High Rate Treatment Research Articles

#4400 QUALITY OF LIFE, PRURITUS BURDEN, AND TREATMENT SATISFACTION IN CHRONIC KIDNEY DISEASE PATIENTS IN GERMANY

Abstract Background and Aims Chronic kidney disease (CKD) and its related symptoms significantly impact patients’ health-related quality of life (HRQoL). CKD-associated pruritus (CDK-aP) often affects patients with advanced CKD, particularly those on renal replacement therapy, and remains mostly underrecognized by both patients and medical providers. To explore the current patients’ impairment of HRQoL due to CKD-aP, we conducted a quantitative survey amongst members of a CKD patient association in Germany. Methods Our questionnaire was distributed via the channels of the German National Kidney Patients Association (Bundesverband Niere e.V.) from mid-June to mid-September 2022. Responses of 569 CKD-patients of a total of roughly 16,000 members were analysed regarding their general health, HRQoL, and general treatment satisfaction using multiple choice questions. Pruritus burden was assessed with a 0-10 numeric rating scale. Results The demographic details are displayed in Figure 1. Among the surveyed CKD patients, 33% were transplanted, 39% on hemodialysis, and 7% on peritoneal dialysis. We could confirm that most CKD patients (92 %) suffered from comorbidities. Initially, 12% reported dermatological comorbidities but when asked specifically about pruritus, 62% reported this symptom which was also associated with worse HRQoL (Figure 2). However, only one third was receiving antipruritic treatment by a physician. Furthermore, patients who were able to fully or at least partially participate in their medical decisions showed higher satisfaction and higher HRQoL (86% vs. 65% vs. 43% satisfaction, depending on full/partial/no participation, respectively) yet the patients did not always perceive that shared-decision-making was possible. Patients also showed high interest in topics outside of their primary CKD treatment, such as overall symptom control and additional psychological measures. They reported higher HRQoL when these areas were addressed by the medical team (87% vs. 55% satisfaction). Conclusions Our survey results emphasize the persisting need for shared or co-creative exchange between patient and physician. Improving patient education and the caregiver's awareness of the burden of pruritus – one of the many CKD-related symptoms – could be a first step towards higher patient satisfaction and HRQoL and higher treatment rates. CKD-aP appears underreported by patients via unprovoked questioning and should be screened frequently.

A Retrospective Study of Staphylococcus aureus Bacteremia in a Tertiary Hospital and Factors Associated with Mortality.

Staphylococcus aureus bacteremia (SAB) is a severe infection frequently associated with significant morbidity and mortality. Recent studies have shown that SAB mortality has decreased during the last decades. However, about 25% of patients suffering from the disease will ultimately die. Hence, there is an urgent need for more timely and efficient treatment of patients with SAB. The aim of the present study was to retrospectively evaluate a cohort of SAB patients hospitalized in a tertiary hospital and to identify factors independently associated with mortality. All 256 SAB patients hospitalized from January 2005 to December 2021 in the University Hospital of Heraklion, Greece, were evaluated. Their median age was 72 years, while 101 (39.5%) were female. Most SAB patients were cared for in medical wards (80.5%). The infection was community-acquired in 49.5%. Among all strains 37.9% were methicillin-resistant S. aureus (MRSA), however, definite treatment with an antistaphylococcal penicillin was given only in 22% of patients. Only 14.4% of patients had a repeat blood culture after the initiation of antimicrobial treatment. Infective endocarditis was present in 8%. In-hospital mortality has reached 15.9%. Female gender, older age, higher McCabe score, previous antimicrobial use, presence of a central venous catheter, neutropenia, severe sepsis, septic shock, and MRSA SAB were positively associated with in-hospital mortality, while monomicrobial bacteremia was negatively associated. The multivariate logistic regression model identified only severe sepsis (p = 0.05, odds ratio = 12.294) and septic shock (p = 0.007, odds ratio 57.18) to be independently positively associated with in-hospital mortality. The evaluation revealed high rates of inappropriate empirical antimicrobial treatment and non-adherence to guidelines, as shown, by the lack of repeat blood cultures. These data underline the urgent need for interventions with antimicrobial stewardship, increased involvement of infectious diseases physicians, educational sessions, and creation and implementation of local guidelines for improvement of the necessary steps for timely and efficient SAB treatment. Optimization of diagnostic techniques is needed to overcome challenges such as heteroresistance that may affect treatment. Clinicians should be aware of the factors associated with mortality in patients with SAB to identify those who are at a higher risk and optimize medical management.

Do first-trimester screening algorithms for preeclampsia aligned to use of preventative therapies reduce the prevalence of pre-term preeclampsia: A systematic review and meta-analysis.

