Impact Patient Outcomes Research Articles

Durable pulmonary vein isolationwith optimized high-power and very high-power short-duration temperature-controlled ablation: A step-by-step guide.

Through systematic scientific rigor, the CLOSE guided workflow was developed and has been shown to improve pulmonary vein isolation durability. However, this technique was developed at a time when using power-controlled ablation catheters with conventional power ranges was the norm. There has been increased adoption of a high-power and very high-power short-duration ablation practice propelled by the availability of the temperature-controlled radiofrequency QDOT MICRO catheter. There are fundamental differences in biophysics between very high-powered temperature guided ablation and conventional ablation strategy that may impact patient outcomes. The catheter's design and ablation modes offer flexibility in technique while accommodating the individual operator's clinical discretion and preference to deliver a durable, transmural, and contiguous lesion set. Here, we provide recommendations for 3 different workflows using the QDOT MICRO catheter in a step-by-step manner for pulmonary vein isolation based on our cumulative experience as early adopters of the technology and the data available in the scientific literature. With standardization, temperature-controlled ablation with the QDOT MICRO catheter provides operators the flexibility of implementing different ablation strategies to ensure durable contiguous pulmonary vein isolation depending on patient characteristics.

Predictors for anaemia, blood transfusion and outcome in plastic surgery patients.

In patients undergoing plastic surgery, to identify specific risk factors for anaemia and use of blood products, and assess their impact on patient outcome. For this retrospective study, data were analysed from patients who attended the Plastic Surgery Department at our hospital over a three-year period (2018 to 2020). Adult patients who presented with traumatic injuries, oncologic patients who underwent reconstructive procedures, and patients with soft tissue infections (STIs) who required plastic surgery for tissue coverage were included. Demographic and injury data, hospital admission characteristics, surgical procedures, laboratory test results, transfusion events, and in-hospital complications were extracted from patient records. Of the 350 patients included in the study, 228 (65%) presented with trauma, 76 (22%) underwent reconstructive surgery for cancers and 46 (13%) had STIs. In total, 175 (50%) patients developed anaemia, and 37 (11%) received blood transfusions; these were 20 (54%), 5 (14%), and 12 (32%) patients in the trauma, cancer and STI groups, respectively. Associated comorbidities and upper and lower limb surgery were the most significant risk factors for anaemia, while the number of surgeries and NSTIs were identified as risk factors for blood transfusions. Direct wound closure was consistently a protective factor for both anaemia and blood transfusions. Blood transfusions were independently associated with a high risk of sepsis, wound complications, and prolonged hospital stay. While transfusions are necessary and even lifesaving in surgical patients, blood is a finite resource and its use may negatively impact patient outcome. Therefore, ongoing research must focus on providing safe and restrictive clinical practices while developing sustainable and accessible alternatives.

Planting the Seed for Blood Pressure Control: The Role of Plant-Based Nutrition in the Management of Hypertension.

Hypertension results in significant morbidity, mortality, and healthcare expenditures. Fortunately, it is largely preventable and treatable by implementing dietary interventions, though these remain underutilized. Here, we aim to explore the role of healthy dietary patterns in hypertension management and describe approaches for busy clinicians to address nutrition effectively and efficiently with patients. DASH, Mediterranean, vegetarian, and vegan diets that include minimally processed, plant-based foods as core elements have consistently shown positive effects on hypertension. Recommendations that distill the most healthful components of these diets can significantly impact patient outcomes. Clinicians can harness evidence-based dietary assessment and counseling tools to implement and support behavioral changes, even during brief office visits. Healthful plant-based dietary patterns can often effectively prevent and treat hypertension. Clinicians may help improve patient outcomes by discussing evidence-based nutrition with their patients. Future work to promote infrastructural change that supports incorporating evidence-based nutrition into medical education, clinical care, and society at large can support these efforts.

Improved Waitlist Outcomes in Liver Transplant Patients With Mid-MELD-Na Scores Listed in Centers Receptive to Use of Organs Donated After Circulatory Death.

