Patient Outcome Variables Research Articles

Fall prevention among adult surgical patients in Tabriz, Iran: a best practice implementation project.

Falling out of bed is the most common unintentional cause of injury among patients and is a major safety problem in health care facilities. Current practices for fall prevention may not always be aligned with established best practices, leading to variability in patient outcomes. This uncertainty underscores the need to assess and improve compliance with best practice guidelines for fall prevention. This project aimed to improve fall prevention in the surgical ward of a general hospital in Tabriz, Iran. This study was guided by the JBI Evidence Implementation Framework. A baseline audit was conducted using eleven audit criteria representing best practices for fall prevention. After the implementation of improvement strategies, a follow-up audit was conducted to evaluate changes in practice. The results revealed significant improvements, notably, fall risk assessment upon admission (87% to 92%), fall risk assessment upon ward transfer (39% to 79%), patient participation in fall risk assessment (26% to 68%), reassessment upon change in condition (53% to 74%), communicating fall prevention information to at-risk patients and their families/caregivers (42% to 63%), engagement of patients (100% to 100%), implementation of targeted strategies (89% to 92%), post-fall assessment and interventions (82% to 87%), revising patient fall risk status and reviewing care management plan (41% to 74%), fall prevention information to patients and their families/caregivers upon discharge (44% to 66%), and person-centered education of health care professionals (77% to 81%). The use of standard clinical audit tools in hospitals can improve the quality of patient care and increase the effectiveness of interventions by identifying weaknesses in the patient care process. http://links.lww.com/IJEBH/A283.

Reprogramming the Tumor Immune Microenvironment Through Activatable Photothermal Therapy and GSH depletion Using Liposomal Gold Nanocages to Potentiate Anti-Metastatic Immunotherapy.

Cancer immunotherapy offers significant clinical benefits for patients with advanced or metastatic tumors. However, immunotherapeutic efficacy is often hindered by the tumor microenvironment's high redox levels, leading to variable patient outcomes. Herein, a therapeutic liposomal gold nanocage (MGL) is innovatively developed based on photo-triggered hyperthermia and a releasable strategy by combining a glutathione (GSH) depletion to remodel the tumor immune microenvironment, fostering a more robust anti-tumor immune response. MGL comprises a thermosensitive liposome shell and a gold nanocage core loaded with maleimide. The flexible shell promotes efficient uptake by cancer cells, enabling targeted destruction through photothermal therapy while triggering immunogenic cell death and the maturation of antigen-presenting cells. The photoactivated release of maleimide depletes intracellular GSH, increasing tumor cell sensitivity to oxidative stress and thermal damage. Conversely, GSH reduction also diminishes immunosuppressive cell activity, enhances antigen presentation, and activates T cells. Moreover, photothermal immunotherapy decreases elevated levels of heat shock proteins in tumor cells, further increasing their sensitivity to hyperthermia. In summary, MGL elicited a robust systemic antitumor immune response through GSH depletion, facilitating an effective photothermal immunotherapeutic strategy that reprograms the tumor microenvironment and significantly inhibits primary and metastatic tumors. This approach demonstrates considerable translational potential and clinical applicability.

Revision Hip Arthroscopy: Getting It Right the Second Time

Hip arthroscopy procedures have become increasingly common in the last few decades for treating both intra- and extra-articular hip pathologies. Despite advancements in the field, some patients may not experience improvement and may eventually require revision hip arthroscopy. The multifactorial causes for failure, unknown impacts of the primary procedure and previous iatrogenic considerations can create added complexity for the revision. Given that revision hip arthroscopy has had more variation in patient outcomes and higher rates of subsequent conversion to hip arthroplasty, compared with primary hip arthroscopy, it is imperative to have a good algorithm for patient selection and to understand the various surgical options available to address different pathologies. In this review, we explore the current diagnostic algorithms, etiologies, surgical procedures, outcomes, and provide insights into future directions in the field of revision hip arthroscopy.

Beyond American College of Surgeons Verification: Quality Metrics Associated with High Performance at Level I and II Trauma Centers.

