Retrospective Evaluation Research Articles

Dynamics of ejaculate parameters from 2017 to 2023: a retrospective single-center analysis

Introduction: One of the most important tests to evaluate male fertility is a semen analysis. Assessment of ejaculate parameters allows to assume possible causes of male infertility and helps to determine further treatment. According to modern literature there is a slight but constant deterioration of ejaculate parameters with time.Purpose of the study: to evaluate semen analysis parameters in patients examined in one medical center.Materials and Methods: retrospective evaluation of semen analyses performed in the same laboratory from January 1, 2017 to October 31, 2023 was performed with a total of 47902 patients included. The ejaculate volume, concentration and number of spermatozoa, the proportion of spermatozoa of different categories of motility, sand the proportion of morphologically normal spermatozoa were evaluated. Statistical processing of data was performed using MS Office and SPSS v26 software packages.Results: the mean semen volume from 2017 to 2023 was 3.5 ± 1.5 mL, sperm concentration was 51.9 ± 39.3 million/mL, progressively motile spermatozoa was 48.2 ± 16.5%, number of progressively motile spermatozoa in the sample was 93.7 ± 94.3 million, motile spermatozoa 55.6 ± 17.4%, total motile spermatozoa was 107.5 ± 105.6 million, mean number of morphologically normal forms was 2.8 ± 1.4% in 2017, 2.2 ± 0.9% in 2023, and 3.5 ± 1.5% during the observation period. Mean pH of ejaculate was 7.6 ± 0.3 with noted tendency to increase (7.38 ± 0.33 in 2017, 7.6 ± 0.38 in 2023). The proportion of samples with azoospermia increased from 2.8% in 2017 to 4.5% in 2023. Mean number of patients with cryptozoospermia was 1.5%.Conclusion: there is a trend of decreasing proportion of morphologically normal spermatozoa, increasing ejaculate pH and increasing frequency of azoospermia from 2017 to 2023.

Implementation of a Parent Training Program During Community-Based Dissemination (From In-Person to Hybrid): Mixed Methods Evaluation.

Parent training interventions support and strengthen parenting practices and parent-child relationships and improve child behavior. Between March 2018 and February 2020, a community-based parenting program conducted 38 in-person Chicago Parent Program (CPP) groups. In response to the COVID-19 pandemic, we modified the delivery of the in-person CPP to hybrid delivery using the self-administered, web-based version of the CPP (ezParent) paired with web-based, videoconferenced group sessions. This study aims to describe the delivery transition and implementation outcomes of the hybrid delivery of the CPP (ezParent+group) during community-based dissemination. This single-group, mixed methods retrospective evaluation examined the implementation outcomes using the RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) framework. We report on data from hybrid ezParent delivery between September 2020 and August 2022. Parents completed pre- and postprogram surveys that included motivation to participate and perceived changes in parent-child behavior. Digital analytics captured ezParent completion. Facilitators completed fidelity assessments and participated in postintervention interviews. In total, 24 hybrid ezParent groups (n=240 parents) were delivered by 13 CPP-trained facilitators. Parents reported high levels of satisfaction with the program and improvements in their feelings of parenting self-efficacy and their child's behavior following their participation in hybrid ezParent. On average, parents completed 4.58 (SD 2.43) 6 ezParent modules. The average group attendance across the 4 sessions was 71.2%. Facilitators found the hybrid delivery easy to implement and reported high parent engagement and understanding of CPP strategies. Using the hybrid ezParent intervention is a feasible and effective way to engage parents. Lessons learned included the importance of academic and community-based organization partnerships for delivering and evaluating robust programs. Implementation facilitators and barriers and future research recommendations are discussed.

Long-Term Follow-Up of Computer-Assisted Microvascular Mandibular Reconstruction: A Retrospective Study.

