1
|
Adaptive Strategies for Retention in Care among Persons Living with HIV. NEJM EVIDENCE 2023; 2:10.1056/evidoa2200076. [PMID: 38143482 PMCID: PMC10745095 DOI: 10.1056/evidoa2200076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND Optimizing retention in human immunodeficiency virus (HIV) treatment may require sequential behavioral interventions based on patients' response. METHODS In a sequential multiple assignment randomized trial in Kenya, we randomly assigned adults initiating HIV treatment to standard of care (SOC), Short Message Service (SMS) messages, or conditional cash transfers (CCT). Those with retention lapse (missed a clinic visit by ≥14 days) were randomly assigned again to standard-of-care outreach (SOC-Outreach), SMS+CCT, or peer navigation. Those randomly assigned to SMS or CCT who did not lapse after 1 year were randomly assigned again to either stop or continue the initial intervention. Primary outcomes were retention in care without an initial lapse, return to the clinic among those who lapsed, and time in care; secondary outcomes included adjudicated viral suppression. Average treatment effect (ATE) was calculated using targeted maximum likelihood estimation with adjustment for baseline characteristics at randomization and certain time-varying characteristics at rerandomization. RESULTS Among 1809 participants, 79.7% of those randomly assigned to CCT (n=523/656), 71.7% to SMS (n=393/548), and 70.7% to SOC (n=428/605) were retained in care in the first year (ATE: 9.9%; 95% confidence interval [CI]: 5.4%, 14.4% and ATE: 4.2%; 95% CI: -0.7%, 9.2% for CCT and SMS compared with SOC, respectively). Among 312 participants with an initial lapse who were randomly assigned again, 69.1% who were randomly assigned to a navigator (n=76/110) returned, 69.5% randomly assigned to CCT+SMS (n=73/105) returned, and 55.7% randomly assigned to SOC-Outreach (n=54/97) returned (ATE: 14.1%; 95% CI: 0.6%, 27.6% and ATE: 11.4%; 95% CI: -2.2%, 24.9% for navigator and CCT+SMS compared with SOC-Outreach, respectively). Among participants without lapse on SMS, continuing SMS did not affect retention (n=122/180; 67.8% retained) versus stopping (n=151/209; 72.2% retained; ATE: -4.4%; 95% CI: -16.6%, 7.9%). Among participants without lapse on CCT, those continuing CCT had higher retention (n=192/230; 83.5% retained) than those stopping (n=173/287; 60.3% retained; ATE: 28.6%; 95% CI: 19.9%, 37.3%). Among 15 sequenced strategies, initial CCT, escalated to navigator if lapse occurred and continued if no lapse occurred, increased time in care (ATE: 7.2%, 95% CI: 3.7%, 10.7%) and viral suppression (ATE: 8.2%, 95% CI: 2.2%, 14.2%), the most compared with SOC throughout. Initial SMS escalated to navigator if lapse occurred, and otherwise continued, showed similar effect sizes compared with SOC throughout. CONCLUSIONS Active interventions to prevent retention lapses followed by navigation for those who lapse and maintenance of initial intervention for those without lapse resulted in best overall retention and viral suppression among the strategies studied. Among those who remained in care, discontinuation of CCT, but not SMS, compromised retention and suppression. (Funded by National Institutes of Health grants R01 MH104123, K24 AI134413, and R01 AI074345; ClinicalTrials.gov number, NCT02338739.).
Collapse
|
2
|
1906. Impact of Mask Mandate Timing on Community Transmission of SARS-CoV-2 in the St. Louis Metropolitan Area. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Mask mandates have been a widely used public health tool during the COVID-19 pandemic, but how to optimize their impact in the setting of concurrent but spontaneous population-level behavior changes due to rising case counts is not known. This study aimed to examine how earlier or later mask mandate implementation in the context of spontaneous behavior change would have affected transmission of SARS-CoV-2 and severe COVID-19 outcomes in the St. Louis, Missouri area.
