Patient-related Characteristics Research Articles

Surgical Site Infection After Primary Spinal Fusion Surgery for Adolescent Idiopathic Scoliosis: An Analysis of Risk Factors From a Nationwide Insurance Database.

Retrospective review. The purpose of this study was to quantify the incidence and factors associated with surgical site infection (SSI) in pediatric patients undergoing spinal fusion for adolescent idiopathic scoliosis (AIS). Infection is a morbid complication after spinal fusion. The incidence of SSI after pediatric spinal fusion is likely underestimated; the use of a national database allows for a comprehensive assessment of this rare outcome. The PearlDiver Database was used to identify AIS patients who underwent primary instrumented spinal fusion between 2010 and 2019 and relevant patient records were queried to identify infections within 7, 30, and 90 postoperative days. Patients with nonidiopathic scoliosis were excluded. Logistic regression was used to evaluate risk factors associated with postoperative infection. Out of 9801 patients who underwent primary fusion for AIS, 44 patients (0.4%) developed an infection within 7 postoperative days. The 30 days and 90 days incidences were 1.9% and 2.7%, respectively. Within 90 days, 154 (57.7%) of the patients with infection had undergone reoperation, of whom 72 underwent multiple reoperations. Obesity and male sex ( P < 0.05) were significantly associated with postoperative infection. The length of fusion was not a significant factor in the development of SSI ( P > 0.05). Eleven patients underwent an operation requiring hardware removal within 90 days. There were no significant factors associated with those undergoing hardware removal compared with those undergoing surgical debridement. The study identified a 2.7% 90 days incidence of SSI after posterior spinal fusion for AIS, with 57.7% of all infections requiring a return to the operating room. Preoperative patient-related characteristics associated with increased risk of postoperative SSI were male sex and obesity. The current study can be used to provide preoperative counseling regarding the risk of this postoperative complication. Level III.

Prevention of gastrointestinal anastomotic leakage/ dehiscence in oncological patients.

Background: Anastomotic leakage (AL) is a dreaded complication of surgical procedures concerning the digestive tract. Its occurrence may lead to reoperation, extend the hospital stay, raise the hospitalization costs, worsen the prognosis of the patient by being the risk factor for recurrence of cancer and also increase the proportion of direct mortality. In spite of the development and advancement of operating techniques, according to the literature and criteria, percentage of AL vary from 3 to 30 %. The occurrence of AL depends on multiple factors including: surgical techniques, patient related characteristics, preoperative, intraoperative and postoperative factors. Despite the large-scale research, the pathogenesis of AL is still not fully known.

Norwood operation versus comprehensive stage II after bilateral pulmonary artery banding palliation for infants with critical left heart obstruction

ObjectiveTo determine patient characteristics and outcomes after Norwood versus comprehensive stage II (COMPSII) for infants with critical left heart obstruction who had prior hybrid palliation (bilateral pulmonary artery banding ± ductal stent). MethodsFrom 23 Congenital Heart Surgeons' Society institutions (2005-2020), 138 infants underwent hybrid palliation followed by either Norwood (n = 73, 53%) or COMPSII (n = 65). Baseline characteristics were compared between Norwood and COMPSII groups. Parametric hazard model with competing risk methodology was used to determine risk and factors associated with outcomes of Fontan, transplantation, or death. ResultsInfants who underwent Norwood versus COMPSII had a higher prevalence of prematurity (26% vs 14%, P = .08), lower birth weight (median 2.8 vs 3.2 kg, P < .01) and less frequent ductal stenting (37% vs 99%; P < .01). Norwood was performed at a median age of 44 days and median weight of 3.5 kg, versus COMPSII at 162 days and 6.0 kg (both P < .01). Median follow-up was 6.5 years. At 5 years after Norwood and COMPSII, respectively; 50% versus 68% had Fontan (P = .16), 3% versus 5% had transplantation (P = .70), 40% versus 15% died (P = .10), and 7% versus 11% are alive without transition, respectively. For factors associated with either mortality or Fontan, only preoperative mechanical ventilation occurred more frequently in the Norwood group. ConclusionsHigher prevalence of prematurity, lower birth weight, and other patient-related characteristics in the Norwood versus COMPSII groups may influence differences in outcomes that were not statistically significant for this limited risk-adjusted cohort. The clinical decision regarding Norwood versus COMPSII after initial hybrid palliation remains challenging.

