Part Of Routine Medical Care Research Articles

Pediatric Practices’ Experiences with Massachusetts’ Medicaid Accountable Care Organizations

ObjectiveTo examine the experience of Medicaid Accountable Care Organizations (ACOs) that include pediatric practices, including their motivations and experiences working together. MethodsThis mixed methods study is set within the first two years of the Massachusetts Medicaid ACO Program, which created 17 Medicaid ACOs across the Commonwealth in 2018. It combines qualitative interviews from organizational leaders across three Medicaid ACOs with pediatric representation (N=28; purposive sample; 2018) with a 44-item primary care practice leader survey (N=225 after 64% response rate; statewide stratified random sample of primary care practices; 2019). Interviews gathered information about organizational motivations and experiences with becoming a Medicaid ACO; the survey asked five domains of questions describing the experience of pediatric- and adult-focused primary care practices in joining Medicaid ACOs (e.g., how much practices solved problems jointly with the ACO). We used ordinary least squares regression to describe differences in experiences across pediatric vs. non-pediatric practices. ResultsLeaders of Medicaid ACO with pediatric representation expressed a desire to voice pediatric concerns regarding state Medicaid payment policy and to integrate social services as part of routine medical care. Relative to the experience of adult-focused primary care practice leaders, pediatric-focused practices reported less collaboration within the Medicaid ACO (95% confidence interval 0.81 to 0.05; p = 0.03) and less change toward standardization of policies such as physician compensation (95% confidence interval 0.61 to 0.02; p = 0.04). ConclusionsInitial Medicaid ACO experiences can differ based on the degree to which organizations joining Medicaid ACO programs serve pediatric populations. Article SummaryEarly in Massachusetts’ implementation of Medicaid Accountable Care Organizations (ACO), pediatric-focused practices reported less collaboration and standardization within their Medicaid ACOs than adult-focused practices.

The Diagnostic Characteristic and Reproducibility of Bone Scintigraphy Single-Photon Emission Computed Tomography/Computed Tomography for Diagnosing Aseptic Loosening of Uncemented Total Knee Arthroplasty

BackgroundThe primary objective of this study was to investigate the diagnostic characteristics of bone scintigraphy single-photon emission computed tomography/computed tomography (BS-SPECT/CT) for diagnosing aseptic loosening after uncemented total knee arthroplasty (TKA), and to evaluate the following aspects: how to manage inconclusive results, the interobserver reliability, and the location of tracer uptake between symptomatic cases with and without aseptic loosening. MethodsIn this study, 180 patients who had uncemented TKA and persistent knee pain suspected of aseptic loosening were included. As part of routine medical care, BS-SPECT/CT was used, and its results were compared with the reference standard, which involved revision surgery for aseptic loosening or a 12-month follow-up without revision or imaging. Inconclusive BS-SPECT/CT results were considered either negative (best-case scenario) or positive (worst-case scenario). Sensitivity, specificity, positive/negative likelihood ratios (LRs), and positive/negative predictive values (PPV and NPV) were calculated. Sensitivity analyses were conducted by comparing the diagnostic characteristics between cases with a follow-up of less and more than 2 years of follow-up. The anatomical distribution of tracer uptake and interobserver reliability were also evaluated. ResultsOf the 180 BS-SPECT/CT scans conducted, 22 were determined positive, 113 negative, and 45 inconclusive. The best-case scenario showed a sensitivity of 66.7%, specificity of 93.8%, +LR 10.8, −LR 0.4, PPV 54.6%, and NPV 96.2%. In contrast, the worst-case scenario had a sensitivity of 94.4%, specificity of 69.1%, +LR 3.1, −LR 0.1, PPV 25.4%, and NPV 99.1%. Sensitivity analyses revealed no relevant differences in characteristics between the 2 TKA-interval groups. The interobserver reliability was fair-to-moderate (κ = 0.39; 95% confidence interval 0.18 to 0.60), with an estimated agreement of 79% (95% confidence interval 70 to 87). Four prosthetic zones had a notably higher proportion of cases with tracer uptake in those with aseptic loosening compared to those without. ConclusionsThe test characteristics of BS-SPECT/CT were deemed appropriate in patients who have complaints of uncemented TKA suspected of aseptic loosening. Inconclusive cases were best categorized as negative, especially in patients who have a short interval between TKA and the first BS-SPECT/CT. Increased tracer uptake in 4 prosthetic zones was observed in cases of aseptic loosening, although interobserver reliability was fair to moderate. Level of EvidenceLevel III, Diagnostic Retrospective Cohort Study.

