Treatment-related Information Research Articles

Objective acuity measures for infusion therapy staffing: A predictive model approach—Phase I.

e13553 Background: Acuity is a measure of the complexity of patient care and an estimate of nursing workload. The use of acuity tools is shown to improve care standards, nurse satisfaction and productivity. Existing acuity tools have barriers to adoption, including increased nursing workload, estimate variations among different nurses and clinical care settings, and poor understanding of validity of acuity measures. We aim to build a predictive model for prospectively determining acuity levels and staffing requirements in infusion therapy to address these gaps. This project will be implemented with a phased approach. Here we describe Phase I, to establish a standard measure and documentation process for acuity, then collect and analyze a large data set to quantify the relationship of acuity scores to selected patient characteristics. Methods: A US Oncology Network nursing committee developed evidence-based guidelines for acuity measurement and documentation in August 2023. Nine sites from four independent, community oncology practices were selected to perform acuity rating and documentation using the developed guidelines. Multiple training sessions on the guidelines were conducted with nurses from selected sites. Nurses documented acuity scores (level 1~6) and start time for patients’ infusion visits in the EHR 8/30/2023 – 11/30/2023. Acuity documentation rates were calculated and provided to each site weekly to gain feedback and engagement. Acuity scores were extracted from the electronic health record using natural language processing. Structured data on potential predictors including patient demographics, performance status, lab, and treatment-related information were also collected. Results: A total of 14,610 infusion room visits (5,139 distinct patients) with documented acuity scores were reported. The acuity documentation rate from each site was consistent by week and ranged 60 – 96%. Table reports prevalence of select features by acuity score. Conclusions: An operational workflow was successfully implemented to collect and analyze acuity scores and relevant features. Features of interest include chemotherapy Cycle 1 Day 1, five or more drugs and highly emetogenic treatment. In Phase II, the collected acuity scores and clinical features will be used to build a predictive model to objectively estimate acuity. Phase III will focus on the deployment of the predictive model to oncology practices. [Table: see text]

Benefits of Collaboration Between the Wound, Ostomy, and Continence Nurse and Orthopedic Surgeon When Treating Skin Defects After Soft Tissue Sarcoma Resection: A Retrospective Case-Control Study.

The purpose of this study was to evaluate the benefits of collaborative management between orthopedic surgery and WOC nurses in patients undergoing resection of subcutaneous sarcomas. Retrospective case-control study. The sample comprised 25 patients who underwent wide resection for soft tissue sarcoma, followed by 2-stage split-thickness skin grafting. Data collection occurred between January 2015 and April 2021 in a university hospital based in Kagoshima, Japan. For comparison, we categorized these patients into 2 groups: intervention group participants were managed by an orthopedic surgeon and a WOC nurse; nonintervention group members were managed without WOC nurse participation. Patient background and treatment-related information was retrospectively collected from medical records and compared between the WOC nurse intervention group and the nonintervention group, including maximum tumor diameter, surgical time, maximum skin defect diameter, length of hospital stay, and time from surgery to complete wound healing. The average length of hospital stay was significantly shorter in the WOC nurse intervention group compared with the nonintervention group (38.3 days, SD = 8.0 vs 47.1 days, SD = 10.2; P = .023). Collaborative wound management with a WOC nurse resulted in a shorter hospital length of stay when compared to traditional management with WOC nurse involvement. Based on these findings, we assert that WOC nurses provide an important bridge between postoperative wound management in patients undergoing resection of subcutaneous sarcomas.

Assessing the Potential Role of Artificial Intelligence in Medication-Related Osteonecrosis of the Jaw Information Sharing

