Trends In Use Research Articles

Temporal trends in use of antisecretory agents among patients administered clopidogrel-based dual antiplatelet therapy after percutaneous coronary intervention.

Antisecretory drugs are commonly prescribed with clopidogrel-based dual antiplatelet therapy (DAPT) to prevent gastrointestinal bleeding in high-risk patients after percutaneous coronary intervention (PCI). However, omeprazole and esomeprazole (inhibiting proton pump inhibitors [PPIs]) may increase cardiovascular event rates on co-administration with clopidogrel. This study aimed to examine trends in the use of antisecretory agents in patients administered clopidogrel-based DAPT and the concomitant use of clopidogrel and inhibiting PPIs. We used National Inpatient Sample data compiled by the Health Insurance Review & Assessment Service from 2009 to 2020. Further, we identified patients who were prescribed clopidogrel-based DAPT after PCI and investigated the concomitant use of antisecretory agents with clopidogrel. To verify the annual trend of drug utilization, we used the Cochran-Armitage trend test. From 2009 to 2020, the percentage of H2 receptor antagonist users decreased steadily (from 82.5% in 2009 to 25.3% in 2020); instead, the percentage of PPI users increased (from 23.7% in 2009 to 82.0% in 2020). The use of inhibiting PPI also increased (from 4.2% in 2009 to 30.7% in 2020). Potassium competitive acid blockers (P-CABs) were rarely used before 2019; however, in 2020, it accounted for 7.8% of the antisecretory users. Our study demonstrates that the use of inhibiting PPIs increased steadily in patients administered clopidogrel-based DAPT therapy. This is a major concern since the concomitant use of inhibiting PPIs with clopidogrel could increase the risk of cardiovascular events.

Fulvestrant and elacestrant utilization on prognostic outcome of patients with HR+ve/HER2-ve MBC.

e13094 Background: OS of pts with HR+ve/HER2-ve MBC has improved with CDK4/6i and endocrine therapy. Fulvestrant (FUL) works post progression on aromatase inhibitors in an endocrine resistant cohort. Ealcestrant (ELA) improves PFS compared to FUL in pts with an ESR1 mutation. This retrospective analysis looks at the trends in use of and associated outcome with FUL and ELA among pts with HR+ve/HER2-ve MBC. Methods: We utilized a federated network of de-identified health data representing approximately 135 million pt lives available through the TriNetX Research Network. We identified 14,387pts with HR+ve/HER2-ve MBC treated with endocrine therapy and CDK4/6i diagnosed between Nov 2018 - Nov 2023. OS was computed using the Kaplan Meier product limit method. Results: Mean age was 66 yrs. 5,736(39.9%) pts received FUL and 143(1%) pts ELA. In 2023 median time to use of FUL was 16m to 18m from metastases and median time to use of ELA decreased with time from 50m to 28m. Among pts who received ELA 65% received CDK4/6i for > 12m, 47% received FUL prior ELA, 7% received FUL after ELA. 5-yr OS of the whole cohort was 56.9%. 5-yr OS among pts who did and did not receive ELA was 85.4% and 60.0% respectively (HR 0.28, 95%CI 0.15-0.49, p<0.0001). 5-yr OS among pts who did and did not receive FUL w/o ELA was 61.5% and 60.9% respectively (HR 0.87, 95% CI 0.81-0.94, p<0.0001). 5-yr OS was 85.4% and 52.4% among pts who received ELA and FUL w/o ELA respectively (HR0.23, 95% CI0.14-0.41, p<0.0001). 5-yr OS was 88.7% and 67.9% among pts who received ELA and FUL w/o ELA respectively for > 3m (HR 0.29, 95% CI 0.05-1.145, p=0.11). Among pts who received CDK4/6i > 12m 5-yr OS was 86.0% and 64.9% among pts who received ELA and FUL w/o ELA respectively (HR 0.36, 95% 0.20-0.67, p = 0.0007). Among pts who received ELA 1-yr OS from the start of ELA was 86.0% and 33.3% among pts who received CDK4/6i>12m and < 12m respectively (p=0.72). Conclusions: To our knowledge this is the first real world data set to show the efficacy of ELA among pts with HR+ve/HER2-ve MBC who had progressed on endocrine therapy and CDK4/6i. Our results show decreasing time to use of ELA with improved outcome compared to FUL especially among pts who received CDK4/6i for > 12m. We continue to collect data among pts who are receiving ELA and expect over 200pts at the time of the presentation.

