Significant Difference In Odds Research Articles

Predictive validity of the STarT Back screening tool among older adults with back pain.

The predictive validity of the STarT Back screening tool among older adults is uncertain. This study aimed to assess the predictive validity of the SBT among older adults in primary care. This prospective cohort study included 452 patients aged ≥55 years seeking Norwegian primary care with a new episode of back pain. A poor outcome (persistent disabling back pain) was defined as a score of ≥7/24 on the Roland-Morris Disability Questionnaire (RMDQ) at 3, 6 or 12 months of follow-up. The ability of the SBT risk groups to identify persistent disabling back pain was assessed with multivariable logistic regression, area under receiver operating characteristics curve (AUC), and with the accuracy measures sensitivity, specificity, predictive values and likelihood ratios. The adjusted odds ratios (95% CI) for persistent disabling back pain were 2.40 (1.34-4.30) at 3 months, 3.42 (1.76-6.67) at 6 months and 2.81 (1.47-5.38) at 12 months for the medium-risk group (n = 118), and 8.90 (1.83-43.24), 2.66 (0.81-8.67) and 4.53 (1.24-16.46) for the high-risk group (n = 27), compared to the low-risk group (n = 282). There were no statistically significant differences in odds between the medium- and high-risk groups at any time point. AUC values (95% CI) were 0.65 (0.59-0.71), 0.67 (0.60-0.73) and 0.65 (0.58-0.71) at 3, 6 and 12 months. Accuracy measures were poor at all time points, with particularly poor sensitivity and negative likelihood ratio values. The predictive validity of the SBT risk groups in predicting persistent disabling back pain in older adults was poor. This study found that the STarT Back screening tool had poor predictive validity among older adults and that it may need recalibration or extension before widespread implementation among older adults. Having valid tools for this population may aid clinicians with allocating scarce healthcare resources, which is especially important considering the rapidly ageing population and its expected challenge to the healthcare systems.

Antibiotic impregnated catheters and intrathecal antibiotics for CSF shunt infection prevention in children undergoing low-risk CSF shunt surgery

BackgroundCerebrospinal fluid (CSF) shunts allow children with hydrocephalus to survive and avoid brain injury (J Neurosurg 107:345-57, 2007; Childs Nerv Syst 12:192-9, 1996). The Hydrocephalus Clinical Research Network implemented non-randomized quality improvement protocols that were shown to decrease infection rates compared to pre-operative prophylactic intravenous antibiotics alone (standard care): initially with intrathecal (IT) antibiotics between 2007–2009 (J Neurosurg Pediatr 8:22-9, 2011), followed by antibiotic impregnated catheters (AIC) in 2012–2013 (J Neurosurg Pediatr 17:391-6, 2016). No large scale studies have compared infection prevention between the techniques in children. Our objectives were to compare the risk of infection following the use of IT antibiotics, AIC, and standard care during low-risk CSF shunt surgery (i.e., initial CSF shunt placement and revisions) in children.MethodsA retrospective observational cohort study at 6 tertiary care children’s hospitals was conducted using Pediatric Health Information System + (PHIS +) data augmented with manual chart review. The study population included children ≤ 18 years who underwent initial shunt placement between 01/2007 and 12/2012. Infection and subsequent CSF shunt surgery data were collected through 12/2015. Propensity score adjustment for regression analysis was developed based on site, procedure type, and year; surgeon was treated as a random effect.ResultsA total of 1723 children underwent initial shunt placement between 2007–2012, with 1371 subsequent shunt revisions and 138 shunt infections. Propensity adjusted regression demonstrated no statistically significant difference in odds of shunt infection between IT antibiotics (OR 1.22, 95% CI 0.82–1.81, p = 0.3) and AICs (OR 0.91, 95% CI 0.56–1.49, p = 0.7) compared to standard care.ConclusionIn a large, observational multicenter cohort, IT antibiotics and AICs do not confer a statistically significant risk reduction compared to standard care for pediatric patients undergoing low-risk (i.e., initial or revision) shunt surgeries.