BackgroundArtificial Intelligence, by answering questions about disease prevention strategies, can contribute to making diseases more treatable in their early stages. PurposeThis study aims to evaluate the quality of patient information by assessing the responses of the Chat Generative Pre-trained Transformer (ChatGPT, Open Al, USA) artificial intelligence model to questions related to medication-related osteonecrosis of the jaw (MRONJ). Study design, setting, sampleThe study was prospective cross-sectional design. The study was conducted within the Department of Oral and Maxillofacial Surgery. The study's questions were prepared by an experienced oral and maxillofacial surgeon and directed to the artificial intelligence platform. The responses were evaluated by oral and maxillofacial surgeons using the Global Quality Scale (GQS). Predictor variableThe predictor variable is question type. A total of 120 questions were categorized into six groups, which encompassed general information about MRONJ (Group 1), queries from patients about to initiate medication therapy (Group 2), questions from patients currently undergoing medication treatment (Group 3), inquiries from patients who had completed medication usage (Group 4), general treatment-related information (Group 5), and case scenarios (Group 6). Main Outcome VariablesThe main variable is the GQS score. The GQS rates the quality of information and its utility for the patients. The scores are as follows: Score 1: Poor quality, Score 2: Generally poor quality, Score 3: Moderate quality, Score 4: Good quality, Score 5: Excellent quality. CovariatesNot applicable. AnalysesKruskal-Wallis and Mann-Whitney-U tests were applied for intragroup and intergroup analyses. The statistical significance level was determined as p<0.05 and p<0.01. ResultsThe average score for all questions was calculated to be 3.9±0.8, which is above the "moderate quality" threshold. Group 1 had a mean score of 3.4±1.1; Group 2 had 4.1±0.7; Group 3 had 3.8±0.8; Group 4 had 4.3±0.6; Group 5 had 4.2±0.7; and Group 6 had 4.1±0.5. The variations in mean scores among these groups did not exhibit statistical significance (p>0.05). Conclusions and RelevanceThe artificial intelligence model has generated responses of moderate quality to questions about MRONJ. The use of the artificial intelligence platform may assist in patients gaining a fundamental understanding of MRONJ.

Portrayal of Autism Spectrum disorder and its treatments in Qatar's leading newspapers: A content analysis study

BackgroundThe public cultivates thoughts, perceptions, and beliefs through media. Research has revealed that the media has a significant contribution to the publics’ negative perceptions and stigma surrounding Autism Spectrum Disorder (ASD). However, there are limited studies on the portrayal of ASD in Qatar's printed media. MethodThe current study explored the portrayal of ASD in six leading Qatari newspapers through retrospective content analysis of articles published between 27/08/2019 and 26/09/2020. Quantitative and qualitative data analysis methods were used to assess the extent and format of ASD-related articles as well as the discourse tone and thematic representation. Treatments were evaluated for their level of evidence through comparison with a combination of primary, secondary, and tertiary literature. ResultsA total of 178 ASD-related articles (88 in English and 90 in Arabic) were analyzed. The majority of these articles were displayed with minimal or no distinguishable features from articles about other topics, and placed in the middle of the newspaper or in the supplement section. Qualitative analysis revealed the presence of a stigmatizing tone in ASD articles written in both Arabic and English newspapers. Treatments reported were mostly evidence based, with some articles mentioning interventions without sufficient support from reputable guidelines. ConclusionsThere is much room for improvement in regards to portrayal of ASD in Qatari newspapers; in particular to emphasize on de-stigmatizing language, to promote reporting on the living experience of people with ASD, and to ensure accurate treatment-related information is provided.

Characteristics and associated factors of health information-seeking behaviour among patients with inflammatory bowel disease in the digital era: a scoping review

BackgroundHealth Information-Seeking Behaviour (HISB) is necessary for self-management and medical decision-making among patients with inflammatory bowel disease (IBD). With the advancement of information technology, health information needs and seeking are reshaped among patients with IBD. This scoping review aims to gain a comprehensive understanding of HISB of people with IBD in the digital age.MethodsThis scoping review adhered to Arksey and O'Malley's framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews frameworks (PRISMA-ScR). A comprehensive literature search was conducted in PubMed, Embase, Web of Science, PsycINFO, CINAHL, and three Chinese databases from January 1, 2010 to April 10, 2023. Employing both deductive and inductive content analysis, we scrutinized studies using Wilson's model.ResultsIn total, 56 articles were selected. Within the information dimension of HISB among patients with IBD, treatment-related information, particularly medication-related information, was identified as the most critical information need. Other information requirements included basic IBD-related information, daily life and self-management, sexual and reproductive health, and other needs. In the sources dimension, of the eight common sources of information, the internet was the most frequently mentioned source of information, while face-to-face communication with healthcare professionals was the preferred source. Associated factors were categorized into six categories: demographic characteristics, psychological aspects, role-related or interpersonal traits, environmental aspects, source-related characteristics, and disease-related factors. Moreover, the results showed five types of HISB among people with IBD, including active searching, ongoing searching, passive attention, passive searching, and avoid seeking. Notably, active searching, especially social information seeking, appeared to be the predominant common type of HISB among people with IBD in the digital era.ConclusionInformation needs and sources for patients with IBD exhibit variability, and their health information-seeking behaviour is influenced by a combination of diverse factors, including resource-related and individual factors. Future research should focus on the longitudinal changes in HISB among patients with IBD. Moreover, efforts should be made to develop information resources that are both convenient and provide credible information services, although the development of such resources requires further investigation and evaluation.

