Median Rating Research Articles

Comparing microscope light-associated glare and comfort between heads-up 3D digital and conventional microscopes in cataract surgery: a randomised, multicentre, single-blind, controlled trial

ObjectiveTo compare subjective levels of comfort and visual experiences related to microscope light in patients undergoing their first cataract surgery with topical anaesthesia using a digital microscope (the NGENUITY three-dimensional...

Multimodality, online oncology learning resources: Meeting residents where they are—A pilot to create a new oncology curriculum.

11035 Background: The Accreditation Council for Graduate Medical Education (ACGME) requires internal medicine residents to have access to different medical subspecialties, including hematology/oncology. While inpatient rotations in hematology/oncology have been associated with a decreased interest in a career in oncology, dedicated educational sessions have been shown to improve residents’ interest in the field. In recognition of different learning styles and modalities and the need for asynchronous delivery, we aimed to build an effective curriculum for oncology learners using interactive, multimodality, online learning tools and resources. Methods: Using the Canvas online learning management system, individual learning modules covering major cancer types were created. Each learning module consisted of a pre-survey assessing the learners’ evaluation of their own knowledge and comfort with the topic, a brief audio or video file covering high-yield information about the cancer type, interactive case-based questions reviewing and reinforcing the information, and a post-survey assessing the change in the learners’ evaluation of their knowledge and comfort in clinical application of the information. The pre- and post-surveys were rated on a 5-point Likert scale. Median values and interquartile ranges are reported. A one-sided t-test was used to compare responses. Results: Two fully completed learning modules have been created. The lung cancer module included a high-yield, 10-minute voice-over PowerPoint presentation followed by interactive, case-based questions. The breast cancer module used a high-yield, 10-minute podcast with an accompanying handout for notes followed by case-based interactive questions. Seven learners have completed both pre- and post-survey responses for comparison. Two were completed by PGY1, 4 by PGY2, and 1 by a PGY3 resident. Median rating of the learners’ knowledge of the specific cancer type increased from 2- Fair (1.5) on the pre-survey to 3- Neutral (1) after completing the learning module (p = 0.001). 100% of learners agreed or strongly agreed that their knowledge increased after completing the module. All 7 residents felt more comfortable with their clinical application of the cancer topic material after completing the module, median 2(1) on pre-survey vs. 3(0.5) on post-survey; p = 0.0004. Conclusions: The creation of online, multimodality learning resources has resulted in improvements in learners’ perceived knowledge and comfort with clinical application of oncology topics. Using learning science principles, this pilot project serves as the foundation for further innovative and interactive educational resources and modules created for oncology learners.

Evaluation of Patient-Friendly Diagnosis Clarifications in a Hospital Patient Portal.

Medical data can be difficult to comprehend for patients, but only a limited number of patient-friendly terms and definitions are available to clarify medical concepts. Therefore, we developed an algorithm that generalizes diagnoses to more general concepts that do have patient-friendly terms and definitions in SNOMED CT. We implemented the generalizations, and diagnosis clarifications with synonyms and definitions that were already available, in the problem list of a hospital patient portal. We aimed to assess the extent to which the clarifications cover the diagnoses in the problem list, the extent to which clarifications are used and appreciated by patient portal users, and to explore differences in viewing problems and clarifications between subgroups of users and diagnoses. We measured the coverage of diagnoses by clarifications, usage of the problem list and the clarifications, and user, patient and diagnosis characteristics with aggregated, routinely available electronic health record and log file data. Additionally, patient portal users provided quantitative and qualitative feedback about the clarification quality. Of all patient portal users who viewed diagnoses on their problem list (n = 2,660), 89% had one or more diagnoses with clarifications. In addition, 55% of patient portal users viewed the clarifications. Users who rated the clarifications (n = 108) considered the clarifications to be of good quality on average, with a median rating per patient of 6 (interquartile range: 4-7; from 1 very bad to 7 very good). Users commented that they found clarifications to be clear and recognized the clarifications from their own experience, but sometimes also found the clarifications incomplete or disagreed with the diagnosis itself. This study shows that the clarifications are used and appreciated by patient portal users. Further research and development will be dedicated to the maintenance and further quality improvement of the clarifications.

EUS-guided versus percutaneous liver biopsy: A prospective randomized clinical trial.

