University Hospitals Cleveland Medical Center Research Articles

Judge rules against former employee

Case name: Murray v. University Hospitals Cleveland Medical Center, No. 1:22‐cv‐00391 (N.D. Ohio 12/18/23).

Judge rules against former employee

Case name: Murray v. University Hospitals Cleveland Medical Center, No. 1:22‐cv‐00391 (N.D. Ohio 12/18/23).

Bariatric surgery efficacy in patients with mood disorders

Mood disorders are comorbid in patients with obesity and found in approximately 22.0% to 54.8% of patients who are eligible for bariatric surgery. Given the unclear effect of mood disorders on bariatric surgery outcomes, we aimed this study to assess the impact of mood disorders index bariatric surgery weight loss outcomes. A retrospective study institutional database of index bariatric surgery patients at University Hospitals Cleveland Medical Center between 2016 and 2018. The primary outcome of body mass index was followed over a 4-year period. The secondary outcomes measured were mortality and suicide rates. Mood disorders defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, included depressive and bipolar disorders obtained from electronic medical records International Classification of Diseases, Tenth Revision, coding. A total of 790 patients underwent bariatric surgery between 2016 and 2018. Of these, 15 patients were excluded due to death in the postoperative period or insufficient weight loss data, and a total of 775 patients (620 women and 155 men) were included. Two hundred and ninety-five (38.1%) had an electronic medical record mood disorder diagnosis before surgery, while 480 (61.9%) did not. Both groups had a significant decrease in postoperative body mass index; however, there was no significant difference in the body mass index change between the mood disorder group (mean= 37.63, standard deviation= 9.88) and the control group (mean= 38.72, standard deviation= 9.54; t[294]= 1.40; P= .1634). Patients with mood disorders are as successful with weight loss after index bariatric surgery as those without mood disorders. There was no significant difference in mortality rates between the mood disorder group and the control group. Hence, mood disorders should not be prohibitive for weight loss surgery.

Dermatopathology Trends in African Americans: A Retrospective Analysis of Biopsies.

In a retrospective analysis of biopsies from January 1, 2019 to December 31, 2020, at University Hospitals Cleveland Medical Center, we aimed to determine the frequency of dermatologic conditions biopsied in African Americans (AA). Given that AAs constitute 13.4% of the US population, understanding the skin disease profile within this significant demographic is crucial. From a total of 1701 biopsies collected from 1442 AA patients, benign neoplasms emerged as the most common diagnosis, accounting for 26.7%, predominantly in females. Notably, cutaneous T-cell lymphoma was the most frequently biopsied malignancy, whereas pigmentary disorders were the least common at 1.4%. The study highlighted the higher occurrence of squamous cell carcinoma compared with basal cell carcinoma in AA, contrasting trends in other racial demographics. Moreover, recognizing the unique presentations of skin disorders in different racial backgrounds is essential, especially because disparities have been reported in skin of color training among dermatology residency programs. Understanding these racial differences in skin diseases can assist clinicians in refining their diagnostic approach. Future research could further explore the potential gaps between clinical expectations and histologic findings, improving diagnostic accuracy.

Second-year results from CINEMA: A novel, patient-centered, team-based intervention for patients with Type 2 diabetes or prediabetes at high cardiovascular risk

BackgroundThe care for patients with type 2 diabetes mellitus (T2DM) necessitates a multidisciplinary team approach to reduce cardiovascular (CV) risk but implementation of effective integrated strategies has been limited. Methods and ResultsWe report 2-year results from a patient-centered, team-based intervention called CINEMA at University Hospitals Cleveland Medical Center. Patients with T2DM or prediabetes at high-risk for CV events, including those with established atherosclerotic CVD, elevated coronary artery calcium score ≥100, chronic heart failure with reduced ejection fraction, chronic kidney disease (CKD) stages 2–4, and/or prevalent metabolic syndrome were included. From May 2020 through September 2022, 426 patients were enrolled in the CINEMA program. A total of 227 (54%) completed ≥1 follow-up visit after an initial baseline visit with median (IQR) follow-up time 4 [3–7] months with maximum follow-up time 19 months. Mean age was 60 years, 47 % were women, and 37 % were Black and 85% had prevalent T2DM, 48 % had established ASCVD, 29% had chronic HF, 27% had CKD and mean baseline 10-year ASCVD risk estimate was 25.1 %; baseline use of a SGLT2i or GLP-1RA was 21 % and 18 %, respectively. Patients had significant reductions from baseline in body weight (-5.5 lbs), body mass index (-0.9 kg/m2), systolic (-3.6 mmHg) and diastolic (-1.2 mmHg) blood pressure, Hb A1c (-0.5 %), total (-10.7 mg/dL) and low-density lipoprotein (-9.0 mg/dL) cholesterol, and triglycerides (-13.5 mg/dL) (p<0.05 for all). Absolute 10-year predicted ASCVD risk decreased by ∼2.4 % (p<0.001) with the intervention. In addition, rates of guideline-directed cardiometabolic medication prescriptions significantly increased during follow-up with the most substantive changes seen in rates of SGLT2i and GLP-1RA use which approximately tripled from baseline (21 % to 57 % for SGLT2i and 18 % to 65 % for GLP-1RA, p<0.001 for both). ConclusionsThe CINEMA program, an integrated, patient-centered, team-based intervention for patients with T2DM or prediabetes at high risk for cardiovascular disease has continued to demonstrate effectiveness with significant improvements in ASCVD risk factors and improved use of evidence-based therapies. Successful implementation and dissemination of this care delivery paradigm remains a key priority.

