Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration

Diagnoses of postpartum urinary retention using next-generation non-piezo ultrasound technology: assessing the accuracy and benefits

Postpartum urinary retention has a wide range of publicized incidences, likely caused by frequent misdiagnosis of this puerperal complication. Especially covert postpartum urinary retention has a high number of missed diagnoses due to the lack of symptoms and the time-extensive diagnostics via ultrasound, leading to no treatment and no appropriate follow-up. To simplify the diagnosis and establish a screening tool we analyzed the application of portable handheld-ultrasound devices  (PUD) as used in Point-of-care diagnostics in comparison to established standard ultrasound devices (SUD). This prospective study aimed to evaluate the reliability of non-piezo, chip-based PUD in comparison to the measurement withSUD, containing a piezo transducer, as golden standard for the ultrasound diagnosis of postpartum urinary retention. Randomly, 100 participants between the first and seventh day after delivery in an obstetric ward underwent ultrasound examinations using a EPIQ 5 W (Philips) as SUD and a Butterfly iQ (Butterfly Network) as PUD to compare the accuracy in bladder size after micturition and the estimated post-void residual volume. Intraclass correlation coefficients, Bland-Altman plots, and Pearson correlation coefficients were used for analyzing the reliability and agreement between the measurements of these devices and were calculated for subgroups as body mass index, mode of delivery and timepoint of delivery. The results show a near-perfect agreement (0.994) and correlation (r = 0.982) for estimated post-void residual volume and for most measurements between the two types of ultrasound devices. The agreement rate for the diagnosis of covert postpartum urinary retention is 100%. Subgroup analyses lack a significant difference reflected by agreement and correlation rates. These findings affirm the high reliability of PUD for the diagnosis of postpartum urinary retention and supports their integration into daily clinical practice, thereby simplifying regular controls of the bladder by physicians during daily rounds on the ward. This technology may allow a higher diagnosis rate so that patient care can be optimized and the long-term impact on continence and quality of life can be studied and analysed.

Association of higher potency statin use with risk of osteoporosis and fractures in patients with stroke in a Korean nationwide cohort study

This population-based cohort study aimed to evaluate the risk of osteoporosis and fractures associated with higher-potency statin use compared to lower-potency statin use in patients with stroke, using data from the Health Insurance and Review Assessment database of South Korea (2010-2019). Patients who received statin within 30 days after hospitalization for a new-onset stroke (n = 276,911) were divided into higher-potency (n = 212,215, 76.6%) or lower-potency (n = 64,696, 23.4%) statin initiation groups. The primary outcome was a composite of osteoporosis and osteoporotic fractures. Secondary outcomes were individual components of the primary outcome, including osteoporosis, vertebral fracture, hip fracture, and non-hip non-vertebral fracture. Cox proportional hazard models weighted by standardized morbidity ratios were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). The risk of the composite outcome (HR 0.95, 95% CI 0.93-0.97), osteoporosis (0.93, 0.90-0.96), vertebral fracture (0.95, 0.91-0.99), and hip fracture (0.89, 0.84-0.95) were significantly lower in higher-potency statin users, while the risk for non-hip non-vertebral fracture was not significant (0.98, 0.95-1.02). The use of higher-potency statins compared to lower-potency statins was associated with a lower risk of osteoporosis, vertebral fracture, and hip fracture in patients with stroke.

Association between e-health literacy and perceived importance of future pandemic preparedness in sub-saharan Africa

INTRODUCTION

Emerging and re-emerging infectious diseases continue to pose a severe threat to public health in Sub-Saharan Africa (SSA) and globally. Community-related interventions, such as community e-Health literacy, can contribute to the preparedness to respond effectively to emerging and re-emerging infectious diseases. This study investigated the relationship between e-Health literacy and SSA countries' perceptions of the importance of readiness for potential pandemics.

METHOD

This cross-sectional study was conducted in sub-Saharan African countries (Nigeria, Rwanda, Burundi, and South Africa) among adults aged 18 years and above between July 2020 and August 2021, respondents were recruited through a non-probability sampling technique. Participants were asked to self-report the perceived importance of 13 items on future pandemic preparedness scored on a 5 Likert-point scale. The four key dimensions of pandemic preparedness were online medical consultation, online courses, messaging for healthcare, and shopping. E-Health literacy was the key exposure. The questionnaire was adapted from a previously validated e-Health literacy scale. Data was collected through a self-administered questionnaire online. Data analysis was done using Stata and descriptive statistics including frequency, proportions, means, and standard deviation were used to summarize variables. Inferential statistics including chi-square and logistic regressions were used to test the significance of association between e-health literacy and pandemic preparedness setting the level of significance at 5%.

RESULTS

A total of 1295 people participated in this study. Roughly half of all participants, 685 (52.90%), were aged between 18 and 29 and 685 (52.90%) were females. The standardised average (SE) e-Health literacy score was 29.55 (0.19). Shopping was perceived as the most important dimension of pandemic preparedness across participating countries (mean (SE) of 3.32 (0.06) and above across all countries for online shopping), while online medical consultation was the least perceived as important (mean (SE) of 2.88 (0.08) or less in two countries for instant health advice from chatbot). In the fully adjusted model, e-Health literacy was associated with 8 out of 13 items of the perceived importance of the pandemic preparedness questionnaire. Those include online consultation with doctors (OR = 1.11, 95% CI 1.02-1.21), telephone health advice (OR = 1.07, 95%CI 1.00-1.15), medicine delivery (OR = 1.04, 95% CI 1.03-1.06), getting medicine prescribed in a hospital visit/follow-up in a community pharmacy (OR = 1.07, 95% CI 1.05-1.10), receiving health information via email (OR = 1.08, 95% CI 1.01-1.17) and via social media (OR = 1.08, 95% CI 1.03-1.14), online shopping (OR = 1.07, 95% CI 1.03-1.11) and instant streaming courses (OR = 1.09, 95% CI 1.02-1.16).

CONCLUSIONS

The higher e-Health literacy scores were associated with a higher perception of most elements as important in future pandemic readiness. Strengthening e-Health literacy can be a key element of the preparation for pandemics in SSA countries.

Association between serum cryptoxanthin levels and migraine in American adults: results from NHANES

BACKGROUND

Oxidative stress and neuroinflammation play critical roles in the pathogenesis of migraine, a neurovascular disease. Cryptoxanthin is a carotenoid known for its potent antioxidant and anti-inflammatory properties. However, the specific association between serum cryptoxanthin levels and migraine remains unclear. This study aims to evaluate the correlation between migraine and serum cryptoxanthin levels.

METHODS

For this cross-sectional analysis, information was gathered from individuals ≥20 years who took part in the National Health and Nutrition Examination Survey from 2001 to 2004. Details information was collected on migraines, serum cryptoxanthin levels and various crucial factors. Multivariable logistic regression and restricted cubic spline regression analyses were performed to investigate the relationship between serum cryptoxanthin and the occurrence of migraines.

RESULTS

The study included 8,645 participants, of whom 20.00%(1734/8645) experienced migraine. There was a nonlinear relationship (p < 0.001) between serum cryptoxanthin levels and migraine, which was depicted as an L-shaped curve. The occurrence rate of individuals with serum cryptoxanthin levels below 26.64 nmol/dL experiencing migraine was 0.976 (95% CI: 0.965∼0.987, p<0.001).

CONCLUSION

In adults among the United States, increased levels of serum cryptoxanthin were associated with decreased risk of migriane with a turning point at around 26.64 nmol/dL in American adults. Further studys are needed to confirm our findings.

Impact of Social Determinants of Health on Follow-up for Neonates Requiring Neurocritical Care

OBJECTIVE

 This study aimed exploration of associations of social determinants of health (SDH) with attrition rates of neurocritical care graduates at follow-up.

STUDY DESIGN

 An observational retrospective cohort study was conducted to evaluate the attrition rates of an infant's first appointment scheduled with the NeuroNICU follow-up clinic in correlation with SDH.

RESULTS

 The "No Show" group was more likely to have unemployed (p = 0.014), black or multiracial mothers (p = 0.005), public insurance (p < 0.001), lower gestational age (p < 0.001), live further from the clinic (0.011), and a lower zip code-associated income (p = 0.008). After controlling for driving time, race, and education, infants who had private insurance were 2.268 times more likely to attend their follow-up visit when compared with infants who had public insurance (p = 0.014).

CONCLUSION

 A significant SDH-related difference existed among the "Show" and "No Show" groups. Identifying these factors during neonatal intensive care unit (NICU) admission can facilitate targeted support for families while inpatient and promote improved outpatient follow-up.

KEY POINTS

· Follow-up for neonates requiring neurocritical care is strongly influenced by social determinants.. · Standardized SDH screening in NICUs, identifying high-risk infants for attrition, is used by few.. · Factors influencing disparities in the utilization of follow-up programs require further study.. · Equity-based attrition prevention interventions could improve outcomes and reduce costs..

Impact of Pathway Shape and Length on the Validity of the 6-Minute Walking Test: A Systematic Review and Meta-Analysis

Although guidelines are established for performing the six-minute walking test (6MWT), it is not always possible to implement this test in any setting, due to physical and space limitations. Yet, variations in the conditions of the test could be responsible for heterogeneous outcomes. However, the impact of the condition of the 6MWT is not clearly established in literature. The objective is to determine the influence of different implementation conditions on the validity of the 6MWT. Seventeen articles were retained after a literature review, including 597 participants. Seven articles mention that performing the test on a predetermined short back-and-forth pathway led to lower performance than when the test was performed on pathways of greater distances. The walking distance covered on a rectangular path or on a 10-m eight-form path is greater than with the back and forth on a five- to ten-meter path. Seven articles suggest that the performance achieved on a treadmill is generally lower than that obtained while walking on the ground. Evidence shows that the conditions while performing the 6MWT significantly influence the score, hence the validity of the results. The use of a ground pathway, comprising the longest linear distance possible, seems critical to ensure good validity.

Enteral nutrition support in patients with cancer: association of short-term prognosis and medical costs with inflammation

BACKGROUND

Enteral nutrition (EN) is commonly used for nutritional support in patients with cancer. Whether inflammation, one of the driving factors of malnutrition and cancer, affects the association between EN and short-term prognosis and medical costs in patients with cancer remains unclear. We aimed to investigate the association between EN and short-term prognosis of patients with cancer and the effect of inflammation on EN-associated medical costs.

METHODS

This multicentre prospective cohort study evaluated patients with pathologically confirmed solid tumours. After admission, all patients who received EN, including oral or tube feeding, were assigned to the EN group. The log-rank test was used to identify the optimal cutoff values for inflammatory markers. Cox regression analysis was used to analyse the associations among EN, inflammation, and prognosis. Propensity score matching was used to balance biases between the EN and non-EN groups and validate the stability of the results.