Kliničke karakteristike pneumonija kod bolesnika sa hroničnom opstruktivnom bolesti pluća

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, causing 3.23 million deaths in 2019. The incidence of pneumonia in patients with COPD is almost twice as high as in the general population. Globally, pneumonia is a cause of increased mortality and morbidity rates. A higher incidence of pneumonia and its association with increased mortality and more frequent hospitalizations, which increases the costs of treatment, has been observed in people diagnosed with COPD in comparison to the general population. The aim of this study was to examine the basic clinical features of pneumonia in patients with COPD, as well as to assess the differences in the clinical characteristics of COPD patients in relation to the presence of pneumonia. The study was designed as a case-control study. The study included patients hospitalized and treated at the pneumophysiology department of the Health Center in Kosovska Mitrovica, in the period from January 2017 to December 2019. Data for research purposes were obtained from the patients' medical records. The study included 110 patients with COPD, of which 30 (27.3%) had pneumonia and 80 (72.7%) were not diagnosed with pneumonia. Out of the total number of patients, 65 (59.1%) were males. Patients with pneumonia had statistically significantly lower mean values of leukocytes and neutrophils at admission, and significantly lower hematocrit values at discharge in comparison to patients without pneumonia. COPD patients who had pneumonia were significantly more often treated with antibiotic combination therapy (cephalosporins and fluoroquinolones) and macrolides. Statistically significantly, the most common auscultation findings in patients with COPD and pneumonia included low-pitched and polyphonic wheezes, and complications in the form of effusions and abscesses were also significantly more often registered. In addition to prolonged hospitalization, patients with COPD and pneumonia received significantly lower doses of oxygen compared to COPD patients without pneumonia. Our study shows that pneumonia is highly prevalent and requires long-term hospitalization and treatment, which leads to increased costs, however, it can be cured with adequate treatment, primarily using a combination of several antibiotics.

Safety, Feasibility, and Efficacy of Upfront Daratumumab-Based Therapy in Blacks with Dysproteinemia

Background: Black patients (pts) with dysproteinemia are underrepresented in clinical trials included in new drug applications and biological license application submissions. Even after approval, access to novel therapies remains a challenge. Daratumumab (dara) is an anti-CD38 monoclonal antibody, which has revolutionized the care of patients with both multiple myeloma (MM) and light chain (AL) amyloidosis. The underrepresentation of black pts in clinical trials of dara in newly diagnosed patients with dysproteinemia raises concerns regarding the safety, tolerability and efficacy of dara in this population. We report the results from a cohort of pts treated with dara in the management of newly diagnosed MM (NDMM) and AL amyloidosis. Methods: The Cancer and Aging Resilience Evaluation in Hematologic Malignancies (CARE-Heme) registry is an ongoing prospective registry enrolling pts ≥50 years of age with a diagnosis of hematologic malignancy undergoing treatment at a single institution. For this analysis, we included pts with NDMM and AL amyloidosis treated with dara-based combination therapy between January 2020 and January 2022. We obtained baseline disease- and patient-related characteristics. Toxicity was evaluated by chart review up to the first 6 cycles and adverse events (AEs) were graded using Common Terminology Criteria for Adverse Events (CTCAE v5.0). For patients receiving >1 cycle, response assessment was ascertained using International Myeloma Working Group (IMWG) uniform response criteria. All patients were followed until progression, death or last follow up and progression-free survival (PFS) and overall survival (OS) were measured using Kaplan Meier methods. Health-related quality of life (HRQoL) was measured using Patient-Reported Outcomes Measurement Information System (PROMIS) global 10 and quantified using physical health (PH) and mental health (MH) t-scores at baseline and 3 month follow up. Variables were compared in each race by using independent and paired sample t-tests as appropriate. Results: Over the study period, 36 black pts (NDMM=32; AL=4) and 50 white pts (NDMM=44; AL=6) received upfront dara-based combination therapy. There were no differences in age or sex, IGH translocations, but there was a higher incidence of cytogenetic high-risk disease among the black pts in our cohort (p=0.02). Black pts presented with more advanced disease at the time of presentation - hypercalcemia 33% vs. 14%, p=0.04; renal dysfunction 56% vs. 28%, p=0.01; anemia 67% vs. 38%, p=0.01). Incidence of bone disease was similar between the groups (p=0.69) (Table 1) Among blacks, the most utilized regimen was DaraVRd (56%), DaraRd (17%), DaraKRd (11%) and DaraVCd (11%). While for the white pts, it was DaraVRd (52%), DaraRd (12%), DaraKRd (8%) and DaraVCd (22%). Blacks had a similar incidence of ≥grade 3 non-hematologic AEs (p=0.21), with fatigue, diarrhea and leg edema being the most common. There is a trend towards higher ≥grade 3 hematologic AEs which did not reach statistical significance (p=0.05). After 6 cycles of therapy, overall response rate was comparable (100% vs. 94%, p=0.81) among the two groups (≥VGPR 47% vs. 62%, p=0.36). With 18 month median follow up, there was no difference in median PFS and OS, both not reached (Figure 1). Complete quality of life (QoL) t-scores were available at baseline for 55 pts (20 blacks and 35 whites). The baseline PH and MH related QoL scores were comparable between whites and blacks (p= 0.51; p=0.58, respectively). From baseline to 3 months follow up, PH t-scores improved in both whites as well as blacks although the difference was not statistically significant. Meanwhile, MH t-scores remained largely unchanged from baseline to follow up in both groups. Conclusions: We report the largest cohort to date of black pts with dysproteinemia systematically treated with frontline dara. Our data shows the feasibility of this strategy in a single institution setting with comparable safety, efficacy and HRQoL with the use of upfront dara-based combinations in black and white pts. Our data supports comparable clinical outcomes among black pts when treated with novel therapeutic combinations despite a higher proportion of high risk cytogenetic abnormalities in our cohort without an increase in AEs. Minority representation in cancer clinical trials as well as access to approved novel therapies can significantly help mitigate disparities in outcomes. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Clinical Predictors for Relapse Among Patients with AML Who Responded to Venetoclax-Based Treatment - a Real-World Prospective Analysis from the Revive Study Group