Evaluation of YouTube As A Source For Graves' Disease Information: Is High-Quality Guideline-Based Information Available?

To understand the quality of informational Graves' disease (GD) videos on YouTube for treatment decision-making quality and inclusion of American Thyroid Association (ATA) treatment guidelines. Cross-sectional cohort. Informational YouTube videos with subject matter "Graves' Disease treatment." The top 50 videos based on our query were assessed using the DISCERN instrument. This validated algorithm discretely rates treatment-related information from excellent (≥4.5) to very poor (<1.9). Videos were also screened for ATA guideline inclusion. Descriptive statistics were used for cohort characterization. Univariate and multivariate linear regressions characterized factors associated with DISCERN scores. Significance was set at P < .05. The videos featured 57,513.43 views (SD = 162,579.25), 1054.70 likes (SD = 2329.77), and 168.80 comments (SD = 292.97). Most were patient education (52%) or patient experience (24%). A minority (40%) were made by thyroid specialists (endocrinologists, endocrine surgeons, or otolaryngologists). Under half did not mention all 3 treatment modalities (44%), and 54% did not mention any ATA recommendations. Overall, videos displayed poor reliability (mean = 2.26, SD = 0.67), treatment information quality (mean = 2.29, SD = 0.75), and overall video quality (mean = 2.47, SD = 1.07). Physician videos were associated with lower likes, views, and comments (P < .001) but higher DISCERN reliability (P = .015) and overall score (P = .019). Longer videos (P = .015), patient accounts (P = .013), and patient experience (P = .002) were associated with lower scores. The most available GD treatment content on YouTube varies significantly in the quality of medical information. This may contribute to suboptimal disease understanding, especially for patients highly engaged with online health information sources.

Assessing Laryngectomy Patient Education on YouTube: Investigating Quality and Reliability.

This study aimed to characterize the quality of laryngectomy-related patient education on YouTube and understand factors impacting video content quality. Cross-sectional cohort analysis. Laryngectomy-related videos on YouTube. YouTube was anonymously queried for various laryngectomy procedure search terms. Video quality was evaluated using the validated DISCERN instrument which assesses treatment-related information quality. Descriptive statistics were used to characterize our cohort. Univariate and multivariable linear regression were used to assess factors associated with increased DISCERN score. Significance was set at P < .05. Our 78-video cohort exhibited moderate levels of engagement, averaging 13,028.40 views (SD = 24,246.93), 69.79 likes (SD = 163.75), and 5.27 comments (SD = 18.81). Videos were most frequently uploaded to accounts belonging to physicians (43.59%) or health care groups (41.03%) and showcased operations (52.56%) or physician-led education (20.51%). Otolaryngologists were featured in most videos (85.90%), and most videos originated outside the United States (67.95%). Laryngectomy videos demonstrated poor reliability (mean = 2.35, SD = 0.77), quality of treatment information (mean = 1.92, SD = 0.86), and overall video quality (mean = 1.97, SD = 1.12). In multivariable linear regression, operative videos were associated with lower video quality relative to nonoperative videos (β = -1.63, 95% confidence interval [CI] = [-2.03 to -1.24], P < .001); the opposite was true for videos from accounts with higher subscriber counts (β = 0.02, 95% CI = [0.01-0.03], P = .005). The quality and quantity of YouTube's laryngectomy educational content is limited. There is an acute need to increase the quantity and quality of online laryngectomy-related content to better support patients and caregivers as they cope with their diagnosis, prepare for, and recover from surgery.

Impact of SARS-CoV-2 infection on patients with hematological malignancies: a retrospective study

ABSTRACTObjectivesThis study aimed to evaluate the characteristics of patients with hematological malignancies (HM) and SARS-CoV-2 infection and analyze the risk factors of their severity and mortality.MethodsA retrospective study including inpatients diagnosed HM and SARS-CoV-2 infection between December 2022 and February 2023 were conducted. Demographic information, medical history, comorbidities, diagnosis, treatment related information and outcomes were extracted from electronic medical database. The primary outcome of this study were the severity of SARS-CoV-2 infection and case-fatality rate. The clinical characteristic and outcomes of the patients were summarized and analyzed.ResultsA total of 74 patients with HM and SARS-CoV-2 infection were included. Out of the total cases, 85.1% (63) had a mild /moderate SARS-CoV-2 infection, and 14.9% (11) were severe/ critical infection cases. A total of 8 deaths occurred in all cases for a case-fatality rate of 10.8%. Multivariate analysis identified patients with acute myeloid leukemia (AML) (P = 0.043, OR:5.274, 95%CI:1.053-26.407), primary hematological disease in active state (P = 0.005, OR:13.905, 95%CI:2.180-88.704) were independent risk factors for the severity of SARS-CoV-2 infection and patients with AML had 11.145-fold higher risk of non-survival (P = 0.020, OR:11.145, 95%CI:1.460-85.103) in comparison to the patients with other types of HM. There were no significant differences in the severity and case-fatality rate (P > 0.05) between the patients receiving chemotherapy drugs administration waiting <14 days and ≥14 days after negative SARS-CoV-2 testing.ConclusionThe primary hematological disease in active state may be the main risk factor for negative outcome of the patents. Waiting 14 days for chemotherapy initiation after negative SARS-CoV-2 testing is unnecessary.

