Low Rate Research Articles

Emergency neurosurgery for traumatic brain injury by general surgeons at local hospitals in Sweden: a viable option when time is brain.

Timing of surgical evacuation of mass lesions in traumatic brain injury (TBI) is crucial. However, due to geographical variations, transportation time to the nearest neurosurgical department may be long. To save time, general surgeons at a local hospital may perform the operation, despite more limited experience in neurosurgical techniques. This study aimed to determine whether patient outcomes differed between those who had undergone emergency neurosurgery at local hospitals by general surgeons vs. at university hospitals by neurosurgeons. A nationwide observational study was performed using data from the Swedish Trauma Registry (SweTrau) between 2018 and 2022. A total of 565 TBI patients (local hospitals, n = 21; university hospitals, n = 544) who underwent intracranial hematoma evacuation within 8h after arrival at the hospital were included. Data on demography, admission variables, traumatic injuries, and outcome (Glasgow Outcome Scale [GOS]) at discharge were evaluated. Favourable vs. unfavourable outcomes were defined as GOS scores of 4-5 vs. 1-3. Compared with those treated at university hospitals, patients treated with intracranial hematoma evacuation at local hospitals had lower median Glasgow Coma Scale (GCS) scores (8 vs. 12, p < 0.001), higher rate of acute subdural hematomas (86% vs. 77%, p < 0.001), and lower rate of contusions (14% vs. 53%, p = 0.01). Being operated on at a local hospital was independently associated with higher mortality (p = 0.03) but with a similar rate of favourable outcome (p = 0.74) in multiple logistic regressions after adjustment for demographic and injury-related variables. Although a slightly greater proportion of patients who underwent emergency neurosurgery at local hospitals died, there was no difference in the rate of favourable outcome. Thus, in patients with impending brain herniation, when time is of the essence, evacuation of traumatic intracranial bleeding by general surgeons at local hospitals remains a highly viable option.

More repeated exposures, lower preference ratings: exploring the factors impacting on visual aesthetic fatigue

More repeated exposures, lower preference ratings: exploring the factors impacting on visual aesthetic fatigue

Safety and Efficacy of opioid-sparing Anesthesia Compared with Traditional opioid-anesthesia

Objectives: The rationale of adoption opioid sparing anesthesia (OSA) is to achieve perioperative analgesia with a minimal amount of opioid combined to non-opioid adjuvants during and after surgery, namely multimodal anesthesia. The OSA approach was originally developed to overcome the known complications of opioid-based anesthesia (OA) and the present scoping review (ScR) aims at providing the clinical evidence of safety and efficacy of OSA with respect to OA. Methods: This ScR is mainly focused on studies presenting evidence on the safety and efficacy of OSA versus OA. PubMed, EMBASE databases were utilized to find relevant studies. Search strategy included the following keywords: “opioid sparing anesthesia complications, opioid sparing anesthesia efficacy, opioid sparing anesthesia safety”. The findings from the 25 included studies were categorized into the following subsections: article characteristics, goals of the studies, OSA protocols, and surgical settings analyzed. Results: In the 25 reviewed studies, evidence related to the impact of OSA versus OA was considered. Intraoperative safety and efficacy endpoints include hemodynamic stability and anesthetic/analgesic requirements. Postoperative endpoints include early cognitive dysfunction, opioid-induced bowel disorder, the physical status of mothers and newborns after labor and emergency cesarean, systemic immune and inflammation modifications, postoperative recovery, in-hospital and long-term opioid requirement, early postoperative pain, chronic postsurgical pain. The studies reported a lower intraoperative mean arterial pressure and heart rate fluctuations when α2 agonists are adopted, while no differences were recorded for other complication rates. Analysis of OSA approaches for the postoperative conditions includes α2 agonists, NMDA receptor blocking agents, gabapentinoids, nefopam hydrocloride and locoregional anesthesia techniques with a positive impact on most of the endpoints considered. Discussion: The clinical implementation of OSA encompasses the perioperative use of non-opioid drugs and locoregional anesthesia techniques. The reviewed studies reported OSA as a feasible approach to reduce opioid-related complications with no impact on patient’s safety.

Indocyanine green fluorescence imaging for lymph node detection and long-term clinical outcomes in colorectal cancer surgery: A systematic review and meta-analysis.