Background: Venetoclax (VEN)-based low intensity combinations are approved for the treatment of patients with acute myeloid leukemia (AML) ineligible for intensive chemotherapy. Despite the encouraging composite complete remission rates demonstrated in the VIALE-A trial, disease relapse remains a frequent event with dismal outcome. The aim of the current analysis is to characterize patterns and clinical predictors of relapse in a real-world setting. Methods: The REVIVE study is a prospective, real-life, observational study that assesses patterns of patient selection, efficacy and toxicity. 189 newly diagnosed AML patients from 12 medical centers in Israel were enrolled at initiation of VEN-based low-intensity therapy, between August 12, 2019, and April 15, 2022 (data cut). Demographic, clinical and patient-related baseline characteristics, as well as treatment patterns, safety and efficacy outcomes were collected. For the current analysis, remission was defined as either achieving complete remission (CR), CR with incomplete count recovery (CRi) or morphological leukemia-free state (MLFS). Relapse-free survival (RFS) was calculated from the date of first response to the date of progression of disease or death from any cause, whichever occurs first or lost follow-up in the population of responding patients (CR, CRi, MLFS). A cox proportional hazards model was used to compare relapse-free survival between subgroups of baseline characteristics. Results: Of the 189 patients recruited to the study, 110 (58.2%) achieved a response (CR- 55.5%, CRi- 39.1%, MLFS- 5.5%). The median age of these patients was 75 years, 58.2% were males and 69.1% had ECOG performance status of 0-1. The median time to remission was 35 (0-193) days. As of data cut, with a median follow-up of 278 (31-878) days, 50 patients (45% of responding patients) who achieved response have relapsed. Median RFS was 425 (275-588) days. 1-year after achieving remission 53.3% (42.3%-64.2%) of the patients remained in remission. The estimated OS of the patients who responded was 509 (302-680) days. In univariate analysis, there was a statistically significant association of age (p=0.005) and baseline neutrophil counts (p=0.001) with RFS. The expected hazard of relapse in patients <75 of age was 0.4 times the hazard in patients ≥75 (median RFS of 588 vs. 275 days, respectively). The expected hazard of relapse in patients with baseline neutrophils ≥1,000 cells/µl was 2.7 times the expected hazard in patients <1,000 cells/µl. Patients with a normal BMI (<25) had a hazard of relapse that was higher than those with an overweight BMI (≥25) (p=0.06). There was no statistical association of gender, ECOG performance status, type of AML, cytogenetic risk group, and prior HMA exposure with RFS. On a multivariate analysis, only age and baseline neutrophil counts remained significant in the cox proportional hazards model. A comparison of responding patients with prior myeloproliferative neoplasms (MPNs) (n=14), patients who were excluded from registrational clinical studies, to patients with therapy-related AML/ prior MDS (n=40) demonstrated a significant association with RFS. The median RFS was 154 days (range 76-not reached) in the MPN group compared to not reached in the other group (range 298-not reached, KM estimation for 1 year of 25% vs. 63.8%, respectively p=0.0119). Conclusions: In a real-world, prospective analysis, newly diagnosed AML patients who responded to treatment demonstrated a median relapse free survival of more than 1 year (425 days). Clinical factors significantly associated with shorter RFS were age≥75 and baseline neutrophil counts (≥1,000 cells/µl). AML patients with prior MPN have a shorter RFS compared to other secondary AML patients. Analysis of patterns of post-relapse salvage approaches and survival is planned for future analysis. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Treatment Sequencing Strategies in Advanced Neuroendocrine Tumors: A Review.