Methods
Our model utilized aggregated hospitalization and death data for St. Louis city and county residents admitted to nearly all hospitals in the metropolitan area. We first fit a real-life model to estimate changes in transmission after the July 3, 2020 mask mandate, and then created counterfactual scenarios in which 1) 10%, 25%, and 50% of the changes were attributed to the mandate (as opposed to spontaneous behavior change) and 2) the mandate was implemented 3 or 7 days earlier, or 7 or 14 days later. We used an SEIR (Susceptible-Exposed-Infectious-Recovered) model framework and fit models in R.
Results
Assuming that 50% of increased masking was due to the mandate, implementing a mandate 7 days earlier was associated with a reduction from 12,685 (IQR: 10,463-16,560) to 12,294 (10,296-15,205) cumulative hospitalizations by September 30, while a 2-week delay was associated with an increase to 13,277 (10,808-17,908) hospitalizations. Trends were similar, but with reduced magnitude, when assuming that 10% or 25% of increased masking was due to the mandate (Figure). Depending on whether 10%, 25%, or 50% of increased masking was due to the mandate, implementing the mandate 1 week early was associated with a return to baseline (June 26) hospital census 1-7 days earlier, while delaying the mandate by 2 weeks led to a 2-12 day delay in return to baseline.
Hospital census and cumulative deaths in the real-life (baseline) model and under 12 counterfactual scenarios which vary mask mandate timing (3 or 7 days earlier, or 7 or 14 days delayed) and percentage of increase in masking that is attributed to the mask mandate (Panels A-B: 10%, Panels C-D: 25%, and Panels E-F: 50%).
As more of the increase in masking is attributed to the mandate, the costs of delaying the mandate and the benefits of earlier implementation increase. While differences in hospital census are most apparent several weeks after the mandate, differences in deaths gradually become more apparent over time.
Conclusion
Impact of a mask mandate depends on both timing and percent of increased masking that is attributed to the mandate. Implementing a mandate even a few days earlier is associated with fewer cumulative hospitalizations and earlier return to baseline, but the overall duration of implementation is slightly longer. Given wide variations in public behavior, locally-tailored models are essential for estimating the impact of interventions and informing the local public health response.
Disclosures
All Authors: No reported disclosures.
Collapse
|
3
|
A Real-World Study Assessing the Relationship Between Positive Airway Pressure Treatment, Excessive Daytime Sleepiness, and Patient Satisfaction in Obstructive Sleep Apnoea. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
4
|
Quantifying inequities in COVID-19 vaccine distribution over time by social vulnerability, race and ethnicity, and location: A population-level analysis in St. Louis and Kansas City, Missouri. PLoS Med 2022; 19:e1004048. [PMID: 36026527 PMCID: PMC9417193 DOI: 10.1371/journal.pmed.1004048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/02/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Equity in vaccination coverage is a cornerstone for a successful public health response to COVID-19. To deepen understanding of the extent to which vaccination coverage compares with initial strategies for equitable vaccination, we explore primary vaccine series and booster rollout over time and by race/ethnicity, social vulnerability, and geography. METHODS AND FINDINGS We analyzed data from the Missouri Department of Health and Senior Services on all COVID-19 vaccinations administered across 7 counties in the St. Louis region and 4 counties in the Kansas City region. We compared rates of receiving the primary COVID-19 vaccine series and boosters relative to time, race/ethnicity, zip-code-level Social Vulnerability Index (SVI), vaccine location type, and COVID-19 disease burden. We adapted a well-established tool for measuring inequity-the Lorenz curve-to quantify inequities in COVID-19 vaccination relative to these key metrics. Between 15 December 2020 and 15 February 2022, 1,763,036 individuals completed the primary series and 872,324 received a booster. During early phases of the primary series rollout, Black