Treatment-related Characteristics Research Articles

Management and outcomes of breast cancer patients with radiotherapy interruption.

Many cancer patients have not received timely treatment or even had treatment interruptions due to the COVID-19 pandemic. The objective of this investigation was to evaluate whether the prognosis of patients with breast cancer after surgery was affected by any interruptions in radiotherapy. The healthcare documents for breast cancer patients experiencing radiotherapy interruption after surgery, including treatment-related characteristics, and time of interruption, type of disease progression, and survival status, were collected between January and April 2020 during the Wuhan blockade. The final number of patients included was 148, and neither the Kaplan-Meier (KM) survival curve nor the cross-tabulation analysis found statistical significance. Cox regression analysis also did not identify risk factors associated with PFS. The prognosis of patients with postoperative breast cancer may not be significantly impacted by the interruption of radiotherapy, given its integration with additional treatments like targeted and endocrine therapies.

A systematic review of sham acupuncture validation studies

BackgroundAcupuncture is widely used worldwide; however, studies on its effectiveness have been impeded by limitations regarding the design of appropriate control groups. In clinical research, noninvasive sham acupuncture techniques can only be applied through validation studies. Therefore, this systematic review aimed to evaluate the scope of existing literature on this topic to identify trends.MethodsWe queried Pubmed, EMBASE, and the Cochrane Central Register of Controlled Trials databases from inception to July 2022 for relevant articles. Author names were used to identify additional relevant articles. Two independent reviewers assessed the identified articles based on the inclusion and exclusion criteria. The following data were extracted: study design, information regarding acupuncturists and participants, general and treatment-related characteristics of the intervention and control groups, participants’ experience of acupuncture, and research findings.ResultsThe database query yielded 673 articles, of which 29 articles were included in the final review. Among these, 18 involved the use of one of three devices: Streitberger (n = 5), Park (n = 7), and Takakura (n = 6) devices. The remaining 11 studies used other devices, including self-developed needles. All the included studies were randomized controlled trials. The methodological details of the included studies were heterogeneous with respect to outcomes assessed, blinding, and results.ConclusionsSham acupuncture validation studies have been conducted using healthy volunteers, with a focus on blind review and technological developments in sham acupuncture devices. However, theren may be language bias in our findings since we could not query Chinese and Japanese databases due to language barriers. There is a need for more efforts toward establishing control groups suitable for various acupuncture therapy interventions. Moreover, there is a need for more rigorous sham acupuncture validation studies, which could lead to higher-quality clinical studies.

Quality of care transition, patient safety incidents, and patients’ health status: a structural equation model on the complexity of the discharge process

BackgroundThe transition of patients between care contexts poses patient safety risks. Discharges to home from inpatient care can be associated with adverse patient outcomes. Quality in discharge processes is essential in ensuring safe transitions for patients. Current evidence relies on bivariate analyses and neglects contextual factors such as treatment and patient characteristics and the interactions of potential outcomes. This study aimed to investigate the associations between the quality and safety of the discharge process, patient safety incidents, and health-related outcomes after discharge, considering the treatments’ and patients’ contextual factors in one comprehensive model.MethodsPatients at least 18 years old and discharged home after at least three days of inpatient treatment received a self-report questionnaire. A total of N = 825 patients participated. The assessment contained items to assess the quality and safety of the discharge process from the patient’s perspective with the care transitions measure (CTM), a self-report on the incidence of unplanned readmissions and medication complications, health status, and sociodemographic and treatment-related characteristics. Statistical analyses included structural equation modeling (SEM) and additional analyses using logistic regressions.ResultsHigher quality of care transition was related to a lower incidence of medication complications (B = -0.35, p < 0.01) and better health status (B = 0.74, p < 0.001), but not with lower incidence of readmissions (B = -0.01, p = 0.39). These effects were controlled for the influences of various sociodemographic and treatment-related characteristics in SEM. Additional analyses showed that these associations were only constant when all subscales of the CTM were included.ConclusionsQuality and safety in the discharge process are critical to safe patient transitions to home care. This study contributes to a better understanding of the complex discharge process by applying a model in which various contextual factors and interactions were considered. The findings revealed that high quality discharge processes are associated with a lower likelihood of patient safety incidents and better health status at home even, when sociodemographic and treatment-related characteristics are taken into account. This study supports the call for developing individualized, patient-centered discharge processes to strengthen patient safety in care transitions.