Neuroendocrine tumor (NET) incidence has grown. The treatment landscape for advanced NETs is rapidly evolving, but there are limited head-to-head data to guide treatment sequencing decisions. We assessed the available clinical data to aid practicing clinicians in their routine clinical decision-making. Clinical trials have demonstrated efficacy benefits for new therapies in advanced NETs. Emerging long-term data from these trials have enabled clinicians to make more accurate risk-benefit assessments, particularly for patients receiving multiple lines of therapy. However, clinical data specifically regarding treatment sequencing are limited. In lieu of definitive data, treatment sequencing should be based on disease-related factors (e.g., site of tumor origin, volume of disease) and patient-related characteristics (e.g., comorbidities, patient preferences). Clinical decision-making in advanced NETs remains highly individualized and complex; important evidence gaps regarding treatment sequencing remain. Given this, advanced NET management should be a joint effort of multidisciplinary teams at referring and high-volume centers. Additional clinical trial and real-world evidence are needed to meet the challenge of understanding how to sequence available NET therapies. Until these trials are conducted, the best practices provided in this review may serve as a guide for clinicians making treatment sequencing decisions based on the available data.

Pathologic Outcomes in Single Versus Multiple Areas of Architectural Distortion on Digital Breast Tomosynthesis.

BACKGROUND. Digital breast tomosynthesis (DBT) has led to increased detection of architectural distortion (AD). Management of patients with multiple areas of AD is not established. OBJECTIVE. The purpose of this article is to compare pathologic outcomes between single and multiple areas of AD identified on DBT. METHODS. This retrospective study included 402 patients (mean age, 56 years) who underwent image-guided core needle biopsy of AD visualized on DBT between April 7, 2017, and April 16, 2019. Patients were classified as having a single or multiple areas of AD according to the presence of distinct areas of AD described in the clinical radiology reports. The pathologic diagnosis for each AD was on the basis of the most aggressive pathology identified on either biopsy or surgical excision, if performed. Patients with single and multiple areas of AD were compared. RESULTS. The sample included 372 patients with a single AD (145 benign, 121 high risk, 105 malignant, one other) and 30 patients with multiple visualized ADs, including 66 biopsied ADs (10 benign, 35 high risk, 21 malignant). At pathologic assessment on a per-lesion basis, multiple compared with single ADs showed higher frequency of high-risk pathology (53.0% vs 32.5%, p = .002) but no difference in frequency of malignancy (31.8% vs 28.2%, p = .56). In multivariable analysis of a range of patient-related characteristics, the presence of single versus multiple areas of AD was not independently associated with malignancy (p = .51). In patients with multiple areas of AD, the most aggressive pathology (benign, high risk, or malignant) across all ADs was not associated with the number of ADs (p = .73). In 8 of 24 patients with at least two ipsilateral biopsied ADs, the ipsilateral areas varied in terms of most aggressive pathology; in 5 of 10 patients with contralateral biopsied ADs, the contralateral areas varied in most aggressive pathology. CONCLUSION. The presence of multiple areas of AD, compared with a single AD, was significantly more likely to yield high-risk pathology but was not significantly different in yield of malignancy. In patients with multiple ADs, multiple ipsilateral or contralateral ADs commonly varied in pathologic classification (benign, high risk, or malignant). CLINICAL IMPACT. These findings may help guide management of AD visualized by DBT, including multiple ADs. For patients with multiple areas of AD, biopsy of all areas may be warranted given variation in pathologic diagnoses.

Comparison of Clinical-related Characteristics of Endodontic Patients Before and During the COVID-19 Pandemic

Objective: To compare patient-related and clinical-related characteristics of endodontic patients, before and during the COVID-19 pandemic.&#x0D; &#x0D; Methods: The study population comprised 506 patients (teeth: n=674) aged 13–81 years who attended undergraduate dental clinics in the Endodontics Department of the Faculty of Dentistry at Biruni University for endodontic treatment. Patient-related and clinical-related data were compared at two time intervals: before the first COVID-19 case was reported in Turkey and after the first COVID-19 case was reported in Turkey&#x0D; &#x0D; Results: There were no significant differences in terms of age and sex of the patients attending the clinics before versus during the pandemic. The incidence of reported pain before the pandemic was significantly lower than that reported during the pandemic (p=0.041). Periapical health before the pandemic was significantly better than that during the pandemic (p

Liposomal amphotericin B exposure in critically ill patients: a prospective pharmacokinetic study.