The indocyanine green fluorescence imaging (ICG-FI) technique is increasingly being used in laparoscopic colorectal surgery for lymph node mapping. However, there is no definitive standard regarding whether the application of this technique can significantly increase the detection rate of metastatic lymph nodes and improve long-term prognosis. PubMed, Embase, Web of Science, and Cochrane Library databases were searched to include studies including ICG-FI in laparoscopic colorectal surgery. Data on the detection rate of lymph nodes, metastatic rate of ICG-positive nodes, and long-term clinical outcomes were extracted following inclusion criteria. Eighteen studies with a total of 1552 patients 922 with ICG-guided laparoscopic and 630 without ICG technique were finally included. Clinical stage II/III colorectal tumors were the most commonly studies types. The patients using the ICG-FI technique had more harvested lymph nodes (weighted mean: 23.5 vs. 18.9; WMD=4.6; p<0.00001) during dissection but a lower metastasis rate of ICG-positive nodes (61/218 [28%] vs. 96/333 [28.9%]; OR=1.45; p=0.08). Compared with conventional laparoscopic colorectal surgery, additional ICG-FI technique did not improve the 3year overall survival rate (272/289 [94.1%] vs. 269/289 [93.1%]; OR=1.19; p=0.61), relapse-free survival (246/289 [85.1%] vs. 249/289 [86.2%]; OR=0.92; p=0.72), and local recurrence rate (22/289 [7.6%] vs. 28/289 [9.7%]; OR=0.77; p=0.38). The overall detection rate of sentinel lymph nodes, lymph flow, and metastatic rate of ICG-positive nodes with the help of ICG-FI were 86.8%, 89.9%, and 22.8%, respectively. No patients experienced major adverse events during ICG injection preoperatively or postoperatively. Indocyanine green fluorescence imaging-guided procedure, compared to conventional laparoscopic dissection, can assist in obtaining a greater number of harvested lymph nodes and metastatic lymph nodes, however, it did not significantly improve the long-term clinical outcomes. Level III systematic review of randomized control and nonrandomized studies.

HPV Vaccine Awareness and Uptake Among Sexually Transmitted Infections Clinic Users: A Cross-Sectional Study in Bologna, Italy

Human Papillomavirus (HPV) infection poses a significant health risk, particularly for high-risk groups such as men who have sex with men (MSM), people living with HIV (PLHIV), and transgender individuals. Despite the availability of effective vaccines, uptake among these groups remains suboptimal due to various social and behavioral barriers (BeSD). A cross-sectional survey was conducted at the Sexually Transmitted Infections (STIs) clinic in Bologna, Italy, from 8 April to 12 April 2024 using a paper questionnaire, investigating HPV vaccine uptake and BeSD factors influencing vaccination decisions. Statistical analyses included descriptive statistics and multivariate logistic regression. Among the 236 respondents, PLHIV and transgender individuals demonstrated lower uptake rates (60.0% and 15.6%) if compared to women under 30 years old (72.7%). Concern about HPV infection varied significantly across groups, with MSM showing the highest worry (48.7%). Perceptions of vaccine safety and access were mixed, influencing vaccination decisions. Multivariate analysis indicated that age inversely correlated with infection worry (OR: 0.94, 95% CI: 0.91–0.98), while being a woman under 30 (OR: 164.0, 95% CI: 17.2–1560.18) or MSM (OR: 3.53, 95% CI: 1.37–9.11) was positively associated with vaccine uptake. The study identifies disparities in HPV vaccine uptake among STI clinic users in Bologna, Italy, emphasizing the need for targeted public health campaigns. These campaigns could engage STI clinics and address awareness, safety perceptions, and access barriers to enhance vaccination coverage among sexual and gender minorities.

Intracytoplasmic sperm injection compared with in vitro fertilisation in patients with non-male factor infertility with low oocyte retrieval: a single-centre, retrospective cohort study

ObjectiveTo investigate the effects of in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) on the clinical outcomes of non-male factor patients aged >35 with three or fewer oocytes retrieved.DesignRetrospective...

PET-Based TheraP Eligibility and Outcomes of VISION-Eligible Patients with Metastatic Castration-Resistant Prostate Cancer Who Received 177Lu-PSMA-617: Importance of 18F-FDG-Avid Discordant Findings.