Abstract PO4-13-07: Association of clonal hematopoiesis (CH) with clinical outcomes among survivors of breast cancer (BC)

Abstract Background: Clonal hematopoiesis (CH) refers to the identification of clonal expansion of hematopoietic cells due to somatic mutations in leukemia-associated genes without evidence of hematologic anomalies. CH, particularly with variant allele frequency (VAF) ≥ 10%, has been associated with adverse outcomes, including reduced survival in advanced malignancies and higher risk of cardiovascular events. The aim of this study was to evaluate the biological and prognostic relevance of CH in survivors of breast cancer (BC). Methods: CANTO (NCT01993498) is a prospective, multicenter cohort enrolling patients diagnosed with stage I-III BC. CANTO collects clinical, tumor and treatment-related characteristics at diagnosis (dx). Follow-up visits are scheduled at 1, 2, 4 and 6 years after dx and data on disease status, type of recurrence, and survival status are collected. We assessed CH among pts ≥ 40 years, without previous solid or hematological cancer, with blood samples available at dx and year 4 or experiencing death or disease recurrence before year 4. CH was determined using Next-Generation Sequencing with unique molecular identifiers (HaloPlexHS, Agilent Technologies) for 17 genes (including DNMT3A, TET2, ASXL1, PPM1D, ATM, JAK2 and TP53) on blood samples obtained at dx. Outcomes of interest included invasive disease-free survival (iDFS), distant disease-free survival (DDFS) and overall survival (OS) defined according to STEEP criteria. Kaplan-Meier estimator, log-rank test and multivariate Cox models assessed prognostic role of CH. Results: In the cohort with available CH data (N=1219) mean age (SD) was 57.5 (10.1) years, 62% of pts were postmenopausal, 40.9% were current or former smokers, 46.2% had stage I BC, 77.7% had HR+/HER2- BC, 53.5% received chemotherapy and 80.8% hormonal therapy. CH was detected with a VAF ≥ 1% in 306 pts (25.1%) including 207 pts (67.6%) with DNMT3A mutation, ≥ 2% in 186 (15.3%) and ≥ 10% in 45 (3.7%) pts. Pts with CH ≥ 10% were more frequently older (65.3 vs 57.2 years, p&amp;lt; .0001) and with a previous history of cardiovascular disease (53.3% vs 37.3%, p&amp;lt; 0.02). At a median (IQR) follow-up of 7.0 (6.2-7.8) years 246 iDFS, 161 DDFS and 118 OS events were observed. Only 8 cases of new hematological malignancies were observed. Pts harboring CH with a VAF ≥ 10% had worse OS (log-rank p=0.04) and CH with a VAF ≥ 10% was associated with higher risk of death (HR= 2.4, 95%CI 1.04-5.6); presence of CH with lower VAF was not associated with worse OS. Table displays complete results for all tested associations. Conclusions: CH at dx was identified in 25% of pts with stage I-III BC aged ≥ 40 years in the CANTO cohort, including 4% with a VAF ≥ 10%. In a large, prospective cohort of survivors of BC, we confirmed known associations of CH with older age and cardiovascular history. We observed few secondary hematological malignancies. CH with a VAF ≥ 10% was significantly associated with higher risk of death while adjusting for other relevant prognostic factors. Furthermore, a trend towards higher risk of DDFS events was observed among pts harboring CH with a VAF ≥ 10%. Table. Citation Format: Davide Soldato, Antonin Della Noce, Antonio Di Meglio, Christophe Marzac, Barbara Pistilli, Anne-Laure Martin, Sibille Everhard, Marie Breckler, Sandrine Boyault, Marina Rousseau, Olivier Trédan, Charles Coutant, Paul Cottu, Olivier Rigal, Christelle Levy, Christelle Jouannaud, Baptiste Sauterey, Nathalie Droin, Bastien Job, Aurélie Bertaut, Fabrice André, Ines Vaz Luis, Jean-Baptiste Micol. Association of clonal hematopoiesis (CH) with clinical outcomes among survivors of breast cancer (BC) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-13-07.

Abstract PO5-16-08: Breast cancer in men: 15 years of experience in an oncology reference center in northern Mexico

