High Percentage Of Patients Research Articles

Inequalities in colon cancer treatment in Uruguay: Does age have a say?

125 Background: Colorectal cancer (CRC) is the second most diagnosed cancer in men and women in Uruguay. Survival from CRC is known to be worse in those aged 65 years and older, despite more than 70% of cases occurring in this age group. It has been said that elderly cancer patients are often under-treated compared to younger ones, and that this unequal access to treatment in practice, despite universal access in theory, accounts for at least some of the reported survival difference. A better understanding of age-related inequalities in treatment would help to inform interventions to improve cancer control, therefore a retrospective study was undertaken to investigate if there are age-related inequalities in CRC care in Uruguay. Methods: Data on age, sex, tumor site and stage and treatments received (cancer-directed surgery and chemotherapy) were obtained for 1372 patients diagnosed with CRC. Likelihood of receipt of 1) cancer-directed surgery, 2) chemotherapy in surgical patients, 3) chemotherapy in non-surgical patients by age, adjusting for sex, cancer stage, was examined. Results: More than two-thirds (67%) of our population were aged 60 years or older at diagnosis and a slightly higher proportion were men (53%). Seventy six percent received cancer directed surgery, either in a curative or palliative intent. When analyzing patients with stage I-III cancers, 81% of patients received curative intent surgery. Those in the oldest age group (80+ years) were significantly less likely to be operated than those in the <60 years age group (p 0.002) specially if the tumor was in the sub peritoneal rectum. In relation to receipt of chemotherapy in surgical patients, similar age patterns were observed, although in a much more extreme manner (p <0.001). Increasing age was also strongly associated with reduced likelihood of receiving systemic therapy, with a higher percentage of patients <60 years old receiving at least palliative chemotherapy in comparison to the 80+ year age group (p <0,001). No differences in relation to gender or tumour location were observed. Conclusions: Age remains a major factor in treatment decisions. Research is needed both to identify the most effective treatment for colon cancer in older populations and to understand clinicians’ decision-making processes to ensure equitable access.

Optimizing workflow for OncotypeDx result turnaround time from surgery to report at safety net hospital.

317 Background: OncotypeDx test has been widely used for breast cancers patients with early-stage (I-IIIa), hormone-receptor positive, HER2-negative disease. It predicts the benefit of adjuvant chemotherapy in addition to hormone therapy. Delivering OncotypeDx results in a timely manner is important to inform treatment decisions. As a quality improvement project, we implemented a strategy to reduce the Turn Around Time (TAT) from breast surgery to OncotypeDx report at Bellevue Cancer Center, the tertiary referral center of the NYC Health and Hospitals System. Methods: The primary measure was TAT from surgery to receiving OncotoypeDx result in electronic medical record (EMR). We compared TAT before and after implementation of the strategy. The historical control was from 5/2021 through 3/2022, while the group after strategy implementation was from 6/2023 to 1/2024. The strategy revolved around streamlining the identification of eligible patients by collaborating with the breast surgery team, creating and utilizing a smart phrase in the EMR. It also involved ordering OncotypeDx by closely communicating with the pathology department, obtaining insurance approval by working with the OncotypeDx vendor, and tracking OncotypeDx results. The above process was done by a breast surgery provider that offered real time updates in the EMR. Results: The patient groups were similar both before and after implementing the strategy, including patient number (26 and 27 respectively) and patient mean age (61 and 59). The majority of both groups were minority patients (77% and 81%). We found that a higher percentage of patients were from Medically Underserved Areas and Populations (MUA/P) in the group after strategy implementation (35% and 56%). Our strategy reduced the average TAT from 56 days to 30 days. Conclusions: We developed a strategy to optimize the OncotypeDx workflow in a large safety net health system despite an increase in patients from MUA/P. Initiating ordering of OncotypeDx by breast surgery along with communication with pathology and the vendor significantly reduced TAT. EMR integration with OncotypeDx vendor would be the next step to further improve the process. Before Strategy Implementation (n=26) After Strategy Implementation (n=27) Patient Mean Age 61 59 Race (%) White 27 18.5 Hispanic 39 44.4 Black 7 25.9 Asian 23 11.1 Other 4 0 Ethnicity (%) Hispanic 39 44.4 Non-Hispanic 61 55.6 Underserved Area and Population (%) 35 56 Health Professional Shortage Area (%) 50 59 Non-English Speaking (%) 50 40.7

Means to an end: Characteristics and follow-up of emergency department patients with a history of suicide attempt via medication overdose.

