National Registry Data Research Articles

Prediction of Stroke-Associated Hospital-Acquired Pneumonia: Machine Learning Approach.

Stroke-associated Hospital Acquired Pneumonia (HAP) significantly impacts patient outcomes. This study explores the utility of machine learning models in predicting HAP in stroke patients, leveraging national registry data and SHapley Additive exPlanations (SHAP) analysis to identify key predictive factors. We collected data from a national stroke registry covering January 2014 to July 2022, including 9,840 patients diagnosed with ischemic and hemorrhagic strokes. Five machine learning models were trained and evaluated: XGBoost, Random Forest, Support Vector Machine (SVM), Logistic Regression, and Artificial Neural Network (ANN). Performance was assessed using accuracy, precision, recall, F1-score, AUC, log loss, and Brier score. SHAP analysis was conducted to interpret model outputs. The ANN model demonstrated superior performance, with an F1-score of 0.86 and an AUC of 0.94. SHAP analysis identified key predictors: stroke severity, admission location, Glasgow Coma score (GCS), systolic and diastolic blood pressure at admission, ethnicity, stroke type, mode of arrival, and age. Patients with higher stroke severity, dysphagia, and those arriving by ambulance were at increased risk for HAP. This study enhances our understanding of early predictive factors for HAP in stroke patients and underlines the potential of machine learning to improve clinical decision-making and personalized care.

Ontology-based integration and querying of heterogeneous rare disease data sources – POLVAS perspective

The integration of rare disease medical databases belonging to different countries is an important problem, as a large number of observations are required for reliable statistical inference of patient data in order to facilitate clinical research. Such integration of national registry data, which requires harmonisation of the heterogeneous data sets into a unified view, is facilitated in the European FAIRVASC project by developing a domain-specific ontology. The FAIRVASC project is dedicated to the rare disease of anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). This paper focuses on the practical issues and challenges, encountered during the process of integrating the Polish national database POLVAS into the federated database within the FAIRVASC project. It discusses the use of ontology-based methods for data integration and the importance of ensuring patient privacy and data protection. It addresses the problem of missing information in POLVAS, which can be obtained by aggregating other data available within the database, incompatibility of data types and formats, and mapping polish data names into the common vocabulary. The modifications of mappings used to ‘uplift’ national data into the Resource Description Framework (RDF) triplestore are also proposed. The described methods allow for integrating the Polish national database into the European network over which federated queries are performed.

Residential areas, travel burdens, and children with cancer: Analysis of mobility and mortality ratios using data from Japan's national population-based cancer registry

Objectives Although childhood cancer treatment has recently become centralized at specialized hospitals worldwide, the relationship between mortality ratios and living in rural areas or traveling long distances for treatment remains controversial. In the present study, we examined whether regional differences in patient mobility and mortality ratios exist in Japan.Methods We investigated 10,713 patients with cancer aged ≤18 years, diagnosed between 2016 and 2019, registered in the national cancer registry data. The patients were divided into two categories based on their residence at diagnosis: urban and rural. Urban areas were defined as metropolitan or urban areas according to the 2015 census or as prefectural cities; all other areas were defined as rural. Additionally, we divided the patients into two groups based on the one-way travel time to the treatment hospital (≤1 h or >1 h), as estimated from location information at the community level using route-planner web services. Next, we calculated the percentage of patients who received treatment within their residences in both areas and for each treatment type. We compared the percentage of distant metastasis in all cancers and each diagnosis group between the two areas using the chi-square test. We finally applied Cox proportional hazard models to obtain adjusted mortality hazard ratios for urban versus rural areas and travel times of ≤1 h versus >1 h.Results Overall, 77% of the patients were classified as urban residents. The percentages of patients receiving treatment within their residency, secondary medical care area, prefecture, and regional block levels were 22-46%, 80-87%, and 95-99%, respectively. Only central nervous system tumors (III) showed a significant difference in the percentage of distant metastases, which were more common in urban areas (6% vs. 3%). The adjusted mortality hazard ratios were not significantly different between urban and rural areas for all cancers or each diagnosis group. The travel time comparison yielded significant differences of 1.17 for all cancers and 2.57 for lymphomas (II).Conclusion Approximately 80% of the patients received treatment within their prefecture, although a few traveled long distances across regional blocks. We observed no differences in the mortality ratio between urban and rural areas, although significant differences were found in all cancers and one cancer in the travel burden comparison. These results highlight the need for continued evaluation of the increasing trend in patient travel burden and its impact on survival, as childhood cancer treatment has become centralized in Japan.

