Unique Patient Research Articles

ICD-10 Diagnosis Codes are Over-Utilized in the Diagnosis of Chronic Pancreatitis

ABSTRACT BACKGROUND Large databases, such as the OneFlorida Clinical Research Consortium1, rely on ICD-10 diagnosis codes to identify patients with specificity. Patients enrolled in retrospective research studies are often collected via the use of ICD-10 diagnosis codes. These codes can be subject to error due to over- or under-diagnosing, which is especially true in diseases that are difficult to diagnose, such as chronic pancreatitis (CP). Symptoms of chronic pancreatitis can be vague and non-specific, particularly in the early stages of the disease. This study aimed to determine if ICD-10 diagnosis codes for CP are overutilized and to recognize alternative pathologies that likely lead to the ICD-10 diagnosis code for CP being placed. METHODS A retrospective analysis was conducted of all patients with ICD-10 codes K86.0 (alcohol-induced chronic pancreatitis) and K86.1 (other chronic pancreatitis) who were seen in either an outpatient or inpatient setting at a tertiary care center from February 2018 to February 2020. Data was extracted from the institution’s integrated electronic data repository. This study was approved by the Institutional Review Board (IRB). A total of 1,360 unique patient charts were reviewed, of which 176 carried ICD-10 code K86.0 and 1,184 carried ICD-10 code K86.1. The diagnosis of CP was defined as either being made by a gastroenterologist, proven by biopsy, or having classic findings of CP on cross-sectional imaging with appropriate symptoms. RESULTS A total of 504 (37%) out of the 1,360 patient charts did not have any evidence of chronic pancreatitis despite being labeled with an ICD-10 code for CP. When broken down by diagnosis code, 41 of 176 charts (23.3%) with K86.0 and 461 of 1,184 charts (38.6%) with K86.1 did not have any evidence of CP. Of these patients, 163 had a single episode of acute pancreatitis of any etiology, 107 had recurrent acute pancreatitis, 29 had an episode of acute necrotizing pancreatitis, 22 had cancer (pancreatic or cholangiocarcinoma), 19 had pancreatic resection without underlying CP, 48 had chronic abdominal pain of non-pancreaticobiliary etiology (IBS, IBD, gastritis, PUD, gastroparesis), and 81 had no identifiable abdominal pathology. CONCLUSIONS We found that even at a tertiary care center and a pancreatic center of excellence, many patients with no evidence of chronic pancreatitis were labeled at some point in their care with an ICD-10 diagnosis code for CP. The majority of these had an alternative pancreatic pathology however a significant number had no evidence of a pancreaticobiliary pathology. Although the OneFlorida database makes multicenter research more accessible, it does not replace labor-intensive chart review for CP given the propensity for over-diagnosis.

Understanding risk factors for revision surgery after cubital tunnel release: Analysis of patient selection, surgeon, and clinical factors

PurposeThe purpose of this study was to identify and characterize factors that may contribute to revision surgery following primary cubital tunnel release (CuTR) surgery. MethodsA retrospective study was performed by reviewing all patients who underwent CuTR at a single institution between 2014 and 2021. Only primary in situ CuTR surgeries were included. Exclusion criteria were any case of primary ulnar nerve transpositions or ulnar nerve decompression surgery related to pathology other than isolated ulnar neuropathy (ie. elbow fracture repair, medial epicondylitis debridement, etc.). Revision surgery was defined as return to the operating room by the index surgeon or another surgeon within the same practice for repeat ulnar nerve decompression and/or transposition. Patient demographics and surgical information was analyzed to determine factors that may be associated with revision surgery following primary in situ ulnar nerve decompression. ResultsA total of 1367 patients met inclusion criteria. Revision rate following primary CuTR was 1.2 ​% (n ​= ​16). Of the factors evaluated, younger age (46.6 vs 57.0 years) and a history of cervical stenosis had a higher correlation with undergoing a revision. Patients who had revision surgery were more likely to have negative electrodiagnostic studies versus those who did not. Otherwise, there was no association between sex, race, tobacco use, medical comorbidities, symptom severity, bilateral symptoms, or concurrent surgery and the subsequent need for revision ulnar nerve decompression. ConclusionsFollowing primary in situ CuTR, younger age or a history of cervical stenosis may be at higher risk of undergoing revision surgery. Additionally, patients without electrodiagnostic evidence of ulnar neuropathy may have less reliable outcomes versus those who have a positive nerve study. Given the unpredictable nature of ulnar nerve surgery, further prospective data including diagnostic imaging and biomechanical evaluation of patients following ulnar nerve release may help provide a deeper understanding of this unique patient population. Level of evidencePrognostic, level IV.