Availability and accessibility of a wide range of medications may be a contributing factor to rising medication-related overdose (OD) rates. Treatment for both suicide attempts (SAs) and ODs often occurs in the emergency department (ED), highlighting its potential as a screening and intervention point. The current study aimed to identify sociodemographic and clinical characteristics of individuals who reported SA via medication OD compared to other methods and to examine how these patients' suicide severity and behaviors differed over 12-month post-ED follow-up. Data were analyzed from Phases 1 and 2 of the Emergency Department Safety Assessment and Follow-up Evaluation multicenter study (N = 1376). Participants with a history of SA (n = 987) were categorized based on whether they indicated a past medication-related SA via OD. Of participants with history of SA, 62.7% (n = 619) reported medication OD for either their most serious or their most recent SA. Multivariate analyses indicated female birth sex, diagnosis of bipolar disorder, and having some college education were significantly associated with membership in the medication OD attempt group (p <0.05). Of those who attempted suicide over the 12-month follow-up, nearly 60% of participants in the medication OD attempt group reported a subsequent SA via OD over follow-up. However, nearly half (46.5%) of participants with no medication OD at baseline also reported medication OD at follow-up. Among patients presenting to the ED, females, individuals with bipolar disorder, and patients with a college education, respectively, may be at highest risk for SAs via medication OD. Prospectively, medication OD appears to be a frequent method, even among individuals with no prior attempt via OD, as demonstrated by the high percentage of patients who did not have a medication OD at baseline, but reported a medication OD during follow-up.

Mainstream Germline Genetic Testing with Expanded Eligibility for Early Breast Cancer Patients in a Large Integrated Health System.

This study evaluated a new mainstream genetic testing pathway for hereditary cancer, with expanded eligibility for early-stage breast cancer patients. The study compared multigene panel (62 genes) germline testing uptake and results for breast cancer patients at 4 pilot sites (n = 502 patients) and 10 non-pilot sites (n = 1792 patients) within Kaiser Permanente Northern California from December 2020, to June 2021. At the pilot sites, breast care coordinators (BCCs) offered and consented patients for testing, with eligibility expanded to include all patients age 65 years or younger. At the non-pilot sites, eligible patients were referred to genetics for pre-test counseling, ordering, and follow-up evaluation with the standard guideline that included all patients age 45 years or younger. Demographic and disease characteristics were similar at the pilot and non-pilot sites. At the pilot verses non-pilot sites, a higher percentage of patients was tested overall (61.6% vs 31.7%) and across all age groups. The median time from breast biopsy to test result also was reduced (22 vs 33 days, respectively). A higher percentage of patients at the pilot sites was identified as having a pathogenic/likely pathogenic variant (PV/LPV) in a breast cancer-related gene (3.6% vs 1.6%). Although the percentage of total patients tested was nearly twofold higher at the pilot sites than at the non-pilot sites, the percentage of total patients seen by genetics was estimated to be similar (33.7% vs 31.7%). Mainstream genetic testing of breast cancer patients facilitated by BCCs makes it feasible for a large health care system to expand germline genetic testing to early breast cancer patients age 65 years or younger.

Comparison of Externally Transferred and Self-Recruited Patients with Hip and Knee Revision Arthroplasty at a Certified Maximum-Care Arthroplasty Center (ACmax).

According to the guidelines of the EndoCert initiative, certified maximum-care arthroplasty centers (ACmax) are obliged to admit patients from certified arthroplasty centers (AC) if these patients need to be transferred to the more specialized ACmax due to difficult replacement and revision procedures as well as after complications in primary care that are beyond the expertise of the smaller centers. This study investigated whether the cohort of transferred patients differed from the patients directly recruited at the ACmax for factors such as severity of diagnosis, comorbidities or outcome. The aim was to determine whether transferred patients increased the resource requirements for the ACmax. A total of 136 patients were included in the retrospective study and analyzed in terms of case severity, length of hospital stays (LOS), Diagnosis-Related Group charges, readmission rate and concomitant diseases. All patients were followed for up to 12 months after the initial hospital stay. There were significant differences between the groups of transferred and self-recruited patients. For example, transferred patients had a higher Patient Clinical Complexity Level (PCCL). Similarly, the increased Case Mix Index (CMI) of transferred patients indicated more intensive care during the inpatient stay. The higher values for the comorbidity indices also supported these results. This had an impact on the LOS and overall costs, too. The differences between the groups were also reflected by adverse events during the one-year follow-up. The higher percentage of patients with septic revisions, whose treatment is especially demanding, among transferred patients aggravated the differences even further. Thus, transferred patients were associated with increased resource requirements for the ACmax. While it serves patients' safety to transfer them to an ACmax with specialized expertise and greater structural quality, the care of transferred patients ties up considerable resources at the ACmax that might only be insufficiently reimbursed by the generalized tariffs.