RESULTS

A total of 5121 patients were included, with 2965 (57.90%) men and an average age of 59.06 (11.30) years. A total of 462 patients received EN, with 390 (84.4%) receiving oral nutritional supplementation. During the 90-day follow-up, 304 patients died. In the low inflammation group, there was no association between EN and short-term prognosis (hazard ratio [HR] = 0.92, 95% confidence interval [CI] = 0.39-2.18). In the high inflammation group, EN significantly improved the short-term prognosis (HR = 0.48, 95% CI = 0.30-0.76). In patients with low inflammation (p < 0.001), EN increased hospitalisation costs (p < 0.001) without reducing length of stay (LOS) (p = 0.15). In patients with high inflammation, EN did not increase hospitalisation expenses (p = 0.47) but reduced the LOS (p = 0.004).

CONCLUSION

EN can improve the short-term prognosis of patients with high inflammation and reduce LOS without increasing the hospitalisation expenses. Baseline inflammation levels may serve as effective indicators for personalised and precise EN treatment.

CLINICAL TRIAL REGISTRATION

ChiCTR1800020329 (chictr.org.cn).

Three-year seroprevalence of SARS-CoV-2 nucleocapsid protein antibody among children, parental awareness, and contributors of infection: a single-school cohort study in Chiba, Japan

BACKGROUND

Coronavirus disease 2019 (COVID-19) in children is often asymptomatic, posing challenges in detecting infections. Additionally, factors contributing to infection remain poorly understood. This study aimed to investigate trends in anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid antibody seroprevalence, the relationship between seroprevalence and parental perception of child infection, and factors related to COVID-19 in children.

METHODS

In December 2020, 355 children aged 6-12 years in one elementary school were enrolled in the study. The anti-SARS-CoV-2 nucleocapsid antibody seroprevalence was assessed, and questionnaires were administered annually for three years. Parents' perceptions of infection and factors contributing to infection were examined.

RESULTS

The seroprevalence was 0.6%, 2.2%, and 60.9% in the first, second, and third years, respectively. The third-year seroprevalence among children reported as 'infected,' 'not tested but had symptoms,' and 'not infected' by parents was 97.3%, 83.3%, and 35.7%, respectively. Increased odds of seropositivity at the third-year measurement were observed in lower grades (adjusted odds ratio [aOR]=2.79 compared with higher grades) and in children more likely to play with others (aOR=3.97 for 'somewhat' and 2.84 for 'often,' compared with 'rarely'). No significant associations with seropositivity were found for sex, siblings, body mass index, serum 25-OH vitamin D3 concentration, or sleep duration.

CONCLUSION

The Omicron variant outbreak from the end of 2021 led to a sharp increase in seroprevalence among children, with many unaware of their infection. Frequent play with others may facilitate transmission in children. These data provide useful information for developing countermeasures against COVID-19 and other future pandemics.

Using clinical data to reclassify ESUS patients to large artery atherosclerotic or cardioembolic stroke mechanisms

PURPOSE

Embolic stroke of unidentified source (ESUS) represents 10-25% of all ischemic strokes. Our goal was to determine whether ESUS could be reclassified to cardioembolic (CE) or large-artery atherosclerosis (LAA) with machine learning (ML) using conventional clinical data.

METHODS

We retrospectively collected conventional clinical features, including patient, imaging (MRI, CT/CTA), cardiac, and serum data from established cases of CE and LAA stroke, and factors with p < 0.2 in univariable analysis were used for creating a ML predictive tool. We then applied this tool to ESUS cases, with ≥ 75% likelihood serving as the threshold for reclassification to CE or LAA. In patients with longitudinal data, we evaluated future cardiovascular events.

RESULTS

191 ischemic stroke patients (80 CE, 61 LAA, 50 ESUS) were included. Seven and 6 predictors positively associated with CE and LAA etiology, respectively. The c-statistic for discrimination between CE and LAA was 0.88. The strongest predictors for CE were left atrial volume index (OR = 2.17 per 1 SD increase) and BNP (OR = 1.83 per 1 SD increase), while the number of non-calcified stenoses ≥ 30% upstream (OR = 0.34 per 1 SD increase) and not upstream (OR = 0.74 per 1 SD increase) from the infarct were for LAA. When applied to ESUS cases, the model reclassified 40% (20/50), with 11/50 reclassified to CE and 9/50 reclassified to LAA. In 21/50 ESUS with 30-day cardiac monitoring, 1/4 in CE and 3/16 equivocal reclassifications registered cardiac events, while 0/1 LAA reclassifications showed events.

CONCLUSION

ML tools built using standard ischemic stroke workup clinical biomarkers can potentially reclassify ESUS stroke patients into cardioembolic or atherosclerotic etiology categories.

Shared care planning in people with cognitive disorders and dementia: a survey among patients and caregivers in Italy

BACKGROUND

There is wide convergence in the positions of scientific societies, patient associations and public bodies regarding the advisability of advance care planning (ACP) in cognitive disorders and dementia to respect the specificity of the person. Nevertheless, planning in advance for dementia represents a unique challenge. In Italy, law n. 219/2017 introduced ACP for the first time at the regulatory level, under the name of shared care planning (SCP). Few surveys on the law implementation have been conducted in Italy, but none have specifically involved patients with cognitive disorders and their caregivers. To contribute filling the gap, we conducted a survey among patients and caregivers attending a memory clinic to investigate what their knowledge, attitudes and experiences were regarding SCP.

METHODS

We developed two semi-structured questionnaires for patients and caregivers organized into the following sections: (i) knowledge of the law; (ii) general attitude on SCP; (iii) experience about SCP; (iv) attitude about realizing a SCP; (v) advance directives. Participation in the survey was offered to consecutive patients discharged from the memory clinic during 26 target weeks and to their caregivers. The interviews were conducted on the occasion of the last scheduled visit to the facility; telephone interview was also provided. Information was collected by means of an online platform (Google Forms). Descriptive and basic inferential analysis was performed by means of SPSS (IBM). The analysis of the open-ended questions was also conducted with the support of the Voyant Tools.

RESULTS

Sixty-six patient and 65 caregiver interviews were collected. No participant reported that a doctor has ever talked to the patient about SCP. The large majority of patients (85%) and almost all caregivers (95%) agree/absolutely agree with the opportunity for patients to realize SCP. Almost all participants agree/absolutely agree with the usefulness for the patients of indicating a trusted person to act on their behalf (91% patients and 95% caregivers). Forty-three (65%) patients and 48 (74%) caregivers believe it would be good to start SCP with the patient when the time is right. Among them, 20 caregivers and 12 patients believe it is already time to talk about SCP.

CONCLUSIONS

Study results showed patients' and caregivers' interest in the SCP process and, at the same time, their mixed attitude when SCP is referred specifically to themselves or their loved ones. This indicates the need to introduce the discourse on SCP into clinical practice while remaining very sensitive to the individual patient's pace and wishes, including his/her possible refusal to talk about SCP.

Novel prehospital lactate cut-off estimation for mortality: a multicentre observational study

OBJECTIVES

Point-of-care testing available in prehospital settings requires the establishment of new medical decision points. The aim of the present work was to determine the cut-off of the lactate threshold that activates alert triggers for all-cause 2-day mortality.

DESIGN

Multicentre, prospective, ambulance-based, observational study.

SETTING

Patients treated via emergency medical services (EMSs) and delivered to the emergency department between 2019 and 2023 were selected in Spain.

PARTICIPANTS

Adults with any acute disease.

PRIMARY AND SECONDARY OUTCOME MEASURES

Epidemiological data, vital signs and prehospital point-of-care glucose and lactate levels were obtained. The outcome was all-cause 2-day in-hospital mortality. The cut-offs were obtained via three different methods: (i) indirect (which considers survivors and non-survivors), direct (which considers only survivors) assessment and lactate quartile. Additionally, the quartile approach was used to determine the differences in lactate distribution between survivors and non-survivors. Three different back-to-back studies with the same methodology were used.

RESULTS

A total of 11 713 patients fulfilled the inclusion criteria. The mortality rate was 4.6% (542 patients). The difference in the median prehospital lactate concentration (mmol/L) between survivors and non-survivors was statistically significant (p<0.001): 2.29 (95% CI 1.43 to 3.38) and 7.14 (95% CI 5.11 to 9.71), respectively. Globally, the cut-off for all the studies combined was estimated by the direct method to be 3.71 mmol/L (95% CI 2.92 to 3.91), which was similar to the indirect value of 3.07 (95% CI 2.95 to 5.49) and the third quartile of 4.00. The mortality rate in patients who were less than 3.71 mmol/L was 0.004%, and that above that cut-off was 18%.

CONCLUSIONS

This study established a real-world lactate cut-off for 2-day in-hospital mortality of 3.71 mmol/L (95% CI 2.92 to 3.91) on the basis of data from the EMS. Considering this cut-off point could improve patient management via EMS services, allowing quick identification of patients at high risk of clinical worsening.

TRIAL REGISTRATION NUMBER

ISRCTN Registry (ISRCTN17676798, ISRCTN48326533, ISRCTN49321933).

A systematic review of whether the number of linguistic errors in medical interpretation is associated with the use of professional vs ad hoc interpreters

Medical consultations depend on a shared linguistic understanding between the patient and physician. When language concordance is not possible, interpretation is required. Prior studies have revealed that professional in-person interpretation (PIPI) results in patients reporting higher satisfaction and a better understanding of things the physician explained. Despite this, language-discordance often results in using family and/or friends for ad hoc interpretation. This systematic review examines the linguistic aspect of medical interpretation by assessing the number of linguistic errors made and their relation to professional in-person interpretation (PIPI) or in-person ad hoc interpretation (IPAHI). PIPI was defined as people employed as interpreters, but with no specific requirements for education or experience. This systematic review examines studies comparing the number of errors when using PIPI and IPAHI. We performed a PICO-criteria-based search in five scientific databases. We screened English and Danish studies published between 1995 and October 2024. Furthermore, we screened references from, and citations of the included articles. We used the appropriate Cochrane Tool for risk of bias assessment. We identified six studies using a PICO search and one additional study by snowballing. The included studies revealed critical methodological differences, and consequently a statistical synthesis of results was not conducted. We found indications that the number of interpreting errors was significantly lower when using PIPI than family members for IPAHI. Interpreting error rates were not significantly lower when comparing PIPI to the use of medical staff without interpretation training for IPAHI. Generally, we found that the difference between PIPI and IPAHI tended to be more prominent when dealing with more severe diagnoses, e.g., incurable cancer. The methodological differences between included studies and the risk of bias within included studies limit the conclusions drawn in this review. Also, no other kinds of interpretation than PIPI and IPAHI were considered, and the recommendations are solely based on accuracy. Considering these limitations and the fact that no other systematic reviews within this highly specific topic exist, this review resulted in the following recommendations: 1) Professional in-person interpretation should be the first choice in language-discordant medical consultations. 2) If professional interpretation is not possible, using medical staff without interpretation training should be chosen before interpretation by family or friends. 3) All consultation participants should keep sentences short and straightforward, as this is related to a lower risk of omissions in interpretation.

Peak Oxygen Consumption Scaled to Body Composition Is Associated With Mortality and Morbidity in People With a Fontan Circulation

BACKGROUND

Peak oxygen consumption (peak V ̇ $$ \dot{\mathrm{V}} $$ O2) is traditionally scaled by body mass, but it is most appropriately scaled by fat-free mass. However, it is unknown whether peak V ̇ $$ \dot{\mathrm{V}} $$ O2 scaled by fat-free mass is associated with mortality and morbidity in people with a Fontan circulation. The aim of this study was to assess the associations between different expressions of peak V ̇ $$ \dot{\mathrm{V}} $$ O2 with mortality and morbidity in people with a Fontan circulation.

