Patient-level Characteristics Research Articles

The Relationship Between an Individual's Birthday and Admission for Traumatic Injury.

Birthdays provide an opportunity to celebrate; however, they can also be associated with various adverse medical events. This is the first study to examine the association between birthdays and in-hospital trauma team evaluation. This retrospective study analyzed trauma registry patients 19-89years of age, who were evaluated by in-hospital trauma services from 1/1/2011 to 12/31/2021. 14,796 patients were analyzed and an association between trauma evaluation and birthdays was found. The strongest incidence rate ratios (IRRs) were on the day of birth (IRR: 1.78; P < .001) followed by ±3days of the birthday (IRR: 1.21; P = .003). When incidence was analyzed by age groups, 19-36years of age had the strongest IRR (2.30; P < .001) on their birthday, followed by the >65 groups (IRR: 1.34; P = .008) within ±3days. Non-significant associations were seen in the 37-55 (IRR: 1.41; P = .209) and 56-65 groups (IRR: 1.60; P = .172) on their birthday. Patient-level characteristics were only significant for the presence of ethanol at trauma evaluation (risk ratio: 1.83; P = .017). Birthdays and trauma evaluations were found to have a group-dependent association, with the greatest incidence for the youngest age group being on their birthday, and the oldest age group within ±3days. The presence of alcohol was found to be the best patient-level predictor of trauma evaluation.

Which Procedures Contribute Most to the System-Wide Burden of Postoperative Venous Thromboembolism?

While clinical risk assessment models examine patient-level characteristics that portend morbidity, there is a paucity of literature exploring which procedures contribute most to the system-wide burden of venous thromboembolism (VTE). We aimed to identify highly contributory procedures as potential targets for quality improvement. All patients in the 2020 National Surgical Quality Improvement Program (NSQIP) Public User File were included. Current Procedural Terminology (CPT) codes were analyzed individually and grouped by National Healthcare Safety Network groupings. We counted prevalence of VTE and calculated VTE rate for each CPT and for each grouping. Of 902,968 included patients, 7501 (.83%) sustained postoperative VTE. Of 2748 unique CPT codes, VTE occurred for 762 (28%). Twenty procedure codes (.7%) contributed 39% of the total VTE. VTE rates of these procedures ranged from high-volume procedures with low VTE rates such as laparoscopic cholecystectomy (.25%) and laparoscopic hysterectomy (.32%) to lower volume procedures with high VTE rate such as Hartmann's procedure (4.32%), Whipple procedure (3.85%), and distal pancreatectomy (3.82%). The CPT grouping with the most VTE was colon surgeries (1275/7501). A small number of procedures contributes to the system-wide burden of VTE. High-risk procedures are important targets for standardized prophylaxis protocols. For low-risk procedures, careful attention should be paid to patient-specific factors that may increase VTE risk such as obesity, cancer, or limited mobility, as many common procedures contribute greatly to the systemic burden of VTE. Overall, surveillance can perhaps be targeted on a smaller number of procedures, allowing for more efficient use of quality improvement resources.

Practice Pattern Variation in Adoption of New and Evolving Percutaneous Coronary Intervention Procedures.

Assess factors contributing to variation in the use of new and evolving diagnostic and interventional procedures for percutaneous coronary intervention (PCI). Evidence-based practices for PCI have the potential to improve outcomes but are variably adopted. Finding possible drivers of PCI procedure-use variability is key for efforts aimed at establishing more uniform practice. Veterans Affairs Clinical Assessment, Reporting, and Tracking Program data were used to estimate a proportion of variation attributable to hospital-, operator-, and patient-level factors across (a) radial arterial access, (b) intravascular imaging/optical coherence tomography, and (c) atherectomy for PCI. We used random-effects models with hospital, operator, and patient random effects. Overlap between levels generated cumulative variability estimates greater than 100%. A total of 445 operators performed 95,391 PCI procedures across 73 hospitals from 2011 to 2018. The rates of all procedures increased over this time. 24.45% of variability in the use of radial access was attributable to the hospital, 53.04% to the operator, and 57.83% to patient-level characteristics. 9.06% of the variability in intravascular imaging use was attributable to the hospital, 43.92% to the operator, and 21.20% to the patient. Lastly, 20.16% of the variability in use of atherectomy was attributed to the hospital, 34.63% to the operator, and 57.50% to the patient. The use of radial access, intracoronary imaging, and atherectomy is influenced by patient, operator, and hospital factors, but patient and operator-level effects predominate. Efforts to increase the use of evidence-based practices for PCI should consider interventions at these levels.