IntelliVent: A Review on Enhancing Patient Care with Advanced Ventilation Systems

IntelliVent: Enhancing Patient Care with Advanced Ventilation System intends to revolutionize mechanical ventilation by creating an automated ventilator that uses an Ambu bag and has complete monitoring features. The system precisely sets and controls respiratory parameters such as tidal volume, respiratory rate, minute ventilation, peak and plateau pressures, I:E ratio, and FiO2 levels utilizing a DC motor-driven cam lever mechanism for precision Ambu bag compression. IntelliVent uses modern sensors to monitor important patient characteristics such as blood pressure, glucose levels, oxygen saturation, body temperature, and platelet count, allowing for dynamic modifications to match unique patient demands. The complex control software offers different ventilation modes and real-time feedback loops, which improves system adaptability and responsiveness. IntelliVent's user-friendly interface, which includes real-time visualization of critical parameters and vital signs, helps clinicians make informed judgments. This project seeks to provide a cost-effective, dependable, and adjustable ventilation solution that will improve patient care quality and efficiency in critical care settings. IntelliVent aims to ensure safety, efficacy, and regulatory compliance through thorough calibration, bench testing, and clinical trials, thereby setting a new standard in mechanical ventilation technology.

Identifying risk factors for postoperative ileus following open abdominal aortic aneurysm repair

BackgroundPostoperative ileus (POI) is a common complication following major abdominal surgery. The majority of the data available regarding POI after abdominal surgery is from the gastrointestinal and urological literature. These data have been extrapolated to vascular surgery, especially with regard to enhanced recovery programs for open abdominal aortic aneurysm (AAA) surgery. However, vascular patients are a unique patient population and extrapolation of gastrointestinal and urological data may not necessarily be appropriate. Therefore, the purpose of this study was to delineate the prevalence and risk factors of POI in patients undergoing open AAA surgery. MethodsThis was a retrospective, single-institution study of patients who underwent open AAA surgery from January 2016 to July 2023. Patients were excluded if they had undergone nonelective repairs or had expired within 72 hours of their index operation. The primary outcome was rates of POI, which was defined as the presence of two or more of the following after the third postoperative day: nausea and/or vomiting, inability to tolerate oral food intake, absence of flatus, abdominal distension, or radiological evidence of ileus. ResultsA total of 123 patients met study criteria with an overall POI rate of 8.9% (n = 11). Patients who developed a POI had a significantly lower body mass index (24.3 kg/m2 vs 27.1 kg/m2; P = .003), were more likely to undergo a transperitoneal approach (81.8% vs 42.0%; P = .022), midline laparotomy (81.8% vs 37.5%; P = .008), longer total clamp times (151.6 minutes vs 97.7 minutes; P = .018), greater amounts of intraoperative crystalloid infusion (3495 mL vs 2628 mL; P = .029), and were more likely to return to the operating room (27.3% vs 3.6%; P = .016). Proximal clamp site was not associated with POI (P=.463). Patients with POI also had higher rates of postoperative vasopressor use (100% vs 61.1%; P = .014) and greater amounts of oral morphine equivalents in the first 3 postoperative days (488.0 ± 216.0 mg vs 203.8 ± 29.6 mg; P = .016). Patients who developed POI had longer lengths of stay (12.5 days vs 7.6 days; P < .001), a longer duration of nasogastric tube decompression (5.9 days vs 2.2 days; P < .001), and a longer period of time before diet tolerance (9.1 days vs 3.7 days; P < .001). Of those who developed a POI (n = 11), four (36.4%) required total parental nutrition during the admission. ConclusionsPOI is a morbid complication among patients undergoing elective open AAA surgery that prolongs hospital stay. Patients at risk for developing a POI are those with a lower body mass index, as well as those who had an operative repair via a transperitoneal approach, midline laparotomy, longer clamp times, larger amounts of intraoperative crystalloid infusion, a return to the operating room, postoperative vasopressor use, and higher amounts of oral morphine equivalents. These data highlight important perioperative opportunities to decrease the prevalence of POI.