Trends in Open Versus Endoscopic Carpal Tunnel Release From 2010 to 2021.

This study compared trends in use, predictive factors, and reimbursement of endoscopic carpal tunnel release (ECTR) withthose of open carpal tunnel release (OCTR) from 2010 to 2021 using a national administrative database. ECTR and OCTR patients were identified in the PearlDiver M151Ortho data set. Numeric and proportional utilization of these procedures was characterized for each year of study. Multivariate analysis was conducted to identify predictive factors for having ECTR performed. The average 90-day reimbursement of ECTR and OCTR was determined. From 2010 through 2021, 441,023 ECTR and 1,767,820 OCTR procedures were identified. The proportional use of ECTR compared with OCTR rose from 2010 (15.7% of procedures) to 2021 (26.1%). Independent predictors of having ECTR performed rather than OCTR included geographic variation (compared with having surgery in the Midwest, Northeast odds ratio [OR], 1.53; West OR, 1.62; and South OR, 1.66), having Medicare or commercial insurance (compared with commercial, Medicare OR, 0.94, and Medicaid OR, 0.69), female sex, and fewer comorbidities. The average 90-day reimbursement for ECTR was $3,114.82, compared with $3,087.62 for OCTR. As of 2021, over one-fourth of carpal tunnel releases are done endoscopically. Several factors independently predict whether patients receive ECTR or OCTR.

Characterization of kratom use and knowledge at a rural, Oregon community health center

BackgroundKratom is an herbal supplement that has drawn attention for its use in the self-treatment of opioid withdrawal, and its widespread availability with minimal restrictions. Past Web-based research has attempted to determine patterns and trends of use, but generalizability to underserved populations is unclear. ObjectiveThe purpose of this study was to characterize behavior related to kratom, attitudes toward kratom, and knowledge of kratom in a rural, underserved population. MethodsWe developed, refined, and administered a cross-sectional, 36-item survey to examine use, attitudes, and knowledge of kratom. We recruited participants and administered the survey alongside medical office appointments between January and April 2023. Data were summarized using descriptive statistics. ResultsA convenient sample of 186 patients (of the 907-patient clinic panel) were invited to participate and 150 returned the survey. Most patients were female (52.0%) and white (86.6%), and approximately half had an income below the federal poverty level (48.5%). Seventeen participants reported previous experience with kratom use, with one actively using kratom. The most commonly reported reasons for use were pain (47.1%) and mental health (41.2%). Kratom knowledge was low regardless of kratom use history, with most respondents correctly answering between 1 and 3 questions (n = 71 of 86; 82.3%) of the 5 knowledge-focused items. ConclusionResults suggest that although active kratom use is uncommon in this Oregon population, 1 in 10 surveyed had used kratom. Regardless of past use, respondents had limited knowledge of kratom. Future research should focus on understanding trends in kratom use behaviors in underserved populations, addressing patient knowledge gaps, and evaluating patient safety and health equity implications.

Trends in Use and Evidence of Adherence to Risk Evaluation and Mitigation Strategy Pregnancy Testing Requirements for Thalidomide, Lenalidomide, and Pomalidomide in the USA, 2000-2020.