The VISION and TheraP trials introduced different PET-based criteria for patient selection for treatment with 177Lu-PSMA-617 (LuPSMA). TheraP used a higher prostate-specific membrane antigen (PSMA) uptake threshold than VISION and required 18F-FDG PET to exclude patients with discordant findings. Although the screen-failed patients had shorter overall survival (OS) than those treated with LuPSMA, it remains unclear whether their outcomes might have been modified if they had been exposed to LuPSMA. In this study, we evaluated associations between the TheraP eligibility criteria and subgroups and the treatment outcomes of patients who were deemed suitable and treated on the basis of VISION criteria. Methods: Consecutive patients who were treated with LuPSMA and who underwent pretreatment PSMA and 18F-FDG PET were classified as TheraP-eligible (TheraP-E) and TheraP-ineligible (TheraP-I), the latter of which were subclassified as low PSMA or discordant. Odds ratios for an at least 50% decline in prostate-specific antigen (PSA50) were computed using logistic regression, and hazard ratios (HRs) for PSA progression-free survival (PSA-PFS) and OS were computed using Cox regressions. Multivariable analyses were adjusted for baseline imaging and clinical parameters. Results: Of 75 patients, 31 (41%) were deemed TheraP-I; of those, 24 were subclassified as having discordant disease. TheraP-I patients had a lower PSA50 rate than that of TheraP-E patients (28% vs. 67%; odds ratio, 0.19; 95% CI, 0.06-0.52; P = 0.002) and a higher risk of PSA progression (HR, 2.0; 95% CI, 1.2-3.3; P = 0.007). OS in the TheraP-I group was numerically shorter than in the TheraP-E group, but the comparison was only marginally significant (10.4 mo vs. not reached; HR, 1.9; 95% CI, 1.0-3.7; P = 0.054). TheraP-I patients with low PSMA had no significantly different risk of death (P = 0.9) from that of TheraP-E patients, but those with discordant findings had higher risk of death (HR, 2.3; 95% CI, 1.1-4.6; P = 0.02). Discordant disease remained prognostic for OS after adjusting for baseline imaging and clinical parameters (HR, 3.0; 95% CI, 1.3-6.8; P = 0.01). Conclusion: In VISION-eligible patients who were treated with LuPSMA, TheraP-I patients with discordant findings had lower PSA50, PSA-PFS, and OS. Our study suggests that the shorter OS of TheraP-I patients is mainly driven by the presence of discordant disease.

Factors Inducing Cutaneous Adverse Reactions in Cancer Patients Treated with PD-1 and PD-L1 Inhibitors: A Machine-Learning Algorithm Approach

Immune checkpoint inhibitors (ICIs) show promise in cancer treatment but can lead to immune-related adverse events (irAEs), notably affecting the skin. Understanding the factors behind these skin reactions is crucial for effective management during treatment. Hence, the aim of this study was to uncover associations between patient characteristics and cutaneous adverse reactions among cancer patients undergoing ICI treatment. The study involved 209 cancer patients receiving ICIs. Statistical methods, including the chi-square test, Fisher's exact test, and multivariable logistic regression, were employed to analyze variables such as hypertension, antihistamine use, cancer metastasis, diabetes, and opioid usage. Additionally, machine learning techniques, including logistic regression, elastic net, random forest, and support vector machines (SVM), were utilized to develop predictive models anticipating skin-related adverse events. Results highlighted significant associations between specific patient attributes and the incidence of skin reactions post-ICI treatment. Notably, patients using antihistamines or with cancer metastasis exhibited higher rates of skin adverse reactions, while those with diabetes or using opioids displayed lower incidence rates. Robust performance in forecasting these adverse events was observed, particularly in the predictive models employing logistic regression and elastic net. This pioneering study contributes crucial insights into predictive modeling for ICI-induced skin reactions, emphasizing the importance of personalized treatment strategies. By identifying risk factors and utilizing tailored predictive models, healthcare providers can proactively manage adverse events, optimizing the benefits of ICIs while mitigating potential side effects.