Prospective studies comparing EUS-guided liver biopsy (EUS-LB) to percutaneous LB (PC-LB) are scarce. We compared the efficacy and safety of EUS-LB with those of PC-LB in a prospective randomized clinical trial. Between 2020 and 2021, patients were enrolled and randomized (1:1 ratio). The primary outcome was defined as the proportion of patients with ≥11 complete portal tracts (CPTs). The sample size (n = 80) was calculated based on the assumption that 60% of those in the EUS-LB and 90% of those in the PC-LB group will have LB with ≥11 CPTs. The secondary outcomes included proportion of patients in whom a diagnosis was established, number of CPTs, pain severity (Numeric Rating Scale-Pain Intensity), duration of hospital stay, and adverse events. Eighty patients were enrolled (median age, 53 years); 67.5% were female. Sixty percent of those in the EUS-LB and 75.0% of those in the PC-LB group met the primary outcome (P = 0.232). The median number of CPTs was higher in the PC-LB (17 vs 13; P = 0.031). The proportion of patients in whom a diagnosis was established was similar between the groups (92.5% [EUS-LB] vs 95.0% [PC-LB]; P = 1.0). Patients in the EUS-LB group had less pain severity (median Numeric Rating Scale-Pain Intensity, 2.0 vs 3.0; P = 0.003) and shorter hospital stay (2.0 vs 4.0 hours; P < 0.0001) compared with the PC-LB group. No patient experienced a serious adverse event. EUS-guided liver biopsy was safe, effective, better tolerated, and associated with a shorter hospital stay.

Development of quality indicators for the diagnosis and treatment of urinary tract infections in general practice: a RAND appropriateness method

ObjectiveTo develop a set of quality indicators for the diagnosis and antibiotic treatment of adult patients with suspected urinary tract infections in general practice.DesignA Research and Development/University of California Los...

Assessing the Impact of a Multi-Modal Neuro-Ophthalmology Educational Workshop on Resident Confidence in the Neuro-Ophthalmology Examination (P1-2.005)

<h3>Objective:</h3> To identify gaps in Neuro-Ophthalmology training and assess resident responsiveness to a multi-modal Neuro-Ophthalmology workshop. <h3>Background:</h3> The Neuro-Ophthalmology examination is essential for neurological localization. However, increased workloads and limited exposure make it challenging for residents to become proficient. This study aims to identify gaps in Neuro-Ophthalmology training and assess resident responsiveness to a multi-modal Neuro-Ophthalmology workshop. <h3>Design/Methods:</h3> This is a single-center, mixed methods, quantitative-qualitative (convergent parallel design) survey-based study evaluating resident confidence in neuro-ophthalmological examination. The utility of a didactic-based and hands-on Neuro-Ophthalmology workshop covering evaluation of visual fields, extraocular movements (EOM), and fundoscopic exam was assessed. A survey composed of Likert scales (1=strongly agree, 5=strongly disagree) and open-ended questions for qualitative feedback was administered before and after the workshop. Descriptive data and paired comparisons (Wilcoxon signed-rank test) are reported. <h3>Results:</h3> 16 adult and pediatric neurology residents (81% adult, median post-graduate training-year 3, [range 1–4]) participated in the 2-hour workshop. Pre-workshop surveys revealed that residents were least confident in disc edema assessment (median rating 4 [range 2–5]) and reported an unmet need for teaching and feedback about examination techniques (median rating 4 [range 2–5]). Post-workshop surveys demonstrated a significant improvement (p&lt;0.05) in overall confidence in exam skills, specifically when identifying relative-afferent pupillary defects and pathognomonic characteristics of ophthalmological disorders. Fundoscopic exam confidence did not improve significantly, but results were limited given early termination of breakout sessions. Videos of EOM abnormalities and immediate feedback from instructors were reported as most helpful. Residents suggested increasing workshop length for future sessions. <h3>Conclusions:</h3> A combined didactic-based and hands-on Neuro-Ophthalmology workshop is helpful in identifying gaps in Neuro-Ophthalmology training and increasing resident confidence. Additional instruction in visual acuity and fundoscopic assessments may be beneficial in future workshops. We aim to utilize our findings to create an optimized Neuro-Ophthalmology curriculum with future application to other aspects of resident training. <b>Disclosure:</b> Dr. Kang has nothing to disclose. Dr. Flowers has received intellectual property interests from a discovery or technology relating to health care. Dr. Lee has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Dr. Lavin has nothing to disclose. Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Shah has received publishing royalties from a publication relating to health care.

