting residue of partially cystic thyroid nodules after ultrasound-guided ethanol and thermal ablation.

To develop and validate a nomogram model for predicting residue of partially cystic thyroid nodules (PCTNs) after ethanol and thermal ablation. From July 2015 to August 2022, a total of 97 patients (age 40.78 ± 12.61 years) with 107 treated benign PCTNs receiving ethanol and thermal ablation were enrolled. Pre-ablative laboratory test results and the ultrasound (US) and contrast-enhanced ultrasound (CEUS) features of lesions were collected. They were categorized into non-residue group and residue group according to the CEUS examination assessment after ablation. Univariate and multivariate logistic regression analysis were adopted to build a nomogram. The nomogram was validated by internal stratified fivefold cross-validation. The calibration, discrimination and clinical utility of the nomogram were investigated to assess the performance of the model. Residue was reported in 30 out of 107nodules (28.0%). Multivariate logistic regression analysis revealed initial volume (OR=1.12, 95%CI 1.06-1.19) and presence of septum (OR=3.19, 95%CI 1.09-9.36) were predictors of residue of PCTNs. The nomogram developed by the above factors showed good calibration and discrimination. The area under the curve (AUC), sensitivity and specificity of this model were 0.832, 86.7% and 68.8%, respectively. When applied to internal validation, the model revealed good generalizability with stratified fivefold cross-validation in the cohort (mean AUC = 0.821). The nomogram model has good performance for predicting the residue of PCTNs undergoing ethanol and thermal ablation. This could play a role in the decision of treatment and follow-up in clinical practice.

Discontinuation and relapse with paliperidone palmitate three-monthly for maintenance of schizophrenia: Two year follow-up of use in clinical practice

The use of antipsychotic long-acting injections (LAI) aims to reduce risk of relapse and hospitalisation in patients with schizophrenia compared with oral medication. Paliperidone palmitate is currently the only LAI that can be administered at three-monthly intervals for maintenance treatment of schizophrenia. This prospective study aimed to evaluate relapse and continuation in licensed use of paliperidone palmitate three-monthly (PP3M) over a 2-year follow-up in clinical practice. Non-interventional, observational study of patients treated in the South London and The Maudsley NHS Foundation Trust. A total of 166 patients initiated on PP3M, 55 were excluded from the study (non-F20 diagnosis (n = 43); F20 >65 years old (n = 12)). Of the 111 patients included, 67 (60%) continued PP3M for 2 years. Overall 102 patients received more than one dose of PP3M and 92 (90%) remained on the same dose of PP3M for the whole of their treatment duration. Relapse (defined as a step-up in clinical care) occurred in eight patients (7%) while on PP3M. The most common reason for discontinuation was patient refusal and the most frequent medication prescribed after discontinuation was paliperidone palmitate one-monthly (PP1M). Post hoc, we analysed outcome in those continuing any form of PPLAI (those continuing with PP3M and those switching back to PP1M). Continuation over 2 years with any PPLAI formulation was 73% (81/111) and relapse was recorded in 9% (10/111). Overall, PP3M was an effective maintenance treatment for schizophrenia after stabilisation on PP1M in a clinical setting.

Validation of the Arabic linguistic version of the Danish Prostatic Symptom Score for benign prostatic hyperplasia associated with lower urinary tract symptoms