Lenalidomide, pomalidomide, and thalidomide are effective treatments for multiple myeloma but are teratogenic. To mitigate this risk, the US Food and Drug Administration (FDA) required risk evaluation and mitigation strategy (REMS) programs for these drugs, which include pregnancy testing among women of childbearing potential-twice before initiation, weekly in the first month on treatment, and every 2-4 weeks thereafter. We evaluated dispensing trends of lenalidomide, pomalidomide, and thalidomide and assessed adherence to REMS pregnancy testing requirements among at-risk patients taking these drugs. Using three US health insurance claims databases (Optum Clinformatics® [2004-2020], Merative Marketscan [2003-2019], and Medicaid [2000-2018]), we assessed monthly use of the drugs, patient characteristics and treatment persistence among drug initiators, and claims-based evidence for adherence to pregnancy testing requirements among initiators with child-bearing potential. Lenalidomide was the most prescribed agent following its approval in 2006 and through the end of the study period. A total of 48,311 lenalidomide (mean age = 59 years [standard deviation (SD) = 16]), 17,550 thalidomide (mean age = 65 years [SD = 12]), and 6560 pomalidomide initiators (mean age = 65 years [SD = 11]) were identified; 45% of initiators of each drug were women. Among initiators under follow-up on day 90, 70% were still on therapy. Initiators of childbearing potential comprised 3% (N = 1,920) of all initiators; among this cohort, 12% had evidence in claims data of two pregnancy tests before initiation, and 9% with at least 33 days of follow-up of four tests during the first month of treatment. By contrast, 52% who received a refill had claims-based evidence of a pregnancy test within 7 days of dispensing. Although most patients who initiated lenalidomide, pomalidomide, and thalidomide were not of child-bearing potential, further investigation into actual non-adherence to pregnancy testing is needed.

Impact of Society Guidelines on Trends in Use of Newer P2Y12 Inhibitors for Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention.

Over the past decade, major society guidelines have recommended the use of newer P2Y12 inhibitors over clopidogrel for those undergoing percutaneous coronary intervention for acute coronary syndrome. It is unclear what impact these recommendations had on clinical practice. All percutaneous coronary intervention procedures (n=534 210) for acute coronary syndrome in England and Wales (April 1, 2010, to March 31, 2022) were retrospectively analyzed, stratified by choice of preprocedural P2Y12 inhibitor (clopidogrel, ticagrelor, and prasugrel). Multivariable logistic regression models were used to examine odds ratios of receipt of ticagrelor and prasugrel (versus clopidogrel) over time, and predictors of their receipt. Overall, there was a significant increase in receipt of newer P2Y12 inhibitors from 2010 to 2020 (2022 versus 2010: ticagrelor odds ratio, 8.12 [95% CI, 7.67-8.60]; prasugrel odds ratio, 6.14 [95% CI, 5.53-6.81]), more so in ST-segment-elevation myocardial infarction than non-ST-segment-elevation acute coronary syndrome indication. The most significant increase in odds of receipt of prasugrel was observed between 2020 and 2022 (P<0.001), following a decline/plateau in its use in earlier years (2011-2019). In contrast, the odds of receipt of ticagrelor significantly increased in earlier years (2012-2017, Ptrend<0.001), after which the trend was stable (Ptrend=0.093). Over a 13-year-period, there has been a significant increase in use of newer P2Y12 inhibitors, although uptake of prasugrel use remained significantly lower than ticagrelor. Earlier society guidelines (pre-2017) were associated with the highest rates of ticagrelor use for non-ST-segment-elevation acute coronary syndrome and ST-segment-elevation myocardial infarction cases while the ISAR-REACT 5 (Prospective, Randomized Trial of Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndrome) trial and later society guidelines were associated with higher prasugrel use, mainly for ST-segment-elevation myocardial infarction indication.

Abstract PO1-17-08: Post-approval treatment patterns and tolerability of neratinib in HER2+ early-stage breast cancer