Liver transplant (LT) using organs donated after circulatory death (DCD) has been increasing in the United States. We investigated whether transplant centers' receptiveness to use of DCD organs impacted patient outcomes. Transplant centers were classified as very receptive (group 1), receptive (2), or less receptive (3) based on the DCD acceptance rate and DCD transplant percentage. Using organ procurement and transplantation network/UNOS registry data for 20 435 patients listed for LT from January 2020 to June 2022, we compared rates of 1-y transplant probability and waitlist mortality between groups, broken down by model for end-stage liver disease-sodium (MELD-Na) categories. In adjusted analyses, patients in group 1 centers with MELD-Na scores 6 to 29 were significantly more likely to undergo transplant than those in group 3 (aHR range 1.51-2.11, P < 0.001). Results were similar in comparisons between groups 1 and 2 (aHR range 1.41-1.81, P < 0.001) and between groups 2 and 3 with MELD-Na 15-24 (aHR 1.19-1.20, P < 0.007). Likewise, patients with MELD-Na score 20 to 29 in group 1 centers had lower waitlist mortality than those in group 3 (scores, 20-24: aHR, 0.71, P = 0.03; score, 25-29: aHR, 0.51, P < 0.001); those in group 1 also had lower waitlist mortality compared with group 2 (scores 20-24: aHR0.69, P = 0.02; scores 25-29: aHR 0.63, P = 0.03). One-year posttransplant survival of DCD LT patients did not vary significantly compared with donation after brain dead. We conclude that transplant centers' use of DCD livers can improve waitlist outcomes, particularly among mid-MELD-Na patients.

Debunking the July Effect in lung transplantation recipients

ObjectiveThe “July Effect” is a theory that the influx of trainees from July to September negatively impacts patient outcomes. We aimed to study this theoretical phenomenon in lung transplant recipients given the highly technical nature of thoracic procedures. MethodsAdult lung transplant hospitalizations were identified within the National Inpatient Sample (2005-2020). Recipients were categorized as academic Q1 (July to September) or Q2-Q4 (October to June). In-hospital mortality, operator-driven complications (pneumothorax, dehiscence including wound dehiscence, bronchial anastomosis, and others, and vocal cord/diaphragm paralysis, all 3 treated as a composite outcome), length of stay, and inflation-adjusted hospitalization charges were compared between both groups. Multivariable logistic regression was performed to assess the association between academic quarter and in-hospital mortality and operator-driven complications. The models were adjusted for recipient demographics and transplant characteristics. Subgroup analysis was performed between academic and nonacademic hospitals. ResultsOf 30,788 lung transplants, 7838 occurred in Q1 and 22,950 occurred in Q2-Q4. Recipient demographic and clinical characteristics were similar between groups. Dehiscence (n = 922, 4% vs n = 236, 3%), post-transplant cardiac arrest (n = 532, 2% vs n = 113, 1%), and pulmonary embolism (n = 712, 3% vs n = 164, 2%) were more common in Q2-Q4 versus Q1 recipients (all P < .05). Other operator-driven complications, in-hospital mortality, and resource use were similar between groups (P > .05). These inferences remained unchanged in adjusted analyses and on subgroup analyses of academic versus nonacademic hospitals. ConclusionsThe “July Effect” is not evident in US lung transplantation recipient outcomes during the transplant hospitalization. This suggests that current institutional monitoring systems for trainees across multiple specialties, including surgery, anesthesia, critical care, nursing, and others, are robust.

Early referral to nephrological care improves long-term survival and hospitalization after dialysis initiation, independent of optimal dialysis start – a call for harmonization of reimbursement policies

Early treatment of kidney disease can slow disease progression and reduce the increased risk of mortality associated with end-stage kidney disease. However, uncertainty exists whether early referral (ER) to nephrological care per se or an optimal dialysis start impacts patient outcome after dialysis initiation. We determined the effect of ER and suboptimal dialysis start on the 3-year mortality and hospitalizations after dialysis initiation. Between January 2015 and July 2018, 349 patients with ≥1 month of follow-up started dialysis at nine Romanian dialysis clinics. After excluding patients with COVID-19 during follow-up, 254 patients (97 ER and 157 late referral) were included in this retrospective study. The observational period was truncated at 3 years, death, or loss to follow-up. Clinical and laboratory data were retrieved from the quality database of the nephrological care providers. Patients were followed for a median (25–75%) of 36 (16–36) months. At dialysis start, ER patients had higher hemoglobin, phosphate, and albumin levels and started dialysis less often via a central dialysis catheter (p < 0.001 for each). Logistic regression analysis demonstrated an independent lower risk for frequent hospitalizations for ER patients (odds ratio 0.22 (95% confidence interval 0.1–0.485), p < 0.001), and Cox regression analysis revealed an improved survival (hazard ratio 0.540 (95% confidence interval 0.325–0.899), p = 0.02), both independent of optimal dialysis start. In conclusion, early referral to nephrological care was associated with improved survival and lower hospitalization rates during the three years after dialysis initiation, independent of optimal dialysis start. These results strongly support the reimbursement of nephrological care before dialysis initiation.

