Lower Rates Of Success Research Articles

Demographic, clinical characteristics, managements strategies and in-hospital outcomes of patients enrolled in prospective nationwide SCAD registry

Abstract Spontaneous coronary artery dissection (SCAD) is an uncommon yet increasingly recognized cause of acute coronary syndrome (ACS), particularly in young to middle-aged women. This multicentric, prospective nation-wide registry aimed to elucidate the demographic characteristics, clinical presentation, management strategies, and outcomes of patients with SCAD. A total of 95 patients with SCAD were enrolled in 10 centers, with females constituting 81% of the cohort, and with an average age of 49.7±11.9 years. Among the traditional risk factors, prior hypertension was observed in 49%, followed by hyperlipidemia in 43%, diabetes mellitus in 9% and prior or current smoking in 47% of patients. The presentation of SCAD as ST-elevation myocardial infarction (STEMI) was predominant, occurring in 61% of cases, with the left anterior descending artery (LAD) being the most involved vessel (68%). Regarding the classification of SCAD, type 2 SCAD was the most frequent (53%), followed by type 1 (24%) and type 4 (16%). Notably, involvement of the distal segment of the culprit artery was observed in 68% of cases, while baseline TIMI 3 flow was noted in 52% of patients. Percutaneous coronary intervention (PCI) was performed in 52% of cases, with pre-interventional TIMI 0-2 flow (62% Vs. 28%; p<0.05) and proximal artery involvement (41% Vs. 13%; p<0.05) being more prevalent compared to conservatively managed patients. Final stent implantation was performed in 67% of PCI cases, with TIMI 3 flow restoration in 76% of patients undergoing PCI. The average left ventricular ejection fraction prior to discharge was 51±9.9%. In-hospital mortality was reported in three female patients, undergoing attempted PCI with left main and LAD involvement. The use of antiplatelet therapy was widespread, with aspirin administered to 98% and P2Y12 inhibitors to 75% of patients at discharge. Data from this prospective nationwide multicentric SCAD registry show that SCAD occurs predominantly in relatively young female patients, with moderately prevalent traditional cardiovascular risk factors, usually presents as STEMI, with good overall survival rates despite half of the patients managed conservatively. PCI was often attempted in SCAD lesion with compromised arterial flow and located proximally, with lower rates of stent implantation and procedure success compared to traditionally observed rates in primary PCI. This underscores the importance of heightened awareness and tailored management approaches for this unique subset of ACS patients in order to refine risk stratification, optimize treatment strategies, and improve outcomes in this population.

Outcomes of Trabeculectomy and Predictors of Success in Patients of African Ancestry with Primary Open Angle Glaucoma.

To investigate outcomes of trabeculectomy ab externo in African ancestry primary open-angle glaucoma (POAG) patients, and to analyze the impact of demographic and phenotypic factors on surgical success and complication rates. A retrospective case-control study enrolled 63 eyes of 55 POAG cases who underwent trabeculectomy ab externo. Data on demographics, family glaucoma history, surgical specifics, and pre/postoperative measures (intraocular pressure, visual acuity, visual field, medication usage, complications within one year) were collected. Analysis included linear/logistic regression models adjusting for inter-eye correlation. Trabeculectomy yielded success without additional medication in 46%, qualified success with medication in 22%, and surgical failure necessitating further intervention in 32% within one year. Subjects experienced reduction in intraocular pressure (IOP) (46%), daily glaucoma medication (73%), and eye drop usage (67%) 1-year post-trabeculectomy (all P<0.001). However, there was a postoperative decline of 56% in visual acuity (VA) (P<0.001) and a significant worsening of visual field parameters, including a 14% decrease in mean deviation (P=0.02) and a 19% decrease in visual field index (P=0.004). Top of FormBottom of Form59% of patient eyes experienced complications within one year of surgery. Univariate analysis of predictive factors for surgical outcomes revealed that younger age at surgery (P=0.01) and family history of glaucoma (P=0.046) were predictive of lower rates of surgical success. Multivariable analysis revealed worse preoperative VA (OR 0.79 per 0.1 LogMAR increases, P=0.02) was associated with lower likelihood of surgical success. This study underscores the low rates of trabeculectomy success and high rates of complications in an African ancestry population with POAG. While the procedure exhibited positive effects on IOP control and medication reduction, our analysis found that multiple factors, particularly age, family history, and worse preoperative VA play crucial roles in influencing surgical success. Trabeculectomy in African ancestry individuals with primary open-angle glaucoma shows a 46% success rate and frequent complications, indicating that younger age and family history are significant predictors of surgical failure in this high-risk population.

