Changes In Guidelines Research Articles

Evaluating Danish Breast Cancer Group locoregional radiotherapy guideline adherence in clinical treatment data 2008–2016: The DBCG RT Nation study

Background and purposeGuideline adherence in radiotherapy is crucial for maintaining treatment quality and consistency, particularly in non-trial patient settings where most treatments occur. The study aimed to assess the impact of guideline changes on treatment planning practices and compare manual registry data accuracy with treatment planning data. Materials and methodsThis study utilised the DBCG RT Nation cohort, a collection of breast cancer radiotherapy data in Denmark, to evaluate adherence to guidelines from 2008 to 2016. The cohort included 7448 high-risk breast cancer patients. National guideline changes included, fractionation, introduction of respiratory gating, irradiation of the internal mammary lymph nodes, use of the simultaneous integrated boost technique and inclusion of the Left Anterior Descending coronary artery in delineation practice. Methods for structure name mapping, laterality detection, detection of temporal changes in population mean lung volume, and dose evaluation were presented and applied. Manually registered treatment characteristic data was obtained from the Danish Breast Cancer Database for comparison. ResultsThe study found immediate and consistent adherence to guideline changes across Danish radiotherapy centres. Treatment practices before guideline implementation were documented and showed a variation among centres. Discrepancies between manual registry data and actual treatment planning data were as high as 10% for some measures. ConclusionNational guideline changes could be detected in the routine treatment data, with a high degree of compliance and short implementation time. Data extracted from treatment planning data files provides a more accurate and detailed characterisation of treatments and guideline adherence than medical register data.

Parents' Perceptions of Schools' COVID-19 Mitigation Strategies: A Phenomenological Study.

At the onset of the COVID-19 pandemic, schools closed across the United States. Given the impact of virtual learning and lost access to school resources, schools eventually reopened with COVID-19 mitigation protocols in place. This qualitative study sought to understand parental perceptions of school-based COVID-19 mitigation strategies. Using a phenomenology approach, nine focus groups were completed with 40 parents of children in grades K-8 representing eight Maryland counties. Based on acceptance of masking policies (as indicated on a survey), parents were sorted into 2 groups-lower and higher masking acceptance. A thematic analysis was conducted for each group and themes were compared between the 2 groups. The main themes were related to parents' general sentiments regarding COVID-19, compliance, pandemic-related changes over time, changes in personal opinions, and in-person learning. Both groups described challenges related to inconsistent COVID-19 mitigation policies and practices, the challenges of rapid and frequent changes in guidelines during the pandemic, and the benefits of in-person learning. Parents of elementary and middle school children, regardless of general acceptance of masking policies, shared concerns about implementation and guidance regarding school-based mitigation strategies.

New tatt? We're ok with that! Relaxing the tattoo deferral for plasmapheresis donors maintains safety and increases donations.

Tattooing is one of the leading donor deferral reasons in Australia. Until September 2020, donors were deferred from all donation types for 4 months after a tattoo. At this time, our guideline changed such that donations of plasma for further manufacture were accepted immediately, provided the tattoo was administered in a licensed or regulated Australian establishment. We examined the effects of this change. Donors with a tattoo deferral in the 2 years before or after the guideline change were identified and followed up until 3 November 2022. Between the two periods, we compared blood-borne virus (BBV) incidence, donor return, and the number of donors and donations regained after deferral. The incidence of BBV infection in donors after a tattoo deferral was zero in both periods. To exceed a residual risk of 1 in 1 million for hepatitis C virus, 190 donors would need to be infected yearly from a tattoo. Donors returned to donate significantly faster after the change (median return 85 days compared with 278 days). An extra 187 donations per 10,000 person-years of observation were gained, yielding a total of 44,674 additional plasma donations nationally 0-4 months after getting a tattoo. Allowing plasma donations immediately post-tattoo resulted in a substantial donation gain with no adverse safety effect. Lifeblood subsequently reduced the deferral for transfusible component donations to 7 days for tattoos in Australian licensed/regulated establishments.

