Patients Research Articles

Evaluation and Outcomes of Iatrogenic Oropharyngeal Dysphagia.

To investigate the outcomes of iatrogenic oropharyngeal dysphagia and compare them with outcomes from different types of dysphagia aetiologies. Retrospective analysis. This study was conducted on patients evaluated at a tertiary hospital's Swallowing Disorder Center using physical examination and fibreoptic endoscopic evaluation of swallowing (FEES) between January 2015 and October 2021. Patients were divided into six groups according to the potential cause of dysphagia: (1) Post head and neck cancers (HNCs) treatment; (2) Post-surgery for non-cancerous aetiology; (3) Neurological; (4) Intracranial; (5) Head and neck pathology; and (6) Others. Of these, the first and second groups comprise dysphagia caused by treatment (iatrogenic dysphagia). FEES results were analysed using the Swallowing Performance Status Scale (SPSS) and the Penetration Aspiration Scale (PAS). Of the 507 patients included, 146 (28.8%) had iatrogenic dysphagia, and 361 (71.2%) had non-iatrogenic dysphagia. After swallowing therapy, 138 patients underwent a follow-up FEES examination (47 patients with iatrogenic dysphagia and 91 patients with non-iatrogenic dysphagia). After swallowing intervention (compensatory technique and food consistency changes), the follow-up FEES examination revealed significant improvement in the non-iatrogenic group (p < 0.001), while the iatrogenic group showed no significant improvement after intervention. PAS and SPSS scores also demonstrated greater improvement in the non-iatrogenic group. This study emphasises that iatrogenic dysphagia is a common entity in the swallowing disorders outpatient ENT clinic. It is more likely to persist and resist conventional swallowing therapy, leading to worse outcomes compared to non-iatrogenic dysphagia.

Externally validated digital decision support tool for time-to-osteoradionecrosis risk-stratification using right-censored multi-institutional observational cohorts.

Externally validated digital decision support tool for time-to-osteoradionecrosis risk-stratification using right-censored multi-institutional observational cohorts.

One-year evaluation of rotational stability and visual outcomes following horizontal, vertical, and oblique implantation of ICL V4c

BackgroundTo evaluate and compare the rotational stability and visual outcomes of Implantable Collamer Lens (ICL) V4c implantation in horizontal, vertical, and oblique orientations and to identify risk factors contributing to postoperative lens rotation.MethodsIn this retrospective study, 502 eyes of 265 patients who underwent ICL V4c implantation for myopia correction were analyzed. Patients were categorized into three groups based on implantation orientation: horizontal, vertical, or oblique. Preoperative parameters included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), intraocular pressure (IOP), manifest refraction spherical equivalent (MRSE), axial length (AL), anterior chamber depth (ACD), white-to-white (WTW) distance, and sulcus-to-sulcus (STS) measurements. Postoperative evaluations were conducted at 1 year and included UDVA, CDVA, MRSE, IOP, vault measurements, and rotational angles of the ICL. Logistic regression analysis was performed to determine risk factors associated with significant ICL rotation (> 5°).ResultsAll three groups achieved excellent visual outcomes, with 100% of cases attaining postoperative UDVA equal to or better than preoperative CDVA. No statistically significant differences were observed among the groups in terms of postoperative MRSE, IOP, or vault measurements. Although the mean rotational angles were comparable across the groups, the oblique implantation group demonstrated a higher incidence of rotations exceeding 5° compared to the horizontal and vertical groups. Furthermore, larger WTW distances were identified as a significant risk factor for increased rotational instability in the oblique group.ConclusionsICL V4c implantation is a highly effective procedure for myopia correction, providing excellent visual outcomes regardless of implantation orientation. However, oblique implantation, particularly in eyes with larger WTW distances, is associated with a higher risk of postoperative rotational instability. Careful consideration of WTW measurements may help minimize rotational risks in such cases.

Assessing the cost of illness of RSV and non-RSV acute respiratory infections in Nepali children.