Clinicians’ experience with technology within the physical environment of trauma rooms: a focus group study

PurposeThis study aims to investigate how trauma team members perceive technological equipment and tools in the trauma room (TR) environment and to identify how the technological equipment could be optimized in relation to the TR’s space.Design/methodology/approachA total of 21 focus group sessions were conducted with 69 trauma team members, all of whom worked in Level I TRs from six teaching hospitals in the USA.FindingsThe collected data was analyzed and categorized into three parent themes: imaging equipment, assistive devices and room features. The results of the study suggest that trauma team members place high importance on the availability and versatility of the technological equipment in the TR environment. Although CT scans are a usual procedure necessity in TRs, few facilities were optimized for easy access to CT-scanners for the TR. The implementation of cameras and screens was suggested as an improvement to accommodate situational awareness. Rapid sharing of data, such as imaging results, was highly sought after. Unorthodox approaches, such as the use of automatic doors, were associated with slowing down the course of actions.Practical implicationsThis study provides health-care designers with the knowledge they need to make informed decisions when designing TRs. It will cover key considerations such as room layout, equipment selection, lighting and controls. Implementing the strategies will help minimize negative patient outcomes.Originality/valueLevel I TRs are a critical element of emergency departments and designing them correctly can significantly impact patient outcomes. However, designing a TR can be a complex process that requires careful consideration of various factors, including patient safety, workflow efficiency, equipment placement and infection control. This study suggests multiple considerations when designing TRs.

Digital mammogram based robust feature extraction and selection for effective breast cancer classification in earlier stage

Breast cancer poses a significant health risk for women, demanding early detection to mitigate its mortality impact. Leveraging the power of Deep Learning (DL) in medical imaging, this paper introduces a hybrid model that integrates YOLOv7 and Half UNet for feature extraction. YOLOv7 identifies and localizes potential cancerous regions, while Half UNet focuses on extracting pertinent features with its encoder-decoder structure. The fusion of these discriminative features, coupled with feature selection via Coati Optimization, ensures a comprehensive and optimized dataset. The selected features then feed into the CatBoost classification algorithm, refining parameters iteratively for precise predictions and minimizing the loss function. Evaluation metrics, including precision, recall, specificity, and accuracy, demonstrate the model’s superior performance. Notably, the proposed model surpasses existing methods in early-stage breast cancer detection. Beyond numerical metrics, its significance lies in the potential to positively impact patient outcomes and increase survival rates. By amalgamating cutting-edge DL techniques, the model excels in identifying intricate patterns crucial for early cancer detection. The efficient fusion of YOLOv7 and Half UNet, coupled with feature optimization through Coati Optimization, sets this model apart. This research contributes to the evolving landscape of medical imaging and DL applications, emphasizing the potential for enhanced breast cancer diagnosis and improved patient prognoses.

Intraoperative Prophylaxis with Palonosetron for Postoperative Nausea and/or Vomiting in Adults Undergoing Cardiothoracic Surgery Under General Anesthesia: A Single-Center Retrospective Study

This study assessed the efficacy of palonosetron, alone or with dexamethasone, in reducing postoperative nausea and/or vomiting (PONV) and its impact on hospitalization duration in patients who undergo adult cardiothoracic surgery (CTS) under general anesthesia. This retrospective analysis involved 540 adult patients who underwent CTS from a single-center cohort, spanning surgeries between September 2021 and March 2023. Sensitivity, logistic, and Cox regression analyses evaluated antiemetic effects, PONV risk factors, and outcomes. At the Virginia Mason Medical Center (VMMC), Seattle, WA. Adults undergoing cardiothoracic surgery at VMMC during the specified period. Patients were categorized into the following 4 groups based on antiemetic treatment: dexamethasone, palonosetron, dexamethasone with palonosetron, and no antiemetic. Primary outcomes encompassed PONV incidence within 96 hours postoperatively. Secondary outcomes included intensive care unit stay duration and postoperative opioid use. Palonosetron recipients showed a significantly lower PONV rate of 42% (v controls at 63%). The dexamethasone and palonosetron combined group also demonstrated a lower rate of 40%. Sensitivity analysis revealed a notably lower 0- to 12-hour PONV rate for palonosetron recipients (9% v control at 28%). Logistic regression found decreased PONV risk (palonosetron odds ratio [OR]: 0.24; dexamethasone and palonosetron OR: 0.26). Cox regression identified varying PONV hazard ratios related to female sex, PONV history, and lower body mass index. This single-center retrospective study underscored palonosetron's efficacy, alone or combined with dexamethasone, in managing PONV among adult patients who undergo CTS. These findings contribute to evolving antiemetic strategies in cardiothoracic surgery, potentially impacting patient outcomes and satisfaction positively.