Ethical dilemmas in healthcare management: A comprehensive review

This research paper comprehensively examines ethical dilemmas in healthcare management, offering insights into emerging trends, technological impacts, and anticipated guideline changes. The paper explores healthcare managers' multifaceted challenges, including conflicting stakeholder interests, the delicate balance between patient rights and organizational goals, and navigating diverse cultural values. Strategies for mitigating ethical dilemmas, such as education, policy implementation, and collaborative decision-making, are discussed. Additionally, the paper delves into the evolving ethical landscape influenced by genomic medicine, artificial intelligence, and telehealth. The implications for healthcare managers include the need for continuous education, ethical leadership, and technological literacy. As healthcare transforms, embracing ethical practices becomes imperative for fostering patient-centric, equitable, and ethically sound healthcare environments. Keywords: Healthcare Management Ethics, Ethical Dilemmas, Technological Impacts, Ethical Leadership.

Trends in gestational diabetes in Iceland before and after guideline changes in 2012: a nationwide study from 1997 to 2020.

Internationally accepted diagnostic criteria recommendations for gestational diabetes (GDM) in 2010 resulted in a rise in global prevalence of GDM. Our aim was to describe the trends in GDM before and after Icelandic guideline changes in 2012 and the trends in pregestational diabetes (PGDM). The study included all singleton births (N = 101 093) in Iceland during 1997-2020. Modified Poisson regression models were used to estimate prevalence ratios (PRs) with 95% confidence intervals (CIs) for risk of GDM overall and by maternal age group, as well as overall risk of PGDM, according to time period of birth. The overall prevalence of GDM by time period of birth ranged from 0.6% (N = 101) in 1997-2000 to 16.2% (N = 2720) in 2017-2020, and the prevalence of PGDM ranged from 0.4% (N = 57) in 1997-2000 to 0.7% (N = 120) in 2017-2020. The overall relative GDM prevalence rate difference before and after 2012 was 380%, and the largest difference was found among women aged <25 years at 473%. Risk of GDM increased in 2017-2020 (PR 14.21, CI 11.45, 17.64) compared to 1997-2000 and was highest among women aged >34 years with PR 19.46 (CI 12.36, 30.63) in 2017-2020. Prevalence rates of GDM and PGDM increased during the study period. An accelerated rate of increase in GDM was found after 2012, overall, and among all maternal age groups. Women aged >34 years had the greatest risk of GDM throughout all time periods, while women aged <25 years appear to have a higher relative rate difference after 2012.

Digestive and breast cancer patients managed during the first wave of COVID-19 pandemic: Short and middle term outcomes.

The first wave of coronavirus disease 2019 (COVID-19) pandemic in Spain lasted from middle March to the end of June 2020. Spanish population was subjected to lockdown periods and scheduled surgeries were discontinued or reduced during variable periods. In our centre, we managed patients previously and newly diagnosed with cancer. We established a strategy based on limiting perioperative social contacts, preoperative screening (symptoms and reverse transcription-polymerase chain reaction) and creating separated in-hospital COVID-19-free pathways for non-infected patients. We also adopted some practice modifications (surgery in different facilities, changes in staff and guidelines, using continuously changing personal protective equipment…), that supposed new inconveniences. To analyse cancer patients with a decision for surgery managed during the first wave, focalizing on outcomes and pandemic-related modifications. We prospectively included adults with a confirmed diagnosis of colorectal, oesophago-gastric, liver-pancreatic or breast cancer with a decision for surgery, regardless of whether they ultimately underwent surgery. We analysed short-term outcomes [30-d postoperative morbimortality and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection] and outcomes after 3 years (adjuvant therapies, oncological events, death, SARS-CoV-2 infection and vaccination). We also investigated modifications to usual practice. From 96 included patients, seven didn't receive treatment that period and four never (3 due to COVID-19). Operated patients: 28 colon and 21 rectal cancers; laparoscopy 53.6%/90.0%, mortality 3.57%/0%, major complications 7.04%/25.00%, anastomotic leaks 0%/5.00%, 3-years disease-free survival (DFS) 82.14%/52.4% and overall survival (OS) 78.57%/76.2%. Six liver metastases and six pancreatic cancers: no mortality, one major complication, three grade A/B liver failures, one bile leak; 3-year DFS 0%/33.3% and OS 50.0%/33.3% (liver metastases/pancreatic carcinoma). 5 gastric and 2 oesophageal tumours: mortality 0%/50%, major complications 0%/100%, anastomotic leaks 0%/100%, 3-year DFS and OS 66.67% (gastric carcinoma) and 0% (oesophagus). Twenty breast cancer without deaths/major complications; 3-year OS 100% and DFS 85%. Nobody contracted SARS-CoV-2 postoperatively. COVID-19 pandemic-related changes: 78.2% treated in alternative buildings, 43.8% waited more than 4 weeks, two additional colostomies and fewer laparoscopies. Some patients lost curative-intent surgery due to COVID-19 pandemic. Despite practice modifications and 43.8% delays higher than 4 weeks, surgery was resumed with minimal changes without impacting outcomes. Clean pathways are essential to continue surgery safely.