Traditional obstetric practice has relied upon history-based assessment to screen for preeclampsia and guide preventative therapies but is hampered by low sensitivity, high false positive rates and low treatment rates. First-trimester screening algorithms represent the most efficacious approach for risk prediction and could target early initiation of aspirin to well-defined high-risk populations. A large randomised controlled trial has demonstrated clinical benefits of this approach, but widespread practice implementation has remained elusive. We performed a systematic review and meta-analysis summarising studies linking first-trimester preeclampsia screening algorithms with initiation of preventative therapy and examine their effect on pre-term preeclampsia rates compared with standard maternity care. Odds ratios were calculated together with 95% confidence intervals. 7 studies with a total of 377,790 participants were included. Within singleton populations, early initiation of aspirin in response to a high-risk screening algorithm result reduced the prevalence of pre-term preeclampsia by 39% compared with routine antenatal care (OR 0.61; 95% CI: 0.52-0.70). There were significant reductions in the prevalence of preeclampsia at <32 to 34 weeks, preeclampsia at any gestation and stillbirth. First-trimester screening algorithms for preeclampsia aligned with early initiation of preventative therapy with aspirin reduces the prevalence of pre-term preeclampsia. This article is protected by copyright. All rights reserved.

Skills of undergraduate dental students in performing atraumatic restorative treatment one year survival rate of this restoration.

Objective: To assess the skills of the undergraduate dental students in performing Atraumatic Restorative Treatment and the one year survival of this restoration. Study Design: Cross sectional study. Setting: Department of Community Dentistry, Multan Medical &amp; Dental College, Multan. Period: Sept 2021 to Aug 2022. Material &amp; Methods: Through convenient purposive sampling selected 2nd year dental students were assigned to collect the extracted teeth to perform ART according to the given guidelines using Glass Ionomer Cement. The research supervisor assessed the characteristics of the filling and keeping in view the status of the restoration it has given Alfa, Bravo or Charlie score. The students who scored Alfa were then allowed to perform ART on patients in Out Patient Department. The demographics of the patients along with caries assessment (Class I, II &amp; III) were recorded. Patients were kept on telephonic contact and were recalled after 1 year to evaluate the survival rate. Results: A total 100 ART restorations were done on extracted teeth. Around 76 fillings were found to be perfect while 24 fillings were associated with any one or two defects. Later 100 patients were included having any of the 3 classes of caries. Mean age of the patients was 32 years. The success rate of ART restorations at 12 months was found to be 89% with highest success rate of 62% was reported in Class I ART restorations. Conclusion: Extraordinary high survivals rates of Atraumatic Restorative Treatment found in this study represented the reliability of this method as an affordable preventive and curative treatment for dental caries particularly in developing countries.

Factors predicting birth satisfaction in Hungary

Birth satisfaction is influenced by demographic, obstetric and cognitive factors. There is a paucity of research on birth satisfaction in Hungary, despite the country displaying high rates of medical interventions during childbirth. A cross-sectional study was conducted online with 78 Hungarian women. Participants completed the Birth Satisfaction and the Birth Beliefs scales alongside a demographic and obstetric questionnaire. Birth satisfaction was associated with parity, place of birth, pain management methods, delivery mode and adherence to birth plan, as well as beliefs in birth as a medical process, but not with self-efficacy or birth beliefs as a natural process. However, when considered together, none of the variables predicted birth satisfaction, implying that other factors may be at play. Given the limited research on birth satisfaction in Hungary, these results constitute important foundations for further research.