METHODS AND RESULTS

Eighty-seven participants (aged 24.1±7.3 years; 53% women) with a Fontan circulation completed a cardiopulmonary exercise test and a dual-energy x-ray absorptiometry scan. Cox proportional hazard regressions models assessed the association (hazard ratio [HR]) between different expressions of peak V ̇ $$ \dot{\mathrm{V}} $$ O2 with a composite outcome of Fontan failure (FF). Participants were followed up for a median of 6.5 years (95% CI, 6.4-6.9). Individuals experiencing FF (n=10/87) had a significantly lower absolute peak V ̇ $$ \dot{\mathrm{V}} $$ O2. In univariable models, peak V ̇ $$ \dot{\mathrm{V}} $$ O2 ratio scaled to body mass was not significantly associated with FF (HR, 0.91; P=0.111). However, peak V ̇ $$ \dot{\mathrm{V}} $$ O2 scaled by fat-free mass (HR, 0.90; P=0.020) or lean mass (HR, 0.90; P=0.017) was significantly and inversely associated with FF. These associations remained significant after adjusting for age, sex, and peak respiratory exchange ratio.

CONCLUSIONS

The association between peak V ̇ $$ \dot{\mathrm{V}} $$ O2 and FF is improved when scaled to measures of body composition. Applied clinically, a 1-unit increase in peak V ̇ $$ \dot{\mathrm{V}} $$ O2 scaled to fat-free mass or lean mass is associated with a ≈10% lower risk of FF.

Readmissions after next-day discharge following transcatheter aortic valve implantation

BACKGROUND

No data compare newer-generation transcatheter heart valves (THVs) in terms of next-day discharge (NDD) following transfemoral (TF) transcatheter aortic valve implantation (TAVI).

AIMS

We aimed to evaluate the safety of NDD in unselected patients who received ACURATE (neo/neo2), Evolut (PRO/PRO+/FX) and the SAPIEN (3/Ultra) THVs.

METHODS

This multicentre registry included patients who underwent TF-TAVI without a preprocedural permanent pacemaker implantation (PPI) and were discharged the next day without a new PPI. The primary endpoint was unplanned readmissions at 30 days. Multinomial gradient-boosted inverse probability of treatment-weighted (IPTW) propensity scores (stage 1) followed by the modified Poisson regression (stage 2) approach were used to compare the average effects of the THVs on the primary outcome.

RESULTS

A total of 963 all-comer patients (ACURATE=264, Evolut=306, and SAPIEN=393) were included in this study. ACURATE patients were older (p<0.001) and included a greater proportion of females (p<0.001), whereas Evolut patients had a higher risk profile as assessed by the Society of Thoracic Surgeons score (p=0.01). There were no differences between the groups in terms of right or left bundle branch block (p=0.75). At 30 days, the overall readmission rate was 8%, and there were no differences in cardiac (ACURATE 4.6% vs Evolut 4.2% vs SAPIEN 3.1%; p=0.56) or non-cardiac readmissions (ACURATE 4.6% vs Evolut 3.3% vs SAPIEN 4.6%; p=0.64). Readmission for new PPI was 2.7%, 1.0% and 1.8% (p=0.32) and for heart failure (HF) was 1.5%, 2.0% and 1.3% (p=0.76) in ACURATE, Evolut and SAPIEN patients, respectively. The IPTW propensity score model followed by modified Poisson regression indicate that, using ACURATE as the reference, no significant differences were found in 30-day readmissions (relative risk [RR] 0.76, 95% confidence interval [CI]: 0.38-1.52; p=0.38 for Evolut and RR 0.74, 95% CI: 0.44-1.22; p=0.28 for SAPIEN).

CONCLUSIONS

In pacemaker-naïve patients undergoing TF-TAVI with newer-generation THVs, NDD was not associated with a negative impact on overall 30-day readmissions, cardiac or non-cardiac readmissions, readmissions for PPI or HF after discharge, or mortality, regardless of the type of THV.

Is patient participation in hypertension care based on patients' preferences? A cross-sectional study in primary healthcare

AIMS

The purpose of this study was to address the need to improve opportunities for patient participation in their health and health services. This paper reports if and how patients' preferences matched their experiences of participation in treatment for hypertension in primary healthcare and what factors were linked with having had opportunities for participation that matched one's preferences.

METHODS AND RESULTS

A total of 949 adult patients treated for hypertension completed the Patient Preferences for Patient Participation (4Ps) tool, with which they ranked their preferences for and experiences of patient participation. Descriptive and comparative analyses of 4Ps data were performed to identify patient characteristics associated with preference-based participation. Approximately half of the participants experienced patient participation to the extent that they preferred. Women were more likely to have had less patient participation than their preference compared with men. Women were also more likely to prefer being more engaged in hypertension care than men. There were also marked associations between age and educational level with the extent of participation preferred and experienced, leaving patients younger than or with lower education than the mean in this study with more insufficient opportunities for patient participation.

CONCLUSION

There is a lack of concurrence between patients' preferences for, and experiences of, patient participation, especially for women. Further efforts to facilitate person-centred engagement are required, along with research on what strategies can overcome human and organizational barriers.

REGISTRATION

ClinicalTrials.gov: NCT03554382.

Weekday effect of surgery on in-hospital outcome in pancreatic surgery: a population-based study

IMPORTANCE

There is conflicting evidence regarding weekday dependent outcome in complex abdominal surgery, including pancreatic resections.

OBJECTIVE

To clarify weekday-dependency of outcome after pancreatic resections in a comprehensive nationwide context.

DESIGN

Retrospective cross-sectional study of anonymized nationwide hospital billing data (DRG data).

SETTING

Germany between 2010 and 2020. PARTICIPANTS AND EXPOSURE: all patient records with a procedural code for a pancreatic resection.

MAIN OUTCOME AND MEASURES

Primary endpoint was complication occurrence and failure to rescue, i.e. mortality in case of complications, by weekday of index surgery.

RESULTS

94,661 patient records with a pancreatic resection were analyzed, of whom 45.2% were female. Mean age was 65.3 years. In 46.3% of all patient records, the main diagnosis was pancreatic carcinoma. The most common index surgery was pancreaticoduodenectomy (61.2%). Occurrence of at least one of predefined complications was 67.6% (64,029 cases) and was highest following a Monday index surgery. In-hospital mortality in case of at least one complication, i.e. failure to rescue (FtR), accounted for 8,040 deaths (97.7% of 8,228 total deaths, 12.6% FtR, 8.7% in-hospital mortality). FtR was highest (13.1%) following a Monday index surgery and lowest (11.8%) after a Thursday index surgery. Overall in-hospital mortality followed the same trend as FtR. In a multivariable logistic regression, in the overall cohort, in addition to increased age, frailty, male sex, benign entities, and total pancreatectomy performance, Wednesday (adjusted Odd's Ratio, OR, 0.92, 95% Confidence Interval, CI, 0.85-0.99) and Thursday (adjusted OR, 0.89, CI, 0.82-0.96) index surgeries were associated with lower FtR in reference to Monday. Stratified by patient volume, complication occurrence and FtR was only dependent of the weekday of index surgery in low volume hospitals.

CONCLUSIONS AND RELEVANCE

Pancreatic resections are complex procedures with high complication rates and FtR, resulting in high in-hospital mortality. Complication occurrence and FtR is dependent on the weekday of index surgery and mediates the same distribution pattern for overall in-hospital mortality. Stratified by patient volume, this weekday dependency of the index surgery on complication occurrence and FtR was only observed in low volume hospitals.

Predictors of Response to Medical Cannabis for Chronic Pain: A Retrospective Review of Real-Time Observational Data

Objective

People living with chronic pain increasingly use medical cannabis for symptom relief. We conducted a retrospective cohort study examining cannabis for chronic pain relief using anonymous archival data obtained from the medicinal cannabis tracking app, Strainprint®.

Method

We acquired cannabis utilization data from 741 adults with chronic pain and used multilevel modeling to examine the association of age, sex, type of pain (muscle, joint or nerve pain), cannabis formulation (high CBD, balanced CBD:THC, or high THC), route of administration (inhaled or ingested), cannabis use before vs. during the COVID-19 pandemic, and duration of cannabis use, with pain relief.

Results

Most patients were female (n = 464; 63%), with a mean age of 39 (SD = 11), and our cohort had completed a total of 83,622 tracked cannabis sessions through Strainprint. The majority of sessions reported use of inhaled cannabis products (78%), typically with high tetrahydrocannabinol (THC; 64%) versus high cannabidiol (CBD; 15%) or balanced THC:CBD (21%) products. The median change in pain scores across sessions was -3.0 points on a 10-point numeric rating scale (NRS; IQR -4.5 to -2.0). In our adjusted model, greater pain relief was associated with male vs. female sex (-0.69 points on a 10-point NRS; 95%CI -0.46 to -0.91). We found statistically significant, but trivial associations with joint pain (-0.05 points), balanced THC:CBD products in the long term (-0.003 points), and cannabis use during the pandemic (0.18 points).

Conclusions

We found that people living with chronic pain report important pain relief when using cannabis for medical purposes, and that men may achieve greater pain relief than women.

Impact of vancomycin therapeutic drug monitoring on mortality in sepsis patients across different age groups: a propensity score-matched retrospective cohort study

Background

Due to its potent antibacterial activity, vancomycin is widely used in the treatment of sepsis. Therapeutic drug monitoring (TDM) can optimize personalized vancomycin dosing regimens, enhancing therapeutic efficacy and minimizing nephrotoxic risk, thereby potentially improving patient outcomes. However, it remains uncertain whether TDM affects the mortality rate among sepsis patients or whether age plays a role in this outcome.

Methods

We analyzed data from the Medical Information Mart of Intensive Care-IV database, focusing on sepsis patients who were admitted to the intensive care unit (ICU) and treated with vancomycin. The primary variable of interest was the use of vancomycin TDM during the ICU stay. The primary outcome was 30-day mortality. To control for potential confounding factors and evaluate associations, we used Cox proportional hazards regression and propensity score matching (PSM). Subgroup and sensitivity analyses were performed to assess the robustness of our findings. Furthermore, restricted cubic spline models were utilized to investigate the relationship between age and mortality among different groups of sepsis patients, to identify potential non-linear associations.