Abstract Background: While the approval status for neratinib in HER2+ early-stage breast cancer (EBC) allows its use following any trastuzumab-based therapy, the phase 3 ExteNET trial (NCT00878709), which yielded an improvement in disease-free survival, was conducted when single-agent adjuvant trastuzumab was standard of care (SOC) and before approvals of adjuvant pertuzumab + trastuzumab (FDA-approved 2017) or trastuzumab emtansine (T-DM1; FDA-approved 2019). Given recent changes in SOC for HER2+ EBC, health care professionals may seek contemporary and real-world information regarding treatment patterns and tolerability of neratinib. Methods: A literature review was performed to identify studies that characterized trends in use of extended adjuvant neratinib in HER2+ EBC. Due to differences in study design (interventional, observational, claims data) and populations studied, a descriptive summary of data is presented in lieu of statistical cross-study comparisons. Results: Following FDA approval of neratinib in HER2+ EBC in 2017, five studies have reported treatment patterns of extended adjuvant neratinib in a clinical trial or real-world setting; three studies included safety data (Table 1). In the phase 2 CONTROL trial (NCT02400476; N=563; 2015–2021), approx. 82%, 17%, and 1% of neratinib-treated pts received prior adjuvant trastuzumab, pertuzumab, or T-DM1, respectively, and prior neoadjuvant/adjuvant pertuzumab did not affect rates of grade ≥3 diarrhea, diarrhea-related discontinuations, or treatment duration.1 In an interim analysis of the observational ELEANOR study (NCT04388384; N=187; 2020–ongoing), approx. 41%, 33%, and 19% of neratinib-treated pts received prior adjuvant trastuzumab (as their only anti-HER2 treatment), pertuzumab + trastuzumab, or T-DM1, respectively; corresponding rates of grade ≥3 diarrhea were 19%, 25%, and 14%, respectively, with no new safety signals reported.2 In a chart review from the US Oncology Network (N=166; 2017–2020), approx. 99%, 43%, and 2% of neratinib-treated pts received prior adjuvant trastuzumab (56% as their sole anti-HER2 treatment), pertuzumab, or T-DM1, respectively.3 Diarrhea was mainly moderate (29%; n=43/150) or mild (22%; n=33/150), with few severe cases (1%; n=2/150).3 In a retrospective analysis employing the IQVIA claims database (N=385; 2017–2021), prior use of recently approved adjuvant agents increased over time, with rates of prior pertuzumab + trastuzumab or prior T-DM1 as high as 52% and 14%, respectively, in 2020.4 In the Neat-HER virtual registry (N=46; 2018–2021), approx. 41% and 11% of neratinib-treated pts received prior adjuvant pertuzumab or T-DM1, respectively.5 Conclusions: Recent studies have observed neratinib use in clinical practice following adjuvant trastuzumab-based therapy including pertuzumab + trastuzumab or T-DM1. Preliminary data suggest a similar safety profile for pts with/without prior pertuzumab. These datasets are limited by the fact that: (1) some pts were enrolled in the CONTROL trial prior to launch of adjuvant T-DM1 and pertuzumab; (2) the interval between T-DM1 launch in Europe and start of the ELEANOR study was relatively short; and (3) not all toxicity measures were formally graded. A summary of available safety and effectiveness results is forthcoming. Additional interventional and non-interventional studies will continue to evaluate the safety and effectiveness of neratinib following current SOC adjuvant therapy in HER2+ EBC. Table 1. Treatment patterns of HER2-targeted adjuvant agents preceding neratinib use in HER2+ EBC ITT, intent-to-treat; T-DM1, ado-trastuzumab emtansine. aTherapies were recorded as used for adjuvant therapy in CONTROL, ELEANOR, US Oncology, and Neat-HER. CONTROL includes unpublished data. In the IQVIA claims analysis, HER2-targeted agent(s) used within 12 months prior to neratinib initiation were assumed to be adjuvant therapies. Pertuzumab use was generally taken in combination with trastuzumab as dual HER2 blockade and some pts received more than one anti-HER2 adjuvant treatment, for example T-DM1 in addition to pertuzumab plus trastuzumab. bAdjuvant trastuzumab monotherapy or in combination with chemotherapy unless noted otherwise. cThe proportion of patients who took at least one tablet of neratinib for ≥75% of the prescribed treatment days and did not take neratinib on days when neratinib was not prescribed. dData forthcoming. eIncludes prior trastuzumab monotherapy and trastuzumab used in combination with pertuzumab; 93/166 pts (56%) received trastuzumab as their only anti-HER2 agent (monotherapy or in combination with chemotherapy; unpublished data). fIncludes prior trastuzumab monotherapy as well as trastuzumab used in combination with pertuzumab. References Citation Format: Kelly McCann, Nadia Harbeck, Debu Tripathy, Arlene Chan, Jay Andersen, Joyce O'Shaughnessy, Gregory Vidal. Post-approval treatment patterns and tolerability of neratinib in HER2+ early-stage breast cancer [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 PO1-17-08.

Trends in Use of the Cognitive Assessment and Care Planning Services (CAACPS) Visit: A Primary Palliative Care Tool (RP303)

Trends in Use of the Cognitive Assessment and Care Planning Services (CAACPS) Visit: A Primary Palliative Care Tool (RP303)

Trends of use and characterisation of anti-dementia drugs users: a large multinational-network population-based study.