Impact of Individual Characteristics on Hospital Outcomes in Exacerbated COPD in a Biomass-Exposed Turkish Population

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality globally, and factors such as biomass exposure, demographic characteristics, and comorbidities significantly influence patient outcomes during exacerbations. Aim: This study aims to clarify the impact of patient characteristics on key hospital outcomes, including ICU admissions, hospital length of stay, and in-hospital mortality, focusing on the contextual role of biomass exposure rather than its direct impact. Methods: Using a multicenter, retrospective cohort design, we analyzed the medical records of patients admitted with COPD exacerbations from January 2021 to December 2023. Eligible patients were over 40 years old with confirmed COPD exacerbation, excluding those with other significant lung conditions, severe organ dysfunction, or incomplete data. The collected data included demographics, smoking history, comorbidities, medications, laboratory results, and clinical outcomes, with smoking status categorized into current, former, or never smokers. Results: Our analysis comprised 334 patients with a mean age of 69 ± 8.8 years, including 52 (15.6%) females. Biomass exposure, observed in 22% of patients, was associated with a higher likelihood of being female (p &lt; 0.001), lower smoking rates (p &lt; 0.001), higher prevalence of diabetes mellitus type 2 (p = 0.020), lower peripheral blood eosinophilia (p = 0.001), increased intensive care unit (ICU) admissions (p = 0.034), and higher in-hospital mortality (p = 0.043). Non-survivors tended to be older and had a higher prevalence of hypertension, a history of childhood pneumonia, longer COPD duration, greater need for non-invasive ventilation (NIV) during hospitalization, and more frequent ICU admissions. Univariate Cox regression analysis revealed no significant associations between characteristics and outcomes. Conclusions: Patients with biomass exposure were more likely to be female and had higher rates of ICU admission and in-hospital mortality.

Study on CO2-Enhanced Oil Recovery and Storage in Near-Depleted Edge–Bottom Water Reservoirs

The geological storage of carbon dioxide (CO2) is a crucial technology for mitigating global temperature rise. Near-depleted edge–bottom water reservoirs are attractive targets for CO2 storage, as they can not only enhance oil recovery (EOR) but also provide important potential candidates for geological storage. This study investigated CO2-enhanced oil recovery and storage for a typical near-depleted edge–bottom water reservoir that had been developed for a long time with a recovery factor of 51.93%. To improve the oil recovery and CO2 storage, new production scenarios were explored. At the near-depleted stage, by comparing the four different scenarios of water injection, gas injection, water-alternating-gas injection, and bi-directional injection, the highest additional recovery of 3.62% was achieved via the bi-directional injection scenario. Increasing the injection pressure led to a higher gas–oil ratio and liquid production rate. After shifting from the near-depleted to the depleted stage, the most effective approach to improving CO2 storage capacity was to increase reservoir pressure. At 1.4 times the initial reservoir pressure, the maximum storage capacity was 6.52 × 108 m3. However, excessive pressure boosting posed potential storage and leakage risks. Therefore, lower injection rates and longer intermittent injections were expected to achieve a larger amount of long-term CO2 storage. Through the numerical simulation study, a gas injection rate of 80,000 m3/day and a schedule of 4–6 years injection with 1 year shut-in were shown to be effective for the case considered. During 31 years of CO2 injection, the percentage of dissolved CO2 increased from 5.46% to 6.23% during the near-depleted period, and to 7.76% during the depleted period. This study acts as a guide for the CO2 geological storage of typical near-depleted edge–bottom water reservoirs.

Clinical Subtype Trajectories in Sepsis Patients Admitted to the ICU: A Secondary Analysis of an Observational Study