Structural Stability Evaluation of Natural Fiber Retrofitted Low-Cost Rammed Earthen Houses Under Seismic Loading

Earthen houses constructed using the rammed technique have long served for housing across the globe. However, despite their environmental benefits, these houses may pose unacceptable earthquake risks for the communities. To address this, the current study focuses on investigating the seismic response of unreinforced and retrofitted rammed earth model houses using unidirectional shaking table experiments. Retrofitting is performed using two different approaches. The first method is the traditional way using cement, lime and natural fibers like straw and jute mixed with soil. The second method is a new and innovative approach that uses bitumen-treated natural fibers such as jute and bamboo strips as external encasing reinforcement along with special L-shaped corner reinforcement using jute and bamboo sheets. The study shows that rammed earth houses retrofitted using the proposed novel and low-cost methods with jute/bamboo fibers demonstrate promising results in terms of structural strength and ductility compared to the stabilized counterpart. The fundamental period of the retrofitted and unreinforced houses is found in the order of 0.08 and 0.12 indicating an enhancement in lateral stiffness depending on various level retrofitting methods. The study provides valuable insights and points toward potential changes in the seismic design guidelines for low-cost rammed earthen houses.

Hereditary Cancer Clinics Improve Adherence to NCCN Germline Testing Guidelines for Pancreatic Cancer.

Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, with a 5-year overall survival rate of 10%. In November 2018, NCCN recommended that all patients with PDAC receive genetic counseling (GC) and germline testing regardless of family history. We hypothesized that patients with PDAC were more likely to be referred for testing after this change to the guidelines, regardless of presumed predictive factors, and that compliance would be further improved following the implementation of a hereditary cancer clinic (HCC). We conducted a single-institution retrospective analysis of patients diagnosed with PDAC from June 2017 through December 2021 at University of California, Irvine. We compared rates of genetics referral among patients in different diagnostic eras: the 18-month period before the NCCN Guideline change (pre-NCCN era: June 2017 through November 2018), 14 months following the change (post-NCCN era: December 2018 through January 2020), and 18 months after the creation of an HCC (HCC era: June 2020 through December 2021). Family and personal cancer history, genetics referral patterns, and results of GC were recorded. Data were compared using chi-square, Fisher exact, and multivariate analyses. A total of 335 patients were treated for PDAC (123 pre-NCCN, 109 post-NCCN, and 103 HCC) at University of California, Irvine. Demographics across groups were comparable. Prior to the guideline changes, 30% were referred to GC compared with 54.7% in the post-NCCN era. After the implementation of the HCC, 77.4% were referred to GC (P<.0001). The odds ratio (OR) for referral to GC among patients with a positive family history of cancer progressively decreased following the change (pre-NCCN era: OR, 11.90 [95% CI, 3.00-80.14]; post-NCCN era: OR, 3.39 [95% CI, 1.13-10.76]; HCC era: OR, 3.11 [95% CI, 0.95-10.16]). The 2018 updates to the NCCN Guidelines for PDAC recommending germline testing for all patients with PDAC significantly increased GC referral rates at our academic medical center. Implementation of an HCC further boosted compliance with guidelines.