Abstract Background Breast cancer in men accounts for about 1% of all breast cancers. Classic risk factors include increasing age, a family history of cancer, and mutations in predisposing genes. The alteration of the estrogen-androgen ratio has been as involved in the genesis of this cancer due to its increased risk in conditions such as liver dysfunction, obesity, marijuana use, thyroid disease, Klinefelter’s syndrome, hormonal therapies, orchitis, cryptorchidism, and testicular damage. Purpose Hereby we aim to update the analysis of the published demographic, clinical and treatment-related characteristics of this disease in our center including the last 15 years, as well as newly identified relevant variables that will serve as the basis for awareness and screening programmes for our population. Methods We performed a retrospective observational analysis of the medical records of men diagnosed with breast cancer that were treated in “Centro Universitario Contra el Cáncer” between January 2007 and December 2022. A total of seventeen cases of male breast cancer were included in the analysis. The variables included are age at diagnosis, body mass index, comorbidities, cigarette and alcohol use, method of diagnosis, histological type/grade, clinical stage, estrogen, progesterone, and human epidermal growth factor receptor-2 (HER2) receptor status, and treatment received. We also looked at the dates of symptom onset, diagnosis, and treatment to determine the intervals between these events. SPSS v25 software was used for data analysis. The Shapiro-Wilk test was employed to determine the normality of the variables. Variables with a normal distribution were described with median and interquartile range for the 25th and 75th percentiles. Categorical variables were expressed as absolute numbers and percentages. Results Although we found some similarities between the characteristics of our population and those reported in the American and European series, there were many significant differences. Mean age at diagnosis was 62.9 (±11.7) years, 5.5 years earlier than the reported age of 68.4 years. In terms of risk factors, our population was twice as likely to report a family history of cancer as the American series (41% vs. 15-20%). Overweight and obesity together accounted for 76.5% followed by alcohol consumption in 70.6% and cigarette smoking in 47.1% of patients. Diabetes mellitus and systemic arterial hypertension were present in 70% of our population. These entities are known to alter the estrogen-androgen ratio. The initial symptom in 88.2% of patients was a retroareolar tumor. The mean time from symptom onset to cancer diagnosis was 14.4 months. Estrogen and/or progesterone receptor status was positive in 82.3%. HER2 overexpression was not found. 17.6% of the cancers were classified as triple negative in contrast to the 0.3% reported in other series. Regarding treatment, 88.3% underwent upfront surgery, of which 76% were modified radical mastectomies. Axillary node dissection was performed in 86.6% of the cases and sentinel node biopsy in the rest. Seventy-six percent of patients received chemotherapy and radiotherapy in the adjuvant setting. Tamoxifen was the most common drug of choice (87.5%) in the patients considered as candidates for hormonal therapy Conclusions This study updates the results previously reported from our center with additional information that enabled new important conclusions to be drawn about our population. These findings provide the basis for a better understanding of this disease, which is necessary to establish public policies and recommendations to reduce the negative impact of this type of cancer. Table. Demographic and Clinical Characteristics of the Patients Citation Format: Fernando Peña, Javier A. Martínez-Moyano, Francisco Alvarado-Villarreal, Carlos Salazar-Mejía, David Hernández-Barajas, Oscar Vidal-Gutiérrez. Breast cancer in men: 15 years of experience in an oncology reference center in northern Mexico [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-16-08.

Radiographic outcomes and non-union factor analysis in fragmentary segmental femoral shaft fractures (AO/OTA 32C3) treated with reamed antegrade nailing

This study retrospectively assessed radiographic outcomes and risk factors associated with non-union in femoral shaft fragmentary segmental fractures (AO/OTA 32C3) treated with reamed antegrade intra-medullary nailing. Radiological outcomes, including union and alignment, were evaluated. The risk factors for non-union were investigated, including demographics and treatment-related characteristics, such as the number of interlocking screws, segmentation length, main third fragment length, distance of the main third fragment, width ratio and exposed nail length in one cortex from immediate post-operative radiographs. Multivariate logistic regression was used for statistical analysis. Among 2295 femoral shaft fracture patients from three level-1 trauma centers, 51 met the inclusion criteria. The radiological union was achieved in 37 patients (73%) with a mean union time of 10.7 ± 4.8 months. The acceptable axial alignment was observed in 30 patients (59%). Multiple logistic regression analysis identified only exposed nail length as a significant risk factor for non-union (odds ratio: 1.599, p = 0.003) and the cut-off value was 19.1 mm (sensitivity, 0.786; specificity, 0.811). The study revealed high rates of non-union (27%) and malalignment (41%). Therefore, patients who underwent intramedullary nailing with an exposed nail length greater than 19.1 mm or about twice the nail diameter should be cautioned of the potential non-union.

Epidemiology of Accidental Injuries at Home and Related Risk Factors for Mortality among Older Adults in South Korea: A Retrospective Cohort Study.

Background and Objectives: Accidental home injuries among older adults are increasing globally, but reporting is limited. This study aims to establish foundational data for program development and policies to prevent accidental injuries at home in older adults by using data on the occurrence of accidental injuries at home and analyzing the risk factors of mortality due to accidental injuries among adults aged 65 years and older. Materials and Methods: This retrospective study used data from the community-based Severe Trauma Survey in South Korea. This study identified general, injury-related, and treatment-related characteristics of older adults who were transported to the emergency department with accidental injuries at home. Single-variable and multiple logistic regression analyses were used to identify risk factors for mortality after injury. Results: The majority of older adults in this study who experienced accidental injuries at home were aged 75 to 84 (42.8%) and female (52.8%), with 1465 injured from falls and slips (68.0%). Risk factors for mortality included older age (≥85 years) (ORs 2.25, 95% CI 1.47-3.45), male sex (ORs 1.60, 95% CI 1.15-2.20), mechanism of injury (falls or slips vs. contact injury, ORs 6.76, 95% CI 3.39-13.47; airway obstruction vs. contact injury, ORs 13.96, 95% CI 6.35-30.71), higher severity (moderate vs. mild, ORs 2.56, 95% CI 1.45-4.54; severe vs. mild, ORs 12.24, 95% CI 6.48-23.12; very severe vs. mild, ORs 67.95, 95% CI 38.86-118.81), and receiving a blood transfusion (ORs 2.14, 95% CI 1.24-3.67). Conclusions: Based on these findings, the home and community environments where older adults live should be inspected and monitored, and in-home accidental injury prevention strategies should be developed tailored to the characteristics of older adults' risk factors and their injury-related characteristics.