Low- and middle-income countries (LMICs) bear the greatest burden of the global respiratory syncytial virus (RSV) morbidity and mortality, but lack cost data to evaluate the health-economic impact of RSV burden on families, the healthcare system, and society. This prospective observational study was performed by the RSV GOLD III - Health Economic Research Group and estimated the costs associated with RSV illness in Nepal. We collected healthcare resource utilisation data from children <2 years old fulfilling the World Health Organization (severe) acute respiratory infections ((S)ARI) case definition over one local respiratory season (July to November 2023) at two public hospitals in Nepal. We used hospital records and caregiver interviews to collect direct medical, direct non-medical, and indirect cost data to generate total per-patient costs. We included 730 patients with a mean age of 6.8 (standard deviation = 5.8) months. RSV infection was confirmed in 72.6% of the inpatients (n/N = 469/646) with SARI. The mean total cost per RSV episode was USD 43 (95% confidence interval (CI) = 25-62) for non-severe, USD 312 (95% CI = 293-332) for severe, and USD 664 (95% CI = 381-947) for life-threatened patients. Of the total costs, the healthcare system incurred USD 16 (36.3%), USD 58 (18.6%), and USD 57 (8.6%) in each category of illness. Household-level costs were 1.4% (USD 19) of the country's gross domestic product per capita for non-severe, 15.1% (USD 200) for severe, and 35.7% (USD 472) for life-threatened patients, with costs for inpatients often reaching catastrophic levels. Our findings show a significant healthcare and economic burden of RSV illness in Nepal, highlighting the need to prioritise RSV prevention strategies. Our cost burden data can inform the modelling of costs and benefits of future RSV interventions in Nepal.

Inpatient and Outpatient Palliative Care Utilization Rates of Patients with Spine Metastases.

Retrospective review. Specialty Palliative Care (PC) can be instrumental in improving patient quality of life for patients with spine metastasis. It is important to identify disparities in access to PC to ensure that equitable care is provided to all patients. No prior study has assessed the impact of sociodemographic and treatment factors on the utilization of in-patient PC (IPPC) and outpatient PC (OPPC) in patients with spine metastases. We examined IPPC and OPPC utilization in a cohort of 265 patients seen by our institution's Brain and Spine Metastases Tumor Board (BSMTB) between February 1, 2018, and February 31, 2020. Statistical analyses were performed comparing characteristics and outcomes between patients who did or did not utilize IPPC and/or OPPC. We observed no difference in rates of IPPC and OPPC consultation between patients across gender or race. Outpatient PC consultations varied across insurance and primary tumor type (P=0.056 and P=0.025, respectively). Patients who received surgical intervention or radiation therapy within 30 days of being presented at BSMTB had higher rates of OPPC utilization than those who did not (P=0.0032 and P=0.040, respectively). Patients who received an IPPC consult had worse overall survival than patients who did not consult IPPC (6.5mo vs. 24.2mo median survival) while those seen by OPPC had less of a survival disadvantage; median survival for OPPC was 11.2 months versus 19.2 months for those who were not seen by OPPC. We identified differences in PC utilization across insurance and primary tumor type. Additionally, we present the unique finding that patients who receive surgery or RT for their spine metastases had higher rates of OPPC consultations than those who did not. Further work is needed to better appreciate PC utilization trends and identify interventions that improve the accessibility of PC.

Myringoplasty and Myringoplasty with Cortical Mastoidectomy in Dry Ear: 60 Comparison of Surgical Outcome

Background: Chronic suppurative otitis media (CSOM) is one of the most common diseases of younger age in middle class population of the developing countries which causes significant impact in speech, cognitive, educational and psychological development in children and hearing impairment and recurrent ear discharge in adult. Aim: To identify the difference of graft take rate and hearing gain in the treatment of CSOM by myringoplasty and myringoplasty with cortical mastoidectomy in dry ear. Methods: Randomized controlled trial was conducted in the Department of Otolaryngology – Head &amp; Neck Surgery, Dhaka Medical College Hospital, Dhaka from July 2018 to December 2019 with 54 patients having inactive mucosal COM. Total 54 patients age ranging from 15 to 55 years were taken. Group A: 27 of the patient were done myringoplasty and Group-B: 27 patient were done myringoplasty with cortical mastoidectomy. Postoperative follow up was given on 7th day, 2 weeks, 6 weeks and 3 months postoperatively. PTA was done to every patient 3 months postoperatively and hearing gain was compared between two groups. Results: Graft take rate was 22(81.48%) and hearing gain was 8.48(±6.83) dB in 27 patients of group-A and 24(88.89%) and 10.61 (±12.25) dB respectively in 27 patients of group-B. No statistically significant difference was found between two groups. Conclusion: Cortical mastoidectomy performed in inactive mucosal COM in this study gives no statistically significant benefit over myringoplasty alone as regards graft take rate and hearing improvement. Bangladesh J Otorhinolaryngology 2024; 30 (2): 58-67