The American College of Surgeons (ACS) Committee on Trauma has established a framework for trauma center quality improvement. Despite efforts, recent studies show persistent variation in patient outcomes across national trauma centers. We aimed to investigate whether risk-adjusted mortality varies at the hospital level and if high-performing centers demonstrate better adherence to ACS Verification, Review, and Consultation (VRC) program quality measures. We analyzed data from the 2018-2021 ACS TQIP Participant Use Files, focusing on adult admissions at ACS-verified Level I or II trauma centers for blunt, penetrating, or isolated traumatic brain injury. We used mixed-effects models to assess center-specific risk-adjusted mortality and identified high-performing centers (HPTC), defined as those with the lowest decile of overall risk-adjusted mortality. We compared patient and hospital characteristics, outcomes, and adherence to ACS-VRC quality measures between HPTC and non-HPTC. Over the study period, 1,498,602 patients across 442 Level I and II trauma centers met inclusion criteria: 65.3% presenting with blunt injury, 9.3% with penetrating injury, and 25.4% with isolated TBI. Management at HPTC was associated with lower odds of major complications, failure-to-rescue and takeback. Furthermore, HPTC status was associated with increased odds of adherence to several ACS-VRC quality measures, including balanced resuscitation (Odds Ratio [OR] 1.40, 95%Confidence Interval [CI] 1.29-1.51), appropriate pediatric admissions (OR 1.88, 95%CI 1.07-3.68), and substance abuse screening (AOR 1.14, 95%CI 1.12-1.16). Significant variation in risk-adjusted mortality persists across trauma centers. Given the association between adherence to quality measures and high-performance, multidisciplinary efforts to refine and implement guidelines are warranted.

Evaluating the Effectiveness of Physical Therapy in Patients Post-Arthroscopic Partial Meniscectomy for Traumatic Meniscal Tears.

ABSTRACT Background: Meniscal tears are among the most common knee injuries, often resulting from sports-related activities or trauma. The menisci are vital for maintaining knee health and function, and a tear can lead to pain, swelling, and impaired mobility. Arthroscopic partial meniscectomy (APM) is a common surgical intervention aimed at alleviating symptoms by removing the damaged portion of the meniscus. Despite the benefits, postoperative challenges such as pain, reduced knee function, and prolonged recovery times are common, making rehabilitation a critical component of recovery. Objective: This study aims to evaluate the effectiveness of physical therapy in patients who have undergone APM for traumatic meniscal tears. The objective is to determine the impact of structured rehabilitation on pain levels, knee function, and overall quality of life compared to standard postoperative care without intensive physical therapy. Methods: A retrospective cross-sectional study was conducted with a sample size of under 50 participants from various private and public orthopedic clinics in Karachi. The study involved patients who had undergone APM and were assessed using the Visual Analog Scale (VAS) and Lysholm scoring scale. The exclusion criteria included patients with meniscal tears less than 10mm, non-traumatic meniscal tears, other knee surgeries, and pre-existing conditions that might interfere with physical therapy outcomes. Results: The average age of participants was approximately 36 years, with a mean body weight of 69 kg. Sports-related trauma was the leading cause of meniscal tears (41.9%), followed by accidents (34.9%) and age-related degeneration (23.3%). Physical therapy led to significant improvements in knee function, with 76.7% of participants reporting good functionality and 93% noting reduced pain and swelling. However, challenges such as difficulty with stair climbing (51.2%) and muscle soreness (27.9%) were also reported. Conclusion: Physical therapy plays a crucial role in the postoperative rehabilitation of patients following APM. The findings indicate that structured rehabilitation significantly improves functional outcomes, reduces pain, and enhances the quality of life. However, variability in patient outcomes suggests the need for further research to optimize rehabilitation protocols, considering individual factors such as the extent of the injury, pre-existing conditions, and patient adherence.