A Retrospective Study Evaluating Neonatal Vancomycin Loading Doses to Achieve a Therapeutic Target

Background: Vancomycin is a glycopeptide antibiotic that has been used to treat hospital-acquired gram-positive infections for more than 5 decades. However, the literature is divided regarding the therapeutic advantages of vancomycin loading doses in neonates. Objectives: This study aimed to investigate the effect of vancomycin loading doses on therapeutic target attainment in neonates with sepsis. Methods: A retrospective cohort study was conducted to compare the vancomycin target attainment (area under the curve 0–24 hours/minimum inhibitory concentration ≥400) in neonates before and after the 2019 change in vancomycin prescription guidelines at a neonatal unit in Cape Town, South Africa. As the standard of care, Bayesian modelling software was used to compute the area under the curve from the trough concentrations. Results: Two hundred ten neonates were included. Multivariate regression analysis showed a 2-fold increase in the odds of target attainment among neonates receiving a loading dose of vancomycin. Early target attainment (within 8–12 hours of treatment initiation) was significantly higher in the loading dose group compared with the no loading dose group [97/105 (92.4%) versus 64/105 (61.0%); P &lt; 0.001]. However, the overall proportion of neonates achieving target attainment at 24 hours was similar between groups [73/105 (69.5%) in the loading dose group versus 62/105 (59.0%) in the no loading dose group; P = 0.110]. The nephrotoxicity rates were low [2/105 (1.9%) in the loading dose group and 2/105 (1.9%) in the no loading dose group]. Conclusions: The addition of a vancomycin loading dose to neonates may facilitate early therapeutic target attainment.

Evolution of germline BRCA1/2 testing practices: A five-year comparative analysis among oncology providers and patients.

e13172 Background: The Association of Cancer Care Centers (ACCC) launched a quality improvement initiative in 2018 to address suboptimal germline BRCA1/2 testing rates and identify barriers impeding testing for patients with early-stage or metastatic breast cancer. Between 2018 and 2023, changes in clinical guidelines led to expanded testing criteria and increased referrals for genetic testing. A follow-up survey in 2023 aimed to assess changes in testing practices and challenges faced by cancer care teams, considering the evolving landscape of genetic testing and the impact of the COVID-19 pandemic. Methods: In 2018, a survey of 95 oncology providers was conducted to explore provider characteristics, testing characteristics, and challenges/barriers to germline BRCA 1/2 testing. The survey was conducted again in 2023 for comparative analysis with a response of 115 oncology providers. The surveys explored provider characteristics, testing practices, and challenges/barriers to germline BRCA1/2 testing. To comprehensively understand the patient's perspective, an additional survey was conducted in October 2023, involving 61 individuals recently diagnosed with breast cancer to evaluate the patient experience with germline BRCA 1/2 testing and subsequent follow-up. Results: The adoption of expanded testing criteria, which influenced changes in clinical guidelines, has led to a substantial increase in referrals for genetic testing. The utilization of genetic testing by medical oncologists experienced a notable surge with 64% of survey respondents in 2023 reporting that medical oncologists most often initiated tests for germline BRCA1/2 mutations, compared to 29% in 2018. Patients’ awareness and engagement were high, with 82% undergoing germline BRCA1/2 testing, 48% undergoing testing at diagnosis, 33% before treatment, and 13% during treatment. In 2023, 23% of providers reported routinely ordering germline BRCA1/2 testing for patients with early-stage breast cancer, marking a threefold increase from the 2018 survey results. For patients with metastatic breast cancer, 41% of providers routinely ordered BRCA mutation testing, a threefold increase from 14% in 2018. While testing rates improved, challenges and barriers persist such as patient concerns (47%), access to genetic counselors (42%), turnaround time for test results (36%), and reimbursement issues (28%). Conclusions: The comparative analysis revealed a moderate improvement in germline BRCA1/2 testing practices, with increased provider engagement and patient awareness. Despite progress, challenges persist, needing multi-pronged efforts to enhance testing uptake and distribute critical information on testing to patients. The results indicate positive trends but underscore the importance of addressing barriers for comprehensive patient care.

