Patient Characteristic Variables Research Articles

Artificial Intelligence Approaches for Predicting the Risks of Durable Mechanical Circulatory Support Therapy and Cardiac Transplantation.

Background: The use of AI-driven technologies in probing big data to generate better risk prediction models has been an ongoing and expanding area of investigation. The AI-driven models may perform better as compared to linear models; however, more investigations are needed in this area to refine their predictability and applicability to the field of durable MCS and cardiac transplantation. Methods: A literature review was carried out using Google Scholar/PubMed from 2000 to 2023. Results: This review defines the knowledge gaps and describes different AI-driven approaches that may be used to further our understanding. Conclusions: The limitations of current models are due to missing data, data imbalances, and the uneven distribution of variables in the datasets from which the models are derived. There is an urgent need for predictive models that can integrate a large number of clinical variables from multicenter data to account for the variability in patient characteristics that influence patient selection, outcomes, and survival for both durable MCS and HT; this may be fulfilled by AI-driven risk prediction models.

Responsiveness of multiple patient-reported outcome measures for acute postsurgical pain: primary results from the international multi-centre PROMPT NIT-1 study

BackgroundPostsurgical outcome measures are crucial to define the efficacy of perioperative pain management; however, it is unclear which are most appropriate. We conducted a prospective study aiming to assess sensitivity-to-change of patient-reported outcome measures assessing the core outcome set of domains pain intensity (at rest/during activity), physical function, adverse events, and self-efficacy. MethodsPatient-reported outcome measures were assessed preoperatively, on day 1 (d1), d3, and d7 after four surgical procedures (total knee replacement, breast surgery, endometriosis-related surgery, and sternotomy). Primary outcomes were sensitivity-to-change of patient-reported outcome measures analysed by correlating their changes (d1–d3) with patients' global impression of change and patients' specific impression of change items as anchor criteria. Secondary outcomes included identification of baseline and patient characteristic variables explaining variance in change for each of the scales and descriptive analysis of various patient-reported outcome measures from different domains and after different surgeries. ResultsOf 3322 patients included (18 hospitals, 10 countries), data from 2661 patients were analysed. All patient-reported outcome measures improved on average over time; the median calculated sensitivity-to-change for all patient-reported outcome measures (overall surgeries) was 0.22 (range: 0.07–0.31, scale: 0–10); all changes were independent of baseline data or patient characteristics and similar between different procedures. ConclusionsPain-related patient-reported outcome measures have low to moderate sensitivity-to-change; those showing higher sensitivity-to-change from the same domain should be considered for inclusion in a core outcome set of patient-reported outcome measures to assess the effectiveness and efficacy of perioperative pain management.

Abstract 17682: Recurrent Corynebacterium Striatum Infective Endocarditis: A Case Series and Patient-Specific Risk Factors

Introduction: Corynebacterium species traditionally classified as culture contaminant is now emerging as a cause of recurrent bacteremia and infective endocarditis (IE) especially in patients with cardiac devices. The ability to form biofilms and propensity for antibiotic resistance causes recurrent infections making treatment very challenging. Current literature about Corynebacterium IE, the risk factors and predictors of recurrence is very limited. Methods: We report 2 cases with recurrent Corynebacterium bacteremia and endocarditis and describe their individual risk factors and management. Results: The first patient, a 52-year-old female with chronic tracheostomy due to bilateral vocal fold paresis and prior pseudomonas aortic valve endocarditis s/p aortic valve replacement with 2 episodes of recurrent Corynebacterium bacteremia. Her risk factors for recurrence being prosthetic valve and chronic tracheostomy. Was initially bacteremic with Corynebacterium striatum and positive TEE showing 1cm aortic valve vegetation treated with vancomycin for 6 weeks. She represented 3 months later with recurrent Corynebacterium bacteremia. In addition to antibiotics required tracheostomy decannulation and right cordotomy as definitive therapy. The second patient, a 76 year old male with history of ESRD on HD, heart failure with BiV ICD with 3 prior episodes of recurrent Corynebacterium bacteremia. His risk factors being chronic hemodialysis and presence of ICD. Initial 3 episodes were thought to be secondary to infected permcath which was replaced and then substituted by AV fistula. TEE at all times was negative. Device removal was recommended but patient refused and was treated with 6 weeks of vancomycin each time. Was readmitted for the fourth time with recurrent Corynebacterium striatum bacteremia. TEE remained negative. ICD was deemed as the nidus of recurrent infection and eventually underwent ICD lead extraction. Conclusion: We illustrate the variability in patient characteristics and risk factors for recurrent Corynebacterium endocarditis. Presence of tracheostomy, chronic HD and cardiac devices are possible risk factors. Surgical intervention seems to be the only curative option in these cases.