P1211 Factors Associated with the Optimization of Biological Therapy in Crohn's Disease and Ulcerative Colitis: Insights from the National GEDIIB Patient Registry in Brazil

Abstract Background Biological therapy has revolutionized the treatment of inflammatory bowel disease (IBD); however, a subset of patients still requires therapy optimization to achieve therapeutic goals. This study aimed to identify patients who underwent biological therapy optimization (TO) and compare their characteristics with those who did not require such adjustments. Methods A retrospective study was conducted using data from the national patient registry of GEDIIB (Brazilian Crohn's and Colitis Organization). A total of 1,660 patients with Crohn's disease (CD) and 530 patients with ulcerative colitis (UC) undergoing biological therapy were included. The need for TO was determined based on clinical or endoscopic criteria specific to each participating center. Statistical analyses included association tests and Poisson regression. Results The need for TO was more frequent among patients with CD(33.3%) compared to those with UC (26.2%) (p=0.003). In CD, optimization was associated with younger age (p=0.016), stenosing (p=0.03) or penetrating behavior (p=0.015), perianal disease (p<0.001), presence of fistula (p=0.019), and prior surgery (p=0.044). Table 1 displays the adjusted frequency ratio (FR) for TO in CD patients. After adjusting for confounding factors, the most significant predictors for optimization in CD were younger age, perianal disease, and prior surgery. In UC, optimization was associated with younger age (p=0.013), pancolitis extent (p<0.001), previous surgery (p=0.037), hospitalization (p=0.025), and chronic liver disease (p=0.024). Table 2 presents the adjusted FR for therapy optimization in UC patients. After adjustment, the factors most strongly associated with optimization in UC were prior surgery and chronic liver disease. Conclusion Approximately 30% of patients required optimization of biological therapy. This need was associated with younger age, a more severe disease profile, and the presence of complications, such as perianal disease in CD, as well as a history of surgery and hospitalization in UC. References Papamichael K, Cheifetz AS, Melmed GY, Irving PM, Vande Casteele N, Kozuch PL, Raffals LE, Baidoo L, Bressler B, Devlin SM, Jones J, Kaplan GG, Sparrow MP, Velayos FS, Ullman T, Siegel CA. Appropriate Therapeutic Drug Monitoring of Biologic Agents for Patients With Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol. 2019 Aug;17(9):1655-1668.e3. doi: 10.1016/j.cgh.2019.03.037. Fróes RSB, Andrade AR, Faria MAG, de Souza HSP, Parra RS, Zaltman C, Dos Santos CHM, Bafutto M, Quaresma AB, Santana GO, Luporini RL, de Lima Junior SF, Miszputen SJ, de Souza MM, Herrerias GSP, Junior RLK, do Nascimento CR, Féres O, de Barros JR, Sassaki LY, Saad-Hossne R. Clinical factors associated with severity in patients with inflammatory bowel disease in Brazil based on 2-year national registry data from GEDIIB. Sci Rep. 2024 Feb 21;14(1):4314. doi: 10.1038/s41598-024-54332-1.

Disability Benefit and Gambling Disorder: A Longitudinal Study Based on National Registry Data.

Rates of gambling disorder (GD) have been found to be higher among people receiving disability benefit, but few studies have investigated whether receiving disability benefit prospectively actually increases the risk of GD. The present study investigated whether those with a disability benefit had an increased risk of developing GD using a case-control design. The study sample was retrieved from the Norwegian Patient Registry (NPR, N = 5,131) and consisted of all adults in Norway (18 years and older) who had received a GD diagnosis (F63.0 according to ICD-10) between 2008 and 2018. The study group was age and sex matched with a random sample from the (1) general population (FD-trygd, n = 30,164), and (2) and individuals with other somatic or psychiatric illnesses (NPR, n = 30,476). The results of logistic regression analysis showed that people receiving disability benefit had higher odds of later being diagnosed with GD compared to the general population (odds ratio [OR] = 2.27, 95% CI [2.02, 2.54]), and compared to individuals in the NPR (OR = 2.13, 95% CI [1.90, 2.38]). Recipients of disability benefit constitute a group who is vulnerable in terms of developing GD. Although the present study found evidence for a prospective association, causality could not be established. The study identified a cohort that may benefit from targeted prevention and intervention strategies regarding gambling behavior.

Subacute thyroiditis - Is it really linked to viral infection? Retrospective hospital patient registry study.