Prostate Cancer Screening Uptake in Transgender Women

There is no consensus in prostate-specific antigen (PSA) screening guidelines regarding transgender women despite their known prostate cancer risk. To identify factors associated with recent (within the last 2 years) PSA screening in transgender women compared with cisgender men. This case-control study used data from the 2018 and 2020 Behavioral Risk Factor Surveillance System (BRFSS) surveys to characterize rates of PSA screening for prostate cancer within the past 2 years and multivariable logistic regressions to characterize factors associated with recent screening among transgender women. The BRFSS program of the Centers for Disease Control and Prevention annually surveys over 400 000 US adults on behavioral risk factors, chronic illnesses, and use of preventive services. Respondents to the BRFSS who were cisgender men or transgender women 40 years or older and who had complete PSA testing responses and no prostate cancer history were included; 313 transgender women and 138 937 cisgender men met inclusion criteria. Matching was performed by age, race and ethnicity, educational level, employment, annual income, survey year, and cost barriers to care. Data were collected on November 2, 2022, and analyzed from November 2, 2022, to December 3, 2023. Rates of and factors associated with recent PSA screening in transgender women. Among the 1275 participants included in the matched cohort (255 transgender women and 1020 cisgender men; 570 [44.7%] aged 55-69 years), recent PSA screening rates among transgender women and cisgender men aged 55 to 69 were 22.2% (n = 26) and 36.3% (n = 165), respectively; among those 70 years and older, these rates were 41.8% (n = 26) and 40.2% (n = 98), respectively. In the matched cohort, transgender women had lower univariable odds of recent screening than cisgender men (odds ratio [OR], 0.65 [95% CI, 0.46-0.92]; P = .02). In a hierarchical regression analysis adding time since the last primary care visit, effect size and significance were unchanged (OR, 0.61 [95% CI, 0.42-0.87]; P = .007). After adding whether a clinician recommended a PSA test, there was no statistically significant difference in odds of screening between transgender women and cisgender men (OR, 0.83 [95% CI, 0.45-1.27]; P = .21). The results were further attenuated when clinician-led discussions of PSA screening advantages and disadvantages were added (OR, 0.87 [95% CI, 0.47-1.31]; P = .32). In a multivariable logistic regression among transgender women, having a recommendation for PSA testing was the factor with the strongest association with recent screening (OR, 12.40 [95% CI, 4.47-37.80]; P < .001). In this case-control study of one of the largest cohorts of transgender women studied regarding PSA screening, the findings suggest that access to care or sociodemographic factors were not principal drivers of the screening differences between transgender women and cisgender men; rather, these data underscore the clinician's role in influencing PSA screening among transgender women.

SARS-CoV-2 Infection and Related Hospitalization among Cancer Survivors.

Little is known about SARS-CoV-2 infection and COVID-19 severity among a growing population of cancer survivors. We describe the association of infection and related hospitalization by recency of cancer diagnosis in a large U.S. cohort. Participants were sent electronic surveys between April 2020 and January 2021 to collect information on SARS-CoV-2 infection and potential COVID-19-related risk factors. SARS-CoV-2 infections were identified using survey report of a COVID-19-positive test and electronic health record data. Cumulative incidence of SARS-CoV-2 infection was estimated up to 365 days from baseline survey and stratified by recency of cancer diagnosis. Among those with SARS-CoV-2 infection, we used logistic regression to estimate the association between recency of cancer diagnosis and hospitalization within 30 days of infection. Cumulative incidence of SARS-CoV-2 infection at 365 days was 3.3% [95% confidence interval (CI), 3.2%-3.5%] among those without cancer history and ranged from 2.8% (95% CI, 2.3%-3.5%) to 3.7% (95% CI, 2.9%-4.7%) among those with a history of cancer depending on recency. There was no statistically significant difference in odds of hospitalization within 30 days following SARS-CoV-2 infection by cancer diagnosis recency. Our null findings are consistent with other studies on COVID-19 infection risk in cancer survivors, where COVID-19 severity and sequelae were independent of cancer history and were likely associated with factors such as intensive care unit admission, noncancer comorbid conditions, and long-term care residency. This study can inform COVID-19 risk-counseling of cancer survivors and their caregivers as we continue to contend with COVID-19.

Unraveling the Link: Cannabis Use Disorder and Pulmonary Embolism-Related Hospital Outcomes in Female Breast Cancer Survivors