Evidence Synthesis and Linkage for Modelling the Cost-Effectiveness of Diagnostic Tests: Preliminary Good Practice Recommendations.

To develop preliminary good practice recommendations for synthesising and linking evidence of treatment effectiveness when modelling the cost-effectiveness of diagnostic tests. We conducted a targeted review of guidance from key Health Technology Assessment (HTA) bodies to summarise current recommendations on synthesis and linkage of treatment effectiveness evidence within economic evaluations of diagnostic tests. We then focused on a specific case study, the cost-effectiveness of troponin for the diagnosis of myocardial infarction, and reviewed the approach taken to synthesise and link treatment effectiveness evidence in different modelling studies. The Australian and UK HTA bodies provided advice for synthesising and linking treatment effectiveness in diagnostic models, acknowledging that linking test results to treatment options and their outcomes is common. Across all reviewed models for the case study, uniform test-directed treatment decision making was assumed, i.e., all those who tested positive were treated. Treatment outcome data from a variety of sources, including expert opinion, were utilised for linked clinical outcomes. Preliminary good practice recommendations for data identification, integration and description are proposed. Modelling the cost-effectiveness of diagnostic tests poses unique challenges in linking evidence on test accuracy to treatment effectiveness data to understand how a test impacts patient outcomes and costs. Upfront consideration of how a test and its results will likely be incorporated into patient diagnostic pathways is key to exploring the optimal design of such models. We propose some preliminary good practice recommendations to improve the quality of cost-effectiveness evaluations of diagnostics tests going forward.

Postoperative infectious complications worsen oncologic outcomes following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma.

Pancreaticoduodenectomy (PD) remains the only curative option for patients with pancreatic adenocarcinoma (PDAC). Infectious complications (IC) can negatively impact patient outcomes and delay adjuvant therapy in most patients. This study aims to determine IC effect on overall survival (OS) following PD for PDAC. Patients who underwent PD for PDAC between 2010 and 2020 were identified from a single institutional database. Patients were categorized into two groups based on whether they experienced IC or not. The relationship between postoperative IC and OS was investigated using Kaplan-Meier and Cox-regression multivariate analysis. Among 655 patients who underwent PD for PDAC, 197 (30%) experienced a postoperative IC. Superficial wound infection was the most common type of infectious complication (n = 125, 63.4%). Patients with IC had significantly more minor complications (Clavien-Dindo [CD] < 3; [59.4% vs. 40.2%, p < 0.001]), major complications (CD ≥ 3; [37.6% vs. 18.8%, p < 0.001]), prolonged LOS (47.2% vs 20.3%, p < 0.001), biochemical leak (6.1% vs. 2.8%, p = 0.046), postoperative bleeding (4.1% vs. 1.3%, p = 0.026) and reoperation (9.6% vs. 2.2%, p < 0.001). Time to adjuvant chemotherapy was delayed in patients with IC versus those without (10 vs. 8 weeks, p < 0.001). Median OS for patients who experienced no complication, noninfectious complication, and infectious complication was 33.3 months, 29.06 months, and 27.58 months respectively (p = 0.023). On multivariate analysis, postoperative IC were an independent predictor of worse OS (HR 1.32, p = 0.049). IC following PD for PDAC independently predict worse oncologic outcomes. Thus, efforts to prevent and manage IC should be a priority in the care of patients undergoing PD for PDAC.

Changes in the Perioperative Management and Outcomes of Patients With Upper Tract Urothelial Carcinoma Undergoing Radical Nephroureterectomy at Memorial Sloan Kettering Cancer Center: Over 20 Years of Experience.

We evaluated surgical trends, perioperative management evolution, and oncologic outcomes in patients who underwent radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) at a tertiary cancer center over a 24-year period. Between 1995 and 2018, we evaluated 743 consecutive patients with UTUC who underwent RNU. Generalized additive models were used to estimate the associations between date of surgery and continuous outcomes using a linear model, dichotomous outcomes using a logit link, categorical outcomes using multinomial models, and 2- and 5-year survival outcomes using Cox proportional hazards models. Over the study period, preoperative diagnostic endoscopic biopsies increased from 10% to 66%, along with the proportion of patients who underwent RNU for high-grade disease from 55% to 91%. The rate of open RNU declined from 100% to 56% with a rise in minimally invasive approaches. Median lymph node yield increased with more retroperitoneal lymph node dissections performed. Neoadjuvant chemotherapy utilization increased with a contemporary utilization rate of 32%, coinciding with an increase in pT0 rate from 2% to 8%. Cancer-specific survival probabilities improved over the study period, while metastasis-free and overall survival remained stable. We found several changes in treatment patterns and outcomes for patients with UTUC over the past 2 decades. How individual alterations in management factors, such as patient selection, perioperative chemotherapy, lymphadenectomy, and salvage therapies, impact patient outcomes is challenging in the setting of multiple overlapping practice changes for this rare disease and warrants further investigation.