Triglyceride-glucose index and prognosis in non-diabetic critically ill patients: data from the eICU database

BackgroundThe triglyceride-glucose (TyG) index is a marker for insulin resistance (IR) linked to diabetes complications and poor outcomes. Its connection to all-cause mortality in non-diabetic critically ill patients is unknown. This study aims to investigate the TyG index’s impact on mortality in this population, evaluating how IR affects their prognosis.MethodsThis study is retrospective observational research utilizing data from the eICU Collaborative Research Database. A total of 14,089 non-diabetic critically ill patients were included and categorized into three groups based on the TyG index measured on the first day of admission (T1, T2, and T3). Kaplan-Meier survival analysis was performed to compare the 28-day mortality rates among the different groups. Cox proportional hazards models were used to assess the relationship between the TyG index and 28-day mortality. Additionally, we conducted sensitivity analyses, subgroup analyses, and interaction analyses to assess the robustness of the results.ResultsDuring the observation period, 730 patients (5.18%) died in the ICU, while 1,178 patients (8.36%) died in the hospital. The 28-day ICU mortality rate and hospital mortality rate significantly increased with higher TyG index values (P &amp;lt; 0.001). Cox proportional hazards models were used to assess the relationship between the TyG index and 28-day mortality. Specifically, Cox proportional hazards models were used to assess the relationship between the TyG index and 28-day mortality. Furthermore, the analysis showed a nonlinear effect of the TyG index on mortality in non-diabetic critically ill patients, with a critical point at 9.94. While Below 9.94, ICU and hospital mortality rates rose with higher TyG index values. But above 9.94, mortality didn’t significantly increase despite further rises in the TyG index. Sensitivity and subgroup analyses confirmed the robustness of these results, and E-value analysis indicated strong resistance to unmeasured confounding factors.ConclusionThe TyG index demonstrates a significant positive correlation with all-cause mortality in non-diabetic critically ill patients, exhibiting a nonlinear relationship. Consequently, the TyG index serves as a crucial tool for identifying high-risk patients, thereby assisting clinicians in formulating more effective monitoring and intervention strategies.

Liberalizing Maximum High-Flow Nasal Cannula Flow Rates in the General Inpatient Ward Is Associated With Decreased Intensive Care Admissions for Infants With Bronchiolitis

Objective: To compare the use of intensive care for infants with bronchiolitis following a policy change increasing the rate maximums for high-flow oxygen given by nasal cannula [high-flow nasal cannula (HFNC)] allowable in the inpatient (IP) ward setting. Methods: This was a retrospective pre-post cohort study at an urban, tertiary care children’s hospital. Infants without complex chronic conditions presenting to the emergency department with bronchiolitis from December 2018 to March 2019 and December 2019 to March 2020 were included in the study. In December 2019, our institution increased the allowable HFNC flow rate on IP to 2 liters per minute/kilogram. The primary outcome was patient disposition from the emergency department. Secondary outcomes were the need for IP to pediatric intensive care unit (PICU) transfer, the need for care escalation to positive airway pressure or invasive mechanical ventilation, and hospital length of stay. Results: In total, 1043 and 1104 patients were included in the 2018 to 2019 and 2019 to 2020 cohorts, respectively. Infants in the second cohort were more likely to be admitted, though this association was not significant after adjusting for patient age and triage acuity. Infants in the second cohort had a lower risk of admission to the PICU, before and after adjusting for age and triage acuity. The risk of IP-to-PICU transfer, risk of care escalation, and length of stay did not increase. Conclusions: Increasing HFNC flow rates up to 2 liters per minute/kilogram on IP wards was associated with a reduction in intensive care admission and appears safe by balancing measures of care escalation.