Background: Virtual surgical planning has become a well-established practice in head and neck surgery. In oncological surgery, it permits the achievement of safe margins resections and ensures functional reconstructions and optimal esthetic outcomes. This study aimed to evaluate the long-term outcomes after virtually planned mandibular microvascular reconstruction, focusing on functional and esthetic results, as well as health-related quality of life. Methods: A long-term retrospective evaluation of 17 patients with oral cavity malignancy who underwent computer-assisted mandibular resection and reconstruction was performed. Functional and esthetic outcomes were analyzed using the EORTC, QLQ-C30, H&N35, and FACE-Q questionnaires. Results: Time since reconstruction ranged from 7 to 14 years. Patients reported high functional levels on the QLQ-C30 functional scales but lower scores on H&N35. On FACE-Q, patients demonstrated higher appraisal and satisfaction with their smiles compared to their overall facial appearance. Conclusions: In this retrospective case series, patients undergoing computer-assisted mandibular reconstruction for oral malignancies achieved good long-term functional and esthetic outcomes. Although limited by the small sample size, these results support the enduring benefits of virtual planning for mandibular reconstruction. To minimize declines in function and appearance, considerations should include immediate dental implants, enhanced reconstruction of the temporomandibular joint, newer methods of radiotherapy to minimize xerostomia, and oral exercises to prevent trismus.

Hair Shaft Abnormalities as a Dermoscopic Feature of Mycosis Fungoides: Pilot Results.

Diagnosis of persistent erythematous, scaly patches, or plaques can be complex since psoriasis (Ps), eczematous dermatitis (ED), and mycosis fungoides (MF) can be considered. Dermoscopy, which is a noninvasive diagnostic tool, is commonly used to examine blood vessels, scales, and background color; however, research on hair shaft evaluation in inflammatory dermatoses remains scarce. The aim of the study was dermoscopic evaluation of hair shafts in skin lesions localizedon thenon-scalp skin areas in patients diagnosed with MF, Ps, and ED. This was a retrospective evaluation of 55 patients diagnosed with MF, Ps, and ED. Photographic anddermoscopic documentation of these patients and detailed medical history were evaluated. A total of 21 patients with MF, 21 patients with Ps, and 13 patients with ED were evaluated. The examination revealed the presence of various abnormalities of hair shafts (e.g., numerouspili torti, singlepili torti, 8-shaped hairs, pigtail hairs, broken hairs, hair shafts rapidly tapered over long sections, hair shafts irregular in thickness, angulated hairs, branched hairs,the presence of trichorrhexis nodosa,and monilethrix-like hairs), yellow dots, and black dots. The presence ofpili tortiwas found in 80% of patients with MF, compared with 16% of patients with Ps and 8% of patients with ED (p < 0.005), with multiplepili tortifound only in MF patients (67%) (p < 0.005). Statistically significant differences also applied to hair shafts rapidly tapering over long sections and 8-shaped hairs, which occurred only in MF patients (p < 0.005 and p = 0.035, respectively). The presence of hair shaft abnormalities such as numerous pili torti, 8-shaped hairs, and hair shafts rapidly tapering over long sections is an important criterion that should be considered in the dermoscopic differentiation of the patchy/plaque mycosis fungoides and inflammatory dermatoses, such as psoriasis and eczematous dermatitis localizedon thenon-scalp skin areas.

Comparison of keratometry and total corneal power, as measured by an SS-OCT-based optical biometer, for intraocular lens power calculation in Asian eyes.

To investigate whether standard keratometry (K) or total corneal power (TCP) leads to more accurate refractive outcomes for intraocular lens (IOL) power calculation. Public hospital. Retrospective evaluation of a diagnostic test instrument. Preoperatively, all patients underwent optical biometry with Anterion, a swept-source optical coherence tomography device providing both K and TCP. The same IOL model was implanted in all cases. The whole sample was divided into a training dataset, used to optimize the formula constants, and a testing dataset, used to investigate the spherical equivalent prediction error (SEQ-PE) of 8 IOL power formulas. Trueness, precision, and accuracy were evaluated by means of the robust 2-sample t test. Cochran Q test was performed to assess whether the percentage of eyes with an SEQ-PE within each threshold was significantly different; in such an event, the McNemar test was then applied. Both the training and testing datasets included 317 eyes. No significant differences were detected for trueness because of constant optimization. Precision and accuracy were better when K was entered, although a statistically significant difference was observed only with the EVO (precision: P = .02 and accuracy: P = .03) and Haigis ( P < .01 for both precision and accuracy) formulas. No significant differences were observed for the percentage of eyes with an absolute SEQ-PE within any threshold. With most formulas, IOL power calculation is not more accurate when TCP is used instead of K.