Effectiveness of Valsartan's Single-Pill Combination Therapies on Blood Pressure Control in Hypertensive Patients: Malaysian Single-Centre Real-World Experience.

Uncontrolled hypertension can cause cardiovascular disease and is an important public health issue. Single-pill combination (SPC) therapies possess combined blood pressure (BP)-lowering effect and may improve compliance to treatment. This study assessed the effectiveness of valsartan (Val)-based SPC therapies in achieving BP control in hypertensive patients. This was a retrospective study. Data were extracted from the hybrid medical records of patients from the Institut Jantung Negara (IJN), Malaysia. Adults with established diagnosis of hypertension and on prescription of Val-based SPC therapies as part of routine medical care from 1 January 2013 to 31 December 2018, with ≥ 1 year of follow-up were included. Primary endpoint was proportion of patients achieving therapeutic BP control (BP < 140/90 mmHg). Secondary outcomes included change from baseline (CFB) in systolic BP (SBP) and diastolic BP (DBP), and subgroup analysis was based on baseline SBP categories and presence of diabetes. Study included 409 hypertensive patients. The mean (standard deviation [SD]) age of the population was 65.1 (10.6) years old, with male predominance (61.6%). Proportion of patients achieving target BP between baseline and follow-up were 57.0% (P < 0.001). Mean CFB in SBP and DBP were recorded as 19.52 mmHg and 7.47 mmHg, respectively. Over half of the patients achieved the target BP in all subgroups categorised by SBP at baseline, except the subgroup of SBP 160 mmHg-179 mmHg. SPC therapies were continued in 97.3% of patients at 1-year follow-up. Patients using Val-based SPC therapies had significant reduction in BP with good tolerability, with 57% of patients achieving target BP over a prolonged 1-year follow-up period. Uptake of SPC therapy is warranted to improve patient care and outcomes in hypertension.

A-107 Estimating Glomerular Filtration Rate by the Serum Creatinine and Cystatin C-plus-Creatinine Equations: Concordance and Effect on GFR Categorization

Abstract Background Estimating the glomerular filtration rate (GFR) is essential for evaluating kidney function, which is part of routine medical care. Most clinical laboratories report an estimated glomerular filtration rate (eGFR) based on serum creatinine, but cystatin C is a potential alternative marker. Evidence suggests that using the creatinine-plus-cystatin C (the 2021 CKD-EPI creatinine-cystatin C equation) eGFR gives more accurate results than the eGFR based on creatinine alone. Here we compared two 2021 CKD-EPI equations for estimating GFR—one using standardized creatinine alone (Cre) and the other using cystatin C combined with standardized creatinine (Cre-Cys). We also explored the effect of the equations on the GFR category. Methods: We retrospectively analyzed 777 simultaneous values for eGFR calculated by the two 2021 CKD-EPI equations over a period of nine months, from the time our laboratory initiated the Cre-Cys equation to the present.Cystatin C was measured turbidometrically on the Optilite (Binding Site, Birmingham, UK) and the creatinine was measured by the DxC method (Beckman Coulter, California, USA). We excluded any patient with Cre eGFR &amp;gt;90 mL/min/1.73 m2 because we do not result any value above 90 for that parameter. Results Out of 777 patients (52% female and 48% male), we excluded 82 results with Cre GFR &amp;gt; 90. The mean ± SD for Cre-Cys eGFR and Cre eGFR were 37.3 ± 23.8 and 37.1 ± 23.1, respectively, with a non-statistical difference between both groups using the paired T-Test (t = −0.8249, P-value = 0.4097). The mean difference (Cre-Cys eGFR minus Cre eGFR) was 0.28, with a standard deviation of 9.027. The correlation coefficient between Cre eGFR and Cre-Cys eGFR was r = 0.93. Two hundred and seventy-four (35%) samples had a difference between the numerical value of the two eGFR equations significant enough to change the GFR classification. 128 (34.5%) of the males had different categories when both equations calculated the eGFR vs 146 (36%) females. 36.3% of the white and 34% of the black patients had a discrepancy. The calculations matched for the other 502 patients. Of the 274 samples with discordant category classifications, the Cre-Cys equation gave a lower result and a higher (worse) category in 144 (53%), and a higher result and lower (better) category in 130 (47%). Conclusion The use of Cystatin C is growing and has moved beyond the nephrology community. Furthermore, the 2012 KDIGO guidelines suggest using additional tests (such as cystatin C or a clearance measurement) for confirmatory testing in specific circumstances when eGFR based on serum creatinine is less accurate. Currently, cystatin C testing is only available M-F, 8 AM–4 PM at our institute, but increasing availability and decreasing cost will likely expand Cre-Cys eGFR testing in the future. However, understanding the relationships between eGFR values from the different equations and how they will affect patient management can help clinicians optimize their use for kidney function evaluation.