Utility of CT or X-ray in the management of adult nasal fracture

PurposeThe primary objective of this study is to evaluate the use of imaging in the management of nasal fracture in adults and determine if imaging is beneficial to clinical decision making when planning for surgery. A secondary objective of this study is to compare surgical rates for nasal fracture between pediatric and adult populations. MethodsThis is a retrospective case-control study of 357 patients seen at University Hospitals Cleveland Medical Center from January 2015 through January 2020 with a diagnosis of nasal fracture. An odds ratio was calculated to determine likelihood of surgical intervention between patients who had imaging of the nasal bones and patients who did not. Results82 % of patients had either CT or X-ray imaging. The odds ratio of patients who had surgery after CT or X-ray imaging compared to patients who had surgery without prior imaging was 0.092 (95 % CI: 0.0448–0.1898, p-value <0.0001). A total of 54 (15 %) adult patients had surgery, in comparison to 50 % of pediatric patients with diagnosis of nasal fracture. 202 (57 %) of patients did not follow up after initial diagnosis by radiology. ConclusionThe statistical analysis suggests that while CT and X-ray are frequently obtained in the setting of nasal fracture, patients without imaging are more likely to have surgery (p < 0.05) than patients with imaging. This indicates that imaging is likely unnecessary for surgical planning. Most adults do not pursue surgery, and surgical rates for adults with nasal fracture are much lower than those of pediatric patients with nasal fracture.

RING Program: The CFAR Diversity, Equity, and Inclusion Pathway Initiative.

Case Western Reserve University (CWRU)/University Hospitals Cleveland Medical Center in Cleveland, OH, and the University of Pittsburgh (Pitt) in Pittsburgh, PA, forged a strategic alliance to form the Rustbelt Center for AIDS Research. The Rustbelt Center for AIDS Research developed a National Institutes of Health-supported diversity, equity, and inclusion pathway initiative termed the "Rustbelt Investigators for the Next Generation (RING) Program" that provides research training experiences for Puerto Rican students that will help them pursue a biomedical research career in HIV. The RING Program provides 10-week research training experiences in different disciplines of HIV/AIDS for under-represented minority undergraduate and masters students from 4 campuses (Río Piedras, Mayagüez, Humacao, and Cayey) at the University of Puerto Rico. Mentors are drawn from both CWRU and Pitt. The RING Program recently completed our first wave of recruitment. Recruitment sessions were either virtual or on site at the University of Puerto Rico campuses and included an overview presentation, a Q&A session, and in-person interviews. We interviewed 32 eligible applicants and accepted 10 into the program, of which 9 were female. Five students were matched with faculty at CWRU and 5 with faculty at Pitt. The RING Program is a comprehensive program in laboratory and implementation science that aims to enhance under-represented Hispanic undergraduate and masters students' passion for pursuing a biomedical research career in HIV.

A-384 Laboratory Evaluation of the SeptiCyte Rapid Host Response Assay In Differentiating Infection-Positive Versus Infection-Negative Systemic Inflammation Patients Suspected of Sepsis