Does a Resistance Training Program Affect Between-arms Volume Difference and Shoulder-arm Disabilities in Female Breast Cancer Survivors? The Role of Surgery Type and Treatments. Secondary Outcomes of the EFICAN Trial

ObjectiveThe aims were (i) to assess the effects of a 12-week resistance training program on between-arms volume difference and shoulder-arm disabilities in breast cancer survivors and (ii) to evaluate whether the main risk factors for developing cancer-related lymphedema and shoulder-arm disabilities were associated with the effects of the training program. DesignRandomized controlled trial. SettingUniversity facilities. Participants60 female breast cancer survivors participated. Eligibility criteria: to be a breast cancer survivor, and to have completed surgery, chemotherapy, and/or radiotherapy up to 10 years before recruitment. Exclusion criteria: metastatic breast cancer, a breast reconstruction intervention planned within 6 months, any absolute contraindication for exercise, to perform more than 300 minutes/week of structured exercise. InterventionsParticipants were randomized to an exercise group (12-week resistance training program) or a control group. Main Outcome MeasuresBetween-arms volume difference, shoulder-arm disabilities, and upper-limb muscular strength were evaluated at baseline and at week 12. Treatment-related information was registered from medical history. ResultsNo between-group differences were observed on between-arms volume difference (1.207; 95% CI -0.964, 3.377; P=.270) or shoulder-arm disabilities (2.070; 95% CI -4.362, 8.501; P=.521) after the training program. Likewise, there was no association of surgery type, presence of lymph node resection, chemotherapy, radiotherapy, and hormone therapy with the changes in between-arms volume and perceived shoulder-arm disabilities after the intervention. However, a higher increase in upper limb muscular strength was associated with a reduced shoulder-arm disabilities (-0.429; P=.020) in the exercise group. ConclusionsThe findings suggest that resistance training does not affect between-arms volume difference and shoulder-arm disabilities in female breast cancer survivors. The main risk factors for developing lymphedema were not associated with the effects of the intervention, although a higher increase in upper-limb muscular strength was associated with reduced shoulder-arm disabilities.

Financial Toxicity and Quality of Life in Patients Taking Oral Therapy for Hematologic Malignancies