Characteristic and management motor neuron disease in the largest tertiary hospital in the Philippines: A one-year period cross sectional analytic study

BackgroundMotor neuron disease (MND) is largely understudied in many underdeveloped and developing countries, including the Philippines. The practice and management of MND is generally insufficient, and thus, the quality of life of these patients are consequently compromised. ObjectivesThe aim of this study is to determine the clinical profile and describe the management of MND patients seen in the largest tertiary hospital in the Philippines for one year. MethodsThis is a cross-sectional study of MND patients diagnosed clinically and via electromyogram-nerve conduction study (EMG NCS) in the Philippine General Hospital (PGH) from January to December 2022. Clinical characteristics, diagnostics and management information were obtained and summarized. ResultsThe incidence of MND in our neurophysiology unit was 4.3% (28/648), with amyotrophic lateral sclerosis (ALS) being the most common variant (67.9%, n = 19). Male to Female ratio was 1:1, with the median age of onset of 55 (36–72) years old and median onset duration to diagnosis of 1.5 (0.25–8) years. Limb onset was more prevalent (82.14%, n = 23) with upper limbs initially involved (79.1%, n = 18). Split hand syndrome was found in almost half (53.6%) of the patients. The median ALS functional rating score-revised (ALSFRS-R) and medical research council (MRC) scores were 34 (8–47) and 42(16–60) respectively while the median King’s clinical stage was 3 (1–4). Only half of the patients were able to undergo magnetic resonance imaging (MRI) and only one had neuromuscular ultrasound. Only one of the 28 patients was able to take riluzole, and only one was on oxygen support. None had gastrostomy and none used non-invasive ventilation. ConclusionThis study showed that the management of MND in the Philippines is largely inadequate and further improvement in the health care system in handling rare neurologic cases must be implemented to enhance their quality of life.

The VR leadless pacemaker: Results of an expert panel using the RAND/UCLA method.

Leadless pacemakers were developed to reduce complications associated with transvenous pacemaker implantation and long-term follow-up. Existing international guidelines lack detailed instructions on patients suitable for leadless pacemaker implantation. Our aim was to develop a consensus document that provides medical guidance for all health professionals involved in the indication and implantation of Transcatheter Pacing System single-chamber device (VR leadless) pacemakers for patients with atrial fibrillation or in sinus rhythm. A panel of experts, including interventional and non-interventional cardiologists, used the Research ANd Development/University of California at Los Angeles (RAND/UCLA) method to rate the appropriateness of leadless pacemaker implantation for 64 scenarios in patients with atrial fibrillation and 192 scenarios in sinus rhythm. The scenarios were rated individually and again during a moderated group session. Median ratings and level of agreement were calculated to classify each scenario as appropriate, inappropriate, or questionable. This consensus statement, based on available literature and the experts' opinions, summarizes recommendations for standardizing and optimizing leadless pacemaker implantation. The limitation for vascular access via the superior vena cava was the most influential variable when indicating leadless pacemaker implantation in both patients with atrial fibrillation and patients in sinus rhythm. Life expectancy, risk of infection, prosthetic valve, left ventricular ejection fraction (LVEF), limitation for vascular access via the superior vena cava, and mobility and exercise capacity determine who is advised to undergo VR leadless pacemaker implantation. More prospective studies are needed to optimize existing recommendations.

Long-Term Analgesic Efficacy of Neurolytic Splanchnic Nerve Block via the Transintervertebral Disc Approach to Retrocrural Space: A Multicenter Retrospective Study.