Clustering of restorative sleep and lifestyle habits in Japanese male working population

Non-restorative sleep (NRS) affects not only individuals’ health, but also company productivity, highlighting the importance of measures in the workplace to improve sleep. This study aimed to examine the clustering of the presence of restorative sleep (RS) and lifestyle habits in a Japanese working population and to explore the characteristics of these clusters. The subjects were 58,150 Japanese working men aged 40−59 years who underwent health check-ups across the country from April 2015 to March 2016. Data for the presence of RS, the frequency and amount of drinking, smoking/exercise habits, and body mass index obtained from health check-ups were clustered with latent class analysis. In addition, the characteristics of each cluster were examined from the perspectives of lifestyle-related disease-associated blood test results obtained from health check-ups and the status of medical treatment at medical institutions as determined from medical claims data. Consequently, RS and lifestyle habits were found to form five clusters. The “NRS, no exercise, drinkers” cluster showed the highest probability of not achieving RS. An “Obese, occasional binge drinkers” cluster with a higher percentage of patients with sleep-apnea syndrome and a “Nondrinkers” cluster with proportions of those taking sleeping pills/anxiolytics and antidepressants/antipsychotics were observed. Furthermore, the “Daily smokers and drinkers” and “RS and drinkers” clusters showed a relatively high probability of achieving RS. These findings suggest that some individuals may not be aware of the sleep disorders caused by their drinking and smoking habits. Measures to improve sleep must be tailored to the characteristics of each cluster.

Preoperative Chemoradiotherapy for Resectable Gastric Cancer

BackgroundIn Western countries, the current standard of care for resectable gastric cancer is perioperative chemotherapy. Preoperative chemoradiotherapy has been considered, but data are limited regarding this treatment as compared with perioperative chemotherapy alone.MethodsWe conducted an international, phase 3 trial in which patients with resectable adenocarcinoma of the stomach or gastroesophageal junction were randomly assigned to receive preoperative chemoradiotherapy plus perioperative chemotherapy or perioperative chemotherapy alone (control). In both groups, patients received either epirubicin, cisplatin, and fluorouracil or fluorouracil, leucovorin, oxaliplatin, and docetaxel both before and after surgery; the preoperative-chemoradiotherapy group also received chemoradiotherapy (45 Gy in 25 fractions of radiation, plus fluorouracil infusion). The primary end point was overall survival, and secondary end points included progression-free survival, pathological complete response, toxic effects, and quality of life.ResultsA total of 574 patients underwent randomization at 70 sites in Australasia, Canada, and Europe: 286 to the preoperative-chemoradiotherapy group and 288 to the perioperative-chemotherapy group. A higher percentage of patients in the preoperative-chemoradiotherapy group than in the perioperative-chemotherapy group had a pathological complete response (17% vs. 8%) and greater tumor downstaging after resection. At a median follow-up of 67 months, no significant between-group differences in overall survival or progression-free survival were noted. The median overall survival was 46 months with preoperative chemoradiotherapy and 49 months with perioperative chemotherapy (hazard ratio for death, 1.05; 95% confidence interval, 0.83 to 1.31), and the median progression-free survival was 31 months and 32 months, respectively. Treatment-related toxic effects were similar in the two groups.ConclusionsThe addition of preoperative chemoradiotherapy to perioperative chemotherapy did not improve overall survival as compared with perioperative chemotherapy alone among patients with resectable gastric and gastroesophageal junction adenocarcinoma. (Funded by the National Health and Medical Research Council and others; TOPGEAR ClinicalTrials.gov number, NCT01924819.)