Background There has been an increase in the use of oral agents for the treatment of hematologic malignancies. Though clinically efficacious and convenient, oral therapies often have higher out-of-pocket cost than intravenous medications due to differences in insurance coverage. High financial burden and sequelae thereof, known as financial toxicity (FT), can negatively impact patient mood, adherence, quality of life (QoL), and outcomes. We present cross-sectional data from a longitudinal survey to evaluate the economic, psychosocial, and QoL impact of oral anti-cancer medications (OAMs) in the treatment of hematologic malignancies. Methods We used database query to identify patients at a midwestern, tertiary care, academic medical center who were 18 years or older and were prescribed Enasidenib, Ivosidenib, Venetoclax, Gilteritinib, Midostaurin, Ibrutinib, Acalabrutinib, Imatinib, Nilotinib, Ponatinib, Bosutinib, Duvelisib, or Idelalisib within the past 3 months. Chart review confirmed medication initiation within the past 3 months for a diagnosis of MDS, AML, CML, ALL, CLL, HL, or NHL. Patients were recruited by phone and consented by email. Consenting patients were sent an 85-item online survey assessing sociodemographic information, treatment-related information, and validated surveys, including the Functional Assessment of Cancer Therapy (FACT-G7) and Comprehensive Score for Financial Toxicity (COST) questionnaires. Participants received a follow-up survey 3 months after completing the initial survey. Statistical analysis was performed with GraphPad Prism 9 by Spearman's rank correlation, Mann-Whitney U test, or Kruskal-Wallis H test as appropriate. Results Between November 2021 and April 2023, 528 patients were identified, of whom 152 were eligible for participation and 28 consented and completed the initial survey (18.4%). Demographics are reported in Table 1. The group was predominantly male (64.3%), white (92.9%), married (78.6%), college-educated (64.3%), and financially stable (50% with annual income over $100,000). In the six months prior to diagnosis, 57.1% of participants were working full time and 35.7% were retired. At the time of survey completion, 25% were working full time, 50% were retired, and 14.3% were disabled or unable to work due to health. All participants were insured (60.7% Medicare, 35.7% private insurance). All participants on Medicare had Part A and B coverage, and 82.4% had Part D coverage. All but 1 participant had prescription drug coverage. AML (32.1%), CLL (25%), and CML (17.9%) were the most common diagnoses. Venetoclax (46.6%) was the most common OAM. Results are summarized in Table 2. Those with a history of depression or anxiety had no difference in financial stress, experiencing cancer as a financial hardship, QoL satisfaction, or bother from side effects (SE) as those without such history. Income was inversely associated with identifying cancer as a financial hardship (rs -0.485; 95% CI, -0.732 to -0.125) and with pain (rs -0.389; 95% CI, -0.678 to -0.007). Income had no correlation with QoL satisfaction or bother from SE. Insurance coverage had no association with financial stress, seeing cancer as a financial hardship, QoL satisfaction, or bother from SE. Those disabled or unable to work felt more financial stress than those who were retired (P=0.018). They also saw cancer as more of a financial hardship than those who either worked full time or were retired (P=0.005). Those who had a family member stop working or reduce work hours had lower income (P=0.009), greater financial stress (P=0.015), worse QoL satisfaction (P=0.013), and increased bother from SE (P=0.017) than those who did not. Financial stress was negatively associated with QoL satisfaction (rs -0.552; 95% CI, -0.775 to -0.206) and positively associated with bother from SE (rs 0.469; 95% CI, 0.105 to 0.772). Experiencing cancer as a financial hardship was negatively associated with QoL satisfaction (rs -0.517; 95% CI, -0.755 to -0.159). Conclusions In this well-resourced cohort taking OAMs to treat hematologic malignancies, there were multiple indicators of FT. Patient or family loss of employment was notably associated with financial stress and hardship. Financial stress and hardship were associated with worse satisfaction with QoL and worse experience of SE. Further study should define change in these features over time and interventions to mitigate distress.

Analysis of the YouTube Videos About Children with Cerebral Palsy: a research article

Analysis of the YouTube Videos About Children with Cerebral Palsy: a research article&#x0D; &#x0D; ABSTRACT&#x0D; Purpose: Because cerebral palsy (CP) is a long-term disease, parents need to have information at hand throughout their lives. The videos shown on YouTube, may be inadequate or contain erroneous information since they are not subjected to a process of evaluation and are not regularly updated. In this study, we investigated the scientific content and quality of the YouTube videos related to CP.&#x0D; Material and Methods: The YouTube online library was searched using the term “Children with Cerebral Palsy”. The quality and content of the videos was explored with the GQS (Global Quality Scale) and scientific content with the CPss (Cerebral Palsy Scoring System). The characteristics of the videos (video length, source, date of upload, likes etc.) were recorded.&#x0D; Results: The study was completed with 29 videos. Of the videos, 43.44% included diagnostic information, while 23.3% contained treatment-related information, and 21.18% provided information about associated comorbidities. The mean GQS score was 1.96 ±1.34, the CPss score was 5.75±4.08. According to the quality level of the information content, only 1 video qualified as providing good, 7 videos as moderate, and 21 videos as providing poor information.&#x0D; Conclusion: Health professionals need to be aware of the content available on video-sharing platforms and should be ready to direct their patients to e-information sources that provide accurate and reliable information.&#x0D; Keywords: Cerebral Palsy; children; YouTube; video; quality

Preliminary Evidence of the Association between Time on Buprenorphine and Cognitive Performance among Individuals with Opioid Use Disorder Maintained on Buprenorphine: A Pilot Study.