Rural-Urban Disparities in Hospital Admissions and Mortality Among Patients with COVID-19: Evidence from South Carolina from 2021 to 2022.

Although rural communities have been hard-hit by the COVID-19 pandemic, there is limited evidence on COVID-19 outcomes in rural America using up-to-date data. This study aimed to estimate the associations between hospital admissions and mortality and rurality among COVID-19 positive patients who sought hospital care in South Carolina. We used all-payer hospital claims, COVID-19 testing, and vaccination history data from January 2021 to January 2022 in South Carolina. We included 75,545 hospital encounters within 14 days after positive and confirmatory COVID-19 testing. Associations between hospital admissions and mortality and rurality were estimated using multivariable logistic regressions. About 42% of all encounters resulted in an inpatient hospital admission, while hospital-level mortality was 6.3%. Rural residents accounted for 31.0% of all encounters for COVID-19. After controlling for patient-level, hospital, and regional characteristics, rural residents had higher odds of overall hospital mortality (Adjusted Odds Ratio - AOR = 1.19, 95% Confidence Intervals - CI = 1.04-1.37), both as inpatients (AOR = 1.18, 95% CI = 1.05-1.34) and as outpatients (AOR = 1.63, 95% CI = 1.03-2.59). Sensitivity analyses using encounters with COVID-like illness as the primary diagnosis only and encounters from September 2021 and beyond - a period when the Delta variant was dominant and booster vaccination was available - yielded similar estimates. No significant differences were observed in inpatient hospitalizations (AOR = 1.00, 95% CI = 0.75-1.33) between rural and urban residents. Policymakers should consider community-based public health approaches to mitigate geographic disparities in health outcomes among disadvantaged population subgroups.

Hospital readmissions and mortality following discharge against medical advice: a five-year retrospective, population-based cohort study in Veneto region, Northeast Italy

ObjectivesThe aim of this study was to examine the odds of readmission and mortality after discharge against medical advice (DAMA) in the Veneto region of Northeast Italy, drawing on data...

Comparing In-Person Only, Telemedicine Only, and Hybrid Health Care Visits Among Older Adults in Safety-Net Clinics.

Older adults face challenges in seeking health care. This study examined factors associated with in-person only versus telemedicine only versus hybrid health care visits among adults 65+ in safety-net clinics. Data were obtained from a large Texas-based Federally Qualified Health Center (FQHC) network. The dataset included 12,279 appointments for 3914 unique older adults between March and November 2020. The outcome of interest was a 3-level indicator of telemedicine visits: in-person visits only, telemedicine visits only, and hybrid (in person + telemedicine) visits during the study period. We used a multinomial logit model adjusting for patient level characteristics to assess the strength of the relationships. Compared to their white counterparts, black and Hispanic older adults were significantly likely to have telemedicine only visits versus in-person only visits (black RRR: 0.59, 95% confidence interval [CI]: 0.41-0.86; Hispanic RRR: 0.46, 95% CI: 0.36-0.60). However, there were no significant racial and ethnic differences in hybrid utilization (black RRR: 0.91, 95% CI: 0.67-1.23; Hispanic RRR: 0.86, 95% CI: 0.70-1.07). Our findings suggest that hybrid opportunities may bridge racial and ethnic disparities in access to care. Clinics should consider building capacity for both in-person and telemedicine opportunities as complementary strategies.

Patient Factors which Lead to Disagreement in Triage Decisions

Introduction:Multiple triage algorithms have been proposed to optimize the allocation of medical resources in mass casualty incidents. Despite attempts at standardization, first responders often assign patients to triage categories that deviate from those prescribed by these algorithms. This study seeks to understand what patient level factors cause these deviations, and identify clinical factors which cause variance toward over or under triage. Rather than evaluate these decisions against a gold standard, we instead seek to identify patients that cause controversy among first responders with respect to their choices.Method:This will be an online survey distributed to EMT and Paramedic students in the US. They will be provided with fifty patient cards containing a clinical vignette including description of injuries and vital signs. For each vignette, they will select a triage category (Red, Yellow, Green, or Black.) We will analyze responses to identify areas of controversy, where triage classification showed a significant split between respondents. We can then evaluate these patients for clinical trends.Results:Data collection and analysis are planned for completion by March 30, 2023.Conclusion:Identifying patient-level characteristics that contribute to triage variance can allow emergency managers to anticipate under-triage and over-triage following an MCI. This can aid emergency providers as they plan to receive an influx of patients. It also addresses the sub-cognitive biases that impact first responders decision-making, which may aid EMS educators who train first responders in triage.

