Differences in buprenorphine initiation and retention for opioid use disorder between primary care and substance use disorder specialty care settings.

The influence of lower limb kinematic characteristics in stroke patients on gait speed mediated by paretic side propulsive force.

Patients admitted to a skilled nursing facility (SNF) for short-term rehabilitation after hospitalization often feel unprepared to return home and may appeal discharge dates set by SNFs and/or insurers. There are additional concerns that Medicare Advantage (MA) insurers may be more aggressive about discharging patients earlier compared with traditional Medicare. Yet, little has been published on the characteristics of patients who appeal and their outcomes. Retrospective cohort study. Participants included patients admitted to a single SNF after hospitalization from March 1, 2024, to March 31, 2025, who filed discharge appeals. We collected information via chart reviews on patient demographics (eg, age, insurance coverage), comorbidities, function scores, and documented reasons for appeal. We also identified outcomes following appeal (eg, 30-day rehospitalization, death). Of 453 eligible SNF admissions, 47 (10.4%) patients filed 58 appeals [mean age 79.3 (SD = 10.6), 25 (53.2%) female, 9 (19.1%) Asian, 7 (14.9%) Black, 20 (42.6%) in traditional Medicare, 27 (57.4%) in MA]. Median (IQR) time from SNF admission to first appeal was 19.0 (15.0-30.5) days. Eleven patients (23.4%) won their appeals. The median (IQR) time from first appeal to discharge was 8 (7-13) and 4 (3-8) days among patients who won their appeals vs those who lost their final appeal, respectively. The 30-day rehospitalization and 30-day mortality rates among those who won their appeals were 0% (n = 0 of 11) and 18.2% (n = 2 of 11), respectively. Among those who lost their final appeal, rates were 27.8% (n = 10 of 36) and 0% (n = 0 of 36), respectively. The most common reason for appealing was patient and/or family/caregiver concern about discharge readiness (n = 28, 59.6%). In this single-SNF study, 10% of post-acute patients appealed their discharge, commonly citing concerns about discharge readiness, with most ultimately losing their final appeal. This study lays the groundwork for future research examining appeals processes and outcomes on a broader scale.

Postoperative pain after video-assisted thoracoscopic surgery affects 43%-99% of patients and is associated with prolonged hospital stay. Pre- and intraoperative risk factors can help identify patients at higher risk of postoperative pain. This study aimed to assess if quantitative sensory testing, psychological factors, and patient characteristics can predict postoperative pain. Patients undergoing elective video-assisted thoracoscopic surgery for confirmed or suspected lung cancer were included. Pain sensitivity was evaluated by quantitative sensory testing using cuff algometry, and psychological factors were assessed by the pain catastrophizing scale, and the hospital anxiety and depression scale. Clinical pain was assessed bidaily and summarized as time-weighted pain and opioid consumption was measured as cumulative dose, both within 48 h of surgery. Prediction models using pre- and intra-operative variables were established, and backward elimination was applied to identify independent predictors. Domain-specific models were constructed within five domains of predictors (i.e., quantitative sensory testing, psychological factors, demographics, perioperative, and tumour pathology). Subsequently, independent variables from the five domain-specific models were combined into a multifactorial model. Domain-specific models explained between 5.1%-12.8% of variance except the demographics model which explained 39.5% of opioid consumption. The multifactorial models for pain intensity and opioid consumption explained 20.3% and 40.4%, respectively. This study suggests that pre- and intra-operative factors contribute to the prediction of postoperative pain intensity and opioid consumption with varying precision. Demographic variables proved to be best and predicted 39.5% of postoperative opioid consumption. The multimodal models explained 20.3% of postoperative pain and 40.4% of postoperative opioid consumption. This assessment and analysis presents factors that are associated with how patients who have undergone video-assisted thoracosopic surgery as a group report post-operative pain. Both patient-specific factors and perioperative management details appear to contribute.

Association of denosumab treatment with survival and skeletal-related events in Asian men with mCRPC: A real-world observational study.

Nocturnal hypertension, especially with well-controlled daytime blood pressure (BP), has emerged as a significant risk factor for cardiovascular disease. This study investigated its prevalence by morning home BP cut-off values and examined associated patient characteristics using data from the Japan Morning Surge-Home Blood Pressure (J-HOP) study. This post hoc analysis included 2675 participants from the J-HOP study who had complete data on nighttime home BP, measured using validated automatic oscillometric devices. Nocturnal hypertension was defined as a nighttime systolic BP greater than or equal to 120 mmHg and diastolic BP greater than or equal to 70 mmHg. Among the participants, 60.5% had nocturnal hypertension. The proportion of patients with nocturnal hypertension decreased as the cut-off value for morning home BP was lowered: 40.5, 32.1, 23.7, and 14.6% for less than 135/85 mmHg, less than 130/80 mmHg, less than 125/75 mmHg, and less than 120/70 mmHg, respectively. The prevalence of nocturnal hypertension was significantly higher in individuals with diabetes compared with those without, at morning home BP thresholds of less than 135/85 mmHg (48.1 vs. 39.3%; P = 0.03) and less than 130/80 mmHg (41.0 vs. 30.6%; P = 0.01). Individuals taking diuretics had a significantly lower prevalence of nocturnal hypertension compared with those not taking diuretics, at a morning home BP threshold of less than 135/85 mmHg (35.3 vs. 42.9%; P = 0.01). A considerable number of patients continued to show nocturnal hypertension even at lower morning home BP thresholds. Diabetes may contribute to nocturnal hypertension despite well-controlled morning BP, while diuretic use may help prevent it.