People on buprenorphine maintenance treatment (BMT) commonly present cognitive deficits that have been associated with illicit drug use and dropout from buprenorphine treatment. This study has compared cognitive responses to the Stroop Task and the Continuous Performance Task (CPT) among individuals on BMT, with recent drug use, and healthy controls and explored the associations between cognitive responses and drug use, craving, and buprenorphine use among participants on BMT. The participants were 16 individuals on BMT and 23 healthy controls. All participants completed a 60 min laboratory session in which they completed the Stroop Task and the CPT, a saliva drug test, a brief clinical history that collected substance-use- and treatment-related information, and the Opioid Craving Scale. The results showed that the BMT participants presented more commission errors (MBMT participants = 2.49; Mhealthy controls = 1.38; p = 0.048) and longer reaction times (MBMT participants = 798.09; Mhealthy controls = 699.09; p = 0.047) in the Stroop Task than did the healthy controls. More days on buprenorphine were negatively associated with reaction time in the CPT (-0.52) and the number of commission errors (-0.53), simple reaction time (-0.54), and reaction time correct (-0.57) in the Stroop Task. Neither drug use nor craving was significantly associated with the results for the cognitive tasks. Relative to the control participants, the BMT individuals performed worse in terms of longer reaction times and more commission errors in the Stroop Task. Within the BMT participants, longer times on buprenorphine were associated with better cognitive results in terms of faster reaction times for both tasks and lower commission errors for the Stroop Task.

Economic burden of beta-thalassaemia major receiving hypertransfusion therapy at a public hospital in Mumbai.

Background Treating beta-thalassaemia major may entail high costs with considerable out-of-pocket expenditure. Therefore, determination and valuation of the economic costs of a common haemoglobinopathy such as beta-thalassaemia major in India may provide insights to evolve policies for reduction or elimination of the disease. We estimated economic burden of beta-thalassaemia major in Mumbai in terms of cost to the family and the healthcare system. Methods This single-centre, prospective, cross-sectional, non-interventional study included children <12 years of age treated at the thalassaemia day care centre of a public hospital in Mumbai. The demographic data and treatment-related information was recorded. Cost of illness was studied from a societal perspective by the prevalence-based approach. Direct (medical and non-medical), indirect (loss of wages and loss of school days) and intangible costs (closed-ended iterative bidding) were calculated for each patient by interview. Results The total annual cost of treating 130 children with beta-thalassaemia major in Mumbai was ₹86 72 412 (US$ 127 535) or ₹66 710 (US$ 981) per patient per year and ₹12 82 30 412 (US$ 1 885 741) including intangible costs. Direct costs contributed to 94% of the cost of illness with chelation therapy (23%) and blood investigations (21%) being major contributors. Direct and indirect costs correlated significantly with duration of blood transfusion (p<0.05 and p=0.006, respectively), whereas indirect costs correlated with socioeconomic status (rho=0.25). Conclusion The majority (94%) of costs incurred by families for treatment of beta-thalassaemia major are direct costs, especially expenses for chelation and blood investigations. Even at subsidized rates, financial burden to the families from lower socioeconomic strata is likely to be considerable as these are out-of-pocket expenses. In consideration of the economic impact of treating beta-thalassaemia major in individual families, the healthcare system and society, it is prudent to promote and pursue long-term and short-term measures with urgent emphasis on prevention as a public health activity at the national level in India.

Treatment Patterns of Monoclonal Antibodies in Patients With Severe Uncontrolled Asthma Treated by Pulmonologists in Spain

Introduction and objectivesThe use of monoclonal antibody (mAb)-based therapies is becoming the new standard of care for severe uncontrolled asthma (SUA). Even though patients may qualify for one or more of these targeted treatments, based on different clinical criteria, a global vision of mAb prescription management in a large sample of hospitals is not well characterised in Spain.The objective was to give a global vision of mAb prescription management in a large sample of hospitals in Spain. Materials and methodsWe used an aggregate data survey method to interview pulmonology specialists in a large sample of Spanish centres (90). The following treatment-related information was obtained on patients treated with mAbs: specific mAbs prescribed, treatment interruption, switch and restart and the reasons for these treatment changes. ResultsmAb prescription was more frequent in females (13.3% females vs 7.4% males; p<0.001). There were no differences in prevalence by hospital complexity level. In contrast, there were differences by geographical area. Omalizumab was the most prescribed mAb (6.2%), followed by mepolizumab (2.9%). Discontinuation of Omalizumab (due to a lack of effectivity) and switches from this mAb to mepolizumab were more frequent. Very few restarts to the first treatment were observed after a switch from ≥2mAbs. ConclusionsOmalizumab appeared as the most prescribed mAb in SUA but was also the most withdrawn; a specific and objective characterisation of patients with SUA, along with asthma phenotyping, and together with further evaluation of safety and effectiveness profiles, will lead to future progress in the management of SUA with mAbs.