Computational modeling of revision total hip arthroplasty involving acetabular defects: A systematic review.

Revision total hip arthroplasty (rTHA) involving acetabular defects is a complex procedure associated with lower rates of success than primary THA. Computational modeling has played a key role in surgical planning and prediction of postoperative outcomes following primary THA, but modeling applications in rTHA for acetabular defects remain poorly understood. This study aimed to systematically review the use of computational modeling in acetabular defect classification, implant selection and placement, implant design, and postoperative joint functional performance evaluation following rTHA involving acetabular defects. The databases of Web of Science, Scopus, Medline, Embase, Global Health and Central were searched. Fifty-three relevant articles met the inclusion criteria, and their quality were evaluated using a modified Downs and Black evaluation criteria framework. Manual image segmentation from computed tomography scans, which is time consuming, remains the primary method used to generate 3D models of hip bone; however, statistical shape models, once developed, can be used to estimate pre-defect anatomy rapidly. Finite element modeling, which has been used to estimate bone stresses and strains, and implant micromotion postoperatively, has played a key role in custom and off-the-shelf implant design, mitigation of stress shielding, and prediction of bone remodeling and implant stability. However, model validation is challenging and requires rigorous evaluation and comparison with respect to mid- to long-term clinical outcomes. Development of fast, accurate methods to model acetabular defects, including statistical shape models and artificial neural networks, may ultimately improve uptake of and expand applications in modeling and simulation of rTHA for the research setting and clinic.

Smokers with higher positive or negative urgency have lower rates of smoking cessation success 12 months after a quit attempt

Impulsivity dimensions have been shown to be associated with smoking status and tobacco use disorder severity. However, it is important to determine the specific impulsivity traits associated with smoking relapse. This study aimed at investigating the associations between impulsivity traits and smoking cessation success among adult smokers at 12 months after a quit attempt. Participants were 68 adult smokers enrolled in a 3-month course of simvastatine or placebo associated with behavioral cessation support, with a 9-month follow-up (ADDICSTATINE study). They were classified in 3 groups according to smoking status: abstinent, reduction ≥ 50%baseline or reduction < 50%baseline at 3 and 12 months. Impulsivity traits were assessed using the UPPS-P-scale. At 12 months, abstainers and participants who reduced smoking by 50% or more had significantly lower scores in negative and positive urgency compared to participants who reduced smoking by less than 50% (p = 0.011 and 0.0059). These urgency traits scores at 12 months were significantly and negatively correlated with smoking reduction at 12 months (p = 0.017 and 0.0012). These impulsivity traits were also associated with the smoking cessation success at 3 months. Patients who were abstinent at 3 months had also lower negative and positive urgency (p = 0.017 and 0.0039). Smoking cessation success at 3 and 12 months were not associated with the other impulsivity traits, sensation seeking, lack of premeditation or perseverance. Our findings suggest that positive and negative urgency are associated with smoking cessation success. Proposing better tailored-based-treatment targeting these impulsivity traits in combination with conventional treatment may help improving smoking treatment success.

Medical management of early pregnancy loss with mifepristone and misoprostol in emergency departments compared to a Complex Family Planning office: Implementation of a COVID-19 institutional policy change