Are There Differences in Short-Term Postoperative Outcomes Among Surgical Subspecialists Performing Lower Extremity Flap Procedures? A National Surgical Quality Improvement Project (NSQIP) Analysis of 1324 Patients

Introduction: Soft tissue flaps are an integral and versatile tool to help manage soft tissue defects of varying severities. These complex procedures can be done by a variety of specialties and can lead to a variety of postoperative complications. Locoregional flaps are the middle rung of the reconstructive ladder and can be performed by surgeons of various training pathways. The profile of patients and their complications when stratified by surgical specialty is unknown. The purpose of this study was to compare short-term postoperative outcomes between surgical subspecialists performing a locoregional flap of the lower extremity to determine factors influencing complication rates. Methods: The National Surgical Quality Improvement Project (NSQIP) database was queried using Current Procedural Terminology code 15,738 to identify adult patients undergoing a muscle, myocutaneous, or fasciocutaneous lower extremity flap procedure from 2016 to 2019. We examined the primary outcome of a pooled wound complication rate with secondary outcomes including the individual NSQIP wound- and nonwound complications. Results: A total of 1324 patients were identified. Plastic surgeons performed 926 (70%) procedures, general surgeons performed 243 (18%) procedures, orthopedic surgeons performed 89 (7%) procedures, and vascular surgeons performed 66 (5%) procedures. On multivariate analysis, surgical subspecialty was not associated with the primary outcome, but malignancy-related operations and nonelective status were considered significant. Conclusions: Patient characteristics, but not surgeon subspecialty, account for the variation in patient outcomes in lower extremity flap reconstruction. Larger, prospective studies examining these outcomes are needed to further characterize complication risk factors in this patient population.

Design overview and usability of the codesigned My Surgical Pathway E-health tool for supporting patient self-managed surgical preparation and recovery

IntroductionSurgery plays a critical role in global health, often facing significant quality challenges such as high rates of postoperative complications, variability in patient outcomes, and inconsistencies in care pathways, due to the complex nature of the perioperative journey. The My Surgical Pathway (MSP) app is an e-health intervention designed to address these challenges by supporting self-management and integrated care throughout the entire perioperative journey. This study aims to describe the features and functions of MSP and report on the results of usability testing from both patients and healthcare workers. MethodsThis mixed-methods study evaluated the usability of the My Surgical Pathway (MSP) app using quantitative surveys, qualitative feedback, and observation data from patients and healthcare workers. Structured 2-hour user testing sessions included interaction with the MSP app, completion of the User Version of the Mobile Application Rating Scale (uMARS), and think-aloud activities. Data analysis combined quantitative and qualitative insights to identify usability issues and inform potential improvements. ResultsThe mixed-method user-testing evaluation of the co-designed e-health intervention revealed high overall app quality scores, with an average of 4.50 out of 5. All user-type interfaces received mean scores above the minimum acceptability threshold of 3.0, demonstrating the intervention's efficacy in supporting patient surgery journeys, enhancing healthcare worker coordination, and meeting diverse user needs. Notably, the highest individual item scores were for credibility of source (4.92) and interactivity (4.85), highlighting the application's reliability and engaging nature. ConclusionsThe study evaluated the 'My Surgical Pathway' (MSP) e-health intervention, co-designed with consumers and healthcare workers to support self-management of surgical care. Results indicate high user satisfaction, with an overall app quality score of 4.50 out of 5 on the uMARS tool. Users praised MSP's engagement, education, and responsiveness, highlighting its potential to improve patient experiences and clinician workflows. Recommendations for future research include expanding participant diversity and hospital settings, and employing longitudinal designs for a comprehensive evaluation.

Principal Component Analysis of a Real-World Cohort of Descemet Stripping Automated Endothelial Keratoplasty and Descemet Membrane Endothelial Keratoplasty Cases: Demonstration of a Powerful Data-Mining Technique for Identifying Areas of Research.

Principal component analysis (PCA) is a descriptive exploratory statistical technique that is widely used in complex fields for data mining. However, it is rarely used in ophthalmology. We explored its research potential with a large series of eyes that underwent 3 keratoplasty techniques: Descemet membrane endothelial keratoplasty (DMEK), conventional Descemet stripping automated endothelial keratoplasty (ConDSAEK), or ultrathin-DSAEK (UT-DSAEK). All consecutive DMEK/DSAEK cases conducted in 2016 to 2022 that had ≥24 months of follow-up were included. ConDSAEK and UT-DSAEK were defined as preoperative central graft thickness ≥130 and <130 μm, respectively. Seventy-six patient, disease, surgical practice, and temporal outcome variables were subjected to PCA, including preoperative anterior keratometry, the use of sulfur hexafluoride gas (SF6) versus air for primary tamponade, and postoperative best corrected visual acuity and endothelial cell density. Associations of interest that were revealed by PCA were assessed with the Welch t test or Pearson test. A total of 331 eyes were treated with DMEK (n = 165), ConDSAEK (n = 95), or UT-DSAEK (n = 71). PCA showed that ConDSAEK and UT-DSAEK clustered closely, including regarding postoperative best corrected visual acuity, and were clearly distinct from DMEK. PCA and follow-up univariate analyses suggested that in DMEK, 1) flatter preoperative anterior keratometry (average, K1, and K2) associated with more rebubbling (P = 0.004-0.089) and graft detachment (P = 0.007-0.022); 2) graft marking did not affect postoperative ECD; and 3) lower postoperative endothelial cell density associated with SF6 use (all P > 0.001) and longer surgery (P = 0.005-0.091). All associations are currently under additional investigation in our hospital. PCA is a powerful technique that can rapidly reveal clinically relevant associations in complex ophthalmological datasets.