Abstract Background Early diagnosis of sepsis is critical for timely treatment but remains challenging. A rapid host response assay, SeptiCyte, was recently approved by the FDA for aiding early differentiation of infection-positive from infection-negative systemic inflammation in patients suspected of sepsis. This test is a fully automated reverse transcription polymerase chain reaction (RT-qPCR) assay that quantifies changes in the expression of two host immune response genes and results are available in about 1 hour. The present study aimed to evaluate the SeptiCyte assay performance in a clinical setting at a large medical center. Methods Eighty-two patients admitted to the University Hospitals Cleveland Medical Center with suspected sepsis from July to September 2022 were included in the study. SeptiCyte samples were obtained at the time of initial evaluation. In addition, healthy donor blood samples and extracted RNA samples were also utilized for assay validation. The SeptiCyte assay was performed according to the manufacturer's instructions using multi-chambered fluidic cartridges and the Idylla Console (Immunexpress, Seattle, WA). The assay result was reported as the SeptiScore (range 0–15), a calculated ratio of the expression of two host immune response genes, and the SeptiCyte band (ranging from 1 to 4, with 1 indicating the lowest risk of sepsis and 4 indicating the highest risk). The assay cutoff values are 5.0, 6.2 and 7.4 respectively for the band 2, 3 and 4. Results Intra- and inter-assay precision was 0.2–6.2% and 0–3.2%, respectively. % Recovery at the cutoff for band 3 (SeptiScore 6.0) was 102.4% with a CV of 2.4%. Method comparison with the Immunexpress lab demonstrated equivalent performance, as evidenced by a slope of 0.99 and an intercept of 0.27 by Deming regression. SeptiScore showed a weak positive correlation with CRP (Correlation Coefficient 0.389, P &amp;lt; 0.01) but no association with procalcitonin (n = 76), lactate (n = 78), international normalized ratio (INR), platelet, neutrophil, lymphocyte, or white blood cell (WBC) count (n = 82). CRP (n = 71) median concentration in patients with band 4 (16.8) was significantly higher than in patients who were band 1 (3.6). The SeptiScore of blood culture positive cases (n = 22) was 7.2 ± 2.0 (mean ± SD) and that of pathogen negative non-sepsis (by sepsis retrospective review of event only, n = 10) cases was 5.6 ± 1.6 (P &amp;lt; 0.05). In addition, the median SeptiScore was notably higher in patients with viral infection compared to those without infection (9.2 vs 6.2, P &amp;lt; 0.05). Further analysis showed 92% (11/12) of patients with hematologic cancer were categorized as band 4 including one non-sepsis case per the retrospective review. SeptiScore was similar between patients with non-hematologic cancer and those without malignancy (P &amp;gt; 0.05). Conclusion The SeptiCyte RAPID assay showed good analytical performance. SeptiScore represents an independent factor to quantify host response in patients suspected of sepsis. It may add value in aiding differentiation between infection-positive from infection-negative systemic inflammation with promising results in patients with viral infections or those with positive blood cultures. The negative predictive value of low SeptiScore within band 1 or 2 may need further investigation.

Predicting the final clinical phenotype after the first attack of optic neuritis

Background and objectivesTo evaluate the factors determining the final clinical phenotype after an initial isolated attack of optic neuritis (ON). ON could be an isolated event or the initial presentation of a chronic neuroimmunological condition. MethodsThis was a retrospective analysis of patients presenting to University Hospitals Cleveland Medical Center for an initial, isolated attack of ON. Final clinical phenotypes were idiopathic ON, multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein associated disease (MOGAD), or secondary ON (e.g. neurosarcoidosis). Several potential predictors at the time of initial presentation were compared among the different phenotypes to determine early predictors. Categorical variables were compared using Pearson χ2 or Fisher's exact test, and continuous variables were compared using independent t-test. ResultsSixty-four patients met criteria (average age 41.3 ± 13.3, 78.1% females). Average time to final diagnosis was 8.3 months, and average follow-up was 47 months. The final phenotypes were MS (22, 34%), idiopathic ON (14, 22%), MOGAD (11, 17%), NMOSD (10, 16%), and secondary ON (7, 11%). White race, unilateral ON, short segment hyperintensity on orbital MRI, classical demyelination on brain MRI, and not requiring PLEX were associated with MS. Older age, poor steroid responsiveness, and requiring PLEX were associated with NMOSD. African American race, bilateral ON, papillitis on fundoscopy, long segment hyperintensity on orbital MRI, and normal brain MRI were associated with MOGAD. Normal or thinned retinal nerve fiber layer on OCT, short segment hyperintensity on orbital MRI, and normal brain MRI were associated with idiopathic ON. ConclusionThe final clinical phenotype may be predictable at the time of initial ON presentation. This requires a careful evaluation of patient demographics, treatment response, funduscopic findings, OCT, and orbital and brain MRIs. Utilizing early predictors in clinical practice could better inform prognosis and management decisions.