Subacute thyroiditis (SAT) is a painful inflammatory disorder of the thyroid gland, which - after a phase of thyrotoxicosis - leads to transient, or less frequently permanent hypothyroidism. Apart from a strong association with specific HLA alleles, the causes are uncertain. Viral disease has been hypothesised as a trigger, with Enteroviruses, namely Echoviruses and Coxsackieviruses, showing a seasonal distribution that coincides with the incidence of SAT. In the first year of the COVID-19 pandemic, strict hygiene measures led to a sharp decline in infections and thus offered the opportunity to test this hypothesis. We analysed national registry data of hospitalised patients from Germany during the years 2015 to 2022 (Federal statistical Office (Destatis), Wiesbaden, Germany) and surveillance data on infectious diseases from the same years (clinical-virology.net and RKI). Statistical analysis includes modelling of seasonality by month, polynomial autoregression and Granger causality to assess dependency of future SAT frequencies from past ones, and association of virus incidence to SAT frequency, respectively. Our study confirms previously described epidemiological findings with higher incidence in females and a seasonal peak in late summer coinciding with the seasonality of enteroviruses until 2019. In 2020, the pattern remained unchanged, except for the marked reduction of enteroviruses and other pathogens (except SARS-CoV-2) due to hygienic measures. Moreover, the SAT seasonality in the years 2021 and 2022 was apparently unaltered through the COVID-19 pandemic. Our study provides strong evidence that despite their seasonal pattern, Echoviruses and Coxsackieviruses are not the cause of SAT. Moreover, no other analysed virus (including Influenza A and B, Parainfluenza, Rhinovirus, Human Coronaviruses including SARS-CoV-2) showed any association.

Place of death and healthcare utilisation at the end of life among individuals with mental and behavioural disorders as underlying cause of death: population-level multiple-register study.

Understanding the place of death for individuals with mental and behavioural disorders (MBDs) is essential for identifying disparities in healthcare access and outcomes, as well as addressing broader health inequities within this population. To examine the place of death among individuals in Sweden with the underlying cause of death reported as a MBD and compare variations between diagnostic groups, as well as explore associations between place of death and individual, sociodemographic and clinical factors. This population-level analysis used death certificate data (gender, age, underlying cause of death and place of death) recorded between 2013 and 2019 and other national register data. MBD group differences were compared using chi-square tests (χ2) and multinominal logistic regressions explored variations in place of death. The final sample consisted of 2875 individuals. Our regression model revealed that individuals with MBDs other than intellectual disabilities were less likely to die in hospitals (odds ratio 0.60-0.134 [95% CI = 0.014-0.651]) or care homes (odds ratio 0.11-0.97 [95% CI = 0.003-0.355]) than at home. Substance use disorders were the most common underlying cause of death (61.3%). This group consisted predominantly of men (78.8%, χ2, P < 0.001), and tended to be younger (χ2, P < 0.001). Individuals with intellectual and developmental disabilities are more likely to die in hospitals or care homes than at home. Those with MBDs, particularly substance use disorders, face a high risk of premature death, highlighting gaps in healthcare and palliative care provision for these populations.

Increase in Occurrence of Attention Deficit Hyperactivity Disorder Differs by Age Group and Gender-Finnish Nationwide Register Study.

This study describes epidemiology of attention deficit hyperactivity disorder (ADHD) and use of ADHD medication across all age groups in Finland. This retrospective study is based on nationwide registers in Finland. The study population included individuals with ADHD diagnosis and/or an ADHD medication record at least once during 2015-2020. The yearly prevalence of ADHD was higher in males than in females and was highest in the age groups of 6- to 12- and 13- to 17-year-old males. In 2020, the yearly prevalence was 4.2% in ≤12-year-old, 6.7% in 13- to 17-year-old, 0.7% in ≥18-year-old males, and 1.1%, 2.6%, and 0.6%, respectively, in females. The gender-related differences were greatest among 6- to 12- and 13- to 17-year-olds, after which the differences evened out. During the study period from 2015 to 2020, the yearly prevalence more than doubled in each of the five Finnish administrative university hospital areas. The prevalence was higher in males, but the relative growth was higher in females compared to males. The incidence per 100,000 inhabitants was the highest in ≤12-year-old males and increased in all age groups and in both genders. The use of medication was more common in males than in females, and the overall proportion of prevalent ADHD patients on medication remained around 80%. Decrease in medication use was observed in connection with the transition from adolescence to adulthood, in both genders. Both prevalence and incidence of ADHD more than doubled in Finland during the study period 2015-2020. This study presents the most comprehensive analysis of national register data at personal-level linkage in Finland, since it included all age groups, and both diagnosed ADHD patients and individuals receiving medication, not limited to reimbursed medication.