Erectile dysfunction and associated factors among patients with diabetes attending follow-up at a public hospital, Harar, Eastern Ethiopia. A cross-sectional study design.

The global prevalence of erectile dysfunction among patients with diabetes is high. It is the most underestimated problem but has a great physical, psychological, and social impact on the individual with the disease, family, and society in general. Thus, this study aimed to assess the magnitude of erectile dysfunction and associated factors among patients with diabetes attending follow-up at a public hospital, Harar, Eastern Ethiopia. Facility-based cross-sectional study was conducted on selected 210 adult male patients with diabetes attending follow-up at a public hospital, Harar, Eastern Ethiopia, from 1 February to 30 March 2020. Simple random sampling was used to select study participants. A pre-tested interviewer-administered structured questionnaire was used to collect the data. The data were entered to EpiData version 3.1 and exported to SPSS version 20 for analysis. Bivariate and multivariable binary logistic regression were carried out, and a P-value of <0.05 was taken as statistically significant. A total of 210 adult male patients with diabetes participated in the study. The overall magnitude of erectile dysfunction was 83.8%, with 26.7% suffering from mild, 37.5% mild to moderate, 29% moderate, and 6.8% severe erectile dysfunctions. Age 46-59 years [adjusted odds ratio (AOR): 2.560; 95% confidence interval (CI) (1.73, 6.53)], age ≥ 60 years [AOR: 2.9; 95% CI (1.48, 5.67)], and poor glycemic control [AOR: 2.140; 95% CI (1.9, 7.44)] were significantly associated with erectile dysfunction among patients with diabetes. The present study revealed a high magnitude of erectile dysfunction among population with diabetes. The age categories of 46-59 and ≥60 and having poor glycemic control were the only variables significantly associated with erectile dysfunction. Thus, routine screening and management for erectile dysfunction in patients with diabetes should be part of routine medical care particularly for adult male patients and those with poor glycemic control.

Preauricular sulcus: Radiological incidence in the female gender in a multicultural population.

The preauricular sulcus is a bony groove seen on the inferior aspect of the iliac bone. It is thought and accepted to be an indicator of female gender. To our knowledge, this study would be the first to examine the sulcal incidence in a multicultural population. To date, there are limited studies to also test the existing hypothesis that the sulcus is only seen in the female gender. The results of this study would be applicable to the field of forensic medicine and gender identification in the post-mortem setting. Retrospective review of 500 adult pelvic X-ray radiographs (250 female and 250 male) obtained as part of routine medical care in a metropolitan public health service (encompassing three hospitals) was performed. The radiographs were examined by two post-FRANZCR examination senior registrars who recorded their results independently. The mean age of the female population was 70.1 years, and the mean age of the male population was 75.5 years. This study found that the preauricular sulcus is only present in the female pelvis. The incidence was 41.2% (103 of 250) in the examined female patient population. The sulcal incidence in this study was also found to be significantly higher than previously reported in prior studies. This study supports the previous notion that the presence of preauricular sulcus in a pelvic specimen would indicate the female gender. The absence of the sulcus does not necessarily confer the male gender.

Re: WHO Classification of Tumours, 5th Edition, Volume 8: Urinary and Male Genital Tumours

Prostate-specific antigen (PSA) levels in midlife are strongly associated with the long-term risk of lethal prostate cancer in cohorts not subject to screening. This is the first study evaluating the association between PSA levels drawn as part of routine medical care in the Norwegian population and prostate cancer incidence and mortality.To determine the association between midlife PSA levels <4.0 ng/ml, drawn as part of routine medical care, and long-term risk of prostate cancer death.The Norwegian Prostate Cancer Consortium collected >8 million PSA results from >1 million Norwegian males ≥40 yr of age. We studied 176 099 men (predefined age strata: 40–54 and 55–69 yr) without a prior prostate cancer diagnosis who had a nonelevated baseline PSA level (<4.0 ng/ml) between January 1, 1995 and December 31, 2005.Baseline PSA.We assessed the 16-yr risk of prostate cancer mortality. We calculated the discrimination (C-index) between predefined PSA strata (<0.5, 0.5–0.9, 1.0–1.9, 2.0–2.9, and 3.0–3.9 ng/ml) and subsequent prostate cancer death. Survival curves were plotted using the Kaplan-Meier method.The median follow-up time of men who did not get prostate cancer was 17.9 yr. Overall, 84% of men had a baseline PSA level of <2.0 ng/ml and 1346 men died from prostate cancer, with 712 deaths (53%) occurring in the 16% of men with the highest baseline PSA of 2.0–3.9 ng/ml. Baseline PSA levels were associated with prostate cancer mortality (C-index 0.72 for both age groups, 40–54 and 55–69 yr). The fact that the reason for any given PSA measurement remains unknown represents a limitation.We replicated prior studies that baseline PSA at age 40–69 yr can be used to stratify a man's risk of dying from prostate cancer within the next 15–20 yr.A prostate-specific antigen level obtained as part of routine medical care is strongly associated with a man’s risk of dying from prostate cancer in the next two decades.