ObjectivesTo evaluate the implementation of mifepristone and misoprostol for medical management of early pregnancy loss (EPL) in emergency departments (EDs) by comparing efficacy, complication, and follow-up rates for patients treated in EDs to those in the Complex Family Planning (CFP) outpatient office. Study DesignIn COVID-19's first wave, we expanded medication management of EPL to our EDs. This retrospective study evaluated 72 patients receiving mifepristone and misoprostol for EPL from 4/1/2020-3/31/2021, comparing treatment success, safety outcomes, and follow-up rates by location. We did not perform a power calculation. ResultsThirty-three (46%) patients received care in the ED and 39 (54%) at CFP. Treatment success was lower in the ED (23, 70%) compared to CFP (34, 87.2%), but after adjusting for insurance status and type of pregnancy (miscarriage, uncertain viability, unknown location) this was not significant: aOR 0.48 (95%CI 0.13-1.81), p=0.28. More ED patients underwent emergent interventions (3 vs 0). Complications in the ED cohort included two emergent uterine aspirations, one uterine artery embolization, and two blood transfusions. Among these, two cases were attributed to misdiagnosis (a cesarean scar and a cervical ectopic pregnancy interpreted as incomplete miscarriages) and one to guideline nonadherence (anticoagulated patient). No complications occurred in the CFP group. Follow-up rates were over 80% in both groups. More ED patients engaged in telehealth follow-up (67% vs 18.0%, p≤0.0001). ConclusionsIn this small sample, we observed a trend toward lower rates of treatment success following medication management of EPL in the ED, compared to the CFP office. This analysis highlights that both correctly making uncommon diagnoses and adhering to new guidelines presented challenges during our implementation process. IMPLICATIONSImplementing mifepristone and misoprostol for EPL in our EDs achieved lower rates of pregnancy resolution compared to outpatient management. Complex uncommon diagnoses and implementing new care pathways in EDs may have contributed to complications and highlight opportunities for improvement. Additional studies are needed to further quantify safety outcomes for EPL management in EDs. TWEETABLE ABSTRACTED provision of mifepristone and misoprostol for early pregnancy loss during COVID-19 was less effective than outpatient care. There were more serious complications in the ED group due to misdiagnosis and guideline nonadherence.

Does my work matter? Reduced sense of mattering as a source of gender disparities

AbstractWomen may experience lower rates of entry and success into certain academic and professional spaces because of their observations that their work contributions are less valued than men's. We introduce sense of mattering as a mechanism that may help explain women's underrepresentation in male‐dominated fields and leadership roles, distinguish it from related constructs, and advance a theoretical framework for how sense of mattering may shape gender disparities. Women's professional contributions are often undervalued, and women perceive and anticipate this unfair disadvantage, which may in turn limit their success, retention, and representation in stereotypically masculine spaces and roles. Attending to sense of mattering has the potential to improve upon past attempts to reduce gender disparities by emphasizing the importance of increasing the extent to which women's contributions are recognized and valued.

Efficacy of cap-assisted endoscopy for the visualization of the major duodenal papilla: a systematic review and meta-analysis

The current standard of practice is to use a duodenoscope for the evaluation of the major duodenal papilla (MDP). Recently, cap-assisted endoscopy (CAE), which uses a transparent cap at the tip of a standard front-viewing endoscope, has emerged as an alternative. A systematic literature search was performed in several databases from inception to January 2023 to identify studies evaluating the efficacy of CAE for the evaluation of the MDP. Nine studies including 806 patients met our inclusion criteria. The pooled rate of technical success for CAE was 93.2% (95% confidence interval, 85.6-96.9; I2= 84.6%). A subgroup analysis comparing CAE with a standard endoscope showed higher odds for the evaluation of the MDP with CAE (but not a duodenoscope, which was better than CAE) with an odds ratio of 57.294 (95% confidence interval, 17.767-184.755; I2= 45.303%). CAE offers a significant advantage with high rates of complete MDP evaluation compared with standard forward-viewing endoscopy. However, CAE is associated with lower rates of success when compared with side-viewing endoscopes.

The effect of alcohol use on smoking cessation: A systematic review.

Only a small minority of all attempts to stop smoking is successful, especially among smokers who are heavy drinkers and those with an alcohol use disorder. The current systematic review focusses on the negative effects of alcohol use, either before or during attempts to quit smoking, on the success rate of these attempt(s) in alcohol drinking tobacco smokers. We conducted a systematic review of naturalistic and experimental studies, which included at least 40 tobacco smokers with a recorded drinking status (non-drinking, heavy drinking, alcohol use disorder) and a clearly documented change in alcohol consumption. We could not conduct a meta-analyses and, thus, used consistency across studies to draw conclusions. The evidence presented here shows that alcohol use is associated with lower rates of success in quitting smoking in 20 out of 27 studies. This includes both lapses and relapses. Similarly, in 19 out of 20 long-term follow-up studies, the duration of smoking abstinence was shorter among persons with higher alcohol consumption. Finally, 12 out of 13 experimental studies showed that exposure of smokers to alcohol cues or to drinking of alcohol, induce a strong propensity to smoke. It is, therefore, recommended for smokers who drink alcohol and who intend to quit smoking to use an integrated approach i.e., to stop or substantial reduce their alcohol consumption before and/or during their attempt to quit smoking.