ABSTRACT Objective: To validate an Arabic version of the Danish Prostatic Symptom Score (DAN-PSS), a self-administered quality-of-life questionnaire. Patients and methods: The reliability of the Arabic DAN-PSS was assessed by determining the internal consistency (Cronbach’s α coefficient) and by assessing the test–retest reliability (Kappa [κ] test). Inter-domain associations were examined using Spearman’s correlation coefficient (r). The discrimination validity was evaluated using receiver operating characteristic (ROC) curves. The sensitivity to change of the questionnaire and its individual items was assessed before and after intervention using a paired t-test. Results: In all, 106 men (55 patients with BPH and 51 without BPH symptoms) were included. A high level of internal consistency amongst the three domains of the answered Arabic DAN-PSS questionnaire was observed (Cronbach’s α > 0.70). Also, there was a good correlation between storage and voiding (r = 0.75; P < 0.001) and post-micturition symptoms domains (r = 0.51; P < 0.001). Voiding and post-micturition symptoms domains also had a good correlation (r = 0.51; P < 0.001). The agreement between the test and retest scores had a κ value of 0.83 (P < 0.001). The ROC curve had an area under the curve of 0.98. The sensitivity to change comparing patients with BPH who received medical or surgical intervention revealed Arabic DAN-PSS mean (SD) scores of 34.7 (17.7) and 17 (8.7) before and after the intervention, respectively (P < 0.001). Conclusion: The Arabic DAN-PSS is a clear questionnaire, valid, reliable, and responsive that can be used for BPH associated with lower urinary tract symptoms assessment and follow-up in clinical practice and research in Arabic-speaking patients. Abbreviations: AUC: area under the curve; BPH: benign prostatic hyperplasia; CI: confidence interval; DAN-PSS: Danish Prostatic Symptom Score; DRE: digital rectal examination; ICIQ-MLUTS: International Consultation on Incontinence Male LUTS Questionnaire; ICS: international continence society; IPSS: international Prostatic Symptom Score; IPSS-Arb: Arabic version of the IPSS; LUTS: lower urinary tract symptoms; PSA: prostatic specific antigen; PSS: prostatic symptom score; QoL: quality of life; ROC: receiver operating characteristic; UTI: urinary tract infection.

Cross-cultural translation, adaptation and validation of a Japanese version of the functional index for hand osteoarthritis (J-FIHOA)

BackgroundHand osteoarthritis (OA) has a wide spectrum of clinical presentations and physical function is one of the core domains where patients suffer. The Functional Index for Hand Osteoarthritis (FIHOA) is a leading assessment tool for hand OA-related functional impairment. Our objective was to make a Japanese version of FIHOA (J-FIHOA) and validate it among Japanese hand OA patients.MethodsForward and backward translation processes were completed to create a culturally adapted J-FIHOA. A prospective, observational multicenter study was undertaken for the validation process. Seventeen collaborating hospitals recruited Japanese hand OA patients who met the American College of Rheumatology criteria. A medical record review and responses to the following patient-rated questionnaires were collected: J-FIHOA, Hand20, Health Assessment Questionnaire (HAQ), numerical rating scale for pain (NRS pain) and Short Form 36 Health Survey (SF-36). We explored the structure of J-FIHOA using factor analysis. Cronbach’s alpha coefficients and item-total correlations were calculated. Correlations between J-FIHOA and other questionnaires were evaluated for construct validity. Participants in clinically stable conditions repeated J-FIHOA at a one- to two-week interval to assess test-retest reliability. To evaluate responsiveness, symptomatic patients who started new pharmacological treatments had a 1-month follow-up visit and completed the questionnaires twice. Effect size (ES) and standardized response mean (SRM) were calculated with pre- and post-treatment data sets. We assessed responsiveness, comparing ES and SRM of J-FIHOA with other questionnaires (construct approach).ResultsA total of 210 patients participated. J-FIHOA had unidimensional structure. Cronbach’s alphas (0.914 among females and 0.929 among males) and item-total correlations (range, 0.508 to 0.881) revealed high internal consistency. Hand20, which measures upper extremity disability, was strongly correlated with J-FIHOA (r = 0.82) while the mental and role-social components of SF-36 showed no correlations (r = − 0.24 and − 0.26, respectively). Intraclass correlation coefficient for test-retest reliability was 0.83 and satisfactory. J-FIHOA showed the highest ES and SRM (− 0.68 and − 0.62, respectively) among all questionnaires, except for NRS pain.ConclusionsOur results showed J-FIHOA had good measurement properties to assess physical function in Japanese hand OA patients both for ambulatory follow-up in clinical practice, and clinical research and therapeutic trials.

Complete skin clearance and Psoriasis Area and Severity Index response rates in clinical practice: predictors, health-related quality of life improvements and implications for treatment goals.