and Hispanic individuals from high SVI zip codes were vaccinated at less than half the rate of White individuals from low SVI zip codes, but rates increased over time until they were higher than rates in White individuals after June 2021; Asian individuals maintained high levels of vaccination throughout. Increasing vaccination rates in Black and Hispanic communities corresponded with periods when more vaccinations were offered at small community-based sites such as pharmacies rather than larger health systems and mass vaccination sites. Using Lorenz curves, zip codes in the quartile with the lowest rates of primary series completion accounted for 19.3%, 18.1%, 10.8%, and 8.8% of vaccinations while representing 25% of the total population, cases, deaths, or population-level SVI, respectively. When tracking Gini coefficients, these disparities were greatest earlier during rollout, but improvements were slow and modest and vaccine disparities remained across all metrics even after 1 year. Patterns of disparities for boosters were similar but often of much greater magnitude during rollout in fall 2021. Study limitations include inherent limitations in the vaccine registry dataset such as missing and misclassified race/ethnicity and zip code variables and potential changes in zip code population sizes since census enumeration. CONCLUSIONS Inequities in the initial COVID-19 vaccination and booster rollout in 2 large US metropolitan areas were apparent across racial/ethnic communities, across levels of social vulnerability, over time, and across types of vaccination administration sites. Disparities in receipt of the primary vaccine series attenuated over time during a period in which sites of vaccination administration diversified, but were recapitulated during booster rollout. These findings highlight how public health strategies from the outset must directly target these deeply embedded structural and systemic determinants of disparities and track equity metrics over time to avoid perpetuating inequities in healthcare access.
Collapse
|
5
|
Abstract No. 370 Single center retrospective study on the efficacy of contrast enhanced ultrasound for detection of endoleak after endovascular aortic repair. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
6
|
Deliberation, Dissent, and Distrust: Understanding Distinct Drivers of Coronavirus Disease 2019 Vaccine Hesitancy in the United States. Clin Infect Dis 2022; 74:1429-1441. [PMID: 34272559 PMCID: PMC8406882 DOI: 10.1093/cid/ciab633] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite the availability of safe and efficacious coronavirus disease 2019 vaccines, a significant proportion of the American public remains unvaccinated and does not appear to be immediately interested in receiving the vaccine. METHODS In this study, we analyzed data from the US Census Bureau's Household Pulse Survey, a biweekly cross-sectional survey of US households. We estimated the prevalence of vaccine hesitancy across states and nationally and assessed the predictors of vaccine hesitancy and vaccine rejection. In addition, we examined the underlying reasons for vaccine hesitancy, grouped into thematic categories. RESULTS A total of 459 235 participants were surveyed from 6 January to 29 March 2021. While vaccine uptake increased from 7.7% to 47%, vaccine hesitancy rates remained relatively fixed: overall, 10.2% reported that they would probably not get a vaccine and 8.2% that they would definitely not get a vaccine. Income, education, and state political leaning strongly predicted vaccine hesitancy. However, while both female sex and black race were factors predicting hesitancy, among those who were hesitant, these same characteristics predicted vaccine reluctance rather than rejection. Those who expressed reluctance invoked mostly "deliberative" reasons, while those who rejected the vaccine were also likely to invoke reasons of "dissent" or "distrust." CONCLUSIONS Vaccine hesitancy comprises a sizable proportion of the population and is large enough to threaten achieving herd immunity. Distinct subgroups of hesitancy have distinctive sociodemographic associations as well as cognitive and affective predilections. Segmented public health solutions are needed to target interventions and optimize vaccine uptake.