MP-453090-1 SPORTS RELATED SUDDEN CARDIAC ARREST IN CANADA: INCIDENCE AND SURVIVAL

Sports-related sudden cardiac arrest (SCA) is widely recognized in young competitive athletes, yet recent studies have shown it occurs most frequently in middle-aged, recreational athletes. Few studies have comprehensively described the incidence of sports-related SCA in the general population. To describe sports-related SCA events in 3 Canadian Provinces: Ontario, Saskatchewan, and British Columbia, with a combined estimated population of 7.5 million. C-SCAN is a multidisciplinary network measuring the scope of SCA across Canada. We conducted a cohort study using Emergency Medical Services records from consecutive SCAs ages 18-85 that had no obvious cause, were treated, and occurred during or ≤1 hour after sports activity. The intensity level for each sport was assigned an estimated metabolic equivalent (MET). We defined moderate exercise as a MET score of 3-5.9 and vigorous as ≥6. A total of 14,130 SCAs occurred between Jan 1, 2016 - Dec 31, 2020, of which 272 (1.9%) were sport-related. Most were male (93%; 253/272), with a median age of 60 years [IQR 50, 70]. The overall incidence was 1.2 per 100,000 person-years (95% CI, 1.1-1.3), with males having a 14-fold higher incidence than females 2.3 (95% CI: 2.0-2.6) vs. 0.2 (95% CI: 0.1-0.3) per 100,000 person-years, respectively. SCAs occurred during 35 unique sports (Figure 1); intensity was vigorous (44.9%; 122/272) , moderate (30.5%; 83/272) or uncertain (24.6% ; 67/272). Most took place in recreational facilities (62.1%; 169/272), with high rates of bystander witnessed (73.9%; 201/272) and bystander CPR (79.0%; 215/272). Bystanders applied an AED in 43.4% (118/272) of cases and AED shocks were delivered in 99/118 (84%), when an AED was applied. Median EMS response time was 6 [IQR 5, 9] minutes, with an initial shockable rhythm reported in 51.1% (139/272). Over half of those with known final vital status (52.3%; 134/256) survived to hospital discharge. Sport-specific survival rates were highly variable (Figure 1, Table 1). Almost 30% (74/272) reported symptoms ≤1 hour of sports activity, with chest pain (n=28), shortness of breath (n=18), and dizziness (n=12) being most common. Sports-related SCA occurs infrequently, yet attracts high rates of bystander intervention, resulting in a high proportion of survivors. Data on sport-specific survival and preceding symptoms could help inform risk stratification and public response strategies.Tabled 1Table 1: Characteristics and interventions of sports-related SCAs (n = 272)SportMale cases (n = 253)(n, %)Female cases (n = 19)(n, %)Age (mean, SD)Bystander AED applied (n, %)Survived to hospital discharge (n, %)Hockey43 (17%)0 (0%)56 (12.4)34 (79.1%)31/40 (77.5%)Cycling39 (15.4%)1 (5.3%)63.7 (9.4)4 (10%)17/38 (44.7%)Running/jogging31 (12.3%)3 (15.8%)49.3 (17.1)12 (35.3%)19/30 (63.3%)Ball sports30 (11.9%)3 (15.8%)57 (16.8)16 (48.5%)21/31 (67.7%)Home/gym workout26 (10.3%)2 (10.5%)60.2 (11.6)12 (42.9%)10/27 (37%)Swimming23 (9.1%)4 (21.1%)58.9 (18.2)16 (59.3%)7/27 (25.9%)Racket sports20 (7.9%)0 (0%)65.1 (8.7)9 (45%)14/18 (77.8%)Exercise Class14 (5.5%)5 (26.3%)58.7 (13.2)5 (26.3%)9/17 (52.9%)Winter sports12 (4.7%)0 (0%)64.1 (14.1)7 (58.3%)2/12 (16.7%)Other8 (3.2%)0 (0%)57.2 (17.4)3 (37.5%)3/8 (37.5%)Water sports7 (2.8%)1 (5.3%)55.5 (12.8)0 (0%)1/8 (12.5%)Survival rate calculation includes only those for whom final vital status is known. Open table in a new tab

Visual review of acute stroke neuroimaging prior to transfer acceptance increases likelihood of endovascular therapy

ObjectivesDemand for thrombectomy, and interhospital transfer to comprehensive stroke centers (CSCs), for acute stroke is increasing. There is an urgent need to identify patients most likely to benefit from transfer. We evaluated whether CSC providers’ review of neuroimaging prior to transfer acceptance improved patient selection for thrombectomy and correlated with higher rates of treatment. Materials and methodsA retrospective database of all patients transferred to Stanford's CSC for thrombectomy between 2015-2019 was used. Pre-acceptance images, when available for visual review, were reviewed by the CSC stroke team via virtual PACS, RAPID software, or LifeImage platforms. Results525 patients met inclusion criteria. 147 (28%) had neuroimaging available for review prior to transfer. Of those who did not recanalize en route, 267 (50.8%) underwent thrombectomy. Patients with imaging available for review prior to acceptance were significantly more likely to receive thrombectomy (68% vs 54%, RR 1.26; p=0.006, 95% CI 1.09-1.48). Patient images that were reviewed via RAPID were CT-based perfusion studies; these were more likely to receive thrombectomy (70% vs 54%, RR 1.30; p=0.01, 1.09-1.56). Patients who received EVT were more likely to have had pre-transfer vessel imaging, regardless of availability for visual review (76% vs 59%, RR 1.44; p<0.001, 1.18-1.76). ConclusionsPatients with concern for acute stroke transferred for consideration of thrombectomy who had neuroimaging visually reviewed prior to transfer acceptance and did not recanalize by time of arrival were significantly more likely to undergo thrombectomy. Additional prospective studies are needed to confirm our findings.