Predictors of treatment delay among drug resistant tuberculosis patients in Uganda

BackgroundDrug resistant tuberculosis (DR-TB) continues to be a significant global public health concern despite the availability of effective TB medicines. Equally, delayed DR-TB treatment initiation is associated with increased morbidity, amplified resistance, transmission risk and poor treatment outcomes. This study aimed to investigate treatment delays and identify predictors of delayed treatment initiation among DR-TB patients in Uganda.MethodA retrospective study was conducted using routine DR-TB national case registration data between January 2012 and December 2019. Stata version 15 was used to run uni-variate analysis to describe patient characteristics using frequencies and percentages; bivariate analysis to identify significant differences in median times to treatment initiation; and logistic regression model was fitted, and adjusted odds ratio (AOR) with 95% confidence interval was used to identify factors associated with DR-TB treatment delay.ResultsA total of 2,166 DR-TB patients were included in this study. The median treatment initiation delay was 10 days. Approximately 57% of DR-TB patients experienced delays in starting their treatment beyond the acceptable 7-day timeframe. Being diagnosed as RR-TB [AOR = 1.22; 95% CI: 1.08–1.37], and being a recurrent TB patient [AOR = 1.22; 95% CI: 1.01–1.47] were associated with treatment delays. Patients with previous history of ‘lost to follow-up’ (LTFU), failure and being diagnosed as Pre-XDR-TB were less inclined to delay DR-TB treatment.ConclusionSeveral DR-TB patients experienced treatment delay. The delay was significant among patients diagnosed as RR-TB and those with TB treatment history of recurrent TB. This highlights the need for heightened vigilance among healthcare workers when managing DR-TB patients with a history of past TB treatment and those diagnosed as RR-TB to minimize delays. Furthermore, future research should investigate a comprehensive list of variables influencing the timing of treatment initiation after diagnosis. An in-depth understanding of the effects of these factors can inform targeted interventions to optimize treatment strategies for improved DR-TB patient outcomes.

Prevalence of gastric cancer following colorectal endoscopic submucosal dissection for lesions more than 20 mm: A retrospective analysis.

Colorectal endoscopic submucosal dissection (ESD) for large tumors is spreading worldwide. Gastric cancer (GC) sometimes occurs after colorectal ESD. However, its status including frequency and risk factors have not been examined well. In this study, we analyzed the detailed status of GC after colorectal ESD. This was a single-center retrospective study. Patients receiving colorectal ESD between 2010 and 2018 were reviewed. All patients were recommended to receive esophagogastroduodenoscopy (EGD) for screening. Finally, 436 patients receiving EGD, who underwent colorectal ESD for lesions of ≥20 mm were analyzed. The primary outcome was the GC rate after colorectal ESD, including intramucosal cancer. As a control, we compared it to the GC rate in matched Japanese national cancer registry data. The secondary outcome was risk factors for developing GC. The mean age was 66.9 ± 10.6 and 55.3% were males. The GC rate was 5.96% (26/436) with a median observation period of 27 months. It was significantly higher than the mean GC rate in the diagnosed age calculated with the cancer registry (0.26%, observed value/expected value ratio [95% confidence interval]: 22.20 [14.50-32.53], p < 0.01). The comparison between cases with and without GC showed that significant risk factors were male (p = 0.02) and smokers (p < 0.01) and their GC rates were 8.3% and 10.9%. Also, in the limited cases, Helicobacter pylori infection (past and present) and atrophic gastritis were significant and their GC rates were 11.1% and 11.6%. The GC rate was high after resecting colorectal tumors of ≥20 mm, suggesting the necessity of EGD.

Using National IVF Registries to Validate Clinical Outcomes Following IVF Covered by Health Insurance.