Collapse
|
7
|
Multidrug resistant Gram-negative bacilli infection in critically ill patients with Coronavirus disease 2019. Int J Infect Dis 2022. [PMCID: PMC8884770 DOI: 10.1016/j.ijid.2021.12.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
8
|
KPC-producing Klebsiella pneumoniae ST11 spreading in colonized and infected patient from a Transplant Unit. Int J Infect Dis 2022. [DOI: 10.1016/j.ijid.2021.12.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
9
|
Understanding Drivers of Coronavirus Disease 2019 (COVID-19) Racial Disparities: A Population-Level Analysis of COVID-19 Testing Among Black and White Populations. Clin Infect Dis 2021; 73:e2921-e2931. [PMID: 33315066 PMCID: PMC7799327 DOI: 10.1093/cid/ciaa1848] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Indexed: 12/13/2022] Open
Abstract
Background Disparities in coronavirus disease 2019 (COVID-19) testing—the pandemic’s most critical but limited resource—may be an important but modifiable driver of COVID-19 inequities. Methods We analyzed data from the Missouri State Department of Health and Senior Services on all COVID-19 tests conducted in the St Louis and Kansas City regions. We adapted a well-established tool for measuring inequity—the Lorenz curve—to compare COVID-19 testing rates per diagnosed case among Black and White populations. Results Between 14/3/2020 and 15/9/2020, 606 725 and 328 204 COVID-19 tests were conducted in the St Louis and Kansas City regions, respectively. Over time, Black individuals consistently had approximately half the rate of testing per case than White individuals. In the early period (14/3/2020 to 15/6/2020), zip codes in the lowest quartile of testing rates accounted for only 12.1% and 8.8% of all tests in the St Louis and Kansas City regions, respectively, even though they accounted for 25% of all cases in each region. These zip codes had higher proportions of residents who were Black, without insurance, and with lower median incomes. These disparities were reduced but still persisted during later phases of the pandemic (16/6/2020 to 15/9/2020). Last, even within the same zip code, Black residents had lower rates of tests per case than White residents. Conclusions Black populations had consistently lower COVID-19 testing rates per diagnosed case than White populations in 2 Missouri regions. Public health strategies should proactively focus on addressing equity gaps in COVID-19 testing to improve equity of the overall response.
Collapse
|
10
|
Outcomes Associated With Social Distancing Policies in St Louis, Missouri, During the Early Phase of the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2123374. [PMID: 34468756 PMCID: PMC8411298 DOI: 10.1001/jamanetworkopen.2021.23374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/27/2021] [Indexed: 01/10/2023] Open
Abstract
Importance In the absence of a national strategy in response to the COVID-19 pandemic, many public health decisions fell to local elected officials and agencies. Outcomes of such policies depend on a complex combination of local epidemic conditions and demographic features as well as the intensity and timing of such policies and are therefore unclear. Objective To use a decision analytical model of the COVID-19 epidemic to investigate potential outcomes if actual policies enacted in March 2020 (during the first wave of the epidemic) in the St Louis region of Missouri had been delayed. Design, Setting, and Participants A previously developed, publicly available, open-source modeling platform (Local Epidemic Modeling for Management & Action, version 2.1) designed to enable localized COVID-19 epidemic projections was used. The compartmental epidemic model is programmed in R and Stan, uses bayesian inference, and accepts user-supplied demographic, epidemiologic, and policy inputs. Hospital census data for 1.3 million people from St Louis City and County from March 14, 2020, through July 15, 2020, were used to calibrate the model. Exposures Hypothetical delays in actual social distancing policies (which began on March 13, 2020) by 1, 2, or 4 weeks. Sensitivity analyses were conducted that explored plausible spontaneous behavior change in the absence of social distancing policies. Main Outcomes and Measures Hospitalizations and deaths. Results A model of 1.3 million residents of the greater St Louis, Missouri, area found an initial reproductive number (indicating transmissibility of an infectious agent) of 3.9 (95% credible interval [CrI], 3.1-4.5) in the St Louis region before March 15, 2020, which fell to 0.93 (95% CrI, 0.88-0.98) after social distancing policies were implemented between March 15 and March 21, 2020. By June 15, a 1-week delay in policies would have increased cumulative hospitalizations from an observed actual number of 2246 hospitalizations to 8005 hospitalizations (75% CrI: 3973-15 236 hospitalizations) and increased deaths from an observed actual number of 482 deaths to a projected 1304 deaths (75% CrI, 656-2428 deaths). By June 15, a 2-week delay would have yielded 3292 deaths (75% CrI, 2104-4905 deaths)-an additional 2810 deaths or a 583% increase beyond what was actually observed. Sensitivity analyses incorporating a range of spontaneous behavior changes did not avert severe epidemic projections. Conclusions and Relevance The results of this decision analytical model study suggest that, in the St Louis region, timely social distancing policies were associated with improved population health outcomes, and small delays may likely have led to a COVID-19 epidemic similar to the most heavily affected areas in the US. These findings indicate that an open-source modeling platform designed to accept user-supplied local and regional data may provide projections tailored to, and more relevant for, local settings.