Short-term outcomes associated with the use of a new powered circular stapler for rectal reconstructions: a retrospective study comparing it to manual circular staplers using inverse probability of treatment weight analysis

BackgroundThe most common postoperative complication in malignant rectal surgery is anastomotic leakage (AL). AL after anterior or low anterior resection in rectal tumors is a fatal postoperative complication. Recently, the first automated suture circular stapler, which is expected to reduce the incidence of AL, (J&J).Materials and methodsThis study included a total of 248 rectal tumor patients who underwent double stapler technique (DST) anastomotic procedures in the department of gastroenterological surgery /pediatric surgery at Gifu University School of Medicine from January 2017 to December 2021. The experience of a single institution utilizing the The Echelon circular™ stapler (ECP stapler:Manual VS Automatic) in rectal surgery cases was evaluated retrospectively from maintained database.ResultOne hundred thirty-nine patients (58.4%) were performed by manual circular stapling, 99 patients (41.6%) by powerd circular stapling. Diverting stoma was performed in 45 cases (32.4%) by manual circular stapling, 42 patients (42.4%) by powerd circular stapling Postoperative complications were occurred clavien-dindo grade II or higher in 57 cases (23.9%) and grade III or higher in 20 cases (8.4%). Anastomotic leakage occurred in 14 patients (5.9%) within all grades. After IPTW, the variables of patient characteristics was SMD ≤ 0.2 (Table.3), and there was a significant difference in anastomotic leakage (Odds Ratio (OR), 0.57; 95% Confidence Interval(CI), 0.34–0.98 and there was a significant difference in anastomotic leakage (Odds Ratio (OR), 0.58; 95% Confidence Interval(CI), 0.34–0.98; p = 0.044). In addition, there was no significant difference in postoperative complications in grade II or higher (OR, 0.88; 95%CI, 0.65–1.18; p = 0.394) and grade III or higher (OR, 0.45; 95%CI, 0.28–0.73; p = 0.001) were significantly remarkable lower in powered circular stapling group.ConclusionIn this IPTW comparison of patients undergoing rectal reconstructions, the ECP trial cohort had lower risks of several surgical complications AL and statistically signifcant lower rates of ileus/bowel obstruction, infection, and bleeding as Clavien-Dindo ≥ grade II and III as compared with for whom manual circular staplers were used.

Nociception assessment with videopupillometry in deeply sedated intensive care patients: Discriminative and criterion validations

BackgroundNociceptive assessment in deeply sedated patients is challenging. Validated instruments are lacking for this unresponsive population. Videopupillometry is a promising tool but has not been established in intensive care settings. Aim/ObjectiveTo test the discriminate validity of pupillary dilation reflex (PDR) between non-noxious and noxious procedures for assessing nociception in non-neurological intensive care unit (ICU) patients and to test the criterion validity of pupil dilation using recommended PDR cut-off points to determine nociception. MethodsA single-centre prospective observational study was conducted in medical–surgical ICU patients. Two independent investigators performed videopupillometer measurements during a non-noxious and a noxious procedure, once a day (up to 7 days), when the patient remained deeply sedated (Richmond Agitation–Sedation Scale score: −5 or −4). The non-noxious procedures consisted of a gentle touch on each shoulder and the noxious procedures were endotracheal suctioning or turning onto the side. Bivariable and multivariable general linear mixed models were used to account for multiple measurements in same patients. Sensitivity and specificity, and areas under the curve of the receiver operating characteristic curve were calculated. ResultsSixty patients were included, and 305 sets of 3 measurements (before, during, and after), were performed. PDR was higher during noxious procedures than before (mean difference between noxious and non-noxious procedures = 31.66%). After testing all variables of patient and stimulation characteristics in bivariable models, age and noxious procedures were kept in the multivariable model. Adjusting for age, noxious procedures (coefficient = −15.14 (95% confidence interval = −20.17 to −15.52, p < 0.001) remained the only predictive factor for higher pupil change. Testing recommended cut-offs, a PDR of >12% showed a sensitivity of 65%, and a specificity of 94% for nociception prediction, with an area under the receiver operating curve of 0.828 (95% confidence interval = 0.779–0.877). ConclusionsIn conclusion, PDR is a potentially appropriate measure to assess nociception in deeply sedated ICU patients, and we suggest considering its utility in daily practices. RegistrationThis study was not preregistered in a clinical registry. Tweetable abstractPupillometry may help clinicians to assess nociception in deeply sedated ICU patients.