OBJECTIVES: Sepsis is an evolving process and proposed subtypes may change over time. We hypothesized that previously established sepsis subtypes are dynamic, prognostic of outcome, and trajectories are associated with host response alterations. DESIGN: A secondary analysis of two observational critically ill sepsis cohorts: the Molecular diAgnosis and Risk stratification of Sepsis (MARS) and the Medical Information Mart for Intensive Care-IV (MIMIC-IV). SETTING: ICUs in the Netherlands and United States between 2011–2014 and 2008–2019, respectively. PARTICIPANTS: Patient admission fulfilling the Sepsis-3 criteria upon ICU admission adjudicated to one of four previously identified subtypes, comprising 2,416 admissions in MARS and 10,745 in MIMIC-IV. MAIN OUTCOMES AND MEASURES: Subtype stability and the changes per subtype on days 2, 4 and 7 of ICU admission were assessed. Next, the associated between change in clinical subtype and outcome and host response alterations. RESULTS: In MARS, upon ICU admission, 6% (n = 150) of the patient admissions were α-type, 3% (n = 70) β-type, 55% (n = 1317) γ-type, and 36% (n = 879) δ-type; in MIMIC-IV, this was α = 22% (n = 2398), β = 22% (n = 2365), γ = 31% (n = 3296), and δ = 25% (2686). Overall, prevalence of subtypes was stable over days 2, 4, and 7. However, 28–56% (MARS/MIMIC-IV) changed from α on ICU admission to any of the other subtypes on day 2, 33–71% from β, 57–32% from γ, and 50–48% from δ. On day 4, overall subtype persistence was 33–36%. γ or δ admissions remaining in, or transitioning to, subtype γ on days 2, 4, and 7 exhibited lower mortality rates compared with those remaining in, or transitioning to, subtype δ. Longitudinal host response biomarkers reflecting inflammation, coagulation, and endothelial dysfunction were most altered in the δ-δ group, followed by the γ-δ group, independent of the day or biomarker domain. CONCLUSIONS AND RELEVANCE: In two large cohorts, subtype change to δ was associated with worse clinical outcome and more aberrant biomarkers reflecting inflammation, coagulation, and endothelial dysfunction. These findings underscore the importance of monitoring sepsis subtypes and their linked host responses for improved prognostication and personalized treatment strategies.

Implementation of Immunization Services Through a Pediatric Urgent Care Clinic.

Pediatric urgent care (PUC) centers may bolster immunization campaigns by offering vaccination during acute care visits, but few such programs have been described. We conducted a quality improvement initiative at an academically affiliated federally qualified health center that provides primary, specialty, and PUC services to children. Our PUC began offering routine immunizations in July 2020. The percentage of visits by eligible patients age ≤21 years during which immunization screening (process) and administration (outcome) occurred was measured from March 1, 2021, to February 19, 2023. Administration rates were measured across age, sex, race, language, and medical home groups. Data were analyzed with statistical process control methods. Grievance and adverse event data were monitored (balancing). We completed 4 plan-do-study-act cycles. Provider-facing bundles that included training, decision support, electronic health record signaling, and financial incentives were not associated with meaningful changes in screening and administration (cycles 1-3). A dedicated nurse vaccinator (DNV) was added on October 31, 2022 (cycle 4). The mean screening rate increased from 44.7% to 67.4% during the DNV period, and the mean administration rate increased from 26.5% to 50.8%. Lower administration rates were observed during visits by Black and English-speaking patients, and by patients empaneled outside our site. Provider-facing interventions alone were not effective at increasing vaccine screening and administration in our PUC, but marked improvement was observed with the addition of a DNV. Future interventions are needed to address disparities. Additional investigation is needed to determine whether our results are reproducible in other PUCs with access to vaccines.

Physicians' perspectives on cancer-related fatigue management and their suggestions for improvements in medical training: a cross-sectional survey study in Germany.

Contrary to guidelines, many cancer patients are not screened for cancer-related fatigue (CRF) and do not receive information or adequate treatment. As physicians play a key role in cancer therapy, their knowledge of this common sequela and perspectives on its management are of major interest. For an online survey, physicians working in oncology in Germany were systematically drawn from registers and invited by using institutional newsletters or colleagues. Descriptive analyses, logistic regression analysis of physicians' knowledge, and Mann‒Whitney U tests were performed. Two-thirds of the 148 surveyed physicians felt (rather) well informed about CRF and capable of counseling patients. Only 32% of the sample were aware of CRF-specific guidelines. Despite of this, participants rated the scientific evidence for recommending physical activity, exercise programs, and psychotherapeutic interventions in accordance with guidelines as being mostly (very) strong. However, despite 82.4% of the physicians being (rather) aware of its evidence, only 56.1% often to almost always recommended psychotherapeutic interventions. CRF was rarely covered in medical studies and medical specialist training. The completion of advanced training for palliative care increased the likelihood of knowing guidelines (OR = 2.6, 95% CI [1.1-6.0], p < 0.05). Suggestions for improving training included the mandatory coverage of CRF in medical training or its consideration in interprofessional supportive care workshops. Although awareness and recommendation rates were adequate for some interventions in CRF treatment (such as physical activity), there were lower recommendation rates for others, including psychotherapy. Studies are required assessing for the reasons of this knowledge-to-practice gap. Moreover, training is needed among physicians in order to enhance knowledge of CRF guidelines. Clinicaltrials.gov , identifier: NCT04921644. Registered in June 2021.