Procedural Characteristics and Clinical Outcomes Associated with Chronic Total Occlusion Percutaneous Coronary Intervention in Patients with a History of Prior Coronary Artery Bypass Graft: A Meta-Analysis.

Owing to advances in procedural techniques and the training of interventional staff in catheterization labs, recent work has demonstrated the safety of percutaneous coronary intervention (PCI) as a treatment for patients suffering from chronic total occlusion (CTO). However, there has been little research focused on systematic comparisons of PCI outcomes in CTO patients that did or did not exhibit a history of previous coronary artery bypass grafting (CABG). Electronic databases were systematically searched for all studies comparing CTO-PCI outcomes for patients with and without a history of CABG, with event rates subsequently being compared via random-effects models with forest plots and odds ratios with 95% confidence intervals (CI), owing to the assumption of between-studies heterogeneity. In total, 8 observational studies enrolling 13,509 CTO patients were identified, including 3389 and 10,120 patients with and without a history of prior CABG, respectively. Patients were enrolled in these studies from 1999-2018. Pooled analyses indicated that CABG history was not linked to a lower proportion of radial access 24 (95% CI 0.52-1.03, p = 0.08), and a prior CABG history was linked to a greater contrast volume (95% CI 0.12-0.44, p 0.001), higher radiation dose (95% CI 0.27-0.40, p 0.001), longer fluoroscopy time (95% CI 0.42-0.61, p 0.001), longer procedural time (95% CI 0.38-0.64, p 0.001), a higher number of implanted stents (95% CI 0.41-0.60, p 0.001), longer total stent length (95% CI 0.21-0.60, p 0.001), higher technical failure rates (95% CI 1.46-1.85, p 0.001), and higher rates of procedural failure (95% CI 1.42-1.79, p 0.001). The in-hospital mortality (95% CI 1.50-4.03, p 0.001) and periprocedural mortality (95% CI 1.63-3.73, p 0.001) of patients with a history of CABG were also higher. While stroke incidence was comparable in both groups (95% CI 0.80-4.47, p = 0.15), periprocedural major adverse cardiovascular and cerebrovascular events (MACCE) rates were significantly higher among patients exhibiting a history of CABG (95% CI 1.66-2.94, p 0.001). These results suggest that CTO-PCI procedures may be more challenging and associated with lower rates of success in CABG patients relative to procedures performed in patients without any history of CABG. Moreover, in-hospital outcomes including MACCE and mortality were worse for patients that had undergone prior CABG.

Impact of lesion length on the outcomes of chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry.

The impact of occlusion length on the procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We examined the clinical and angiographic characteristics and procedural outcomes of 10,335 CTO PCIs at 42 US and non-US centers between 2012 and 2022. The cohort was divided into two groups based on lesion length (≥20 mm vs. <20 mm). Long lesions were present in 7208 (70%) patients. Comorbidities were more common in patients with long CTOs. Compared with short lesions, long lesions had higher J-CTO score (2.8 ± 1.1 vs. 1.3 ± 1; p < 0.001) and retrograde wiring was more often the initial (15.5% vs. 4.0%; p < 0.001) and successful (22.8% vs. 8.2%; p < 0.001) crossing strategy. Long lesions were more likely to require longer procedure (123 vs. 91 min; p < 0.001) and fluoroscopy (47.1 vs. 32.2 min; p < 0.001) time, larger contrast volume (218 vs. 200 mL; p < 0.001) and higher air kerma radiation dose (2.4 vs. 1.7 Gy; p < 0.001). After adjusting for potential confounders, long lesions were associated with lower technical success (odds ratio [OR]: 0.91 per 10 mm increase; 95% confidence interval [CI]: 0.88, 0.94) and higher major adverse cardiovascular events (MACE) (OR: 1.08 per 10 mm increase; 95% CI: 1.02, 1.15). CTO PCI of long occlusions is independently associated with lower rates of technical success and higher rates of in-hospital MACE.