Safety of robotic cholecystectomy as index training procedure: the UK experience.

To evaluate the safety profile of robotic cholecystectomy performed within the United Kingdom (UK) Robotic Hepatopancreatobiliary (HPB) training programme. A retrospective evaluation of prospectively collected data from eleven centres participating in the UK Robotic HPB training programme was conducted. All adult patients undergoing robotic cholecystectomy for symptomatic gallstone disease or gallbladder polyp were considered. Bile duct injury, conversion to open procedure, conversion to subtotal cholecystectomy, length of hospital stay, 30-day re-admission, and post-operative complications were the evaluated outcome parameters. A total of 600 patients were included. The median age was 53 (IQR 65-41) years and the majority (72.7%; 436/600) were female. The main indications for robotic cholecystectomy were biliary colic (55.5%, 333/600), cholecystitis (18.8%, 113/600), gallbladder polyps (7.7%, 46/600), and pancreatitis (6.2%, 37/600). The median length of stay was 0 (IQR 0-1) days. Of the included patients, 88.5% (531/600) were discharged on the day of procedure with 30-day re-admission rate of 5.5% (33/600). There were no bile duct injuries and the rate of conversion to open was 0.8% (5/600) with subtotal cholecystectomy rate of 0.8% (5/600). The current study confirms that robotic cholecystectomy can be safely implemented to routine practice with a low risk of bile duct injury, low bile leak rate, low conversion to open surgery, and low need for subtotal cholecystectomy.

Retrospective Evaluation of Patients Who Received Surgery as the First Option in the Treatment of Green Type 3-4 Trigger Finger

AİM: To evaluate the clinical and functional outcomes of the patients with trigger finger patients who are treated by open surgery method without applying conservative treatment modalities METHODS: Open A1 pulley surgical release under local anesthesia was applied to 67 trigger finger patients ( 45 female, 22 male, mean age 53,82, range 11-81). The mean follow-up was 38,37 months (range 4-76 months). As assosiated pathologies, there were type 2 DM in 14 and chronic renal failure in 1 patients. RESULTS: In 67 patients pain and triggering were found to be treated by open surgical A1 pulley release. No recurrence seen in triggering nodularity. Postoperatively there were no significant neurovascular complications noted CONCLUSION: As similar to literature, we believe that in the treatment of trigger finger with open surgery method is a safe and effective method and also supplies fast return to daily life. We think that the surgery may be the first choice in selected cases.

Retrospective assessment of parental attitudes versus severity of early maladaptive schemas in a non-clinical population of Polish adults – preliminary reports

Objectives: While from a developmental perspective, a secure bond with a parent is of great importance to a child's functioning, its establishment depends mainly on the caregivers and their parental attitudes – specific strategies or styles that enable the fulfilment of parental responsibilities. The objective of the presented study was to assess the correlation between the early maladaptive schemas and retrospectively assessed parental attitudes. Methods: The study involved 94 people between the ages of 18 and 64 (average age: M=34.84, SD=11.12). Each participant completed a set of the following tools: the Young Schema Questionnaire (YSQ-S3-PL), the Parent-Child Relationship Questionnaire (PCR), and the Young Parent Inventory (YPI). Both parents’ attitudes were similarly associated with the formation of early maladaptive schemas. For both mothers and fathers, loving and rejecting attitudes had the most numerous associations with the formation of early maladaptive schemas. Conclusions: 1. In a retrospective evaluation of the subjects, both parents had a similar impact on the formation of domains of early maladaptive schemas. The Results: only statistically significant differences occurred in the domain of Impaired Autonomy and Performance. Mothers had a stronger influence on the formation of schemas in this group. 2. For both mothers and fathers, loving (L) and rejecting (R) attitudes had the most numerous associations with the formation of early maladaptive schemas. Keywords: early maladaptive schemas, parental attitudes, attachment

Glioma Grade and Molecular Markers: Comparing Machine-Learning Approaches Using VASARI (Visually AcceSAble Rembrandt Images) Radiological Assessment.