Background: The use of cannabis in cancer patients has gained significant attention due to its analgesic properties, which help alleviate cancer-related pain. Studies have also shown the interference of cannabis with the coagulation system. We aimed to study the impact of cannabis use disorder (CUD) and Pulmonary embolism (PE) on outcomes in female breast cancer survivors, considering reports suggesting significant overlap between recreational and medicinal use. Our objective was to compare outcomes in CUD+ (with cannabis use disorder) and CUD- (without cannabis use disorder) cohorts to gain critical insights into this group and understand the impact of CUD on PE-related hospitalization and outcomes. Methods: National Inpatient Sample (NIS) data from 2020 was utilized in order to analyze inpatient cohorts of PE hospitalizations. The International Classification of Diseases 10 (ICD 10) codes for pulmonary embolism, cannabis use disorder, and female breast cancer were utilized to classify cohorts. All cases of female breast cancer and pulmonary embolism with an age &amp;gt;18 years were included in the final analysis. The primary outcome was the impact of CUD on PE-related hospitalizations in female breast cancer survivors. We also compared demographic correlations and comorbidities affecting outcomes between cohorts. Results: This study included a total of 508065 admissions among breast cancer survivors, with a median age of 74 years for the entire cohort. The prevalence of PE admissions was lower in CUD+ cohort compared to CUD- cohort (1.3% vs. 2.1%). The CUD+ cohort was relatively younger (median 66 vs 74 years, p&amp;lt;0.001). Overall, admission rates were higher among white patients (77%) and this trend was statistically significantly higher in the 76-100 th percentile household income group (p&amp;lt;0.002) compared to CUD+(50%) and CUD-(26.5%). Most admissions were non-elective (95.4%), with no statistical significance between CUD- and CUD+ patients (p=0.16). The majority of readmissions occurred in urban teaching hospitals (75.5%), with no significant difference observed between CUD- and CUD+ patients (p=0.111). Regionally, the South had a higher admission rate (37.2%) compared to other regions and this difference was statistically significant (p&amp;lt;0.001) between CUD- and CUD+ patients. Among the coexisting comorbidities, hypertension showed a significant difference between CUD- (70%) and CUD+(37.5%) patients (p&amp;lt;0.001). Alcohol use disorder (p&amp;lt;0.001) and cancer (p&amp;lt;0.001) had significant associations with CUD+, along with prior myocardial infarction (p=0.005) and drug use (p&amp;lt;0.001) were significantly associated with CUD+.Furthermore, there was difference in routine patient disposition between between CUD-(45.3%) and CUD+(37.5%),(p=0.033) and length of stay (4 VS 2 days), (p=0.033) and cost of stay (47033 vs 27668 $), (p=0.017). The multivariable logistic regression analysis showed that the odds of PE-related hospitalization in CUD+ vs CUD- cohorts among female breast cancer survivors were not statistically significant, with an OR of 0.79 (CI: 0.38-1.62, p=0.512). Subgroup analysis by age demonstrated no statistically significant differences in odds for PE-related hospitalization between CUD+ and CUD- cohorts. For the age group of 18-44 years, the OR was 1.37 (CI: 0.18-10.60, p=0.762). In the 45-64 years age group, the OR was 0.48 (CI: 0.15-1.53, p=0.215), and for those aged ≥65 years, the OR was 1.32 (CI: 0.48-3.67, p=0.590). Furthermore, the analysis by race indicated that the odds of PE-related hospitalization did not reach statistical significance in both white and black female breast cancer survivors with CUD. For white patients, the OR was 0.64 (CI: 0.23-1.73, p=0.375), while for black patients, the OR was 1.15 (CI: 0.38-3.46, p=0.804). Conclusion: Among female breast cancer survivors, the presence of CUD did not show a statistically significant impact on the odds of PE-related hospitalization. Subgroup analysis by age and race also revealed no significant differences in the odds of PE-related hospitalization between CUD+ and CUD- cohorts. These findings underscore the importance of considering CUD when managing pulmonary embolism in breast cancer survivor females and emphasize the need for further research to understand the complex interplay between these factors.

Abstract 13123: Sex-Based Disparity in Referral for Catheter Ablation for Atrial Fibrillation at a Single Integrated Health System

Introduction: Catheter ablation for atrial fibrillation (AFCA) is indicated for patients with symptomatic AF and has proven to reduce AF burden and improve quality of life. Older studies have shown that women are less likely to undergo ablation compared to men despite having more AF-related symptoms. We investigated whether an association exists between referral patterns and this sex-based disparity in the modern era of AFCA. Methods and Results: A retrospective cohort study was conducted of outpatients with newly diagnosed AF between 2011 and 2020 using an EMR database at Northwestern Medicine. Of 5,445 patients analyzed, 2,108 were women (mean [standard deviation, SD] age 70 [13], 19.2% non-Hispanic Black) and 3,337 were men (mean [SD] age 66 [13], 11.7% non-Hispanic Black). Other characteristics including insurance status, comorbidities, and prior treatment of AF were also compared by sex. Logistic regression models adjusted for these factors were constructed to determine associations between sex and a set of binary dependent variables including referrals to and visits with general cardiology and electrophysiology (EP) as well as performance of AFCA. In adjusted models, among internal medicine and primary care patients, there were no significant differences in odds of referral to or visits with general cardiology or EP between men and women. Additionally, there was no significant difference in odds to undergo AFCA between men and women once seen by EP (Figure). Conclusions: Our study demonstrates no significant difference with respect to sex in referral patterns or performance of AFCA. Further work must be done to investigate whether these results are generalizable to other health systems regarding performance of AFCA as addressing these differences, when present, could prove essential in dismantling sex-based disparities in AF treatment.

Abstract 18199: Relationship Between Hospital Care Team Segregation Index and Cardiovascular Care for Black and White Patients

Background: High levels of hospital health care team segregation has been associated with worse outcomes for Black patients. We sought to determine whether hospital level segregation index (SI, degree of dissimilarity between composition of teams that care for Black versus White patients) was associated with care by a cardiologist, 30-day readmission, and 1-year survival for Black versus White patients with heart failure (HF). Methods: Using Optum’s de-identified Clinformatics® Data Mart Database, for commercial and Medicare plans, we examined SI among Black and White patients admitted with primary diagnosis of HF from 2010-2018. Hospitals were stratified into three SI groups based on tertiles from least to most segregated hospital teams. Generalized linear mixed-effects models were used to evaluate each outcome including effects of race, SI, race by SI as well as gender, age-adjusted Charlson Comborbidity Index, and hospital factors. For 30-day readmission and 1-year survival, we included effects of cardiology care, 2 and 3-way interactions of race, SI, and cardiology care. Results: Among 119, 272 patients, Black patients were less likely to be seen by a cardiologist compared to White patients across SI tertiles, particularly medium SI hospitals (OR 0.833, 95% CI 0.770-0.902). There was no significant difference in odds of readmission between races across hospital SI levels and whether seen by a cardiologist. For 1-year survival, the odds were significantly higher for Black patients compared to White patients across all SI levels ( Figure ). Conclusion: Black patients with commercial or Medicare insurance were less likely to be seen by a cardiologist for HF care than White patients across SI levels, particularly medium SI. Hospital SI levels did not demonstrate a consistent relationship between 30-day readmission and 1-year survival. Figure .