Collapse
|
11
|
Post-exposure prophylaxis for human immunodeficiency virus after sexual assault in a Midwestern U.S. emergency department. Am J Emerg Med 2021; 49:117-123. [PMID: 34102456 DOI: 10.1016/j.ajem.2021.05.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/01/2021] [Accepted: 05/28/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Emergency departments (EDs) play an essential role in the timely initiation of HIV post-exposure prophylaxis (PEP) for sexual assault victims. METHODS Retrospective analysis of sexual assault victims evaluated and offered HIV PEP in an urban academic ED between January 1, 2005 and January 1, 2018. Data on demographics, comorbidities, nature of sexual assault, initial ED care, subsequent healthcare utilization within 28 days of initial ED visit, and evidence of seroconversion within 6 months of the initial ED visit were obtained. Predictors of subsequent ED visit and follow-up in the infectious diseases clinic were evaluated using logistic regression analysis. RESULTS Four hundred twenty-three ED visits met criteria for inclusion in this study. Median age at ED presentation was 25 years (IQR 21-34 years), with the majority of victims being female (95.5%), Black (63.4%), unemployed (66.3%) and uninsured (53.9%); psychiatric comorbidities (38.8%) and substance abuse (23.6%) were common. About 87% of the patients accepted HIV PEP (368 of 423 ED visits). Age (OR 0.97, 95% CI 0.94-0.99, p = 0.025) and sexual assault involving >1 assailant (OR 0.48, 95% CI 0.26-0.88, p = 0.018) were associated with lower likelihood of HIV PEP acceptance. Ten patients (2.7%) followed up with the infectious disease clinic within 28 days of starting HIV PEP; 70 patients (19%) returned to the ED for care during the same time period. Psychiatric comorbidity (OR 2.48, 95% CI 1.43-4.30, p = 0.001) and anal penetration (OR 2.02, 95% CI 1.10-3.70, p = 0.024) were associated with greater likelihood of repeat ED visit; female gender (OR 0.30, 95% CI 0.11-0.85, p = 0.023) was associated with lower likelihood of repeat visit. Completion of HIV PEP was documented for 14 (3.3%) individuals. CONCLUSIONS While ED patient acceptance of HIV PEP after sexual assault was high, infectious disease clinic follow-up and documented completion of PEP remained low. Innovative care models bridging EDs to outpatient clinics and community support services are needed to optimize transitions of care for sexual assault victims, including those receiving HIV PEP.
Collapse
|
12
|
Lung organoids and other preclinical models of pulmonary fibrosis. QJM 2021; 114:167-173. [PMID: 33484260 DOI: 10.1093/qjmed/hcaa281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/10/2020] [Accepted: 09/21/2020] [Indexed: 11/12/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive fatal disease affecting over 100 000 people in Europe with an increasing incidence. Available treatments offer only slowing of disease progression and are poorly tolerated by patients leading to cessation of therapy. Lung transplant remains the only cure. Therefore, alternative treatments are urgently required. The pathology of IPF is complex and poorly understood and thus creates a major obstacle to the discovery of novel treatments. Additionally, preclinical assessment of new treatments currently relies upon animal models where disparities with human lung biology often hamper drug development. At a cellular level, IPF is characterized by persistent and abnormal deposition of extracellular matrix by fibroblasts and alveolar epithelial cell injury which is seen as a key event in initiation of disease progression. In-depth investigation of the role of alveolar epithelial cells in health and disease has been impeded due to difficulties in primary cell isolation and culture ex vivo. Novel strategies employing patient-derived induced pluripotent stem cells engineered to produce type 2 alveolar epithelial cells (iAEC2) cultured as three-dimensional organoids have the potential to overcome these hurdles and inform new effective precision treatments for IPF leading to improved survival and quality of life for patients worldwide.