Impact of American Society of Breast Surgeons (ASBS) guidelines on genetic testing (GT) rates among patients with breast cancer (BC).

e22537 Background: Identifying patients with pathogenic germline genetic variants can inform clinical decision-making and risk assessment. Previous studies have suggested low rates of GT in BC patients overall and disproportionately lower rates of GT among black patients. This may be explained in part by clinicians failing to understand the current National Comprehensive Cancer Network (NCCN) GT guidelines, which are complex. In February 2019, the ASBS released updated guidelines recommending GT for all patients with a personal history of BC. The objective of this study was to evaluate the impact of the ASBS guideline change on GT utilization for all BC patients, and for black BC patients in particular. Methods: This retrospective cohort study included 4386 BC patients who were diagnosed and/or treated at the Siteman Cancer Center (SCC) in St. Louis, MO from January 1, 2017 to December 31, 2020. The pre-guideline period included those patients diagnosed between January 1, 2017 and July 25th, 2019 and the post-guideline period included those diagnosed between July 26, 2019 and December 31, 2020. Within the study period, Myriad Genetics was used almost exclusively for GT by breast oncologists and surgeons at SCC. Myriad data was queried to identify all BC patients at SCC with GT. Data including self-reported race/ethnicity, BC subtype (triple negative breast cancer (TNBC) vs other), insurance type (public vs private), and family history of BC (yes vs no) was collected from the electronic medical record (EMR) independently by authors. Multivariate logistic regression analyses and difference in difference (DiD) analyses were performed to compare GT rates pre- and post-guideline change. Results: There was no significant difference in the rate of GT among BC patients pre- vs post-guideline change (17% vs 14.8%, p = 0.05). Similarly, there was no significant difference in GT rates pre- vs post-guideline change for non-Hispanic black (NHB) (14.6% vs 13.1%) and non-Hispanic white (NHW) subgroups (17.8% vs 15.2%) using DiD analysis (p = 0.96). Patients with a family history of BC (odds ratio (OR) 1.41, 95% confidence interval (CI) 1.17-1.69, p &lt; 0.01) and TNBC (OR 1.47, 95% CI 1.15-1.86, p &lt; 0.01) were more likely to receive GT. Patients aged greater than 50 years (OR 0.44, 95% CI 0.37-0.54, p &lt; 0.001) and those with public insurance were less likely to receive GT (OR 0.82, 95% CI 0.67-1.02, p = 0.07). DiD analyses identified no significant differences pre- and post-guideline change for these subgroups. Conclusions: Despite the recent broadening of GT guidelines by ASBS, GT rates remain low among patients with BC. We found no significant impact of the guideline change on the uptake of GT among our population of BC patients overall or by race/ethnicity, family history, BC subtype, age, or insurance status. Multidisciplinary efforts are needed to improve guideline implementation and uptake of GT in BC patients.

A propensity score–matched comparison of cytoreductive strategies in patients with acute myeloid leukemia presenting with hyperleukocytosis.