Incremental predictive value of liver fat fraction based on spectral detector CT for major adverse cardiovascular events in T2DM patients with suspected coronary artery disease

BackgroundThe purpose of this study was to explore the incremental predictive value of liver fat fraction (LFF) in forecasting major adverse cardiovascular events (MACE) among patients with type 2 diabetes mellitus (T2DM).MethodsWe prospectively enrolled 265 patients with T2DM who presented to our hospital with symptoms of chest distress and pain suggestive of coronary artery disease (CAD) between August 2021 and August 2022. All participants underwent both coronary computed tomography angiography (CCTA) and upper abdominal dual-layer spectral detector computed tomography (SDCT) examinations within a 7-day interval. Detailed clinical data, CCTA imaging features, and LFF determined by SDCT multi-material decomposition algorithm were meticulously recorded. MACE was defined as the occurrence of cardiac death, acute coronary syndrome (ACS), late-phase coronary revascularization procedures, and hospital admissions due to heart failure.ResultsAmong 265 patients (41% male), 51 cases of MACE were documented during a median follow-up of 30 months. The LFF in T2DM patients who experienced MACE was notably higher compared to those without MACE (p < 0.001). The LFF was divided into tertiles using the cutoffs of 4.10 and 8.30. Kaplan-Meier analysis indicated that patients with higher LFF were more likely to develop MACE, regardless of different subgroups in framingham risk score (FRS) or coronary artery calcium score (CACS). The multivariate Cox regression results indicated that, compared with patients in the lowest tertile, those in the second tertile (hazard ratio [HR] = 3.161, 95% confidence interval [CI] 1.163–8.593, P = 0.024) and third tertile (HR = 4.372, 95% CI 1.591–12.014, P = 0.004) had a significantly higher risk of MACE in patients with T2DM. Even after adjusting for early revascularization, both LFF tertile and CACS remained independently associated with MACE. Moreover, compared with the traditional FRS model, the model that included LFF, CACS, and FRS showed stable clinical net benefit and demonstrated better predictive performance, with a C-index of 0.725, a net reclassification improvement (NRI) of 0.397 (95% CI 0.187–0.528, P < 0.01), and an integrated discrimination improvement (IDI) of 0.100 (95% CI 0.043–0.190, P < 0.01).ConclusionsThe elevated LFF emerged as an independent prognostic factor for MACE in patients with T2DM. Incorporating LFF with FRS and CACS provided incremental predictive power for MACE in patients with T2DM.Graphical abstractResearch insightsWhat is currently known about this topic?T2DM is associated with increased MACE rates, underscoring the need for improved risk prediction. CACS is a well-established tool for MACE risk assessment but may not capture all risk factors. Hepatic steatosis is a common comorbidity in metabolic syndrome and T2DM.What is the key research question?Does the incorporation of LFF derived from SDCT into existing risk prediction models enhance the accuracy of MACE forecasting in patients with T2DM?What is new?SDCT-LFF measurement introduces a more accurate method for assessing hepatic steatosis. LFF as an independent predictor of MACE in T2DM patients is a novel finding. The study presents LFF as an additional tool for risk stratification, complementing FRS and CACS.How might this study influence clinical practice?Study findings may guide personalized prevention for T2DM patients at higher MACE risk.

Effects of early inpatient rehabilitation on hospital readmission among patients with lower limb amputation due to diabetes mellitus: a retrospective cohort study

Purpose This study examined the impact of inpatient rehabilitation in acute care hospitals on hospital readmission in patients undergoing lower limb amputation (LLA) due to diabetes mellitus (DM) using propensity score analysis. Materials and methods This retrospective cohort study utilized the JMDC database. Patients who underwent transtibial and transfemoral amputation with DM as the reason for admission or comorbidity were included. Patients were divided into the rehabilitation group (started rehabilitation within 14 days of admission) and the non-rehabilitation group (did not receive rehabilitation within 14 days of admission). The primary outcomes were hospital readmission within 30 and 60 days post-discharge. Results Overall, 594 patients were analyzed, with 481 receiving inpatient rehabilitation. After inverse probability weighting (IPW) adjustment, the rehabilitation group had a significantly longer hospital stay than the non-rehabilitation group (rehabilitation: 69.1 [53.4], non-rehabilitation: 39.9 [30.4] days, p < 0.01). Following IPW adjustment, rehabilitation was significantly associated with lower readmission within 30 (OR = 0.519, 95% CI = 0.368–0.734, p < 0.01) and 60 days (OR = 0.673, 95% CI = 0.495–0.913, p = 0.011). Conclusions Early inpatient rehabilitation may be one way to reduce the risk of hospital readmission for patients with LLA due to DM.