Clinical characteristics analysis of persistent airflow limitation in asthmatic children

Objective: To analyze the clinical characteristics of asthmatic children with persistent airflow limitation (PAL) in order to improve understanding of PAL and improve asthma management. Methods: The clinic data of asthmatic children aged 6 to 18 years with and without PAL, who visited the Department of Allergy at Children's Hospital of the Capital Institute of Pediatrics between January 2021 and June 2023, were analyzed retrospectively. The study included a total of 197 patients (153 males and 44 females), with a median age of 9.0 (7.0, 12.0) years. The analysis encompassed demographic features, disease-related factors, laboratory tests, and spirometry parameters. Quantitative data differences between the two groups were assessed using the Student's t-test or the Mann-Whitney U test. Qualitative data comparisons were made using the Chi-square test or Fisher's exact test. Results: This study included 100 non-PAL and 97 PAL patients. The female-to-male ratio in the two groups was 27/73 and 17/80, respectively. Age and BMI were 11.0 (10.0, 13.0) years and 20.3 (17.7, 24.1) kg/m2 in the PAL group, which was significantly higher than in the non-PAL group (P<0.001). Among the PAL group, 49.5% fell within the 9-12 age group. The PAL group had a higher percentage of patients with an asthma duration of more than 3 years (89.7% vs. 62.0%, P<0.001) and a history of pneumonia (13.4% vs. 4.0%, P=0.036) compared to the non-PAL group. Regarding laboratory tests, a higher percentage of patients in the PAL group had an elevated FeNO level (60.9% vs. 37.6%, P=0.002) and animal sensitization (50.7% vs. 30.7%, P=0.022) compared to the non-PAL group. Of the 69 patients who underwent spirometry before and after PAL development, FEV1%pred, FEV1/FVC, and MMEF%pred values gradually decreased, with a significant decline in the year preceding PAL development. Conclusions: Asthmatic children with PAL had characteristics such as relatively older age, higher BMI, longer duration of asthma, eosinophilic inflammation, and atopy. Lung function decline occurred several years before PAL development. Long-term follow-up should focus on the evolving trend of spirometry parameters.

Endocrine Adverse Events Related To Immune Checkpoint Inhibitor Treatment: Relationship Between Antibodies and Severity of Thyroid Dysfunction.

The purpose of this study was to identify predictive and risk factors for the development of immune-related endocrinopathies and to analyze the incidence and characteristics of immune-related endocrinopathies in our population. A retrospective, single-centre cohort carried out at Gregorio Marañón Hospital between January 2018 -December 2019. A total of 163 patients were enrolled. In January 2018 and December 2019, we treated patients who underwent ICI treatment in the Medical Oncology Department of General University Hospital Gregorio Marañón, a tertiary care public hospital in Madrid, as part of an observational, retrospective, single-center cohort study. Endocrinopathies were diagnosed in 19.5% of the patients (n = 32). The tumours with the highest incidence of endocrinopathies were non-small cell lung cancer (25,9%), kidney cell cancer (25%) and hepatocarcinoma (20%). Among the 32 patients who developed endocrinopathy, 18,8%, 19,13%, and 21,28% received anti-CTLA-4, anti-PD-1 and anti-PDL-1, respectively. Thyroid dysfunction was the most frequent endocrinopathy (12,8%). A higher percentage of patients with negative antiTPO and antiTG antibodies developed G1 hypothyroidism compared to patients with positive antibodies who developed a higher proportion of G2 hypothyroidism. The presence of an initial phase of thyrotoxicity was not related to greater severity. We observed longer progression-free survival in patients who developed thyroid dysfunction. Pre-existing antibodies were independently associated with endocrinopathies. Moreover, our study let us conclude that the presence of thyroid autoantibodies may be related to its severity. It is important to determine anti-thyroid antibodies prior to the start of immunotherapy as a risk factor for thyroid dysfunction, which in turn is a prognostic marker.

Clinical characteristics and outcomes of patients with antibody-related autoimmune encephalitis presenting with disorders of consciousness: A prospective cohort study.