Computational mechanobiology model evaluating healing of postoperative cavities following breast-conserving surgery

Breast cancer is the most commonly diagnosed cancer type worldwide. Given high survivorship, increased focus has been placed on long-term treatment outcomes and patient quality of life. While breast-conserving surgery (BCS) is the preferred treatment strategy for early-stage breast cancer, anticipated healing and breast deformation (cosmetic) outcomes weigh heavily on surgeon and patient selection between BCS and more aggressive mastectomy procedures. Unfortunately, surgical outcomes following BCS are difficult to predict, owing to the complexity of the tissue repair process and significant patient-to-patient variability. To overcome this challenge, we developed a predictive computational mechanobiological model that simulates breast healing and deformation following BCS. The coupled biochemical-biomechanical model incorporates multi-scale cell and tissue mechanics, including collagen deposition and remodeling, collagen-dependent cell migration and contractility, and tissue plastic deformation. Available human clinical data evaluating cavity contraction and histopathological data from an experimental porcine lumpectomy study were used for model calibration. The computational model was successfully fit to data by optimizing biochemical and mechanobiological parameters through Gaussian process surrogates. The calibrated model was then applied to define key mechanobiological parameters and relationships influencing healing and breast deformation outcomes. Variability in patient characteristics including cavity-to-breast volume percentage and breast composition were further evaluated to determine effects on cavity contraction and breast cosmetic outcomes, with simulation outcomes aligning well with previously reported human studies. The proposed model has the potential to assist surgeons and their patients in developing and discussing individualized treatment plans that lead to more satisfying post-surgical outcomes and improved quality of life.

Incremental dialysis: review of the literature with pediatric perspective.

Drivers towards initiation of kidney replacement therapy in advanced chronic kidney disease include metabolic and fluid derangements, growth, and nutritional status with focus on health optimization. Once initiated, prescription of dialysis is often uniform despite variability in patient characteristics and etiology of kidney failure. Preservation of residual kidney function has been associated with improved outcomes in patients with advanced chronic kidney disease on dialysis. Incremental dialysis is the approach of reducing the dialysis dose by reduction in treatment time, days, or efficiency of clearance. Incremental dialysis has been described in adults at initiation of kidney replacement therapy, to better preserve residual kidney function and meet the individual needs of the patient. Consideration of incremental dialysis in pediatrics may be reasonable in a subset of children with continued emphasis on promotion of growth and development.

Neuro-imaging characteristics of sensory impairment in cerebral palsy; a systematic review.

Objective: To identify and examine neural reorganization of the sensory network in terms of lesion type, somatotopic organization of the primary somatosensory area, and functional connectivity in relation to sensory function in children and young adults with cerebral palsy (CP). Design: systematic review, Prospero registration ID 342570. Data sources: PubMed; Cochrane; Web of Science; Embase; CINAHL and PEDro from inception to March 13, 2021. Eligibility criteria: All types of original studies, concerning sensory connectivity in relation to sensory outcome in patients with spastic CP, <30 years of age. No publication status or date restrictions were applied. Data extraction and synthesis: Two authors independently determined the eligibility of studies. Quality assessment was performed by a third author. Neuro-imaging/neurophysiological techniques, sensory outcomes and patient characteristics were extracted. Children and young adults with periventricular leucomalacia (PVL) lesions have significantly better hand function and sensation scores than patients with cortical-subcortical/middle cerebral artery (MCA) lesions. Ipsilesional reorganization of the S1 (primary somatosensory cortex) area appears to be the primary compensation mechanism after a unilateral early brain lesion, regardless of the timing of the lesion. Interhemispheric reorganization of the sensory system after early brain lesions is rare and, when it occurs, poorly effective. Diffusion tractography shows a positive correlation between the ascending sensory tract (AST) diffusivity metrics of the more affected hemisphere and sensory test outcomes. Because of the large variability in study design, patient characteristics, neuroimaging/neurophysiological techniques and parameters as well as sensory assessment methods used, it is difficult to draw definite inferences on the relationship between the reorganization of the sensory network following early brain damage and sensory function in children and young adults with CP. In general, sensory function seems to be worse in cortical as opposed to white matter tract (PVL) lesions. International consensus on a clinically relevant sensory test battery is needed to enhance understanding of the intriguing compensatory mechanisms of sensory network following early brain damage and potential consequences for rehabilitation strategies. https://www.crd.york.ac.uk/prospero/.