Children With Type 1 Interferonopathy: Commonalities and Diversities in a Large Patient Cohort.

This study aimed to provide a comprehensive overview of the clinical features, laboratory and screening results, treatment options, and outcomes of patients with type I interferonopathy. Our secondary goal was to identify the predictors of long-term morbidity or mortality. We included children with genetically confirmed type I interferonopathies, with a follow-up duration of > 1 year. Data were obtained retrospectively from medical records. Of the 40 eligible patients for the study, 52.5% were female, with a median age of disease onset of 1.5 years (range 0.1-13.2 yrs). They were diagnosed at an average age of 6.8 (SD 4.6) years. Aicardi-Goutières syndrome was the most common diagnosis (n = 15, 37.5%). The central nervous system was the most frequently affected system (n = 27, 67.5%). Janus kinase inhibitors were administered to 17 (42.5%) patients. Twenty-five patients (62.5%) developed at least 1 permanent morbidity or died during follow-up; thus, they were included in the poor outcome group. Although younger age at disease onset, intracranial calcification (ICC), and lack of chilblains and elevated acute-phase reactants were significant in univariate logistic regression analysis, only ICC on magnetic resonance imaging at admission (adjusted odds ratio 19.69, 95% CI 1.08-359.05, P = 0.04) was found to be a significant predictor of poor outcomes in multivariate logistic regression analysis. For the first time, we evaluated the predictors of poor outcomes in patients with type I interferonopathy with a broad spectrum of subtypes. Further, our study's unique patient characteristics can provide valuable insights into these extremely rare conditions.

A Retrospective Study of Pediatric Patients With Low- or Intermediate-Risk Acute Myeloid Leukemia Who Underwent Allogeneic Hematopoietic Cell Transplantation for the AML-05 Study Conducted by the Japanese Pediatric Leukemia/Lymphoma Study Group

The AML-05 study aimed to examine the efficacy and safety of a therapeutic strategy based on risk stratification for low-, intermediate-, or high-risk acute myeloid leukemia (AML) pediatric patients. Allogeneic hematopoietic cell transplantation (allo-HCT) was not indicated for low- or intermediate-risk AML patients in first complete remission. The present retrospective study for the AML-05 study aimed to identify prognostic factors for survival and to determine optimal allo-HCT according to multivariate analysis on overall survival (OS), event-free survival (EFS), cumulative incidence of relapse (CIR), and cumulative incidence of nonrelapse mortality for and between low- and intermediate-risk AML group patients in the AML-05 study who had undergone allo-HCT after its completion and relapse. The unique patient numbers (UPNs) of the AML-05 study were matched with the Transplant Registry Unified Management Program (TRUMP)-registered numbers, and the tied data on the AML-05 study's UPNs and the TRUMP-registered numbers were analyzed. The primary endpoint was 3-yr OS. Among 443 AML patients in the AML-05 study, 79 (32 low-risk AML and 47 intermediate-risk AML) were analyzed. The following statistically favorable prognostic factors were identified by multivariate analysis on the low- and intermediate-risk AML groups, respectively: UCB (OS—hazard ratio [HR], 0.105; 95% CI, 0.011 to 0.941; P = .004 and EFS—HR, 0.065, 95% CI, 0.007 to 0.577, P = .014) and late relapse (OS—HR, 0.212; 95% CI, 0.072 to 0.626; P = .005 and EFS—HR, 0.236; 95% CI, 0.088 to 0.630; P = .004). Three-year OS, 3-yr EFS, and 3-yr CIR were significantly different between the low- and intermediate-risk AML groups. UCB may be a safe and beneficial donor source for low-risk AML patients, while late relapse was a favorable prognostic factor for intermediate-risk AML patients. Intermediate-risk AML patients with late relapse and low-risk AML patients may benefit from allo-HCT after relapse.

Iron Deficiency in Pulmonary Hypertension.