Developing Implementation Strategies for the Adoption of the Enhanced Recovery After Surgery (ERAS) Protocols: A Co‐Design Study

ABSTRACTBackgroundThe clinical effectiveness of Enhanced Recovery After Surgery (ERAS) protocols in reducing length of stay and postoperative complications is well established. Yet, the uptake of these protocols remains variable in many healthcare settings.MethodsWe used the Generative Co‐Design Framework for Healthcare Innovation to design and deliver strategies to implement ERAS protocols at one Australian tertiary hospital. Co‐design groups included surgeons, anaesthetists, perioperative and surgical nurses, and health consumers with previous surgery experience. Two workshops with co‐designers were held over 4 months. Textual data derived through workshop artefacts and discussions were analysed inductively. Then, subcategories representing implementation strategies were deductively mapped to the level they primarily target, individual, team and organisation. Finally, using a consensus‐building approach, the top two implementation strategies were ranked across each group.ResultsIn total, 36 practitioners across perioperative, ward, surgery and anaesthetics and 4 consumers participated in the co‐design sessions. Through the analysis, 16 implementation strategies were identified, and half of these were aimed at the organisational level. Strategies ranked in the top two commons across all groups of practitioners included reviewing clinical pathways and processes. Consumers believed receiving patient education about ERAS, including its risks and benefits, was essential.ConclusionOur findings underscore the intricate nature of coordinating diverse stakeholders in co‐design processes. Despite the challenges this may present, it provides valuable insights and promotes consensus‐driven solutions, ultimately strengthening the implementation of ERAS initiatives.Patient or Public ContributionConsumers were involved in the co‐design process and were co‐researchers.

Racial Differences in Survival and Healthcare Resource Utilization Among Medicaid-Insured Adults With Metastatic Prostate Cancer.

Racial Differences in Survival and Healthcare Resource Utilization Among Medicaid-Insured Adults With Metastatic Prostate Cancer.

Dispensing Patterns of Inhaled Asthma Medication Before and During COVID-19 Among Young Adults in the Netherlands: A Retrospective Inception Cohort Study.

The impact of the coronavirus disease 2019 (COVID-19) pandemic on asthma medication trajectories, including changes in medication type or dosage, remains unclear. This study compared dispensing patterns among adults who initiated asthma inhalers before pandemic (cohorts 2014 and 2017) and during pandemic (cohort 2020). We performed retrospective inception cohort study using University of Groningen IADB.nl community pharmacy dispensing database. Individuals aged 16-44 years who initiated inhaled asthma treatment in 2014, 2017, or 2020 were followed for 2 years. Treatment steps (1-5) were based on the Global Initiative for Asthma (GINA) guideline. Primary outcomes included time to treatment step switch (step-up or step-down) and time to first oral prednisolone/prednisone, and were compared between cohorts using Cox regression models. In 2014, 2017 and 2020, 1193, 960 and 730 patients initiated asthma inhalers, respectively. In all cohorts, more than half of the patients initiated treatment at the lowest step. During 2-year follow-up, fewer patients switched their treatment steps in 2020 when compared with 2014 (adjusted hazard ratio (aHR): 0.86 (95% confidence interval (CI): 0.76-0.99). From 2014 to 2020, the likelihood of treatment stepping-down decreased over time, with a 21% in 2017 (aHR: 0.79 (0.68-0.92)) and 24% in 2020 (aHR: 0.76 (0.64-0.90)) compared to 2014, while the likelihood of stepping-up did not change significantly. The risk of taking oral prednisolone/prednisone was also significantly lower in 2020 (aHR: 0.76 (0.61-0.94)). During the pandemic, fewer asthma patients switched treatment steps and took oral prednisolone/prednisone. Since 2014, fewer individuals stepping down medication, with a decrease of 21% in 2017 and 24% in 2020. Possible drivers include improved adherence, better asthma control, and increased telemedicine use-trends that predate and have been accelerated by the pandemic. Research incorporating clinical data is necessary to confirm these hypotheses.