Differential Engagement by Race/Ethnicity in Experimental Trials of Mental Health Treatment Interventions: A Systematic Review.

Objective: Research on mental health interventions, largely from observational studies, suggests that individuals who are Black, Indigenous, and People of Color (BIPOC) have lower treatment engagement than non-Latino Whites. This systematic review focuses on prospective, experimental treatment trials, which reduce variability in patient and intervention characteristics and some access barriers (eg, cost), to examine the association of race/ethnicity and engagement. Data Sources: A systematic search of PubMed and PsycINFO through May 2020 using terms covering mental health treatment, engagement, and race/ethnicity. Study Selection: US-based, English-language, prospective experimental (including quasi-experimental) trials of adults treated for DSM-defined mental disorders were included. Studies had to compare engagement (treatment initiation and retention, medication adherence) across 2 or more ethnoracial groups. Fifty-five of 2,520 articles met inclusion criteria. Data Extraction: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Collaboration bias-risk assessment tool were used to report study findings. Results: Twenty-nine articles (53%) reported significant ethnoracial engagement differences, of which 93% found lower engagement among BIPOC groups compared largely to non-Latino Whites. The proportion of significant findings was consistent across quality of studies, covariate adjustments, ethnoracial groups, disorders, treatments, and 4 engagement definitions. Reporting limitations were found in covariate analyses and disaggregation of results across specific ethnoracial groups. Conclusions: Prospective experimental treatment trials reveal consistently lower BIPOC engagement, suggesting persisting disparities despite standardized study designs. Future research should improve inclusion of understudied groups, examine covariates systematically, and follow uniform reporting and analytic practices to elucidate reasons for these disparities.

Developing a method to capture parental experience in a neonatal surgical centre in the context of COVID-19: a qualitative study

IntroductionImproved parental experience is related to improved mental and physical health outcomes for the infant. The COVID-19 pandemic abruptly impacted on healthcare delivery and services need information to shape how...

A Machine Learning Algorithm for Predicting the Risk of Developing to M1b Stage of Patients With Germ Cell Testicular Cancer.

Objective:Distant metastasis other than non-regional lymph nodes and lung (i.e., M1b stage) significantly contributes to the poor survival prognosis of patients with germ cell testicular cancer (GCTC). The aim of this study was to develop a machine learning (ML) algorithm model to predict the risk of patients with GCTC developing the M1b stage, which can be used to assist in early intervention of patients.MethodsThe clinical and pathological data of patients with GCTC were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Combing the patient's characteristic variables, we applied six machine learning (ML) algorithms to develop the predictive models, including logistic regression(LR), eXtreme Gradient Boosting (XGBoost), light Gradient Boosting Machine (lightGBM), random forest (RF), multilayer perceptron (MLP), and k-nearest neighbor (kNN). Model performances were evaluated by 10-fold cross-receiver operating characteristic (ROC) curves, which calculated the area under the curve (AUC) of models for predictive accuracy. A total of 54 patients from our own center (October 2006 to June 2021) were collected as the external validation cohort.ResultsA total of 4,323 patients eligible for inclusion were screened for enrollment from the SEER database, of which 178 (4.12%) developing M1b stage. Multivariate logistic regression showed that lymph node dissection (LND), T stage, N stage, lung metastases, and distant lymph node metastases were the independent predictors of developing M1b stage risk. The models based on both the XGBoost and RF algorithms showed stable and efficient prediction performance in the training and external validation groups.ConclusionS-stage is not an independent factor for predicting the risk of developing the M1b stage of patients with GCTC. The ML models based on both XGBoost and RF algorithms have high predictive effectiveness and may be used to predict the risk of developing the M1b stage of patients with GCTC, which is of promising value in clinical decision-making. Models still need to be tested with a larger sample of real-world data.