An updated time-trend analysis of anti-dementia drugs (ADDs) is lacking. The aim of this study is to assess the incident rate (IR) of ADD in individuals with dementia using real-world data. Primary care data (country/database) from the UK/CPRD-GOLD (2007-20), Spain/SIDIAP (2010-20) and the Netherlands/IPCI (2008-20), standardised to a common data model. Cohort study. Participants: dementia patients ≥40years old with ≥1year of previous data. Follow-up: until the end of the study period, transfer out of the catchment area, death or incident prescription of rivastigmine, galantamine, donepezil or memantine. Other variables: age/sex, type of dementia, comorbidities. Statistics: overall and yearly age/sex IR, with 95% confidence interval, per 100,000 person-years (IR per 105 PY (95%CI)). We identified a total of (incident anti-dementia users/dementia patients) 41,024/110,642 in UK/CPRD-GOLD, 51,667/134,927 in Spain/SIDIAP and 2,088/17,559 in the Netherlands/IPCI.In the UK, IR (per 105 PY (95%CI)) of ADD decreased from 2007 (30,829 (28,891-32,862)) to 2010 (17,793 (17,083-18,524)), then increased up to 2019 (31,601 (30,483 to 32,749)) and decrease in 2020 (24,067 (23,021-25,148)). In Spain, IR (per 105 PY (95%CI)) of ADD decreased by 72% from 2010 (51,003 (49,199-52,855)) to 2020 (14,571 (14,109-15,043)). In the Netherlands, IR (per 105 PY (95%CI)) of ADD decreased by 77% from 2009 (21,151 (14,967-29,031)) to 2020 (4763 (4176-5409)). Subjects aged ≥65-79years and men (in the UK and the Netherlands) initiated more frequently an ADD. Treatment of dementia remains highly heterogeneous. Further consensus in the pharmacological management of patients living with dementia is urgently needed.

Patterns of Use of Endocrine and Hormonal Therapy in Patients with Gender Dysphoria [ID 2683388

INTRODUCTION: Gender dysphoria (GD) is the emotional distress experienced by transgender individuals. While hormonal and endocrine therapy has been shown to improve outcomes, there is a paucity of data assessing patterns of use. The objective of our study was to determine trends in use of therapy in patients with GD. METHODS: We utilized the MarketScan Research Databases to identify patients aged 18–64 years with GD from 2008 to 2021. Use of guideline-recommended hormonal therapy including testosterone for transgender males and estradiol, spironolactone, and GnRH agonists for transgender females was examined. Patients were included if they had at least one full year of continuous insurance and drug enrollment. The utilization rate of each agent for each given year and duration of the first hormonal treatment were examined. RESULTS: A total of 36,847 patients were identified. The cohort included 18,195 (49.4%) patients with self-reported gender as male, and 18,652 (50.6%) as female. Overall, 61.0% of the cohort used hormonal therapy including estradiol in 33.4%, spironolactone in 27.3%, testosterone in 25.7%, and GnRH agonists in 0.3%. Use of hormonal therapy increased in more recent years of the study. Overall, hormonal therapy was used in 55.9% of those aged 18–24 years, 64.3% of those 25–34 years, 66.8% of patients 35–44 years, 64.2% of those 45–54 years, and in 61.5% of patients aged 55–64 years. CONCLUSION: The use of endocrine and hormonal therapy among transgender individuals is substantial and has increased over the last decade.

Rising trend in use of patient-reported outcomes in atrial fibrillation clinical trials

Rising trend in use of patient-reported outcomes in atrial fibrillation clinical trials

Trends in antidiabetic drug use and expenditure in public hospitals in Northwest China, 2012-21: a case study of Gansu Province