Relationship Between Mean Arterial Pressure and Furosemide Stress Test Success Rates: A Retrospective Cohort Study.

The furosemide stress test (FST) is a safe and easy assessment of renal tubular function. Other factors, such as mean arterial pressure (MAP), which may influence the success rates of the FST, have not been well defined. To evaluate the relationship between MAP and success rates of the FST in critically ill patients. Retrospective, single-center, institutional review board (IRB)-approved cohort study. Critically ill adult patients given at least one dose of intravenous (IV) furosemide (≥1-1.5 mg/kg) were included. Primary outcome was whether a MAP ≥ 75 mm Hg would equate to a higher FST success rate. Secondary outcome was the success rates of patient on one or more vasopressors. Of 225 patients, 88 (39.1%) had a successful FST. In patients with a MAP ≥ 75 mm Hg, 60 out of 104 (57.7%) had a successful FST compared to 28 out of 121 (23.1%) of patients who had a MAP < 75 mm Hg (odds ratio [OR], 4.53, 95% CI, 2.55-8.74, P < 0.001). Patients on vasopressors at the time of the furosemide dose had lower rates of success compared to those not on vasoactive agents (30.4% versus 68.2%, p = 0.026). Limitations of this study include its retrospective design and reliance on documented urine output. Patients with a MAP ≥ 75 mm Hg were significantly more likely to have a successful FST compared to those with a MAP < 75 mm Hg. This represents the first report of factors that may influence FST success rates.

Efficacy of erythromycin compared to clarithromycin and azithromycin in adults or adolescents with community-acquired pneumonia: A Systematic Review and meta-analysis of randomized controlled trials

BackgroundIt is debatable whether erythromycin has similar efficacy to other macrolides in treating community-acquired pneumonia (CAP). The aim of this meta-analysis is to compare the efficacy of erythromycin with clarithromycin and azithromycin. MethodsWe performed this meta-analysis of randomized controlled trials (RCTs) of adults or adolescents with CAP which compared the efficacy of erythromycin monotherapy to either azithromycin or clarithromycin. We searched PubMed and EMBASE and Cochrane Library databases and three clinical trial registries up to November 02, 2021. We evaluated heterogeneity and used random-effects models to perform risk ratios with 95% confidence intervals. ResultsWe included four RCTs (total of 472 patients), which compared the clinical efficacy of erythromycin versus clarithromycin. No studies comparing monotherapy of erythromycin versus azithromycin were found. Erythromycin use was associated with significantly lower rates of clinical success (RR, 0.79; 95% CI, 0.64 to 0.98; P-value = 0.033; I2 = 20.27%), clinical cure (RR,0.67; 95% CI, 0.48 to 0.92; P-value = 0.014; I2 = 8.75%), and radiological success (RR, 0.84; 95% CI, 0.71 to 0.996; P-value = 0.045; I2 = 20.12%) than clarithromycin. ConclusionErythromycin is less effective than clarithromycin as empiric treatment of CAP in adults and adolescents. Because of this and the higher rate of adverse reactions, erythromycin should not be used in the majority of CAP patients when azithromycin and clarithromycin are available.

Gender differences in the determinants of becoming a professor in Germany. An event history analysis of academic psychologists from 1980 to 2019

Theories on gender bias argue that women in academia benefit less from their academic achievements than men do; women, as a result, show lower rates of success in becoming tenured professors. Based on longitudinal data from CVs of virtually all psychologists in German academia, we analyze factors that lead to a first permanent professorship in German psychology departments. We find no overall gender differences in getting a tenured position when considering all psychologists and holding research productivity and other observable factors constant. Among currently tenured professors, women show a 32% higher chance of having gotten tenure than men. Interaction effects reveal that women's publishing or signaling investments are not devalued when they try to obtain tenure. We particularly find that women benefit more from their scholarly publications than men do. Hence, we find no support for gender bias or devaluation of women's academic achievements.