Treatment fatigue among adult patients with chronic heart failure in a tertiary care hospital in Ethiopia: a mixed-methods study

Background/Aims Patients with heart failure must adhere to strict treatment regimens, including pharmacological treatments, medical appointments and lifestyle modifications. This study aimed to assess the extent of treatment regimen fatigue among patients with heart failure in Ethiopia and identify factors that may exacerbate this. The authors also aimed to gather insights from patients and health professionals about how to ameliorate the impact of treatment regimen fatigue. Methods An explanatory sequential mixed-methods study was conducted at a specialist cardiac clinic in Ethiopia from 1 August to 30 September 2021. In the quantitative stage, the Treatment Regimen Fatigue Scale was delivered via interview to 325 patients with heart failure to collect data on their level of treatment regimen fatigue and analyse this against their demographic, clinical and treatment-related characteristics. The influences of factors on treatment regimen fatigue were tested using the Mann–Whitney U, Kruskal–Wallis and Chi square tests, as appropriate. In the qualitative stage, interviews were conducted with 14 patients with heart failure and 10 specialist health professionals to identify possible interventions to reduce treatment regimen fatigue. Interviews were recorded, transcribed and subject to content analysis to identify themes. Results In the quantitative phase, participants' mean level of treatment regimen fatigue was −48.38±13.1, indicating low levels of fatigue. Several factors had a significant impact on level of treatment regimen fatigue, including living alone (U=7819.5; Z=−3.01; P=0.003); poor knowledge of heart failure (U=4379.0; Z=−4.24; P&lt;0.001); lack of family support (U=6152.5; Z=−4.09; P&lt;0.01); presence of two or more comorbidities (U=11273.5; Z=−2.28; P=0.023); adverse drug effects (U=6990.0; Z=−2.78; P=0.006); poor availability of medications (U=10215.0; Z=−3.43; P=0.001); and reliance on health insurance to obtain medication (X2=7.18; P=0.028). Qualitative results indicated that improving patients' self-care, making changes to the structure of the cardiac clinic (eg more regular follow up with the same clinician) and improving the general healthcare system could reduce treatment regimen fatigue. Conclusions Patients with heart failure seem to experience low levels of treatment regimen fatigue, but this can be influenced by a variety of demographic, clinical and treatment-related factors. Interventions on a local and systemic level could reduce the risk of treatment regimen fatigue, but there is no one-size-fits-all solution.

Abstract 2241: Healthcare underutilization, healthcare mistrust, and quality of life among cancer survivors who use cannabis

Abstract Background: An increasing number of states have legalized the use of cannabis and its derivatives. As a result, marijuana use is expected to increase among cancer survivors. Research shows that cancer survivors use cannabis to manage a myriad of cancer-related symptoms, including pain and nausea. Despite this, there is limited evidence on how cannabis use among cancer survivors impacts healthcare utilization, healthcare mistrust, and quality of life among cancer survivors. Environmental scanning is needed to inform clinical oncologic outcomes as well as the benefits and risks of cannabis use among cancer survivors. Objectives: To examine differences in healthcare utilization, healthcare mistrust, and quality of life between adult cancer survivors who have ever used cannabis and those who have never used it. Methods: We recruited adults with a history of cancer through Qualtrics online panels for an online survey across all the states with different levels of marijuana laws (e.g., decriminalized and/or medical use only, and fully illegal and/or CBD oil only). We assessed sociodemographic, behavioral, psychological, cancer-related, and treatment-related characteristics, as well as quality of life, healthcare utilization, healthcare mistrust, and cannabis use (e.g., types, duration of use, current/ever use). Results: Based on a total of 747 respondents, 395 were eligible and enrolled in the survey. Nearly one-fourth of participants were non-White (n=103, 26.1%), and 240 (60.8%) were female. Two hundred and forty participants indicated they had ever used cannabis (240/395, 60.8%). Of these, 35% (n=84) were current users of cannabis. Compared to individuals who never used cannabis, ever users had greater healthcare system mistrust (t(257)=2.58, p=.01), underutilized healthcare systems in the last 12 months (e.g., “..had a medical problem but never sought any medical attention about my condition” and “…did not come back for a follow-up appointment that my doctor gave me”) (t(248)=2.83, p=.005), and reported worse physical (t(260)= -3.32, p&amp;lt;.001) and emotional well-being (t(260)= -2.36, p=.02). There was no difference between these two groups (ever users vs. never users) for functional well-being (t(260)= 1.08, p=.28). Discussion: The present study provides empirical evidence on differences between cancer survivors who ever used and never used cannabis. Compared to never users, ever users of cannabis had greater mistrust of the healthcare system, underutilized healthcare, and reported lower physical and emotional well-being. Further studies are needed to examine how cannabis use impacts the long-term health and wellbeing of cancer survivors. Citation Format: Sunny Jung Kim, Ghader Dargahi Abbasabad, Viktor Clark, Susan Hong, Vanessa B. Sheppard. Healthcare underutilization, healthcare mistrust, and quality of life among cancer survivors who use cannabis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2241.