Baseline Serum Prostate-specific Antigen Value Predicts the Risk of Subsequent Prostate Cancer Death—Results from the Norwegian Prostate Cancer Consortium

Background and objectiveProstate-specific antigen (PSA) levels in midlife are strongly associated with the long-term risk of lethal prostate cancer in cohorts not subject to screening. This is the first study evaluating the association between PSA levels drawn as part of routine medical care in the Norwegian population and prostate cancer incidence and mortality. The objective of the study was to determine the association between midlife PSA levels <4.0 ng/ml, drawn aspart of routine medical care, and long-term risk of prostate cancer death. MethodsThe Norwegian Prostate Cancer Consortium collected >8 million PSA results from >1 million Norwegian males (more than or equal to) 40 yr of age. We studied 176 099 men (predefined age strata: 40–54 and 55–69 yr) without a prior prostate cancer diagnosis who had a nonelevated baseline PSA level (<4.0 ng/ml) between January 1,1995 and December 31, 2005. We assessed the 16-yr risk of prostate cancer mortality. We calculated the discrimination (C-index) between predefined PSA strata (<0.5, 0.5–0.9, 1.0–1.9, 2.0–2.9, and 3.0–3.9 ng/ml) and subsequent prostate cancer death. Survival curves were plotted using the Kaplan-Meier method. Key findings and limitationsThe median follow-up time of men who did not get prostate cancer was 17.9 yr. Overall, 84% of men had a baseline PSA level of <2.0 ng/ml and 1346 men died from prostate cancer, with 712 deaths (53%) occurring in the 16% of men with the highest baseline PSA of 2.0–3.9 ng/ml. Baseline PSA levels were associated with prostate cancer mortality (C-index 0.72 for both age groups, 40–54 and 55–69 yr). The fact that the reason for any given PSA measurement remains unknown represents a limitation. Conclusions and clinical implicationsWe replicated prior studies that baseline PSA at age 40–69 yr can be used to stratify a man’s risk of dying from prostate cancer within the next 15–20 yr. Patient summaryA prostate-specific antigen level obtained as part of routine medical care is strongly associated with a man’s risk of dying from prostate cancer in the next two decades.

Improving uptake of advance care planning through education and training in a public hospital geriatric clinic.

Advance care planning (ACP) is an important part of routine medical care. However, Western Australia (WA) consistently demonstrates poor rates of completion. International and interstate ACP programs have previously led to an increase in ACP discussion and documentation. This study aimed at evaluating the effect of a multifaceted intervention on completion of ACP in a geriatric outpatient setting in WA. The Plan-Do-Study-Act (PDSA) cycle was used for this audit. The components of the intervention comprised of education and communication skill training, improving access to ACP documents and patient resources. Pre- and post-intervention reviews of documented future care planning discussions were performed and compared. Of the 100 patients audited, there was an absolute increase of 23% (p = 0.02) in any form of future care planning. More specifically, discussions regarding ACP increased by 13% (p = 0.01), Advance Care Directive (ACD) by 23% (p < 0.001), Enduring Power of Attorney (EPA) by 24% (p = 0.02), Enduring Power of Guardianship (EPG) by 31% (p = 0.002), together with a 10% (p = 0.02) increase in the provision of ACP resources to patients. Older patient age (p = 0.02) and abnormal cognitive testing (p = 0.02), but not established dementia, were patient-related factors associated with initiation of ACP discussions. A simple structured multifaceted intervention improved the uptake of ACP discussions in a hospital geriatric clinic.