Call for Action to target interhospital Variation in Cardiovascular Mortality, Readmissions, and Length-of-Stay: Results of A National Population Analysis.

Excessive interhospital variation threatens healthcare quality. Data on variation in patient outcomes across the whole cardiovascular spectrum are lacking. We aimed to examine interhospital variability for 28 cardiovascular All Patient Refined-Diagnosis-related Groups (APR-DRGs). We studied 103,299 cardiovascular admissions in 99 (98%) Belgian acute-care hospitals between 2012 and 2018. Using generalized linear mixed models, we estimated hospital-specific and APR-DRG-specific risk-standardized rates for in-hospital mortality, 30-day readmissions, and length-of-stay above the APR-DRG-specific 90th percentile. Interhospital variation was assessed based on estimated variance components and time trends between the 2012-2014 and 2016-2018 periods were examined. There was strong evidence of interhospital variation, with statistically significant variation across the 3 outcomes for 5 APR-DRGs after accounting for patient and hospital factors: percutaneous cardiovascular procedures with acute myocardial infarction, heart failure, hypertension, angina pectoris, and arrhythmia. Medical diagnoses, with in particular hypertension, heart failure, angina pectoris, and cardiac arrest, showed strongest variability, with hypertension displaying the largest median odds ratio for mortality (2.51). Overall, hospitals performing at the upper-quartile level should achieve improvements to the median level, and an annual 633 deaths, 322 readmissions, and 1578 extended hospital stays could potentially be avoided. Analysis of interhospital variation highlights important outcome differences that are not explained by known patient or hospital characteristics. Targeting variation is therefore a promising strategy to improve cardiovascular care. Considering their treatment in multidisciplinary teams, policy makers, and managers should prioritize heart failure, hypertension, cardiac arrest, and angina pectoris improvements by targeting guideline implementation outside the cardiology department.

Institution of a difficult airway response team for emergency department patients with anticipated or encountered difficult airways: Descriptive analysis of a 5-year experience at an academic teaching hospital.

This study aimed to describe characteristics and outcomes associated with difficult airway response team (DART) encounters in the emergency department (ED). We performed a descriptive analysis of a prospective, single-center database of DART encounters in the ED from April 1, 2016 to March 31, 2021 cross-referenced with retrospective chart review. Adult ED patients ≥18 years old for whom a DART was activated were eligible. We prospectively collected activation characteristics, intubation indications, operator characteristics, and intubation methods used for DART encounters. Retrospective chart review was conducted to obtain patient demographics and outcome variables. Descriptive analyses were computed for all outcomes. We analyzed 89 DART encounters. No intubation attempts were made prior to DART activation in 52 cases (58.4%). The most common indications for intubation were angioedema (n=17, 19.1%) or other airway obstruction (n=15, 16.9%). A definitive airway was established by anesthesiology (n=46, 51.7%), emergency medicine (n=25, 28.1%), trauma surgery (n=9, 10.1%), and ENT (n=5, 5.6%). The most common method of intubation used to establish a definitive airway was video laryngoscopy with a bougie or D-blade (n=29, 32.6%) followed by flexible fiberoptic intubation (n=19, 21.3%). A surgical airway was required in eight encounters (cricothyrotomy [n=4, 4.5%]; tracheostomy [n=4, 4.5%]). Cases were managed in the ED (n=73, 82%), operating room (OR) (n=10, 11.2%), and intensive care unit (ICU) (n=1, 1.1%). All patients requiring intubation had an endotracheal or surgical airway established. Our findings provide important insights regarding ED DART utilization and have implications when considering institution of a DART in the ED.