Navigator utilization rates in breast cancer patients by race in a comprehensive cancer center.

e18501 Background: African-Americans have the highest overall cancer death rate and shortest survival time of any racial or ethnic group in the United States. Elucidation of disparities in cancer care access is important since previous work has indicated that when equal access to Radiation Therapy (RT) in prospective randomized trials is granted, race does not independently affect outcomes. The most common cancer studied in African-American radiation therapy (RT) access disparities research is breast cancer. Furthermore, prospective analyses have demonstrated that African-Americans receive hypofractionation following breast-conserving surgery less frequently than Caucasians. As such, the goal of this study is to eventually evaluate the impact of patient navigation on short-course RT access for African-American breast cancer patients. Methods: Our study is a prospective survey-based evaluation of the impact of patient navigation on access to hypo-fractionated RT and financial toxicity in African-American breast cancer patients. As the first step to investigating the impact of patient navigation on RT access in this population, medical records of women with breast cancer in our center (University Hospitals Cleveland Medical Center, Seidman Cancer Center) were identified from support groups. The baseline navigation rate for this population was determined from the initial data collected during tumor board sessions from June 2022 through October 2022. Results: We identified female patients who were diagnosed with breast cancer and thus were eligible for navigation. From June 1st through October 31st, 30 female patients were identified. Nine (30%) were Caucasian and 21 (70%) were African-American. Of the 21 African-American female patients, only four (19%) were connected with patient navigation services. Of the 9 Caucasian female patients, only four (44.4%) were connected with patient navigation services; this difference between African-American and Caucasian patients did not reach statistical significance. The total baseline navigation rate at our center during this period was 26.67% (8 out of 30 patients). Conclusions: Over a recent five-month period, it was determined that the baseline navigation rate for Caucasian female breast cancer patients is numerically more than 2x that of African-American female patients at our comprehensive cancer center. This information is an important precursor to the first investigation of the impact of patient navigation on reducing RT access disparities facing African-American breast cancer patients. We anticipate that after collating and analyzing survey results for patients pre-RT versus post-RT as well as for those with versus without patient navigation, navigation will serve to overcome barriers in compliance to therapy and increase adherence to optimal care.

Rates and Predictors of Serious Infections in MS and NMOSD Patients treated with Anti-CD20 Therapy (P7-3.008)

<h3>Objective:</h3> To evaluate the rates and predictors of serious infections in MS and NMOSD patients treated with anti-CD20 agents. <h3>Background:</h3> Chronic immunosuppression with anti-CD20 therapy can increase the risk of serious infections including complicated COVID19. <h3>Design/Methods:</h3> MS and NMOSD patients treated with ocrelizumab or rituximab at University Hospitals Cleveland Medical Center were evaluated. Patients hospitalized for any infection during their anti-CD20 therapy were identified and compared to those without infection-related hospitalizations. Significant differences were evaluated in a multivariate logistic regression model to identify predictors of serious infection. <h3>Results:</h3> There were 184 patients treated with anti-CD20 therapy (average age 48+/−13 years, 67% females, 84% MS). Of those, 21 (11%) patients had one or more serious infection during therapy including 16 MS patients treated with ocrelizumab and 5 NMOSD patients treated with rituximab. The most common serious infections were complicated COVID19 (9), bacterial skin infections (5), bacterial pneumonia (3), urosepsis (3), ocular infection (1), and disseminated shingles (1). Compared to those without serious infections, patients with serious infections had a higher average time on anti-CD20 therapy (1087.57±5 days vs 796.28±35 t= −2.61, P=0.005) and were more likely to have total lymphopenia (80% vs 40%; p=.004). There was a trend towards higher rates of hypogammaglobulinemia in patients with serious infections (24% vs 10%; P=.07). Logistic regression identified total lymphopenia (&lt;1.0×109/L) as an independent predictor of serious infection in patients treated with anti-CD20 therapy. <h3>Conclusions:</h3> Serious infections are rare in MS and NMOSD patients treated with anti-CD20 therapies. Those with serious infections were exposed to treatment longer and more frequently had lymphopenia and hypogammglobulinemia. Total lymphopenia during therapy is an independent risk factor for serious infections. <b>Disclosure:</b> Dr. Abboud has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. The institution of Dr. Abboud has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech . Dr. Abboud has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Abboud has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon. Dr. Abboud has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Dr. Abboud has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Abboud has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Abboud has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Abboud has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen. Dr. Abboud has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Genentech. Dr. Abboud has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for BMS. Dr. Abboud has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion . Dr. Abboud has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Horizon. The institution of Dr. Abboud has received research support from Genentech . The institution of Dr. Abboud has received research support from Novartis. The institution of Dr. Abboud has received research support from BMS. The institution of Dr. Abboud has received research support from Sanofi-Genzyme. Dr. Mears has nothing to disclose. Dr. Jakubecz has nothing to disclose. Dr. Serra has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen Idec. Dr. Serra has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Bristol Myers Squibb.