e18509 Background: Hyperleukocytosis (white blood cell (WBC) count greater than 100x109), which may lead to the clinical entity of leukostasis, is a hematologic emergency present at diagnosis in 18% of patients with acute myeloid leukemia (AML). There is controversy regarding the appropriate cytoreductive strategy, which may include cytoreductive chemotherapy, hydroxyurea, and/or leukapheresis. The American society for apheresis (ASFA) released guidelines in 2023 making leukapheresis a Category III recommendation, however significant heterogeneity and methodologic flaws exist in the evidence used to make these recommendations. Methods: Retrospective analysis of 58 patients at Massey Comprehensive Cancer Center between 2017 and 2023 who received either hydroxyurea alone (n=35) or both hydroxyurea and leukapheresis (n=23) for hyperleukocytosis at time of presentation for AML diagnosis was performed. Baseline characteristics including age, sex, Charlson Comorbidity Index (CCI), European LeukemiaNet (ELN) risk stratification, and WBC count prior to cytoreduction were collected. Comparisons of complete remission rates (CR/CRi), 30- and 60-day mortality, median overall survival (OS), and rates of therapy-induced tumor lysis syndrome (TLS) and disseminated intravascular coagulation (DIC) were analyzed using Kaplan-Meier, Fisher’s exact, Mann-Whitney tests, respectively on a propensity score matched cohort to account for differing initial WBC counts between the treatment groups. Results: PSM was used to match presenting WBC counts between the two cohorts. Other baseline characteristics including median age (65y v. 60y), median CCI (5 v. 4), ELN adverse risk rate (31.53% v. 26.1%) did not differ after PSM. No significant difference was found between the hydroxyurea group compared to the hydroxyurea and leukapheresis group, respectively, when analyzing for rate of CR/CRi (36.5% v. 43.5%), 30-day mortality (10.5% v. 17.3%), 60-day mortality (10.5% v. 34.8%), median OS (7.77 mo. v. 8.07 mo.), or rates of DIC (10.5% vs. 8.7%) and therapy induced TLS (0% v. 0%). Conclusions: Patients who received hydroxyurea alone had similar outcomes when compared to the combined treatment group with respect to median OS, CR/CRi, and mortality rates. These results are notable given that leukapheresis is not available at many medical centers and is a resource-heavy procedure, and especially so in light of new ASFA guideline changes. However, these results reflect the laboratory entity of hyperleukocytosis rather than the clinical entity of leukostasis. Further work is ongoing to assess impact of cytoreductive strategies in leukostasis in AML, and among different cytogenetic and molecular subtypes. Decisions for leukapheresis or other cytoreductive strategies should be made on a case-by-case decision at an experienced center when possible.

Prospects for the Formation of Russian-Centric Model of Higher Education

Russian higher education, experiencing the influence of both objective processes (transition to the information society and knowledge economy, globalization, internationalization, increasing environmental ventures, changes in the geopolitical situation) and internal transformations (change of political guidelines, exit from the Bologna system, return to value-based educational paradigm) is being modified again today. The article is devoted to the study of the prospects for the formation of a new Russian-centric model as the basis for transforming Russia into a new global educational center based on an effective balance of traditional and innovative educational technologies, repositioning Russia in the global context, including in the educational sphere, the development of new formats of international cooperation in the field of education with the predominance of Russian educational practices. The paper presents the results of a study of current scientific and expert discourse on the state of Russian higher education, identifying the drivers of the formation of a Russian-centric educational model. The article summarizes the nature and types of educational technologies used in modern domestic higher education, assesses the quality of teaching in modern Russian universities, as well as the need for foreign citizens to obtain higher education in the Russian Federation based on pilot surveys of Russian and foreign students conducted by the author. Conclusions are drawn about the positive prospects for creating a Russian-centric model based on the high standards of Russian higher education, the fundamental traditions of teaching in Russian higher education, taking into account the introduction of the latest educational innovations, as well as the high demand from foreign students and applicants for obtaining Russian universities’ diplomas.