Pulmonary hypertension (PH) is a complex cardiovascular condition that is characterized by elevated pulmonary arterial pressure, which leads to significant morbidity and mortality. Among the various factors that influence the pathophysiology and progression of PH, iron deficiency has become a critical, yet often overlooked, element. In this review, the prevalence, implications, and therapeutic potential of addressing iron deficiency in patients with PH are elucidated.Iron deficiency, which is prevalent in a significant proportion of patients with PH, has been associated with worsened clinical outcomes, including diminished exercise capacity, impaired oxygen transport and utilization, and compromised right ventricular function. The pathophysiological linkages between iron deficiency and PH are multifaceted and involve alterations in oxygen sensing, endothelial function, and metabolic disturbances.In this review, the evidence from recent clinical trials and studies that assess the impact of iron supplementation, both oral and intravenous, on PH outcomes is critically analyzed. Although some studies suggest improvements in exercise capacity and hemodynamic parameters following iron repletion, the responses appear variable and are not universally beneficial. This review highlights the complexities of iron metabolism in PH and the challenges in effectively diagnosing and treating iron deficiency in this patient population.Furthermore, the potential mechanisms through which iron supplementation might influence pulmonary vascular and right ventricular function, emphasizing the need for personalized treatment approaches are discussed. In this review, the importance of recognizing iron deficiency in the management of patients with PH is highlighted, and further research is warranted to establish comprehensive, evidence-based guidelines for iron supplementation in this unique patient cohort. The ultimate goal of this review is to improve clinical outcomes and quality of life for patients suffering from this debilitating condition.

Impact of a first-year medical student patient navigation initiative on healthcare access and students' skills

Background: Medical schools with complex patient populations, characterized by linguistic diversity and uncertain immigration status, face challenges in imparting essential skills in patient care, particularly in understanding healthcare barriers, building rapport, and fostering empathy. A South Florida medical school with a predominantly non-English-speaking and undocumented patient population piloted a Patient Navigation (PN) program within the first-year curriculum to address these challenges. We present the student feedback from the program’s first two years to guide medical schools in simultaneously caring for this unique patient population, with the aim of enhancing medical education. Methods: This program diverged from traditional Patient Navigation approaches by leveraging specialized hospital-associated translation services and collaborating with the Health System's Financial Assistance program. We performed a crosssectional study on student feedback surveys to identify program features significantly associated with a satisfying PN experience, and to provide insights to optimize and refine the program for future implementations. Results: The program engaged 245 out of 306 first-year medical students in PN for 118 patients. Successful contact was established with 55% of patients and 70% achieved their navigation objectives. Satisfaction metrics revealed that students given patients were nearly five times more satisfied than their counterparts. This positively impacts both student experience and patient outcomes, showcasing the program's effectiveness in bridging healthcare disparities. Discussion: The PN program proved successful in linking low-risk patients to follow-up care, offering medical students first-hand exposure to the challenges of care for primarily non-English-speaking and undocumented populations. The initiative aimed to enhance healthcare access for marginalized patients while providing medical students with an immersive understanding of patient-centric care beyond conventional curricular offerings. Key lessons learned include improving communication channels between students and patients, and optimizing community resources for streamlined patient support. Future iterations will prioritize these lessons, emphasizing cultural competence and patient advocacy to enhance both student education and patient care outcomes.

The promise and challenges of Artificial Intelligence-Large Language Models (AI-LLMs) in obstetric and gynecology

HIGHLIGHTS 1. The article highlights how Artificial Intelligence with Large Language Models (AI-LLMs) greatly improves diagnosis and treatment personalization in obstetrics &amp; gynecology, and also enhances medical education through interactive simulations and up-to-date learning materials.2. The article also discusses the ethical issues linked to AI, emphasizing the need for cooperation among different stakeholders to use AI responsibly in medicine, focusing on protecting data privacy and minimizing reliance on technology. ABSTRACT The introduction of Artificial Intelligence through Large Language Models (AI-LLM) into medicine holds great promise for improving patient care and medical education, especially in obstetrics and gynecology. AI-LLM can significantly improve diagnostic accuracy and treatment efficiency by utilizing large medical databases, which is especially useful for dealing with rare diseases that are difficult to document or understand by human practitioners alone. In addition, AI-LLM can provide informed patient care recommendations by analyzing large amounts of data and providing insights based on unique patient profiles, with the added benefit of being accessible 24/7 via the internet. This constant availability ensures that patients receive prompt information and assistance as needed. In the field of education, AI-LLMs enhance the learning experience by incorporating interactive simulations into the curriculum, improving medical students' and professionals' practical knowledge. They also ensure that educational materials are always up-to-date reflecting the most recent research and worldwide medical standards. This access latest information from global resources helps to bridge the educational gap, making advanced knowledge more accessible to learners regardless of their geographic location. However, the introduction of AI-LLMs is not without challenges. Ethical issues, such as data privacy and the risk of overreliance on technology, must be addressed. Effective management of these concerns necessitates collaboration among medical professionals, technological experts, academics, hospital committees, and representatives of patients. This multidisciplinary teamwork is vital for upholding ethical norms and preserving patient dignity and respect. AI-LLMs can considerably improve both patient care and medical education in obstetrics and gynecology provided they are appropriately balanced with innovation and ethics.