Commissural and Coronary Alignment After Transcatheter Aortic Valve Replacement Using the New Supra-Annular, Self-Expanding Evolut FX System

HomeCirculation: Cardiovascular InterventionsAhead of PrintCommissural and Coronary Alignment After Transcatheter Aortic Valve Replacement Using the New Supra-Annular, Self-Expanding Evolut FX System No AccessLetterRequest AccessAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessLetterRequest AccessCommissural and Coronary Alignment After Transcatheter Aortic Valve Replacement Using the New Supra-Annular, Self-Expanding Evolut FX System Sung-Han Yoon, MD, Shayef Gabasha, MD, Luis Augusto Palma Dallan, MD, Anene Ukaigwe, MD, Gilbert H.L. Tang, MD, MSc, MBA, Gregory Rushing, MD, Mark Pelletier, MD, Steven Filby, MD, Cristian Baeza, MD and Guilherme F. Attizzani, MD Sung-Han YoonSung-Han Yoon https://orcid.org/0000-0003-0465-7061 Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (S.-H.Y., S.G., L.A.P.D., A.U., G.R., M.P., S.F., C.B., G.F.A.). Search for more papers by this author , Shayef GabashaShayef Gabasha Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (S.-H.Y., S.G., L.A.P.D., A.U., G.R., M.P., S.F., C.B., G.F.A.). Search for more papers by this author , Luis Augusto Palma DallanLuis Augusto Palma Dallan https://orcid.org/0000-0002-8122-6647 Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (S.-H.Y., S.G., L.A.P.D., A.U., G.R., M.P., S.F., C.B., G.F.A.). Search for more papers by this author , Anene UkaigweAnene Ukaigwe Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (S.-H.Y., S.G., L.A.P.D., A.U., G.R., M.P., S.F., C.B., G.F.A.). Search for more papers by this author , Gilbert H.L. TangGilbert H.L. Tang https://orcid.org/0000-0001-7219-990X Department of Cardiovascular Surgery, Mount Sinai Health System, New York (G.H.L.T.). Search for more papers by this author , Gregory RushingGregory Rushing Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (S.-H.Y., S.G., L.A.P.D., A.U., G.R., M.P., S.F., C.B., G.F.A.). Search for more papers by this author , Mark PelletierMark Pelletier Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (S.-H.Y., S.G., L.A.P.D., A.U., G.R., M.P., S.F., C.B., G.F.A.). Search for more papers by this author , Steven FilbySteven Filby Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (S.-H.Y., S.G., L.A.P.D., A.U., G.R., M.P., S.F., C.B., G.F.A.). Search for more papers by this author , Cristian BaezaCristian Baeza https://orcid.org/0000-0003-2001-332X Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (S.-H.Y., S.G., L.A.P.D., A.U., G.R., M.P., S.F., C.B., G.F.A.). Search for more papers by this author and Guilherme F. AttizzaniGuilherme F. Attizzani Correspondence to: Guilherme F. Attizzani, MD, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106. Email E-mail Address: [email protected] https://orcid.org/0000-0001-9233-1242 Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (S.-H.Y., S.G., L.A.P.D., A.U., G.R., M.P., S.F., C.B., G.F.A.). Search for more papers by this author Originally published3 Apr 2023https://doi.org/10.1161/CIRCINTERVENTIONS.122.012657Circulation: Cardiovascular Interventions. 2023;0:e012657FootnotesThis manuscript was sent to S. Chiu C. Wong, Guest Editor, for review by expert referees, editorial decision, and final disposition.For Sources of Funding and Disclosures, see page XXX.Correspondence to: Guilherme F. Attizzani, MD, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106. Email guilherme.[email protected]org Previous Back to top Next FiguresReferencesRelatedDetails Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/CIRCINTERVENTIONS.122.012657PMID: 37009735 Originally publishedApril 3, 2023 Keywordsheart valvecoronary accesscommissural alignmentaortic roottranscatheter aortic valve replacementPDF download Advertisement SubjectsCatheter-Based Coronary and Valvular Interventions