The relationship between platelet parameters and bacterial types in patients with bacteremia: A retrospective observational study.

To analyze the relationship between platelet parameters and bacterial types in patients with bacteremia. Data from 265 patients with positive blood bacterial cultures were collected. Clinical parameters and procalcitonin (PCT) were recorded. In 265 patients with bacteremia, gram-negative (G-) bacteria accounted for 56% of cases, and gram-positive (G +) bacteria accounted for 44% of cases. In patients with bacteremia, white blood cell counts (WBC), neutrophil counts (NEUT), the percentage of neutrophils (NEUT%), and PCT were increased, and lymphocyte counts (LYM) and the percentage of lymphocytes (LYM%) were decreased. The differences in plateletcrit values, NEUT%, LYM%, and PCT between the G- and the G + bacteria group were significantly different. The cutoff values of PCT, platelet, plateletcrit, and NEUT% were 1.31 ng/mL, 211 × 109/L, 0.205%, and 87.41%, respectively. The incidence of thrombocytopenia was 12%. There was no significant difference in WBC, NEUT%, PCT, platelet, platelet nadir, and days of thrombocytopenia between the G- and the G + bacteria among patients with thrombocytopenia. Platelet, plateletcrit, NEUT%, and PCT are helpful for the early identification of G- and G + bacteria. The combination of PCT and hemogram parameters is more conducive to the early differential diagnosis of bacterial classification.

Evaluation of the Clinical Nursing Effects of a Traditional Chinese Medicine Nursing Program Based on Care Pathways for Patients With Type 2 Diabetes: Protocol for a Randomized Controlled Clinical Trial.

To improve the performance of health care institutions, reduce overmedication, and minimize the waste of medical resources, China is committed to implementing a clinical pathway management model. This study aims to standardize nursing practices, foster clinical thinking in nurses, and promote patient recovery. The purpose of this study is to evaluate the clinical effects of a traditional Chinese medicine (TCM) nursing program based on nursing pathways for patients with type 2 diabetes mellitus (T2DM). This study uses a prospective, randomized, single-blind, parallel-controlled design. Based on sample size calculations, the study will include 594 patients with diabetes, with 2 groups of 297 patients: an observation group will receive a TCM nursing program based on clinical pathways, while a control group will receive routine care. Both groups will be evaluated before and after the intervention using assessment indicators. The primary outcome is the quality of life score, measured by a diabetes-specific quality of life questionnaire. Secondary outcomes include hospital stay duration, medical expenses, health knowledge, blood glucose control, symptom scores, and patient satisfaction. This study was funded in August 2021 and has received approval from the Ethics Committee of Guang'anmen Hospital, China Academy of Chinese Medical Sciences (2022-022-KY-01). The trial is ongoing, with the first patient enrolled in September 2022. The study is expected to conclude in April 2025. To date, 380 patients have been recruited, with 202 randomized into the study, though no statistical analysis of the data has yet been conducted. A single-blind method is used; nurses are aware of group assignments and intervention plans, while patients remain blinded. Final results are planned for release in the first quarter of 2025. This study seeks to integrate existing national standardized nursing protocols with clinical pathways to implement more efficient and higher-quality nursing practices. The goal is to standardize nursing procedures, enhance patients' quality of life, and improve self-care and medication adherence after discharge. International Traditional Medicine Clinical Trial Registry ITMCTR2022000048; https://tinyurl.com/y4jd68h4. DERR1-10.2196/58951.

Individualized estimation of conditional survival for patients with spinal chordoma.