Abstract 11840: Outcomes and Disparities of Asian Patients With Severe Chronic Kidney Disease Admitted for Heart Failure

Introduction: Socioeconomic disparities in cardiovascular and renal disease pose global public health challenges Despite its large population, Asia lacks proportional representation in heart failure (HF) data, limiting our understanding of risk factors and outcomes for Asians with HF and severe CKD. This study aims to explore the sex, racial, and ethnic differences in in-hospital all-cause mortality, baseline risk factors, and in-hospital complications among Asian patients admitted for HF with CKD. Hypothesis: Asian patients with CKD admitted for HF are linked with increased mortality, in-hospital complications, higher costs, and a longer length of stay compared to non-Asian patients. Methods: This retrospective study included patients 18 or older with heart failure and CKD 3-5 on discharge from 2016 to 2019. Multivariate logistic regression calculated the odds ratio (OR) adjusting for Elixhauser co-morbidities, age, and sex. The primary outcome was disparities in racial/ethnic, sex, and age of in-hospital mortality of patients admitted for HF complicated by CKD. Results: This study involved 510,525 patients, revealing Hispanics (OR: 0.791; CI: 07125-0.8747; p&lt;0.001) and African Americans (OR: 0.664; CI: 0.608-0.7258; p&lt;0.001) were associated with significantly lower mortality compared to Asians. Controlling for age and gender, Asians with HF &amp; CKD had significantly higher odds of diabetes, hyperlipidemia, and hypertension compared to non-Asians. Asian males with HF and CKD were associated with significantly higher odds of mortality (OR: 1.072; CI: 1.037-1.109; p&lt;0.001) and cardiovascular co-morbidities including atrial fibrillation, coronary bypass graft, implantable pacemaker, and chronic ischemic heart disease compared to non-Asian males. Asians, compared to non-Asians, were associated with significantly higher odds of acute MI, acute kidney injury, sepsis, and PRBC transfusion when controlling for Elixhauser co-morbidities. Conclusions: This study reveals significant health disparities among Asian patients with HF and CKD. The significant difference in odds of mortality and cardiovascular co-morbidities indicates the need for further research regarding the possible causality of such disparities.

Abstract 043: Intra‐cranial Rescue stenting in patients with incomplete perfusion following mechanical thrombectomy;a systemic review and meta‐analysis.

Introduction Incomplete reperfusion following Mechanical Thrombectomy (MT) ranges from 12–34% and patients with Intracranial atherosclerotic (ICAS) occlusions are disproportionally affected.(1, 2)These patients are also more likely to experience poor functional outcomes. (3) Rescue stenting (RS) in these patients has shown promising rates of recanalization and better outcomes in preliminary studies. In our systemic review and meta‐analysis, we included Sixteen dual arm and seven single arm studies in order to study recanalization rate and compare outcomes following rescue stenting in patients with incomplete reperfusion compared to those managed conservatively (no‐RS).(4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19)(20, 21, 22, 23, 24, 25, 26) Methods Our study was performed according to the preferred reporting items for systematic review and meta‐analysis (PRISMA) guidelines.(27) We incorporated studies that included participants, aged 18 years or older, and met the following criteria: (1) participants with ischemic stroke with Intracranial Atherosclerotic Stenosis (ICAS) who underwent at least one attempt of MT and had incomplete perfusion after the procedure (2) participants who received rescue stenting after MT with incomplete reperfusion, with no restrictions on the type of stents or stenting procedure used; (3) both observational studies (case series, cohort studies) and experimental designs (randomized controlled trials) were considered; (4) the control group consisted of patients incomplete reperfusion following MT but did not received no rescue stenting and were conservatively managed. We reported the recanalization rate in patients undergoing MT and compared the outcomes between the RS and no‐RS groups; MRS ≤ 2 at 90 days, Mortality at 90 days, Symptomatic Intra cranial Hemorrhage (sICH), Any Intracranial Hemorrhage (ICH), vessel dissection and vessel perforation Results Patients who underwent stenting experienced recanalization rate of 84% (95% CI: 79.0 – 88.1). They also had significantly higher odds of a better functional outcome (MRS ≤ 2 at 90 days) at 3 months compared to the no‐RS group (OR 2.70 [95% CI: 1.89 ‐ 3.86]). Odds of sICH (OR 0.92 [95% CI: 0.62 ‐ 1.36]) and any ICH (OR: 0.64 [95% CI 0.40 ‐ 1.03]) were lower but insignificant in the RS group. Odds of mortality at 90 days were significantly lower in the RS group(OR 0.59 [95% CI: 0.42 ‐ 0.83]). No significant difference in Odds of Vessel dissection (OR 1.22 [95% CI: 0.19 ‐ 8.07]) or vessel perforation (OR 0.40 [ 95% CI: 0.10 ‐ 1.61]) between the two groups was noted. Conclusion Out meta‐analysis which included the most recent studies indicates that rescue setting after mechanical thrombectomy for large artery intracranial atherosclerosis with incomplete perfusion or with residual stenosis (&gt;50 percent) is associated with better clinical outcomes and indicates lower mortality rate and associated complications. Therefore, rescue stenting can be considered as a safe and viable option in these patients.