Patient factors associated with the offering of telehealth appointments from primary care physicians among Medicare Beneficiaries: Results from a national survey

IntroductionThis study assessed patient factors associated with self-reported telehealth offerings from their primary care physicians (PCPs) among Medicare beneficiaries during the COVID-19 pandemic, and compared potential telehealth accessibility of telehealth appointments from PCP by US census region before and during the COVID-19 pandemic. MethodsData were from the Medicare Current Beneficiary Survey (MCBS) 2021 Winter COVID-19 Supplement. We conducted a multivariable logistic regression to examine patient-level factors associated with telehealth offerings. ResultsOverall, 78% Medicare beneficiaries reported that they had access to telehealth appointments from their PCPs during the COVID-19 pandemic. Majority beneficiary respondents reported to have Internet access (82.1%) and own at least one type of computer device (81.5%). Respondents with Internet access (Adjusted Odds Ratio (AOR) = 1.66, 95% Confidence Interval (CI): 1.38, 2.00; p < 0.0001) and owning a device (AOR = 1.43, 95 %CI: 1.19, 1.72; p < 0.0001) were more likely to report PCP telehealth offerings controlling for patient characteristic variables in the model. Respondents who were female (AOR = 1.16, 95 %CI: 1.02, 1.31; p = 0.020), age group of 65–74 years (AOR = 1.29, 95 %CI: 1.07, 1.56; p = 0.008), income ≥$25,000 (AOR = 1.36, 95 %CI: 1.18 1.56; p < 0.0001), metropolitan residence (AOR = 1.96, 95 %CI: 1.72, 2.24; p < 0.0001), and with a history of weakened immune system (AOR = 1.46, 95 %CI: 1.18, 1.80; p < 0.0001) or diabetes (AOR = 1.20, 95 %CI: 1.06, 1.37; p = 0.005) were more likely to report PCP telehealth offerings compared to their counterparts. Non-Hispanic Black (AOR = 0.70, 95 %CI: 0.58, 0.85; p < 0.0001) (compared to Non-Hispanic-White) and beneficiaries living in the South (compared to those living in the Northwest, Midwest, and West) were less likely to report PCP telehealth offerings. DiscussionKey findings suggested health disparities existed in telehealth offerings from PCPs in terms of Internet access, device owning, age, race/ethnicity, income, residential locations, and census regions. Policy makers should consider these health disparities and provide targeted incentives and/or interventions when expanding and encouraging utilization of telehealth among Medicare beneficiaries.

Risk Prediction of Major Adverse Cardiovascular Events Occurrence Within 6 Months After Coronary Revascularization: Machine Learning Study

BackgroundAs a major health hazard, the incidence of coronary heart disease has been increasing year by year. Although coronary revascularization, mainly percutaneous coronary intervention, has played an important role in the treatment of coronary heart disease, major adverse cardiovascular events (MACE) such as recurrent or persistent angina pectoris after coronary revascularization remain a very difficult problem in clinical practice.ObjectiveGiven the high probability of MACE after coronary revascularization, the aim of this study was to develop and validate a predictive model for MACE occurrence within 6 months based on machine learning algorithms.MethodsA retrospective study was performed including 1004 patients who had undergone coronary revascularization at The People’s Hospital of Liaoning Province and Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from June 2019 to December 2020. According to the characteristics of available data, an oversampling strategy was adopted for initial preprocessing. We then employed six machine learning algorithms, including decision tree, random forest, logistic regression, naïve Bayes, support vector machine, and extreme gradient boosting (XGBoost), to develop prediction models for MACE depending on clinical information and 6-month follow-up information. Among all samples, 70% were randomly selected for training and the remaining 30% were used for model validation. Model performance was assessed based on accuracy, precision, recall, F1-score, confusion matrix, area under the receiver operating characteristic (ROC) curve (AUC), and visualization of the ROC curve.ResultsUnivariate analysis showed that 21 patient characteristic variables were statistically significant (P<.05) between the groups without and with MACE. Coupled with these significant factors, among the six machine learning algorithms, XGBoost stood out with an accuracy of 0.7788, precision of 0.8058, recall of 0.7345, F1-score of 0.7685, and AUC of 0.8599. Further exploration of the models to identify factors affecting the occurrence of MACE revealed that use of anticoagulant drugs and course of the disease consistently ranked in the top two predictive factors in three developed models.ConclusionsThe machine learning risk models constructed in this study can achieve acceptable performance of MACE prediction, with XGBoost performing the best, providing a valuable reference for pointed intervention and clinical decision-making in MACE prevention.

Patient Experience and Hospital Environment Measures at Military Treatment Facilities.