To explore the clinical characteristics, short- and long-term functional outcomes, and risk factors for antibody-related autoimmune encephalitis (AE) in patients with disorders of consciousness (DoC). Clinical data were collected from AE patients admitted to Xuanwu Hospital of Capital Medical University from January 2012 to December 2021, and patients were followed up for up to 24 months after immunotherapy. A total of 312 patients with AE were included: 197 (63.1%) with anti-NMDAR encephalitis, 71 (22.8%) with anti-LGI1 encephalitis, 20 (6.4%) with anti-GABAbR encephalitis, 10 (3.2%) with anti-CASPR2 encephalitis, 10 (3.2%) with anti-GAD65 encephalitis, and 4 (1.3%) with anti-AMPAR2 encephalitis. Among these patients, 32.4% (101/312) presented with DoC, and the median (interquartile range, IQR) time to DoC was 16 (7.5, 32) days. DoC patients had higher rates of various clinical features of AE (p < .05). DoC was associated with elevated lumbar puncture cerebrospinal fluid (CSF) pressure, CSF leukocyte count, and specific antibody titer (p < .05). A high percentage of patients in the DoC group had a poor prognosis at discharge and at 6 months after immunotherapy (p < .001), but no significant difference in prognosis was noted between the DoC group and the non-DoC group at 12 and 24 months after immunotherapy. Dyskinesia (OR = 3.266, 95% CI: 1.550-6.925, p = .002), autonomic dysfunction (OR = 5.871, 95% CI: 2.574-14.096, and p < .001), increased CSF pressure (OR = 1.007, 95% CI: 1.001-1.014, p = .046), and modified Rankin scale (mRS) score ≥3 at the initiation of immunotherapy (OR = 7.457, 95% CI: 3.225-18.839, p < .001) were independent risk factors for DoC in AE patients. DoC is a relatively common clinical symptom in patients with AE, especially critically ill patients. Despite requiring longer hospitalization, DoC mostly improves with treatment of the primary disease and has a good long-term prognosis after aggressive life support and combination immunotherapy.

Association of serum iron profile in female patients with melasma

Background: Melasma, an acquired pigmentary disorder, presents as symmetric, hyperpigmented macules and patches, primarily on the face. Its prevalence ranges from 1.5% to 33.3% and affects women more than men, impacting self-image and quality of life. Genetic predisposition, sun exposure, and hormonal factors significantly increase tyrosinase activity. The study aims to find an association between serum iron profile and melasma among female patients. Methods: This hospital-based cross-sectional study occurred in the Department of Dermatology and Venereology at Dhaka Medical College Hospital, enrolling 100 women from July 2022 to June 2023. Participants were divided into groups: Group A (patients with melasma) and Group B (healthy respondents without melasma). Results: The study compared two groups, finding no significant differences in age, marital status, occupation, or income. Group A had a higher percentage of patients with a family history of melasma (70% vs 28%) and significantly lower levels of hemoglobin, serum ferritin, iron, and transferrin saturation, but higher TIBC levels compared to Group B. Melasma was mainly central facial and symmetrical. Group A had a higher frequency of low haemoglobin, ferritin, iron, and transferrin saturation. The mMASI scores showed a negative correlation with hemoglobin, iron, ferritin, and transferrin saturation, and a positive correlation with TIBC, indicating more severe melasma with poorer iron profiles. Conclusions: There was a significant inverse correlation between low body iron stores and the severity of melasma, indicating that iron deficiency may contribute to or aggravate melasma in females. Therefore, the findings suggest that iron supplementation could improve treatment outcomes for melasma.

Congenital airway anomalies and syndromes associated in newborns with esophageal atresia

ObjectiveThis study aims to define the associated comorbidities, syndromes and anatomic findings in newborns with esophageal atresia using bronchoscopy. MethodRetrospective analysis of the database was performed on patients that underwent surgery with esophageal atresia or tracheoesophageal fistula diagnosis between 2016 and 2023 in Dr. Luis Calvo Mackenna Children´s Hospital in whom an airway study was done with rigid laryngotracheoscopy. Demographic data, comorbidities and airway anomalies were registered. ResultsData from 37 patients was analyzed. Comorbidities were present in 62.1 % of the patients. Airway anomalies such as tracheomalacia, laryngomalacia, tracheal diverticulum, congenital tracheal stenosis and cleft were present in 56.75 % of the patients. 72.9 % of the patients had Type C EA and in 32.4 % of the cases tracheoesophageal fistula was located at the carina. ConclusionIn the last 7 years we have done an airway study in 82.2 % of newborns with esophageal atresia. There is a high percentage of patients with airway anomalies, therefore we consider the importance of performing an endoscopic airway study in all patients with EA.

The Impact of Li-Fraumeni and Germline Retinoblastoma Mutations on Leiomyosarcoma Initiation, Outcomes, and Genetic Testing Recommendations.