Liposomal amphotericin B (L-AmB) is a broad-spectrum antifungal drug. Little is known about its pharmacokinetics (PK) in critically ill patients. The aim of this study was to document the PK of L-AmB in this population. It was also explored if covariates may be identified that influence its exposure. All adult, critically ill patients (at the intensive care unit or hematology ward) treated with L-AmB between October 2016 and January 2020 were eligible for this study. The administered dose was left at the discretion of the treating clinician. Plasma samples were collected at predose and 1, 2, 4, 8, 12, 16, 20 and 24h postdose at an early (day 2-3) and/or later (≥ day 6) treatment day. Additionally, daily trough concentrations were collected until day 14. Of 33 included patients, 31 were evaluable; their median [IQR] age and body weight was 59 [54-64] years and 68 [59-77] kg, respectively. L-AmB was administered at doses between 2.7mg/kg and 12.3mg/kg, with a median [IQR] trough concentration of 3.1 [2.0-4.7] mg/l. The overall median area under the 24 h concentration-time curve (AUC0-24) and peak plasma concentration (Cmax) were 169.0 [117.0-253.0] mg h/l and 23.2 [16.9-33.7] mg/l, respectively. A considerable intra- and interpatient PK variability for Cmax and AUC0-24 was observed but no explaining variables, except the administered dose, could be identified. The PK of L-AmB in critically ill patients was documented. A considerable variability in exposure was observed between and within patients; however, it was not associated with a multitude of patient-related characteristics.

P08.06.A Work resumption following lower-grade glioma surgery: a multicenter cohort study

Abstract Background Patients with lower-grade glioma (LGG) are often of working age. For LGG patients post-surgical work resumption is at risk from treatment including resective surgery. However, little is known on determinants of returning to work. In this study we examined determinants of post-surgical work resumption after nine months using patient- and tumor-related characteristics, such as tumor and resection cavity locations. Material and Methods This retrospective multicenter cohort study included adults with supratentorial WHO grade II and III gliomas who underwent a first-time surgery in Paris, Munich or Amsterdam between 2011 and 2016. Patient-related characteristics included age, sex, patient condition, received treatments, classification of work type and skill level. Presurgical tumors and postsurgical resection cavities were manually segmented on MRI and registered to standard brain space. These segmentations were mapped to Schaefer, XTRACT and Harvard-Oxford atlas parcellations of cortical, white matter and grey nuclei structures. Predictors of postsurgical return to work were examined in multivariable logistic regression and Bayesian hurdle regression models. Results The cohort consisted of 219 patients. Before surgery 192 (88%) patients were able to work, and after surgery 119 (62%) resumed work. Independent predictors of returning to work were male sex (OR = 3.21, CI = 1.44 - 7.46, p = 0.005) and lower age (per 1 year older, OR = 0.96, CI = 0.92 - 0.99, p = 0.029). No associations were found between work resumption and locations of the tumor or resection cavity. Conclusion Many patients are able to work before and many return to work after first-time LGG surgery. Inability to resume work is exclusively associated with patient-related characteristics and not with tumor or resection locations. This novel information may inform patient counseling.

P11.37.B When to resect or biopsy for patients with supratentorial glioblastoma: a multivariable prediction model

Abstract Background The prospects of a patient with suspected glioblastoma may rely heavily on the indication for surgical resection versus biopsy only. Biopsy percentages vary considerably across hospitals and guidelines for treatment of glioblastoma lack criteria for surgical decision-making. To identify patient and tumor characteristics associated with the decision to resect or biopsy a glioblastoma and to develop and validate a prediction model for decision support. Material and Methods Clinical data and pre-operative MRI scans were collected for adults who underwent first-time surgery for supratentorial glioblastoma from a registry-based cohort study of 12 hospitals from the Netherlands, Germany, France, Italy, and the United States between 1st of January 2007 and 31st of December 2011. The main outcome was the type of surgical procedure: surgical resection or biopsy only. Predictors were patient- and tumor-related characteristics. Radiological factors were extracted from MRI using an automated tumor segmentation method. A prediction model was constructed using multivariable logistic regression analysis. The model was cross-validated and externally validated with a leave-one-hospital-out approach. Results Out of 1053 patients treated for glioblastoma, 28% underwent biopsy only. Biopsy rates varied from 15-40% across hospitals. The prediction model showed excellent discrimination with an average area under the curve of 0.86. Of the patient-related characteristics, younger age was associated more with resection and Karnofsky Performance Score of 60 or less with biopsy. Of the tumor-related characteristics, a location in the right hemisphere, unifocality, no tumor midline crossing, and no involvement of the cortical spinal tract, were associated with resection, as well as a high expected resectability index, a location in the right occipital lobe, and a higher percentage of tumor in Schaefer’s dorsal or ventral attention, limbic, and default networks. External validation proved acceptable to outstanding discrimination with areas under the curve ranging between 0.79 and 0.92 for hospitals. Conclusion A prediction model is presented and validated to support the decision to resect or to biopsy a patient with a suspected supratentorial glioblastoma. In this prediction model, tumor-related characteristics were more informative than patient-related factors. This may support surgical decision-making for individual patients, or facilitate comparisons of patient cohorts between surgeons or institutions.