"I Often Just Don't Know what to Say!": Variations in Multidisciplinary Palliative Care Clinicians' Confidence and Needs Related to Spiritual Care.

Spiritual care is a core component of high-quality palliative care, yet gaps exist in spiritual care provision. Understanding clinicians' levels of confidence around spiritual care and their perceptions of necessary knowledge/skills to enhance their ability to provide spiritual care is foundational for improving delivery of spiritual care in practice. To understand confidence levels with providing spiritual care and perceived needs in relation to the provision of spiritual care among palliative clinicians (nurses, social workers, chaplains). N = 260 clinicians participating in interprofessional communication and end-of-life care training programs completed a structured survey. Clinicians responded to 42 closed-ended questions assessing their confidence in engaging in spiritual care across 6 dimensions, and one open-ended question: "What areas of knowledge or skill would best help to improve your ability to provide spiritual care across diverse populations?" Findings reveal varied levels of confidence with spiritual care across dimensions. Chaplains reported the highest levels of confidence compared with nurses and social workers. Key areas of knowledge/skills to improve spiritual care provision were: (1) Training and support for clinicians in spiritual care; (2) Strategies for providing spiritual care to patients from diverse cultural and/or religious backgrounds; (3) Better understanding of specific populations and contexts that may affect spiritual care provision; and (4) Clinicians' personal growth & practices to improve spiritual care. Additional support with spiritual care provision is needed, especially among spiritual care generalists. A focus on culturally attuned care is needed, honoring unique patient contexts and centering patient and family priorities.

The genomic and immunogenomic landscape of mechanics pathway informs clinical prognosis and response to mechanotherapy.

Mechanics shape cell and tissue plasticity and maintain their homeostasis. In cancers, mechanical signals regulate cancer hallmarks via mechanotransduction pathways, such as proliferation, metastasis and metabolic reprogramming. However, comprehensive characterization of mechanotransduction pathway genes and their clinical relevance across different cancer types remains untouched. Herein, we systematically portrayed the alterations of mechanotransduction pathway genes across 31 cancer types using The Cancer Genome Atlas (TCGA) databases. All the cancer types could be categorized into 6 subtypes based upon the transcriptional pattern of mechanics pathway genes. Each subtype has its own unique molecular expression pattern, mutation landscapes, immune infiltrates, and patient clinical outcome. We further found that the responses of two subtypes of cancers, one with the optimal outcome and the other with the worst prognosis, to a classical mechanotherapeutic agent (Fasudil, RhoA/ROCK inhibitor) were totally different, indicating that our cancer stratification system based upon mechanotransduction pathway genes could inform clinical responses of patients to mechanotherapeutic agents. Collectively, our study provides a novel pan-cancer landscape of the mechanotransduction pathways and underscores its potential clinical significance in the prediction of clinical prognosis and therapeutic responses to mechanotherapy among cancer patients.

Why is ethnicity a risk factor for postpartum haemorrhage?

Postpartum haemorrhage (PPH) is a leading cause of maternal mortality and morbidity on a global scale. Ethnic background is known to be a determinant of variation in the outcomes of women receiving maternity care across the world. Despite free maternity healthcare in the UK National Health Service, women with an ethnic minority background giving birth have an increased risk of PPH, even when other characteristics of the mother, the baby and the care received are considered. Improving PPH care has significant implications for improving health equity. The underlying causes of ethnic disparities are complex and multifaceted. It requires a deep dive into analysing the unique patient factors that make these women more likely to suffer from a PPH as well as reflecting on the efficacy of intra and postpartum care and prophylactic treatment these women receive.

Quality of life from childhood to adulthood: Perspectives from adult patients with pediatric-onset intestinal failure.