Black Patients with Movement Disorders Less Likely to Receive Treatment with Deep Brain Stimulation (S29.001)

<h3>Objective:</h3> To identify existing racial disparities in Deep Brain Stimulation (DBS) utilization in those hospitalized for Parkinson Disease (PD), Essential Tremor (ET), and dystonia. <h3>Background:</h3> DBS is an effective surgical treatment option for those with PD, ET, and dystonia. Racial disparities in DBS utilization in patients with PD have been documented demonstrating that Black patients receive DBS at disproportionately lower rates compared to White patients. To our knowledge, no studies have investigated if this pattern of disuse persists in other movement disorders with FDA-approval for DBS: ET and dystonia. <h3>Design/Methods:</h3> The Nationwide Inpatient Sample (NIS) database from the Healthcare Cost and Utilization Project was queried for all hospitalizations from 2012–2018 with a primary diagnosis of PD, ET, or dystonia. A total of 21,964, 3,307, and 1,439 discharges were recorded for PD, ET, and dystonia, respectively. Within that sample, treatment with DBS was identified. The sex, race, age, payment method, income quartile, year of treatment, and mortality score of patients were extracted. Hospital characteristics included hospital size, urban/rural setting, teaching status, and geographic region. A multivariate logistic regression was performed to identify predictors for use of DBS. <h3>Results:</h3> Between the years 2012–2018, Black patients with PD, ET, and dystonia were all significantly less likely to receive DBS than White patients. Compared to White patients, Black patients with PD were nearly 8 times less likely to receive DBS (OR=0.13, CI=0.1–0.17, p&lt;0.0001), and Black patients with ET and dystonia were 4–5 times less likely to receive DBS (OR=0.21, CI=0.14–0.32, p&lt;0.0001; OR=0.22, CI=0.1–0.49, p=0.0002; respectively). Importantly, when controlling for all patient and hospital level characteristics, these racial disparities remained. <h3>Conclusions:</h3> Our analysis using the NIS database shows that Black patients with a diagnosis of PD, ET, or dystonia were less likely to be treated with DBS than White patients were between 2012 and 2018. <b>Disclosure:</b> Mr. Dorritie has nothing to disclose. Mohammad Faysel has nothing to disclose. Prof. Gruessner has nothing to disclose. Dr. Robakis has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amneal pharmaceuticals.

Prevalence and predictive risk factors of self-stigmatization in patients with rare diseases: Based on health ecology model.

Given the cause of self-stigmatization of patients with rare diseases is complicated, and the self-stigmatization can be prevented by managing the related risk factors. This study aimed to report the prevalence as well as influencing factors associated with self-stigmatization in patients with rare diseases. From January to April 2022, the respondent-driven sampling (RDS) method was used to select patients with rare diseases through the Chinese Organization for Rare Disorders as the subjects. Based on the theoretical model of health ecology, logistic regression analysis was used to explore the association between self-stigmatization level and sample characteristics of patients with rare diseases. A total of 530 patients were included, 50.2% of whom were male, and most of them are under 45 years old (86.5%). The prevalence of self-stigmatization in patients with rare diseases was 85.7%. Logistic regression analysis indicated that age (OR: 0.624, 95% CI: [0.399, 0.976]), mental health status (OR: 0.184, 95% CI: [0.076, 0.445]), family relations (OR: 0.180, 95% CI: [0.074, 0.434]), full time work (OR: 2.835, 95% CI: [1.024, 7.849]) and medical insurance (OR: 0.296, 95% CI: [0.105, 0.835]) were risk factors for self-stigmatization of patients with rare diseases. Chinese patients with rare diseases have a high level of self-stigmatization, and the potential risk factors are multi-level and multi-dimensional.