Combining Endovascular Aneurysm Sealing with Chimney Grafts – 5 Year Follow-Up after 47 Procedures

To evaluate longer-term results of a cohort treated with primary chimney endovascular aneurysm sealing (ChEVAS) for complex abdominal aortic aneurysms or secondary ChEVAS after failed endovascular aneurysm repair/endovascular aneurysm sealing. A single-center study was conducted of 47 consecutive patients (mean age 72±8years, range 50-91; 38 men) treated with ChEVAS from February 2014 to November 2016 and followed through December 2021. The main outcome measures were all-cause mortality (ACM), aneurysm-related mortality, occurrence of secondary complications and conversion to open surgery. Data are presented as the median (interquartile range [IQR]) and absolute range. 35 patients received a primary ChEVAS (=group I) and 12 patients a secondary ChEVAS (=group II). Technical success was 97% (group I) and 92% (group II); 30-day mortality was 3% and 8%, respectively. The median proximal sealing zone length was 20.5mm (IQR 16, 24; range 10-48) in group I and 26mm (IQR 17.5, 30; range 8-45) in group II, respectively. During a median time of follow-up of 62months (range 0-88), ACM amounted to 60% (group I) and 58% (group II); aneurysm mortality was 29% and 8%, respectively. An endoleak was seen in 57% (group I: 15 type Ia endoleaks, four isolated type Ib, and 1 endoleak type V) and 25% (group II: 1 endoleak type Ia, one type II, and 2 type V), aneurysm growth in 40% and 17%, migration in 40% and 17%, resulting in 20% and 25% conversions in group I and II, respectively. Overall a secondary intervention was performed in 51% (group I) and 25% (group II), respectively. The occurrence of complications did not significantly differ between the 2 groups. Neither the number of chimney grafts, nor the thrombus ratio significantly affected the occurrence of abovementioned complications. While initially delivering a high technical success rate, ChEVAS fails to provide acceptable longer-term results both in primary and secondary ChEVAS, resulting in high rates of complications, secondary interventions and open conversions.

MP17-05 ASSOCIATION OF UROLOGY PRACTICE IMPLEMENTATION OF MULTIPARAMETRIC MRI AND GENOMIC TESTING ON TREATMENT RATES IN MEN WITH NEWLY DIAGNOSED PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP17-05 ASSOCIATION OF UROLOGY PRACTICE IMPLEMENTATION OF MULTIPARAMETRIC MRI AND GENOMIC TESTING ON TREATMENT RATES IN MEN WITH NEWLY DIAGNOSED PROSTATE CANCER Kassem Faraj, Lindsey Herrel, Mary Oerline, Samuel Kaufman, Vahakn Shahinian, and Brent Hollenbeck Kassem FarajKassem Faraj More articles by this author , Lindsey HerrelLindsey Herrel More articles by this author , Mary OerlineMary Oerline More articles by this author , Samuel KaufmanSamuel Kaufman More articles by this author , Vahakn ShahinianVahakn Shahinian More articles by this author , and Brent HollenbeckBrent Hollenbeck More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003237.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate biomarkers, including multiparametric MRI (mpMRI) and/or tissue-based genomics, are increasingly used to inform decision-making by providing additional information about prostate cancer biology. Biomarkers applied uniformly, thereby ignoring significant competing physiologic risks (i.e., a high risk of noncancer mortality), may lead to treatment in a population with limited clinical benefit. We assessed the association of practice use of prostate biomarkers and treatment rates in men with newly diagnosed prostate cancer by noncancer mortality risk. METHODS: We used a 20% national Medicare sample and performed a retrospective cohort study of men with newly diagnosed prostate cancer in 2015 through 2018. Practice-level use of mpMRI and genomics was characterized using the percentage of a practice’s patient panel using either biomarker and sorted into 3 groups—no use, use below the median (low use), use above the median (high use). We fit 3 separate multilevel models to evaluate the relationship between practice-level use of a biomarker (mpMRI, genomics, both) and use of localized treatment by noncancer mortality risk at 10 years. RESULTS: Between 2015 and 2018, 1576 (61.5%) and 934 (36.4%) of 2,564 urology practices used mpMRI or genomics in at least 1 man with cancer. On multilevel regression analysis, high use of mpMRI by a practice was associated with a 6.0% (p<0.05) higher treatment rate in the group with very high noncancer mortality risk, compared to no use. Adoption of genomics only impacted the moderate risk group, as high use of genomics was associated with a 4.5% (p<0.05) reduction in the rate of treatment, compared to no testing. When evaluating both biomarkers (Figure 1), use of the two biomarkers was associated with significant increase in treatment rates in the group with the highest noncancer mortality risk (7.1% difference, p<0.05), compared with no testing. CONCLUSIONS: Compared to practices that do not use biomarker (genomics, mpMRI) testing after incident prostate cancer, practices that increasingly use biomarkers are more likely to treat patients with higher 10-year noncancer mortality risk. This association is mainly dominated by practice-level adoption of mpMRI. Source of Funding: This study is supported by funding from National Cancer Institute Advanced Training in Urologic Oncology T32 Grant No T32CA180984 (Faraj) and by funding from the National Cancer Institute RO1CA269367 (Hollenbeck, Shahinian) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e214 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kassem Faraj More articles by this author Lindsey Herrel More articles by this author Mary Oerline More articles by this author Samuel Kaufman More articles by this author Vahakn Shahinian More articles by this author Brent Hollenbeck More articles by this author Expand All Advertisement PDF downloadLoading ...