To evaluate in vitro fertilization (IVF) cycles covered by health insurance using a national commercial claims database and to validate key clinical events against national IVF registries. Retrospective cohort study SUBJECTS: US women aged 20-44 who underwent IVF from 2005 to 2020 in Optum's de-identified Clinformatics® Data Mart Database (CDM). Undergoing IVF MAIN OUTCOME MEASURES: IVF cycles and rates of pregnancies (inclusive of losses and terminations), live births, and live birth types (e.g., singleton, twin, and triplet or higher order). We identified more than 3,000 IVF cycles in each year from 2005 to 2020 within CDM. When comparing our rates of clinical outcomes to external benchmark data, the results were similar across all the years of our study. For example, in 2020 the percentage of pregnancies after first embryo transfer was 62.03% (95% CI: 59.48-64.47) in CDM and 64.96% in data from the Society for Assisted Reproductive Technology (SART). The rate of live birth after first embryo transfer was 44.58% (95% CI: 41.90-47.21) in CDM in 2020 and 46.95% in SART in 2020. The rate of singleton births was 94.17% (95% CI: 92.24-96.10) in CDM in 2020; and this rate was 94.37% in SART in 2020. For twin births, the rate was 5.48% (95% CI: 3.60-7.35) in CDM in 2020 and 5.46% in SART in 2020. The rate of triplet or higher order births was 0.35% (95% CI: 0.00-0.84) in CDM in 2020 and 0.17% in SART in 2020. We found CDM can be used to accurately identify IVF cycles covered by insurance and key clinical outcomes such as rates of pregnancies, live births, and live birth types, and our reported rates were similar to national IVF clinical registry data. Our findings support that CDM is a robust data source to conduct research about IVF insurance coverage and can accurately evaluate clinical outcomes resulting from IVF. Policymakers who are considering insurance coverage for IVF can use CDM to model and measure the impact of new or existing policies for IVF insurance coverage.

Underlying disease risk among patients with fatigue: a population-based cohort study in primary care.

Presenting to primary care with fatigue is associated with a wide range of conditions, including cancer, although their relative likelihood is unknown. To quantify associations between new-onset fatigue presentation and subsequent diagnosis of various diseases, including cancer. A cohort study of patients presenting in English primary care with new-onset fatigue during 2007-2017 (the fatigue group) compared with patients who presented without fatigue (the non-fatigue group), using Clinical Practice Research Datalink data linked to hospital episodes and national cancer registration data. The excess short-term incidence of 237 diseases in patients who presented with fatigue compared with those who did not present with fatigue is described. Disease-specific 12-month risk by sex was modelled and the age-adjusted risk calculated. The study included 304 914 people in the fatigue group and 423 671 in the non-fatigue group. In total, 127 of 237 diseases studied were more common in men who presented with fatigue than in men who did not, and 151 were more common in women who presented with fatigue. Diseases that were most strongly associated with fatigue included: depression; respiratory tract infections; insomnia and sleep disturbances; and hypo/hyperthyroidism (women only). By age 80 years, cancer was the third most common disease and had the fourth highest absolute excess risk in men who presented with fatigue (fatigue group: 7.01%, 95% confidence interval [CI] = 6.54 to 7.51; non-fatigue group: 3.36%, 95% CI = 3.08 to 3.67; absolute excess risk 3.65%). In women, cancer remained relatively infrequent; by age 80 years it had the thirteenth highest excess risk in patients who presented with fatigue. This study ranked the likelihood of possible diagnoses in patients who presented with fatigue, to inform diagnostic guidelines and doctors' decisions. Age-specific findings support recommendations to prioritise cancer investigation in older men (aged ≥70 years) with fatigue, but not in women at any age, based solely on the presence of fatigue.

Module Creation Within the TOPS Registry: An Opportunity for Longitudinal Collection of Procedure-specific Clinical Outcomes.

The Tracking Operations and Outcomes for Plastic Surgeons (TOPS) data registry, first launched in 2002 by the American Society of Plastic Surgeons (ASPS) in collaboration with the Plastic Surgery Foundation (PSF), was designed to avoid the perceived shortcomings of other national data registries as they pertain to interests of the plastic surgery community. Given the diversity of plastic surgery practice, the ASPS and PSF sought to ensure that the TOPS registry platform would support detailed collection of data useful to plastic surgeons practicing in all subspecialties. Therefore, a key design element of the TOPS registry is its ability to incorporate custom-made modules that allow for focused collection of topic/procedure-specific information. Although the TOPS database has collected information on more than 1.6 million plastic surgery procedures and outcomes since its inception more than 20 years ago, only a handful of custom modules have been created. This article outlines the senior author's experience collaborating with the ASPS and PSF to successfully develop and implement a custom module within the TOPS registry. This information serves to promote further awareness, usage, and creation of TOPS modules, as these modules enable assessment of complex clinical conditions by leveraging data collection efforts through the single largest national plastic surgery organization.