Identifying Patient Satisfaction Determinants in Hemodialysis Settings: A Systematic Review.

PurposePatient satisfaction is a measure of care quality that assists providers in determining the effectiveness of their services while meeting patients’ expectations. This study aimed to review existing studies that have focused on patients’ satisfaction determinants in Hemodialysis (HD) settings.MethodsElectronic databases (PubMed, ScienceDirect, Scopus, and Google Scholar) were searched from 2000 onwards to identify studies using search terms related to patient satisfaction and hemodialysis centers. Article review was limited to studies written in English. A total of 19 articles were included by following the PRISMA statement. Data were extracted using a structured form and summarized in a tabular format to identify different determinants that showed a relationship with patient satisfaction. Determinants were classified into provider-related determinants and patient-related characteristics.ResultsProvider-related determinants of patient satisfaction in HD centers include staff, facility, service, and treatment. Patient-related characteristics associated with satisfaction include demographics and health status history. Based on this systematic review, key correlates of patient satisfaction in hemodialysis centers include: staff, facility, service, treatment, patient’s demographics, and health status.ConclusionThe findings of this study can help healthcare facilities in taking measures in line with the specified determinants to enhance patient satisfaction and improve the organizational performance of the healthcare centers. It is important to constantly study and improve these determinants based on patient feedback to improve patient satisfaction and quality of care.

Satisfaction With Telehealth Among Patients With Irritable Bowel Syndrome During COVID-19: Cross-Sectional Survey Findings.

INTRODUCTION:Coronavirus disease 2019 rapidly shifted health care toward telehealth. We assessed satisfaction with and preferences for telehealth among patients with irritable bowel syndrome (IBS).METHODS:We conducted a cross-sectional survey in an integrated healthcare system in Southern California with members aged 18–90 years with an International Classification of Diseases 9 and 10 codes for IBS from office-based encounters between June 1, 2018, and June 1, 2020. Eligible patients were emailed a survey assessing telehealth satisfaction overall and by patient-related factors, IBS characteristics, health and technologic literacy, utilization, and coronavirus disease 2019 perceptions. We identified perceived telehealth benefits and challenges. Multivariable logistic regression identified predictors of telehealth dissatisfaction.RESULTS:Of 44,789 surveys sent, 5,832 (13.0%) patients responded and 1,632 (3.6%) had Rome IV IBS. Among 1,314 (22.5%) patients with IBS and prior telehealth use (mean age 52.6 years [17.4]; 84.9% female; and 59.4% non-Hispanic White, 29.0% Hispanic, and 5.6% non-Hispanic Black), 898 (68.3%) were satisfied, 130 (9.9%) were dissatisfied, and 286 (21.8%) felt neutral. In addition, 78.6% would use telehealth again. Independent predictors of telehealth dissatisfaction include social media use of once a week or less (adjusted odds ratio [OR] = 2.1; 1.3–3.5), duration of IBS for <1 year (adjusted OR = 8.2; 1.9–35.8), and willingness to travel 60 plus minutes for face-to-face visits (adjusted OR = 2.6; 1.4–3.7). Patients' main concern with telehealth was a lack of physical examination.DISCUSSION:Most of the patients with IBS are satisfied with telehealth. Shorter duration of IBS diagnosis, comfort with technology, and increased willingness to travel were associated with telehealth dissatisfaction. These predictors may help identify a target population for a focused IBS-telehealth program.

Imaging features of radiation-induced lung disease and its relationship with clinical and dosimetric factors in breast cancer patients.