This study aimed to leverage Visually AcceSAble Rembrandt Images (VASARI) radiological features, extracted from magnetic resonance imaging (MRI) scans, and machine-learning techniques to predict glioma grade, isocitrate dehydrogenase (IDH) mutation status, and O6-methylguanine-DNA methyltransferase (MGMT) methylation. A retrospective evaluation was undertaken, analyzing MRI and molecular data from 107 glioma patients treated at a tertiary hospital. Patients underwent MRI scans using established protocols and were evaluated based on VASARI criteria. Tissue samples were assessed for glioma grade and underwent molecular testing for IDH mutations and MGMT methylation. Four machine learning models, namely, Random Forest, Elastic-Net, multivariate adaptive regression spline (MARS), and eXtreme Gradient Boosting (XGBoost), were trained on 27 VASARI features using fivefold internal cross-validation. The models' predictive performances were assessed using the area under the curve (AUC), sensitivity, and specificity. For glioma grade prediction, XGBoost exhibited the highest AUC (0.978), sensitivity (0.879), and specificity (0.964), with f6 (proportion of non-enhancing) and f12 (definition of enhancing margin) as the most important predictors. In predicting IDH mutation status, XGBoost achieved an AUC of 0.806, sensitivity of 0.364, and specificity of 0.880, with f1 (tumor location), f12, and f30 (perpendicular diameter to f29) as primary predictors. For MGMT methylation, XGBoost displayed an AUC of 0.580, sensitivity of 0.372, and specificity of 0.759, highlighting f29 (longest diameter) as the key predictor. This study underscores the robust potential of combining VASARI radiological features with machine learning models in predicting glioma grade, IDH mutation status, and MGMT methylation. The best and most balanced performance was achieved using the XGBoost model. While the prediction of glioma grade showed promising results, the sensitivity in discerning IDH mutations and MGMT methylation still leaves room for improvement. Follow-up studies with larger datasets and more advanced artificial intelligence techniques can further refine our understanding and management of gliomas.

Avascular necrosis after surgery of developmental dysplasia of the hip in children after walking age: incidence and risk factors

Introduction Developmental dysplasia of the hip (DDH) is a common congenital anomaly in children. It includes a spectrum of anatomic abnormalities ranging from acetabular dysplasia to frank hip dislocation. Avascular necrosis (AVN) is one of the main complications associated with the treatment of DDH. It is a devastating problem that can lead to acetabular dysplasia and joint incongruity and cause premature osteoarthritis. The study aims to evaluate the incidence and risk factors of AVN after open reduction of developmental dislocation of the hip in children after walking age. Patients and methods Between the period of April 2014 and April 2019, a retrospective cohort evaluation of DDH cases was managed by surgery in the form of open reduction and pelvic osteotomy with or without femoral shortening. All grades of Tönnis classification were included. This study included 200 cases with an age range from 1 to 7 years, and the average age is 3.5 years at the time of last follow-up. The mean follow was 2.29 years, which ranged from 1 to 4 years. Plain radiography obtained in anteroposterior and frog lateral views after 1 year follow-up to diagnosis AVN as established in the literature. Results In this study, the mean time of intervention was 2.26 ± 0.97 years with an age range from 1 to 5 years. Twenty-six (13%) cases were managed only by open reduction and capsulorrhaphy, 174 (72.5%) cases had pelvic osteotomies, either Salter or Dega osteotomy, of whom 104 had femoral shortening and derotational osteotomy (59.77%). No AVN was reported in 159 (79.5%) cases, while AVN was evident in 41 (20.5%) cases. Discussion Incidence of AVN after open reduction depend on variable factor discussed in this study with total incidence of AVN 41 (20.5%) cases. This result is similar to other studies, with the incidence of AVN ranging from 15 to 30%. In the present study, the incidence of AVN increased 17 times in cases with postoperative immobilization in the hip spica more than or equal to 60° in the form of 21 cases showed AVN. Conclusion Postoperative hip immobilization in spica less than 60° as children with postoperative hip abduction more than or equal to 60° showed an increase incidence of AVN.

Retrospective evaluation of radiofrequency volumetric tissue reduction for hypertrophic turbinates in dogs with brachycephalic obstructive airway syndrome.