DynaCT biliary reconstruction via a 3D C-arm cholangiography system: clinical application in hepatolithiasis.

Dyna computed tomography (DynaCT) is an innovative clinical imaging tool used to obtain three-dimensional (3D) images of biliary structures via the Artis Zee DSA system (SIEMENS Company, Germany). DynaCT is a type of 3D cone beam computed tomography (CBCT) reconstruction produced from a two-dimensional (2D) cholangiography system by rotating the C-arm without moving the patient. The aim of this study was to evaluate the technical approach and application value of DynaCT to diagnosis hepatolithiasis and biliary stenosis. This was a retrospective single-centre series of 37 hepatolithiasis patients with tubes receiving one-step percutaneous transhepatic cholangioscopic lithotripsy (one-step PTCSL) between October 2021 and October 2022: twenty-one patients were guided by CT (CT group) and sixteen by DynaCT biliary reconstruction (DynaCT group). We compared DynaCT biliary reconstruction technology with computed tomography (CT) in the application of bile ducts. DynaCT biliary reconstruction was successfully performed in 37 patients. Biliary stenosis, including anatomy, morphology, and size, was visualized via DynaCT. Compared with the CT group, the DynaCT group was characterized by significantly more target biliary branches with stones (92 vs. 48, P < 0.05), a higher percentage of secondary stenosis (75.76% vs. 24.24%, p < 0.05), a greater percentage of biliary infection (37.5% vs. 9.5%, P = 0.041), a shorter overall stone clearance time (26.38 ± 13.49 vs. 52.67 ± 30.10, P = 0.001), and a lower rate of reoperation for residual stones (25.00% vs. 66.67%, P = 0.012). DynaCT had a lower contrast agent (25.61 ± 5.13 vs. 42.69 ± 11.15, p < 0.05). However, DynaCT increased radiation exposure (38.12 ± 10.59 vs. 25.79 ± 4.76, p < 0.05). There were no significant differences between the two groups regarding the clearance ratio of the calculus or several postoperative complications. DynaCT for biliary reconstruction has the potential to be a powerful evaluation tool for one-step PTCSL surgery and could lead to new possibilities for hepatobiliary surgery. DynaCT was used for the first time in patients with hepatolithiasis and biliary stenosis. Compared with CT, DynaCT for biliary reconstruction results in higher-quality 3D biliary, blood vessel and liver images. On the basis of the DynaCT biliary model, one-step PTCSL has the potential to improve the stone clearance ratio and shorten the stone clearance time and reoperation ratio.

Real-world mepolizumab treatment in eosinophilic granulomatosis with polyangiitis reduces disease burden in the United States.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare, chronic inflammatory disease characterized by asthma and small/medium vessel vasculitis. Mepolizumab is approved for use in EGPA disease management alongside oral corticosteroids (OCS), but evidence of its real-world impact is limited. To compare real-world treatment patterns and health outcomes, particularly OCS use, EGPA-related hospitalizations/relapses, and asthma exacerbations pre- and post-mepolizumab initiation in US patients with EGPA. Patients with EGPA receiving ≥2 mepolizumab doses were identified using administrative claims data from Komodo Health's Comprehensive Dataset (December 2016-March 2020). Outcomes assessed pre- and post-mepolizumab initiation included corticosteroid/other medication use, EGPA-related hospitalizations/relapses, and asthma exacerbations. Overall, 114 patients were identified; of these, 60 (53%) received mepolizumab 300 mg at index. Average daily OCS dose per dispensing was significantly lower post- versus pre-mepolizumab initiation (21.2 vs 26.8 mg/day, 21% relative reduction, P<0.001); mean number of OCS bursts also decreased (0.9 vs 1.8, 50% relative reduction, P<0.001). Patients experienced significantly lower rates of EGPA-related hospitalization (0.86 vs 1.55 per person-year [PPY], 49% relative reduction, P=0.004) and EGPA relapse (3.18 vs 3.94 PPY, 19% relative reduction, P=0.004) post- versus pre-initiation. Most patients (91%) had an asthma diagnosis at baseline; among these patients, asthma exacerbation rates were significantly lower post- versus pre-initiation (1.05 vs 1.84 PPY, 42% relative reduction, P=0.004). Mepolizumab was associated with significant steroid-sparing benefits and significantly reduced rates of EGPA-related hospitalizations, EGPA relapses, and asthma exacerbations in this real-world study of US patients with EGPA, confirming the benefits of mepolizumab treatment seen in clinical trials.