The rise of endovascular repair for abdominal, thoracoabdominal, and thoracic aortic aneurysms

BackgroundGiven changes in intervention guidelines and the growing popularity of endovascular treatment for aortic aneurysms, we examined the trends in admissions and repairs of abdominal aortic aneurysms (AAAs), thoracoabdominal aortic aneurysms (TAAAs), and thoracic aortic aneurysms (TAAs). MethodsWe identified all patients admitted with ruptured aortic aneurysms and intact aortic aneurysms repaired in the Nationwide Inpatient Sample between 2004 and 2019. We then examined the use of open, endovascular, and complex endovascular repair (OAR, EVAR, and cEVAR) for each aortic aneurysm location (AAA, TAAA, and TAA), alongside their resulting in-hospital mortality, over time. cEVAR included branched, fenestrated, and physician-modified endografts. Results715,570 patients were identified with AAA (87% intact repairs and 13% rupture admissions). Both intact AAA repairs and ruptured AAA admissions decreased significantly between 2004 and 2019 (intact 41,060-34,215, P < .01; ruptured 7175-4625, P = .02). Of all AAA repairs performed in a given year, the use of EVAR increased (2004-2019: intact 45%-66%, P < .01; ruptured 10%-55%, P < .01) as well as cEVAR (2010-2019: intact 0%-23%, P < .01; ruptured 0%-14%, P < .01). Mortality after EVAR of intact AAAs decreased significantly by 29% (2004-2019, 0.73%-0.52%, P < .01), whereas mortality after OAR increased significantly by 16% (2004-2019, 4.4%-5.1%, P < .01). In the study, 27,443 patients were identified with TAAA (80% intact and 20% ruptured). In the same period, intact TAAA repairs trended upward (2004-2019, 1435-1640, P = .055), and cEVAR became the most common approach (2004-2019, 3.8%-72%, P = .055). A total of 141,651 patients were identified with ascending, arch, or descending TAAs (90% intact and 10% ruptured). Intact TAA repairs increased significantly (2004-2019, 4380-10,855, P < .01). From 2017 to 2019, the mortality after OAR of descending TAAs increased and mortality after thoracic endovascular aneurysm repair decreased (2017-2019, OAR 1.6%-3.1%; thoracic endovascular aneurysm repair 5.2%-3.8%). ConclusionsBoth intact AAA repairs and ruptured AAA admissions significantly decreased between 2004 and 2019. The use of endovascular techniques for the repair of all aortic aneurysm locations, both intact and ruptured, increased over the past two decades. Most recently in 2019, 89% of intact AAA repairs, infrarenal through suprarenal, were endovascular (EVAR or cEVAR, respectively). cEVAR alone increased to 23% of intact AAA repairs in 2019, from 0% a decade earlier. In this period of innovation, with many new options to repair aortic aneurysms while maintaining arterial branches, endovascular repair is now used for the majority of all intact aortic aneurysm repairs. Long-term data are needed to evaluate the durability of these procedures.

Associations between news coverage, social media discussions, and search trends about celebrity deaths, screening, and other colorectal cancer-related events

ObjectiveColorectal cancer (CRC) is the third leading cause of cancer death among both men and women in the United States. CRC-related events may increase media coverage and public attention, boosting awareness and prevention. This study examined associations between several types of CRC events (including unplanned celebrity cancer deaths and planned events like national CRC awareness months, celebrity screening behavior, and screening guideline changes) and news coverage, Twitter discussions, and Google search trends about CRC and CRC screening. MethodsWe analyzed data from U.S. national news media outlets, posts scraped from Twitter, and Google Trends on CRC and CRC screening during a three-year period from 2020 to 2022. We used burst detection methods to identify temporal spikes in the volume of news, tweets, and search after each CRC-related event. ResultsThere is a high level of heterogeneity in the impact of celebrity CRC events. Celebrity CRC deaths were more likely to precede spikes in news and tweets about CRC overall than CRC screening. Celebrity screening preceded spikes in news and tweets about screening but not searches. Awareness months and screening guideline changes did precede spikes in news, tweets, and searches about screening, but these spikes were inconsistent, not simultaneous, and not as large as those events concerning most prominent public figures. ConclusionsCRC events provide opportunities to increase attention to CRC. Media and public health professionals should actively intervene during CRC events to increase emphasis on CRC screening and evidence-based recommendations.