SUMMARY Goal: We examined the relationship of nine hospital environment measures (room cleanliness, room quietness, food temperature, food variety, mattress comfort, room temperature, room privacy, hospital signage, adequate parking) to two patient outcome measures (likelihood of recommending hospital, overall satisfaction with hospital) by type of services received (medical, obstetric, surgical) at all military medical treatment facilities globally. Our aim was to understand the impact of various hospital environment measures on the patient experience. Methods: We analyzed six logistic regression models, one for each patient satisfaction measure and each service line (medical, obstetric, surgical). The patient characteristic variables were gender, patient age group, and beneficiary category (active duty, active duty family member, retiree, retiree dependents). Results are based on 20,534 completed surveys representing inpatient care delivered October 2019 to March 2020. Data are from the Military Health System TRICARE Inpatient Satisfaction Survey, which is based on the Hospital Consumer Assessment of Healthcare Providers and Systems survey with additional Department of Defense questions. Principal Findings: Across all models, nearly all hospital environment measures were found to be significantly related to patient satisfaction outcomes, aside from food variety in two models and room privacy and temperature in one model. The strongest environment impact factor was room cleanliness for both outcomes with odds ratios ranging from 2.1 to 2.7, p &lt; .01 in all cases. The order of impact for the other eight environment factors varied across service lines with some playing dominant roles dependent on the type of care being received. Significant odds ratios (p &lt; .05) ranged from 1.3 to 2.0 for room quietness, 1.5 to 1.9 for hospital signage, 1.3 to 1.5 for both food variety and food temperature, 1.3 to 1.8 for mattress comfort, 1.3 to 1.6 for room temperature, and 1.3 to 1.8 for adequate parking. Hospital environment measures represented a breadth of the patient experience and were significantly related to a patient’s overall satisfaction and likelihood to recommend military inpatient facilities. Applications to Practice: Healthcare leaders continuously focus on improving the overall patient experience. Fostering a positive experience includes many factors such as provider and nurse interactions and communications with patients. Moreover, the hospital environment should not be overlooked as also having an impact on patient satisfaction, and hospital leaders—both military and civilian—should continue to emphasize hospital amenities as well.

Abstract 8922: Provider Preferences Drive AF Ablation Cost Variability

Background: AF ablation approaches and outcomes vary. Very little work has been done to assess the variability of ablation costs to health systems and drivers of variability. Objective: Determine the drivers of cost variability in AF ablation procedures. Methods: We assessed the costs of AF ablation procedures performed between 2013-2020 at a single tertiary care center. Cost to the health system were inflation-adjusted and separated into facility, imaging, implant, pharmacy, supply, labs, and other services. Only patients who were outpatient and had an ablation by an operator who performed &gt;10 procedures were included. Lasso multivariable regression was used to identify the primary drivers of variability in costs, including operator and patient characteristics. Results: 1072 patients with 1284 AF ablations were included (age: 65.1, SD: 11.0; men: 68%; CHADS2-Vasc: 2.8, SD: 1.9, beta blockers: 63%, non-white race: 6%). Procedures were performed by 8 operators. Proportional contributions to overall costs are shown in the Figure. Regression analysis demonstrated higher average cost for men, (1.25%), non-white race (2.6%), beta-blocker use (1.9%), prior ablation (0.98%), anticoagulation use (1.4%), and operator (highest operator cost increase vs. lowest, 18%). There was no relation to CHADS2-Vasc or age. Cost variability was primarily driven by supplies including catheters and other equipment. Conclusion: Cost variability was only modestly related to patient characteristics. The largest contributor to cost in AF ablations was supplies, which are primarily operator dependent.

MP05-04 CLINICALLY SIGNIFICANT PROSTATE CANCER DETECTION RATES ON MRI GUIDED FUSION NEEDLE BIOPSY - EXPERIENCE FROM THE PENNSYLVANIA UROLOGIC REGIONAL COLLABORATIVE