Adult patients with pediatric onset short bowel syndrome (SBS) or intestinal failure (IF) have been described as a distinct population warranting further research. The aim of this exploratory study aimed was to offer initial insights into this population's navigation of childhood, adolescence, and transition into adulthood. Both quantitative and qualitative data were collected from a convenience sample of adults with pediatric-onset SBS/IF using a disease-specific pilot survey; 14 questionnaires were completed. Responses indicated childhood and adulthood were complex and marked by joys and trials, while adolescence was experienced by many as a particularly challenging time. As adults, numerous patients experienced barriers to accessing the medical care they desired and described difficulties finding experienced and knowledgeable providers who listened and offered individualized care. This study highlights the importance of further studying this unique patient population, suggesting it can offer critical insights to inform the development of interventions and transition programs.

“A life-changing experience and the beginning of a lifelong commitment”: experiences and impact of Global Health Community Service-Learning in undergraduate dental curriculum in Canada

BackgroundGlobal Health Community Service-Learning (GHCSL) can have a profound professional and personal impact on learners. This pedagogy provides understanding of unfamiliar environments and challenges learners to step out of their comfort zones, adapt to new cultures, and navigate unique situations. Yet, there are relatively few studies exploring the experiences of learners participating in community service-learning placements in global regions as part of undergraduate dental curriculum. This study aimed to explore the experiences and impact of the GHCSL program in East Africa among undergraduate dental learners at the Schulich School of Dentistry.MethodsEight undergraduate dental learners were enrolled in GHCSL pilot placements. Placement agreements were established with Makerere University in Kampala, Uganda, and the University of Rwanda in Kigali, Rwanda for the summer of 2022. Stakeholders from both institutions were engaged in the development and implementation of these placements. Learners were required to engage in weekly reflection through a ‘storytelling and incident-based narrative’ while carrying out their placement. A qualitative study design was employed, and an inductive interpretive approach was utilized to thematically analyze the learners’ reflective essays.ResultsFive major themes emerged from the learners’ reflective essays: (1) experiential clinical learning; (2) cultural humility and social awareness; (3) awareness of contrasting healthcare systems; (4) commitment to service; and (5) personal and professional growth. Most learners reflected on their engagement with diverse communities, being exposed to unique patient cases, and witnessing the adaptability exuded in resource-constrained environments. These experiences presented the learners with an opportunity to develop cultural humility and gain a newfound motivation to mitigate global oral health disparities in populations beyond that of their local communities. Learners also reflected on enhanced social awareness experiences and the awareness of contrasting healthcare systems in Canada and their placements, which encouraged the development of empathy, communication, and compassion skills, as well as an understanding of the disproportionate burden of conditions in low-resource settings.ConclusionThe reflective essays concluded that the GHCSL placements had a positive impact on the learners, encouraging many to develop a heightened desire for lifelong learning to address oral health disparities within a global context.

COVID-19 Infection in Ultramarathon Runners: Findings of the Ultrarunners Longitudinal TRAcking Study.

Ultramarathon runners are a unique patient population who have been shown to have a lower rate of severe chronic medical conditions. This study aimed to determine the effect that COVID-19 infection has had on this population and their running behavior. The Ultrarunners Longitudinal TRAcking (ULTRA) Study is a large longitudinal study of ultramarathon runners. Questions on health status, running behavior, and COVID-19 infection were included in the most recent survey. Community survey. Seven hundred thirty-four ultramarathon runners participated in the study. None. Personal, exercise, and COVID-19 infection history. 52.7% of study participants reported having been symptomatic from a COVID-19 infection, with 6.7% testing positive multiple times. Participants required a total of 4 days of hospitalization. The most common symptoms included fever (73.6%), fatigue (68.5%), sore throat (68.2%), runny nose (67.7%), and cough (67.4%). Cardiovascular symptoms, which are of particular interest in the running population, included shortness of breath (46.3%), tachycardia (44.7%), chest pain (36.2%), and wheezing (33.3%). A total of 50 subjects (6.8%) reported long COVID (symptoms lasting more than 12 weeks). Severe COVID-19 infection has been rare in this population of ultramarathon runners, although symptomatic infection that affects running is common. To support the well-being of this group of highly active athletes, clinicians should appreciate that cardiovascular symptoms are common and the long-term significance of these symptoms in runners is unknown. Level 2 prospective study.

Piloting a Patient-Driven Online Survey to Better Understand Cancer in Adolescents and Young Adults (AYA) in the United States.