The celiac plexus block is effective for treating intractable cancer pain and has been the focus of many studies. At our affiliated institution, fluoroscopy-guided splanchnic nerve block with a single needle via the transintervertebral disc approach was the first choice of treatment. The short-term efficacy of this technique has been reported, but the long-term efficacy is not clear. In the present study, we investigated the long-term analgesic efficacy of this technique. This multicenter, retrospective, observational study reviewed the medical records of patients who underwent neurolytic splanchnic nerve block (NSNB) via the transintervertebral disc approach for intractable cancer pain at five tertiary hospitals in Japan from April 2005 to October 2020. The primary outcome was the long-term analgesic efficacy of a one-time NSNB via the transintervertebral disc approach. In total, 76 patients were included in the analysis. The median lowest numerical rating scale (NRS) score was 1 within 14days. At 1, 2, 3, and 6months after the nerve block, the median NRS score was also ≤2, while the median equivalent oral morphine dose did not show any clinically noticeable increase at those times. The long-term analgesic efficacy of NSNB via the transintervertebral disc approach in patients with intractable cancer pain has been demonstrated.

American Academy of Orthopaedic Surgeons/Major Extremity Trauma and Rehabilitation Consortium Appropriate Use Criteria: Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery.

The Major Extremity Trauma and Rehabilitation Consortium and the American Academy of Orthopaedic Surgeons developed an Appropriate Use Criteria (AUC) titled The Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery . Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care, aid decision making, and obtain the best possible outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The AUC was derived by identifying clinical indications typical of patients undergoing pelvic or extremity surgery. These indications were most often parameters observable by the clinician, including symptoms or results of diagnostic tests. The 480 patient scenarios and 10 treatments were developed by the writing panel, a group of clinicians who are specialists in this AUC topic. Next, a separate, multidisciplinary, voting panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a nine-point scale to designate a treatment as "appropriate" (median rating, 7 to 9), "may be appropriate" (median rating, 4 to 6), or "rarely appropriate" (median rating, 1 to 3).

Older patients with primary central nervous system lymphoma: Survival and prognostication across 20 U.S. cancer centers.

There is a paucity of large-scale data delineating outcomes and prognostication of older patients with primary central nervous system lymphoma (PCNSL). We retrospectively analyzed 539 newly-diagnosed PCNSL patients ages ≥60 years across 20 U.S. academic centers. The median age was 70 years (range 60-88); at least one geriatric syndrome was present in 46%; the median Cumulative Index Ratings Scale-Geriatrics (CIRS-G) score was 6 (range, 0-27); and 36% had impairment in activities of daily living (ADL). The most common induction regimens were high-dose methotrexate (HD-MTX) ± rituximab; methotrexate, temozolomide, rituximab (MTR); and rituximab, methotrexate, procarbazine, vincristine (R-MPV). Overall, 70% of patients achieved remission, with 14% undergoing consolidative autologous stem cell transplant (ASCT) and 24% receiving maintenance. With 58-month median follow-up, median progression-free survival (PFS) and overall survival (OS) were 17 months (95% CI 13-22 months) and 43 months (95% CI 31-56 months), respectively. Three-year PFS and OS were highest with MTR (55% and 74%, respectively). With single-agent methotrexate ± rituximab, 3-year PFS and OS were 30% (p=.0002) and 47% (p=.0072). On multivariate analysis, increasing age at diagnosis and Cooperative Oncology Group (ECOG) performance status (PS) was associated with inferior PFS; age, hypoalbuminemia, higher CIRS-G score, and ECOG PS adversely affected OS. Among patients receiving maintenance, 3-year PFS was 65% versus 45% without maintenance (p=0.02), with 3-year OS of 84% versus 61%, respectively (p=.0003). Altogether, outcomes in older PCNSL patients appeared optimized with HD-MTX combination induction regimens and maintenance therapy. Furthermore, several prognostic factors, including geriatric measures, were associated with inferior outcomes.

Radiofrequency ablation versus high ligation and stripping for the treatment of symptomatic great saphenous vein insufficiency: Short-term patient-reported outcomes