Correlation of Patient-Reported Outcomes Measurement Information System (PROMIS) measures with unplanned healthcare resources utilization (HRU) among patients with epilepsy (PWE): a retrospective cohort study (P6-1.001)

<h3>Objective:</h3> To evaluate whether PROMIS scores correlate with unplanned HRU among PWE. <h3>Background:</h3> Mental, physical, and social health determinants have a significant effect on quality of life with sparse data on their effect on unplanned HRU. <h3>Design/Methods:</h3> We utilized the PROMIS-16 questionnaire to assess patients’ mental, physical, and social health. Patients completed the questionnaire as part of routine medical care at outpatient neurology clinic visits. We performed a retrospective analysis of the PROMIS measures completed between June 2018, and August 2022. PROMIS data was combined with Health Plan claims data on utilization at 7, 30 and 90-day from the index clinic visit and analyzed using a logit model. A pathologic score in each of the 8 PROMIS measures (Anxiety&gt;62, Depression&gt;60, Fatigue &gt;65, Pain&gt;65, Sleep Disturbance&gt;65, Cognition&lt;35, Physical function&lt;35, Social scores&lt;35) was analyzed as an independent predictor of unplanned HRU in each of 4 domains (Mortality all causes, Hospitalization all causes, ED treat and release all causes and Urgent care all causes). <h3>Results:</h3> The cohort included 6485 unique PWE (13159 encounters; 53.1% females, 10.1% black, median age 46.4-years). The following statistically significant correlations emerged: 1) pathological Physical Function and Social Scores were associated with 90-day mortality; 2) pathological Fatigue, Pain, Sleep Disturbance, Physical Function, and Social Scores were associated with 7-day Hospitalization, 3) Pathological Anxiety, Depression, Fatigue, Pain, Physical Function, and Social Scores were associated with 7-day ED visits, 4) Pathological scores on each of the 8 measures correlated with 90-day Hospitalization (7 measures with a 30-day) and ED visits (5 measures with a 30-day), and 5) Pathological Fatigue scores correlated with 90-day urgent care utilization. <h3>Conclusions:</h3> PROMIS scores are associated with unplanned HRU at short index times from outpatient neurology clinic visits among PWE. This prognostic utility supports the routine collection of patient-reported health measures in clinical practice along with developing timely interventions. <b>Disclosure:</b> Dr. Urban has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neuropace. The institution of Dr. Kirkpatrick has received research support from American Academy of Neurology. The institution of Dr. Kirkpatrick has received research support from Academic Pediatric Association. The institution of Dr. Kirkpatrick has received research support from American Academy of Pediatrics. The institution of Dr. Kirkpatrick has received research support from Society of Family Planning. The institution of Dr. Kirkpatrick has received research support from North American Society for Pediatric and Adolescent Gynecology. Dr. Rajasekaran has a non-compensated relationship as a PI with UCB Drug study that is relevant to AAN interests or activities. Dr. Rajasekaran has a non-compensated relationship as a PI with Engrail Drug study that is relevant to AAN interests or activities. Dr. Fong has nothing to disclose. Dr. Hanmer has nothing to disclose. Dr. Bagic has nothing to disclose. The institution of Dr. Thirumala has received research support from University of Pittsburgh.

Drug-free remission is an achievable target with immunosuppressive treatment in idiopathic granulomatous mastitis.

Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disease, in which there is no clear established treatment algorithm. Several physicians keep away from using immunosuppressive(IS) treatments in routine clinical practice. This study aimed to evaluate the rates of drug-free remission of the patients with IGM in a period of 3-year follow-up. This retrospective study conducted with 55 biopsy-proven IGM patients, who were followed up between February, 2011, and November, 2021, in rheumatology outpatient clinic of Gulhane Training and Research Hospital. The demographic and clinical characteristics of the patients were obtained from patients' files. The 3-year follow-up data were assessed for long-term outcome analyses. There were 55 female patients with a mean age of 36.8 ± 6.3years. Fifty-four (98.1%) patients were in drug-free remission at the end of 3years. The median duration of drug-free remission in patients receiving methotrexate (MTX), only corticosteroid (CS), and azathioprine was 19.7, 32.9, and 14.7months, respectively. The drug-free remission duration for the patient who received cyclosporine A as IS was 28.3months. The median duration of IS treatment was 15.8months, and the median duration of treatment with CS and other IS combination was 6.7months. Recurrence was observed in 4 (80%) patients without IS therapy after surgery, of whom MTX was used in 3 (75%) patients and achieved remission. IS agents provide high rate of prolonged drug-free remission and should be considered a part of routine medical care of the patients with IGM.

Deep-learning-based prognostic modeling for incident heart failure in patients with diabetes using electronic health records: A retrospective cohort study.