Results

A total of 14,053 sepsis patients met the study criteria, of whom 6,826 received at least one TDM during their ICU stay. After PSM, analysis of 4,329 matched pairs revealed a significantly lower 30-day mortality in the TDM group compared with the non-TDM group (23.3% vs.27.7%, p < 0.001). Multivariable Cox proportional hazards regression showed a significantly reduced 30-day mortality risk in the TDM group [adjusted hazard ratio (HR): 0.66; 95% confidence interval (CI): 0.61-0.71; p < 0.001]. This finding was supported by PSM-adjusted analysis (adjusted HR: 0.71; 95% CI: 0.66-0.77; p < 0.001) and inverse probability of treatment weighting analysis (adjusted HR: 0.72; 95% CI: 0.67-0.77; p < 0.001). Kaplan-Meier survival curves also indicated significantly higher 30-day survival in the TDM group (log-rank test, p < 0.0001). Subgroup analyses by gender, age, and race yielded consistent results. Patients with higher severity of illness-indicated by sequential organ failure assessment scores ≥6, acute physiology score III ≥40, or requiring renal replacement therapy, vasopressors, or mechanical ventilation-experienced more pronounced mortality improvement from vancomycin TDM compared with those with lower severity scores or not requiring these interventions. The results remained robust after excluding patients with ICU stays <48 h, those with methicillin-resistant Staphylococcus aureus infections, or when considering only patients with septic shock. In subgroup analyses, patients under 65 years (adjusted HR: 0.50; 95% CI: 0.43-0.58) benefited more from vancomycin TDM than those aged 65 years and older (adjusted HR: 0.75; 95% CI: 0.67-0.83). Notably, sepsis patients aged 18-50 years had the lowest mortality rate among all age groups, at 15.2% both before and after PSM. Furthermore, in this age group, vancomycin TDM was associated with a greater reduction in 30-day mortality risk, with adjusted HRs of 0.32 (95% CI: 0.24-0.41) before PSM and 0.30 (95% CI: 0.22-0.32) after PSM.

Conclusion

Vancomycin TDM is associated with reduced 30-day mortality in sepsis patients, with the most significant benefit observed in patients aged 18-50. This age group exhibited the lowest mortality rates and experienced the greatest reduction in mortality following TDM compared with older patients.

Association between Obstructive Sleep Apnea and Age-related Macular Degeneration Development and Progression

OBJECTIVE

To evaluate the risk of age-related macular degeneration (AMD) development and progression in individuals with diagnosed obstructive sleep apnea (OSA).

DESIGN

Retrospective cohort study.

SUBJECTS

Before propensity score matching (PSM), 60 652 and 1 173 723 individuals with OSA or not, respectively, were included in the study. After PSM and applying inclusion/exclusion criteria, 58 700 individuals in each cohort were subsequently analyzed.

METHODS

Data were collected using TriNetX, a deidentified electronic health records research network. Individuals with an International Classification of Diseases, 10th Revision, code for OSA confirmed with polysomnography and an additional code for continuous positive airway pressure use were compared with individuals without diagnosed OSA (control cohort) for the development of main outcome measures at 5 years. Secondary analyses were included to assess nonadvanced AMD progression in individuals with and without diagnosed OSA at 5 years.

MAIN OUTCOME MEASURES

The main outcome measures were the incidence of AMD, macular hemorrhage, legal blindness, and requiring anti-VEGF intervention at 5 years. Individuals with nonadvanced AMD with and without an OSA diagnosis were separately analyzed for progression to late AMD and the development of macular hemorrhage, legal blindness, and requiring anti-VEGF therapy at 5 years.

RESULTS

At 5 years, individuals with diagnosed OSA had a significantly elevated risk of nonexudative AMD (hazard ratio [HR], 2.64; 95% confidence interval [CI], 2.37-2.96; P < 0.001), exudative AMD (HR, 2.48; 95% CI, 1.99-3.11; P = 0.002), and requiring anti-VEGF therapy (HR, 2.85; 95% CI, 2.26-3.59; P < 0.001) compared with the control cohort. In the secondary analysis, individuals with nonadvanced AMD with diagnosed OSA were associated with an elevated risk of geographic atrophy (HR, 7.00; 95% CI, 4.47-11.0; P = 0.03), exudative AMD (HR, 2.87; 95% CI, 2.37-3.48; P = 0.03), and requiring anti-VEGF injections (HR, 4.72; 95% CI, 3.59-6.22; P = 0.02) compared with those with nonadvanced AMD without diagnosed OSA.

CONCLUSIONS

In a large, heterogeneous database, an elevated risk of developing AMD and progression to later stages of the disease was observed among individuals with diagnosed OSA.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Cognitive Impairment in Cerebral Amyloid Angiopathy: A Single-Center Prospective Cohort Study

Background/Objectives: Cognitive impairment represents a core and prodromal clinical feature of cerebral amyloid angiopathy (CAA). We sought to assess specific cognitive domains which are mainly affected among patients with CAA and to investigate probable associations with neuroimaging markers and Cerebrospinal Fluid (CSF) biomarkers. Methods: Thirty-five patients fulfilling the Boston Criteria v1.5 or v2.0 for the diagnosis of probable/possible CAA were enrolled in this prospective cohort study. Brain Magnetic Resonance Imaging and CSF biomarker data were collected. Every eligible participant underwent a comprehensive neurocognitive assessment. Spearman's rank correlation tests were used to identify possible relationships between the Addenbrooke's Cognitive Examination-Revised (ACE-R) sub-scores and other neurocognitive test scores and the CSF biomarker and neuroimaging parameters among CAA patients. Moreover, linear regression analyses were used to investigate the effects of CSF biomarkers on the ACE-R total score and Mini-Mental State Examination (MMSE) score, based on the outcomes of univariate analyses. Results: Cognitive impairment was detected in 80% of patients, and 60% had a coexistent Alzheimer's disease (AD) pathology based on CSF biomarker profiles. Notable correlations were identified between increased levels of total tau (t-tau) and phosphorylated tau (p-tau) and diminished performance in terms of overall cognitive function, especially memory. In contrast, neuroimaging indicators, including lobar cerebral microbleeds and superficial siderosis, had no significant associations with cognitive scores. Among the CAA patients, those without AD had superior neurocognitive test performance, with significant differences observed in their ACE-R total scores and memory sub-scores. Conclusions: The significance of tauopathy in cognitive impairment associated with CAA may be greater than previously imagined, underscoring the necessity for additional exploration of the non-hemorrhagic facets of the disease and new neuroimaging markers.

Impaired Awareness and Symptomatology of Hypoglycemia in Adults with Type 1 Diabetes using Continuous Glucose Monitoring

CONTEXT & OBJECTIVE

Sparse large-scale studies have characterized hypoglycemia symptomatology in adults with type 1 diabetes (T1D) who use continuous glucose monitoring (CGM). This research aimed to evaluate the relationship of impaired awareness of hypoglycemia (IAH) with hypoglycemia symptomatology and frequency in this population.

DESIGN

A cross-sectional survey was conducted in 2023. HypoA-Q was used to evaluate hypoglycemia frequency, symptomatology, and awareness.

SETTING & PARTICIPANTS

Registrants who used CGM in the T1D Exchange, a U.S. national T1D registry.

RESULTS

Surveys were completed by 1,480 adults with T1D who used CGM (53% female; mean diabetes duration 26 years). Compared to those with intact hypoglycemia awareness, IAH was associated with less frequent hypoglycemia symptom presentation across various glucose levels and lower glucose concentrations for first presenting hypoglycemia symptoms when awake (P<0.05 for all). More than 70% of individuals with IAH did not regularly experience symptoms during episodes with glucose <54 mg/dL. When asleep, those with IAH were less frequently awoken by symptoms, more frequently awoken by others who recognized their hypoglycemia, and more frequently acknowledged hypoglycemia after an episode (P<0.05 for all) despite using CGM. With reduced symptoms, both when awake and asleep, those with IAH experienced more hypoglycemic episodes that they were unable to self-treat than those with intact awareness (P<0.05).

CONCLUSION

IAH continues to be associated with a significant reduction in detection of hypoglycemia symptoms, both when awake and asleep, in adults using CGM. Current diabetes technologies do not fully protect adults with type 1 diabetes from hypoglycemia.

Spontaneous adverse drug reactions reported in a thirteen-year pharmacovigilance program in a tertiary university hospital

Objectives

We aimed to assess the characteristics of adverse drug reactions (ADRs) collected in a university hospital.

Methods

A retrospective analysis of ADRs spontaneously reported in the Hospital Pharmacovigilance Program database (RutiRAM) over a 13-year period was conducted. The analysis included a description of ADRs [System Organ Class (SOC)] and their seriousness, the drugs involved [level 1 of the Anatomical Therapeutic Chemical (ATC) Classification System], drug-drug interactions, medication errors, drugs 'under additional monitoring', positive rechallenge, and the 'pharmacovigilance interest' of ADRs. An ADR was considered of 'pharmacovigilance interest' when it was serious, and/or produced sequelae, and/or affected the paediatric population, and/or when the suspected drug was 'under additional monitoring'. Additionally, an exploratory analysis for bivariate associations through an automated method was performed.

Results

A total of 2,148 spontaneous ADRs were registered in the RutiRAM database, with 92.5% recorded by medical doctors. The mean age of cases was 59.2 years (SD 20.9), range 1 day-99 years; 5.7% were paediatric, 46.2% adults, and 48.1% elderly. The drugs most often involved were anti-infectives (ATC group J), mainly amoxicillin-clavulanic acid. 'Blood system disorders' were the most frequent SOC ADRs, and skin rashes were the most frequent ADRs. The 63.2% of ADRs were considered of 'pharmacovigilance interest'. Almost half of ADRs were hospital-acquired, and these were related to medication error; serious ADRs were related to drug-drug interactions and elderly patients, and involved drugs 'under additional monitoring' were related to younger ones.

Conclusion

This is the first study to overview of ADRs reported in an HPVP over more than a decade. Almost two-thirds of the ADRs collected in the RutiRAM database are of sufficient quality to be classified as 'pharmacovigilance interest', and thus can contribute to signal detection and the issuing of drug alerts by pharmacovigilance systems. Analysing ADRs in hospitals contributes to patient safety by implementing relevant actions to prevent medication errors or ADRs, some of which can be applied to other centres.

Beyond the scoreboard: Coaches' UV-related skin cancer knowledge in outdoor sports

BACKGROUND

The global rise in UV radiation is widely recognized as one of the most relevant health impacts of climate change. Consequently, the prevalence of skin cancer is experiencing a significant increase, with outdoor athletes being identified as a particularly vulnerable population group.

OBJECTIVES

This study aims to investigate the extent of UV-specific skin cancer knowledge among coaches in outdoor sports and to examine potential variations in this knowledge between different sports, coach- and club-specific factors.

METHODS

This nationwide representative study was conducted among outdoor sports coaches from the 10 largest outdoor sports associations in Germany. Their knowledge of the risks associated with UV radiation and prevention measures were evaluated using the Skin Cancer and Sun Knowledge Scale (SCSK Scale).

RESULTS

Out of 1200 participating trainers, the UV-specific skin cancer knowledge score averaged 17.76 (±2.98) on a scale ranging from 0 to 25. The true-false statements 'A tan is a sign that the skin is damaged' (true) and 'When using sunscreen, you can tan without any negative effects' (false) were most frequently answered incorrectly. Only 16% of participants correctly identified basal cell carcinoma as the most prevalent form of skin cancer. Differences in UV-specific skin cancer knowledge were evident across different sports, with football and tennis coaches showing the major knowledge deficits. Conversely, trainers in skiing, swimming and mountain sports demonstrated the highest levels of knowledge. Significant deficiencies in knowledge were particularly notable among male trainers, as well as those from the youngest and the oldest age group, with limited training experience and who primarily worked with children and adolescents in small clubs on a regular basis.