Understanding the current acute aortic syndrome (AAS) pathways-The Collaborative Acute Aortic Syndrome Project (CAASP) protocol.

Acute aortic syndrome (AAS) is an emergency associated with high peri-hospital mortality rates. Variable clinical presentation makes timely diagnosis challenging and such delays in diagnosis directly impact patient outcomes. The aims of the Collaborative Acute Aortic Syndrome Project (CAASP) are to characterise and evaluate the current AAS pathways of a cohort of hospitals in the UK, USA and New Zealand to determine if patient outcomes are influenced by the AAS pathway (time to hospital admission, diagnosis and management plan) and demographic, social, geographic and patient-specific factors (clinical presentation and comorbidities). The objectives are to describe different AAS pathways and time duration between hospital admission to diagnosis and management plan instigation, and to compare patient outcomes between pathways. The study is a multicentre, retrospective service evaluation project of adult patients diagnosed on imaging with AAS. It will be coordinated by the UK National Interventional Radiology Trainee Research (UNITE) network and Vascular and Endovascular Research Network (VERN) in conjunction with The Aortic Dissection Charitable Trust (TADCT). All AAS cases diagnosed on imaging between 1st January 2018 to 1st June 2021 will be included and followed-up for 6 months. Eligibility criteria include aortic dissection (AD) Type A, Type B, non A/B, penetrating aortic ulcer, and intramural haematoma. Exclusion criteria are non-AAS pathology, acute on chronic AAS, and age<18. This project will evaluate patient demographics, timing of presentation, patient symptoms, risk factors for AD, physical examination findings, timing to imaging and treatment, hospital stay, and mortality. Univariate and multivariate analysis will be used to identify predictors associated with prolonged time to diagnosis or treatment and mortality at 30 days.

Optimizing the CAR T-Cell Therapy Experience in Multiple Myeloma: Clinical Pearls From an Expert Roundtable

Chimeric antigen receptor T-cell (CAR-T) therapies offer substantial advancement in the treatment of multiple myeloma (MM). However, the CAR-T therapy process involves complex decision-making that is informed by many variables. This review aims to provide an overview of the patient selection and administration process for CAR-T therapy for MM from the perspective of experienced healthcare providers (HCPs), including considerations for each step in the CAR-T therapy process. Referring HCPs should initiate conversations with HCPs at CAR-T capable centers earlier in the treatment journey, even before patients are eligible for CAR-T therapy, particularly for patients from underserved populations and patients with high-risk disease, to ensure adequate time for logistical planning and patient education. Patient selection for CAR-T therapy may be guided by factors such as performance status, rate of disease progression, and logistical considerations. Some anticancer therapies may affect T-cell fitness and therefore impact CAR-T manufacturing and patient outcomes; however, additional research is needed to confirm this in MM. Bridging therapies should be tailored to the needs of the patient and ideally halted 1 week or longer before CAR-T infusion, contingent upon the agent(s) used. Lymphodepletion regimens may need to be modified for patients with renal insufficiency. Collaboration with HCPs at both the treating and referring centers is important to optimize coordinated care of patients. Collaboration with and guidance from experienced HCPs throughout patient selection, referral, and CAR-T administration is instrumental in optimizing patient outcomes as access to CAR-T therapies expands.

Abstract WMP93: Door-to-Thrombolysis Time Between Primary Stroke Centers and Comprehensive Stroke Centers: Is There an Added Benefit?

Introduction: Comprehensive Stroke Centers are skilled, highly trained facilities that provide advanced care to an array of stroke patients. If stroke patients are not able to reach a Comprehensive Stroke Center, Primary Stroke Centers provide convenient and rapid care to patients presenting with acute ischemic stroke. Ideally, these Primary Centers save time to intervention. Whether there are differences in time to intervention, and resultant patient outcomes, between such centers has not been thoroughly studied. To this end, we examined door-to-needle and door-to-stroke alert time between one Comprehensive Stroke Center and three Primary Stroke Centers in Northwest Ohio. Hypothesis: Primary Stroke Centers will have longer time to intervention (i.e., door-to-needle times) than that of Comprehensive Stroke Centers. Methods: From 2018-2023, we examined door-to-needle and door-to-stroke alert times in patients presenting to the ProMedica Health System with ischemic stroke in a retrospective chart review. All patients presented with Large Vessel Occlusion (LVO) ischemic stroke. Results: 293 patients and 255 patients presented to either the Primary Centers or the Comprehensive Stroke Center, respectively. Door-to-needle time was significantly longer in patients presenting to the Primary Centers (Median: 59.00 minutes), compared to the Comprehensive Stroke Centers (Median: 39.50) (Mann Whitney U-Test: p &lt;0.0001). However, door-to-stroke alert was not different between the two centers (Primary, Median: 2; Comprehensive, Median: 1, Mann Whitney U-Test: p = 0.099). Conclusions: We report a longer latency to needle in Primary Stroke Centers compared to Comprehensive Stroke Centers, with no change in door-to-stroke alert time. It is forthcoming whether this difference impacts patient outcome measures. Such findings suggest that stopping at Primary Stroke Centers may not provide either a time- or outcome-benefit in lieu of immediate arrival to a Comprehensive Stroke Center.