Patients with type 2 diabetes mellitus (T2DM) have more than twice the risk of developing heart failure (HF) compared to patients without diabetes. The present study is aimed to build an artificial intelligence (AI) prognostic model that takes in account a large and heterogeneous set of clinical factors and investigates the risk of developing HF in diabetic patients. We carried out an electronic health records- (EHR-) based retrospective cohort study that included patients with cardiological clinical evaluation and no previous diagnosis of HF. Information consists of features extracted from clinical and administrative data obtained as part of routine medical care. The primary endpoint was diagnosis of HF (during out-of-hospital clinical examination or hospitalization). We developed two prognostic models using (1) elastic net regularization for Cox proportional hazard model (COX) and (2) a deep neural network survival method (PHNN), in which a neural network was used to represent a non-linear hazard function and explainability strategies are applied to estimate the influence of predictors on the risk function. Over a median follow-up of 65 months, 17.3% of the 10,614 patients developed HF. The PHNN model outperformed COX both in terms of discrimination (c-index 0.768 vs 0.734) and calibration (2-year integrated calibration index 0.008 vs 0.018). The AI approach led to the identification of 20 predictors of different domains (age, body mass index, echocardiographic and electrocardiographic features, laboratory measurements, comorbidities, therapies) whose relationship with the predicted risk correspond to known trends in the clinical practice. Our results suggest that prognostic models for HF in diabetic patients may improve using EHRs in combination with AI techniques for survival analysis, which provide high flexibility and better performance with respect to standard approaches.

Trends in emergency department visits associated with cannabis use among older adults in California, 2005-2019.

The use of cannabis among older adults is increasing in the United States. While cannabis use has been suggested to help alleviate chronic symptoms experienced by older adults, its potential adverse effects may lead to unintended consequences, including increased acute healthcare utilization related to its use. The objective of this study was to examine trends in cannabis-related emergency department (ED) visits in California. Using data from the Department of Healthcare Access and Information, we conducted a trend analysis of cannabis-related ED visits from all acute care hospitals in California from 2005 to 2019. For each calendar year, we determined the cannabis-related ED visit rate per 100,000 ED visits for adults aged ≥65 utilizing primary or secondary diagnosis codes. We estimated the absolute and relative changes in overall cannabis-related visit rates during the study period and by subgroup, including age (65-74, 75-84, ≥85), race/ethnicity, sex, payer/insurance, Charlson comorbidity index score, and cannabis-related diagnosis code. The cannabis-related ED visit rate increased significantly for adults aged ≥65 and all subgroups (p < 0.001). The overall rate increased from 20.7 per 100,000 visits in 2005 to 395.0 per 100,000 ED visits in 2019, a 1804% relative increase. By race/ethnicity, older Black adults had the highest ED visit rate in 2019 and the largest absolute increase while older males had a higher ED visit rate in 2019 and a greater absolute increase than older women. Older adults with a higher Charlson score had a higher ED visit rate in 2019 and a larger absolute increase during the study period. Cannabis-related ED visits are increasing among older adults in California and are an adverse effect of cannabis use. Asking about cannabis use and providing education about its use should be a part of routine medical care for older adults.

Men's sexual desire, and why women often don't recognize it? Prevalence of erectile dysfunction and associated factors among diabetes mellitus patients attending Mettu Karl Comprehensive Specialized Hospital: A cross-sectional study.

The study aimed to assess the magnitude and predictors of erectile dysfunction at Mettu Karl Comprehensive Specialized Hospital. Male diabetic patients visiting chronic care follow-up at Mettu Karl Comprehensive Specialized Hospital were face-to-face interviewed as part of a retrospective cross-sectional study from April 6, 2022 to May 6, 2022. SPSS version 21 for Windows was used to enter and analyze the data for the descriptive statistics. Following that, a binary logistic regression and a multivariate logistic regression model were used. Based on a p-value of 0.05, variables that had an independent link with sexual dysfunction were found. The adjusted odds ratio and its associated 95% confidence interval were also used to analyze the direction and intensity of the link. A total of 307 diabetic men participated in the study, with a mean age of (52.74, 16.16) and a mean duration of (5.94, 2.974). In this study, 252 people (82.1%) experienced erectile dysfunction, with mild, moderate, and severe cases represented by 30%, 38%, and 14.1% of respondents, respectively. There were statistically significant associations between erectile dysfunction and age (adjusted odds ratio: 4.8, 95% confidence interval: 1.27-18.32), type of diabetes (adjusted odds ratio: 5.8, 95% confidence interval: 1.96-17.73), and comorbidities (adjusted odds ratio: 0.32, 95% confidence interval: 0.15-0.71). This study showed that the prevalence rate of erectile dysfunction is high in Mettu Karl Comprehensive Specialized Hospital. Age, type of diabetes mellitus, and the presence of comorbidity were factors associated with erectile dysfunction. Therefore, assessment and management of erectile dysfunction in the diabetic clinic should be part of routine medical care during follow-up visits with diabetic patients.