Comprehensive disease state reviews: A guide to live and virtual implementation in a therapeutics course

Background: Pharmacy curricula often teach disease states in silos, covering one disease at a time. This approach may inadequately prepare students for caring for patients with multiple coinciding disease states. The purpose of this “how-to” guide is to detail an approach to implementing a comprehensive, capstone-style disease state review into pharmacy therapeutics courses. Methods: This manuscript describes the use of a drug-class review, individual disease-state patient cases, and then layered, multi-disease-state cases that build upon individual cases in an integrated cardiovascular pharmacotherapy course. It also describes pre- and post-test assessments to supplement learning outcomes. Results: The educational activity significantly improved student performance between the pre- and post-tests. Informal feedback indicated appreciation for the real-world applicability of the activity. Conclusion: While cardiovascular examples are provided, this approach could be integrated into any therapeutics-type course. Benefits for students include providing a space to explore therapeutic decision-making for patients with multiple common, overlapping disease states. Faculty also benefit from this design, as once created, it is a robust and comprehensive review that can be used year after year regardless of changes in guidelines.

Prescribing trends of SGLT2 inhibitors among HFrEF and HFpEF patients with and without T2DM, 2013–2021

BackgroundSodium-glucose cotransporter-2 inhibitors (SGLT2i) are recommended for treatment of heart failure (HF), regardless of type 2 diabetes (T2DM) status. However, limited data exist on SGLT2i prescribing in HF patients without T2DM or across HF subtypes.MethodsThis was a serial, cross-sectional study of US MarketScan commercial and Medicare claims (2013–2021). Prevalence of SGLT2i was calculated by calendar year among HFrEF and HFpEF patients and stratified by T2DM status.ResultsAmong 218,066 HFrEF patients [mean (SD): 54.9 (8.92) years; 66.4% male], the prevalence of SGLT2i use increased from 0.3 to 18.6%, while among 150,437 HFpEF patients [56.5 (7.77) years; 47.6% male], it rose from 0.5 to 9.9%. These increases were driven by the subgroup with comorbid T2DM. SGLT2i prevalence use ratios among patients with T2DM compared to those without decreased from > 100 in 2018 to 3.8 in 2021 among HFrEF patients, and from 83.1 in 2018 to 17.5 in 2021, coinciding with the publication of landmark trials and corresponding changes in clinical guidelines.ConclusionsSGLT2i use rose rapidly following changes in guidelines but remained low among those without T2DM. By the end of the study, approximately 1 in 3 HFrEF and 1 in 5 HFpEF patients with T2DM were using an SGLT2i, compared to only 1 in 11 HFrEF and 1 in 85 HFpEF patients without T2DM. Future work identifying barriers with the uptake of GDMT, including SGLT2i, among HF patients is needed.

Retinopathy of prematurity in Germany over 13 years: incidences, treatment preferences and effects of national guideline changes

ObjectiveRetinopathy of prematurity (ROP) is a leading yet avoidable cause of childhood blindness. Screening for ROP is highly effective in preventing blindness secondary to ROP. We provide epidemiological data on...

Newer treatments for diabetes mellitus: A caveat with rapid glycaemic improvement and caution regarding changes in retinopathy screening guidelines within the UK NHS programme.

Newer treatments for diabetes mellitus: A caveat with rapid glycaemic improvement and caution regarding changes in retinopathy screening guidelines within the UK NHS programme.

State of the Art: Intrapartum Antibiotics in Cesarean Section—The Infant Microbiota and Allergic Diseases

(Acta Obstet Gynecol Scand. 2023;102:811–820) Recent changes in guidelines for administering maternal antibiotics for cesarean deliveries (CD) have increased neonatal exposure to antibiotics. Potential long-term effects of this exposure are relatively unknown; recent evidence in other fields has indicated a long-lasting impact of antibiotic exposure on gut microbiota composition, which raises concerns about the effects of antibiotics on the fragile and new gut microbiota of neonates around the time of birth. This review assessed the current guidelines and applications for CD antibiotics, as well as discussed the importance of neonatal intestinal microbiota and the potential consequences of antibiotic prophylaxis in the development of the neonatal immune system and allergic disease.