MP74-11 TRENDS IN THE PHARMACOTHERAPY OF NOCTURIA, 2016-2021: ANALYSIS OF A LARGE MULTI-INSTITUTIONAL RESEARCH NETWORK

You have accessJournal of UrologyCME1 Apr 2023MP74-11 TRENDS IN THE PHARMACOTHERAPY OF NOCTURIA, 2016-2021: ANALYSIS OF A LARGE MULTI-INSTITUTIONAL RESEARCH NETWORK Marco-Jose Rivero, Jaime Perez, Sirpi Nackeeran, Saager Chawla, Nannan Thirumavalavan, and M. Raj Rajasekaran Marco-Jose RiveroMarco-Jose Rivero More articles by this author , Jaime PerezJaime Perez More articles by this author , Sirpi NackeeranSirpi Nackeeran More articles by this author , Saager ChawlaSaager Chawla More articles by this author , Nannan ThirumavalavanNannan Thirumavalavan More articles by this author , and M. Raj RajasekaranM. Raj Rajasekaran More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nocturia is a bothersome lower urinary tract symptom that can be treated with a variety of medications depending on age, sex, and accompanying diagnoses. In the present study, we evaluate global trends in the pharmacotherapy of nocturia from 2016 to 2021. METHODS: We queried TriNetX, a global federated research network, to identify patients aged≥18 years diagnosed with nocturia by ICD-10 code between January 2016 and December 2021. The primary outcome was medication use after diagnosis. Medications analyzed included alpha-blockers, oxybutynin, other anticholinergics, mirabegron, finasteride, dutasteride, desmopressin, tadalafil, melatonin, and botulinum toxin. Treatment rates were analyzed by year (2016–2021) as well as by age bracket. RESULTS: A total of 508,126 adults with nocturia were identified. The average age was 63.2±13.9 years. From 2016 to 2021, the number of nocturia cases increased from 69,868 to 162,306 (average of 18,488 new cases per year) (Figure 1A). Females made up 29.9% of the study population (Figure 1B). Of the males, 33.7% were diagnosed with benign prostatic hyperplasia. Alpha-blockers and anticholinergics were the most commonly used medications for patients aged 40 years and older, followed initially by oxybutynin, and then by finasteride at ages 70 years and older. All medications analyzed experienced a decline in use throughout the study period, though nearly all experienced increased use rates with increasing age, with the exception of desmopressin and botulinum toxin (Figure 1C-D). CONCLUSIONS: From 2016 to 2021, rates of pharmacotherapy for nocturia declined despite increasing case count. This suggests that nocturia may be pharmacologically undertreated in the general population. Source of Funding: This project was supported by the Clinical Research Center of University Hospitals Cleveland Medical Center (UHCMC) and the Case Western Reserve University Clinical and Translational Science Collaborative (CTSC) 4UL1TR000439 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1073 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marco-Jose Rivero More articles by this author Jaime Perez More articles by this author Sirpi Nackeeran More articles by this author Saager Chawla More articles by this author Nannan Thirumavalavan More articles by this author M. Raj Rajasekaran More articles by this author Expand All Advertisement PDF downloadLoading ...

Reply.

*Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, OH; and †University Hospitals Eye Institute, University Hospitals Cleveland Medical Center, Cleveland, OH. Supported by cooperative agreements with the National Eye Institute, National Institutes of Health, Department of Health and Human Services EY20797 and EY20798. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Eye Institute or the National Institutes of Health. Additional support provided by Eye Bank Association of America, The Cornea Society, Vision Share, Inc., Alabama Eye Bank, Cleveland Eye Bank Foundation, Eversight, Eye-Bank for Sight Restoration, Iowa Lions Eye Bank, Lions Eye Bank of Albany, San Diego Eye Bank, and SightLife. Analyses and manuscript preparation were supported by the JAEB Center Research Fund. Financial disclosures/conflicts of interest: J. H. Lass is a voluntary board member of Eversight and the Cleveland Eye Bank Foundation.