Prevalence of Erectile Dysfunction and Associated Factors among Hypertensive Patients Attending Governmental Health Institutions in Gondar City, Northwest Ethiopia: A Cross-Sectional Study

Introduction Erectile dysfunction is a common sexual problem affecting men with hypertension. It may result in withdrawal from sexual engagement, decreased work productivity, psychosocial problems including poor self-esteem and depression, and reduction in quality of life for both the affected men and their female partners. Objective This study was aimed to determine the prevalence of erectile dysfunction and associated factors among hypertensive patients attending governmental health institutions in Gondar city, Northwest Ethiopia. Materials and Methods An institutional-based cross-sectional study was conducted on 423 hypertensive men randomly selected using a systematic random sampling technique. Erectile dysfunction was assessed using the International Index of Erectile Function-5 tool. Sociodemographic, clinical, and behavioral factors were also collected using pretested interviewer-administered questionnaires. Data were entered into EpiData version 4.6 and analyzed using Stata-14. Binary logistic regression was performed to identify factors associated with erectile dysfunction. The level of significance was computed at a p value ≤ 0.05. Results The mean age of the study participants was 58.84 ± 13.52 years. The prevalence of erectile dysfunction among hypertensive men was 46.34% (95% CI: 41.61, 51.12). About 28% of them had a mild form of erectile dysfunction while nearly 6% had severe forms. Age above 60 years (AOR = 3.8, 95% CI: 1.62, 6.55), stage II hypertension (AOR = 3.5, 95% CI: 1.63, 5.74), hypertension duration >10 years (AOR = 2.5, 95% CI:1.12, 4.19), comorbidity (AOR = 1.7, 95% CI: 1.04, 3.15), depression (AOR = 2.35, 95% CI: 1.31, 4.21), and being physically active (AOR = 0.48, 95% CI: 0.28, 0.83) were factors significantly associated with erectile dysfunction. Conclusion Nearly half of the study participants had some form of erectile dysfunction, indicating the presence of a high burden of the problem. Assessment of hypertensive men for erectile dysfunction should be part of routine medical care.

Analysis of the Assortability of Ophthalmologists Using a Therapy as Part of Routine Medical Care for Patients with Inflammatory Eye Diseases

The problem of diagnosis and treatment of inflammatory eye diseases takes a leading place in Russia and in the world, but the most important thing is the correct choice of treatment methods. Purpose of the work: collection and analysis of data on doctors’ preferences under prescribing therapy in patients with inflammatory eye pathology in routine clinical practice. As a result, 5960 clinical cases from 47 Russian cities were analyzed. This article compiles data from October to November 2020. 151 medical researchers were taken part in the participation of the recruitment. Doctors made different diagnoses for referring patients, but significantly more often diagnosis H10.3 was detected — 17.99 % (in 1072 patients). Ophthalmologists preferred to prescribe the following combination of drugs: 1 — antibacterial local, 2 — local antiseptics, 3 — non-steroidal anti-inflammatory local, a combination (antibiotic and glucocorticosteroid), antiallergic in the form of drops of local action. The choice of drugs for inflammatory eye disease is determined by their high efficiency of use for a given disease: antibiotic Signicef® (levofloxacin 0,5 %), nonsteroidal anti-inflammatory drug Broxinac® (bromphenac 0,09 %), fixed combination Kombinil® (ciprofloxacin 0,3 % + dexamethasone 0,1 %), Visallergol® (olopatadine 0,2 %) in the form of topical eye drops.

Underscoring the importance of advance care planning.

Advance care planning is an essential part of routine medical care. It is a billable, iterative process that can result in the completion of advance directives and medical orders, offering NPs the opportunity to assure goal-concordant care for their patients at the end of life.