Association of hospital spending with care patterns and mortality in patients hospitalized with community-acquired pneumonia.

Pneumonia is a leading cause of mortality and intensive therapy is costly. However, it is unclear whether more spending is associated with better patient outcomes or how hospitals could decrease costs. This study investigates the association between hospital spending and 14-day inpatient mortality among community-acquired pneumonia inpatients. This retrospective cohort study focused on adult pneumonia patients discharged between July 2010 and June 2015 from 260 UShospitals in the Premier database. Hospitals were divided into four pneumonia cost-of-care quartiles and average cost was calculated for each hospital. Odds of 14-day inpatient mortality and care practices were compared among high and low-cost hospitals. The study population comprised 534,038 patients with a mean age 69.5 (SD 16.3); 51.9% were female, 75% White, and 71.9% covered by Medicare. Hospitals were largely medium-sized (40.4%), located in the South (49.2%), and in urban areas (82.3%). The fully adjusted population-averaged cost was 14,486 US dollars (95% confidence interval [CI] 13,982-14,867). Hospital practices associated with cost included intensity of diagnostic work-up +$14 (95% CI+12 to +18; p < .0001) and de-escalation of antibiotic therapy, +$6836 (95% CI+2291 to +11,160; p = .004). There was no significant difference in odds of 14-day inpatient mortality between hospitals in the highest and lowest cost quartiles. Greater spending at the hospital level was not associated with lower mortality. Lower diagnostic costs were associated with lower cost of care, suggesting that judicious use of diagnostic testing might reduce costs without worsening patient outcomes.

Disparities in Inpatient Care Including Receipt of Radiotherapy and Mortality in Unhoused Adults with Cancer in the United States

Cancer is the second leading cause of death among unhoused individuals in the United States. This study aims to assess inpatient care and outcomes of unhoused vs. housed adults with cancer. We hypothesize that unhoused patients receive less intensive care than housed patients during hospitalization. All hospitalized adults age ≥18 with a principal cancer diagnosis were identified in the 2016-2020 National Inpatient Sample (NIS). Logistic regression models tested for associations between housing status and primary outcomes: care management (i.e., receipt of invasive procedures, systemic therapy, or radiation therapy [RT]) and inpatient death. Adjusted analyses accounted for patient demographics, socioeconomic status, comorbidities, and potential interactions between housing status and length of stay (LOS). A total of 9,030 unhoused and 2,758,693 housed hospitalized adults with cancer were included in this study. At baseline, there were significant (p<0.05) differences in age <65 years (77% unhoused vs. 41% housed), male sex (75% vs. 53%), race (Black, 25% vs. 13%; White, 58% vs. 71%), and insurance type (Private, 6% vs. 27%; Medicaid, 53% vs. 11%) between groups. There were also differences in the prevalence of certain cancer histologies, including lung (17% vs. 14%) and liver (8% vs. 3%) cancer. Additionally, while comorbidities such as congestive heart failure (18% vs. 15%) and HIV (10% vs. 1%) were more common among unhoused patients, other conditions such as autoimmune disease (21% vs. 26%) and diabetes mellitus (38% vs. 43%) were more common among housed patients. Compared to housed patients, unhoused patients had longer LOS (median 6 vs. 4 days), with 62% hospitalized for ≥5 days (vs. 46%). On adjusted analysis, unhoused patients were less likely to undergo invasive procedures (48% vs. 58%; aOR [95% CI], 0.34 [0.27-0.42]) or receive systemic therapy (6% vs. 8%; 0.41 [0.20-0.85]) while inpatient. There were no significant differences in odds of receipt of RT (2% vs. 1%; 0.85 [0.21-3.41]) or odds of inpatient death (4% vs. 6%; 0.78 [0.52-1.15]) between groups. In this first nationally representative analysis of housing status among hospitalized adults with cancer, unhoused adults were significantly less likely to receive invasive procedures or systemic therapy while inpatient, despite a higher prevalence of certain aggressive cancers and serious comorbidities compared to housed adults. Although there were no significant differences in the receipt of RT or death, disparities in inpatient management among unhoused patients highlight missed opportunities to promote equitable cancer care in this vulnerable population.

Higher Odds of Adverse Cutaneous Reactions in Patients With Dermatomyositis Treated With Hydroxychloroquine Compared With Methotrexate.