Objectives: The study aimed to compare short-term patient-reported outcomes of radiofrequency ablation (RFA) versus high ligation and stripping (HLS) in a cohort with symptomatic great saphenous vein (GSV) insufficiency. Patients and methods: This was a single-institution, retrospective, observational, cohort study of prospectively collected data. All procedures were performed between January 2019 and February 2021. Ninety-seven patients (54 females, 43 males; mean age: 45.2±11.1 years; range, 18 to 76 years) with lower limb chronic venous disease symptoms refractory to exercise, compression stockings, and pharmacotherapy underwent RFA (n=60) or HLS (n=37). Self-reported pain assessment was performed on the first postoperative day using the numeric rating scale, and duration of return to daily activities was questioned on the 30th postoperative day. Results: Patients in the RFA group reported significantly less pain compared to patients in the HLS group with median numeric rating scale scores of 1.5 (0-4) versus 4 (2-5), respectively (p&lt;0.001). The RFA group returned to their daily routine significantly sooner compared to the HLS group (1 [1-1] versus 1.5 [1-4] days, respectively; p=0.004). Conclusion: Radiofrequency ablation is associated with significantly less postoperative pain and earlier return to daily activities compared to HLS in patients with symptomatic GSV insufficiency.

Content Validity of a Collaborative Goal-Setting Pictorial Tool for Children Who Wear Ankle-Foot Orthoses: A Modified Delphi Consensus Study

ABSTRACT Introduction To determine the optimum prescription and dosage for an ankle-foot orthosis and footwear, clinicians and families need to agree on goals for intervention. To facilitate family-centered collaborative goal setting, a table of potential goals and its pictorial representation had been developed previously. These tools incorporated the International Classification of Functioning, Disability, and Health (ICF) and International Organization for Standardization (ISO) clinical objectives for orthoses and were structured in an approach understandable to families. This study aimed to obtain consensus on the content validity of the Table and Pictorial Tools. Methods Seventeen experts from seven countries (orthotists, physical therapists, physicians, surgeons, and engineers) were invited. A modified Delphi technique was used to evaluate and refine the Table Tool (rounds 1 and 2) and Pictorial Tool (rounds 3 and 4). Participants rated their agreement with overall tool structure, content, and feasibility of use on a 4-point Likert scale, and provided open-ended feedback. Consensus was defined as a median score ≥3 (agree) with 75% of responses ≥3. Data were collected using REDCap. After each round, thematic analysis guided document revisions and anonymized feedback. Results Ten experts from four countries completed the study. Round 1 (Table Tool): median ratings were all 3; consensus was achieved for 3/5 questions. Round 2: full consensus was achieved. Round 3 (Pictorial Tool): median ratings were ≥3 for 10/11 questions; consensus was achieved for 4/11 questions. Round 4: full consensus was achieved. Conclusions The content validity for the Table and Pictorial Tools was established by modified Delphi consensus. These tools represent a comprehensive selection of goals across all ICF components. Clinical Relevance These novel tools have the potential to facilitate collaborative goal setting between families and clinicians and aid clinical education. A goal-setting framework specific to orthotic management may improve outcomes within the context of family-centered care.

Abstract P6-05-05: Patient-reported outcomes, perceptions, and knowledge about recurrence in women with high-risk hormone receptor-positive (HR+) breast cancer (BC)