Unintended Consequences of Data Sharing Under the Meaningful Use Program.

Interoperability has been designed to improve the quality and efficiency of health care. It allows the Centers for Medicare and Medicaid Services to collect data on quality measures as a part of the Meaningful Use program. Covered providers who fail to provide data have lower rates of reimbursement. Unintended consequences also arise at each step of the data collection process: (1) providers are not reimbursed for the extra time required to generate data; (2) patients do not have control over when and how their data are provided to or used by the government; and (3) large datasets increase the chances of an accidental data breach or intentional hacker attack. After detailing the issues, we describe several solutions, including an appropriate data use review board, which is designed to oversee certain aspects of the process and ensure accountability and transparency.

Effectiveness of Ustekinumab for patients with moderate to severe Ulcerative Colitis: A Multi-Center Real-World Canadian Study

Background: We aimed to evaluate the real-world effectiveness and safety of ustekinumab for the treatment of both bio-naïve and bio-exposed ulcerative colitis (UC) patients in a real-world setting. Methods: Retrospective, Canadian multicenter cohort study. Primary outcomes were clinical remission and endoscopic remission. Key secondary outcomes included composite clinical and endoscopic response, safety, and persistence. Univariable logistic regression was conducted to examine associations between baseline factors and 12 month clinical and endoscopic response and remission. The primary focus was on the association between these outcomes and bio-exposure status. Results: A total of 198 patients were included, of whom 47.5% were female and 85.9% under 65 years. The majority had severe endoscopic activity at baseline (47.5%, n=87) and were bio-exposed (88.8%, n=176; 33%, n=66 prior failure of 3 or more biologics). Patients were followed for a median of 12.8 (IQR 8.2 to 22.1) months after induction. The overall clinical remission rates were 41.3% (69/167), 38.1% (56/147), and 43.6% (58/133) at 3, 6 and 12 months, respectively. Endoscopic remission rates (MES=0) were 8.0% (7/88), 18.7% (23/123), and 12.5% (11/88) at 3, 6, and 12 months, respectively, and consistently higher in bio-naïve patients compared to bio-exposed patients through 12 months (p&lt;0.05 at all time points). Bio-naive patients were more likely to achieve endoscopic remission compared to bio-exposed (HR=5.40, 95% CI: 1.08-26.93). Adverse events were reported in 14.1% (18/198). Discussion: In a highly refractory and largely bio-exposed population, a substantial proportion of patients with UC treated with ustekinumab can achieve clinical and endoscopic outcomes of importance after 12 months. Prior biologic exposure is associated with lower rates of endoscopic remission.

Clinical Profile and Outcomes of All Admitted COVID-19 Positive Patients with Primary Lung Cancer in a Tertiary Government COVID-19 Referral Center: A Retrospective Cohort Study

Background. COVID-19 infection poses a continuing challenge especially to those already with prior lung disease. To analyze such patients’ profile is essential in today’s health care management. Objective. The study aimed to compare the outcomes of COVID-19 confirmed patients with and without primary lung cancer in terms of hospital stay, recovery, and mortality. Methods. The study employed a retrospective cohort design. Chart review of all adult COVID-19 patients in Philippine General Hospital from January 2021 to June 2021 was done. A matched cohort study was conducted between COVID-19 patients with and without primary lung cancer. Results. Among the 953 COVID-19 patients, there were 14 patients with primary lung cancer. In terms of length of hospital stay, patients with primary lung cancer had shorter days from 1.32 to 15.1 days compared to 2.28 to 18.36 days in patients without primary lung cancer (p-value 0.271). Furthermore, they had 64% recovery rate compared to 78% in those without primary lung cancer (p-value 0.118). In terms of overall mortality rate, primary lung cancer patients had 36% rate as compared to 22% in the non-lung cancer group (p-value 0.119). Diabetes mellitus, mild to severe COVID, Remdesivir, and antibiotic use were associated with longer hospital stay while oxygen support via nasal cannula and invasive ventilation led to shorter hospital stay. Age above 50 years, chronic liver disease, other malignancy, shortness of breath, oxygen support via face mask, high flow nasal cannula, invasive ventilation, antibiotic use, hemoperfusion and nebulization showed a decrease chance of recovery while on contrary, Remdesivir showed an increase chance of recovery. An increase mortality rate was seen among age above 50 years, chronic liver disease, other malignancy, shortness of breath, oxygen support via facemask, high flow nasal cannula, invasive ventilation, antibiotics, hemoperfusion, and nebulization, in contrast to a decrease in Remdesivir therapy. Conclusions. Among all admitted COVID-19 patients, primary lung cancer patients were associated with shorter hospital stay (8.21+6.89days), lower rate of recovery (64%), and higher mortality rate (36%) as compared to those without primary lung cancer. However, based on the computed p-values for each outcome, these differences are not statistically significant.