Use of metformin and insulin among pregnant women with gestation diabetes in the United Kingdom: A population-based cohort study.

The contemporary prescription patterns of antidiabetic drugs following guideline changes recommending metformin as first-line gestational diabetes (GDM) pharmacotherapy is underexplored. We aimed to examined use of metformin and insulin during pregnancy among women with GDM over 20 years in the United Kingdom. We conducted a population-based cohort study using linked data from the Clinical Practice Research Datalink, its pregnancy register and Hospital Episode Statistics from 1998 to 2017. We included pregnancies of women without prior diabetes history who received GDM diagnosis or initiated an antidiabetic drug after 20 weeks gestation. Patient-level and practice-level characteristics were compared between metformin initiators and insulin initiators. We described trends of initiating metformin as first-line treatment and described time to initiation of rescue insulin overall, and by body mass index among metformin initiators. Our cohort included 5633 pregnancies from 5393 women with GDM, of whom 38.9% initiated pharmacotherapy (41% insulin, 59% metformin). Metformin prescriptions (as opposed to insulin) increased substantially, from <5% of pregnancies before 2007 to 42.5% in 2008. Over 85% of pregnancies that were prescribed pharmacotherapy were prescribed metformin as first-line treatment in 2015. Among metformin initiators, 16% initiated rescue insulin, typically occurring within 40 days of metformin initiation. Choice of GDM pharmacotherapy varied by characteristics, including smoking, obesity, race/ethnicity and general practice regions. Metformin was the most prescribed medication for GDM, with large increases over the past 2 decades. The increasing use of oral-antidiabetic drugs during pregnancy, consistent with other regions, highlights the need for future studies examining effectiveness and safety of antidiabetic drug use during pregnancy.

Abstract 1951: Combining diverse data sources to examine disparities in stage at diagnosis among adults with oral cancer in the United States

Abstract Background: The objective of this study is to examine the effects of county-level socioeconomic and healthcare access factors on stage at diagnosis of oral cancer in the United States by combining data from disparate sources. Methods: We abstracted oral cancer data from the Surveillance, Epidemiology, and End Results (SEER) 18 registries research database. These data included tumor characteristics, demographics, and county of residence of cases. We abstracted county-level socioeconomic variables from the American Community Survey (ACS), county-level smoking prevalence from the Behavioral Risk Factor Surveillance System (BRFSS), and county-level healthcare resource data from the Area Health Resource File (AHRF). The binary outcome was stage at diagnosis (distant versus localized or regional). The predictors were age category at diagnosis, sex, race/ethnicity available for individual cases, and county-level variables. We used a multilevel mixed effects analysis to assess the correlates of patient-level and county-level factors on stage at diagnosis of oral cancer in cases diagnosed between 2010 and 2016 from 612 counties. Results: Among 54,099 patients diagnosed with oral cancer, 10954 (20.25%) had distant-stage disease. Multivariable analysis showed statistical difference in distant versus localized or regional stage at diagnosis between non-Hispanic Whites and Non-Hispanic Blacks (odds ratio [OR]: 1.872, 95% confidence interval [CI]: 1.743 - 2.0), Asians (OR: 1.762, 95% CI: 1.619 - 1.917), and Hispanics (OR: 1.380, 95% CI: 1.274 - 1.495), and between females and males (OR: 1.348, 95% CI: 1.282 - 1.427). The proportion of patients with distant stage disease also increased significantly with increasing age. In addition to patient-level characteristics, some county-level factors were also associated with distant stage at diagnosis. The proportion of patients with distant stage disease was significantly higher in counties with above-median percentage of foreign-born residents (OR: 1.157, 95% CI: 1.011 - 1.323) and above-median prevalence of ever smokers (OR: 1.123, 95% CI: 1.022 - 1.233). Of 2.18% total variability in stage at diagnosis, 0.4% was accounted for by patient-level characteristics and 0.32% by county-level characteristics, leaving 1.46% unexplained variation. Conclusion: We see significant roles of county-level smoking and foreign-born status on the risk of distant stage at diagnosis of oral cancer. This suggests a critical need to understand the oral health practices and behaviors of immigrant populations, including their tobacco product use and oral cancer screening uptake. Citation Format: Sana Chawla, Jaya M. Satagopan. Combining diverse data sources to examine disparities in stage at diagnosis among adults with oral cancer in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1951.