The Effect of Pelvic Incidence on Outcomes Following Hip Arthroscopy for Femoroacetabular Impingement and Acetabular Labral Tears

Objectives: Left untreated, femoroacetabular impingement (FAI) poses an elevated risk for the early progression of degenerative joint disease. As a result, the utilization of hip arthroscopy has increased to counteract the maladaptive effects of FAI, as femoroacetabular osteoplasties have been shown to reconcile deleterious loading patterns caused by CAM and pincer lesions. However, variations in the sagittal alignment of the lumbosacral spine also pose an elevated risk for the early progression of degenerative joint disease. While femoroacetabular osteoplasties improve degenerative loading patterns caused by CAM and pincer lesions, variations in the sagittal alignment of the lumbosacral spine may continue to generate deleterious effects on the labrum, chondrolabral junction, and articular cartilage following hip arthroscopy for acetabular labral tears and FAI. Thus, the purpose of this study was to evaluate the impact of pelvic incidence (PI) on patient-reported outcomes measures (PROMs) and rates of achieving clinically meaningful outcomes following primary hip arthroscopy for acetabular labral tears and FAI. Methods: A retrospective review of a prospectively collected, single-surgeon database was performed to identify patients ≥18 years of age who underwent primary hip arthroscopy for the treatment of labral tears secondary to FAI with a minimum of 12 months of follow-up. Patients with a history of ipsilateral hip or spine surgery, absence of preoperative lumbar spine imaging, radiographic evidence of hip dysplasia or advanced hip osteoarthritis, and contraindicated spinal pathologies were excluded. PI, pelvic tilt (PT), sacral slope (SS), and acetabular version were measured on 2-D supine lumbar images, and patients were stratified into low PI (PI &lt; 45°), moderate PI (45° ≤ PI ≤ 60°), and high PI (PI &gt; 60°) cohorts. PROMs, VAS Pain, and frequencies of achieving clinically meaningful outcomes were compared between groups. PROMs and frequencies of achieving clinically meaningful outcomes were compared between cohorts using one-way analysis of variance tests and Fisher’s exact tests, respectively. Additionally, a sensitivity analysis using a linear mixed-effects model with time as a continuous variable was carried out to evaluate the weighted differences in PROM averages between cohorts. Results: A total of 74 patients undergoing primary hip arthroscopy for FAI and acetabular labral tears met eligibility criteria and were subsequently stratified into low ( n=28), moderate ( n=31), and high ( n=15) PI cohorts. The mean ± SD length of follow-up was 25.16 ± 2.91 months, and no significant differences were observed between cohorts in patient demographics. However, as expected, patients in the high PI cohort displayed significantly larger mean values for PT ( P=0.001), SS ( P&lt;0.001), acetabular version ( P&lt;.001), and acetabular inclination ( P=0.049). Moreover, despite no differences in preoperative outcome scores between cohorts, the high PI cohort displayed significantly inferior scores for all PROMs and VAS pain across 6-, 12, and 24-month follow-ups. This finding also extended to our sensitivity analysis, with the high PI cohort displaying significantly lower weighted averages in scores across all PROMs relative to the moderate PI cohort ( P≤.001 for all). Additionally, the high PI cohort demonstrated significantly lower rates of clinically meaningful outcome achievement and overall patient satisfaction at 12- and 24-month follow-ups compared to the moderate and/or low PI cohorts. No significant differences were found between cohorts in terms of revision hip arthroscopy, subsequent spine surgery, or conversion to THA. Conclusions: Following hip arthroscopy to address acetabular labral tears, patients with a high PI exhibit significantly inferior PROMs relative to those with moderate and low PI. Thus, despite addressing FAI deformities, variations in lumbosacral alignment may continue to impact patient outcomes. Although the current study design limits our ability to infer causality, the significantly greater acetabular version and inclination values observed in the high PI cohort lead us to speculate that the sagittal imbalance in the setting of a high PI places increased mechanical stress on the anterior-superior acetabulum, which portends poor outcomes following hip arthroscopy. Overall, our findings highlight the critical importance of analyzing pelvic alignment in order to prognosticate outcomes following hip arthroscopy for acetabular labral tears in the setting of FAI.