Enrichment using a selectable CD34t marker enhances TCR/CAR transduced T cell functionality and transgene expression in clinically relevant receptors

Abstract Gene-modified TCR transduced T cells and CAR T cells are used clinically and display a range of efficacy across multiple cancers. Many therapies have successfully controlled patient’s tumors; however, some have shown off-target adverse events which are harmful to patients’ overall outcomes. T cell-based therapies have high variation in patient outcome due to multiple factors, such as transduction efficiency and T cell phenotypes. To reduce product variability, our lab developed a selectable marker gene for use in cellular constructs. This selectable marker is a truncated, non-signaling CD34 molecule (CD34t), which can be used to remove the non-transduced T cells that function as bystanders. Our clinical trials have used two TCRs (TIL 1383I and HERV-E) and one CAR (CD19 CAR). Following transduction with these CD34t constructs, we determined transduction efficiency by expression of CD34t. CD34t expression correlates with transgene, allowing us to select high CD34t expressors, and thus high transgene expressors. The selected population produces higher levels of inflammatory cytokines and CD107a expression compared to the nonselected. This improved functionality is likely due to the selected population having higher levels of transgene across the population, whereas the nonselected has a broader range of transgene expressions with fewer expressors total. This selectable marker contributes to a more functional product, which may in turn improve patient response clinically.

Association of Hospital Market Competition with Outcomes of Complex Cancer Surgery

BackgroundThe association of hospital market competition, financial costs, and quality of oncologic care has not been well-defined. This study sought to evaluate variations in patient outcomes and financial expenditures after complex cancer surgery across high- and low-competition markets.MethodsMedicare 100% Standard Analytic Files were used to identify patients with lung, esophageal, gastric, hepatopancreaticobiliary, or colorectal cancer who underwent surgical resection between 2018 and 2021. Data were merged with the annual hospital survey database, and the hospital market Herfindahl–Hirschman index was used to categorize hospitals into low- and high-concentration markets. Multi-level, multivariable regression models adjusting for patient characteristics (i.e., age, sex, comorbidities, and social vulnerability), year of procedure, and hospital factors (i.e., case volume, nurse-bed ratio, and teaching status) were used to assess the association between hospital market competition and outcomes.ResultsAmong 117,641 beneficiaries who underwent complex oncologic surgery, the mean age was 73.8 ± 6.1 years, and approximately one-half of the cohort was male (n = 56,243, 47.8%). Overall, 63.8% (n = 75,041) of the patients underwent care within a high-competition market. Notably, there was marked geographic variation relative to market competition. High versus low market-competition hospitals were more likely to be in high social vulnerability areas (35.1 vs 27.5%; p < 0.001), as well as care for racial/ethnic minority individuals (13.8 vs 7.7%; p < 0.001), and patients with more comorbidities (≥ 2 Elixhauser comorbidities: 63.1 vs 61.1%; p < 0.001). In the multivariable analysis, treatment at hospitals in high- versus low-competition markets was associated with lower odds of achieving a textbook outcome (odds ratio, 0.95; 95% confidence interval, 0.91–0.99; p = 0.009). Patients at high-competition hospitals had greater mean index hospitalization costs ($19,462.2 [16211.9] vs $18,844.7 [14994.7]) and 90-day post-discharge costs ($7807.8 [15431.3] vs $7332.8 [14038.2]) (both p < 0.001) than individuals at low-competition hospitals.ConclusionsHospital market competition was associated with poor achievement of an optimal postoperative outcome and greater hospitalization costs.