Комплексная биологическая очистка сточных вод предприятий мясо-молочной промышленности

About 200 enterprises producing meat product and more than 50 enterprises of the dairy industry operate in the Republic of Belarus. Up to 70 % of the water used in these industries is contaminated with fatty substances. At present, physicochemical methods (coagulation and flocculation) and biological treatment using microorganisms-destructors of fats and oils are most widely used for the treatment of fat-containing wastewater, it is advisable to use these treatment methods in combination. Recently, more and more attention has been paid to the complete or partial replacement of chemical flocculants by biological or microorganisms with flocculating ability. In this paper, the process of wastewater treatment of meat and dairy industry enterprises was studied using a consortium of flocculant microorganisms and the microbial preparation Antoil. The investigated microbial consortium was shown to be as active as the most common polyacrylamide-based synthetic flocculants used for wastewater treatment. The flocculating activity was 92-98 %. It has been established that the process of purification of the studied wastewater with the help pf the consortium of microorganisms used depends on the temperature and pH value of the effluents. Dairy and meat industry wastewater was treated with an efficiency of 60.9-98.0 % in 7 days in the temperature range of 10-40 °C and pH 4-9. It is shown that the use of a consortium of flocculant microorganisms makes it possible to achieve high rates of wastewater treatment of a cheese-making plant and a poultry farm not only in terms of suspended solids, but also in terms of COD. The effectiveness of the combined use of a consortium of flocculant microorganisms and the microbial preparation Antoil for the treatment of wastewater from poultry farms and maintaining the treatment efficiency at a high level (86.5-92.9 %) during burst discharges has been practically confirmed.

Analysis of risk factors associated with the high incidence of amblyopia in preterm infants at the corrected gestational age of 12 months

ObjectiveTo investigate the perinatal and in-hospital risk factors associated with the high incidence of amblyopia in preterm infants and to analyze the correlation between the amblyopia and neurodevelopment.MethodsChildren discharged from the neonatal intensive care unit (NICU) at 12 months of corrected gestational age were retrospectively included in this study. Ocular screening was performed in children. At the risk of amblyopia was determined according to the American Academy of Ophthalmology Guidelines for automated preschool vision screening factors. Differences in perinatal characteristics, complications during hospitalization, and treatment modalities between the two groups of children were analyzed, and multifactorial logistic regression analysis was used to identify the independent risk factors for amblyopia. The results of developmental assessment were collected retrospectively to analyze the correlation between amblyopia and various aspects of neurological development.ResultsA total of 128 preterm infants, 30 in the amblyopia risk group and 98 in the non-amblyopia risk group, were included in this study. Univariate analysis showed that the amblyopia risk group had lower birth weights, higher rates of asphyxia, preterm brain white matter injury, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), sepsis during hospitalization, and higher rates of treatment with pulmonary surfactant (PS), blood transfusion, invasive ventilator, and levothyroxine. Logistic regression analysis showed that BPD in the neonatal period (odds ratio [OR] 8.355, 95% confidence interval [CI] 1.492, 46.786), brain white matter injury (OR 16.742, 95% CI 0.684, 409.804), treatment with levothyroxine (OR 2.859, 95% CI 0.946, 8.639), and use of an invasive ventilator (OR 2.983, 95% CI 0.942, 9.445) were independent risk factors for amblyopia at 12 months of corrected gestational age, while the administration of glucocorticoids (OR 0.055, 95% CI 0.004, 0.737) was a protective factor. Regarding neurodevelopmental assessment, the number of infants with lagging fine motor development was greater in the amblyopia risk group.ConclusionThe presence of BPD in the neonatal period, brain white matter damage in preterm infants, and use of levothyroxine and invasive ventilator were high risk factors for amblyopia. The use of glucocorticoids therapy was a protective factor. Children with risk of amblyopia had a higher rate of poor fine motor development.