The aim is to extensively evaluate imaging features of radiation induced lung disease in breast cancer patients and to determine the relationship of imaging alterations with dosimetric parameters and patient related characteristics. A total of 76 breast cancer patients undergoing radiotherapy (RT) were studied retrospectively by case notes, treatment plans, dosimetric parameters, and chest computed tomography (CT) scans. Time intervals, that chest CT scans were acquired, were grouped as 1-6 months, 7-12 months, 13-18 months and more than 18 months after RT. Chest CTs (one or more for each patient) were assessed for the presence of ground glass opacity, septal thickening, consolidation/patchy pulmonary opacity/alveolar infiltrates, subpleural air cyst, air bronchogram, parenchymal bands, traction bronchiectasis, pleural/subpleural thickening and pulmonary volume loss. These alterations were scored by applying a system devised by Nishioka et al. Nishioka scores were analyzed for the relationship with clinical and dosimetric factors. IBM SPSS Statistics for Windows, version 22.0 (IBM Corp., Armonk, N.Y., USA) was used to analyze data. Median follow-up time was 49 months. Advanced age and aromatase inhibitor intake were correlated with higher Nishioka scores for 1-6 months' period. However, both were found nonsignificant in multivariate analysis. Nishioka scores of CT scans acquired more than 12 months after RT were positively correlated with mean lung dose, V5, V20, V30, and V40. Receiver operating characteristic analysis revealed that V5 for ipsilateral lung was the most robust dosimetric parameter predicting chronic lung injury. V5 >41% indicates the development of radiological lung changes. Keeping V5 ≤41% for ipsilateral lung could provide avoiding chronic lung sequelae.

IgG4-related hypertrophic pachymeningitis with tumor-like intracranial and intracerebral lesions

ObjectiveIgG4-related hypertrophic pachymeningitis is a rare fibroinflammatory disorder that may cause localized or diffused thickening of the dura mater. Misinterpretations of the clinical and imaging findings are common. Clinical manifestations depend on the location of the inflammatory lesion and on compression of neural structures leading to functional deficits. A dural biopsy is commonly needed for a definitive diagnosis. Immunomodulatory therapy is considered the therapy of choice.MethodsFour patients with IgG4-related hypertrophic pachymeningitis were identified over a 5-year period. Patient-related characteristics including age, preoperative workup, signs and symptoms of patients, and diagnostic procedures were evaluated. Furthermore, the surgical treatment and 5-year follow-up outcomes were analyzed.ResultsThere were two adults and two adolescents (mean age 32 years; range 15 to 67 years). Two patients were male, and two were female. No history of disease was known in any of the patients. Clinical symptoms were epilepsy (n = 2), ataxia and nausea (n = 1), and facial nerve palsy (n = 1). MR imaging studies showed contrast enhancing lesions in the temporal region in two patients, and in the cerebellar region in the other two patients. Subtotal resection was performed in two instances and a biopsy via a suboccipital retrosigmoid approach was obtained in the other two patients. Histochemical and immunohistochemical investigations revealed an IgG 4 disease in all of these patients. Immunomodulatorry therapy led to clinical stability during follow-up of 5 years in all four cases.ConclusionThe diagnosis of IgG4-related hypertrophic pachymeningitis is challenging, but is of great relevance as treatment differs significantly from other forms of pachymeningitis and a specific therapeutic approach may avoid long-term neurological complications. Our series contributes to a better clinical characterization of this rare disease.

Retrospective analysis of healthcare disparities in Philadelphia chromosome-positive ALL: A single-institution experience of a large metropolitan area.

12067 Background: Philadelphia chromosome-positive (Ph+) ALL is an aggressive hematological neoplasm with a dismal prognosis. Hematopoietic stem cell transplant (HSCT) remains the standard of care for those reaching complete remission due to high relapse rates with conventional therapy alone. We have previously demonstrated findings concerning for imbalanced outcomes among racial groups in AML. In the era of TKIs targeting BCR-ABL1 in combination with conventional therapy, it is unclear whether trends noted in AML are also seen in Ph+ ALL. Thus, the purpose of this study was to investigate the impact of healthcare disparities on outcomes in Ph+ ALL with regards to access to care, response rates, toxicities, and overall outcomes. Methods: We retrospectively analyzed 59 patients with Ph+ B-ALL treated at our institution with TKIs +/- chemoimmunotherapy during January 2015 to January 2021. Baseline patient demographics were obtained, including insurance type, performance status at diagnosis, cytogenetic and molecular profiling, dates and doses of induction, toxicity, response, MRD analysis, and HSCT access and outcomes. Race was determined by patient self-report as recorded in the electronic medical record. Results: We divided 58 patients (one excluded as race was unknown) into two cohorts: 23 (39.7%) patients that identified as minorities, including African American, Hispanic/Latino, and Asian, and 35 (60.3%) identifying as White. There were no differences in baseline characteristics including age (p =.367), sex (p =.788), ECOG at diagnosis (p =.438), Charlson Comorbidity Index scores (p =.551), or presence of additional poor-prognostic mutations (p &gt;.999). Despite this, minorities were significantly more likely to be treated with lower-intensity regimens compared to non-minorities (p =.022). Achievement of CR by MRD was approaching statistical significance favoring the non-minority cohort (60.0% versus 27.3%, p =.055). Receipt of HSCT numerically favored the non-minority cohort, approaching statistical significance (54.3% versus 26.1%, p =.056). At a median follow-up time of 3.3 y., the median OS was not reached between the two groups and there was no difference in survival between the two groups (p =.662). Conclusions: Despite similar patient-related characteristics, minority populations are more likely to be treated with lower-intensity strategies, concerning for bias in regimen selection. Achievement of CR by MRD and receipt of HSCT appeared to be numerically lower in the minority cohort. While there appeared to be no difference between the two cohorts with regards to survival during the follow-up period, it is unclear if this would be maintained with longer follow-up. These findings highlight the need for ongoing vigilance regarding physician biases and increasing the need for improving access to curative treatment for all patients.