Utilization, Workflow, and Outcomes of Endovascular Thrombectomy in Patients With vs Without Premorbid Disability in a National Registry.

Given the paucity of high-quality safety/efficacy data on acute stroke therapies in patients with premorbid disability, they risk being routinely excluded from such therapies. We examined utilization of endovascular thrombectomy (EVT), associated workflow, and poststroke outcomes among patients with vs without premorbid disability. We used national registry data on thrombolysis/EVT for the Czech Republic from 1 January 2016 to 31 December 2020. Premorbid disability was defined as prestroke modified Rankin Scale score (mRS) ≥3. We compared proportions of patients with vs without premorbid disability who received EVT and examined workflow times. We compared ΔmRS-change in mRS from prestroke to 3 months-in patients with vs without premorbid disability, in addition to intracerebral hemorrhage (ICH), mortality, and discharge NIHSS (National Institutes of Health Stroke Scale score), adjusting for age, sex, baseline NIHSS, and comorbidities, and verified using propensity score weighting (PSW) and matching for differences in treatment assignment. We stratified by age group (<65, 65-74, 75-84, ≥85 years) to explore outcome heterogeneity with vs without premorbid disability. Among 22,405 patients with ischemic stroke who received thrombolysis/EVT/both, 1,712 (7.6%) had prestroke mRS ≥ 3. Patients with prestroke disability were less likely to receive EVT vs those without (10.1% vs 20.7%, aOR: 0.30, 95% CI 0.24-0.36). When treated, they had longer door-to-arterial puncture times (median: 75 minutes, IQR: 58-100 vs 54, IQR: 27-77, adjusted difference: 12.5, 95% CI 2.68-22.3). Patients with prestroke disability receiving thrombolysis/EVT/both had worse ΔmRS (adjusted rate ratio, aIRR on PSW: 1.57, 95% CI 1.43-1.72), rates of 3-month mRS 5-6, discharge NIHSS, and mortality (aOR-PSW [mortality]: 2.54, 95% CI 1.92-3.34), while ICH did not significantly differ. 32.1% of patients with prestroke disability receiving thrombolysis/EVT/both successfully returned to prestroke state, but this proportion ranged from 19.6% for those older than 85 years to 66.0% for those younger than 65 years. Regardless of premorbid disability, EVT was associated with better outcomes including lower ΔmRS (aIRR-PSW: 0.87, 95% CI 0.83-0.91) and mortality, with no interaction of treatment effect by premorbid disability status (e.g., mortality pinteraction = 0.73). EVT recipients with premorbid disability did not differ significantly for several outcomes including ΔmRS (aIRR: 0.99, 95% CI 0.84-1.17) but were more likely to have 3-month mRS 5-6 (70.1% vs 39.5% without premorbid disability, aOR: 1.85, 95% CI 1.12-3.04). Patients with premorbid disability were less likely to receive EVT, had slower treatment times, and had worse outcomes compared with patients without premorbid disability. However, regardless of premorbid disability, patients fared better with EVT vs medical management and one-third with prestroke disability returned to their prestroke status.

Early Patient-Reported Outcome Measures Following Computer Navigated Total Hip Arthroplasty: A Study From the Australian Orthopaedic Association National Joint Replacement Registry.

Total hip arthroplasty (THA) is a well-established treatment for symptomatic hip osteoarthritis (OA). The use of computer navigation in THA aims to achieve the reconstruction of the joint more consistently and precisely. The aim of this study was to contrast patient-reported outcome measures (PROMs) for THA procedures with and without commercially available navigation technologies. Postoperative PROMs for primary THA procedures performed for OA between August 2018 and December 2022 and recorded in the Australian Orthopaedic Association National Joint Replacement Registry were analyzed. Procedures using computer navigation were compared to those using conventional instrumentation. Baseline patient characteristics and surgeon volume were subanalyzed. Multivariable regressions were used to compare postoperative PROMs. There were 13,400 THA procedures for OA with PROMs recorded and 749 with navigation. The mean (SD) EuroQol-visual analog scales (EQ-VASs) scores for navigated cases were 67.3 (19.3) preoperatively and 81.7 (15.0) postoperatively, compared with 66.0 (20.3) and 80.5 (15.8) for the non-navigated group. Oxford Hip scores and patient-reported change were similar between groups. The change from preoperative to postoperative EQ-VAS and Oxford Hip score did not significantly differ between computer-navigated and non-navigated cases. After adjusting for patient and procedure factors, the use of computer navigation was associated with a higher rate of procedure satisfaction (rate ratio 1.03, 95% confidence interval 1.01 to 1.06, P= 0.02). While procedural satisfaction was marginally higher following navigated THA (P= 0.02), there were no statistically significant differences in the change in EQ-VAS or when comparing navigated with "non-navigated" approaches for primary THAs. Based on the reviewed national registry data for PROMS, we were unable to demonstrate clinically relevant evidence to support claims of superiority of non-navigated or navigated primary THAs. Further work, including similar comparisons with long-term follow-up, will be of value in elucidating if a true clinically relevant difference exists.