Psoriasis Area and Severity Index (PASI) 90 is suggested to be the new standard endpoint for randomized controlled trials of biologics for psoriasis, whereas treatment guidelines often still refer to PASI 75. To analyse in a real-world setting: firstly, what factors are associated with higher levels of treatment response to biologics; secondly, the health-related quality of life gains associated with different response levels in clinical practice. Biologically naïve patients with PASI, Dermatology Life Quality Index (DLQI) and EuroQol (EQ)-5D outcomes before (maximum 6 months) and after (3-12 months) switch to biologics during registration in the Swedish National Registry for Systemic Treatment of Psoriasis (PsoReg) were included (n = 515). Patient characteristics associated with higher treatment response were analysed by regression analyses. Improvements in absolute PASI, DLQI and EQ-5D were assessed in different PASI percentage response levels. High PASI percentage response was associated with higher PASI before switch and lower body mass index. DLQI and EQ-5D improved within all responder groups (P < 0·001). The magnitude of improvements in DLQI (P = 0·02) differed between responder groups. The mean (SD) DLQI improvements for PASI 75<90 responders, PASI 90<100 responders and patients achieving complete skin clearance (PASI 100) were 9·9 (7·4), 11·5 (7·0) and 8·0 (6·1), respectively. PASI percentage change is largely dependent on absolute PASI before switch. Patients in clinical practice lack 'baseline' PASI values as they may switch directly from one treatment to another or stay successfully treated for a longer time period. Treatment goals such as PASI 90 are thus not suitable for treatment guidelines or for follow-up in clinical practice. What's already known about this topic? Randomized clinical trials of biologics as well as treatment guidelines include treatment goals based on a percentage improvement compared with baseline Psoriasis Area and Severity Index (PASI), such as PASI 75 or PASI 90. Few studies have assessed which factors are associated with high skin clearance rates, or health-related quality of life (HRQoL) improvements associated with different levels of skin clearance in clinical practice. What does this study add? A high absolute PASI before switch to biologics and low body mass index are associated with higher PASI percentage response. Few patients with baseline PASI >30 achieved complete skin clearance (CSC). All responder groups achieved significant HRQoL improvements. Patients achieving CSC (PASI 100) had lower absolute PASI before switch and lower improvements in absolute PASI and HRQoL than patients with almost cleared skin. What are the clinical implications of this work? Relative measures based on PASI percentage, such as PASI 75 or PASI 90, are not suitable for treatment guidelines or for follow-up in clinical practice.

Development and validation of a quantitative method for estimation of the urate burden in patients with gouty arthritis using dual-energy computed tomography.

To develop a method that allows approximating the mass of monosodium uric acid (MSU) in a gouty tophus using phantom measurements and including tophus density into the calculation of the dual-energy computed tomography (DECT) tophus volumetry. We prepared specimens of different concentrations of MSU placed in an epoxy-based phantom and an excised porcine foreleg. Density and volumetric measurements were performed in sequential single-source DECT scans acquired with increasingly higher tube currents. We developed a method for estimating the tophus mass by multiplying the detected tophus volume with its mean density and adding a specific gravimetric coefficient k. k was derived from the DECT scans by comparing the approximated MSU masses in the epoxy phantom with the known true MSU masses of the specimens. Comparison of the approximated MSU masses in the porcine foreleg scans with the true MSU masses of the syringe contents showed similar performance to sole volume measurement while providing additional information on the true uric acid burden: Over 70% of the true urate masses have been detected in MSU concentrations ≥ 45%, while the detection rate was much lower for MSU concentrations ≤ 40%. Retrospective analysis of patients with proven gouty arthritis confirmed the diagnostic potential of the mass approximation technique. We successfully established a method to include tophus density measurement for estimation of the uric acid burden in milligrams (instead of ml) in a phantom setting for MSU concentrations above 40%. Future studies should validate its use for follow-up in clinical practice. • Including tophus density measurement in dual-energy computed tomography scans in a phantom setting can be used for estimating the urate burden in milligrams, which might be useful for imaging follow-up. • The mass [mg] of the uric acid burden in a patient with gouty arthritis can be calculated by multiplying volume [ml] with mean density [HU] using a specific gravimetric coefficient. • Retrospective analysis of two patients with gouty tophi showed the relevance of measuring urate mass in addition to urate volume alone.