CONCLUSIONS

Serious knowledge deficiencies are evident among German outdoor sports coaches. The study results emphasize the necessity for enhanced coach education and the implementation of evaluated concepts for climate adaptation in sports.

Gaps in Heat-Related Knowledge, Practices and Adaptation Strategies Among Coaches in German Outdoor Sports

Objectives

Climate change is increasing the risk of heat-related illness in outdoor sports. Coaches have a responsibility to protect the athletes in their care. In this study, the knowledge and practice of German coaches in heat prevention were evaluated nationwide.

Methods

Coaches (n = 1,200) from the ten largest outdoor sports in Germany were asked about their knowledge using the knowledge of heat-related illness symptoms index (KOSI, range [0-14]). Prevention measures currently implemented by coaches were analyzed in terms of relative compliance with specified recommendations (heat prevention score (HPS), range [0-100]).

Results

The KOSI averaged 10.31 ± 1.81 and pointed to clear knowledge deficits: the lowest score values were shown by coaches in skiing (9.85 ± 1.80), soccer (10.07 ± 2.33) and golf (10.09 ± 1.75; pANOVA = 0.015). Heat protection in training was also deficient: The HPS showed a mean value of 62.41 ± 14.89. The greatest deficits existed in tennis (57.71 ± 14.29), mountain sports (58.17 ± 13.08) and soccer (58.70 ± 13.86; pANOVA < 0.001). No correlation between theoretical knowledge and practical prevention was found.

Conclusion

In Germany, coaches are insufficiently prepared for the health hazards of heat. Promoting onsite educational programs seems essential to ensure safer sports environments.

The association between systemic immune-inflammation index (SII) and early nosocomial infections after cardiopulmonary bypass surgery in children with congenital heart disease

BACKGROUND

Infections occurring postoperatively in pediatric patients with congenital heart disease (CHD) following cardiopulmonary bypass (CPB) surgery pose a considerable challenge, affecting the duration of hospitalization, financial costs, and patient outcomes. Studies investigating the association between systemic immune-inflammation index (SII) and early infections after CHD surgery are very rare. This study seeks to delineate the link between SII and the occurrence of early nosocomial infections in pediatric patients undergoing CPB surgery for CHD.

METHODS

A cross-sectional analysis was performed on 325 pediatric patients who underwent CPB surgery for CHD between July 2020 and June 2023. The primary exposure was the SII value on the first postoperative day. The outcome was the occurrence of nosocomial infections within the first week following CPB surgery. Multivariable logistic regression models and subgroup analyses were employed to evaluate the association between SII and the risk of early nosocomial infections.

RESULTS

The median age of the study cohort was 4.4 years, with a male preponderance of 51.7%. The median SII value was recorded at 0.6 × 10^12/L. The rate of nosocomial infections within the first week post-CPB surgery was 53.5%. An inverse association was observed between SII and the incidence of early nosocomial infections. After controlling for multiple confounders, an increment of 1 × 10^12/L in SII corresponded to a 25% reduction in the likelihood of nosocomial infections (OR = 0.75; 95%CI: 0.57, 0.99; P = 0.044). Subgroup analyses substantiated the consistency of these findings.

CONCLUSIONS

The study demonstrated that an elevated SII corresponded to a reduced likelihood of early nosocomial infections after CPB surgery in children with CHD, a finding that merits additional investigation.

Effects of alcohol-related problems on the costs of frequent emergency department use: an economic analysis of a case-control study in Spain

Introduction

Alcohol-related problems increase the probability of frequent emergency department (ED) use. In this study, we compared the direct healthcare expenses incurred during a single visit among frequent and non-frequent ED users and analyzed the impact of alcohol-related issues in healthcare costs arising from ED usage.

Methods

The study relied on secondary analyses of economic data from a 1:1 matched case-control study with the primary aim of identifying the clinical characteristics of hospital ED frequent users in a Mediterranean European environment with a public, universal, and tax-funded health system. The participants ranged in age from 18 to 65 years and underwent ED visits at a high-complexity Spanish hospital (cases ≥5 times, controls <5) from December 2018 to November 2019. Each case was matched to a control with the same age, gender, and date of attendance at the ED. Clinical data and direct healthcare costs for a single ED visit were obtained by a retrospective review of the first electronic medical register. Costs and duration of stay were compared between cases and controls using paired-samples t-tests, and ED users with and without alcohol-related problems were compared using bivariate (independent-samples t-tests, one-way analysis of variance, Chi square tests, and multiple linear regression) and multivariate analyses (multiple linear regression models with backward stepwise selection algorithm, and dependent variable: total mean direct costs).

Results

Among 609 case-control pairs (total n = 1218), mean total healthcare direct costs per ED visit were 22.2% higher among frequent compared with non-frequent users [mean difference 44.44 euros; 95% confidence interval (CI) 13.4-75.5; t(608) = 2.811; p = 0.005]. Multiple linear regression identified length of stay, triage level, ambulance arrival, and the specialty discharging the patient as associated with total healthcare costs for frequent users. In bivariate analyses, a history of alcohol-related problems was associated with a 32.5% higher mean total healthcare costs among frequent users [mean difference 72.61 euros; 95% confidence interval 25.24-119.97; t(320.016) = 3.015; p = 0.003].

Conclusion

The findings confirm the high cost of frequent ED use among people with alcohol-related problems, suggesting that costs could be reduced through implementation of intervention protocols.

Associations between obesity and severity of coronavirus disease 2019 in Brazilian inpatients: A 2021 secondary data analysis

In the backdrop of the global obesity pandemic, recognized as a notable risk factor for coronavirus disease 2019 (COVID-19) complications, the study aims to explore clinical and epidemiological attributes of hospitalized COVID-19 patients throughout 2021 in Brazil. Focused on four distinct age cohorts, the investigation scrutinizes parameters such as intensive care unit (ICU) admission frequency, invasive mechanical ventilation (IMV) usage, and in-hospital mortality among individuals with and without obesity. Using a comprehensive cross-sectional study methodology, encompassing adult COVID-19 cases, data sourced from the Influenza Epidemiological Surveillance Information System comprises 329 206 hospitalized patients. Of these individuals, 26.3% were affected by obesity. Analysis reveals elevated rates of ICU admissions, increased dependence on IMV, and heightened in-hospital mortality among the individuals with obesity across all age groups (p < .001). Logistic regression, adjusting for confounding variables, underscores a progressively rising odds ratio for mortality in younger age brackets: 1.2 (95%CI 1.1-1.3) for those under 50 years, 1.1 (95%CI 1.0-1.2) for the 50-59 age group, and 1.1 (95%CI 1.0-1.2) for the 60-69 age group. Conversely, no significant mortality difference is observed for patients over 70 years (OR: 0.972, 95%CI 0.9-1.1). In summary, hospitalized COVID-19 patients with obesity, particularly in younger age groups, exhibit elevated rates of ICU admission, IMV requirement, and in-hospital mortality compared with the control group. Notably, the 'obesity paradox' is not evident among hospitalized COVID-19 patients in 2021.

Health service utilization, substance use treatment response, and death in patients with opioid use disorder and comorbid hepatitis C findings from prospective cohort study with administrative database linkage

BACKGROUND

Among patients with opioid use disorder (OUD), high rates of overdose and death have been reported in subgroups with Hepatitis C Virus (HCV). Evidence on the comorbid effect of HCV on clinical and substance use trajectories has been limited by small sample sizes, short follow-up, and heavy reliance on administrative data which lacks granularity on important prognostic factors. Additionally, few studies include populations on substance use treatment.

AIM

To establish the impact of HCV exposure (antibody positivity) on health care utilization patterns, substance use treatment response, and death in a cohort of patients with OUD on opioid agonist therapy (OAT).

METHODS

This multi-center prospective cohort study recruited adult patients with OUD on OAT from 57 substance use treatment centers in Ontario, Canada. The study collected substance use outcomes, and classified patients with ≥50 % positive opioid urine screens over one year of follow-up as having poor treatment response. Additional data obtained via linkage with ICES administrative databases evaluated the relationship between HCV status, healthcare service utilization, and death over 3 years of follow-up. Multiple logistic regression models established the adjusted impact of HCV on various outcomes.

RESULTS

Among recruited participants (n = 3430), 44.10 % were female with a mean age of 38.64 years (Standard deviation: 10.96). HCV was prevalent in 10.6 % of the cohort (n = 365). Methadone was used most often (83.9 %, n = 2876), followed by sublingual buprenorphine (16.2 %, n = 554). Over the three-year follow-up, 5.3 % of patients died (n = 181). Unadjusted results reveal rates of hospitalization (all-cause, mental-health related, critical care) and emergency department visits (mental health-related), were significantly higher among HCV patients. Associations diminished in adjusted models. Active injection drug use exhibited the highest predictive risk for all outcomes.

CONCLUSION

A high degree of acute physical and mental illness and its resulting health service utilization burden is concentrated among patients with OUD and comorbid HCV. Future research should explore the role for targeted interventions and how best to implement integrated healthcare models to better address the complex health needs of HCV populations who inject drugs.

Pulse oximetry and oxygen services for under-five children with community-acquired pneumonia attending primary and secondary level health facilities in Lagos, Nigeria (INSPIRING-Lagos): a pre-implementation and post implementation study

Introduction

Childhood pneumonia is a leading cause of child mortality in Nigeria and poor quality of care is a persistent issue. We aimed to understand whether introducing primary care stabilisation rooms equipped with pulse oximetry and oxygen systems alongside healthcare worker (HCW) training improved the quality of care for children with pneumonia in Lagos State.

Methods

Setting: Ikorodu local government area, Lagos. Population: children aged 0-59 months with clinically diagnosed pneumonia. Intervention: establishment of 'stabilisation rooms' within government (n=7) and private (n=7) primary care facilities, designed for short-term oxygen delivery for hypoxaemic children prior to hospital transfer, alongside HCW training on integrated management of childhood illness (IMCI), pulse oximetry and oxygen therapy. Two secondary facilities with inpatient oxygen systems received training and pulse oximeters. Primary outcome: composite 'correct management' of hypoxaemic pneumonia including oxygen therapy administration, referral and admission to hospital. Analysis: mixed-effects logistic regression comparing baseline (September 2020-August 2021) and implementation (September 2021-November 2022) periods, adjusted for clustering by facility.

Results

We screened 20 158 children, of which 160 children with hypoxaemic pneumonia (SpO2<90%) were recruited. The proportion of hypoxaemic children with 'correct management' remained low and unchanged: 9/98 (9%) with data on referral and admission at baseline, and 6/52 (12%) during implementation (mixed effects logistic regression adjusted OR (aOR): 1.17 (95% CI 0.30, 4.52), p=0.822). Oxygen use for children with hypoxaemia increased from baseline 10/105 (10%) to 13/55 (24%) during implementation (aOR 3.01 (95% CI 1.05, 8.65), p=0.040). But subsequent referral and hospital admission remained low. Low pulse oximetry use by health workers in children with clinical pneumonia persisted through baseline (73/798, 9%) and implementation (122/1125, 11%).