512 Length of Stay Prediction Based on an Artificial Neural Network

Abstract Introduction Hospital length of stay (LOS) is difficult to predict in patients with burn injuries due to the complexity of the injuries and the wide variability in patient outcomes. Predicting hospital LOS in patients with burn injuries can have numerous benefits for patients, physicians, and insurance companies. Artificial neural networks may offer insight into more accurate LOS predictions. Methods We obtained electronic health records (EHR) for burn patients from July 01, 2011 - July 01, 2021. An artificial neural network was used to model the relationship between the input features and LOS. The input features were preprocessed by normalizing each feature to the range [0, 1] and transformed using log normal. The preprocessed data was split into training (70%), validation (15%), and testing (15%) sets. The neural network consisted of one hidden layer with 13 neurons and a linear output layer. Results The neural network achieved an R-squared (R2) value of 0.72 on the training data, indicating that 72% of the variance in the data (n=1347). The validation and testing R2 values were 0.66 and 0.68, respectively. The overall R2 value, computed by combining the predictions on the training, validation, and testing data, was 0.70. The best performance, validation performance, and testing performance achieved by the neural network during the training process were 0.28, 0.27, and 0.30, respectively. These values indicate the average squared difference between the predicted output and the true output for each set, with lower values indicating better performance. Conclusions The results suggest that the neural network can model the relationship between the input features and LOS with reasonable accuracy. The R2 values indicate that the model explains a substantial amount of the variability in the data. Further testing and validation may be needed to assess the robustness and reliability of the model. Applicability of Research to Practice Patient outcomes are largely variable and determining LOS to a closer degree helps planning more robust treatment plans. Additionally, these models have the potential to serve as a more accurate gauge of whether they are following closely to their expected treatment timeline. As survival rates continue to improve, the improvement focus has and will continue to shift towards patient outcomes.

The Role of Hospital Characteristics in Clinical and Quality Outcomes for Gastrointestinal Bleeding in a National Cohort.

There is substantial variability in patient outcomes for gastrointestinal bleeding (GIB) across hospitals. This study aimed to identify hospital factors associated with GIB outcomes. This was a retrospective cohort study of Medicare fee-for-service beneficiaries hospitalized for GIB from 2016 to 2018. These data were merged with the American Hospital Association Annual Survey data to incorporate hospital characteristics. We used generalized linear mixed-effect models to estimate the effect of hospital-level characteristics on patient outcomes after adjusting for patient risk factors including anticoagulant and antiplatelet use, recent GIB, and comorbidities. The primary outcome was 30-day mortality, and secondary outcomes included length of stay and a composite outcome of 30-day readmission or mortality. Factors associated with improved GIB 30-day mortality included large hospital size (defined as beds >400, odds ratio [OR] 0.93, 95% confidence interval [CI] 0.90-0.97), greater case volume (OR 0.97, 95% CI 0.96-0.98), increased resident and nurse staffing (OR 0.88, 95% CI 0.83-0.94), and blood donor center designation (OR 0.93, 95% CI 0.88-0.99). Patients treated at a hospital with multiple advanced capabilities, such as availability of advanced endoscopy, advanced intensive care unit (ICU) capabilities (both a medical-surgical ICU and cardiac ICU), blood donor center, and liver transplant center, had a 22% reduction in 30-day mortality risk, compared with those hospitalized in a hospital with none of these services (OR 0.78, 95% CI 0.68-0.91). However, length of stay increased with additional services. Patients hospitalized for GIB at hospitals with multiple advanced specialized capabilities have lower mortality but longer lengths of stay. Further research should examine the processes of care linked to these services that contribute to improved mortality in GIB.

Osteopathic manipulative treatment for chronic inflammatory diseases.

Chronic inflammatory diseases (CIDs) are debilitating and potentially lethal illnesses that affect a large proportion of the global population. Osteopathic manipulative treatment (OMT) is a manual therapy technique developed and performed by osteopathic physicians that facilitates the body's innate healing processes. Therefore, OMT may prove a beneficial anti-inflammatory modality useful in the management and treatment of CIDs. This work aims to objectively evaluate the therapeutic benefits of OMT in patients with various CIDs. In this review, a structured literature search was performed. The included studies involving asthma, chronic obstructive pulmonary disease, irritable bowel syndrome, ankylosing spondylitis, and peripheral arterial disease were selected for this work. Various OMT modalities, including lymphatic, still, counterstain, and muscle energy techniques, were utilized. Control treatments included sham techniques, routine care, or no treatment. OMT utilization led to variable patient outcomes in individuals with pathologies linked to CID.