THE CLINICAL IMPLICATIONS OF GRAF TYPE IIA HIP DYSPLASIA

IntroductionThere is little evidence surrounding the clinical implications of a diagnosis of IIa hip dysplasia with no consensus as to its efficacy as a predictor pathological dysplasia or treatment. Therefore, we evaluated the importance of categorising 2a hip dysplasia in to 2a- and 2a+ to better understand the clinical outcomes of each.MethodsA 9-year retrospective cohort study of patients with a diagnosis of type IIa hip dysplasia between 2011 – 2020 (n=341) in our centre. Ultrasound scans were graded using Graf's classification, assessment of management and DDH progression was completed through prospective data collection by the authors.ResultsThe prevalence of IIa hip dysplasia within our population was 6.7/1000 live births. There was significantly higher incidence of treatment in the IIa- (31.4%, n=17/54) group when compared to the 2a+ group (10%, n=28/287), (p&lt;0.01). In those that had an abnormality (torticollis and/or foot abnormality) treatment rates (24% n=7/29) were significantly (p&lt;0.05) higher than those without anatomical abnormality (15%, n=48/312).ConclusionThis study has demonstrated the significant clinical impact of a IIa- diagnosis on progression to pathological dysplasia and therefore higher rates of treatment in IIa- hips. Furthermore, we have demonstrated the importance of detection of IIa hips through a national screening program, to allow for timely intervention to prevent missing the acetabular maturation window. Therefore, it is our recommendation that all patients with additional anatomical abnormalities and those with a diagnosis of type IIa- hip dysplasia be considered for immediate treatment or urgent follow up following their diagnosis to prevent late conservative intervention.

Regional practice variation in pelvic organ prolapse surgery in Tuscany, Italy: a retrospective cohort study on administrative health data

ObjectivesTo explore determinants of practice variation in both access, and quality and efficiency of surgical care for pelvic organ prolapse (POP).Design and settingA retrospective cohort study employing administrative health data...

Detection of the characteristic magnetic signal of paclitaxel and its application in the inhibition of glioma cells

Glioma, a type of brain tumor, is one of the most challenging cancers for human beings due to its genetic heterogeneity, high recurrence rate and difficulty of effective treatment. To explore a novel treatment method for glioma, a scientific hypothesis was proposed that a chemical substance or biological agent may generate a characteristic magnetic signal, and this signal is the fundamental reason that the chemical substance or biological agent works for cancer treatment. Based on this hypothesis, a superconducting quantum interference device (SQUID) using the stochastic resonance (SR) method was established, and the characteristic magnetic signal of paclitaxel was detected and clearly visualized for the first time. Then, cell experimental results demonstrated that the detected characteristic magnetic signal of paclitaxel was as effective as paclitaxel for the inhibition of glioma cells. Our study suggested that the application of paclitaxel's characteristic magnetic signal might provide an ideal treatment direction for glioma patients due to its lack of side effects, high focusable penetration and effectiveness.

Minimal Risk Maneuvers of Automated Vehicles: Effects of a Contact Analog Head-Up Display Supporting Driver Decisions and Actions in Transition Phases

Minimal risk maneuvers (MRMs), as part of highly automated systems, aim at minimizing the risk during a transition phase from automated to manual driving. Previous studies show that many drivers have an urge to intervene in transition phases despite the system’s capability to safely come to a standstill. A human–machine interface (HMI) concept was developed to support driver decisions by providing environmental information and action recommendations. This was investigated in a static driving simulator experiment with 36 participants. Two scenarios that differed in the traffic on the adjacent left lane were implemented and the HMI concept displayed the content accordingly. Results of the study again show a high intervention rate of drivers overtaking the obstacle from the left, even if the lane is occupied by other vehicles. The HMI concept had a positive influence on the manner of intervention by encouraging a standstill in the shoulder lane. Nevertheless, negative consequences included accidents and dangerous situations, but at lower frequencies and proportions during drives with the HMI concept. In conclusion, the risk during the transition phase was reduced. Furthermore, the results showed a significant decrease in the subjective workload and a positive influence on the drivers’ understanding and predictability of the automated system.

The impact of race and ethnicity on survival in primary liver cancer: A propensity-adjusted analysis.