Collapse
|
13
|
71P Impact of body mass index (BMI) on pathological complete response (pCR) and survival of breast cancer (BC) patients receiving neoadjuvant chemotherapy (NAC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
14
|
The accuracy of computed tomography for clavicle non-union evaluation. Shoulder Elbow 2021; 13:195-204. [PMID: 33897851 PMCID: PMC8039767 DOI: 10.1177/1758573219884067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/06/2019] [Accepted: 09/26/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The primary aim of this study is to determine the accuracy of CT scanning when evaluating non-union of the clavicle. METHODS A retrospective review was performed of all CT scans undertaken for suspected nonunion of midshaft clavicle fractures over a 10-year period. The influence of scan timing, callus and patient characteristics was evaluated. RESULTS One hundred eighty-four CT scans were analysed. No patient was incorrectly diagnosed with union (n = 85). Ninety-nine scans were reported as non-union with inadequate bridging callus, 19 of which were united at operation or on repeat CT imaging and represented delayed unions. Atrophic callus was found in 57 patients and all of which had a confirmed non-union (positive predictive value 100%). A hypertrophic callus was found in 42 patients, all of the delayed unions were found in this group (positive predictive value for non-union 55%, p < 0.001). CT compared to radiographs showed greater inter-observer agreement for union (weighted kappa 0.75 vs. 0.50 respectively). Overall, CT is 100% sensitive and 81.7% specific for non-union diagnosis. DISCUSSION CT has excellent accuracy to determine clavicle union but approximately one in five suspected non-unions went onto unite. Hypertrophic callus finding resulted in a delayed union in approximately half of the cases in our study.
Collapse
|
15
|
The Emerging Intersection Between Injection Drug Use and Early Syphilis in Nonurban Areas of Missouri, 2012-2018. J Infect Dis 2021; 222:S465-S470. [PMID: 32877535 DOI: 10.1093/infdis/jiaa056] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The national rate of syphilis has increased among persons who inject drugs (PWID). Missouri is no exception, with increases in early syphilis (ES), congenital syphilis, and PWID, especially in nonurban counties. METHODS Disease intervention specialist records for ES cases in Missouri (2012-2018) were examined. Drug use was classified as injection drug use (IDU) (opioid or methamphetamine) or non-IDU (opioid, methamphetamine, or cocaine). Rates were compared based on residence, sex of sex partner, and drug use. RESULTS Rates of ES in Missouri increased 365%, particularly in small metropolitan and rural areas (1170%). Nonurban areas reported a higher percentage of persons with ES who used injection drugs (12%-15%) compared with urban regions (2%-5%). From 2012 to 2018, women comprised an increasing number of ES cases (8.3%-21%); 93% of women were of childbearing age. Increasingly more women in rural areas with ES also reported IDU during this time (8.4%-21.1%). CONCLUSIONS As syphilis increases in small metropolitan and rural regions, access to high-quality and outreach-based sexual health services is imperative. Healthcare policy to equip health departments with harm reduction services and drug treatment resources offers an opportunity to impact both syphilis increases as well as health outcomes associated with IDU.