243 Mood disorder affects age at onset of adult-onset cervical dystonia

IntroductionMood disorder is common in cervical dystonia (CD) and may precede the onset of dystonia. There is controversy as to whether mood disorder is part of the primary process or secondary to the disability.We assessed the characteristics of CD patients in relation to a past history of mood disorder.MethodsWe collected demographic data, medical history of mood disorder, and prospectively measured prevalence of mood disorder using the BAI and BDI.ResultsIn 193 patients (128 women and 65 men) mean age at onset of CD was 43.9 years with mean duration, 17.5 years. Men had earlier age at onset of CD than women(p=0.0037). 53/128 (41%) women with a history of a mood disorder had a significantly earlier median age at onset than 75/128 (59%) women without a history of mood disorder (p=0.005). 33(26%) women with mood disorder prior to CD also had an earlier age at onset than the 75(59%) without such a history (p=0.0154). A history of mood disorder was more common in women(41%) than men(31%). 54/128(42%) women and 21/65(32%) men had current mood disorder symptoms.ConclusionsThe significant differences in the age at onset in women with, and without, a history of mood disorder strongly indicates that anxiety and depression are primary non-motor (and premotor) symptoms of CD.ihedinachindukwe@gmail.com

Predicting unplanned hospital readmission in palliative outpatients (PRePP) \u2013 study protocol of a longitudinal, prospective study to identify informal caregiver-related and structural predictors

BackgroundAlthough the majority of German patients in a palliative state prefer to die at home, the actual place of death is most often a hospital. Unplanned hospital readmissions (UHA) not only contradict most patients’ preferences but also increase the probability of an aggressive end-of-life treatment. As limited knowledge is available which factors contribute to an UHA, the PRePP-project aims to explore predictors related to informal caregivers (IC) as well as medical and structural factors.MethodsThis prospective, observational, mono-centric study will assess structural and medical factors as well as ICs’ psychological burden throughout seven study visits. Starting in April 2021 it will consecutively include 240 patients and their respective IC if available. Standardized measures concerning ICs’ Quality of Life (WHOQOL-BREF), psychological distress (NCCN-Distress Thermometer), anxiety (GAD-7) and depressiveness (PHQ-9) will be assessed. If participants prefer, assessment via phone, browser-based or paper-based will be conducted. Medical records will provide routinely assessed information concerning patient-related characteristics such as gender, age, duration of hospital stay and medical condition. Nurse-reported data will give information on whether hospitalization and death occurred unexpectedly. Data will be progressed pseudonymized. Multivariable regression models will help to identify predictors of the primary endpoint “unplanned hospital admissions”.DiscussionThe PRePP-project is an important prerequisite for a clinical risk assessment of UHAs. Nevertheless, it faces several methodological challenges: as it is a single center study, representativity of results is limited while social desirability might be increased as the study is partly conducted by the treatment team. Furthermore, we anticipated an underrepresentation of highly burdened participants as they might refrain from participation.Trial registrationThis study was retrospectively registered 19 October 2021 at clinicaltrials.gov (NCT05082389). https://clinicaltrials.gov/ct2/show/NCT05082389

How are patient-related characteristics associated with shared decision-making about treatment? A scoping review of quantitative studies

ObjectivesTo identify what patient-related characteristics have been reported to be associated with the occurrence of shared decision-making (SDM) about treatment.DesignScoping review.Eligibility criteriaPeer-reviewed articles in English or Dutch reporting on associations...