Outcome and microbiological findings of patients with cardiac implantable electronic device infection.

Infections associated with cardiac implantable electronic devices (CIEDs) are a multifactorial disease that leads to increased morbidity and mortality. The aim was to analyze patient-, disease- and treatment-related characteristics including microbiological and bacterial spectrum according to survival status and to identify risk factors for 1- and 3-year mortality in patients with local and systemic CIED infection. In a retrospective cohort study, we analyzed data from patients with CIED-related local or systemic infection undergoing successful transvenous lead extraction (TLE). Survival status as well as incidence and cause of rehospitalization were recorded. Microbiology and antibiotics used as first-line therapy were compared according to mortality. Independent risk factors for 1- and 3-year mortality were determined. Data from 243 Patients were analyzed. In-hospital mortality was 2.5%. Mortality rates at 30days, 1- and 3years were 4.1%, 18.1% and 30%, respectively. Seventy-four (30.5%) patients had systemic bacterial infection. Independent risk factors for 1-year mortality included age (OR 1.05 [1.01-1.10], p = 0.014), NT-proBNP at admission (OR 4.18 [1.81-9.65], p = 0.001), new onset or worsened tricuspid regurgitation after TLE (OR 6.04 [1.58-23.02], p = 0.009), and systemic infection (OR 2.76 [1.08-7.03], p = 0.034), whereas systemic infection was no longer an independent risk factor for 3-year mortality. Staphylococcus aureus was found in 18.1% of patients who survived and in 25% of those who died, p = 0.092. There was a high proportion of methicillin-resistant strains among coagulase-negative staphylococci (16.5%) compared to Staphylococcus aureus (1.2%). Staphylococci are the most common causative germs of CIED-infection with coagulase-negative staphylococci showing higher resistance rates to antibiotics. The independent risk factors for increased long-term mortality could contribute to individual risk stratification and well-founded treatment decisions in clinical routine. Especially the role of tricuspid regurgitation as a complication after TLE should be investigated in future studies.

Sociodemographic and treatment-related determinants of recent substance use among adults with comorbid substance misuse and psychotic disorders discharged from substance use treatment

IntroductionRates of alcohol and illicit substance use are higher among persons with psychotic disorders relative to the general population. The adverse health and psychological effects of substance use behaviors disproportionately impact persons with psychotic disorders. Prior research has shown that persons with psychotic disorders experience increased difficulty in reducing substance use behaviors, and interventions targeting substance use behavior change among this population have demonstrated limited effectiveness. One reason for this is that little is known about the factors that influence substance use and behavior change among this population. To address these disparities, the present study investigated sociodemographic and treatment-related factors of substance use recurrence among persons with psychotic disorders who received substance use treatment services. MethodsData came from the 2015–2018 Treatment Episode Dataset-Discharges (TEDS-D). TEDS-D collects annual data on adolescent and adult discharges from state-certified substance use treatment centers in the United States. The study conducted all analyses with a subsample of 1956 adult discharges with a psychotic disorder who received services from an outpatient substance use treatment center for at least one month. χ2 tests of independence and multivariable logistic regression analyses were used to examine associations of sociodemographic and treatment-related characteristics with substance use recurrence while in treatment (α < 0.05 analyses). The study presents results from multivariable logistic regression models as adjusted odds ratios (AORs) with 95 % confidence intervals (CI). ResultsThose who were age 50 or older, were referred to treatment by the criminal justice system, and attended substance use self-help groups had lower odds of substance use recurrence while in treatment. Sex, educational attainment, employment status, living situation, type of substance use, and treatment history were not significantly associated with substance use recurrence. ConclusionsIn designing treatment services, providers should consider whether focusing on sociodemographic, including cultural, factors can affect more positive substance use behavior change and other desired treatment outcomes among those with psychotic disorders and comorbid substance misuse. Further study is needed to identify these factors among specific subpopulations of those with psychotic disorders and substance misuse.

Characteristics, treatment patterns and burden of illness in US patients with asthma newly initiating multiple-inhaler triple therapy

IntroductionFor patients with asthma who remain symptomatic on medium-dose inhaled corticosteroid/long-acting β2-agonist, add-on long-acting muscarinic antagonist is a treatment option, which can be administered as multiple-inhaler triple therapy (MITT). A...