Catheter-associated urinary tract infections in critically Ill patients with COVID-19: a retrospective cohort study.

Catheter-associated urinary tract infections (CA-UTIs) pose a significant challenge in intensive care unit (ICU) patients with COVID-19. The study aims to assess the prevalence of CA-UTIs, identify the causative pathogens and their resistance profiles, and determine the risk factors and outcomes associated with CA-UTIs in ICU patients with COVID-19. Single-center, retrospective cohort study. The study included 201 adult ICU patients diagnosed with COVID-19 between March 2020 and July 2021. Patients were categorized into CA-UTI (n = 56) and non-CA-UTI (n = 145) groups. Data on demographic characteristics, clinical course, treatment, and outcomes were collected. Logistic regression analysis was used to identify risk factors for CA-UTI. CA-UTIs developed in 28% of patients (n = 56). Incidence density of 15.8 episodes per 1000 catheter days. The average onset occurrence is 7.2 days after ICU admission. Patients with CA-UTI had longer ICU stays (18.8 days vs 10.5 days, p < 0.001) and more elevated mortality rates (75.0% vs 54.5%, p = 0.010), higher mechanical ventilation (MV) usage (98.2% vs 88.3%, p = 0.027), a longer average duration of MV (16.6 days vs 9.1 days, p < 0.001). Longer ICU and hospital stays were significant risk factors for CA-UTI. Other factors, such as the use of corticosteroids, chronic organ insufficiency or immunocompromized status, female sex, age, diabetes mellitus, and the duration of urinary catheterization, did not show significant associations with CA-UTI risk in this cohort. Gram-negative bacteria, particularly Klebsiella pneumoniae (28 cases), was the most common pathogen, with a high prevalence of multidrug resistance (38.8%) with type ESBL, MBL, NDM, and OXA-48. The occurrence of multidrug resistant (MDR) organisms was 68.8%. The findings of this study underscore the prevalence of CA-UTIs in ICU patients with COVID-19, significantly impacting patient outcomes. Effective infection control and targeted antimicrobial therapy are crucial to managing these infections.

Health-system specialty pharmacist intervention types, acceptance, and associated actions for patients with multiple sclerosis.

Health-system specialty pharmacy (HSSP) pharmacists play an integral role in the care of patients with multiple sclerosis (PwMS) by facilitating medication access, providing counseling, improving adherence, and decreasing provider workload. However, current literature detailing pharmacist interventions and their acceptance rates in this population is limited. The purpose of this study was to identify the types and acceptance rate of clinical interventions completed by pharmacists for PwMS. To evaluate the acceptance rate of HSSP pharmacist interventions, we conducted a retrospective, multicenter, observational, descriptive study for the period from October 2019 to August 2022. Intervention types were categorized into reasons for intervention, recommendations from the pharmacists, and their acceptance rates. For 225 patients enrolled in HSSP services, 449 interventions were completed, with an average of 2.0 interventions per patient. Most interventions identified were associated with medication adherence (28.7%), medication regimen (27.6%), adverse drug reaction (ADR) (20.7%), and laboratory values (15.1%). The average adherence, defined by the proportion of days covered, was 94%. The most common recommendations were to continue therapy (14.9%), schedule laboratory tests (12.7%), and follow up with providers (11.8%). Recommendations had an acceptance rate of 85.3%, with 3.8% of recommendations declined and 10.9% requiring follow-up with providers. Pharmacists impact patient outcomes through the completion of clinical interventions that improve adherence, identify medication regimen problems, manage ADRs, and coordinate proper laboratory testing. Pharmacist recommendations were most often accepted for interventions related to medication regimen and ADRs. Proper identification and management of medication regimen concerns, as well as tolerability of medications, can positively impact adherence and improve overall patient outcomes.