Conclusion

Equipping primary care stabilisation rooms with pulse oximetry and oxygen increased oxygen use for children with hypoxaemia but did not improve referral or hospital admission rates. Persistent failure to assess children with pulse oximetry likely contributed to under-recognition of hypoxaemia and therefore failure to initiate correct care. Further work to improve initial triage, assessment and treatment of children with severe pneumonia in Lagos is urgently needed.

Trial registration number

ACTRN12621001071819.

The Freiburg Index of Post-TIPS Survival accurately predicts mortality in patients with acute decompensation of cirrhosis

INTRODUCTION

The recently developed Freiburg Index of Post-TIPS Survival (FIPS) allows improved risk classification of patients with decompensated cirrhosis allocated to transjugular intrahepatic portosystemic shunt (TIPS) implantation. This study investigated the prognostic value of the FIPS in patients hospitalized with acute decompensation of cirrhosis (AD), outside the setting of TIPS implantation.

METHODS

A total of 1133 patients with AD were included in a retrospective, multi-centre study. Ninety-day, 180-day and 1-year mortality were recorded and the FIPS' performance in predicting mortality at these time points was analysed using ROC analyses.

RESULTS

Ninety-day, 180-day and 1-year mortality were 17.7%, 24.4% and 30.8%. Uni- and multivariable Cox regression models showed that the FIPS independently predicted 1-year mortality in the study cohort (HR 1.806, 95% CI 1.632-1.998, p < .0001). In ROC analyses, the FIPS offered consistently high performance in the prediction of mortality within 1 year after AD (area under the receiver operator characteristic [AUROC]: 1-year mortality .712 [.679-.746], 180-day mortality .740 [.705-.775] and 90-day mortality .761 [.721-.801]). In fact, in the subgroup of patients presenting with variceal bleeding, the FIPS even showed significantly improved discriminatory performance in the prediction of long-term mortality (AUROC 1-year mortality: .782 [.724-.839]) in comparison with established prognostic scores, such as the CLIF-C AD score (.724 [.660-.788], p = .0071) or MELD 3.0 (.726 [.662-.790], p = .0042).

CONCLUSIONS

The FIPS accurately predicts mortality in patients with AD and seems to offer superior prognostication of long-term mortality in patients with variceal bleeding.

Risk of Intestinal Complications, Extraintestinal Morbidity, and Mortality in Patients with Crohn's Disease and Ocular Involvement

PURPOSE

Patients with Crohn's disease (CD) and subsequent ocular manifestations may have worse outcomes when compared to matched patients with CD without ocular disease.

METHODS

In this retrospective cohort study, an aggregated electronic health records research network, TriNetX (Cambridge, MA, USA), was used to identify patients diagnosed with CD stratified by the presence or absence of ocular involvement with at least 1 year of follow-up. Propensity score matching (PSM) was performed to control for baseline demographics and medical comorbidities.

RESULTS

Patients with CD with ocular disease showed a greater risk of undergoing bowel resections (RR: 2.06, 95% CI: 1.48-2.85, p < 0.001), developing other CD-related gastrointestinal complications (RR: 1.31, CI: 1.15-1.49, p < 0.001), or acquiring Clostridioides difficile infections (RR: 2.19, CI: 1.89-2.54, p < 0.001). Further, patients with CD with ocular sequelae had a greater risk of developing NASH (RR: 1.43, CI: 1.31-1.56, p < 0.001), CD-related nutrient deficiencies (RR: 1.38, CI: 1.29-1.49, p < 0.001), iron deficiency anemia (RR: 1.41, CI: 1.33-1.50, p < 0.001), CD-related dermatological disease (RR: 1.84, CI: 1.65-2.05, p < 0.001), osteoporosis (RR: 1.49, CI: 1.37-1.64, p < 0.001) and primary sclerosing cholangitis (RR: 1.63, CI: 1.11-2.38, p = 0.011). Among patients with CD with ocular involvement, there was an elevated risk of MI (RR: 1.36, CI: 1.14-1.63, p < 0.001), stroke (RR: 1.42, CI: 1.18-1.70, p < 0.001), VTE (RR: 1.37, CI: 1.22-1.54, p < 0.001), and sepsis (RR: 1.53, CI: 1.37-1.71, p < 0.001).

CONCLUSIONS

Patients who have CD and subsequent ocular involvement have an increased risk of local intestinal complications, extraintestinal morbidity, and cardiovascular complications when compared to patients with CD without ocular involvement.

Bruxism, Lifestyle, Anxiety, and Sleep Impairment in Dental Students

The aim of this study was to verify the correlation of self-reported sleep and awake bruxism with demographic characteristics, oral behaviors, anxiety, temporomandibular disorder (TMD) signs and symptoms, sleep quality, and orthodontic treatment history in dental students. A total of 104 students of Dentistry located in Paraná (South Brazilian State) answered the following self-administered questionnaires: Oral Behavior Checklist, State Anxiety Inventory, TMD signs and symptoms questionnaire, and the Pittsburgh Sleep Quality Index. Associations between possible awake bruxism (AB) and sleep bruxism (SB) with sleep quality, anxiety, and TMD were analyzed by Poisson Regression with robust variance. The significance level adopted was 5%. The frequency of AB and SB was 76% and 55.8%, respectively. A statistically higher frequency of AB was observed in students who had the following conditions: use of psychotropic medication, physical activity practitioners, moderate or high level of anxiety, more oral behaviors, sleep disorders, and sleep bruxism. Sleep bruxism was diagnosed more frequently in students who presented moderate or high levels of anxiety, oral behaviors, and sleep disorders. The frequency of TMD reported was higher in students with SB, as well as in those with AB. In conclusion, lifestyle, moderate and high anxiety levels, and sleep disorders are associated with a higher prevalence of AB and SB. Furthermore, AB and SB are associated with a higher frequency of TMD reporting.

Diverticulitis evaluation and management among United States emergency departments over an eight-year period

INTRODUCTION

Diverticulitis is a common reason for presentation to the Emergency Department (ED). However, as imaging options, risk stratification tools, and antibiotic options have expanded, there is a need for current data on the changes in incidence, computed tomography (CT) performance, antibiotic usage, and disposition over time.

METHODS

This was a cross-sectional study of ED patients with a diagnosis of diverticulitis from 1/1/2016 to 12/31/2023. Using the Epic Cosmos database, all ED visits for acute diverticulitis were identified using ICD-10 codes. Outcomes included total ED presentations for diverticulitis, admission rates, CTs performed, outpatient antibiotic prescriptions, and antibiotics administered in the ED for admitted patients.

RESULTS

There were 186,138,130 total ED encounters, with diverticulitis representing 927,326 (0.50 %). The rate of diverticulitis diagnosis increased from 0.40 % to 0.56 % over time. The admission rate declined over time from 33.6 % to 27.7 %, while the CT rate rose from 83.0 % to 92.6 %. Among those discharged, 90.4 % received an antibiotic, which remained consistent over time. Metronidazole (55.1 %) and ciprofloxacin (40.8 %) were the most commonly prescribed antibiotics, followed by amoxicillin-clavulanate (36.1 %). Among those admitted, most received either metronidazole (62.0 %), a fluoroquinolone (40.4 %), a third-generation cephalosporin (18.9 %), or a penicillin-based agent (38.1 %). Among both discharged and admitted patients, there was a marked shift to penicillin-based agents as the primary antibiotic regimen.

CONCLUSION

Diverticulitis remains a common ED presentation, with a gradually rising incidence over time. Admission rates have decreased, while CT imaging has become more common. Most patients receive antibiotics, though the specific antibiotic has shifted in favor of penicillin-based agents. These findings can provide key benchmarking data and inform future initiatives to guide imaging and antibiotic use.

Knowledge, attitudes, and practices of pregnant women regarding epidural analgesia: a multicentre study from a developing country

BACKGROUND

Epidural analgesia has emerged as one of the best methods that can be used to reduce labour pain. This study was conducted to assess awareness, attitudes, and practices of pregnant women who visited maternity and antenatal healthcare clinics about epidural analgesia during normal vaginal birth.

METHODS

This multicentre study was conducted in a cross-sectional design among pregnant women using a pre-tested questionnaire. The study population in this study was pregnant women who visited maternity and antenatal healthcare clinics in Palestine.

RESULTS

In this study, a total of 389 pregnant women completed the questionnaire. Of the pregnant women, 381 (97.9%) were aware of the existence of epidural analgesia, 172 (44.2%) had already used epidural analgesia, and 57 (33.1%) experienced complications as a result of epidural analgesia. Of the pregnant women, 308 (79.2%) stated that epidural analgesia should be available during vaginal birth. Of the pregnant women, 243 (62.5%) stated that they would use epidural analgesia if offered for free or covered by insurance. Multivariate logistic regression showed that women who were younger than 32 years, who have used epidural analgesia, and those who stated that epidural analgesia should be available during vaginal birth were 2.78-fold (95% CI: 1.54-5.04), 4.96-fold (95% CI: 2.71-9.10), and 13.57-fold (95% CI: 6.54-28.16) more likely to express willingness to use epidural analgesia, respectively.

CONCLUSIONS

Pregnant women had high awareness of the existence, moderate knowledge, and positive attitudes towards epidural analgesia for normal vaginal birth. Future studies should focus on educating pregnant women about all approaches that can be used to reduce labour pain including their risks and benefits.

Symptom Burden and Dietary Changes Among Older Adults with Cancer: A Cross-Sectional Study

BACKGROUND

Malnutrition has a direct impact on both the toxicities of cancer therapy and the overall survival of oncological patients. However, its prevalence amongst vulnerable groups such as older patients (age ≥ 65 years) is often underestimated. Screening tools recognizing patients at risk are well established, yet they do not take into account that cancer therapy may lead to changes in dietary habits or that therapy's side effects may negatively influence nutritional status.

METHODS

To close this gap, we combined the validated Nutritional Risk Score 2002 (NRS-2002) and G8 screening tools with short questionnaires addressing diet changes and symptom load and screened 300 cancer inpatients between 12/2022 and 12/2023. Descriptive statistics (Fisher's exact, Student's t-test) as well as heat mapping were applied for data analysis.

RESULTS

Overall, two in three inpatients ≥65 years were at risk for malnutrition, and the majority of patients (87.67%) scored ≤14 points on the G8 and were considered frail. Surprisingly, the symptom complex of oral discomfort was most often mentioned by patients (xerostomia-178/300 patients, loss of appetite: 122/300 patients, dysgeusia: 93/300 patients). Diet changes were also common, with patients mainly avoiding certain foods (122/300 patients) or using dietary supplements (106/300 patients).

CONCLUSIONS

Taken together, older cancer inpatients are frail and have a high risk of malnutrition. Screening should not only consider energy intake but also symptom burden and dietary changes to optimize supportive care.