Hydroxychloroquine (HCQ) use for the treatment of dermatomyositis (DM) has been associated with adverse cutaneous reactions. We applied a new user, active comparator, retrospective design to assess differences in adverse cutaneous reactions or hospitalizations between HCQ and methotrexate (MTX) use among patients with DM. We used a national network of data from insurance registries (TriNetX), enrolling patients with two International Classification of Diseases (ICD) codes for DM separated by 6 months or more who had a prescription for either (but not both) HCQ or MTX on or after DM diagnosis. Outcomes were adverse cutaneous reactions (ICD codes) or hospital admission (Current Procedural Terminology (CPT) codes) within 4 months from the prescription dispense date. Logistic regression was used to produce adjusted odds ratios (aORs) and 95% confidence intervals (CIs) comparing outcomes in the HCQ group (n=1364) and the MTX group (n=1400), adjusted for age at first DM diagnosis, year of birth, sex, and time from DM diagnosis to first prescription. Overall, we found no significant difference in odds of hospitalization in those taking HCQ (aOR 1.05; 95% CI: 0.79-1.39) compared with those on MTX. Patients with DM on HCQ had 30% higher odds of adverse cutaneous reaction diagnosis compared with patients on MTX (aOR 1.30; 95% CI: 1.02-1.59). Age at DM diagnosis was an effect modifier of this association, with higher odds of adverse cutaneous reaction among patients taking HCQ who were younger at diagnosis. Compared with MTX use, HCQ use, especially in younger patients, may result in higher odds of adverse cutaneous reactions.

Obesity as a Risk Factor in Cosmetic Abdominal Body Contouring: A Systematic Review and Meta-Analysis.

The incidence of obesity is on the rise around the globe. Outside of the massive weight loss (MWL) patient population, knowledge of risk factors associated with abdominal body contouring (BC) is limited. This systematic review and meta-analysis assesses the impact of obesity has on cosmetic abdominal BC outcomes. A systematic review conducted in accordance with PRISMA 2020 was done. PubMed, Embase, Scopus, and COCHRANE databases were reviewed under search syntax "obesity," "abdominoplasty," "panniculectomy," and "body contouring" for articles. Cosmetic was defined as abdominoplasty or panniculectomy outside the context of MWL. Obesity was defined as BMI≥30kg/m2. Studies reporting postoperative outcomes with less than 50% of their population involving MWL patients were included. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Of 3088 initial studies, 16 met inclusion criteria, and nine were used for pooled and meta-analysis. Meta-analysis demonstrated that obesity was associated with more seromas (OR 1.45, 1.06-1.98, p = 0.02), hematomas (OR 2.21, 1.07-4.57, p = 0.03), and total surgical site occurrences (OR 1.99, 1.30-3.04, p = 0.0016). There was no significant difference in odds of any other complications. Analysis by obesity class showed no significant increase in odds in seromas or wound dehiscence. This review demonstrates obesity increased odds of postoperative complications following cosmetic abdominal BC. However, risk of complications does not continue to increase with higher obesity class. A BMI ≥ 30kg/m2 should not be a strict contraindication to cosmetic abdominal BC. Instead, plastic surgeons should evaluate patients on a case-by-case basis. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials

BackgroundRecent randomized controlled trials did not show benefit of early/immediate coronary angiography (CAG) over a delayed/selective strategy in patients with out-of-hospital cardiac arrest (OHCA) and no ST-segment elevation. However, whether selected subgroups, specifically those with a high pretest probability of coronary artery disease may benefit from early CAG remains unclear.MethodsWe included all randomized controlled trials that compared a strategy of early/immediate versus delayed/selective CAG in OHCA patients and no ST elevation and had a follow-up of at least 30 days. The primary outcome of interest was all-cause death. Odds ratios (OR) were calculated and pooled across trials. Interaction testing was used to assess for heterogeneity of treatment effects.ResultsIn total, 1512 patients (67 years, 26% female, 23% prior myocardial infarction) were included from 5 randomized controlled trials. Early/immediate versus delayed/selective CAG was not associated with a statistically significant difference in odds of death (OR 1.12, 95%-CI 0.91–1.38), with similar findings for the composite outcome of all-cause death or neurological deficit (OR 1.10, 95%-CI 0.89–1.36). There was no effect modification for death by age, presence of a shockable initial cardiac rhythm, history of coronary artery disease, presence of an ischemic event as the presumed cause of arrest, or time to return of spontaneous circulation (all P-interaction > 0.10). However, early/immediate CAG tended to be associated with higher odds of death in women (OR 1.52, 95%-CI 1.00–2.31, P = 0.050) than in men (OR 1.04, 95%-CI 0.82–1.33, P = 0.74; P-interaction 0.097).ConclusionIn OHCA patients without ST-segment elevation, a strategy of early/immediate versus delayed/selective CAG did not reduce all-cause mortality across major subgroups. However, women tended to have higher odds of death with early CAG.Graphical abstract

The Comparative Effectiveness of Ciprofloxacin and Metronidazole for an Initial Episode of Pouchitis: A Propensity-Matched Study.