BackgroundSince the twenty-first century, the prevalence of diabetes has risen globally year by year. In Gansu Province, an economically underdeveloped province in northwest China, the cost of drugs for diabetes patients accounted for one-third of their total drug costs. To fundamentally reduce national drug expenditures and the burden of medication on the population, the relevant departments of government have continued to reform and improve drug policies. This study aimed to analyse long-term trends in antidiabetic drug use and expenditure in Gansu Province from 2012 to 2021 and to explore the role of pharmaceutical policy.MethodsData were obtained from the provincial centralised bidding and purchasing (CBP) platform. Drug use was quantified using the anatomical therapeutic chemistry/defined daily dose (ATC/DDD) method and standardised by DDD per 1000 inhabitants per day (DID), and drug expenditure was expressed in terms of the total amount and defined daily cost (DDC). Linear regression was used to analyse the trends and magnitude of drug use and expenditure.ResultsThe overall trend in the use and expenditure of antidiabetic drugs was on the rise, with the use increasing from 1.04 in 2012 to 16.02 DID in 2021 and the expenditure increasing from 48.36 in 2012 to 496.42 million yuan in 2021 (from 7.66 to 76.95 million USD). Some new and expensive drugs changed in the use pattern, and their use and expenditure shares (as the percentage of all antidiabetic drugs) increased from 0 to 11.17% and 11.37%, but insulins and analogues and biguanides remained the most used drug class. The DDC of oral drugs all showed a decreasing trend, but essential medicines (EMs) and medical insurance drugs DDC gradually decreased with increasing use. The price reduction of the bid-winning drugs was over 40%, and the top three drugs were glimepiride 2mg/30, acarbose 50mg/30 and acarbose 100mg/30.ConclusionsThe implementation of pharmaceutical policies has significantly increased drug use and expenditure while reducing drug prices, and the introduction of novel drugs and updated treatment guidelines has led to changes in use patterns.

(4) - Early Outcomes and Trends in Use of Donation After Circulatory Death (DCD) Donors for Multi-Organ Heart Transplantation (HT) in US

(4) - Early Outcomes and Trends in Use of Donation After Circulatory Death (DCD) Donors for Multi-Organ Heart Transplantation (HT) in US

Trends in Use of Crop Cultivars from Organic and Conventional Seed Multiplication: Moving Toward 100% Organic Seed Use in German Organic Agriculture

Trends in Use of Crop Cultivars from Organic and Conventional Seed Multiplication: Moving Toward 100% Organic Seed Use in German Organic Agriculture

How have cannabis use and related indicators changed since legalization of cannabis for non-medical purposes? Results of the Canadian Cannabis Survey 2018–2022

BackgroundCannabis use for non-medical purposes was legalized and regulated in Canada through the Cannabis Act in October 2018. This paper examined trends in use of cannabis for non-medical purposes and related indicators from pre- to post-legalization in Canada (2018–2022). MethodsData from 5 years of the Canadian Cannabis Survey, an annual web-based survey administered to Canadians 16 years of age or older, were used in the analysis (n2018=12,952; n2019=11,922; n2020=10,821; n2021=10,733; n2022=10,048). Cannabis measures include questions about use, types of products, sources, risk perceptions and beliefs, and exposure to public education campaigns and health warnings. Adjusted logistic regression models tested differences in outcomes over time. ResultsPast 12-month cannabis consumption increased among Canadians from 22 % in 2018 to 27 % in 2022 (AOR=1.41;99 % CI:1.28–1.54). Similarly, daily/almost daily (DAD) consumption increased from 5 % in 2018 to 7 % in 2022 (AOR=1.36;99 % CI:1.16–1.59). Consumption of dried flower, hash/kief, and concentrates/extracts (e.g., wax, shatter, budder) decreased since 2018, whereas consumption of edibles, beverages and vape pens/cartridges increased (p < 0.001). Legal purchasing increased from 4 % in 2018 to 69 % in 2022, while accessing cannabis through social and illegal sources decreased over time (p < 0.001). ConclusionMore Canadians are reporting cannabis consumption since legalization and regulation of cannabis for non-medical purposes, continuing a pre-existing trend despite an increase in awareness of the risks of consuming cannabis. Trends in product use indicate a transition from dried flower and concentrates/extracts towards consumption of cannabis foods, drinks and vape pens/cartridges. The legal market is increasingly displacing the illicit cannabis market in Canada.

Psychotropic Medication Administration in Pediatric Emergency Departments.