Is cancer stage data missing completely at random? A report from a large population-based cohort of non-small cell lung cancer.

Population-based datasets are often used to estimate changes in utilization or outcomes of novel therapies. Inclusion or exclusion of unstaged patients may impact on interpretation of these studies. A large population-based dataset in Ontario, Canada of non-small cell lung cancer patients was examined to evaluate the characteristics and outcomes of unstaged patients compared to staged patients. Multivariable Poisson regression was used to evaluate differences in patient-level characteristics between groups. Kaplan-Meier estimates of survival and log-rank statistics were utilized. In our Ontario cohort of 51,152 patients with NSCLC, 11.2% (n=5,707) were unstaged, and there was evidence that stage data was not missing completely at random. Those without assigned stage were more likely than staged patients to be older (RR [95%CI]), (70-79 vs. 20-59: 1.51 [1.38-1.66]; 80+ vs. 20-59: 2.87 [2.62-3.15]), have a higher comorbidity index (Score 1-2 vs 0: 1.19 [1.12-1.27]; 3 vs. 0: 1.49 [1.38-1.60]), and have a lower socioeconomic class (4 vs. 1 (lowest): 0.91 [0.84-0.98]; 5 vs. 1 (lowest): 0.89 [0.83-0.97]). Overall survival of unstaged patients suggested a mixture of early and advanced stage, but with a large proportion that are probably stage IV patients with more rapid death than those with reported stage IV disease. In this case study, evaluation of stage-specific health care utilization and outcomes for staged patients with stage IV disease at the population level may have a bias as a distinct subset of stage IV patients with rapid death are likely among those without a documented stage in administrative data.

MP16-08 DISTINGUISHING CHARACTERISTICS OF CHILDREN WITH PRIMARY HYPEROXALURIA TYPE 1 IN PEDSNET

You have accessJournal of UrologyCME1 Apr 2023MP16-08 DISTINGUISHING CHARACTERISTICS OF CHILDREN WITH PRIMARY HYPEROXALURIA TYPE 1 IN PEDSNET Gregory Tasian, Kimberley Dickinson, Julia Schuchard, Grace Park, Nicole Marchesani, Akanksha Mittal, Nathan Cheng, Christina Ching, David Chu, Ryan Walton, Karyn Yonekawa, Caroline Gluck, Kathleen Kan, William DeFoor, Kyle Rove, and Christopher Forrest Gregory TasianGregory Tasian More articles by this author , Kimberley DickinsonKimberley Dickinson More articles by this author , Julia SchuchardJulia Schuchard More articles by this author , Grace ParkGrace Park More articles by this author , Nicole MarchesaniNicole Marchesani More articles by this author , Akanksha MittalAkanksha Mittal More articles by this author , Nathan ChengNathan Cheng More articles by this author , Christina ChingChristina Ching More articles by this author , David ChuDavid Chu More articles by this author , Ryan WaltonRyan Walton More articles by this author , Karyn YonekawaKaryn Yonekawa More articles by this author , Caroline GluckCaroline Gluck More articles by this author , Kathleen KanKathleen Kan More articles by this author , William DeFoorWilliam DeFoor More articles by this author , Kyle RoveKyle Rove More articles by this author , and Christopher ForrestChristopher Forrest More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003236.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Primary hyperoxaluria type 1 (PH1) is an ultra-rare disorder of hepatic overproduction of oxalate that causes early onset kidney stones, chronic kidney disease, and systemic oxalosis. We sought to identify defining clinical characteristics of children with PH1 in order to develop approaches that facilitate its early diagnosis. METHODS: We determined the association between patient-level characteristics of PH1 in a case-control study conducted between January 2009 and August 2021 in PEDSnet, a clinical research network of eight pediatric health systems in the United States. We matched each patient with confirmed PH1 to 4 control patients with kidney stone disease not due to PH1 by sex and PEDSnet site at date of diagnosis (cohort entrance date). We obtained patient characteristics and diagnostic test results occurring before to less than 6 months after cohort entrace from a centralized query of the data pooled from the electronic health records and from manual chart review at each PEDSnet site. Differences in patient characteristics and diagnostic test results between patients were compared using paired tests as appropriate for the distribution of and type of data. RESULTS: The study sample included 37 patients with PH1 and 147 controls. Compared to patients with kidney stone disease not due to PH1, patients with PH1 were younger, were less likely to have immobility, had a higher percentage of stone comprised of calcium oxalate monohydrate, and had a lower eGFR measured within 6 months of cohort entrance (Table 1). There were no statistically significant differences in prevalent diagnosis of failure to thrive, cumulative stone size on ultrasound, nephrocalcinosis on ultrasound or CT, or echocardiography results. CONCLUSIONS: In this study, children with PH1 were characterized by presentation before adolescence, absence of immobility, high percentage of calcium oxalate monohydrate stone composition, and decreased eGFR at diagnosis. If validated in external populations, these consortium of characteristics may enable a strong clinical suspicion for PH1 diagnosis, facilitating confirmatory testing, and facilitating initation of targeted therapeutics. Source of Funding: Alnylam Pharmaceuticals © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e205 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gregory Tasian More articles by this author Kimberley Dickinson More articles by this author Julia Schuchard More articles by this author Grace Park More articles by this author Nicole Marchesani More articles by this author Akanksha Mittal More articles by this author Nathan Cheng More articles by this author Christina Ching More articles by this author David Chu More articles by this author Ryan Walton More articles by this author Karyn Yonekawa More articles by this author Caroline Gluck More articles by this author Kathleen Kan More articles by this author William DeFoor More articles by this author Kyle Rove More articles by this author Christopher Forrest More articles by this author Expand All Advertisement PDF downloadLoading ...