You have accessJournal of UrologyProstate Cancer: Detection & Screening I (MP05)1 Sep 2021MP05-04 CLINICALLY SIGNIFICANT PROSTATE CANCER DETECTION RATES ON MRI GUIDED FUSION NEEDLE BIOPSY - EXPERIENCE FROM THE PENNSYLVANIA UROLOGIC REGIONAL COLLABORATIVE Ako Adams Ako, Serge Ginzburg, Eric Singer, Bruce Jacobs, Claudette Fonshell, Adam Reese, Edouard Trabulsi, Jeffery Tomaszewski, John Danella, Laurence Belkoff, Thomas Guzzo, Robert Uzzo, and Jay Raman Ako Adams AkoAko Adams Ako More articles by this author , Serge GinzburgSerge Ginzburg More articles by this author , Eric SingerEric Singer More articles by this author , Bruce JacobsBruce Jacobs More articles by this author , Claudette FonshellClaudette Fonshell More articles by this author , Adam ReeseAdam Reese More articles by this author , Edouard TrabulsiEdouard Trabulsi More articles by this author , Jeffery TomaszewskiJeffery Tomaszewski More articles by this author , John DanellaJohn Danella More articles by this author , Laurence BelkoffLaurence Belkoff More articles by this author , Thomas GuzzoThomas Guzzo More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Jay RamanJay Raman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001972.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Magnetic resonance imaging (MRI) fusion needle biopsy has been shown to outperform systematic biopsy in detecting clinically significant prostate cancer. This study sought to: 1) Examine the variability of clinically significant prostate cancer detection rates in a large, regional quality improvement collaborative. 2) Examine the association between patient characteristics and clinically significant prostate cancer detection. METHODS: The Pennsylvania Urologic Regional Collaborative (PURC) is a physician-led data-sharing and quality improvement collaborative comprised of urology practices across Pennsylvania and New Jersey. We analyzed 857 first-time MRI fusion biopsy procedures performed at 5 PURC practices with a minimum of 30 procedures between January 2015 and June 2019. Chi-square tests and hierarchical logistic regression analyzed the variability in cancer detection rates by practice and the association between patient characteristics and Gleason ≥4+3 tumor detection. RESULTS: Median prostate specific antigen (PSA) was 6.8 ng/ml, 14.4% of men were ≤59 years old. Detection rates for Gleason ≥4+3 tumors by practice ranged from 14.3% to 28.3% (p=0.02). Age, digital rectal examination, PSA, gland volume and Prostate Imaging-Reporting and Data System version2 (PI-RADSv2) score were significantly associated with Gleason ≥4+3 tumors. Adjusting for patient characteristics demonstrated that there was no significant variation in Gleason ≥4+3 tumor detection by practice (Intercept variance = 0.04; p=0.26). PIRADSv2 ≥4 was associated with increased likelihood of detecting a Gleason ≥4+3 tumor (OR 2.67; 95% CI 1.76–4.07; p<0.0001). CONCLUSIONS: Variability in clinically significant prostate cancer detection between individual practice sites was predominantly due to variability in patient characteristics. Results highlight the importance of pre-biopsy MRI in the diagnosis of clinically significant prostate cancer. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e77-e78 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ako Adams Ako More articles by this author Serge Ginzburg More articles by this author Eric Singer More articles by this author Bruce Jacobs More articles by this author Claudette Fonshell More articles by this author Adam Reese More articles by this author Edouard Trabulsi More articles by this author Jeffery Tomaszewski More articles by this author John Danella More articles by this author Laurence Belkoff More articles by this author Thomas Guzzo More articles by this author Robert Uzzo More articles by this author Jay Raman More articles by this author Expand All Advertisement Loading ...

Quantitative Systems Pharmacology Modeling of Avadomide-Induced Neutropenia Enables Virtual Clinical Dose and Schedule Finding Studies

Avadomide is a cereblon E3 ligase modulator and a potent antitumor and immunomodulatory agent. Avadomide trials are challenged by neutropenia as a major adverse event and a dose-limiting toxicity. Intermittent dosing schedules supported by preclinical data provide a strategy to reduce frequency and severity of neutropenia; however, the identification of optimal dosing schedules remains a clinical challenge. Quantitative systems pharmacology (QSP) modeling offers opportunities for virtual screening of efficacy and toxicity levels produced by alternative dose and schedule regimens, thereby supporting decision-making in translational drug development. We formulated a QSP model to capture the mechanism of avadomide-induced neutropenia, which involves cereblon-mediated degradation of transcription factor Ikaros, resulting in a maturation block of the neutrophil lineage. The neutropenia model was integrated with avadomide-specific pharmacokinetic and pharmacodynamic models to capture dose-dependent effects. Additionally, we generated a disease-specific virtual patient population to represent the variability in patient characteristics and response to treatment observed for a diffuse large B-cell lymphoma trial cohort. Model utility was demonstrated by simulating the avadomide effect in the virtual population for various dosing schedules and determining the incidence of high-grade neutropenia, its duration, and the probability of recovery to low-grade neutropenia.