Change in Cardiorespiratory Fitness and the Risk of Colorectal and Prostate Cancer Incidence in Men.

The aim of this prospective cohort study was to investigate the associations between changes in cardiorespiratory fitness (CRF) and the risk of colorectal and prostate cancer in men. Data from men who completed a health assessment both in military conscription in youth and an occupational health profile assessment (HPA) later in life were used. CRF was assessed as estimated V̇O2max, using a cycle ergometer fitness test at both time points. We linked the assessment data to national register data on colorectal and prostate cancer incidence, and hazard ratios and confidence intervals were estimated using Cox proportional hazard regression. 139,764 men with a mean age of 18 (SD 0.6) at conscription and 43 (SD 8.9) at HPA were included. The average time between the two assessments was 25.9 (SD 9.0) years and mean follow-up time following HPA test was 10.0 (SD 5.6) years for prostate and colorectal cancer. Annual percentage change in relative and absolute V̇O2max from conscription to HPA was inversely associated with the risk of colorectal cancer incidence, hazard ratio of 0.83 (95% CI [0.72-0.94]) and 0.88 (95% CI [0.79-0.99]), respectively. These associations were driven by data from individuals in the lowest and moderate level fitness tertials at conscription. Change in CRF was not associated with prostate cancer incidence risk. Changes in, not only level of, CRF from youth to adulthood are related to colorectal cancer incidence risk and therefore, improving CRF should be considered as an important colorectal cancer risk reduction strategy.

Healthcare Utilisation in Danish Primary Care Among Patients With Low Back or Neck/Thoracic Spine Pain Before and After Assessment in Secondary Care.

To describe characteristics and primary healthcare utilisation in Danish patients with low back pain (LBP) or neck/thoracic spine pain (NTP) 8years before and 2years after assessment in secondary care. In this cohort study, we included patients aged ≥ 18 who were assessed at an outpatient spine clinic from 2013 to 2021 and linked self-reported information with national registry data. We calculated the prevalence of all-cause healthcare utilisation in primary care. Then, we determined changes in the number of consultations from before to after assessment in secondary care using generalised estimating equations. We included 56,949 LBP patients and 18,926 NTP patients. The baseline characteristics were similar overall. For both LBP and NTP, all-cause healthcare utilisation increased slightly over time, with a substantial increase in the quarter before the secondary care assessment and a decrease after. Before the assessment, almost all patients consulted general practitioners (95%), while some consulted physiotherapists or chiropractors (60%). Overall, consultations decreased by 19% and 17% for patients with LBP and NTP from 12 to 1month before to 1-12months after the assessment. In contrast, 13-24months after assessment, we found a slight increase in consultations in both groups compared to the same period before. Patients with LBP and NTP were similar and used similar primary healthcare, which slightly increased over the 10 years. As physiotherapists and chiropractors are first-line providers of guideline-recommended spine pain treatment, the finding that 40% did not consult these professions the year before the secondary care assessment indicates that not all patients receive recommended care before referral.

Post-Marketing Safety of Ustekinumab Based on 14-Year Follow-Up in Danish National Patient Data.