To strategically optimize diagnostic capacity in a low-resource, rural hospital setting, we developed a systematic evaluation of diagnostic tool needs and associated costs. This local data-driven method, accounting for patient characteristics and disease prevalence, can be adapted to other contexts. A retrospective patient record analysis was conducted at San Miguel Hospital (SMH) in Sucumbíos, Ecuador, which provides outpatient and emergency care to inhabitants of the Ecuadorian and Colombian Amazon basin. Ethics approval was granted retrospectively by the Research Ethics Committee on Human Beings of the Universidad San Francisco de Quito.Data was retrieved from electronic medical records (EMRs) of the first 796 patients seen after hospital opening. For each of the 1975 diagnoses made, patient characteristics and the presence or absence of appropriate diagnostic tools were recorded. Unavailable tools were further evaluated for accessibility within the local context. Serving a population primarily of mixed and indigenous ethnicities, SMH confirmed 66% of diagnoses using existing resources, with potassium hydroxide (KOH) fungal microscopy, chikungunya and influenza rapid tests, and access to anatomical pathology identified as the diagnostic tools offering the highest return on investment. Data from SMH's EMRs suggest which diagnostic tools would offer the greatest return on investment through increased diagnostic confirmation. This evaluation tool supports improved health care delivery at SMH and, with adaptation, can be applied in comparable health care settings. N/A.

Patients in intensive care units (ICUs) are at an increased risk of healthcare-associated infections with Gram-negative bacteria (GNB), for which sinks in patient rooms are known reservoirs. We investigated the association between water-free care practices and the incidence of GNB detections in Dutch ICUs in non-outbreak settings. We performed a retrospective ecological study (2018-2022) using data from the Infectious diseases Surveillance Information System-Antibiotic Resistance (ISIS-AR), the National Intensive Care Evaluation registry and a questionnaire on water-free care. Detections (colonisation and infections) of seven bacteria groups (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter spp., all Enterobacterales, extended-spectrum beta-lactamase-producing Enterobacterales [ESBL-E] and carbapenemase-producing Enterobacterales) were analysed at ICU-year level. Incidence rate ratios (IRRs) were calculated for water-free vs. non-water-free ICUs, adjusted for ICU and patient characteristics. Data from 37 ICUs were analysed, 22 ICU-years in the water-free group and 131 in the non-water-free group. Water-free ICUs were larger, with more surgery admissions and mechanically ventilated patients. For all bacteria, adjusted IRRs were close to 1 with broad 95% confidence intervals (CIs), ranging from 0.82 (95% CI: 0.44-1.52) for ESBL-E to 1.39 (95% CI: 0.69-2.84) for Acinetobacter spp. Sensitivity analyses showed similar results. Although positive effects of water-free care on GNB detection rates have been described in single ICUs, these findings were not reflected in this Dutch multi-centre study. Possible explanations are low infection prevalence, high prevention standards, widespread usage of selective decontamination and insufficient power to detect small differences. Evidence for benefits of water-free care in non-outbreak settings remains limited, highlighting the importance of future research in different ICU settings.

Neoadjuvant immune checkpoint inhibition (Neo-ICI) in melanoma is an emerging therapeutic strategy that induces pathologic responses with significant prognostic implications for survival. Tumor burden in nonresectable melanoma has a major impact on immunotherapy efficacy, yet little is known on its impact in the Neo-ICI setting. We evaluated the association between tumor burden, measured by the sum of diameters (SoD), and pathological response in melanoma patients treated with Neo-ICI. A meta-analysis of published trials in resectable stage III/IV melanoma was conducted, extracting data on patient characteristics, treatment regimens, pathological response, and survival outcomes. A total of 451 patients were included in the meta-analysis. The pooled pathological complete response (pCR) rate was 47% (95% confidence interval: 35-58%; P < 0.001). Meta-regression demonstrated a significant association between SoD and pCR (moderator = -0.36; P = 0.032), with greater tumor burden associated with lower pCR rates. No significant association was observed between SoD and recurrence-free survival (RFS). This study identifies higher tumor burden as a potential risk factor for lower pathologic response rates to neoadjuvant therapy, underscoring the need to incorporate tumor burden into future clinical research and potentially clinical decision-making.