Collapse
|
16
|
O-17 A TNM-Immune (TNM-I) classification staging system for predicting survival in colon cancer in a multicenter international SITC study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
17
|
Future directions in regional anaesthesia: a reply. Anaesthesia 2020; 75:555. [DOI: 10.1111/anae.14975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
18
|
3:27 PM Abstract No. 65 Prostate artery embolization in prostate size greater than 80 g: a single-center experience with 2-year follow-up. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
19
|
Abstract No. 681 Angioplasty and/or stenting for transplant renal artery stenosis. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
20
|
560 The inclusion of pulmonary arterial pressure misclassifies diastolic function using the current EACVI guidelines in pre-capillary pulmonary hypertension. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pulmonary hypertension (PH) can be pre-capillary or post-capillary (PVH) etiology based on left-sided filling pressures and pulmonary vascular resistance. The 2016 EACVI/ASE Recommendations for the Evaluation of Left Ventricular Diastolic Function (LVDF) provides flow-diagrams to categorize patients. Parameters used include left atrial volume, Doppler-derived transmitral and mitral annular velocities, and systolic PA pressure (sPAP). There are no dedicated criteria to assess the diastolic function in pulmonary arterial hypertension (PAH). Additionally, diseases such as scleroderma can result in both PAH and PVH, thus including sPAP may alter LVDF diagnostic reliability in this population.
Purpose
Because elevated PAP is fundamental to PAH, we hypothesized that the EACVI/ASE diastolic function algorithm has a lower predictive value in correctly classifying diastolic function in scleroderma.
Methodology
We performed a single-center retrospective analysis of scleroderma patients who underwent complete echocardiography and comprehensive right and left heart catheterization for PH evaluation. PH categorization was defined using the 6th World Symposium hemodynamic definitions (PAH as mPAP ≥20 mmHg, PCWP ≤15 mmHg, PVR ≥ 3 WU). Diastolic function categorization used 2016 EACVI/ASE recommendations. Index catheterization and echocardiogram closest to cardiac catheterization were analyzed.
Results
260 patients underwent evaluation and 63 were diagnosed with PH. PAH was diagnosed in 35 (age 64 ±10, mPAP 55± 18 mmHg, LVEF 60 ± 6%) and PVH in 28 (age 65 ± 10, mPAP 34 ± 14 mmHg, LVEF 63 ± 6%). Of the PAH patients, 20 had normal LVEDP (≤ 12 mmHg) and 15 increased LVEDP. In the PAH normal LVEDP patients, the EACVI algorithm classified diastolic function as normal in 25%, grade 2 in 5%, Grade 3 in 5%, and "indeterminate" in 65%. In the PAH group with increased LVEDP (> 12 mmHg), 27% were incorrectly identified as normal, 7% as grade 2 dysfunction, and 66% as indeterminate. The diastolic function algorithm has a sensitivity of 27% and specificity of 75% to diagnose a LVEDP ≤ 12 mmHg, with an AUC of 0.508 (p = 0.91). With exclusion of sPAP from the algorithm, indeterminate cases in both PAH groups were reclassified as normal, resulting in improved sensitivity (93%) but poorer specificity (10%), and a similar AUC (0.517, p = 0.72). In PVH patients, the algorithm performed better with a sensitivity of 63% and specificity of 83% to predict LVEDP > 12 mmHg with AUC 0.773, p = 0.017.
Conclusion
In scleroderma patients with PAH, the EACVI diastolic algorithm performs poorly and is confounded by including PAP as a parameter. The sensitivity of the algorithm is improved by the exclusion of sPAP although with reduced specificity. It remains inadequate to reliably diagnose normal LVEDP. While useful in other populations, algorithm modifications including exclusion of PAP, must be employed in suspected scleroderma PAH.