Postoperative Management of Recurrence After Radiosurgery and Surgical Resection for Brain Metastases and Predicting Benefit From Adjuvant Radiation

Stereotactic radiosurgery (SRS) is often used as upfront treatment for brain metastases. Progression or radionecrosis after SRS is common and can prompt resection. However, postoperative management strategies after resection for SRS failure vary widely, and no standard practice has been established. In this approved study, we retrospectively reviewed patients who received SRS for a brain metastasis followed by resection of the same lesion. We extracted patient-, disease-, and treatment-related variables and information on disease-related outcomes. Univariate and multivariate analyses of clinicopathologic variables were used to create a model to predict factors associated with local failure (LF). A total of 225 patients with brain metastases treated with SRS from 2009 to 2017 followed by surgical resection were identified. Overall, 65% of cases had gross total resection (GTR) on postoperative imaging review. Twenty-one patients (9.3%) received adjuvant radiation therapy to the surgical cavity, and 204 (90.7%) were observed. Of these 204 patients, 118 had GTR with evidence of tumor within the pathology specimen. With a median follow-up of 13 months after resection, 47 patients (40%) developed LF after surgery. After salvage resection of a brain metastasis initially treated with SRS, the observed LF rate was 40% among those who had a GTR and evidence of tumor on pathologic examination. This LF rate is sufficiently high that adjuvant radiation to the surgical bed after salvage resection should be considered in these cases when there is tumor in the pathology, even after a GTR.

Prostate cancer public health system database from Brazil: Racial disparities and heterogeneity of treatment interventions to understand evidence-based practice patterns in a large real-world database.

5025 Background: The Brazilian Public National Health System (SUS) provides an opportunity to understand epidemiologic information, treatments, discrepancies in care, and costs of men with prostate cancer (PCa) using a large real-world dataset. This analysis focuses on racial disparities and heterogeneity of specific interventions to understand evidence-based practice patterns in Brazil. Additionally, the dataset can serve as a model for other low-middle income countries (LMIC). Methods: Patients included in the database were those with a diagnosis of PCa receiving care in the SUS from 01/01/2008 to 08/31/2022. Data were analyzed using a proprietary Healthcare Data Science platform offered by TECHTRIALS and included information regarding stage, demographics, cancer-related information, treatment-related information, and resources utilized. Results: 657,609 PCa pts were diagnosed and treated at SUS during the 14.5-year study period of whom 382,263 (58%) were brown/black (non-white) and 262,820 (42%) white. Median age of the population was 72.6 years, and did not vary with race. 26.16% of the pts were diagnosed with stage IV and this was not impacted by race or localization, including state or type of city (capital or not). Rates of radical prostatectomy and radiation utilization were similar between race categories. Additionally, in patients with stage IV disease, rates of systemic therapy utilization including chemotherapy with docetaxel (7.7%), with a tendency to increase use in the last years, and androgen receptor signaling inhibitors (ARSI) with (0.6%) or enzalutamide (0.08%), were low and similar between race categories. Rates of first-generation anti-androgens and estrogens were higher (56%) The total costs of prostate cancer directed care was R$4.31 billions (US$820 millions) and race did not impact total cost of care and cost by procedure or therapy type options. Conclusions: This is one of the largest studies using public health-system databases for Prostate cancer with Real World Data ever published. Race had no impact in presenting stage, treatment received and even in the costs involved. Underutilization of chemotherapy (docetaxel) in a scenario of limiting resources and without the use of new hormonal therapies is a matter of concern, together with an overuse of agents without proven survival advantage. Our data highlights the need for increased access to life prolonging agents for patients with metastatic PCa in the SUS.

Support and information needs for patients with non-small cell lung cancer receiving concurrent chemo-radiotherapy treatment with curative intent: Findings from a qualitative study.

Concurrent chemotherapy and radiotherapy treatment (CCRT) is used to treat locally advanced Non-Small Cell Lung Cancer (NSCLC) in patients with suitable fitness. CCRT is associated with significant toxicity and time spent receiving treatment. Our aim was to identify the support and information needs of patients, and where possible their informal caregivers (IC), at key points along the CCRT pathway. Participants were NSCLC patients who were either about to undergo, currently receiving or had finished CCRT. Semi-structured interviews were conducted with participants, and their IC where applicable, at the treatment centre or participants' home. Interviews were audio recorded and transcribed prior to undergoing thematic analysis. Fifteen patients were interviewed; five were interviewed with their IC. Themes of physical, psychological, and practical support needs are identified with associated subthemes exploring specific needs, such as dealing with late treatment effects, and how patients seek support. Information needs prior to, during and following CCRT were also established as predominant themes with subthemes detailing the needs at these time points. Examples include differences in participant desire for toxicity information and life after treatment. The need for disease, treatment and symptom related information and support remains consistent throughout CCRT and beyond. Further information and support for other matters including engaging in regular activities may also be desired. Time allocated within consultations to establish changes in needs or desire for further information may benefit patient and IC experience and QOL.