Determinants of morbidity and local control after cryoablation of sporadic extra-abdominal desmoid tumors.

Characteristics and short-term outcomes of patients with hematological malignancies admitted to Intensive care units: a retrospective cohort study using the Japanese Intensive care PAtient Database.

Neuroblastoma (NB) with central nervous system (CNS) metastases is rare at diagnosis, but occurs more often during relapse/progression. Patients with CNS metastases face a dismal prognosis, with no standardized curative treatment available. Novel therapeutic approaches, such as intraventricular radio-immunotherapy with 131I-omburtamab (Omb), have been developed. In this study, we report a retrospective, single-tertiary center analysis of a 23-year cohort of NB patients with CNS metastases, highlighting current treatment strategies. Retrospective data analysis of all NB patients with CNS metastases treated at Hospital Sant Joan de Déu, Barcelona, from January 2000 to January 2023. Patient characteristics at diagnosis, first-line treatment, relapse patterns, and CNS metastasis management were analyzed in search of risk variables and survival outcomes. CNS metastases at relapse were identified in 39/185 (21.1%) patients. Median age at diagnosis was 2.7years, and 24/39 were male. Stage 4 NB with multisite compartment metastases accounted for most cases (92.2%). CNS events occurred predominantly at first relapse (29/39, 74.4%) and with neurological symptoms (23/38, 60.5%). MCYN amplification and concomitant extra-CNS metastases at CNS relapse were associated with poorer overall survival (OS) (p = 0.018 and p = 0.0059, respectively). Neurological symptoms upon relapse significantly increased the risk for subsequent CNS events (p = 0.028). Curative-intent treatment was attempted in 34/39 (87.2%) patients. After adjusting for immortal time bias, RT plus Omb significantly improved OS (p<0.0001). In our experience, MYCN amplification and concomitant extra-CNS metastases at CNS relapse significantly decrease OS. Multimodal treatment, including 131I-omburtamab radioimmunotherapy, significantly improves survival outcomes.

Prostate cancer in Korea: Nationwide trends in prevalence and medication use during 2011-2021.

Outcomes of tisagenlecleucel versus allogeneic hematopoietic stem cell transplantation in relapsed or refractory large B-cell lymphoma.

Diagnostic labels used by health professionals for patellofemoral pain: A cross-sectional online survey.

Red blood cells are often overprepared for surgery, leading to waste and increased costs, despite the need for cross-matching tests. This study aimed to develop a model for predicting the number of red blood cell units required during cardiovascular surgery using patient characteristics. This retrospective study included patients who underwent cardiovascular surgery at our hospital from April 2022 to October 2022. Multiple regression analysis was performed using preoperative patient attributes and blood data, with red blood cell units used during surgery as the objective variable. Models were developed using patient demographics and blood data, with additional models incorporating specific surgical procedures to assess predictive accuracy. Model 1 included age, sex, weight, hematocrit, prothrombin time-international normalized ratio, serum creatinine, volume of preoperatively donated diluted autologous blood, and history of cardiovascular surgery. Model 2 included the same variables as Model 1, plus aortic aneurysm resection as a surgical procedure. The predictive equations of the study showed superior accuracy for both Model 1 and Model 2 compared to the conventional red blood cell units requested by physicians or those predicted using the surgical blood order equation based on correlation coefficients. Model 2 outperformed both Model 1 and conventional methods in predictive utility. This study developed a clinically useful formula for predicting the number of red blood cell units required during surgery based on preoperative patient-specific data, without restricting the analysis to specific procedures. This formula may improve blood product inventory management and reduce medical costs.

While antineutrophil cytoplasmic antibody (ANCA)-associated small-vessel vasculitis (AAV) is increasingly recognized, cases presenting with initial gastrointestinal symptoms remain underexplored. This study aimed to analyze the clinical characteristics of AAV patients with gastrointestinal onset. Seven AAV patients meeting ACR/EULAR criteria, who presented with gastrointestinal symptoms between January 2017 and 2024, were retrospectively identified. A literature review was conducted across multiple databases, including PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, and Wanfang. In total, 23 patients were included in the study. Among the 23 AAV patients with gastrointestinal symptoms, 15 (65.2%) were male, with a median age of 54 years (range: 18-79). Common clinical manifestations included hematochezia (56.5%), weight loss (43.5%), and purpura (34.8%). Eight (34.8%) had superficial gastritis, and seven (30.4%) had colonic ulcers, as identified by gastrointestinal endoscopy. Laboratory findings revealed elevated D-dimer levels and anemia in most patients, with impaired renal function and a median hemoglobin level of 105 g/L. Anti-PR3 immunoglobulin G (IgG) and antimyeloperoxidase IgG antibodies were positive in 83.3 and 80% of cases, respectively. Abdominal computed tomography (CT) revealed wall thickening in 39.1% of patients, and chest CT identified interstitial lung disease in 73.9% of patients. Nine patients (39.1%) were initially misdiagnosed, with five (55.6% of those nine) misdiagnosed as having inflammatory bowel disease. Most patients responded well to glucocorticoid and immunosuppressive therapy, with 39.1% receiving a combination of glucocorticoids and cyclophosphamide. Gastrointestinal symptoms in AAV are rare, and misdiagnosis remains a concern. Early detection requires assessing gastrointestinal, pulmonary, and renal involvement.