Erectile dysfunction and associated factors among diabetic patients at, Hawassa, Southern, Ethiopia

BackgroundErectile dysfunction is an inability to initiate and have a persistent erection firm enough to have satisfying sexual intercourse. The prevalence of erectile dysfunction in diabetic men is considerably high, but it is often underdiagnosed and under-managed.ObjectiveThis study aimed to determine erectile dysfunction and associated factors among diabetic patients at, Hawassa, Southern, Ethiopia.MethodsThe institution-based cross-sectional study was conducted on 352 adult male diabetic patients randomly selected from Adare general and Hawassa comprehensive specialized hospitals using a simple random sampling technique. The number of patients to be selected from each hospital was proportionally assigned based on the total population of diabetes mellitus patients following chronic care during the study period. The descriptive statistics and multiple logistic regressions (bivariate and multivariate analysis) were carried out.ResultThe prevalence of erectile dysfunction was 72.2% (95%CI, 1.76–3.68). After adjusting all factors, old age, diabetes duration, drinking alcohol, and poor glycemic control had shown significant association with erectile dysfunction.ConclusionThe occurrence of erectile dysfunction in this study community is very high. Drinking alcohol, poor glycemic control, age, and duration of diabetes were predictors of erectile dysfunction in this study area. Assessment and management of erectile dysfunction in the diabetic clinic should be part of routine medical care during follow-up visits with diabetic patients. Healthcare providers should emphasize screening and treating older patients and those who have had a diabetes diagnosis for a longer duration.

Giant cell tumor of bone: Effect of longer dosing intervals of denosumab on tumor control and bone related complications.

11525 Background: Giant cell tumor of bone (GCTB) is a benign but locally aggressive bone neoplasm characterized by osteoclast activation causing destructive osteolysis. Denosumab, a human monoclonal antibody against RANK ligand, has emerged as an effective treatment option when surgery is not recommended, but can cause significant bone toxicity. Current standard dosing is every 4 weeks after 3 weekly loading doses. As patients (pts) with GCTB are often young adults, frequent denosumab administration long-term may be burdensome and associated with increased risk of complications. We assessed whether alternative, longer dosing intervals are associated with differences in efficacy or bone toxicity. Methods: Retrospective chart review was conducted on GCTB pts over 18 years old at University of Michigan who received at least 1 year of standard denosumab treatment. Pts were identified using a free-text medical record search engine with keywords “giant cell tumor” and “denosumab” until August 2020. We compared bone-related adverse effects and tumor control in pts who continued denosumab every 4 weeks versus longer treatment intervals. Decision to increase interval between doses was based on provider and pt discussion and preference as part of routine medical care. Results: 37 GCTB pts were identified; 51% female and 49% male. Average age was 41 years (range 22-73). Most common primary location was lower extremity (38%), followed by pelvis (35%), upper extremity (14%), spine (8%), and head/neck (5%). Metastasis were present at start of treatment in 14% of pts, involving lung (n = 4) and spine (n = 1). Pts received median of 71 (range 15-139) total doses of denosumab. Dosing interval was increased in 38% (n = 14). With the first interval change, 43% changed to every 6 weeks, 29% every 8 weeks, and 29% every 12 weeks dosing. Most common final dosing interval was 12 weeks (n = 8). 6 pts (16%) had bone complications after mean of 56 doses. This included osteonecrosis of the jaw (n = 4), atypical fracture (n = 1), and non-healing dental wounds (n = 2). All pts with bone complications were treated on the monthly dosing schedule, but there was no statistically significant difference compared to longer intervals (p = 0.22). Pts with GCT progression (n = 10) were either no longer receiving therapy or had missed denosumab doses. There was no statistically significant difference in PFS with standard vs. interval increased dosing (p = 0.97). However, 5-year PFS was superior with interval increased vs standard dosing (p = 0.036). Conclusions: Increasing the interval of denosumab dosing for GCTB provided similar tumor control as compared to standard dosing and is potentially associated with less bone toxicity and more convenience for afflicted pts. Further larger scale studies are needed to better define the optimal interval of denosumab administration in GCTB and the effect on efficacy, toxicity, and associated health care expense.

Trials & Tribulations of Liver Transplantation- are trials now prohibitive without surrogate endpoints?

During the past 5 decades, liver transplantation has moved from its pioneering days where success was measured in days to a point where it is viewed as a routine part of medical care. Despite this progress, there are still significant unmet needs and outstanding questions that need addressing in clinical trials to improve outcomes for patients. The traditional endpoint for trials in liver transplantation has been 1-year patient survival, but with rates now approaching 95%, this endpoint now poses a number of significant financial and logistical barriers to conducting trials because of the large numbers of participants required to demonstrate only an incremental improvement. Here, we suggest the following solutions to this challenge: adoption of validated surrogate endpoints; bigger and better collaborative multiarm, multiphase studies; recognition by funders and institutions that work on larger collaborative research projects is potentially more important than smaller, self-led bodies of work; ringfenced areas of research within trial frameworks where individuals can take a lead; and fair funding structures using both industry and public sector money across national and international borders.