Clinical Study of the Prediction of Malignancy in Thyroid Nodules: Modified Score versus 2017 American College of Radiology's Thyroid Imaging Reporting and Data System Ultrasound Lexicon

The clinical importance of thyroid nodules rests with the need to exclude thyroid cancer. In the present study, we developed a modified Thyroid Imaging Reporting and Data System (TI-RADS) score using gray-scale ultrasound, contrast-enhanced ultrasound (CEUS) and shear-wave elastography (SWE) images to predict malignancy of thyroid nodules and compared this modified score system with the subjective scoring criteria based on the Thyroid Imaging Reporting and Data System (TI-RADS, 2017 edition). The results revealed that by using SWE and CEUS (enhanced pattern) to downgrade TI-RADS category 4 and 5 nodules, the malignancy rate for TI-RADS category 4 and 5 nodules increased from 47.6% with American College of Radiology (ACR) TI-RADS assessment alone to 49.4% with ACR TI-RADS combined with shear wave elastography (SWE) and CEUS (enhanced pattern). Likewise, by using the modified TI-RADS to adjust TI-RADS category 3 nodules, the malignancy rate for TI-RADS category 3 nodules increased from 13.9%–20.0%. The discriminating power for detection of malignancy of the variable score 2 (ACR TI-RADS + SWE + CEUS), with an area under the curve (AUC) of 0.899 (95% confidence interval [CI]: 86.1%–93.6%), was higher than that of score 1 (ACR TI-RADS), with an AUC of 0.862 (95% CI: 81.9%–90.6%; p > 0.05). With a point 4.5 as the optimal cutoff value, a score of 1 predicted malignancy with an accuracy of 75.6%, sensitivity of 85.0% and specificity of 71.6%. However, with a point 5.5 as the optimal cutoff value, a score of 2 predicted malignancy with an accuracy of 84.9%, sensitivity of 81.0% and specificity of 86.6%. The modified TI-RADS based on ACR TI-RADS + SWE + CEUS (enhanced pattern) could contribute to a reduction in the number of biopsies performed on benign nodules and the implementation of consistent follow-up in clinical practice.

Comparison and development of machine learning tools in the prediction of chronic kidney disease progression

BackgroundUrinary protein quantification is critical for assessing the severity of chronic kidney disease (CKD). However, the current procedure for determining the severity of CKD is completed through evaluating 24-h urinary protein, which is inconvenient during follow-up.ObjectiveTo quickly predict the severity of CKD using more easily available demographic and blood biochemical features during follow-up, we developed and compared several predictive models using statistical, machine learning and neural network approaches.MethodsThe clinical and blood biochemical results from 551 patients with proteinuria were collected. Thirteen blood-derived tests and 5 demographic features were used as non-urinary clinical variables to predict the 24-h urinary protein outcome response. Nine predictive models were established and compared, including logistic regression, Elastic Net, lasso regression, ridge regression, support vector machine, random forest, XGBoost, neural network and k-nearest neighbor. The AU-ROC, sensitivity (recall), specificity, accuracy, log-loss and precision of each of the models were evaluated. The effect sizes of each variable were analysed and ranked.ResultsThe linear models including Elastic Net, lasso regression, ridge regression and logistic regression showed the highest overall predictive power, with an average AUC and a precision above 0.87 and 0.8, respectively. Logistic regression ranked first, reaching an AUC of 0.873, with a sensitivity and specificity of 0.83 and 0.82, respectively. The model with the highest sensitivity was Elastic Net (0.85), while XGBoost showed the highest specificity (0.83). In the effect size analyses, we identified that ALB, Scr, TG, LDL and EGFR had important impacts on the predictability of the models, while other predictors such as CRP, HDL and SNA were less important.ConclusionsBlood-derived tests could be applied as non-urinary predictors during outpatient follow-up. Features in routine blood tests, including ALB, Scr, TG, LDL and EGFR levels, showed predictive ability for CKD severity. The developed online tool can facilitate the prediction of proteinuria progress during follow-up in clinical practice.

Can we predict lesion detection rates in second-look ultrasound of MRI-detected breast lesions? A systematic analysis