Leiomyosarcomas (LMS) are clinically and molecularly heterogeneous, occurring mostly in sporadic but also syndromic settings. The role of pathogenic germline variants (PGV) as LMS drivers and their impact on outcomes remains uncertain. We performed a comprehensive clinicopathologic and molecular analysis using a tumor-normal DNA next-generation sequencing assay (Memorial Sloan Kettering-Integrated Mutational Profiling of Actionable Cancer Targets) of germline-associated LMS compared with sporadic LMS. Among 285 LMS [120 soft-tissue LMS (STLMS) and 165 uterine LMS (ULMS)] with germline testing, 78 (27%, 43 STLMS and 35 ULMS) cases harbored PGV, with 35/78 (45%) of PGV carriers showing biallelic inactivation of the corresponding gene in the tumor (26 STLMS and nine ULMS). The most frequent germline predispositions were TP53 (Li-Fraumeni syndrome; 17 patients, 16 in STLMS) and RB1 (retinoblastoma; 13 patients, 11 in STLMS). Germline TP53 and somatic RB1 alterations often co-occurred in the tumor andvice versa. Other biallelically inactivated PGV were enriched in DNA damage repair-related genes: CHEK2, MSH2, MSH6, RAD51D, BRCA2, and FANCA. Monoallelic PGV were mostly in ULMS and associated with co-occurring TP53 and RB1 somatic alterations. Patients with STLMS with biallelic but not monoallelic PGV were significantly younger than patients with sporadic STLMS (median ages 38 vs. 52 vs. 58 years). No differences in disease-specific or progression-free survival were observed in germline-associated versus sporadic LMS regardless of biallelic status. Although patients with ULMS had a relatively low proportion of PGV, a high percentage of patients with STLMS with PGV had tumor biallelic status, indicating that PGV drive tumorigenesis in these individuals. These findings have significant implications for genetic testing recommendations.

Prospective open-label trial with rituximab in patients with chronic inflammatory demyelinating polyradiculoneuropathy not responding to conventional immune therapies

BackgroundTo evaluate the efficacy of rituximab in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients not responding to conventional immune therapies.MethodsAn open-label, prospective exploratory study was conducted with intravenous rituximab on 17...

Single-center analysis of a real-world cohort of patients with metastatic urothelial carcinoma evaluated by NGS: molecular landscape and efficacy of targeted therapies.

To describe the molecular profile of a real-world cohort of patients with metastatic urothelial carcinoma (mUC) and to evaluate the benefit of next-generation sequencing (NGS) panels in guiding therapy in patients with mUC and the outcomes of DNA-matched treatments recommended by a multidisciplinary molecular tumor board (MMTB). This was a single-center analysis of a real-world cohort of adult patients with mUC included in an ongoing trial that aimed to evaluate the clinical utility of NGS for solid tumors. Genomic analysis was performed for each patient, most of them using the Ion Torrent Oncomine Focus Assay. Genomic results were discussed during MMTB meetings. We included 43 patients with mUC treated with platinum-based combinations and immunotherapy. Twenty-five patients (58.1%; 95% CI 43.4-72.9) had at least one tumor pathogenic alteration. The MMTB classified 16 (48.5%) of the 33 tumor pathogenic alterations found in our real-world cohort of mUC patients as ESCAT I, which is the maximum grade of actionability. After excluding patients who were not candidates for targeted therapies, the MMTB provided guidance on matched therapy for seven patients. Among these patients, three achieved a partial response for an overall response rate of 42.9%, a median progression-free survival of 7.3months (95% CI 6.7-7.9) and a median overall survival of 10.9months (95% CI 2.4-19.5). We recommend that all patients with mUC undergo NGS at diagnosis given the high percentage of patients with pathogenic alterations in our real-world cohort and the efficacy data of patients treated with targeted therapies.

Postoperative Outcomes of Bascom Cleft Lift Versus Excision With Secondary Wound Healing for Pilonidal Sinus Disease: A Multicenter Retrospective Analysis.