Attrition from HIV treatment after enrollment in a differentiated service delivery model: A cohort analysis of routine care in Zambia.

Many sub-Saharan Africa countries are scaling up differentiated service delivery (DSD) models for HIV treatment to increase access and remove barriers to care. We assessed factors associated with attrition after DSD model enrollment in Zambia, focusing on patient-level characteristics. We conducted a retrospective record review using electronic medical records (EMR) of adults (≥15 years) initiated on antiretroviral (ART) between 01 January 2018 and 30 November 2021. Attrition was defined as lost to follow-up (LTFU) or died by November 30, 2021. We categorized DSD models into eight groups: fast-track, adherence groups, community pick-up points, home ART delivery, extended facility hours, facility multi-month dispensing (MMD, 4-6-month ART dispensing), frequent refill care (facility 1-2 month dispensing), and conventional care (facility 3 month dispensing, reference group). We used Fine and Gray competing risk regression to assess patient-level factors associated with attrition, stratified by sex and rural/urban setting. Of 547,281 eligible patients, 68% (n = 372,409) enrolled in DSD models, most commonly facility MMD (n = 306,430, 82%), frequent refill care (n = 47,142, 13%), and fast track (n = 14,433, 4%), with <2% enrolled in the other DSD groups. Retention was higher in nearly all DSD models for all dispensing intervals, compared to the reference group, except fast track for the ≤2 month dispensing group. Retention benefits were greatest for patients in the extended clinic hours group and least for fast track dispensing. Although retention in HIV treatment differed by DSD type, dispensing interval, and patient characteristics, nearly all DSD models out-performed conventional care. Understanding the factors that influence the retention of patients in DSD models could provide an important step towards improving DSD implementation.

Daily pain and opioid administration in hospitalized patients with cancer: the importance of psychological factors, recent surgery, and current opioid use.

Pain is common and variable in its severity among hospitalized patients with cancer. Although biopsychosocial factors are well established as modulators of chronic pain, less is known about what patient-level factors are associated with worse pain outcomes among hospitalized cancer patients. This prospective cohort study included patients with active cancer presenting to the emergency department (ED) with pain severity of ≥4/10 and followed pain outcomes longitudinally throughout hospital admission. Baseline demographic, clinical, and psychological factors were assessed on ED presentation, and daily average clinical pain ratings and opioid consumption during hospitalization were abstracted. Univariable and multivariable generalized estimating equation analyses examined associations of candidate biopsychosocial, demographic, and clinical predictors with average daily pain and opioid administration. Among 113 hospitalized patients, 73% reported pain as the primary reason for presenting to the ED, 43% took outpatient opioids, and 27% had chronic pain that predated their cancer. Higher pain catastrophizing ( B = 0.1, P ≤ 0.001), more recent surgery ( B = -0.2, P ≤ 0.05), outpatient opioid use ( B = 1.4, P ≤ 0.001), and history of chronic pain before cancer diagnosis ( B = 0.8, P ≤ 0.05) were independently associated with greater average daily pain while admitted to the hospital. Higher pain catastrophizing ( B = 1.6, P ≤ 0.05), higher anxiety ( B = 3.7, P ≤ 0.05), lower depression ( B = -4.9, P ≤ 0.05), metastatic disease ( B = 16.2, P ≤ 0.05), and outpatient opioid use ( B = 32.8, P ≤ 0.001) were independently associated with higher daily opioid administration. Greater psychological distress, especially pain catastrophizing, as well as pain and opioid use history, predicted greater difficulty with pain management among hospitalized cancer patients, suggesting that early assessment of patient-level characteristics may help direct consultation for more intensive pharmacologic and nonpharmacologic interventions.