Clinical and functional outcomes of locked plating vs. cerclage compression wiring for AO type C patellar fractures- a retrospective single-center cohort study

PURPOSE

Although "tension-band wiring" is still commonly used to stabilize patellar fractures, the technique has recently been scrutinized due to biomechanical insufficiency. Consequently, the AO Foundation renamed the principle to compression cerclage wiring (CCW). Several studies propose favorable outcomes when utilizing locked plating (LP). This study aims to compare outcome of CCW and LP for complex patellar fractures.

METHODS

A retrospective, single-center cohort study was performed on patients who underwent operative treatment for (AO 34 C-Type) patellar fractures between April 2013 and March 2023. Patients with a 12 month follow up were included. We grouped and compared patients based on the applied treatment strategy: group LP vs. group CCW. Primary outcome parameters included implant-related complications and revision surgeries. Secondary outcomes were length of stay, return to work and 12 months functional outcome (Lysholm score). Odd ratios for complications and revisions were calculated using the conditional Maximum Likelihood Estimate. The threshold for statistical significance was set at p < 0.05.

RESULTS

Of 145 patients, 63 could be included (group LP: n = 23 and group CCW: n = 40). Fractures in group LP were significantly more complex in regard to AO Classification (p < 0.001), number of fragments (p < 0.001) and degree of comminution (p < 0.001), yet odds of complications were significantly lower in group LP (OR: 0.147; 95%CI: 0.015-0.742; p = 0.009). K-wire migration was the most common complication in group CCW (20%). Odds of revision surgery were significantly lower in group LP (OR: 0.000; 95%CI: 0.000-1.120; p = 0.041). The average Lysholm score at one year was favorable in both groups (89.8; SD: 11.9 in group LP and 90.6; SD: 9.3 in group CCW; n.s.).

CONCLUSION

In our study cohort, LP was routinely chosen for more complex fracture morphologies; nevertheless the data implies that LP may be considered as the superior fixation technique in regard to complications and revision operations. Especially, K-wire migration occurs frequently after CCW. The one year functional outcome was comparable between the groups, with both demonstrating good results. Prospective randomized studies are indicated to validate our findings.

Extraperitoneal Robot-Assisted Laparoscopic Radical Prostatectomy in Continuous Spinal Anesthesia: A New Approach to an Established Technique

Background and Objectives: To prove the feasibility of continuous spinal extraperitoneal robot-assisted laparoscopic radical prostatectomy (cseRALP) in order to expand the pool of eligible patients. Materials and Methods: According to IDEAL guidelines, a consecutive cohort of patients who underwent cseRALP was enrolled. Pre-, intra-, and post-operative data were collected, with particular focus on safety and oncological outcomes. Results: A total of three patients underwent this technique, with no intra- or post-operative medical complications. Only a grade 1 Clavien-Dindo complication was reported, small urinary leakage treated with an indwelling catheter. Oncological and functional results at month 3 were satisfactory, with no recurrence and no stress incontinence. Conclusions: cseRALP seems to be feasible and safe; further trials are mandatory.

Curcuma-Based Nutritional Supplements and Risk of Age-Related Macular Degeneration

Importance

Curcuma-based nutritional supplements (CBNS) are natural anti-inflammatory and antioxidant agents that may confer benefits against age-related macular degeneration (AMD).

Objective

To examine the association between the use of CBNS and the risk of development or progression of AMD.

Design, Setting, and Participants

This was a retrospective cohort study with data collection in June of 2024. Data were gathered from the aggregated electronic health records research network, TriNetX (Cambridge, Massachusetts). Patients without AMD were included in the study before propensity score matching (PSM); these included those taking and not taking CBNS. Patients with no history of AMD were stratified by instances of CBNS prescription records. Patients with a history of early nonexudative AMD stratified by instances of CBNS prescription records were also identified. PSM was performed to control for baseline demographics and medical comorbidities.

Exposures

Patients were stratified by whether or not they were taking CBNS using RxNorm (National Library of Medicine) codes.

Main Outcome Measures

Relative risk (RR) of developing nonexudative AMD, exudative AMD, advanced nonexudative AMD or geographic atrophy (GA), blindness, or requiring intravitreal anti-vascular endothelial growth factor (VEGF) therapy.

Results

A total of 66 804 patients (mean [SD] age, 64.9 [10.1] years; 44 124 female [66.1%]) taking CBNS and 1 809 440 patients (mean [SD] age, 67.0 [9.5] years; 999 534 female [55.2%]) not taking CBNS were included in this study. Among patients without a history of AMD aged 50 years or older, CBNS use was associated with lower rates of developing nonexudative AMD (RR, 0.23; 95% CI, 0.21-0.26; P < .001), advanced nonexudative AMD or GA (RR, 0.11; 95% CI, 0.07-0.17; P < .001), exudative AMD (RR, 0.28; 95% CI, 0.24-0.32; P < .001), blindness (RR, 0.46; 95% CI, 0.36-0.59; P < .001), or requiring intravitreal anti-VEGF therapy (RR, 0.15; 95% CI, 0.13-0.17; P < .001) when compared with matched patients not taking CBNS. Results were consistent among subsets of patients 60 and 70 years or older, respectively. Among patients with early nonexudative AMD, subsequent instances of CBNS prescription records were associated with lower rates of developing advanced nonexudative AMD or GA (RR, 0.58; 95% CI, 0.41-0.81; P < .001) when compared with matched patients with early nonexudative AMD without a CBNS prescription record.

Conclusion and Relevance

Results of this cohort study suggest that a reduced risk of developing AMD or progression to later stages of AMD was associated with subsequent use of CBNS. Further investigation to validate these findings, safety, and potential pharmacoprotective mechanisms of CBNS in AMD are suggested.

Maternal allergy-preventive diet index, offspring infant diet diversity, and childhood allergic diseases

BACKGROUND

Studies of childhood diet diversity and allergic disease have not examined additional associations with an offspring allergy-linked maternal diet index during pregnancy. We studied both associations in a pre-birth cohort.

METHODS

Offspring allergic disease diagnoses were obtained from electronic medical records. Maternal and infant diet were self-reported. Adjusted parametric Weibull time-to-event models assessed associations between maternal diet index, infant diet diversity and time to development of allergic rhinitis, atopic dermatitis, asthma, wheeze, IgE-mediated food allergy, and a combined outcome of any allergic disease except for wheeze.

RESULTS

Infant diet diversity at 1 year was associated with the risk of the combined outcome between 1 and 4 years of age (p = .002). While both maternal diet index and infant diet diversity at 1 year were associated with the risk of the combined outcome between 1 and 4 years of age (both p < .05), infant diet diversity at 1 year did not modify the association between maternal diet index and the risk of the combined outcome between 1 and 4 years of age (p = .5). The group with the lowest risk of the combined allergy outcome had higher maternal diet index and higher infant diet diversity.

CONCLUSIONS

The novel finding that both maternal diet index during pregnancy and infant diet diversity at 12 months are associated with the risk of a combined allergic disease outcome points to two targets for preventive interventions: maternal diet index scores during pregnancy and offspring diet diversity during infancy.

Evaluation of AJCC Nodal Staging for Intraductal Papillary Mucinous Neoplasm-Derived Pancreatic Ductal Adenocarcinoma

BACKGROUND

The American Joint Committee on Cancer (AJCC) eighth edition is based on pancreatic intraepithelial neoplasia-derived pancreatic ductal adenocarcinoma (PDAC), a biologically distinct entity from intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic cancer. The role of nodal disease and the AJCC's prognostic utility for IPMN-derived pancreatic cancer are unclear. This study aimed to evaluate the prognostic role of nodal disease and the AJCC eighth-edition N-staging for IPMN-derived pancreatic cancer.

METHODS

Upfront-surgery patients with IPMN-derived PDAC from four centers were stratified according to the AJCC eighth-edition N stage. Disease characteristics were compared using descriptive statistics, and both overall survival (OS) and recurrence-free survival (RFS) were evaluated using log-rank tests. Multivariable Cox regression was performed to determine the prognostic value of N stage for OS, presented as hazard ratios with 95 % confidence intervals (95 % CIs). A lowest p value log-rank statistic was used to derive the optimal cutoff for node-positive disease.

RESULTS

For 360 patients, advanced N stage was associated with worse T stage, grade, tubular histology, and perineural and lymphovascular invasion (all p < 0.05). The median OS was 98.3 months (95 % CI 82.8-122.0 months) for N0 disease, 27.8 months (95 % CI 24.4-41.7 months) for N1 disease, and 18.1 months (95 % CI 16.2-25.9 months) for N2 disease (p < 0.001). The AJCC N stage was validated and associated with worse OS (N1 [HR 1.64; range, 1.05-2.57], N2 [HR2.42; range, 1.48-3.96]) and RFS (N1 [HR 1.81; range, 1.23-2.68], N2 [HR 3.72; range, 2.40-5.77]). The optimal cutoff for positive nodes was five nodes.

CONCLUSION

The AJCC eighth-edition N-staging is valid and prognostic for both OS and RFS in IPMN-derived PDAC.

Prognostic impact of log odds of positive lymph nodes (LODDS) in the stratification of patients with rectal cancer

INTRODUCTION

The use of the N category of the TNM staging system, lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) in predicting overall survival (OS) and disease-free survival (DFS) in patients with rectal cancer is still controversial.

MATERIAL AND METHODS

A retrospective study of 445 patients with rectal cancer who underwent surgery between 2008 and 2017 in the University Complex Hospital of Vigo was performed. Patients were stratified according to number of lymph nodes examined (NLNE), N staging, LNR and LODDS. The analysis was performed using the log-rank test, Kaplan-Meier functions, Cox regression and ROC curves.

RESULTS

Five-year OS and DFS were 73.7% and 62.5%, respectively. No statistically significant differences were observed depending on NLNE. Increased LNR and LODDS were associated with shorter OS and DFS, independently of NLNE. Multivariate analysis showed that N stage, LNR and LODDS were independently associated with OS and DFS; however, the LODDS system obtained the best area under the curve, with greater predictive capacity for OS (AUC: 0.679) and DFS (AUC: 0.711).

CONCLUSION

LODDS and LNR give prognostic information that is not related to NLNE. LODDS provides better prognostic accuracy in patients with negative nodes than LNR and N stage.

Endoscopic or combined management of post-surgical biliary leaks: a two-center recent experience

BACKGROUND AND AIMS

Post-surgical biliary leaks (PSBL) are one of the most prevalent and significant adverse events emerging after liver or biliary tract surgeries. Endoscopic retrograde cholangiopancreatography (ERCP) alone or combined with another approach (Rendez Vous) as treatment of PSBL obtains optimal outcomes due to the possibility of modifying the resistances in the biliary tree.

METHODS

A retrospective double-center study was conducted in two tertiary centers. Consecutive patients who underwent at least one attempt of PSBL correction by ERCP or Rendez Vous procedure between January 2018 and August 2023 were included. The primary outcome was overall endoscopic clinical success. In contrast, the secondary outcomes were hospital stay exceeding five days and endoscopic clinical success with the first endoscopic procedure at the tertiary center. Both univariate and multivariate analyses were used to assess outcomes.