Unlike traditional survival analysis methods, conditional survival (CS) provides enhanced insight by offering a personalized prognosis estimation as time advances for tumor patients. This study aimed to estimate CS and devised a novel CS-nomogram for real-time prediction of 10-year CS for patients with spinal chordoma. Patients diagnosed with spinal chordoma from 2000 to 2019, as documented in the Surveillance, Epidemiology, and End Results (SEER) database, were included in this study. CS represents the likelihood of surviving an additional y years given that the patient has already survived x years. It is computed using the equation CS(x|y) = S(x + y)/S(x), where S(x) denotes the patient's survival rate at x years. The univariate Cox hazard regression, least absolute shrinkage and selection operator (LASSO) analysis and best subset regression (BSR) methods were employed for variable selection. Based on these selected factors, the CS-based nomogram and a risk classification system were developed. Finally, several approaches were used to validate the performance of our model. Between 2000 and 2019, the SEER database identified 730 patients with spinal chordoma, distributed into 510 in the training group and 220 in the validation group. CS analysis showed that patients experienced a gradual augmentation in their 10-year survival rates over the course of each additional year post-diagnosis. We also successfully created a CS-based nomogram model for forecasting 3-, 5-, and 10-year overall survival, along with 10-year CS. The CS-based nomogram incorporating age, tumor size, tumor extension, multiple primary tumors, and surgery demonstrated robust predictive capabilities. Moreover, a novel risk classification system was constructed to aid in tailored management strategies and personalized treatment decisions for spinal chordoma patients. In contrast to traditional survival assessment methods, our analysis of CS yielded more dynamic and real-time outcomes for spinal chordoma patients. Via our CS-based nomogram model and risk classification system, we have provided more precise prognostic insights for these patients, aiding in treatment planning and follow-up strategy formulation in clinical settings.

Prothrombin Complex Concentrate vs Frozen Plasma for Coagulopathic Bleeding in Cardiac Surgery

Excessive bleeding is a common and prognostically important complication of cardiac surgery. For bleeding related to coagulation factor deficiency, frozen plasma is the most used therapy. Preliminary trials indicate that 4-factor prothrombin complex concentrate (PCC) may be a suitable alternative. To compare the efficacy and safety of PCC with frozen plasma in patients undergoing cardiac surgery with coagulopathic bleeding. Unblinded randomized noninferiority controlled clinical trial at 12 hospitals in Canada and the US involving adults (≥18 years) who had developed bleeding related to coagulation factor deficiency after termination of cardiopulmonary bypass during surgery (November 30, 2022, to May 28, 2024). Final 30-day follow-up visit was completed on June 28, 2024. A total of 265 patients were randomized to receive PCC (1500 IU ≤60 kg; 2000 IU >60 kg) and 263, frozen plasma (3 U ≤60 kg; 4 U >60 kg) in the operating room. A second dose was allowed over the next 24 hours if indicated; thereafter, only frozen plasma could be used. The primary outcome was hemostatic response (effective if no hemostatic interventions occurred from 60 minutes to 24 hours after treatment initiation). The noninferiority of PCC vs frozen plasma was assessed using a 10% margin and a 1-sided α of .025, with subsequent testing for superiority if noninferiority was demonstrated. Secondary outcomes included allogeneic blood transfusions and adverse events. Patients were followed up until postoperative day 30. Of 538 enrolled patients, 420 patients (median age, 66 years [IQR, 57-73 years]; 74%, male; 10%, Asian; 1%, Black; and 65%, White) were included in the primary analysis; of those, 296 (70%) underwent complex surgeries. Compared with the 207 patients in the frozen plasma group, the 213 patients in the PCC group had higher hemostatic effectiveness (166 [77.9%] vs 125 [60.4%]; difference, 17.6%; 95% CI, 8.7%-26.4%; P < .001 for noninferiority and superiority) and had received fewer transfusions including red blood cells, platelets, and noninvestigational frozen plasma units (mean, 6.6 units; 95% CI, 5.7-7.7 vs 9.3 units; 95% CI, 8.0-10.8; difference, 2.7; 95% CI, 1.0-4.4; P = .002). Seventy-seven patients (36.2%) in the PCC group vs 98 (47.3%) in the frozen plasma group experienced serious adverse events (relative risk [RR], 0.76; 95% CI, 0.61-0.96; P = .02). Twenty-two patients (10.3%) in the PCC group and 39 (18.8%) in the frozen plasma group had acute kidney injury (RR, 0.55; 95% CI, 0.34-0.89; P = .02). In this unblinded randomized clinical trial, PCC had superior hemostatic efficacy and safety advantages to frozen plasma among patients requiring coagulation factor replacement for bleeding during cardiac surgery. ClinicalTrials.gov Identifier: NCT05523297.