The objective of this study was to retrospectively assess the effect of Radiofrequency Volumetric Tissue Reduction (RFVTR) on hypertrophic turbinates and clinical outcome in brachycephalic dogs when included in multi-level surgery (MLS). Clinical retrospective multicenter study. 132 client-owned brachycephalic dogs. 132 brachycephalic dogs with high-grade Brachycephalic Obstructive Airway Ayndrome (BOAS) and hypertrophic turbinates were treated with RFVTR as part of MLS of the upper airways. Intranasal obstruction was evaluated by computer tomography (CT) and antero-/retrograde rhinoscopy before and 6 months after RFVTR. The clinical records, the CT images and the rhinoscopy videos were reviewed and clinical evolution was evaluated using a standardized questionnaire. The data was scored semi-quantitatively. In this study, 132 patients were included for a follow-up period of 120 weeks. RFVTR resulted in minor complications, including serous nasal discharge within the first postoperative week in all dogs, and intermittent nasal congestion between 3-8 weeks after treatment in 24.3% of the patients. Rhinoscopy and CT follow-ups were available for 33 patients. Six months after treatment intranasal airspace was increased (p = 0.002) and the presence and overall amount of mucosal contact points was reduced (p = 0.039). MLS with RFVTR led to a significant reduction in turbinate volume at the 6-month follow-up examination and significant clinical improvement over a long-term period of 120 weeks. This suggests the viability of RFVTR as a turbinate-preserving treatment for intranasal obstruction in dogs with BOAS. RFVTR is a minimally invasive turbinoplasty technique for intranasal obstruction in dogs with BOAS and can be included in MLS without increasing complication rates.

Long‐Term Hemorrhagic Morbidity for Children With Moyamoya Treated With Revascularization Surgery in a Single Center Retrospective Cohort

Background Children with moyamoya arteriopathy have reduced subsequent ischemic risk after revascularization surgery and it is also suggested that hemorrhagic risk may also be reduced by minimizing hemodynamic stress on collateral vasculature recruited within the brain parenchyma, but this has been studied only in intermediate follow‐up or follow‐up for more than a decade in East Asian populations. We aimed to evaluate the incidence of hemorrhagic stroke in long‐term follow‐up and identify at‐risk subpopulations. Methods A single surgeon's personal case series with decades of follow‐up was reviewed for children (18 years or younger) treated with revascularization surgery. This included medical records and the surgeon's personal correspondence. Results Hemorrhagic stroke occurred in 2.6% of 302 children followed for a median of 21 years after surgery. Occurring at a median of 19 years (interquartile range 14–22.75) after surgery, these hemorrhages would not be recognized in series that discontinue follow‐up at transition from pediatric to adult neurosurgical care. There was a higher proportion (5.5‐fold hazard, 95% CI, 1.1–27.6) of patients who had prior radiation therapy in the group with hemorrhagic stroke compared with the overall group. Close retrospective evaluation of vascular imaging suggests aneurysms of the collateral periventricular vessels as a common culprit. Conclusion Children who have moyamoya treated with revascularization surgery remain at long‐term risk of hemorrhagic stroke during adulthood, even though their ischemic stroke risk is significantly mitigated. These patients would benefit from continued clinical and radiological follow‐up, potentially with advanced imaging modalities.

534 A Retrospective Evaluation of Non-Clinical Limitations to Day Case Urology at a District General Hospital

534 A Retrospective Evaluation of Non-Clinical Limitations to Day Case Urology at a District General Hospital

Temporal trends in respiratory pathogens following the COVID-19 pandemic and climate variables: A unicentric retrospective evaluation of 24 pathogens in a temperate subtropical region.

Temperature and humidity are studied in the context of seasonal infections in temperate and tropical zones, but the relationship between viral trends and climate variables in temperate subtropical zones remains underexplored. Our retrospective study analyzes respiratory pathogen incidence and its correlation with climate data in a subtropical zone. Retrospective observational study at Moinhos de Vento Hospital, South Brazil, aiming to assess seasonal trends in respiratory pathogens, correlating them with climate data. The study included patients of all ages from various healthcare settings, with data collected between April 2022 and July 2023. Biological samples were analyzed for 24 pathogens using polymerase chain reaction and hybridization techniques; demographic variables were also collected. The data was analyzed descriptively and graphically. Spearman tests and Poisson regression were used as correlation tests. Tests were clustered according to all pathogens, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza viruses, rhinovirus, and respiratory syncytial virus (RSV). Between April 2022 and July 2023, 3329 tests showed a 71.6% positivity rate. Rhinovirus and RSV predominated, exhibiting seasonal patterns. Temperature was inversely correlated with the viruses, notably rhinovirus, but SARS-CoV-2 was positively correlated. Air humidity was positively correlated with all pathogens, RSV, rhinovirus, and atmospheric pressure with all pathogens and rhinovirus. Our results showed statistically significant correlations, with modest effect sizes. Our study did not evaluate causation effects. Despite the correlation between climate and respiratory pathogens, our work suggests additional factors influencing transmission dynamics. Our findings underscore the complex interplay between climate and respiratory infections in subtropical climates.