응급실을 내원한 약물중독 자살시도자의 응급실 기반 자살시도자 사후관리사업 참여 영향요인

Purpose: The purpose of this study was to identify factors that affect the participation of drug intoxication suicide attempters in emergency room-based post-suicide attempt care program for suicide attempters, which is implemented by the country to prevent re-attempts by suicide attempters. Method: This study targeted suicide attempters who attempted suicide by drugs intoxication and visited an emergency room from January 1, 2020 to December 31, 2021. This was a retrospective study that compared the general characteristics, drug intoxication-related characteristics, and treatment-related characteristics of participants and non-participants in an emergency room-based post-suicide attempt care program. Results: There were 416 subjects who visited the emergency room due to suicide attempt drug intoxication. 246 (59.1%) participated in the emergency room-based post-suicide attempt care program and 170 (40.9%) did not participate. Between participants and non-participants in emergency room-based post-suicide attempt care program was significant difference mental illness was significant difference mental illness (χ2=124.91, p&lt;.001), hospital visit time (χ2=8.92, p=.030), systolic blood pressure (χ2=4.71, p=.030), and moderate severity (χ2=12.42, p=.006). Conclusion: Based on the results of this study, in order to increase the participation rate of drug intoxicated suicide attempters in the emergency room-based post-suicide attempter care program, it is necessary to strengthen the capacity of emergency room nurses who initially interview suicide attempters and provide discharge education to respond to suicide attempters. We also suggest developing strategies to prevent suicide re-attempts, such as the development of an administrative system that allows suicide attempters to connect with community counseling organizations after being discharged from the emergency room.

Determining the Appropriateness and Acceptability of a Reduced Postradiotherapy Surveillance Practice in Breast Cancer Patients: Results of a Longitudinal Observational Study

Postradiotherapy surveillance, which aims to detect and treat radiation injury, is important from the patient’s perspective, but also from the radiation oncologist’s perspective. Unfortunately, patient nonattendance increases over the course of five years. The aim of the study was to investigate the appropriateness and acceptability of reduced versus usual (conventional) postradiotherapy surveillance in breast cancer patients. A total of 192 consecutive patients with curatively irradiated breast cancer from two selected treatment years were included in our study, of whom 65 were offered six (after three months, 12 months, 24 months, 36 months, 48 months, and 60 months) and 127 were offered four follow-up appointments (after three months, 12 months, 36 months, and 60 months). Their patient-, tumour- and treatment-related characteristics were analysed, as well as follow-up events and attendance rates. The reduced four-meeting surveillance practice shows similar results to the traditional six-meeting practice in terms of appropriateness and acceptability, with significantly higher attendance rates at 36 and 60 months (p=0.014 and 0.013, respectively) when the individual moments are compared on a one-to-one basis. The patient-, tumour-, and treatment-related variables examined did not show an effect on the attendance rate. There was also no significant difference between the two cohorts in the detection of follow-up events (such as recurrence) and late radiation effects. In conclusion, this retrospective study provides scientific support for the trend towards a risk-adjusted, reduced surveillance practice in radiation oncology. In particular, four postradiotherapy follow-up visits seem to be appropriate and accepted in breast cancer patients after curative postoperative breast irradiation. This reduced postradiotherapy surveillance practice has the advantage of saving time for the patient and resources for the healthcare system without compromising quality; it could also improve patient participation. We, therefore, recommend it as an appropriate standard for breast cancer patients.

Subgroup analysis of steadily increased trends in medullary thyroid carcinoma incidence and mortality in the USA, 2000-2020: a population-based retrospective cohort study.

The incidence rate of medullary thyroid carcinoma (MTC) continues to grow, along with its mortality rate in the USA. However, the subgroup trends in MTC have not yet been established. This population-based retrospective cohort study was based on the Surveillance, Epidemiology, and End Results (SEER) 17/12 registry database. Subgroup analysis was performed through clinicopathological and treatment-related characteristics. Annual average percentage change (AAPC) was calculated using joinpoint regression analysis. A total of 3833 MTC patients and 536 death cases were diagnosed in the SEER database. Between 2000 and 2019, the incidence (AAPC = 1.64) and mortality (AAPC = 3.46) rates of MTC continued to rise. Subgroup analysis showed the proportion of elderly patients (65-84 years) gradually increased in incidence between 2000 and 2020. Patients with early-stage tumors, such as tumors ≤20 mm, showed the same trends. Aspects of treatment, the implementation rate of total thyroidectomy (AAPC = 0.38) and lymph node dissection (AAPC = 1.06) also increased persistently in almost all of the age subgroups. The incidence and mortality of MTC consistently increased from 2000 to 2019. Subgroup analysis indicated a significant increase in elderly patients and early-stage patients, and more attention should be paid to the management of these increased subgroups.