Adolescents and young adults (AYAs) with cancer are a unique patient population in oncology. An opt-in, secure online survey was conducted among a general population of AYA patients and survivors to better understand the current landscape of AYA cancer. A 28-item online survey was designed for cancer patients and survivors diagnosed between the ages of 18 and 39 years.It comprised questions about demographics, treatment site, clinical trial involvement, support services available, and impact on employment, schooling, and finances. A total of 590 patients registered and 447 (76%) completed the survey.This online exercise was found to be feasible and can serve as an effective method to survey the AYA cancer population.

Retrospective Analysis of Treatment Outcomes and Survival Rates in Oral Squamous Cell Carcinoma Patients

ABSTRACT Background: Because of its high rates of morbidity and death, oral squamous cell carcinoma (OSCC) poses a serious threat to world health. To maximize patient care and direct clinical decision-making, it is important to comprehend treatment results and survival rates. Methods: Treatment results and survival rates for OSCC patients treated at a tertiary care facility between 2010 and 2022 were assessed in this retrospective research. Demographic data, tumor features, treatment options, and follow-up results were all included in the data. The relationships between treatment methods and survival rates were evaluated by statistical analysis. Results: There were 107 OSCC patients in all. Compared to radiation and chemotherapy, surgery had reduced recurrence rates and greater overall survival rates as the most common treatment option. There were notable variations in survival rates across the various treatment regimens (P &lt; 0.05). Conclusion: Surgery is the mainstay. Adjuvant treatments, however, are complementary in the management of illness. The significance of customized treatment strategies based on unique patient attributes and tumor features is highlighted by this study in order to maximize results for patients with OSCC. To confirm these results and investigate cutting-edge treatment approaches, more investigation is necessary.

Real-time Whole Genome Sequencing Surveillance as an Effective Outbreak Detection and Mitigation Tool

Background: Detection of outbreaks traditionally relies on passive surveillance, and often misidentify or miss outbreaks. Whole genome sequencing (WGS) surveillance has emerged as a proactive measure, enabling early detection of outbreaks and facilitating rapid intervention strategies. WGS surveillance has not been widely studied due to infrastructure, cost, and evidence barriers regarding its impact on reducing healthcare-associated infections (HAIs). This study represents findings from two years of a real-time WGS surveillance program called the Enhanced Detection System for Healthcare-associated Transmission (EDS-HAT). Methods: The study was conducted at UPMC Presbyterian hospital, a 694-bed tertiary care center. Patient isolates of select bacterial pathogens were collected and underwent WGS weekly from November 2021 to November 2023. Potential transmission was defined using single-nucleotide polymorphism thresholds (≤15 for all organisms except Clostridioides difficile). Genetically related clusters were reviewed weekly for epidemiological linkages (unit, personnel, or procedural commonalities) and appropriate interventions were initiated by the infection prevention and control team. We described the frequency of genetic relatedness and nature of epidemiological linkages. Results: Of 7,051 eligible unique patient organism isolates, 4,723 were deemed healthcare-associated and underwent WGS. EDS-HAT identified 478 (12.2%) isolates genetically related to ≥1 other isolate across 173 clusters. Epidemiological links were found in 278 (58.2%) isolates in 114 clusters, with the majority being unit-based (205 isolates, 71.9%); other epidemiological links included equipment or healthcare workers (32 isolates, 11.5%), external facilities (24 isolates, 8.6%), and shared endoscopes (17 isolates, 6.1%); all endoscope outbreaks were effectively contained at two patients. No epidemiological links could be identified for 200 (41.8%) isolates. Infection prevention initiated 134 interventions in 114 clusters, including 74 (55.2%) general staff notification and education, 25 (18.7%) enhanced cleaning efforts, 23 (17.2%) hand hygiene/personal-protective equipment compliance observations, 9 (6.7%) environmental cultures, and 3 (2.2%) enhanced microbiological surveillance. Following the detection of an epidemiological link and intervention, 94/101 (94.1%) outbreaks were effectively halted on the intervened route (Figure). Conclusion: This study demonstrates the feasibility and efficacy of EDS-HAT as an infection prevention tool. Early detection and intervention of outbreaks significantly enhance the capability of healthcare facilities to control and prevent the spread of HAIs. Investment in infrastructure and implementation costs will result in reducing pathogen transmission and improving patient safety in acute care settings.Disclosure: Alexander Sundermann: Honoraria - Opgen