OCTOPUS – Optical coherence tomography plaque and stent analysis software

Background and objectiveCompared with other imaging modalities, intravascular optical coherence tomography (IVOCT) has significant advantages for guiding percutaneous coronary interventions, assessing their outcomes, and characterizing plaque components. To aid IVOCT research studies, we developed the Optical Coherence TOmography PlaqUe and Stent (OCTOPUS) analysis software, which provides highly automated, comprehensive analysis of coronary plaques and stents in IVOCT images. MethodsUser specifications for OCTOPUS were obtained from detailed, iterative discussions with IVOCT analysts in the Cardiovascular Imaging Core Laboratory at University Hospitals Cleveland Medical Center, a leading laboratory for IVOCT image analysis. To automate image analysis results, the software includes several important algorithmic steps: pre-processing, deep learning plaque segmentation, machine learning identification of stent struts, and registration of pullbacks for sequential comparisons. Intuitive, interactive visualization and manual editing of segmentations were included in the software. Quantifications include stent deployment characteristics (e.g., stent area and stent strut malapposition), strut level analysis, calcium angle, and calcium thickness measurements. Interactive visualizations include (x,y) anatomical, en face, and longitudinal views with optional overlays (e.g., segmented calcifications). To compare images over time, linked visualizations were enabled to display up to four registered vessel segments at a time. ResultsOCTOPUS has been deployed for nearly 1 year and is currently being used in multiple IVOCT studies. Underlying plaque segmentation algorithm yielded excellent pixel-wise results (86.2% sensitivity and 0.781 F1 score). Using OCTOPUS on 34 new pullbacks, we determined that following automated segmentation, only 13% and 23% of frames needed any manual touch up for detailed lumen and calcification labeling, respectively. Only up to 3.8% of plaque pixels were modified, leading to an average editing time of only 7.5 s/frame, an approximately 80% reduction compared to manual analysis. Regarding stent analysis, sensitivity and precision were both greater than 90%, and each strut was successfully classified as either covered or uncovered with high sensitivity (94%) and specificity (90%). We demonstrated use cases for sequential analysis. To analyze plaque progression, we loaded multiple pullbacks acquired at different points (e.g., pre-stent, 3-month follow-up, and 18-month follow-up) and evaluated frame-level development of in-stent neo-atherosclerosis. In ex vivo cadaver experiments, the OCTOPUS software enabled visualization and quantitative evaluation of irregular stent deployment in the presence of calcifications identified in pre-stent images. ConclusionsWe introduced and evaluated the clinical application of a highly automated software package, OCTOPUS, for quantitative plaque and stent analysis in IVOCT images. The software is currently used as an offline tool for research purposes; however, the software's embedded algorithms may also be useful for real-time treatment planning.

Efficacy of X-ray in the diagnosis of pediatric nasal fracture.

Nasal fracture is one of the most common pediatric fractures, and diagnosis can be made with clinical findings or with radiographic imaging. The objective of this study is to determine the extent of x-ray utilization in decision-making regarding closed reduction of pediatric nasal fracture. This a case-control study of 117 patients ages 0-18 with a diagnosis of nasal fracture seen at University Hospitals Cleveland Medical Center between January 2015 and January 2020. The exposure group had x-ray imaging of the nasal bones, and the control group had no x-ray imaging. A total of 59 (50.4%) patients had surgical intervention. The odds ratio to compare x-ray utilization to the control group for patients who underwent closed reduction surgery was .3951 (95% CI: 0.1848-0.8448, p-value=.0166). The statistical analysis suggests that x-ray use is associated with decreased rates of closed reduction surgery. It is likely that while not necessary for the diagnosis of nasal fracture, x-ray serves as an additional data point for diagnosis confirmation, and may reduce the rate of unnecessary surgery for false positive cases of nasal fracture.

How I Manage Hypertension and Proteinuria Associated with VEGF Inhibitor.

1Division of Nephrology & Hypertension, University Hospitals Cleveland Medical Center, Cleveland, Ohio 2Division of Kidney Diseases and Hypertension, The Glomerular Center at Northwell, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York 3Department of Nephrology, Peupliers Private Hospital, Ramsay Générale de Santé, Paris, France Correspondence: Dr. Arash Rashidi, Division of Nephrology & Hypertension, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH 44106. Email: [email protected] Published online ahead of print. Publication date available at www.cjasn.org.

A Comparison of Faculty and Resident Perceptions on the Qualities of Outstanding Surgical Educators

The objective of the study is to compare faculty and resident perspectives regarding the competencies of an outstanding surgical educator in practice. An IRB-approved survey instrument using a five-point Likert scale assessing 50 competencies and behaviors of a surgical educator was sent to study participants. The competencies and behaviors examined were within the domains of: 1) medical knowledge 2) learner-centeredness 3) interpersonal and communication skills 4) professionalism and role-modeling, and 5) intraoperative teaching. Study participants were asked to rate their level of agreement or disagreement regarding each individual competency as being a requirement for an effective surgical educator. T-test was used to compare faculty surgeons' and residents' responses, and statistically significance was defined as p<0.05. University Hospitals Cleveland Medical Center, a tertiary care academic institution PARTICIPANTS: Residents, fellows, and attending surgeons in surgical specialties. There were 115 study participants, 55 faculty and 60 residents. Twelve of 50 (24%) assessed surgical education competencies were rated significantly differently by faculty and residents, with 6 of 12 (50%) being in the category of "intraoperative teaching." There were no differences in faculty and resident responses to competencies/behaviors in the category "interpersonal and communication skills". There were differences in 2 of 7 (28.6%) competencies in the category "medical knowledge", 2 of 15 (13.3%) competencies in the category "learner centeredness", 1 of 10 (10%) in the category "professionalism and role-modeling", 1 of 9 (11.1%) in the category "professionalism and role-modeling", and 6 of 12 (50%) in the category "intraoperative teaching". In general, there is agreement amongst surgical faculty and residents regarding the competencies and behaviors of an effective surgical educator. The main area of difference is in the perception of educator qualities and behaviors necessary for effective intraoperative teaching.