Psoriasis (PsO), a chronic inflammatory skin disorder affecting a substantial proportion of populations globally, often necessitates systemic treatment including biologics. This 14-year cohort study, based on Danish national register data, aimed to investigate the enduring safety profile of ustekinumab compared to other systemic psoriasis treatments. Using comprehensive Danish national register data, this study scrutinized patients diagnosed with psoriasis or psoriatic arthritis (PsA) who received ustekinumab. The treatment group comparators were non-biological systemic treatment (non-biologic), tumor necrosis factor α inhibitor medicine groups (TNF-α), interleukin (IL)-17 inhibitors (IL-17), and IL-23 inhibitors (IL-23). The study periods for comparisons were 2009-2022 for non-biologic and TNF-α, 2015-2022 for IL-17, and 2018-2022 for IL-23. Outcomes were malignancies, cardiovascular events, serious infections, and serious hypersensitivity reactions. Cox proportional hazards regression models were employed to analyze two estimands: a standard intention-to-treat (ITT) estimand and a continuous-index-treatment (CIT) estimand, which considered switch and re-initiation of treatments within individuals. Users of ustekinumab were found to be younger on average, with an average age of 45.1 years compared to 51.6, 47.2, 49.0, and 48.4 years in the non-biologic, TNF-α, IL-17, and IL-23 groups, respectively. Also, 57.3% of the ustekinumab users were male, compared to 46.7%, 48.9%, 50.9%, and 58.3% for the non-biologic, TNF-α, IL-17, and IL-23 groups, respectively. Although the hazard ratio estimates varied across comparators, ustekinumab was found to be safe: regardless of PsA status, no discernible safety signals in terms of malignancy, MACE, severe infections, or severe hypersensitivity reactions were observed for ustekinumab when compared to the treatment comparators. The present study corroborated the enduring safety of ustekinumab in the context of PsO treatment.

Utilisation patterns of radiotherapy among older patients: Insights from Portuguese National Cancer Registry data

IntroductionRadiation therapy (RT) will be required by millions of those aged 70 or older by 2040 based on European growth in cancer incidence among this age group. PurposeThis study evaluates the use of external radiotherapy (EBRT) using data from the Portuguese National Cancer Registry (RON), analysing various cancer locations and age groups. A comparative analysis was conducted between actual EBRT utilization and comorbidity-adjusted optimal rates. MethodsBased on RON’s data, cancer diagnoses from January to June 2018 were analysed. Optimal Utilization Proportions (OUP) of EBRT were obtained from European SocieTy for Radiotherapy and Oncology (ESTRO), Health Economics in Radiation Oncology (HERO) project. Actual utilization percentages (AUP) were calculated using national cancer registry data, and a comparative analysis adjusting for comorbidities was conducted. ResultsFor most cancer locations and age groups, the actual EBRT utilisation fell below the ESTRO-HERO recommendations, with potential untreated patients estimated at 22 % of all new cancer cases across all age groups. Disparities were observed for older patients, such as breast cancer EBRT actual utilisation declining from 68 % to 25 % for patients aged under 70 and 85 or older, respectively. Also, cervix cancer patients aged 75 or older exhibited nearly 100 % optimal EBRT utilisation. Conversely, older patients with bladder and colon cancer had significantly lower RT actual utilisation rates. Comorbidity-adjusted EBRT utilisation rates for lung, rectal, cervix, and breast cancers in patients aged 70–79 did not reached ESTRO-HERO task force recommended rates. The actual EBRT usage in Portugal failed to meet the comorbidity-adjusted optimal utilisation rate for all cancer locations and age groups. Nevertheless, Portuguese actual EBRT for rectal and prostate cancer, exceeded the actual rates in Australian cohort. ConclusionWhile EBRT is essential for older adults with cancer, disparities and suboptimal utilization highlight opportunities for improving cancer care provision.

National Burden and Epidemiological Features of Mass Casualty Incidents in Spain, from 2014 to 2022.

Mass Casualty Incidents (MCIs) pose significant challenges to health care systems, especially regarding emergency preparedness and response. This study aims to analyze the epidemiological characteristics and burden of MCIs in Spain from 2014 to 2022, focusing on the type, frequency, and impact of these incidents on public health and emergency services. A population-based retrospective observational study examined MCIs in Spain between January 2014 and December 2022. Data were collected from various emergency services. Incidents involving 4 or more victims requiring medical assistance and ambulance mobilization were included. The study categorized MCIs into 5 types: road traffic accidents, fires and explosions, chemical poisonings, maritime accidents, and others. A total of 1618 MCIs resulting in 8556 victims were identified, averaging 15 (95% CI, 11-19) incidents per month, with 79% due to road traffic accidents and 13% to fires and explosions, which also had the highest average of 7.6 victims per incident. Despite maritime accidents comprising only 1.9% of incidents, they had the highest fatality rate. MCIs were more frequent on weekends, in January and July, and between 3:00 PM and 9:00 PM. The average response time was 38 minutes, with 35% of victims sustaining severe injuries. Despite a slight decrease in annual MCIs from 2014 to 2022 in Spain, the trend is not statistically significant. The study highlights the need for a national registry and standardized data collection to enhance emergency preparedness and response planning and facilitate the reduction of the MCI burden.