Multi-year Epidemiology of Nontuberculous Mycobacteria Across a Diverse Healthcare System

Background: Nontuberculous mycobacteria (NTM) are ubiquitous potential pathogens implicated in healthcare-associated outbreaks. There is a paucity of studies describing transmission risk in the healthcare setting. To estimate the potential healthcare-associated transmission of NTM, we characterized the frequency of NTM clinical isolates across our multi-facility healthcare system. Method: We performed a retrospective review of all clinical NTM isolates at 21 healthcare facilities in a large health system between January 2019 through June 2023 (inclusion criteria: all first unique species). We analyzed the quarterly frequency of isolates for each species, by facility. We identified higher-than-expected species frequencies, which was defined as a quarterly frequency ≥50% higher than the average quarterly frequency for that facility, for the entire study period (analysis omitted for any hospital with an average quarterly frequency 10 unique patient isolates in any 12-month period or &gt;2 in a single month except for M. abscessus at Hospital A. The quarterly frequency of the three most common species among hospitals with ≥2 unique isolates per 12-month period are displayed in figure 2. An increase of 50% from the average quarterly infection count occurred 34 times for M. avium complex across 10 hospitals, 14 times for M. gordonae across 2 hospitals and 14 times for M. lentiflavum across 2 hospitals (Figure 3). Conclusion: A diverse group of NTM were isolated across our healthcare system over the study period, most commonly M. avium complex, M. gordonae, and M. lentiflavum, each with hospital-specific temporal frequencies that suggest the potential for undetected outbreaks, while frequencies of less commonly isolated species were rarely suggestive of potential undetected outbreaks. Further epidemiologic investigation of in-hospital transmission routes, with whole genome sequencing to determine genetic relatedness, is necessary to identify undetected outbreaks.

The Mechanics, Art, and Value of Central Line Stewardship

Background: Central venous catheter (CVC) utilization and central-line associated bloodstream infection (CLABSI) have increased nationwide. Busy providers can easily overlook the recommended practice of daily assessment of the ongoing indication for CVC. Prospective audit and feedback (PAF) is widely used and the gold standard for antibiotic stewardship programs (ASP), but reports involving PAF for device use are scarce. Therefore, we decided to evaluate the usefulness and feasibility of PAF for reducing device utilization and ultimately CLABSI rates at our 528-bed tertiary care hospital. Methods: A PAF-based Central Line Stewardship (CLS) initiative was launched in February 2023, with a team of hospitalists, infectious diseases physicians, health informatics, vascular access nurses, and infection preventionists. On business days, CVC line-lists were exported from the electronic medical record (EMR), into a REDCap (Research Electronic Data Capture) database for team members to evaluate, in real-time, all non-ICU CVCs in place for more &gt;72 hours (Figures 1 and 2). For CVCs eligible for stewardship, CLS members placed Legal-approved note into the patient’s EMR, advising CVC removal or alternative IV access (Figure 3). CVCs continued to be audited until removal or patient discharge. Recommendation outcomes were tracked over the subsequent 72 hours for acceptance. Standardized Utilization Rates (SUR) and Infection Rates (SIR) were calculated and compared using the National Healthcare Safety Network. Results: Between February and August 2023, the CLS team reviewed 861 CVCs, representing 581 unique patient encounters, and made 622 recommendations. Recommendations to remove or replace the CVC represented 23.5% (146) of reviews, and 57% of these CVCs were removed within 3 days. 95% of removed lines had no adverse outcomes and did not require reinsertion. Hospital-wide CVC utilization decreased 18.7% from a SUR of 1.006 in the previous year, to 0.818 during the 7-month pilot period (p &lt; 0 .001). In the 4 months following the pilot period, decreased CVC utilization was sustained with an SUR of 0.797. Non-ICU CLABSI SIR decreased from 1.282 in 2022 to 1.024 in 2023 (p=0.36). Average time physician required for CLS review approximated a 0.4 full-time equivalent a week. The intervention was well received, with requests for expansion to urinary catheters. Conclusion: CLS safely and significantly reduced device-utilization; directly via documentation and recommendation, and indirectly through increased awareness and the Hawthorne Effect. Examples of the “art” of CLS include when to leave a discoverable note and how to determine ongoing need for CVC in a fragile patient.