Pilonidal sinus disease impacts patient's quality of life. In the Netherlands, it is often treated with excision and secondary healing, which is associated with high recurrence rates and poor wound healing. The Bascom cleft lift, an alternative technique, has shown favorable healing times and recurrence rates. The present study aims to compare successful wound healing, time to healing, complications, and recurrence rate between excision with secondary wound healing and Bascom cleft lift. This is a multicenter retrospective study. Three institutions in the Rotterdam region of the Netherlands participated in the study. Patients who underwent excision with secondary healing or Bascom Cleft Lift between July 2015 and August 2021 were included. Primary endpoints included the rate of successful wound healing and the time to achieve healing. Secondary endpoints included postoperative complications and recurrence rate within twelve months after surgery. Out of 272 patients, 128 underwent Bascom cleft lift and 144 patients excision and secondary healing. Recurrent PSD (47.7% vs 22.2%) and abscess history (53.1% vs 40.3%) were more common in the Bascom cleft lift group compared to excision with secondary wound healing. The median follow-up period at the outpatient clinic was 43 days. Wound healing was 84.4% after Bascom cleft lift vs. 32.6% after excision and secondary healing (p < 0.001), with median time to wound healing of 55 days and 101 days, respectively (p < 0.001). Complications were 28.9% for Bascom cleft lift vs. 13.2% for excision and secondary healing (p = 0.003). Recurrent disease was 6.3% after Bascom Cleft Lift and 11.8% after excision and secondary healing (p = 0.113). It has a retrospective design which makes it prone to selection bias and residual confounding. Additionally, the study's short follow-up period further adds to these limitations as longer follow-up may better identify true recurrence rates. Finally, a deficiency is the absence of collected patient satisfaction data, which is nowadays a common scientific issue. This retrospective study shows that Bascom cleft lift is superior to excision and secondary healing given the higher percentage of patients with successful wound healing within a shorter time. See Video Abstract.

Electrogram-guided Bachmann bundle area pacing to correct interatrial block: Initial experience, safety, and feasibility

BackgroundA lack of standard Bachman Bundle(BB) capture criteria has affected the clinical impact of Bachmann Bundle Area Pacing(BBAP) in patients with inter-atrial block(IAB). ObjectiveWe evaluated the feasibility and safety of electrogram guided BBP using sheath assisted, stylet-driven atrial lead implantation. MethodsPatients with a baseline IAB undergoing dual chamber PPI or ICD implantation were enrolled in a single center,prospective study. BBAP was attempted in all patients with the aid of a Selectra 3D S-40 delivery sheath and Solia S-60 pacing lead. BB capture was confirmed using a combination of fluoroscopy,P wave morphology,and electrophysiological criteria. These included the recording of a high frequency BB potential and a transition between non-selective(NS) to selective(S) BB capture during threshold testing. Procedure-related complications,lead parameters,and P wave morphology were assessed at implantation and follow up. ResultsPermanent BBAP was successful in 32 of the 36(88.9%) enrolled patients. Baseline P wave duration was 148.5+16.1ms. Among patients who underwent successful BBP, the final paced P wave duration was 117.8+19.6ms. There was a correction of the partial or complete interatrial block in 22(91.7%) and 6(75.0%) patients, respectively. BB potentials were recorded in 83.3% of all study patients.A transition from NS to S-BB capture could be demonstrated during threshold testing in 22(87.5%) patients. The only major complications were 2 BBAP lead dislodgements within 24 hours and a rise in pacing impedance at 3 weeks in 1 patient. ConclusionBBAP is feasible in a high percentage of patients and is associated with stable capture thresholds during follow up.

Assessing disparities through missing race and ethnicity data: results from a juvenile arthritis registry.

Ensuring high-quality race and ethnicity data within the electronic health record (EHR) and across linked systems, such as patient registries, is necessary to achieving the goal of inclusion of racial and ethnic minorities in scientific research and detecting disparities associated with race and ethnicity. The project goal was to improve race and ethnicity data completion within the Pediatric Rheumatology Care Outcomes Improvement Network and assess impact of improved data completion on conclusions drawn from the registry. This is a mixed-methods quality improvement study that consisted of five parts, as follows: (1) Identifying baseline missing race and ethnicity data, (2) Surveying current collection and entry, (3) Completing data through audit and feedback cycles, (4) Assessing the impact on outcome measures, and (5) Conducting participant interviews and thematic analysis. Across six participating centers, 29% of the patients were missing data on race and 31% were missing data on ethnicity. Of patients missing data, most patients were missing both race and ethnicity. Rates of missingness varied by data entry method (electronic vs. manual). Recovered data had a higher percentage of patients with Other race or Hispanic/Latino ethnicity compared with patients with non-missing race and ethnicity data at baseline. Black patients had a significantly higher odds ratio of having a clinical juvenile arthritis disease activity score (cJADAS10) of ≥5 at first follow-up compared with White patients. There was no significant change in odds ratio of cJADAS10 ≥5 for race and ethnicity after data completion. Patients missing race and ethnicity were more likely to be missing cJADAS values, which may affect the ability to detect changes in odds ratio of cJADAS ≥5 after completion. About one-third of the patients in a pediatric rheumatology registry were missing race and ethnicity data. After three audit and feedback cycles, centers decreased missing data by 94%, primarily via data recovery from the EHR. In this sample, completion of missing data did not change the findings related to differential outcomes by race. Recovered data were not uniformly distributed compared with those with non-missing race and ethnicity data at baseline, suggesting that differences in outcomes after completing race and ethnicity data may be seen with larger sample sizes.