Visits by youth to the emergency department (ED) with mental and behavioral health (MBH) conditions are increasing, yet use of psychotropic medications during visits has not been well described. We aimed to assess changes in psychotropic medication use over time, overall and by medication category, and variation in medication administration across hospitals. We conducted a retrospective cross-sectional study of ED encounters by youth aged 3-21 with MBH diagnoses using the Pediatric Health Information System, 2013-2022. Medication categories included psychotherapeutics, stimulants, anticonvulsants, antihistamines, antihypertensives, and other. We constructed regression models to examine trends in use over time, overall and by medication category, and variation by hospital. Of 670 911 ED encounters by youth with a MBH diagnosis, 12.3% had psychotropic medication administered. The percentage of MBH encounters with psychotropic medication administered increased from 7.9% to16.3% from 2013-2022 with the odds of administration increasing each year (odds ratio, 1.09; 95% confidence interval, 1.05-1.13). Use of all medication categories except for antianxiety medications increased significantly over time. The proportion of encounters with psychotropic medication administered ranged from 4.2%-23.1% across hospitals (P < .001). The number of psychotropic medications administered significantly varied from 81 to 792 medications per 1000 MBH encounters across hospitals (P < .001). Administration of psychotropic medications during MBH ED encounters is increasing over time and varies across hospitals. Inconsistent practice patterns indicate that opportunities are available to standardize ED management of pediatric MBH conditions to enhance quality of care.

Robotic Technology in Emergency General Surgery Cases in the Era of Minimally Invasive Surgery

Although robotic surgery has become an established approach for a wide range of elective operations, data on its utility and outcomes are limited in the setting of emergency general surgery. To describe temporal trends in the use of laparoscopic and robotic approaches and compare outcomes between robotic and laparoscopic surgery for 4 common emergent surgical procedures. A retrospective cohort study of an all-payer discharge database of 829 US facilities was conducted from calendar years 2013 to 2021. Data analysis was performed from July 2022 to November 2023. A total of 1 067 263 emergent or urgent cholecystectomies (n = 793 800), colectomies (n = 89 098), inguinal hernia repairs (n = 65 039), and ventral hernia repairs (n = 119 326) in patients aged 18 years or older were included. Surgical approach (robotic, laparoscopic, or open) to emergent or urgent cholecystectomy, colectomy, inguinal hernia repair, or ventral hernia repair. The primary outcome was the temporal trend in use of each operative approach (laparoscopic, robotic, or open). Secondary outcomes included conversion to open surgery and length of stay (both total and postoperative). Temporal trends were measured using linear regression. Propensity score matching was used to compare secondary outcomes between robotic and laparoscopic surgery groups. During the study period, the use of robotic surgery increased significantly year-over-year for all procedures: 0.7% for cholecystectomy, 0.9% for colectomy, 1.9% for inguinal hernia repair, and 1.1% for ventral hernia repair. There was a corresponding decrease in the open surgical approach for all cases. Compared with laparoscopy, robotic surgery was associated with a significantly lower risk of conversion to open surgery: cholecystectomy, 1.7% vs 3.0% (odds ratio [OR], 0.55 [95% CI, 0.49-0.62]); colectomy, 11.2% vs 25.5% (OR, 0.37 [95% CI, 0.32-0.42]); inguinal hernia repair, 2.4% vs 10.7% (OR, 0.21 [95% CI, 0.16-0.26]); and ventral hernia repair, 3.5% vs 10.9% (OR, 0.30 [95% CI, 0.25-0.36]). Robotic surgery was associated with shorter postoperative lengths of stay for colectomy (-0.48 [95% CI, -0.60 to -0.35] days), inguinal hernia repair (-0.20 [95% CI, -0.30 to -0.10] days), and ventral hernia repair (-0.16 [95% CI, -0.26 to -0.06] days). While robotic surgery is still not broadly used for emergency general surgery, the findings of this study suggest it is becoming more prevalent and may be associated with better outcomes as measured by reduced conversion to open surgery and decreased length of stay.