Introduction: Human adenoviral infections, though prevalent among children, are often under-reported. Although adenoviral infections are usually self-limiting, they can cause significant morbidity and hospitalisations in children. Aim: To evaluate the demographic, clinical, laboratory and radiological characteristics of paediatric patients hospitalised with Human Adenovirus (HAdV) infection. Materials and Methods: This was a hospital-based retrospective study conducted in the Paediatric Outpatient Department (OPD) and inpatient wards of Rainbow Children’s Hospital, Hyderabad, Telangana, India for a period of 11 months from February 2023 to December 2023. A total of 210 children aged one month to 16 years who tested positive for adenovirus by Polymerase Chain Reaction (PCR) on a nasopharyngeal swab were included in the study. The demographic, clinical, laboratory, and radiological profiles of these cases were analysed. The statistical analysis was performed using the IBM Statistical Package for Social Sciences (SPSS) software version 27.0 (Armonk, NY, USA). Results: Of the 210 children who tested positive for adenovirus, 126 (60%) were males and 129 (61.42%) were between one and five years of age. Notably, 141 children (67.14%) were hospitalised during the summer season. Most cases occurred during the summer months, predominantly among males aged 1-5 years. Symptoms included high-grade persistent fever in 205 cases (97.62%), cough and cold in 129 (61.42%), vomiting in 59 (28.1%) and loose stools in 27 (12.86%). Less frequent presentations were pneumonia in 12 cases (5.71%), seizures in 8 (3.81%), burning micturition in 5 (2.38%) and conjunctivitis in 4 (1.9%). Children were categorised into three groups: A, B and C- based on their clinical presentation as respiratory, gastrointestinal or mixed types, respectively. A significant difference in C-Reactive Protein (CRP) distribution was observed among the three groups (p-value &lt;0.0001). CRP positivity (&gt;10 mg/L) was most frequent in group A, 78/99 (78.8%), followed by group C 36/52 (69.2%), while group B showed a lower proportion 21/59 (35.6%). Group A children had significantly higher CRP levels and a longer duration of fever. Of the 210 cases, 195 children (92.86%) were treated with antibiotics. Conclusion: The HAdV infections present with high-grade fever and respiratory symptoms are their predominant manifestation. HAdV infections should be considered as a differential diagnosis in children with prolonged fever and multisystem involvement. In addition, gastrointestinal involvement was common. All children had favourable outcomes and were discharged without any complications. Early and accurate diagnosis of HAdV infection using rapid diagnostic tests prevents unnecessary antibiotic use and aids parental counselling and should be routinely employed.

Evaluate the feasibility of measuring plasma concentrations of 4 endothelial glycocalyx components and their correlation to patient and treatment characteristics in canine trauma patients. This was an observational study of dogs presenting to a university-based emergency department between August 2021 and March 2022 within 2 hours of traumatic injury and healthy, age-matched controls. We obtained EDTA plasma at arrival and 3, 6, and 24 hours later. Degree of injury was classified based on Animal Trauma Triage score (mild, 0 to 3; moderate, 4 to 6; and severe, ≥ 7). Data collected included signalment, modified Glasgow Coma Scale score, interventions, diagnostic results, and patient outcomes. Plasma concentrations of syndecan-1, hyaluronan, heparan sulfate, and vascular endothelial-cadherin (cadherin-5) were determined via ELISA. 19 canine trauma patients and 16 age-matched controls were enrolled. Hyaluronan was significantly lower at arrival versus 24 hours later and demonstrated a significant increase over all time points. There was a significant negative correlation between heparan sulfate and lactate. Vascular endothelial cadherin was significantly higher in penetrating trauma than blunt trauma at arrival and 6 hours later. Measurement of the 4 markers of endothelial glycocalyx damage in canine trauma patients was generally feasible, and further study may determine clinical application. This was the first evaluation of these glycocalyx biomarkers in canine trauma patients. Additional studies evaluating these and other glycocalyx biomarkers longitudinally are needed to determine the effect of injury and fluid resuscitation on the glycocalyx and outcome in canine trauma patients.

Same day discharge after minimally invasive interval debulking surgery in advanced stage ovarian cancer.