PurposeTo predict detection rates (DR) in second-look ultrasound of MRI-detected breast lesions by systematically combining clinical and anthropomorphic features. MethodsA total of 104 suspicious breast-lesions, that were initially detected on breast MRI and underwent subsequent SLU from January 2013 through December 2013, were evaluated in this retrospective analysis. All images were reviewed by an experienced radiologist for this study. Both anthropomorphic, spatial and BI-RADS lesion features were recorded. Uni- and multivariate Classification and Regression Trees (CRT) statistics were used to predict SLU DR by these features. ResultsAmong 104 MRI-detected lesions, 58 (55.8%) showed a correlate on SLU. In univariate analysis, homogeneous fatty or dense fibro-glandular-tissue-composition (FGT) as assessed by ultrasound, segmental non-mass-distribution pattern and small breast size as assessed by MRI were significantly associated with higher DR on SLU. The remaining BI-RADS features did not significantly affect SLU DR according to our data. The predictive model could stratify the likelihood of SLU correlates as high, intermediate and low according to FGT, lesion type, size and position. ConclusionsBy systematically combining the features FGT, lesion type, size and position, we could predict SLU DR of MRI-detected breast lesions. This may help to decide the preferable method for lesion biopsy or follow-up in clinical practice.

Down Sendromlu hastalarda subklinik hipotiroidizm ve hematolojik parametreler arasındaki ilişki

Introduction: Down syndrome (DS) which is defined as trisomy 21 is the most common chromosomal defect characterized by mental retardation, hypotonia, dysmorphic facial features, and other distinctive phenotypic characteristics. The prevalence of thyroid disorders in DS is 3% and is significantly higher than in the normal population. In this study we aimed to investigate hematologic parameters of children with DS who had and hadn’t subclinical hypothyroidism and compare them with healthy controls. Methods: This study included 184 patients who were followed up with genetically diagnosed DS. Complete blood count, levels of serum electrolytes, glucose, urea, liver function tests, thyroid function tests were reviewed. Results: 102 (55.4%) of the patients with DS were male and 82 (44.6%) were female. Mean age was 6.2 ± 4.0 years. Control group was constituted of outpatient healthy children. White blood cell count, hemoglobin, hematocrit, and neutrophil counts were found to be significantly lower in patients with DS. Platelet count and plateletcrit levels were found to be higher and platelet distribution width was lower in patients with DS than in the control group. Conclusion: We found significant differences among hematological parameters in patients with DS. Subclinical hypothyroidism influences red blood cell distribution width, platelet count and MPV. Knowing the incidence and severity of hematologic abnormalities in patients with DS will be beneficial during follow-up in clinical practice.

Drug persistence and outcomes in a cohort of patients with nonvalvular atrial fibrillation treated with rivaroxaban after 2years of follow-up in clinical practice.

To evaluate medication persistence and outcomes in patients with atrial fibrillation after 2 years of treatment with rivaroxaban in routine practice. Retrospective study of atrial fibrillation patients in whom rivaroxaban was prescribed during the first quarter of 2014 in the healthcare area of Costa del Sol (Málaga). A total of 111 patients (mean age 74.9±10.9years; 52.3% men; CHA2DS2-VASc 3.6±1.3; HAS-BLED 1.3±0.6) were included. A total of 96.3 and 90.6% of patients remained on rivaroxaban therapy after 1 and 2 years of treatment, respectively. During this period, stroke, net clinical benefit outcome (thromboembolic events, myocardial infarction, cardiovascular death and major bleeding) and cardiovascular death occurred in 3.6, 5.4 and 1.8% of patients, respectively. In routine practice, medication persistence with rivaroxaban was high. Rates of major cardiac events were low.

Increased healthcare utilization costs following initiation of insulin treatment in type 2 diabetes: A long-term follow-up in clinical practice

AimsTo compare long-term changes in healthcare utilization and costs for type 2 diabetes patients before and after insulin initiation, as well as healthcare costs after insulin versus non-insulin anti-diabetic (NIAD) initiation. MethodsPatients newly initiated on insulin (n=2823) were identified in primary health care records from 84 Swedish primary care centers, between 1999 to 2009. First, healthcare costs per patient were evaluated for primary care, hospitalizations and secondary outpatient care, before and up to seven years after insulin initiation. Second, patients prescribed insulin in second line were matched to patients prescribed NIAD in second line, and the healthcare costs of the matched groups were compared. ResultsThe total mean annual healthcare cost increased from €1656 per patient 2 years before insulin initiation to €3814 seven years after insulin initiation. The total cumulative mean healthcare cost per patient at year 5 after second-line treatment was €13,823 in the insulin group compared to €9989 in the NIAD group. ConclusionsInitiation of insulin in type 2 diabetes patients was followed by increased healthcare costs. The increases in costs were larger than those seen in a matched patient population initiated on NIAD treatment in second-line.