RESULTS

65 patients were included. Patients with one or multiple) leaks had more possibility to achieve the endoscopic clinical success compared to those affected by the association of leaks and stricture (96% vs 67%, p value 0.005). Leaks occurring in the main biliary duct had less probability (67%) to achieve the overall endoscopic clinical success compared to those in the end-to-end anastomosis (90%), in the resection plane or biliary stump (96%) or first or secondary order biliary branches (100%, p value 0.038). A leak-bridging stent positioning had more probability of achieving the endoscopic clinical success than a not leak-bridging stent (91% vs 53%, p value 0.005).

CONCLUSIONS

ERCP and Rendez Vous procedures are safe and effective for treating PSBL, regardless of the type of preceding surgery, even if technical or clinical success was not achieved on the first attempt. A stent should be placed, if feasible, leak-bridging to enhance treatment efficacy.

Mechanical Ventilation for Children Approaching End of Life: A PHIS Study, 2010-2019

OBJECTIVE

To determine the prevalence of invasive and noninvasive mechanical ventilation (IMV and NIV) for children who die in the hospital, to assess for change over time, and to determine the association between mode(s) of ventilation and hospital resource utilization.

METHODS

Multicenter retrospective cohort of 37 children's hospitals in the United States participating in Pediatric Health Information Systems Database. Included 41 091 hospitalizations for patients 0 to 21 years who died in hospital January 2010 to December 2019. Univariate and multivariate logistic regression examined IMV and NIV use clustered by hospital, adjusting for demographic and clinical characteristics. χ2, Kruskal-Wallis tests and multivariable regression models measured associations between mode of ventilation and resource utilization.

RESULTS

Over the decade, the percentage exposed to any IMV remained unchanged (∼88.5%), whereas any NIV increased 7.1% (18.8% to 25.9%), with wide interhospital variability in NIV use. Exposure to both IMV + NIV increased 6.0% (16.8% to 22.8%). Compared with only IMV, only NIV had lower odds of ICU admission and death, shorter ICU length of stay (LOS), similar hospital LOS, and lower costs. Both IMV + NIV had higher odds of ICU admission, longer duration of IMV, lower likelihood of ICU death, longer ICU and hospital LOS, and higher costs than IMV alone.

CONCLUSIONS

For children who died in the hospital in the past decade, use of NIV has increased without a reciprocal decrease in IMV, because of an increase in exposure to both IMV + NIV, a combination associated with high hospital resource utilization.

Epidemiology of heart failure presentations to United States emergency departments from 2016 to 2023

INTRODUCTION

Heart failure (HF) is a common condition prompting presentation to the Emergency Department (ED) and is associated with significant morbidity and mortality. However, there is limited recent large-scale, robust data available on the admission rates, evaluation, and treatment of HF in the ED setting.

METHODS

This was a cross-sectional study of ED presentations for HF from 1/1/2016 to 12/31/2023 using the Epic Cosmos database. All ED visits with ICD-10 codes corresponding to acute HF were included. We excluded congenital heart disease and isolated right-sided HF. Outcomes included percentage of total ED visits, admission rates, troponin, B-type natriuretic peptide (BNP), chest radiography, and diuretic and nitroglycerin medication administration. Subgroup analyses of medications were performed by medication and route of administration (transdermal, sublingual/oral, and intravenous).

RESULTS

Out of 190,694,752 ED encounters, 2,626,011 (1.4 %) visits were due to acute HF. Of these, 1,897,369 (72.3 %) were admitted to the hospital. The majority of patients had a troponin (90.3 %), BNP (91.1 %), and chest radiograph (89.5 %) ordered. 82.5 % received intravenous diuresis, while 46.2 % received oral diuresis. The most common diuretic was furosemide (78.4 % intravenous, 32.5 % oral), followed by bumetanide (9.5 % intravenous, 7.1 % oral), and torsemide (0 % intravenous, 8.1 % oral). Nitroglycerin was given in 26.0 %, with the most common route being sublingual/oral (16.6 %), followed by transdermal (9.2 %) and intravenous (3.5 %).

CONCLUSION

HF represents a common reason for ED presentation, with the majority of patients being admitted. All patients received diuresis in the ED, with the majority receiving intravenous diuresis with furosemide. Approximately one-quarter received nitroglycerin with the sublingual/oral route being most common. These findings can help inform health policy initiatives, including admission decisions and evidence-based medication administration.

Impact of the COVID-19 pandemic on lung cancer diagnoses and mortality: A nationwide study in France

BACKGROUND

During the first wave of the COVID-19 pandemic, a reduction in the number of newly diagnosed cases of lung cancer has been reported worldwide, often associated with a higher proportion of cases diagnosed at an advanced stage compared with previous years.

METHODS

Using the French National Hospital Database, we investigated incident lung cancer cases and their mortality during pandemic years 2020 and 2021, compared to predictions based on pre-pandemic years 2013-2019. Mortality was assessed up to 24 months following incidence date. Expected numbers of incident cases and all-cause deaths during the pandemic were estimated using Poisson regression models and survival was analyzed using Cox regressions.

RESULTS

The database included 397,092 incident lung cancer cases in total, 20 % of whom underwent thoracic surgery. During the first pandemic wave (March-June 2020), there were 12 % i.e., 1940 fewer incident lung cancer cases than the expected figure (16,325), while no significant difference was found thereafter. Survival at 6 and 24 months improved steadily from 2013 to 2019 and continued to improve during pandemic years 2020-2021. However, during the first wave, a slight excess mortality was observed compared with predictions based on pre-pandemic trends.

CONCLUSIONS

The lower incidence observed during the first wave with no catch-up in the following periods could be explained by deaths among yet undiagnosed patients, either from COVID-19 or as a result of barriers to accessing healthcare. The excess mortality observed for both operated and non-operated patients may be attributable to delayed diagnosis, as well as to COVID-19-related deaths.

Comparison of postoperative prognoses for resectable colorectal cancer with vs. without oncologic emergency using propensity score‑matched analyses: A single-center retrospective observational study

While oncological emergencies in colorectal cancer present distinct challenges, existing literature offers conflicting evidence regarding long-term outcomes. Therefore, the present study compared the postoperative prognoses between patients with and without oncological emergencies. A retrospective evaluation was conducted on patients who had undergone radical surgery for pathological stages II and III colorectal cancer at a single center between January 2012 and December 2020. Patients were classified into the non-emergency and oncological emergency groups. The status of oncologic emergency was divided into obstruction and perforation. The outcomes were compared using propensity score matching. The primary objective was to compare the postoperative prognoses between non-emergency and oncological emergency situations. The secondary objectives included comparing prognoses between obstruction and perforation, identifying the type of recurrence depending on the status of oncologic emergency, and assessing the effect of adjuvant chemotherapy for oncologic emergencies. This study included 524 patients. After propensity score matching, the prognoses of oncological emergencies were worse compared with those without any emergency, whereas those of obstruction and perforation did not significantly differ. Regarding the type of recurrence, peritoneal dissemination in obstruction and local recurrence in perforation was more common compared with that in non-emergency cases. Adjuvant chemotherapy improved the recurrence-free survival for cases with oncological emergencies. The prognoses in cases with oncological emergencies could be worse compared with those without any emergency, whereas obstruction and perforation outcomes can be comparable. The administration of adjuvant chemotherapy should be strongly considered for oncological emergencies.

Insomnia is related to long-term atrial fibrillation recurrence following radiofrequency ablation

OBJECTIVE

Atrial fibrillation (AF), the most common cardiac arrhythmia, presents significant health challenges, and the intricate connection between insomnia and AF has garnered substantial attention. This cohort study aims to investigate the relationship between insomnia and AF recurrences following radiofrequency ablation.

MATERIALS AND METHODS

Data were retrieved from an electronic database of patients who underwent radiofrequency ablation for AF. The primary endpoint was AF recurrence. We utilized a multivariable Cox model, coupled with three propensity score methods, for analysis.

RESULTS

Between January 1, 2017, and June 1, 2022, 541 patients who underwent radiofrequency ablation for AF were recorded in the database. After excluding 185 patients, the final cohort comprised 356 patients. Among them, 68 were afflicted by insomnia, while 288 were not. Over a median follow-up of 755 days, one patient died, and 130 (36.5%) experienced AF recurrence. Multivariate Cox regression analysis revealed that the insomnia group had a higher risk of AF recurrence compared to the non-insomnia group (HR: 1.83, 95% CI: 1.16-2.89). Further landmark analysis showed no significant difference in AF recurrence rates during the initial 1-year follow-up. However, beyond 1 year, the insomnia group demonstrated a significantly higher AF recurrence rate. As the number of insomnia symptoms increased, the risk of AF recurrence also rose significantly, indicating a dose-response relationship.

CONCLUSION

This study establishes a significant link between insomnia and long-term AF recurrence following radiofrequency ablation. It underscores the importance of identifying and addressing insomnia in patients with AF undergoing radiofrequency ablation.

Spiritual Health in Iranian Patients With Cardiovascular Diseases: A Systematic Review and Meta-analysis

This systematic review and meta-analysis aimed to evaluate the spiritual health status of Iranian patients with cardiovascular diseases. A literature search was conducted in national (MagIran and Scientific Information Database) and international (Scopus, PubMed, and Web of Science/ISI) databases from inception to December 2021. A random-effects model was used to estimate the pooled score of spiritual health. Based on the eligibility criteria, 22 articles were selected for the final analysis. The pooled score of spiritual health in Iranian patients with cardiovascular diseases was 61% (95% confidence interval: 54%-68%). In subgroup analysis, the pooled score in patients with heart failure was higher than other patients (67% vs. 58%). Publication bias was not significant (p = 0.554). Results indicated that the spiritual health of Iranian patients with cardiovascular diseases was moderate. Therefore, it is recommended that proper training be provided to these patients to enhance their adaptation to the complications of cardiovascular diseases.

Differences in physical examination findings between those who present with or without headache soon after a whiplash injury: a cross-sectional study

AIM

To determine differences in physical examination findings between people with acute whiplash-associated disorders (WAD) with and without headache.

METHODS

In this cross-sectional study, participants with acute WAD were evaluated to assess differences in the presence of physical impairments. The following were assessed: pain intensity on manual palpation the over spinous process of C1-C3, zygapophyseal joints of C0-C4, and trapezius, sternocleidomastoid, suboccipitalis, masseter and temporalis muscles; cervical range of motion (ROM); flexion-rotation test (FRT); forward head posture; cranio-cervical flexion test (CCFT); neck flexor and extensor endurance; pressure-pain thresholds (PPT) over neural structures and upper limb neural tests (ULNT) in addition to median UNLT + CCF. Correlation analyses were performed to assess the association between examination findings and headache intensity. Logistic regression and discriminant analyses were also performed.

RESULTS

Forty-seven participants (26 men and 21 women; mean age = 38.9 years old) were included in the study. 60% of the participants presented with headache. Several examination findings were significantly different between groups. A group of examination findings composed of neck endurance, manual palpation over cervical and muscular structures, PPT, CCFT, ROM and FRT could discriminate between groups with a sensitivity of 86.7% and specificity of 90%.

CONCLUSIONS

Several neuromusculoskeletal features are different between people with acute WAD with or without headache. A combination of features could distinguish between groups with high levels of sensitivity and specificity.