Determinants, Costs, and Consequences of Common Bile Duct Injury Requiring Operative Repair Among Privately Insured Individuals in the United States, 2003-2020.

Characterize the determinants, all-cause mortality risk, and healthcare costs associated with common bile duct injury (CBDI) following cholecystectomy in a contemporary patient population. Retrospective cohort study using nationwide patient-level commercial and Medicare Advantage claims data, 2003-2019. Beneficiaries ≥18 years who underwent cholecystectomy were identified using Current Procedure Terminology (CPT) codes. CBDI was defined by a second surgical procedure for repair within one year of cholecystectomy. We estimated the association of common surgical indications and comorbidities with risk of CBDI using logistic regression; the association between CBDI and all-cause mortality using Cox proportional hazards regression; and calculated average healthcare costs associated with CBDI repair. Among 769,782 individuals with cholecystectomy, we identified 894 with CBDI (0.1%). CBDI was inversely associated with biliary colic (odds ratio [OR] = 0.82; 95% confidence interval [CI]: 0.71-0.94) and obesity (OR = 0.70, 95% CI: 0.59-0.84), but positively associated with pancreas disease (OR = 2.16, 95% CI: 1.92-2.43) and chronic liver disease (OR = 1.25, 95% CI: 1.05-1.49). In fully adjusted Cox models, CBDI was associated with increased all-cause mortality risk (hazard ratio = 1.57, 95% CI: 1.38-1.79). The same-day CBDI repair was associated with the lowest mean overall costs, with the highest mean overall costs for repair within 1 to 3 months. In this retrospective cohort study, calculated rates of CBDI are substantially lower than in prior large studies, perhaps reflecting quality-improvement initiatives over the past two decades. Yet, CBDI remains associated with increased all-cause mortality risks and significant healthcare costs. Patient-level characteristics may be important determinants of CBDI and warrant ongoing examination in future research.

A Systematic Evaluation of Imaging Diagnostic Morphology of Gastric Submucosal Tumors

Systematic evaluation of the diagnostic morphological features of submucosal tumors (SMTs) in the stomach. The Chinese and English-related clinical research literature published in Chinese and English databases (including PubMed, SinoMed, EMBASE, CNKI, Wanfang, VIP, etc.) from January 2000 to November 2022 were searched. Two researchers independently completed literature screening, content extraction, literature quality assessment, and RCT bias risk, and a meta-analysis was performed using Review Manager 5.3 software in Cochrane. A total of 8 literatures were included, including 1175 patients with SMTs, including 597 GIST, 274 leiomyomas, 2 granulosa cell tumors, 143 ectopic pancreases, 31 cysts, 9 schwannomas, 66 lipoma, and 53 others. Four English and four Chinese literatures were included, and three of the selective results were reported as high risk. The results of the meta-analysis showed significant differences in the shape characteristics, tumor size, echo characteristics, and origin level characteristics of SMTs patients with different diseases (P &lt;0.05). However, imaging diagnostic efficacy was higher, and there was little difference in imaging diagnostic efficacy among SMTs patients with other conditions (P &gt;0.05). Current evidence indicates that imaging techniques have high diagnostic efficiency in the identification and diagnosis of SMTs diseases, and morphological heterogeneity is present in different conditions.

Prednisolone prescribing practices for dogs in Australia.