Outcome Evaluation of a Treatment Program for Men with Paraphilic Disorders Convicted of Sexual Offenses: 10-Year Community Follow-up.

Evidence concerning specific paraphilia treatment effectiveness is limited. We present observation data of 127 men convicted of paraphilic sexual offenses who attended inpatient and outpatient follow-up treatment in Czechia. We collected participants' sociodemographic and treatment-related information, including STATIC-99R scores, and used proportional hazards models to analyze variables' effect on recidivism risk. Within the observation period, the general recidivism and sexual recidivism rates were 33.1% and 16.5%, respectively, and the sexual contact recidivism rate was 4.7%. The total STATIC-99 score for those who re-offended was 5.65 (SD = 2.11) and for those who did not was 3.98 (SD = 2.02). Recidivism risk was 7.52 times higher for those diagnosed with exhibitionism than with pedophilia, sadomasochism, or antisocial personality disorder. General recidivism is comparable to others' findings. We attribute the lower sexual contact recidivism rate to the combined effects of psychological and pharmacological treatment, and higher numbers of non-contact offenses to limited antidepressant use.

Investigating the scope and costs of dental treatment provided under general anaesthesia among children with congenital heart disease.

To identify the types of dental treatment provided under general anaesthesia for children diagnosed with congenital heart disease (CHD), quantify the costs within a publicly funded tertiary paediatric hospital setting and identify factors which affect the cost. A retrospective analysis of dental records (July 2015 to June 2019) was conducted for children with CHD who had undergone a dental general anaesthetic procedure at The Children's Hospital at Westmead, Australia. Patient and treatment-related information were collected, and a costing analysis was performed on 89 dental general anaesthetic procedures. Mean age at the time of the general anaesthetic was 8.15 years. About 27% of children with CHD had a history of dental infection. Dental extractions and restorations comprised the majority of treatments provided, with extractions performed in 86% of procedures. The mean number of days in hospital was 1.43 and the mean cost was $4395.14. The cost was significantly greater when children presented with a facial swelling compared to any other reason. Dental extractions are performed in the majority of general anaesthetics. Not only is there an economic burden to the public health system in providing dental treatment under general anaesthesia for children with CHD, the health impacts also appear to be substantial. A considerable proportion required overnight hospitalisation and days in hospital was strongly related to the cost of the dental general anaesthetic. Systematic referral pathways for accessing dental care are an important consideration for children with CHD.

Risk factors, prognostic potency, and longitudinal variation of anxiety and depression in postoperative glioma patients.

Anxiety and depression are common mental disorders in glioma patients. This study aimed to evaluate the risk factors, prognostic role, and longitudinal changes in anxiety and depression in postoperative glioma patients. Anxiety and depression were assessed by Hospital Anxiety and Depression Scale at baseline, month (M) 6, M12, M24 and M36 in 270 glioma patients after surgical resection. Furthermore, comprehensive clinic characteristics and treatment-related information were collected. Gender (female vs. male) (P = 0.014, odds ratio (OR) = 1.974), marital status (single/divorced/widowed vs. married) (P = 0.019, OR = 2.172), Karnofsky performance status (KPS) score (≤70 vs. > 70) (P = 0.002, OR = 2.556), World Health Organization (WHO) classification (high-grade glioma (HGG) vs. low-grade glioma (LGG)) (P = 0.005, OR = 2.155), and postoperative complications (yes vs. not) (P = 0.001, OR = 2.525) were independently related to anxiety occurrence. Marital status (single/divorced/widowed vs. married) (P = 0.034, OR = 2.026), KPS score (≤70 vs. > 70) (P < 0.001, OR = 3.880), WHO classification (HGG vs. LGG) (P = 0.032, OR = 1.810), and postoperative complications (yes vs. not) (P = 0.001, OR = 2.602) were independently related to depression occurrence. Besides, anxiety (P = 0.038) and depression (P = 0.013) were linked with shorter overall survival (OS), and depression was an independent risk factor for worse OS (P = 0.040, hazard ratio = 1.596). More importantly, anxiety and depression remained at a high prevalence during a 3-year follow-up. Gender, marital status, KPS score, WHO classification, and postoperative complications are risk factors for anxiety and depression; moreover, anxiety and depression are at high prevalence continuously and correlated with worse survival in postoperative glioma patients.