There is minimal evidence regarding the comparative effectiveness of individual antibiotics in the treatment of pouchitis. We sought to evaluate the comparative effectiveness of ciprofloxacin monotherapy, metronidazole monotherapy, and combination therapy (ciprofloxacin and metronidazole) in the treatment of an initial episode of pouchitis after ileal pouch-anal anastomosis for ulcerative colitis (UC). We performed a retrospective cohort study in TriNetX, a global federated research network of electronic health records. Primary outcomes were failure of initial antibiotic therapy and the development of recurrent pouchitis in the first 12 months after an initial episode of pouchitis. One-to-one propensity score matching was performed for age, sex, race, primary sclerosing cholangitis, nicotine dependence, obesity, and previous exposure to tumor necrosis factor inhibitors between the cohorts. Among 271 patients who developed pouchitis (mean age at ileal pouch-anal anastomosis 35.8 years, male sex 57%) and were treated with ciprofloxacin, metronidazole, or combination therapy, 190 (70%) developed recurrent pouchitis. After propensity score matching, there was no significant difference in the odds of early relapse or nonresponse with ciprofloxacin compared with metronidazole monotherapy (adjusted odds ratio 0.56, 95% confidence interval 0.23-1.34) or when either monotherapy was compared with combination therapy. There was also no significant difference in odds of recurrent pouchitis when comparing patients treated with ciprofloxacin with metronidazole monotherapy (adjusted odds ratio 0.86, 95% confidence interval 0.40-1.84) or either monotherapy with combination therapy. In this retrospective cohort study, we demonstrated no significant difference in the real-world effectiveness of ciprofloxacin, metronidazole, or combination therapy for the initial episode of pouchitis.

The association of a scholarly concentrations program with medical students’ matched residencies

ABSTRACT Purpose Many medical school curricula include Scholarly Concentrations (SC) programs. While studies have examined how these programs affect students’ future research involvement, the association of SC programs with students’ specialty choices is uncertain. This study examines the SC program factors associated with congruence between the specialty focus of students’ SC projects and the clinical specialty they matched into for residency. Methods The authors conducted a retrospective cohort study of all students participating in the SC program at Johns Hopkins University School of Medicine for graduating classes 2013–2020. They used data from program questionnaires to categorize students’ specialty interests (baseline) and SC program experiences (post-program). The authors categorized each student’s project into specialties according to their faculty mentors’ primary appointments, abstracted student publications from SCOPUS, and abstracted residency program rankings from Doximity Residency Navigator. The authors used multivariable logistic regression to calculate adjusted odds ratios (aOR) for specialty-congruent matching (same specialty as SC project) and for matching into a Doximity-ranked top 20 or top 10 program. Results Overall, 35.3% of the 771 students matched into the same specialty as their SC projects. Increased odds of specialty-congruent matching occurred with ‘definite’ interest in the specialty at baseline [aOR (95% CI): 1.76 (0.98–3.15)] (P = 0.06) and with increasing publications with SC mentors [aOR (95% CI): 1.16 (1.03–1.30)] (P = 0.01). Congruence between SC specialty focus and matched specialty conferred no significant difference in odds of matching to a Doximity-ranked top 20 or top 10 program. Conclusions Baseline certainty of specialty interest and research productivity were associated with specialty congruence. However, as completing an SC project in a given specialty was not associated with increased odds of matching into that specialty nor into a higher Doximity-ranked program, SC program directors should advise students to pursue SC projects in any topic of personal interest.

Bariatric surgery improves outcomes of hospitalizations for acute heart failure: a contemporary, nationwide analysis.

The link between obesity and poor outcomes in heart failure (HF) has been well-established. This retrospective study sought to examine national rates and outcomes of acute HF hospitalizations in obese individuals with a prior history of bariatric surgery. Academic, university-affiliated; the United States. Adult admissions (≥18 years) including a diagnosis of severe obesity were identified in the 2016-2019 Nationwide Readmissions Database. Patients who previously underwent bariatric operations were categorized into the Bariatric cohort. Multivariable linear and logistic models were used to assess the association of prior bariatric surgery with outcomes of interest. Of an estimated 10,343,828 admissions for a diagnosis of severe obesity, 925,716 (8.9%) comprised the bariatric cohort. After risk adjustment, bariatric surgery was associated with significantly decreased odds of acute HF hospitalization (adjusted odds ratio [AOR]: .40, 95% confidence interval [CI]: .38-.41). Among acute HF hospitalizations, prior bariatric surgery was linked to lower odds of mortality (AOR: .68, 95% CI: .52-.89), prolonged mechanical ventilation (AOR .44, 95% CI: .32-.61), acute renal failure (AOR: .76, 95% CI: .70-.82), and prolonged hospitalization (AOR: .77, 95% CI: .68-.87). Bariatric surgery was linked to a decrement of 1 day (95% CI: .7-1.1) and $1200 in hospitalization costs (95% CI: 400-1900), but no significant difference in odds of 30-day readmission. Bariatric surgery is associated with reduced admissions for acute HF. Among acute HF hospitalizations, bariatric surgery is linked to significantly improved clinical and financial outcomes. Given its potential benefits in obesity and related diseases, bariatric surgery holds promise for promoting value-based healthcare for HF.

Intrauterine Insemination After Human Chorionic Gonadotropin Trigger or Luteinizing Hormone Surge: A Meta-analysis.