500 Background: Primary liver cancer is the fifth most common malignancy and the second most frequent cause of cancer-related death worldwide. Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, followed by Intrahepatic cholangiocarcinoma (ICC), and the incidence of liver cancer is rapidly rising in the United States. Race and ethnicity affect the outcomes in many solid cancers; therefore, we aimed to study the effect of race and ethnicity on overall survival (OS) in primary liver cancer. Methods: We selected adult patients who had primary liver cancer (HCC and ICC) diagnosed between 2004 and 2016 using the NCDB database. We stratified the patients into two groups as white and black. We performed the Kaplan-Meier method for median overall survival (OS), and the Cox regression method for multivariate analyses after adjusting for clinically significant confounding variables. Also, we used 1:1 nearest neighbor propensity score matching to reduce selection bias. Results: A total of 122,049 patients, 83.1% was white, 16.9% was black. Black patients were more likely to be young ( p&lt;.001), to live in the metropolitan area ( p&lt;.001) and South Atlantic states ( p&lt;.001), to be treated academic/research facility ( p&lt;.001), to be uninsured ( p&lt;.001). In contrast, white patients were most frequently to be highly educated ( p&lt;.001), to have higher income ( p&lt;.001), to travel longer distances (≥50 miles) for treatment ( p&lt;.001). Also, black patients had a higher rate of HCC ( p&lt;.001), advanced stage ( p&lt;.001), high metastasis rate ( p&lt;.001), whereas white patients had a higher rate of ICC ( p&lt;.001), higher comorbidity ( p&lt;.001), high treatment rate (surgery, chemotherapy, and radiotherapy) ( p&lt;.001). The gender percentage was similar in both groups. In unmatched groups, white patients had significantly better median OS compared to black (9.9 vs. 8.4 months, p&lt;.001), but this difference did not continue after adjusted for age, sex, facility type, insurance status, income, education, rurality, travel distance, comorbidity, metastatic rate, treatment receipt (surgery, chemotherapy, radiotherapy), primary site (HR=1.01 95% CI: 0.99-1.03, p=.18). In ethnic groups, Hispanics had significantly improved OS compared to non-Hispanic white (NHW) and non-Hispanic black patients (NHB) (median OS 12 vs. 9.7 vs. 8.5 months, respectively, p&lt;.001), and this significance was persisted with multivariate analysis (HR=0.80 95% CI: 0.78-0.82, p&lt;.001). After propensity score matching, white and black patients were similar OS (p=NS) but Hispanics were still significantly improved OS versus NHW and NHB patients (HR=0.76 95% CI: 0.71-0.80, p&lt;.001). Conclusions: Black patients had a higher stage, percentage of metastasis and lower treatment rate, but they had a similar OS compared to white patients. Hispanics had significantly improved OS than others, even after adjusted for clinically important confounding variables.

Abstract TP29: Nurse-led Acute Stroke Process Promotes Advocacy And Treatment Times: A Case Series

Background: Reperfusion therapies for acute ischemic strokes are highly time sensitive. Centers across the world have implemented various approaches in treating these patients when presenting to the ED using multidisciplinary team approaches, straight-to-CT, and straight-to-angio suite. Several studies recently published the efficiency of an ED nurse-led stroke process on improving timeliness and decreasing door-to-treatment times. Purpose: Little to no literature has focused on how a stroke RN leading a stroke alert process serves as a patient advocate to assist the decision-making process. Methods: Our CSC built a stroke program using a multidisciplinary team, parallel workflow approach led by a Stroke Responder, filled by a neuroscience RN specially trained to lead the acute stroke process. This case series exemplifies how the Stroke Responder influenced the decision-making process in 2 stroke alerts. Case Study 1: A 60-year old high-profile public figure presented to the ED with mild aphasia. With a low NIHSS, some providers may be reluctant to offer thrombolysis based off risk vs benefit. In this patient’s case, mild aphasia was debilitating to life and career. The stroke RN emphasized this resulting in the patient receiving thrombolysis and making a full recovery to baseline. Case Study 2: For an incoming stroke alert on a 90+ year old, the stroke RN received pertinent patient information and a family contact number from EMS via telemedicine. The stroke RN was able to confirm information with family and transferred call to neurologist for consent of thrombolysis prior to patient arrival. Patient was transferred straight-to-CT upon arrival, administered the thrombolytic within 12 min, and subsequently taken for mechanical thrombectomy in the right MCA bifurcation when procedure was aborted due to NIHSS from 13 to 3. Conclusion: Highly specialized neuroscience nurses assigned to lead a stroke alert process benefit the patient beyond providing effective care coordination and assisting the neurologist with assessments. They can help drive the decision-making process resulting in higher treatment rates and faster door-to-treatment times.