Longitudinal patterns of use of stimulants and opioids in the AIDS linked to the IntraVenous experience cohort, 2005–2019

BackgroundOverdoses involving opioids and stimulants are on the rise, yet few studies have examined longitudinal trends in use of both substances. We sought to describe use and co-use of opioids and stimulants, 2005–2019, in the AIDS Linked to the Intravenous Experience (ALIVE) cohort – a community-based cohort of people with a history of injection drug use living in or near Baltimore, MD. MethodsWe included 2083 ALIVE participants, who had at least two visits during the study period. Our outcome was based on self-reported use of opioids and stimulants in the prior 6 months. We estimated prevalence of 4 categories of use (neither stimulants nor opioids, only stimulants, only opioids, stimulants and opioids), using a non-parametric multi-state model, accounting for the competing event of death and weighting for informative loss to follow-up. All analyses were stratified by enrollment cohort, with the main analysis including participants who enrolled prior to 2015 and a sub-analysis including participants who enrolled 2015–2018. ResultsIn the main analysis, prevalence of using stimulants and opioids decreased from 38 % in 2005 to 12 % 2013 but stabilized from 2014 onwards (13–19 %). The prevalence of using only stimulants (7–11 %) and only opioids (5–10 %) was stable across time. Participants who reported using both were more likely to report homelessness, depression, and other substance use (e.g., marijuana and heavy alcohol use) than participants in the other use categories. On average, 65 % of visits with use of both were followed by a subsequent visit with use of both; of participants transitioning out of using both, 13% transitioned to using neither. ConclusionsWhile use of stimulants and opioids declined in the cohort through 2013, a meaningful proportion of participants persistently used both. More research is needed to understand and develop strategies to mitigate harms associated with persistent use of both stimulants and opioids.

Trends in Anti-Vascular Endothelial Growth Factor Original Medicare Part B Claims in the United States, 2014–2019

ABSTRACT Purpose To characterize trends in use of and expenditure for the intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents aflibercept, ranibizumab, and bevacizumab among the population enrolled in Original Medicare from 2014 to 2019. Methods The Centers for Medicare and Medicaid Services Physician and Other Supplier Public Use File was used to extract Medicare Part B fee-for-service outpatient injection claims data submitted by ophthalmologists. Multivariable linear regression models were used to evaluate the association between reimbursement, ophthalmologist availability, and agent administration rate. Results Between 2014 and 2019, 17,588,995 intravitreal injection claims were filed by 4218 US ophthalmologists. Medicare costs for anti-VEGF injections increased from 2.51 B USD in 2014 to 4.02 B USD in 2019. Increased state-level ophthalmologist availability and incremental increases in average reimbursement amounts were found to be significantly associated with a 6.8-fold variation in 2019 overall anti-VEGF injection rates across states. Conclusions Medicare injection rates and costs for anti-VEGF injections have both increased between 2014 and 2019, largely driven by increased aflibercept use. There is a significant association between ophthalmologist availability and anti-VEGF injection rate on the state level, suggesting access to care may contribute to the observed state-level disparities in intravitreal injection rates. Further characterization of factors contributing to the state-level variation in injection rates of individual anti-VEGF agents may help inform interventions promoting equitable access to and use of these drugs.

Impact of electronic cigarettes on pediatric, adolescent and young adult leukemia patients.

Electronic cigarettes, which deliver an aerosolized, nicotine-containing product upon inhalation, are a public health issue that continue to gain popularity among adolescents and young adults in the United States. Use of electronic cigarettes is wide, and extends to pediatric patients with multiple comorbidities, including childhood cancer, leaving them vulnerable to further negative health outcomes. Acute leukemias are the most common type of cancer in pediatric populations, and treatment outcomes for these patients are improving; consequently, there is an increased emphasis on the effect of behavioral lifestyle factors on quality of life in survivorship. The rate of electronic cigarette use is higher among pediatric patients with a history of cancer than those without a history of cancer. Because electronic cigarettes are relatively new, much about their acute and long-term consequences remains unknown, as is their effect on therapy outcomes and long-term survivorship. This review article summarizes current knowledge about electronic cigarettes, including their composition and the trends in use among pediatric patients. Furthermore, this review provides a comprehensive description of the impact electronic cigarettes have on leukemia development, treatment and survivorship and highlights gaps in knowledge that will be necessary for developing recommendations, management strategies, and tailored treatments for pediatric leukemia patients and survivors who use these nicotine products.