Exploring humanistic burden of fatigue in adults with multiple sclerosis: an analysis of US National Health and Wellness Survey data

BackgroundThis retrospective study examined the humanistic burden of fatigue in patients with relapsing-remitting multiple sclerosis (RRMS), compared with adults without MS, using data from the 2017 and 2019 US National Health and Wellness Survey.MethodsThe 5-item Modified Fatigue Impact Scale (MFIS-5) was used to assess level of fatigue (MFIS-5 score <15: low fatigue [LF]; MFIS-5 score ≥15: high fatigue [HF]) in patients with RRMS. Health-related quality of life (HRQoL) measures (Short Form 36-Item Health Survey version 2, Euroqol-5 Dimensions-5 Levels [EQ-5D-5L], Patient Health Questionnaire-9 [PHQ-9], Generalized Anxiety Disorder-7 [GAD-7], Perceived Deficits Questionnaire-5) and treatment-related characteristics were assessed.ResultsIn total, 498 respondents were identified as RRMS (n=375 RRMS+LF, n=123 RRMS+HF) and compared with 1,494 matched non-MS controls. RRMS+LF and RRMS+HF had significantly lower Short Form 6 Dimensions health utility, Mental and Physical Component Summary, and EQ-5D-5L scores and higher PHQ-9 and GAD-7 scores, compared with matched non-MS controls (all p<0.001); scores were worse for RRMS+HF than RRMS+LF across all measures (all p<0.001). A higher proportion of RRMS+HF reported moderate-to-severe depression and moderate-to-severe anxiety, compared with RRMS+LF and matched non-MS controls (both p<0.001). Fatigue was a significant predictor of poor HRQoL across all measures (all p<0.001).ConclusionsPatients with RRMS experienced lower HRQoL with higher levels of fatigue, highlighting an unmet need. Results may help to inform physician-patient communication and shared decision-making to address fatigue and its associated impact on patients’ HRQoL.

Epilepsy in childhood and school performance: a nation-wide cohort study.

Childhood epilepsy has been linked to poor academic performance, but large-scale studies are lacking. In this nation-wide study of school-aged children, we examined the association between childhood epilepsy and school performance in standardized tests according to phenotypic and treatment-related characteristics. We performed a matched register-based cohort study of children born in Denmark (1997-2009) who participated in the Danish National School Test Programme between 2010 and 2019. We used population and health registers to identify children with epilepsy and a randomly sampled sex- and age-matched reference cohort without epilepsy (ratio 1:10). Norm-based test scores from language and mathematics reflecting performance as a percentile of the nation-wide distribution of scores (scale 1-100) were used to assess academic performance. Adjusted differences in mean standardized scores between children with and without epilepsy were estimated using linear regression models. Among 582 840 children participating in the School Test Programme, we identified 4659 (0.8%) children with epilepsy (52.8% males) and 46 590 matched reference children. Median age at epilepsy onset was 7.5 years (interquartile range: 4.0-10.6). Childhood epilepsy was associated with poorer school performance overall (mean score = 48.2 versus references = 56.7; adjusted difference = -6.7, 95% CI: -7.4 to -6.0), and worse performance was found in all epilepsy subgroups, including in 3534 children with uncomplicated epilepsy (i.e. no other pre-existing neurologic or intellectual disabilities and no identified possible cause for epilepsy; adjusted difference = -6.0, 95% CI: -6.8 to -5.2). No major variation by sex, age or subject was observed, but larger score differences were seen in children using antiseizure medication at time of testing (e.g. valproate monotherapy, adjusted difference = -9.3, 95% CI: -11.5 to -7.0 and lamotrigine monotherapy, adjusted difference = -13.1, 95% CI: -15.0 to -11.3) and in children with psychiatric comorbidity, especially epilepsy with comorbid intellectual disability (adjusted difference = -27.0, 95% CI: -30.0 to -23.9) and epilepsy with comorbid attention deficit/hyperactivity disorder (adjusted difference = -15.7, 95% CI: -19.0 to -12.4). Children with epilepsy scored significantly lower than their unaffected siblings (adjusted difference = -6.2, 95% CI: -7.1 to -5.4). In conclusion, childhood epilepsy was associated with impaired academic performance throughout schooling, which suggest that there is a widespread need for educational support of children with epilepsy, even when the child has no other comorbidities and when the epilepsy appears well-managed.

Low-dose buprenorphine initiation and treatment continuation among hospitalized patients with opioid dependence: A retrospective cohort study