Surgical therapy of celiac axis and superior mesenteric artery syndrome

IntroductionCompression syndromes of the celiac artery (CAS) or superior mesenteric artery (SMAS) are rare conditions that are difficult to diagnose; optimal treatment remains complex, and symptoms often persist after surgery. We aim to review the literature on surgical treatment and postoperative outcome in CAS and SMAS syndrome.MethodsA systematic literature review of medical literature databases on the surgical treatment of CAS and SMAS syndrome was performed from 2000 to 2022. Articles were included according to PROSPERO guidelines. The primary endpoint was the failure-to-treat rate, defined as persistence of symptoms at first follow-up.ResultsTwenty-three studies on CAS (n = 548) and 11 on SMAS (n = 168) undergoing surgery were included. Failure-to-treat rate was 28% for CAS and 21% for SMAS. Intraoperative blood loss was 95 ml (0–217) and 31 ml (21–50), respectively, and conversion rate was 4% in CAS patients and 0% for SMAS. Major postoperative morbidity was 2% for each group, and mortality was described in 0% of CAS and 0.4% of SMAS patients. Median length of stay was 3 days (1–12) for CAS and 5 days (1–10) for SMAS patients. Consequently, 47% of CAS and 5% of SMAS patients underwent subsequent interventions for persisting symptoms.ConclusionFailure of surgical treatment was observed in up to every forth patient with a high rate of subsequent interventions. A thorough preoperative work-up with a careful patient selection is of paramount importance. Nevertheless, the surgical procedure was associated with a beneficial risk profile and can be performed minimally invasive.

Understanding the Role of Urology Practice Organization and Racial Composition in Prostate Cancer Treatment Disparities.

Black men have a higher risk of prostate cancer diagnosis and mortality but are less likely to receive definitive treatment. The impact of structural aspects on treatment is unknown but may lead to actionable insights to mitigate disparities. We sought to examine the associations between urology practice organization and racial composition and treatment patterns for Medicare beneficiaries with incident prostate cancer. Using a 20% sample of national Medicare data, we identified beneficiaries diagnosed with prostate cancer between January 2010 and December 2015 and followed them through 2016. We linked urologists to their practices with tax identification numbers. We then linked patients to practices on the basis of their primary urologist. We grouped practices into quartiles on the basis of their proportion of Black patients. We used multilevel mixed-effects models to identify treatment associations. We identified 54,443 patients with incident prostate cancer associated with 4,194 practices. Most patients were White (87%), and 9% were Black. We found wide variation in racial practice composition and practice segregation. Patients in practices with the highest proportion of Black patients had the lowest socioeconomic status (43.1%), highest comorbidity (9.9% with comorbidity score ≥ 3), and earlier age at prostate cancer diagnosis (33.5% age 66-69 years; P < .01). Black patients had lower odds of definitive therapy (adjusted odds ratio, 0.87; 95% CI, 0.81 to 0.93) and underwent less treatment than White patients in every practice context. Black patients in practices with higher proportions of Black patients had higher treatment rates than Black patients in practices with lower proportions. Black patients had lower predicted probability of treatment (66%) than White patients (69%; P < .05). Despite Medicare coverage, we found less definitive treatment among Black beneficiaries consistent with ongoing prostate cancer treatment disparities. Our findings are reflective of the adverse effects of practice segregation and structural racism, highlighting the need for multilevel interventions.

Antiviral Pills against SARS-CoV-2 Virus to Combat Future Epidemic Threats in Pakistan

Antiviral pills are oral medications that treat infections through the inhibition of the viral growth and replication cycle. Paxlovid by Pfizer and Molnupiravir by Merck are the two pills effective for high-risk SARS-CoV-2 patients. Paxlovid works by inhibiting the replication cycle of SARS-CoV-2 using cysteine residues in-vitro. These cysteine residues inhibit the main protease of the virus by functioning as reversible covalent inhibitors. Molnupiravir works by introducing a high rate of mutations in the viral RNA causing the virus to become biologically unstable and non-functional. Both antiviral drugs can bridge the gap in the preparedness for viral outbreaks in low-income countries like Pakistan by mitigating the chances of fatality and inpatient treatment in high-risk, unvaccinated individuals. Pakistan has been plagued by various epidemics over the years however SARS-CoV-2 outbreak caused many deaths along with an economic crisis. The country lacks the resources to endure high inpatient treatment rates in case of SARS-CoV-2 infections, which is why the need for antiviral pills like Paxlovid and Molnupiravir is empirical to overcome epidemics and viral outbreaks. This work outlines the antiviral pills and their efficacy against SARS-CoV-2 with a focus on how these drugs can overcome significant gaps in epidemic preparedness and response in Pakistan. We aim to highlight how antiviral pills against SARS-CoV-2 can ensure resilience to future epidemic threats in Pakistan.