Breeding dispersal in a resident boreal passerine can lead to short‐ and long‐term fitness benefits

AbstractWhether an individual disperses or remains site‐faithful between breeding seasons can have important impacts on individual fitness and population dynamics. While several studies have identified factors influencing the probability of breeding dispersal, the consequences of dispersal are much less certain, particularly over an individual’s lifetime. Here, we use 81 cases (13 paired and 55 single dispersals) of breeding dispersal across 55 yr of breeding and re‐sighting data from an individually marked population of Canada jays (Perisoreus canadensis) at the southern edge of their range in Algonquin Provincial Park, Ontario to determine both the short‐ (year after dispersal) and long‐term (lifetime) consequences of breeding dispersal. In the year following dispersal, adults had larger brood sizes and higher nest success compared to the year prior to dispersal. However, when adults dispersed during the fall/winter, they had significantly later lay dates and lower rates of nest success than adults that dispersed during the summer. Additionally, most breeders dispersed to territories of higher quality and individuals that dispersed to a territory of lesser quality experienced lower rates of nest success. Importantly, individuals that dispersed at least once in their lifetime produced an average of 2.7 more young and recruited an average of 0.9 more juveniles into the population compared to individuals that remained site‐faithful. Our study provides rare evidence of both the short‐ and long‐term benefits of breeding dispersal in Canada jays and demonstrates how the timing of dispersal can also have consequences for individual reproductive performance.

Body Mass Index Trends in Women Who Undergo External Cephalic Version in a Tertiary Hospital in Spain

The global epidemic of obesity also affects pregnant women. External cephalic version is a procedure for achieving a cephalic presentation. Obesity has been associated with lower rates of ECV success. The main objective of this article is to analyze the trends in BMI in pregnant women who underwent ECV. A descriptive retrospective analysis of ECV performed in Hospital Clinico Universitario Virgen de la Arrixaca in Murcia (Spain) between 1st of January of 2014 and 31st of December 2018 has been carried out. 417 patients were recruited. The mean maternal BMI was 25.5 kg/m2 at 36 week’s gestation. If BMI is categorized, 2.6% (N=11) of the patients had a BMI below 18.5 kg/m2, 51.1% (N=213) had a BMI between 18.5-24.9 kg/m2, 30.9% (N=129) of the patients had a BMI between 25-29.9 kg/m2 and 14.0% (N=64) had a BMI above 30 kg/ m2. Mean maternal BMI had statistically significant changes between 2014 and 2018 (p&lt;0.001). Maternal BMI has increased over the years in patients who undergo ECV. In patients who undergo ECV, maternal BMI should be related to socio-economic inequalities and social behavior in future researches. It should be also associated with maternal BMI of pregnant women who undergo ECV with ECV success rate and with the type of delivery of those pregnancies. Keywords: External Cephalic Version; Body Mass Index; Pregnant; Obstetrics; Obesity; Overweight. Abbreviations ECV: External Cephalic Version; BMI: Body Mass Index.

Treatment success for patients with tuberculosis receiving care in areas severely affected by Hurricane Matthew - Haiti, 2016.

On October 4, 2016, Hurricane Matthew struck southwest Haiti as a category 4 storm. The goal of this study was to evaluate the impact of the hurricane on tuberculosis (TB) services and patient outcomes in the three severely affected departments-Sud, Grand'Anse, and Nippes-of southwest Haiti. We developed a standard questionnaire to assess a convenience sample of health facilities in the affected areas, a patient tracking form, and a line list for tracking all patients with drug-susceptible TB registered in care six months before the hurricane. We analyzed data from the national TB electronic surveillance system to determine outcomes for all patients receiving anti-TB treatment in the affected areas. We used logistic regression analysis to determine factors associated with treatment success. Of the 66 health facilities in the three affected departments, we assessed 31, accounting for 536 (45.7%) of 1,174 TB patients registered in care when Hurricane Matthew made landfall in Haiti. Three (9.7%) health facilities sustained moderate to severe damage, whereas 18 (58.1%) were closed for <1 week, and five (16.1%) for ≥1 week. Four weeks after the hurricane, 398 (73.1%) of the 536 patients in the assessed facilities were located. Treatment success in the affected departments one year after the hurricane was 81.4%. Receiving care outside the municipality of residence (adjusted odds ratio [aOR]: 0.46, 95% confidence interval [CI]: 0.27-0.80) and HIV positivity (aOR: 0.31, 95% CI: 0.19-0.51) or unknown HIV status (aOR: 0.49, 95% CI: 0.33-0.74) were associated with significantly lower rates of treatment success. Despite major challenges, a high percentage of patients receiving anti-TB treatment before the hurricane were located and successfully treated in southwest Haiti. The lessons learned and results presented here may help inform policies and guidelines in similar settings for effective TB control after a natural disaster.