To assess the odds of pregnancy after intrauterine insemination (IUI) timed by ultrasound monitoring and human chorionic gonadotropin (hCG) administration compared with monitoring luteinizing hormone (LH) levels. We searched PubMed (MEDLINE), EMBASE (Elsevier), Scopus (Elsevier), Web of Science (Clarivate Analytics), ClinicalTrials.gov (National Institutes of Health), and the Cochrane Library (Wiley) from the inception until October 1, 2022. No language limitations were applied. After deduplication, 3,607 unique citations were subjected to blinded independent review by three investigators. Thirteen studies (five retrospective cohort, four cross-sectional, two randomized controlled trials, and two randomized crossover studies) that enrolled women undergoing natural cycle, oral medication (clomid or letrozole), or both for IUI were included in the final random-effects model meta-analysis. Methodologic quality of included studies was assessed with the Downs and Black checklist. Data extraction was compiled by two authors, including publication information, hCG and LH monitoring guidelines, and pregnancy outcomes. No significant difference in odds of pregnancy between hCG administration and endogenous LH monitoring was observed (odds ratio [OR] 0.92, 95% CI 0.69-1.22, P=.53). Subgroup analysis of the five studies that included natural cycle IUI outcomes also showed no significant difference in odds of pregnancy between the two methods (OR 0.88, 95% CI 0.46-1.69, P=.61). Finally, a subgroup analysis of 10 studies that included women who underwent ovarian stimulation with oral medications (clomid or letrozole) did not demonstrate a difference in odds of pregnancy between ultrasonography with hCG trigger and LH-timed IUI (OR 0.88, 95% CI 0.66-1.16, P=.32). Statistically significant heterogeneity was noted between studies. This meta-analysis showed no difference between pregnancy outcomes between at-home LH monitoring and timed IUI. PROSPERO, CRD42021230520.

An Evaluation of Early Complications after Prepectoral Tissue Expander Placement in First-Stage Breast Reconstruction with and without Acellular Dermal Matrix.

Prepectoral breast reconstruction has become popularized with the concurrent use of acellular dermal matrix (ADM). We sought to compare three-month postoperative complication rates and explantation rates for first stage, tissue expander based prepectoral breast reconstruction with and without the use of ADM. A single institution retrospective chart review was performed to identify consecutive patients undergoing prepectoral tissue-expander based breast reconstruction from August 2020 to January 2022. Chi-squared tests were used to compare demographic categorical variables and multiple variable regression models were used to identify variables associated with three-month postoperative outcomes. We enrolled 124 consecutive patients. Fifty-five patients (98 breasts) were included in the no-ADM cohort and 69 patients (98 breasts) were included in the ADM cohort. There were no statistically significant differences between ADM and no-ADM cohort in regard to 90-day postoperative outcomes. On multivariable analysis, there were no independent associations between seroma, hematoma, wound dehiscence, mastectomy skin flap necrosis, infection, unplanned return to the OR, or explanation in the ADM or no ADM groups after controlling for age, BMI, history of diabetes, tobacco use, neoadjuvant chemotherapy, and postoperative radiotherapy. Our results reveal no significant differences in odds of postoperative complications, unplanned return to the OR, or explantation between ADM and no-ADM cohorts. More studies are needed to evaluate the safety of prepectoral, tissue expander placement without ADM.

Sex‐specific association of physical frailty and cognitive function in a population‐based cross‐sectional study of American older adults

AbstractBackgroundWe hypothesized that the association between physical frailty and cognition would be modified by participant sex in a nationally representative sample of elderly adults in the United States.MethodsCross‐sectional data from the National Health and Nutrition Examination Survey (NHANES 2011‐2014) were obtained for participants age ≥60 years. Physical frailty was defined by four measures developed by Fried et al.: exhaustion, weakness, low body mass, and low physical activity, and then categorized into robust (None), pre‐frail (1‐2 measures), or frail (3‐4 measures). Cognitive test scores were converted to z‐scores based on the study sample means and standard deviations. To estimate global cognition, a composite z‐score was calculated by averaging the individual z‐scores. Linear regression models were fit to evaluate the association between frailty and cognition. In addition to the cognitive tests, we evaluated frailty as a risk factor for self‐reported memory complaint (SMC) using logistic regression. We used sampling weights to account for the NHANES design.ResultsA total of 2863 participants aged 60 years or older were included. According to the 4‐items frailty measures, 50.5% of participants were robust, 44.7% were pre‐frail, and 4.8% were frail. The majority of the participants were &gt; 70 (58.9%), women (54.4%), and White (79.4%). After adjustment for age, sex, race/ethnicity, education, alcohol use, income, marital status, diabetes, hypertension, and history of stroke, compared to robust, being frail (β = ‐0.69, 95%CI: ‐0.90, ‐0.48) and pre‐frail (β = ‐0.11, 95%CI: ‐0.19, ‐0.02) was associated with lower global cognitive z‐scores. Compared to men, pre‐frail women had mean adjusted global cognitive z‐scores that were ‐0.33 standard deviations lower (95% confidence interval (CI): ‐0.23, ‐0.42; P&lt;0.001). Similarly, compared to frail men, frail women had mean adjusted global z‐scores that were lower but the difference was not significant. There were no significant differences in odds of SMC by sex with regard to frailty.ConclusionsIn this population‐based cohort, our findings suggest frailty was associated with lower cognitive performance in older adults and modified by sex. Participants who did not meet criteria for 3‐4 measures of frailty but had 1‐2 measures showed similar lower cognitive performance.