Dense tumor‐infiltrating lymphocytes (TILs) in liver metastasis from colorectal cancer are related to improved overall survival

AbstractBackground and ObjectivesTumor‐infiltrating lymphocytes (TILs) represent a host‐tumor interaction, frequently signifying an augmented immunological response. Nonetheless, implications with survival outcomes in patients with colorectal carcinoma liver metastasis (CRLM) warrant rigorous validation. The objective was to demonstrate the association between TILs and survival in patients with CRLM.MethodIn a retrospective evaluation conducted in a single institution, we assessed all patients who underwent hepatectomy due to CRLM between 2014 and 2018. Comprehensive medical documentation reviews were executed. TILs were assessed by a liver pathologist, blinded to the clinical information, in all surgical slides.ResultsThis retrospective cohort included 112 patients. Median overall survival (OS) was 58 months and disease‐free survival (DFS) was 12 months for the entire cohort. Comparison between groups showed a median OS of 81 months in the dense TILs group and 40 months in the weak/absent group (p = 0.001), and DFS was 14 months versus 9 months (p = 0.041). Multivariable analysis showed that TILs were an independent predictor of OS (HR 1.95; p = 0.031).ConclusionsDense TILs are a pivotal prognostic indicator, correlating with enhanced OS. Including TILs information in histopathological evaluations should refine the clinical decision‐making process for this group of patients.

Impact of COVID-19 pandemic on the plant-based food and supplement consumption of the Jordanians and Iraqis: A retrospective evaluation

Impact of COVID-19 pandemic on the plant-based food and supplement consumption of the Jordanians and Iraqis: A retrospective evaluation

Evaluation of pediatric patients with palpitations via cardiac event recorder, Holter monitoring and transesophageal electrophysiologic study in detecting arrhythmia

Objective: Palpitations are a common reason for referral to pediatric cardiologists, the diagnostic workup involves ambulatory, non-invasive recording devices and invasive procedures. We aimed to evaluate arrhythmic symptoms of pediatric patients with a cardiac event recorder, Holter monitoring and transesophageal electrophysiologic study (TEEPS) results. Materials and Methods: Retrospective evaluation of pediatric patients who fitted an event recorder at tertiary University Hospital between January 2002 and August 2012. The data obtained from the same patients’ as cardiac event recorder, Holter monitoring and TEEPS results were studied for comparison. Results: During the study period, 40 patients who had all data of cardiac event recorder, Holter monitoring and TEEPS were included. The median age of the patients included in the study was 12 [interquartile range, 7-15] years. Using the Holter monitoring, supraventricular extrasystoles (SVEs) were detected in six (15%) patients and ventricular extrasystoles (VESs) in three (7.5%). According to the event recorder data of the 40 patients, there was sinus tachycardia in 20 (50%), supraventricular tachycardia (SVT) in three (7.5%), and SVEs in two (5%) patients. The event recorder data of the remaining 15 patients were assessed as normal. The analysis of the TEEPS results revealed atrioventricular nodal reentrant tachycardia in four (10%), atrioventricular reentry tachycardia in three (7.5%), and normal results in the remaining 33 (82.5%) patients. Conclusions: This study demonstrated that a cardiac event recorder may also be considered as an important diagnostic tool in the diagnosis and ruling out of SVT in pediatric patients for whom the cause of arrhythmia cannot be identified with the Holter monitor, in patients who do not accept the use of TEEPS method following the use of Holter monitor, and in patients in whom SVT cannot be stimulated by TEEPS yet complaints persist.