Impact of pharmacist managed oral epidermal growth factor receptor inhibitors.

Pharmacists are an integral part of medication management, with the positive impact of their clinical services in patient outcomes previously studied and reported in literature. The roles and responsibilities of pharmacists continue to expand, including optimizing patient medication and health outcomes related to complex oral anticancer drugs. To evaluate the impact of a pharmacist-managed oral chemotherapy clinic in patients with non-small cell lung cancer (NSCLC) taking oral epidermal growth factor receptor inhibitor (EGFRi) regimens within an integrated healthcare delivery system. This was an observational cohort study using data from Kaiser Permanente Northern and Southern California regions on adult patients who received oncology pharmacist-managed care compared to patients with usual care. Patients were newly initiated with EGFRi therapy to treat NSCLC between 2017 and 2019. The follow-up period was defined as the time from index date (first sold date of EGFRi) to December 2020 or end of membership or death, whichever occurred first. Primary outcome measures included adherence to EGFRi, frequency of imaging during drug exposure, and presence of imaging prior to treatment change. Outcomes were analyzed with Chi-square test for categorical variables, and Student's t-test or Wilcoxon rank-sum test for continuous variables. There were 613 patients in the pharmacist-managed group and 714 patients in the usual care group. Overall, the mean age was 68.2 ± 11.3 years, and 65.1% were female. In the pharmacist-managed group, there was a significantly higher mean proportion of days covered (PDC) during the first three months of therapy (0.86 ± 0.24 vs 0.82 ± 0.36, p = 0.01) and a higher percentage of patients who were adherent to EGFRi therapy (with PDC ≥0.80) during the drug exposure period (95.8% vs 92.4%, p = 0.01). The rate of computed tomography (CT) and magnetic resonance imaging (MRI) during drug exposure was higher in the pharmacist-managed group compared to the usual care group (31.8% vs 20.7%, p < 0.01) with a higher number of mean scans completed per patient (1.15 ± 2.42 vs 0.62 ± 1.63, p < 0.01) and per patient-year (2.60 ± 7.27 vs 1.58 ± 5.95, p < 0.01). Overall, 66.2% of patients had a treatment change, with a higher percentage of patients in the pharmacist-managed group who completed a CT or MRI scan prior to treatment change (36.3% vs 26.3%, p < 0.01). Additionally, the median time between the scan and treatment change was shorter for patients with pharmacist-managed care (1.8 vs 4 months, p = 0.04). Clinical pharmacy services contributed to improved adherence, higher rates of imaging, and shorter time between imaging and treatment changes in NSCLC patients who were taking EGFRi regimens.

Accuracy of intraocular lens power formulas in patients with average keratometry greater than 46 diopters

ObjectiveTo compare the accuracy of Kane, Barrett Universal II, Haigis, and SRK-T formulas in eyes with average keratometry greater than 46 diopters (D). MethodsA retrospective analysis was conducted on 101 eyes of 101 patients with average keratometry greater than 46 D. The absolute prediction error (EA) was obtained for each patient one month after surgery. The mean absolute prediction error (MEA), median absolute prediction error (MedEA) and the percentage of patients with absolute refractive error less than 0.25 D, 0.50 D, and 1.00 D were calculated for each formula analyzed. ResultsThe Kane formula achieved the lowest MEA (0.53 ± 0.43) and the lowest MedEA (0.41), followed by Barrett Universal II (MEA: 0.56 ± 0.42, MedEA: 0.49), SRK-T (MEA: 0.59 ± 0.44, MedEA: 0.54), and Haigis (MEA: 0.77 ± 0.47, MedEA: 0.69), showing a significant difference in the results. It was also observed that the Kane formula was the most accurate, with the highest percentage of patients, with EA less than 0.25 D, 0.50 D, and 1.00 D (30.7%, 54.4%, and 86.1%, respectively), while the Haigis formula was the least accurate (12.9%, 33.7%, and 69.3%, respectively). ConclusionIn eyes with corneas having average keratometry greater than 46 D, the Kane formula proves to be a useful tool in intraocular lens (IOL) power calculation and demonstrates higher precision compared to the Barrett Universal II, SRK-T, and Haigis formulas.