Health consumers' emotional responses toward asthma videos on YouTube are influenced by time since posting, number of tags, subject of content and the emotional tone.

Social media platforms and user-generated videos have become important channels and resources for health consumers seeking information and learning about asthma management. This study examined the characteristics of asthma-related videos on YouTube, health consumers' emotional responses to these videos and explored the video attributes influencing their emotional responses and attitudes toward asthma-related content. The study employed manual subject analysis, sentiment analysis, descriptive statistical analysis and regression modelling. The most popular content categories were Treatment, Prevention and Cause & Pathophysiology. Consumer interactions confirmed interest in Treatment. The time since posting, the number of tags, the subject of content and the general tone (positive/neutral/negative) of a video influenced whether it elicited positive or negative emotions. The consumer interactions might indicate interest in a content category, but the analysis might show negative attitudes to that content. 'Sign & Symptom' content can reduce the positive emotional responses, and 'Cause & Pathophysiology' content can raise the negative emotional responses, thus reducing the consumers' expression of positive attitudes in different ways. The content priorities of video creators and health consumers differed, and keeping the emotional tone positive appears important for fostering positive emotional responses and attitudes.

From Digital Health Literacy to a Digital and Data Capabilities Approach to Sexual Health

Abstract Introduction This article presents a narrative review of scholarly literature addressing the intersection of digital technologies and sexual health, to better understand how digital literacy is currently defined and assessed in this context. It critically reflects on cross-disciplinary literature from across sexual health, digital literacy, and data literacy, to better understand the implications of emergent Australian policy agendas for sexual health workforces. Methods A narrative review of research addressing digital literacy within sexual health literature was conducted in 2022, adopting a sociotechnical approach. A search of 7 databases resulted in 30 full-text articles included for review after duplicates and unrelated results were removed. Results Current definitions of digital literacy are contradictory and at times unclear. Additionally, a consideration of data literacy for sexual health is yet to emerge. Further, literature addressing “digital literacy for sexual health,” has tended to frame literacy as a need (or deficit) for individual sexual health consumers, excluding the digital literacy of health workforces from consideration. Conclusions Drawing on recent research into data capabilities, we note that where the concept of “literacy” has historically been associated with attempts to measure and remediate individual deficits, a “capabilities” approach offers an opportunity to rethink the collective and systemic dimensions of digital and data practices for sexual health workforces and consumers alike. Policy implications Our analysis highlights the potential risk of disenfranchising and stigmatising sexual health workforces and consumers via initiatives promoting digital literacy. We endorse a holistic “capabilities approach” to digital transformation policy and infrastructure.

The outcomes of reoperation for congenital mitral valve diseases in children

BackgroundsWe aimed to study the outcomes of mitral valve (MV) reoperations in children with congenital MV diseases and to summarize our treatment experience.MethodsIn this single-center retrospective study, we enrolled 24 patients aged < 18 years who underwent MV reoperation from among 265 patients who underwent MV repair between January 2013 and July 2023. MV reoperations were based on the types of MV disease. Cox regressions were used to analyze the risk factors for death and second MV reoperation.ResultsA total of 5 patients underwent second MV reoperations. 3 patients experienced early death, and 1 experienced late death. The 3- and 5-year survival rates of the entire cohort were 86.6% ± 7.3% and 72.1% ± 14.5%, respectively. Patients who had the double-orifice MV technique applied during MV reoperation were significantly more prone to receive mechanical MV replacement (P < 0.0001). The use of double-orifice MV technique during MV reoperation was identified as an independent risk factor for second MV reoperation (HR = 8.136, 95%CI = 1.099–60.240; P = 0.040).ConclusionsThe reoperation of the MV in children with congenital MV diseases poses a formidable challenge, manifested by a high postoperative mortality rate and re-intervention rate. Patiently and meticulously repair based on the types of MV disease has demonstrated the capacity to enhance and sustain stable valve function and cardiac function in the vast majority of children. The use of the double-orifice MV technique did not achieve ideal therapeutic results in children with complex valve lesions.