Selective Cytopheretic Device Use in Continuous Kidney Replacement Therapy in Children: A Cohort Study With a Historical Comparator

Rationale & ObjectiveCritically ill children with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) are at increased risk of death. The selective cytopheretic device (SCD) promotes an immunomodulatory effect at circuit ionized calcium <0.40 mmol/L. In an adult CRRT patient study, SCD-treated patients had improved survival/dialysis independence. We report safety data from children who received CRRT-SCD therapy and compared outcomes to a historical pediatric CRRT cohort. Study DesignWe conducted two prospective multicenter studies to evaluate safety and feasibility of SCD in critically ill children. Setting& Participants: Four pediatric institutions enrolled children >10 kg with AKI and multiorgan dysfunction receiving CRRT as standard of care with the SCD integrated post-CRRT membrane. ExposurePatients received CRRT-SCD with regional citrate anticoagulation for up to 7-10 days, or CRRT discontinuation, whichever came first. Analytical ApproachWe report serious adverse events, patient and CRRT-SCD related process and outcome variables. We compared survival to ICU discharge rates between the CRRT-SCD cohort and a matched cohort from the Prospective Pediatric CRRT (ppCRRT) registry, using odds ratios in multivariable analysis for factors associated with ppCRRT patient ICU mortality. To validate these crude analyses, Bayesian logistic regression was performed to assess for attributable benefit-risk assessment of the SCD. ResultsTwenty-two patients received CRRT-SCD treatments. Fifteen serious adverse events were recorded; none were SCD related. Seventeen patients survived to ICU discharge/Day 60. Both multivariable and Bayesian analyses revealed probable benefit of addition of SCD. Fourteen of the 16 patients surviving ICU discharge had normal eGFR and no patient was dialysis dependent at 60 days. Limitations1) Small sample size in SCD-PED cohort 2) Historical control group 3) Adverse events not recorded in control group. ConclusionsSCD therapy is feasible, safe, and demonstrates probable benefit for critically ill children who require CRRT for AKI.

International Delphi Study on Wound Closure and Incision Management in Joint Arthroplasty Part 2: Total Hip Arthroplasty

BackgroundThis modified Delphi study aimed to develop a consensus on optimal wound closure and incision management strategies for total hip arthroplasty (THA). Given the critical nature of wound care and incision management in influencing patient outcomes, this study sought to synthesize evidence-based best practices for wound care in THA procedures. MethodsAn international panel of 20 orthopedic surgeons from Europe, Canada, and the United States evaluated a targeted literature review of 18 statements (14 specific to THA and 4 related to both THA and total knee arthroplasty). There were 3 rounds of anonymous voting per topic using a modified 5-point Likert scale with a predetermined consensus threshold of ≥ 75% agreement necessary for a statement to be accepted. ResultsAfter 3 rounds of voting, consensus was achieved for all 18 statements. Notable recommendations for THA wound management included (1) the use of barbed sutures over non-barbed sutures (shorter closing times and overall cost savings); (2) the use of subcuticular sutures over skin staples (lower risk of superficial infections and higher patient preferences, but longer closing times); (3) the use of mesh-adhesives over silver-impregnated dressings (lower rate of wound complications); (4) for at-risk patients, the use of negative pressure wound therapy over other dressings (lower wound complications and reoperations, as well as fewer dressing changes); and (5) the use of triclosan-coated sutures (lower risk of surgical site infection) over standard sutures. ConclusionsThrough a structured modified Delphi approach, a panel of 20 orthopedic surgeons reached consensus on all 18 statements pertaining to wound closure and incision management in THA. This study provides a foundational framework for establishing evidence-based best practices, aiming to reduce variability in patient outcomes and to enhance the overall quality of care in THA procedures.