Abstract Background: Over half of HR+ BC recurrences occur &amp;gt;5 years (y) from diagnosis (dx). While the risk of late recurrence is constant and extends for at least 20y, little is known about concerns, perceptions, knowledge, and interest in risk reduction in longer-term HR+ BC survivors. Methods: From 1/2021-1/2022, we prospectively identified patients (pts) at Dana-Farber Cancer Institute with a history of stage II/III, HR+/HER2- BC, ≥5y from dx, without recurrence. Pts were invited to participate in a study investigating circulating tumor DNA and risk of recurrence as well as a separate, 1-time survey that assessed physical/mental health (PROMIS), dx/treatment concerns (Brief Illness Perception Questionnaire), risk perceptions, knowledge, and interest in risk reduction. “Overestimation” was defined as estimating ≥20% risk based on the response to the question: “If 100 women with HR+ BC are treated according to recommended guidelines, about how many will have BC come back in the 5-10y following completion of active treatment.” Descriptive statistics included medians and proportions. Logistic regression identified factors associated with overestimation of 5-10y metastatic recurrence risk. Results: Among 166 women (of 209 sent surveys, 79%), median age at dx was 51 (range 21-76), 4% were Hispanic and/or Black; 19% did not have a college degree. Approximately 30% had stage III disease, most received chemotherapy (72%) and radiation (81%) and over half (57%) a mastectomy. Median time from dx was 10 y (range: 5-23). Almost all (97%) reported prior (44%) or current hormonal therapy (14% tamoxifen, 39% AI). Median PROMIS anxiety (53; range: 37-73), physical (51, range: 32-68), and mental (51, range: 25-68) scores were similar to population norms (score of 50). On a 0 (not at all)-10 (extremely) scale, the median rating for concern about dx/treatment was 5; for emotional impact of dx/treatment, the median rating was 9. Regarding risk perceptions, participants estimated that on average, a median of 15 and 10 women (of 100 women) would develop a loco-regional or distant recurrence, respectively, in the 5-10y interval; 43% and 40% estimated the risk of loco-regional and distant recurrence as ≥20%, respectively, for this interval. Pts without a college degree were more likely to overestimate 5-10y distant recurrence risk (multivariable OR: 3.66, 95% CI: 1.56, 8.59); age, chemotherapy receipt, surgery type, stage, and grade were not associated with overestimation. When asked, on average, which women have a higher chance of BC returning after 5y, 17% correctly responded HR+; 42% responded triple negative and 41% responded the risk was the same for both. While &amp;gt;1/3 responded they believed alcohol in moderation may decrease the risk of BC coming back, most also responded that having a healthy weight, eating ≥5 fruits/vegetables a day, and exercise may decrease this risk, with over half reporting engagement in these behaviors (Table). Conclusion: While most longer-term stage II/III HR+ BC survivors report mental and physical health commensurate to population norms, inaccurate knowledge and perceptions about recurrence are common. Strategies to effectively communicate risk (e.g., pictograms, decision/conversation aids) and risk reduction information can promote an accurate understanding of risk in the setting of longer-term HR+ BC survivorship, potentially mitigating emotional concerns which are prevalent ≥5y post-dx. The association between lower educational attainment underscores the importance of attention to literacy and numeracy when developing interventions to improve risk communication. Table. Perceived impact of health behaviors on recurrence risk. Citation Format: Shoshana Rosenberg, Yue Zheng, Katheryn Santos, Elizabeth Riley, Hugh Meadows, Craig Snow, Melissa E. Hughes, Elizabeth Frank, Nancy U. Lin, Ann Partridge, Eric Winer, Heather A. Parsons. Patient-reported outcomes, perceptions, and knowledge about recurrence in women with high-risk hormone receptor-positive (HR+) breast cancer (BC) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-05.

A cross-sectional analysis of Yelp and Google reviews of hospitals in the United States.

Patient satisfaction is now an important metric in emergency medicine, but the means by which satisfaction is assessed is evolving. We sought to examine hospital ratings on Google and Yelp as compared to those on Medicare's Care Compare (CC) and to determine if certain hospital characteristics are associated with crowdsourced ratings. We performed a cross-sectional analysis of hospital ratings on Google and Yelp as compared to those on CC using data collected between July 8 and August 2, 2021. For each hospital, we recorded the CC ratings, Yelp ratings, Google ratings, and each hospital's characteristics. Using multivariable linear regression, we assessed for associations between hospital characteristics and crowdsourced ratings. We calculated Spearman's correlation coefficients for CC ratings versus crowdsourced ratings. Among 3000 analyzed hospitals, the median hospital ratings on Yelp and Google were 2.5 stars (interquartile ratio [IQR], 2-3) and 3 stars (IQR, 2.7-3.5), respectively. The median number of Yelp and Google reviews per hospital was 13 and 150, respectively. The correlation coefficients for Yelp and Google ratings with CC's overall star ratings were 0.19 and 0.20, respectively. For Yelp and Google ratings with CC's patient survey ratings, correlation coefficients were 0.26 and 0.22, respectively. On multivariable analysis, critical access hospitals had 0.22 (95% confidence interval [CI], 0.14-0.30) more Google stars and hospitals in the West had 0.12 (95% CI, 0.05-0.18) more Google stars than references standard hospitals. Patientsuse Google more frequently than Yelp to review hospitals. Median UnS hospital ratings on Yelp and Google are 2.5 and 3 stars, respectively. Crowdsourced reviews weakly correlate with CC ratings. Critical access hospitals and hospitals in the West have higher crowdsourced ratings.

Can unsupervised cluster analysis identify patterns of complex adult spinal deformity with distinct perioperative outcomes?