BackgroundBuprenorphine is an effective treatment for both opioid use disorder (OUD) and chronic pain, but buprenorphine's pharmacology complicates treatment initiation for some patients. Low-dose buprenorphine initiation is a novel strategy that may reduce precipitated withdrawal. Few studies describe what patient populations benefit most from low-dose initiations and the clinical parameters that impact treatment continuation. This study aimed to 1) describe experiences with low-dose buprenorphine initiation, including both successes and failures among hospitalized patients in an urban underserved community; 2) identify patient- and treatment-related characteristics associated with unsuccessful initiation and treatment discontinuation; and 3) assess buprenorphine treatment continuation after discharge. MethodsThis is a retrospective cohort study with opioid-dependent (meaning OUD or receiving long-term opioid therapy for chronic pain) patients who underwent low-dose buprenorphine initiation during hospital admission from October 2021 through April 2022. The primary outcome was successful completion of low-dose initiation. Bivariate analysis identified patient- and treatment-related factors associated with unsuccessful initiation. Secondary outcomes were buprenorphine treatment discontinuation at post-discharge follow-up, 30- and 90-days. ResultsOf 28 patients who underwent low-dose buprenorphine initiation, 68 % successfully completed initiation. Unsuccessful initiation was associated with receipt of methadone during admission and higher morphine milligram equivalents (MME) of supplemental opioids. Of 22 patients with OUD, the percent receiving a buprenorphine prescription at a follow-up visit, 30 days, and 90 days, respectively, was 46 %, 36 %, and 36 %. Of 6 patients with chronic pain, the percent receiving a buprenorphine prescription at a follow-up visit, 30 days, and 90 days, respectively, was 100 %, 100 %, and 83 %. ConclusionLow-dose buprenorphine initiation can be successful in opioid-dependent hospitalized patients. Patients taking methadone or requiring higher MME of supplemental opioids may have more difficulty with the low-dose buprenorphine initiation approach, but these findings should be replicated in larger studies. This study suggests patient- and treatment-related factors that clinicians could consider when determining the optimal treatment strategy for patients wishing to transition to buprenorphine.

Unraveling the safety of adjuvant radiotherapy in prostate cancer: impact of older age and hypofractionated regimens on acute and late toxicity - a multicenter comprehensive analysis.

The objective of this study was to assess the impact of age and other patient and treatment characteristics on toxicity in prostate cancer patients receiving adjuvant radiotherapy (RT). This observational study (ICAROS-1) evaluated both acute (RTOG) and late (RTOG/EORTC) toxicity. Patient- (age; Charlson's comorbidity index) and treatment-related characteristics (nodal irradiation; previous TURP; use, type, and duration of ADT, RT fractionation and technique, image-guidance systems, EQD2 delivered to the prostate bed and pelvic nodes) were recorded and analyzed. A total of 381 patients were enrolled. The median EQD2 to the prostate bed (α/β=1.5) was 71.4 Gy. The majority of patients (75.4%) were treated with intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT). Acute G3 gastrointestinal (GI) and genitourinary (GU) toxicity rates were 0.5% and 1.3%, respectively. No patients experienced >G3 acute toxicity. The multivariable analysis of acute toxicity (binomial logistic regression) showed a statistically significant association between older age (> 65) and decreased odds of G≥2 GI acute toxicity (OR: 0.569; 95%CI: 0.329-0.973; p: 0.040) and decreased odds of G≥2 GU acute toxicity (OR: 0.956; 95%CI: 0.918-0.996; p: 0.031). The 5-year late toxicity-free survival rates for G≥3 GI and GU toxicity were 98.1% and 94.5%, respectively. The only significant correlation found (Cox's regression model) was a reduced risk of late GI toxicity in patients undergoing hypofractionation (HR: 0.38; 95% CI: 0.18-0.78; p: 0.008). The unexpected results of this analysis could be explained by a "response shift bias" concerning the protective effect of older age and by treatment in later periods (using IMRT/VMAT) concerning the favorable effect of hypofractionation. However, overall, the study suggests that age should not be a reason to avoid adjuvant RT and that the latter is well-tolerated even with moderately hypofractionated regimens.

Low-dose diazoxide is safe and effective in infants with transient hyperinsulinism.

Transient hyperinsulinism (THI) is the most common form of recurrent hypoglycaemia in neonates beyond the first week of life. Although self-resolving, treatment can be required. Consensus guidelines recommend the lower end of the diazoxide 5-15 mg/kg/day range in THI to reduce the risk of adverse events. We sought to determine if doses <5 mg/kg/day of diazoxide can be effective in THI. Infants with THI (duration <6 months) were treated with low-dose diazoxide from October 2015 to February 2021. Dosing was based on weight at diazoxide start: 2 mg/kg/day in infants 1000-2000 g (cohort 1), 3 mg/kg/day in those 2000-3500 g (cohort 2)and 5 mg/kg/day in those >3500 g. A total of 73 infants with THI (77% male, 33% preterm, 52% small-for-gestational age) were commenced on diazoxide at a median age of 11 days (range 3-43) for a median duration of 4 months (0.3-6.8), with no difference between cohorts. The mean effective diazoxide dose was 3 mg/kg/day (range 1.5-10); 35% (26/73) required an increase from their starting dose, including 60% (9/15) of cohort 1. There was no association between perinatal stress risk factors or treatment-related characteristics and dose increase. Adverse events occurred in 13 patients (18%); oedema (12%) and hyponatraemia (5%) were the most common. Two infants developed suspected necrotising enterocolitis (NEC); none had pulmonary hypertension. Diazoxide doses <5 mg/kg/day are effective in THI. While the nature of the association between diazoxide and NEC was unclear, other adverse events were mild. We suggest considering starting doses as low as 2-3 mg/kg/day in THI to balance the side effect risk while maintaining euglycaemia.