Although prednisolone is a routinely prescribed medication in dogs, there is a lack of information regarding prednisolone prescribing practices by veterinarians. This study aims to describe characteristics of dogs receiving prednisolone, disease processes treated, doses prescribed as well as to identify factors influencing the dose rate in Australia. The VetCompass Australia database was queried to identify dogs prescribed prednisolone between 1 July 2016 to 31 July 2018 (inclusive). A random sample of 2,000 dogs from this population were selected. Dog demographic data, prednisolone dose and indication for prescription were collated. Indicated dose for the condition treated was compared to prescribed dose. Multivariable linear regression was used to identify patient-level characteristics associated with prescribed prednisolone dose. A large and small breed dog cohort, treated for the same disease process, were compared for differences in dosing. Median age of dogs was 73 (range 2 to 247) months and median body weight was 17 (range 1.56 to 90) kg. Median prescribed prednisolone dose was 0.8 mg/kg/day, with most dogs receiving an anti-inflammatory dose (0.3-1 mg/kg/day, 58%). Prednisolone prescriptions were predominantly for diseases of the integument (n = 1645, 82%) followed by unknown indication and respiratory disease. A total of 152 dogs (8%) were prescribed immunosuppressive doses of prednisolone for conditions where an anti-inflammatory dose would be recommended. Increases in bodyweight were associated with lower doses on mg/kg scale but higher doses on a mg/m2 scale (p < 0.001). Overall, prednisolone was primarily used as an anti-inflammatory in this population, with some inappropriate use of immunosuppressive doses. Increasing bodyweight was associated with a small reduction in dose in mg/kg, suggesting that clinicians are adjusting prednisolone dose rates based on dog bodyweight.

Trends and Surgeon Variations in Early Regrafts After Endothelial Keratoplasty: Analysis of the National Medicare Data Set.

The aims of this study were to determine national-level trends in early regraft rates and examine patient-level and surgeon-level characteristics associated with early regrafts. This was a retrospective, cohort study. We identified beneficiaries aged 65 years or older in the 2011 to 2020 Medicare carrier claims data set who underwent Endothelial keratoplasty (EK) and subsequently underwent an early regraft. The incidence of early regraft for each year was calculated and patient-level and surgeon-level characteristics associated with regrafts were examined using a multivariable regression model. Of 114,383 EK procedures, 4119 (3.60%) were followed by an early regraft, with no significant variations in the rates between years ( P = 0.59). Factors associated with higher odds of early regraft were Black compared with White race (OR 1.151; 95% confidence interval (CI) 1.018-1.302) and the highest quartile of income versus the lowest quartile (OR 1.120; 95% CI 1.002-1.252). Factors associated with lower odds were female sex (OR 0.889; 95% CI 0.840-0.942), receiving surgery in a hospital-based outpatient department versus an ambulatory center (OR 0.813; 95% CI 0.740-0.894), and having a surgeon with the highest quartile of annual EK volume versus the lowest (OR 0.726; 95% CI 0.545-0.967). Early regraft rates among surgeons ranged from 0% to 58.8% with a median [interquartile range] of 3.13 [0-6.15]. We found no significant increases in the early regraft rates over the past decade in the United States. Patient male sex and Black race, ambulatory surgery center-based location of the surgery, and low surgeon EK volume were associated with early regrafts. Substantial surgeon variability in regraft rates may indicate opportunities for improvement through development of best practices on perioperative management and patient counseling.

Constructing State and National Estimates of Vaccination Rates from Immunization Information Systems

Abstract Immunization Information Systems are confidential computerized population-based systems that collect data from vaccination providers on individual vaccinations administered along with limited patient-level characteristics. Through a data use agreement, Centers for Disease Control and Prevention obtains the individual-level data and aggregates the number of vaccinations for geographical statistical areas defined by the US Census Bureau (counties or equivalent statistical entities) for each vaccine included in system. Currently, 599 counties, covering 11 states, collect and report data using a uniform protocol. We combine these data with inter-decennial population counts from the Population Estimates Program in the US Census Bureau and several covariates from a variety of sources to develop model-based estimates for each of the 3,142 counties in 50 states and the District of Columbia and then aggregate to the state and national levels. We use a hierarchical Bayesian model and Markov Chain Monte Carlo methods to obtain draws from the posterior predictive distribution of the vaccination rates. We use posterior predictive checks and cross-validation to assess the goodness of fit and to validate the models. We also compare the model-based estimates to direct estimates from the National Immunization Surveys.