The objective of this study was to use an unsupervised cluster approach to identify patterns of operative adult spinal deformity (ASD) and compare the perioperative outcomes of these groups. A multicenter data set included patients with complex surgical ASD, including those with severe deformities, significant surgical complexity, or advanced age who underwent a multilevel fusion. An unsupervised cluster analysis allowing for 10% outliers was used to identify different deformity patterns. The perioperative outcomes of these clusters were then compared using ANOVA, Kruskal-Wallis, and chi-square tests, with p values < 0.05 considered significant. Two hundred eighty-six patients were classified into four clusters of deformity patterns: hyper-thoracic kyphosis (hyper-TK), severe coronal, severe sagittal, and moderate sagittal. Hyper-TK patients had the lowest disability (mean Oswestry Disability Index [ODI] 32.9 ± 17.1) and pain scores (median numeric rating scale [NRS] back score 6, leg score 1). The severe coronal cluster had moderate functional impairment (mean physical component score 34.4 ± 12.3) and pain (median NRS back score 7, leg score 4) scores. The severe sagittal cluster had the highest levels of disability (mean ODI 49.3 ± 15.6) and low appearance scores (mean 2.3 ± 0.7). The moderate cluster (mean 68.8 ± 7.8 years) had the highest pain interference subscores on the Patient-Reported Outcomes Measurement Information System (mean 65.2 ± 5.8). Overall 30-day adverse events were equivalent among the four groups. Fusion to the pelvis was most common in the moderate sagittal (89.4%) and severe sagittal (97.5%) clusters. The severe coronal cluster had more osteotomies per case (median 11, IQR 6.5-14) and a higher rate of 30-day implant-related complications (5.5%). The severe sagittal and hyper-TK clusters had more three-column osteotomies (43% and 32.3%, respectively). Hyper-TK patients had shorter hospital stays. This cohort of patients with complex ASD surgeries contained four natural clusters of deformity, each with distinct perioperative outcomes.

Abstract 65: Cerebrovascular Reactivity Imaging Is Well Tolerated In Children With And Without Sickle Cell Disease

Background: Cerebrovascular reactivity (CVR) refers to a stimulus-induced change in blood flow, reflecting hemodynamic reserve. Carbon dioxide (CO 2 ) stimulus increases cerebral blood flow (CBF), and exogenous noninvasive CO 2 with concurrent MRI is an established CVR method in adults. However, children with and without sickle cell disease (SCD) have increased resting CBF compared to adults, and few studies have examined CVR in children. Our objective was to determine tolerability of CO 2 CVR MRI in children with and without SCD. Methods: Children undergoing CO 2 CVR MRI had post-scan assessments of their experience and comfort during CVR testing. This included a preference rating ranking 8 experiences, including CVR MRI, in order from most to least enjoyable, a 6-point comfort scale, and a yes/maybe/no question asking if they would do CVR MRI again. The 8 preference items were grouped into quartiles for analysis. The Wilcoxon test was used to compare comfort rating based on SCD status and quartile preference rankings. Spearman’s correlation was used to compare peak end-tidal CO 2 with comfort rating. Results: Nine children with SCD and 22 controls ages 8-21 years old completed CVR MRI, with a median peak end-tidal CO 2 of 50 mmHg [IQR 47, 51]. No child had a serious adverse event. On a 6-point scale, the median comfort rating was 4 (slightly uncomfortable) [IQR 2,4]. There was no difference in comfort based on SCD status (p=0.70) or peak end-tidal CO 2 (p=0.65). Across all participants, CVR fell in the 3rd preference quartile. CVR rated similarly to visiting the dentist (p=0.95), but was better than throwing up (p=0.03). Despite ranking the scan in the 3 rd quartile, the majority reported willingness to repeat CVR MRI, and only one participant (control) said they would not. Conclusion: Noninvasive CO 2 CVR imaging is safe and tolerable in children with and without SCD. After completing the session, most children would be willing to undergo similar testing again.