Medial Patellofemoral Ligament Reconstruction for Adolescents With Acute First-Time Patellar Dislocation With an Associated Loose Body

Background: The management of adolescents with acute first-time patellar dislocation with an associated loose body remains a debated topic. The rate of recurrent dislocation in these patients may be up to 61% if the medial patellofemoral ligament (MPFL) is repaired or not addressed surgically. To our knowledge, a prospective evaluation of MPFL reconstruction for adolescents with acute first-time patellar dislocation with an associated chondral or osteochondral loose body has not been previously performed. Purpose/Hypothesis: The purpose of this study was to analyze patients with a first-time patellar dislocation who required surgery for a loose body, comparing those who underwent MPFL repair or no treatment with those who underwent MPFL reconstruction during the index procedure. The hypothesis was that performing MPFL reconstruction would reduce the rate of recurrent instability and improve patient-reported outcomes compared with MPFL repair or no treatment. A secondary objective was to report outcomes of those patients who underwent reconstruction versus those who did not. Study Design: Case series; Level of evidence, 4. Methods: This was a prospective analysis of adolescents treated with MPFL reconstruction for acute first-time patellar dislocation with associated loose bodies between 2015 and 2017 at a single pediatric level 1 trauma center with minimum 2-year follow-up. Retrospective analysis was previously performed for a similar cohort of adolescents treated with MPFL repair or no treatment. Patient characteristic data, radiographic measurements, and surgical variables were compared. Primary outcome measures included recurrent subluxation or dislocation and the need for further stabilization procedures. Secondary outcomes included Kujala score, Single Assessment Numeric Evaluation score, patient satisfaction, and ability to return to sport. Results: A total of 76 patients were included, 30 in the MPFL reconstruction cohort and 46 in the MPFL repair or no-treatment cohort. The only difference noted in patient characteristic, radiographic, or surgical variables was a smaller Insall-Salvati ratio in the reconstruction group (1.29 vs 1.42; P = .011). Compared with MPFL repair or no treatment, MPFL reconstruction was associated with less recurrent instability (10.0% vs 58.7%; P < .001), fewer secondary procedures (6.7% vs 47.8%; P < .001), and more frequent return to sports (66.7% vs 39.1%; P = .003). No differences in patient-reported outcomes were noted. Conclusion: Performing concomitant MPFL reconstruction in adolescents with first-time patellar dislocation and an intra-articular loose body results in a 5-fold reduction in recurrent instability, reduces the need for subsequent surgery, and improves patients’ ability to return to sports compared with repairing or not treating the MPFL.

Patient-reported outcomes and the identification of subgroups of atrial fibrillation patients: a retrospective cohort study of linked clinical registry and administrative data.

Previous research about the health and quality of life of people with atrial fibrillation has typically identified a single health trajectory. Our study aimed to examine variability in health trajectories and patient characteristics associated with such variability. We conducted a retrospective analysis of data collected between 2008 and 2016 for a cardiac registry in British Columbia (Canada) linked with administrative health data. The Atrial Fibrillation Effect on Quality of Life Questionnaire was used to measure health status at up to 10 clinic visits. Growth mixture models were used and a three-step multinomial logistic regression was conducted to identify predictors of subgroups with different trajectories. The patients (N = 7439) were primarily men (61.1%) over 60years of age (72.9%). Three subgroups of health status trajectories were identified: "poor but improving", "good and stable", and "excellent and stable" health. Compared with the other two groups, patients in the "poor but improving group" were more likely to (1) be less than 60years of age; (2) be women; (3) have greater risk of stroke; (4) have had ablation therapy within 6months to 1year or more than 2years after their initial consultation; and (5) have had anticoagulation therapy within 6months. Using growth mixture models, we found that not all health trajectories are the same. These models can help to understand variability in trajectories with different patient characteristics that could inform tailored interventions and patient education strategies.

Challenges in communication, prognostication and dialysis decision-making in the COVID-19 pandemic: implications for interdisciplinary care during crisis settings.

Using case vignettes, we highlight challenges in communication, prognostication, and medical decision-making that have been exacerbated by the coronavirus disease-19 (COVID-19) pandemic for patients with kidney disease. We include best practice recommendations to mitigate these issues and conclude with implications for interdisciplinary models of care in crisis settings. Certain biomarkers, demographics, and medical comorbidities predict an increased risk for mortality among patients with COVID-19 and kidney disease, but concerns related to physical exposure and conservation of personal protective equipment have exacerbated existing barriers to empathic communication and value clarification for these patients. Variability in patient characteristics and outcomes has made prognostication nuanced and challenging. The pandemic has also highlighted the complexities of dialysis decision-making for older adults at risk for poor outcomes related to COVID-19. The COVID-19 pandemic underscores the need for nephrologists to be competent in serious illness communication skills that include virtual and remote modalities, to be aware of prognostic tools, and to be willing to engage with interdisciplinary teams of palliative care subspecialists, intensivists, and ethicists to facilitate goal-concordant care during crisis settings.