Racial Discrimination and Mental Health: Analyzing the Impact of Discrimination, Stress, Depressive Symptoms and Self-Esteem on Anxiety Experiences

ABSTRACT Background Existing research demonstrates that racial inequity influences mental health outcomes. However, few studies simultaneously analyze the multiple factors influencing racial disparities regarding these outcomes. Our study addresses this gap by analyzing the impact of discrimination, stress, self-esteem, racial identity, depressive symptoms, and demographic factors on anxiety symptoms. Methods Participants were adults recruited from a primary care clinic in the Southeastern region of the United States. We utilized a stratified random sampling strategy to select 383 participants. Participants completed a survey designed to assess levels of anxiety, depression, perceived stress, self-esteem, racial identity, experiences with discrimination, and demographic information. A hierarchical regression analyzed which factors most impact symptoms of anxiety. Results Of the 363 participants in our study, the majority were female (71.3%), 57% were White identifying, 43% were Black identifying, and the average age was 54.4 (SD = 12.3). Model 4 accounted for 58% of the variance of anxiety symptoms and included a combination of depressive symptoms, perceived stress, self-esteem, experiences of everyday discrimination, and interaction terms. Within this model, perceived stress (t = 3.81, p < .01), experiences of everyday discrimination, (t = 2.33, p < .01), and income (t = -1.96, p < .01) were significantly associated with increased anxiety. Conclusions and implications Multiple contextual factors influence the relationship between race and anxiety. In particular, anxiety increases with lower rates of self-esteem and income. Conversely, anxiety increases with higher rates of stress, discrimination, and depressive symptoms. Social workers should consider each of these factors when treating patients presenting with symptoms of anxiety.

Cervical cancer screening rates in females living with HIV at three healthcare settings in the United States, 2010-2019.

Females living with human immunodeficiency virus (FLWHIV) are at increased risk of cervical cancer and U.S. guidelines, first published in 2009 and updated since then, recommend more frequent screening in this population. We examined screening rates among FLWHIV in the U.S. during 2010-2019. This cohort study included 18-89-year-old FLWHIV during 2010-2019 at three U.S. healthcare settings. Sociodemographics, comorbidities, and cervical cancer screening tests were ascertained from administrative and clinical databases. We reported cervical cancer screening rates overall and by modality. Generalized estimating equations with Poisson distribution were used to estimate screening rate ratios (SRRs) and 95% confidence intervals (CIs) for the associations between screening rates and calendar year, age, race and ethnicity, and comorbidity. Among 3,556 FLWHIV, a total of 7,704 cervical cancer screening tests were received over 18,605 person-years during 2010-2019 (screening rate = 41.4 per 100 person-years). Relatively lower screening rates were associated with later calendar years (SRR = 0.71 [95% CI 0.68-0.75] for 2017-2019 versus 2010-2013), older age (SRR = 0.82 [95% CI 0.74-0.89] for 50-65-year-olds versus 18-29-year-olds), non-Hispanic white race versus non-Hispanic Black race (SRR = 0.89 [95% CI 0.81-0.98]) and greater comorbidity burden (SRR = 0.89 [95% CI 0.82-0.98] for ≥ 9 versus 0-6 comorbidity score). The decrease in cervical cancer screening rates during 2010-2019 in this large cohort of FLWHIV may be explained at least partly by guideline changes during the study period recommending longer screening intervals. Our findings of relatively lower screening rates in FLWHIV who were non-Hispanic white, older, and with greater comorbidity burden should be confirmed in other U.S.