Physician preferences for revascularization in patients with ischemic cardiomyopathy: Defining equipoise from web-based surveys

BackgroundThe optimal revascularization approach in patients with heart failure with reduced ejection fraction (HFrEF) and ischemic heart disease (“ischemic cardiomyopathy”) is unknown. Physician preferences regarding clinical equipoise for mode of revascularization and their willingness to consider offering enrollment in a randomized trial to patients with ischemic cardiomyopathy have not been characterized. MethodsWe conducted two anonymous online surveys: 1) a clinical case scenario-based survey to assess willingness to offer clinical trial enrollment for a patient with ischemic cardiomyopathy (overall response rate to email invitation 0.45 %), and 2) a Delphi consensus-building survey to identify specific areas of clinical equipoise (overall response rate to email invitation 37 %). ResultsAmong 304 physicians responding to the clinical case scenario-based survey, the majority were willing to offer the opportunity for clinical trial enrollment to a prototypical patient with ischemic cardiomyopathy (92 %), and felt that a finding of non-inferiority for PCI vs. CABG would influence their clinical practice (78 %). Among 53 physicians responding to the Delphi consensus-building survey, the median appropriateness rating for CABG was significantly higher than that of PCI (p < 0.0001). In 17 scenarios (11.8 %), there was no difference in CABG or PCI appropriateness ratings, suggesting clinical equipoise in these settings. ConclusionsOur findings demonstrate willingness to consider offering enrollment in a randomized clinical trial and areas of clinical equipoise, two factors that support the feasibility of a randomized trial to compare clinical outcomes after revascularization with CABG vs. PCI in selected patients with ischemic cardiomyopathy, suitable coronary anatomy and co-morbidity profile.

Anterior thoracolumbar column reconstruction with the vertebral body stent—safety and efficacy

PurposeThe aim of this study was to assess safety and efficacy of vertebral body stenting (VBS) by analyzing (1) radiographic outcome, (2) clinical outcome, and (3) perioperative complications in patients with vertebral compression fractures treated with VBS at minimum 6-month follow-up.MethodsIn this retrospective cohort study, 78 patients (61 ± 14 [21–90] years; 67% female) who have received a vertebral body stent due to a traumatic, osteoporotic or metastatic thoracolumbar compression fracture at our hospital between 2012 and 2020 were included. Median follow-up was 0.9 years with a minimum follow-up of 6 months. Radiographic and clinical outcome was analyzed directly, 6 weeks, 12 weeks, 6 months postoperatively, and at last follow-up.ResultsAnterior vertebral body height of all patients improved significantly by mean 6.2 ± 4.8 mm directly postoperatively (p < 0.0001) and remained at 4.3 ± 5.1 mm at last follow-up compared to preoperatively (p < 0.0001). The fracture kyphosis angle of all patients improved significantly by mean 5.8 ± 6.9 degrees directly postoperatively (p < 0.0001) and remained at mean 4.9 ± 6.9 degrees at last follow-up compared to preoperatively (p < 0.0001). The segmental kyphosis angle of all patients improved significantly by mean 7.1 ± 7.6 degrees directly postoperatively (p < 0.0001) and remained at mean 2.8 ± 7.8 degrees at last follow-up compared to preoperatively (p = 0.03). Back pain was ameliorated from a preoperative median Numeric Rating Scale value of 6.5 to 3.0 directly postoperatively and further bettered to 1.0 six months postoperatively (p = 0.0001). Revision surgery was required in one patient after 0.4 years.ConclusionVertebral body stenting is a safe and effective treatment option for osteoporotic, traumatic and metastatic compression fractures.

Deep Learning for Fully Automated Radiographic Measurements of the Pelvis and Hip.

The morphometry of the hip and pelvis can be evaluated in native radiographs. Artificial-intelligence-assisted analyses provide objective, accurate, and reproducible results. This study investigates the performance of an artificial intelligence (AI)-based software using deep learning algorithms to measure radiological parameters that identify femoroacetabular impingement and hip dysplasia. Sixty-two radiographs (124 hips) were manually evaluated by three observers and fully automated analyses were performed by an AI-driven software (HIPPO™, ImageBiopsy Lab, Vienna, Austria). We compared the performance of the three human readers with the HIPPO™ using a Bayesian mixed model. For this purpose, we used the absolute deviation from the median ratings of all readers and HIPPO™. Our results indicate a high probability that the AI-driven software ranks better than at least one manual reader for the majority of outcome measures. Hence, fully automated analyses could provide reproducible results and facilitate identifying radiographic signs of hip disorders.