Lessons Learned From a Patient‐Centered, Team‐Based Intervention for Patients With Type 2 Diabetes at High Cardiovascular Risk: Year 1 Results From the CINEMA Program

BackgroundThe care for patients with type 2 diabetes necessitates a multidisciplinary team approach to reduce cardiovascular risk, but implementation of effective integrated strategies has been limited.Methods and ResultsWe conceptualized and initiated a patient‐centered, team‐based intervention called Center for Integrated and Novel Approaches in Vascular‐Metabolic Disease (CINEMA) at University Hospitals Cleveland Medical Center. Patients with type 2 diabetes at high risk for cardiovascular events, including those with established atherosclerotic cardiovascular disease, elevated coronary artery calcium score >100, chronic heart failure with reduced ejection fraction, and/or chronic kidney disease stages 2 to 4 were included. Herein, we present the year 1 results for the program. From May 2020 through August 2021, there were 417 referrals. Among 206 eligible patients, 113 (55%) completed a baseline and ≥1 follow‐up visit through December 2021, with mean (SD) time of 105 (34) days between baseline and first follow‐up visits. Mean age was 59 years, with 49% women and 37% Black patients. Patients had significant reductions from baseline in glycosylated hemoglobin (−10.8%), total cholesterol (−7.9%), low‐density lipoprotein cholesterol (−13.5%), systolic blood pressure (−4.0%), and body mass index (−2.7%) (P≤0.001 for all). In addition, among the 129 (63%) eligible patients not on sodium‐glucose cotransporter 2 inhibitor or glucagon‐like peptide‐1 receptor agonist at baseline, 81% were prescribed evidence‐based therapy with sodium‐glucose cotransporter 2 inhibitor (n=66 [51%]) and/or glucagon‐like peptide‐1 receptor agonist (n=67 [52%]) to reduce the risk of cardiovascular disease in the initial 3‐month follow‐up period.ConclusionsA team‐based, patient‐centered approach to high‐risk disease management appears to be a promising paradigm for care delivery associated with greater use of evidence‐based therapies and improved control of multiple cardiovascular risk factors.

Multicenter Repeatability and Reproducibility of MR Fingerprinting in Phantoms and in Prostatic Tissue.

PurposeTo evaluate multicenter repeatability and reproducibility of T1 and T2 maps generated using MR fingerprinting (MRF) in the International Society for Magnetic Resonance in Medicine/National Institute of Standards and Technology MRI system phantom and in prostatic tissues.MethodsMRF experiments were performed on 5 different 3 Tesla MRI scanners at 3 different institutions: University Hospitals Cleveland Medical Center (Cleveland, OH), Brigham and Women's Hospital (Boston, MA) in the United States, and Diagnosticos da America (Rio de Janeiro, RJ) in Brazil. Raw MRF data were reconstructed using a Gadgetron‐based MRF online reconstruction pipeline to yield quantitative T1 and T2 maps. The repeatability of T1 and T2 values over 6 measurements in the International Society for Magnetic Resonance in Medicine/National Institute of Standards and Technology MRI system phantom was assessed to demonstrate intrascanner variation. The reproducibility between the 4 clinical scanners was assessed to demonstrate interscanner variation. The same‐day test–retest normal prostate mean T1 and T2 values from peripheral zone and transitional zone were also compared using the intraclass correlation coefficient and Bland–Altman analysis.ResultsThe intrascanner variation of values measured using MRF was less than 2% for T1 and 4.7% for T2 for relaxation values, within the range of 307.7 to 2360 ms for T1 and 19.1 to 248.5 ms for T2. Interscanner measurements showed that the T1 variation was less than 4.9%, and T2 variation was less than 8.1% between multicenter scanners. Both T1 and T2 values in in vivo prostatic tissue demonstrated high test–retest reliability (intraclass correlation coefficient > 0.92) and strong linear correlation (R 2 > 0.840).ConclusionProstate MRF measurements of T1 and T2 are repeatable and reproducible between MRI scanners at different centers on different continents for the above measurement ranges.