Rockwood Grade-III Acromioclavicular Joint Separation: A Cost-Effectiveness Analysis of Treatment Options.

Background:The treatment of Rockwood Grade-III acromioclavicular (AC) joint separation has been widely disputed since the introduction of the classification system. The present literature does not reach consensus on whether operative or nonoperative management is more advantageous, nor does it effectively distinguish between operative measures. We hypothesized that nonoperative treatment of Rockwood Grade-III AC joint separation would be more cost-effective when compared with surgical options.Methods:We created a decision-tree model outlining the treatment of Rockwood Grade-III separations using nonoperative management or hook-plate, suture-button, or allograft fixation. After nonoperative intervention, the possible outcomes predicted by the model were uneventful healing, delayed operative management, a second round of sling use and physical therapy, or no reduction and no action; and after operative intervention, the possible outcomes were uneventful healing, loss of reduction and revision, and depending on the implant, loss of reduction and no action, or removal of the implant. A systematic review was conducted, and probabilities of each model state were averaged. A cost-effectiveness analysis was conducted both through rollback analysis yielding net monetary benefit and through incremental cost-effectiveness ratios (ICERs). Thresholds of $50,000/quality-adjusted life-year (QALY) and $100,000/QALY were used for ICER analysis. Furthermore, a sensitivity analysis was utilized to determine whether differential probabilities could impact the model.Results:Forty-five papers were selected from a potential 768 papers identified through our literature review. Nonoperative treatment was used as our reference case and showed dominance over all 3 of the operative measures at both the $50,000 and $100,000 ICER thresholds. Nonoperative treatment also showed the greatest net monetary benefit. Nonoperative management yielded the lowest total cost ($6,060) and greatest utility (0.95 QALY). Sensitivity analysis showed that allograft fixation became the favored technique at a willingness-to-pay threshold of $50,000 if the rate of failure of nonoperative treatment rose to 14.6%. Similarly, at the $100,000 threshold, allograft became dominant if the probability of failure of nonoperative treatment rose to 22.8%.Conclusions:The cost-effectiveness of nonoperative treatment is fueled by its notably lower costs and overall high rates of success in Grade-III separations. It is important to note that, in our analysis, the societal cost (measured in lost productivity) of nonoperative treatment neared that of surgical treatment, but the cost from the health-care system perspective was minimal. Physicians should bear in mind the sensitivity of these conclusions and should consider cost-effectiveness analyses in their decision-making guidelines.Level of Evidence:Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.

Evaluation of the Relationship Between Platelet Indices and Mitral Restenosis After Percutaneous Mitral Balloon Valvuloplasty

Background: Percutaneous mitral balloon valvuloplasty (PMBV) has been established as an effective and safe treatment modality for symptomatic patients with severe rheumatic mitral stenosis. While Wilkin Score (WS) ≤ 8 are associated with higher rates of procedural success and lower rates of restenosis, higher WS are associated with lower rates of procedural success and higher rates of restenosis. It is well known that platelets have substantial role in thromboembolic complications of rheumatic mitral stenosis and various studies showed that increased platelet (PLT) activity in rheumatic mitral stenosis. The aim of this study was to assess the usefulness of PLT indices as a predictor of restenosis in patients who underwent PMBV. Methods: We retrospectively enrolled 178 consecutive patients who underwent PMBV. Patients were classified into the two groups. Study group (n=21) included patients whom we performed redo PMBV during their follow-up as a result of mitral restenosis following previous PMBV (index procedure) and control group (n=157) included patients whom did not undergo a redo PMBV. PLT indices including PLT count, Platelecrit and mean platelet volume values were evaluated in these groups. Results: In study group, PLT count (210 ± 49 vs. 241 ± 62, p=0.010), PCT [0.203 (0.173-0.230) vs. 0.260 (0.243-0.290), p

Abstract 15563: Association of Weight With Ablation Outcomes in Pediatric Wolff-Parkinson-White Syndrome: Analysis of the NCDR® IMPACT Registry