Variability in Outcome After Bilateral, Fluoroquinolones-Associated Achilles Tendon Rupture: A Case Report

BACKGROUND: Achilles tendon rupture can be debilitating, and there is substantial variability in outcomes after Achilles tendon rupture. Patient- and tissue-level characteristics are beginning to emerge as healing indicators with the potential of identifying impaired healing earlier in recovery. CASE PRESENTATION: Patient with fluoroquinolone-induced, bilateral Achilles tendon rupture managed nonoperatively. OUTCOME AND FOLLOW-UP: Tendon tissue level outcomes on ultrasound, strength, range of motion, and patient-reported outcomes are reported. With similar treatment of bilateral tendons, the patient achieved good healing outcomes (evidenced by limited tendon elongation and walking capacity) on one side but had limited healing (evidenced by tendon retraction and need for bracing with walking) on the other side. DISCUSSION: The findings from this case report highlight the variability of patient outcomes after Achilles tendon rupture, even when treatment and the systemic healing environment is similar. This report also demonstrates the potential clinical utility of routine ultrasound imaging to assess early tendon healing before strength and other functional outcomes can be assessed. JOSPT Cases 2024;4(1):12-18. Epub 13 November 2023. doi:10.2519/josptcases.2023.12109

The Role of SOX2 and SOX9 in Radioresistance and Tumor Recurrence.

Head and neck squamous cell carcinoma (HNSCC) exhibits considerable variability in patient outcome. It has been reported that SOX2 plays a role in proliferation, tumor growth, drug resistance, and metastasis in a variety of cancer types. Additionally, SOX9 has been implicated in immune tolerance and treatment failures. SOX2 and SOX9 induce treatment failure by a molecular mechanism that has not yet been elucidated. This study explores the inverse association of SOX2/SOX9 and their distinct expression in tumors, influencing the tumor microenvironment and radiotherapy responses. Through public RNA sequencing data, human biopsy samples, and knockdown cellular models, we explored the effects of inverted SOX2 and SOX9 expression. We found that patients expressing SOX2LowSOX9High showed decreased survival compared to SOX2HighSOX9Low. A survival analysis of patients stratified by radiotherapy and human papillomavirus brings additional clinical relevance. We identified a gene set signature comprising newly discovered candidate genes resulting from inverted SOX2/SOX9 expression. Moreover, the TGF-β pathway emerges as a significant predicted contributor to the overexpression of these candidate genes. In vitro findings reveal that silencing SOX2 enhances tumor radioresistance, while SOX9 silencing enhances radiosensitivity. These discoveries lay the groundwork for further studies on the therapeutic potential of transcription factors in optimizing HNSCC treatment.

Evolution of patient demographics, baseline clinical characteristics and outcomes in Phase 3 trials of biologics (TNFi, IL12/23i, IL17i, IL23i), PDE4i and TYK2i for psoriasis

AbstractBackgroundPsoriasis, a common chronic inflammatory skin disease with major impact on quality of life, is associated with several comorbidities. A better understanding of the pathogenesis of psoriasis has led to the development and approval of new therapeutic strategies such as biologics of different classes (targeting tumour necrosis factor‐α, interleukin (IL) 17 and IL12/23), phosphodiesterase‐4 inhibitors, and janus kinase inhibitors.ObjectivesThe objective of this project was to investigate the evolution of baseline patient characteristics, disease characteristics and outcomes in Phase 3 trials. We hypothesized that the uptake of more effective drugs in the management of patients is reflected in the patient profile considered eligible for clinical trials.MethodsA search in PubMed for Phase 3 trials of biologics, apremilast and deucravacitinib was performed. Forty trials were included and divided into five periods. The first three periods correspond with the chronological development of biologics, Period 4 contains trials of apremilast and Period 5 of deucravacitinib. For each trial, demographics and outcomes were extracted and mean values per period were calculated. Statistical analysis was performed in the biologics group and in the oral therapies group.ResultsBetween Periods 1, 2 and 3: the mean percentage of patients with prior phototherapy (p &lt; 0.001) is different, the mean percentage of patients with prior biologic use (p &lt; 0.001) is higher in Periods 2 and 3, and the outcome variable Psoriasis Area Severity Index (PASI) 100 is more present in recent trials (p &lt; 0.001). Between periods 1 and 3, there are more White patients in Period 1 (p = 0.044) and more patients with baseline Physician Global Assessment 3 in Period 3 (p = 0.041). Between Periods 4 and 5, there are more White patients (p = 0.010) in Period 4, outcome variable PASI 100 and Psoriasis Symptoms and Signs Diary is more present in Period 5 (p = 0.025).ConclusionsThe majority of baseline patient characteristics, disease characteristics and outcome variables remain stable throughout the different periods. Changes in clinical practice were reflected by increased prior biologic use and increased use of PASI 100 as an outcome variable.