Alectinib-induced Non-immune Hemolytic Anemia due to Erythrocyte Membrane Alterations: A Retrospective Evaluation

Alectinib-induced Non-immune Hemolytic Anemia due to Erythrocyte Membrane Alterations: A Retrospective Evaluation

Data to Care Pilot Program in Chicago: Experience, Outcomes, and Direction for the Future.

Data to Care (D2C) involves sharing HIV surveillance data between health care facilities and health departments to improve continuity of care for people living with HIV (PLWH). The Chicago Department of Public Health (CDPH) initiated a D2C pilot program at the University of Chicago Medicine (UCM) from June 2016 to September 2019. To describe the proportion of patients reported by UCM as not in care who were able to be matched to CDPH enhanced HIV/AIDS Reporting System (eHARS) and to report the individual-level factors associated with matching and viral suppression. Retrospective program evaluation. UCM, an academic health care center that provides HIV care to adults via a Ryan White clinic on the south side of Chicago. Adult PLWH who had received care at UCM but did not have current documented HIV care visit(s). Proportion of matched patients; factors associated with matching and viral suppression. Overall, 72.4% (n = 813/1123) of patients reported by UCM were matched by CDPH to eHARS. Individuals aged 40 to 49 years (odds ratio [OR] = 1.99; 95% confidence interval [CI], 1.10-3.62), 50 to 59 years (OR = 2.47; 95% CI, 1.37-4.47), and 60 years or older (OR = 6.18; 95% CI, 3.18-12.32) were more likely to match in eHARS. People who lived outside of Chicago (OR = 0.09; 95% CI, 0.05-0.15) or with unknown zip codes (OR = 0.08; 95% CI, 0.05-0.12) were less likely to match. Men who have sex with men and persons older than 50 years were more likely to be virally suppressed. D2C is an evidence-based strategy for reengagement of PLWH; however, program implementation relies on successful data matching. We found that a large proportion of patients from UCM were not matched, particularly those who were younger or lived outside of Chicago. Additional research is needed to understand ways to improve data matching to facilitate reengagement in HIV care.

Clinical Implementation of DIGEST as an Evidence-Based Practice Tool for Videofluoroscopy in Oncology: A Six-Year Single Institution Implementation Evaluation.

Clinical implementation of evidence-based practice (EBP) tools is a healthcare priority. The Dynamic Grade of Swallowing Toxicity (DIGEST) is an EBP tool developed in 2016 for videofluoroscopy in head and neck (H&N) oncology with clinical implementation as a goal. We sought to examine: (1) feasibility of clinical implementation of DIGEST in a national comprehensive cancer center, and (2) fidelity of DIGEST adoption in real-world practice. A retrospective implementation evaluation was conducted in accordance with the STARI framework. Electronic health record (EHR) databases were queried for all consecutive modified barium swallow (MBS) studies conducted at MD Anderson Cancer Center from 2016 to 2021. Implementation outcomes included: feasibility as measured by DIGEST reporting in EHR (as a marker of clinical use) and fidelity as measured by accuracy of DIGEST reporting relative to the decision-tree logic (penetration-aspiration scale [PAS], residue, and Safety [S] and Efficiency [E] grades). Contextual factors examined included year, setting, cancer type, MBS indication, and provider. 13,055 MBS were conducted by 29 providers in 7,842 unique patients across the lifespan in diverse oncology populations (69% M; age 1-96 years; 58% H&N cancer; 10% inpatient, 90% outpatient). DIGEST was reported in 12,137/13,088 exams over the 6-year implementation period representing 93% (95% CI: 93-94%) adoption in all exams and 99% (95% CI: 98-99%) of exams excluding the total laryngectomy population (n = 730). DIGEST reporting varied modestly by year, cancer type, and setting/provider (> 91% in all subgroups, p < 0.001). Accuracy of DIGEST reporting was high for overall DIGEST (incorrect SE profile 1.6%, 200/12,137), DIGEST-safety (incorrect PAS 0.4% 51/12,137) and DIGEST-efficiency (incorrect residue 1.2%, 148/12,137). Clinical implementation of DIGEST was feasible with high fidelity in a busy oncology practice across a large number of providers. Adoption of the tool across the lifespan in diverse cancer diagnoses may motivate validation beyond H&N oncology.