Introduction: Guidelines for electrophysiology study (EPS) and catheter ablation in Wolff-Parkinson-White syndrome (WPW) are based on age. Size is an established factor in ablation risk and may be the more appropriate factor to consider when deciding timing of EPS. Hypothesis: Weight &lt;30 kg is associated with higher rates of major adverse events (MAE) and deferred ablation, and lower rates of success. Methods: A multicenter retrospective cohort study was performed on children age 1-21 years with WPW and first-time EPS data in IMPACT from 4/16-12/19, excluding those with congenital heart disease, cardiomyopathy, and &gt; 1 ablation target. MAE were defined as cardiac arrest, stroke, tamponade, permanent pacemaker, or unplanned cardiac / vascular surgery. Ablation success was evaluated in those with attempts. Multivariable logistic regression models were used to adjust for measurable confounders - accessory pathway (AP) type, AP location, and use of cryoablation (cryo). Results: 4456 subjects from 84 centers were evaluated, with 14% &lt;30 kg. Subjects &lt;30 kg were more likely to have pre-operative SVT (45% vs. 29%, p&lt;0.001) and inducible SVT (71% vs. 61%, p&lt;0.001), more likely to have left non-septal APs (46% vs. 37%, p&lt;0.001), and less likely to have right septal APs (25% vs. 33%, p&lt;0.001, Table). No difference was seen in the likelihood of deferred ablation based on weight (9.5% vs. 12%, p=0.07). Ablation success was higher in &lt;30 kg: 95% vs. 92% (p=0.009). This effect persisted after adjusting for measurable covariates (OR 1.7, 95% CI 1.03-2.7, p = 0.04). Left non-septal AP location was also associated with success (OR 2.9, CI 1.9-4.2, p &lt;0.0001), and cryo was negatively associated (OR 0.4, CI 0.3-0.5, p&lt;0.0001). MAE were rare, though with higher incidence in &lt;30 kg (0.3% vs. 0.05%, p=0.04). Conclusions: In this analysis of WPW patients with ablation data in IMPACT, weight &lt;30 kg was associated with increased ablation success; a higher incidence of MAE (which were rare) was observed.

Comparison of 1-Year Effectiveness of Trabecular Microbypass Stent implantation (iStent) in Conjunction With Phacoemulsification Among Mild, Moderate, and Severe Primary Open-angle Glaucoma Patients

The study compared 1-year effectiveness of single trabecular microbypass stent (iStent) implantation with phacoemulsification among glaucoma severities in primary open-angle glaucoma. The study found that mild glaucoma had greater success rate and lower number of medications compared with moderate and severe glaucoma. To evaluate the effectiveness of iStent implantation in combination with cataract surgery in moderate to severe glaucoma compared with mild glaucoma. Medical charts of primary open-angle glaucoma subjects undergoing 1 iStent implantation were retrospectively reviewed. Glaucoma was classified on the basis of mean deviation (MD) of the preoperative standard automated perimetry into mild (MD>-6 dB), moderate (MD -6 to -12 dB), and severe (MD<-12 dB). Mixed effect regression models were performed to determine the effect of iStent at 1 year. The outcomes included as follows: (1) intraocular pressure (IOP) and the number of medications, (2) eyes with IOP ≤ severity-based target (18 mm Hg for mild, 15 mm Hg for moderate, 12 mm Hg for severe) (2A) without medication, and (2B) with medication reduction. In total, 104 eyes from 89 subjects were analyzed. Cataract combined with iStent surgery significantly lowered the number of medications in all groups and significantly decreased IOP in moderate and severe glaucoma (P<0.05). There was significantly higher number of medications in moderate (β: 0.58, P=0.002) and severe (β: 1.20, P<0.001) compared with mild glaucoma. Eyes with moderate glaucoma had significantly lower rate of success (criterion 2A) compared with mild glaucoma [odds ratio (OR): 0.008, P=0.047]. Eyes with moderate and severe glaucoma had significantly lower rates of success (criterion 2B) (moderate vs. mild OR: 0.002, P=0.028; severe vs. mild OR: 0.026, P=0.026). Combined phacoemulsification with iStent seems to have a better IOP-lowering and medication-lowering effect in mild glaucoma cases versus those with moderate and severe glaucoma. This difference was found in real-world data over one-year follow-up period. Long-term studies with defined IOP goals and medication removal protocols are warranted.