Biomedical engineering advances: A review of innovations in healthcare and patient outcomes

Engineering has emerged as a dynamic and transformative field, driving revolutionary changes in healthcare and significantly impacting patient outcomes. This review explores recent advances in biomedical engineering, highlighting key innovations that have reshaped the landscape of medical care. The convergence of engineering principles with biological sciences has led to the development of cutting-edge technologies and novel solutions, ushering in a new era of personalized and precision medicine. The review begins by examining breakthroughs in medical imaging, focusing on advancements in high-resolution imaging modalities, such as magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET). These innovations enable clinicians to obtain detailed anatomical and functional information, facilitating early disease detection and accurate diagnosis. The integration of artificial intelligence (AI) and machine learning (ML) into biomedical engineering has played a pivotal role in enhancing diagnostic accuracy, treatment planning, and prognosis prediction. Smart algorithms analyze vast datasets, aiding in the identification of patterns and correlations that may go unnoticed by human observers. This synergy between AI and biomedical engineering has expedited decision-making processes, leading to more efficient and personalized healthcare interventions. In the realm of medical devices, significant strides have been made in the development of implantable and wearable technologies. Miniaturized sensors and biocompatible materials have paved the way for the creation of smart devices capable of monitoring physiological parameters in real-time. These devices not only provide continuous health monitoring but also empower patients to actively participate in their care, promoting preventive measures and lifestyle modifications. Advancements in regenerative medicine and tissue engineering have opened new avenues for the treatment of degenerative diseases and organ failure. Scaffold-based and cell-based therapies hold promise for repairing and regenerating damaged tissues, offering hope for patients with conditions that were once considered untreatable.

Internal hemipelvectomy: A single institution's learning curve and longitudinal experience.

Wide margin resection for pelvic tumors via internal hemipelvectomy is among the most technically challenging procedures in orthopedic oncology. As such, surgeon experience and technique invariably affect patient outcomes. The aim of this clinical study was to assess how an individual surgeon's experiences and advancements in technology and techniques in the treatment of internal hemipelvectomy have impacted patient outcomes at our institution. This study retrospectively examined a single tertiary academic institution's consecutive longitudinal experience with internal hemipelvectomy for primary sarcoma or pelvic metastases over a 26-year period between the years 1994 and 2020. Outcomes were assessed using two separate techniques. The first stratified patients into cohorts based on the date of surgery with three distinct "eras" ("early," "middle," and "modern"), which reflect the implementation of new techniques, including three-dimensional (3D) computer navigation and cutting guide technology into our clinical practice. The second method of cohort selection grouped patients based on each surgeon's case experience with internal hemipelvectomy ("inexperienced," "developing," and "experienced"). Primary endpoints included margin status, complication profiles, and long-term oncologic outcomes. Whole group multivariate analysis was used to evaluate variables predicting blood loss, operative time, tumor-free survival, and mortality. A total of 72 patients who underwent internal hemipelvectomy were identified. Of these patients, 24 had surgery between 1994 and 2007 (early), 28 between 2007 and 2015 (middle), and 20 between 2016 and 2020 (modern). Twenty-eight patients had surgery while the surgeon was still inexperienced, 24 while developing, and 20 when experienced. Evaluation by era demonstrated that a greater proportion of patients were indicated for surgery for oligometastatic disease in the modern era (0% vs. 14.3% vs. 35%, p = 0.022). Fewer modern cases utilized freehand resection (100% vs. 75% vs. 55%, p = 0.012), while instead opting for more frequent utilization of computer navigation (0% vs. 25% vs. 20%, p = 0.012), and customized 3D-printed cutting guides (0% vs. 0% vs. 25%, p = 0.002). Similarly, there was a decline in the rate of massive blood loss observed (72.2% vs. 30.8% vs. 35%, p = 0.016), and interdisciplinary collaboration with a general surgeon for pelvic dissection became more common (4.2% vs. 32.1% vs. 85%, p < 0.001). Local recurrence was less prevalent in patients treated in middle and modern eras (50% vs. 15.4% vs. 25%, p = 0.045). When stratifying by case experience, surgeries performed by experienced surgeons were less frequently complicated by massive blood loss (66.7% vs. 40% vs. 20%, p = 0.007) and more often involved a general surgeon for pelvic dissection (17.9% vs. 37.5% vs. 65%, p = 0.004). Whole group multivariate analysis demonstrated that the use of patient-specific instrumentation (PSI) predicted lower intraoperative blood loss (p = 0.040). However, surgeon experience had no significant effect on operative time (p = 0.125), tumor-free survival (p = 0.501), or overall patient survival (p = 0.735). While our institution continues to utilize neoadjuvant and adjuvant therapies following current guideline-based care, we have noticed changing trends from early to modern periods. With the advent of new technologies, we have seen a decline in freehand resections for hemipelvectomy procedures, and a transition to utilizing more 3D navigation and customized 3D cutting guides. Furthermore, we have employed the use of an interdisciplinary team approach more regularly for these complicated cases. Although our results do not demonstrate a significant change in perioperative outcomes over the years, our institution's willingness to treat more complex cases likely obscures the benefits of surgeon experience and recent technological advances for patient outcomes.