Collapse
|
21
|
Immunoscore predicts significant differences in time to recurrence in stage I colon cancer patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
22
|
Integrative combination of high-plex digital profiling techniques and cluster analysis to reveal complex immune biology in the tumour microenvironment of mesothelioma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz239.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
23
|
Significant differences in outcome between Immunoscore categories in stage I colon cancer patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz154.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
24
|
Efficacy and safety of immune checkpoint inhibitor immunotherapy in elderly cancer patients. Clin Transl Oncol 2019; 22:555-562. [DOI: 10.1007/s12094-019-02161-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/08/2019] [Indexed: 12/14/2022]
|
25
|
03:54 PM Abstract No. 185 The difference between the predicted vs actual microwave ablation (MWA) zone is dependent on liver function tests. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
26
|
03:27 PM Abstract No. 182 Microwave ablation (MWA) in cirrhotic patients: prediction of underablation or overablation based on the energy and volume of ablation. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
27
|
MALDI-TOF MS in Anaerobiospirillum succiniciproducens bacteremia: A report of 4 cases in different hosts. Anaerobe 2018; 54:267-270. [DOI: 10.1016/j.anaerobe.2018.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/02/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
|
28
|
MSI status plus immunoscore to select metastatic colorectal cancer patients for immunotherapies. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy493.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
29
|
|
30
|
Novel immunooncology agent, small-molecule rorγ agonist lyc-55716: Tumor selection process for phase IIa expansion and rationale for clinical evaluation in ovarian cancer following phase I dose finding. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
31
|
Abstract No. 714 Single stick method for central venous port safety and efficacy. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
32
|
Geriatric oncology in Spain: survey results and analysis of the current situation. Clin Transl Oncol 2017; 20:1087-1092. [PMID: 29327240 PMCID: PMC6061214 DOI: 10.1007/s12094-017-1813-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 11/16/2017] [Indexed: 11/30/2022]
Abstract
Introduction Geriatric oncology (GO) is a discipline that focuses on the management of elderly patients with cancer. The Spanish Society of Medical Oncology (SEOM) created a Working group dedicated to geriatric oncology in February 2016. Objectives The main goal of this study was to describe the current situation in Spain regarding the management of elderly cancer patients through an online survey of medical oncologists. Methods A descriptive survey was sent to several hospitals by means of the SEOM website. A personal e-mail was also sent to SEOM members. Results Between March 2016 and April 2017, 154 answers were collected. Only 74 centers (48%) had a geriatrics department and a mere 21 (14%) medical oncology departments had a person dedicated to GO. The vast majority (n = 135; 88%) had the perception that the number of elderly patients with cancer seen in clinical practice had increased. Eighteen (12%) oncologists had specific protocols and geriatric scales were used at 55 (31%) centers. Almost all (92%) claimed to apply special management practices using specific tools. There was agreement that GO afforded certain potential advantages. Finally, 99% of the oncologists surveyed believed it and that training in GO had to be improved. Conclusions From the nationwide survey promoted by the Spanish Geriatric Oncology Working Group on behalf of SEOM, we conclude that there is currently no defined care structure for elderly cancer patients. There is an increasing perception of the need for training in GO. This survey reflects a reality in which specific needs are perceived.
Collapse
|
33
|
P1.07-019 Immune Cell Infiltrates in Non-Small Cell Lung Cancer and Interleukin-22 Expression. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
34
|
Programmed intermittent epidural boluses for maintenance of labor analgesia: an impact study. Int J Obstet Anesth 2017; 30:75-76. [PMID: 28108078 DOI: 10.1016/j.ijoa.2016.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/22/2016] [Indexed: 11/27/2022]
|
35
|
Lobar Distribution in Non-Cystic Fibrosis Bronchiectasis Predicts Bacteriologic Pathogen Treatment. Pneumologie 2016. [DOI: 10.1055/s-0036-1592246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
36
|
Spinal or nerve block for knee arthroscopy? Anaesthesia 2016; 71:1244-5. [PMID: 27611047 DOI: 10.1111/anae.13611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
37
|
|
38
|
Electronic Health Records Implementation in Sub-Saharan Africa: A Review of the Literature. Res Social Adm Pharm 2016. [DOI: 10.1016/j.sapharm.2016.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
39
|
Grip strength measurement: Towards a standardized approach in sarcopenia research and practice. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2015.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
40
|
Abstract
Safe vascular access is integral to anaesthetic and critical care practice, but procedures are a frequent source of patient adverse events. Ensuring safe and effective approaches to vascular catheter insertion should be a priority for all practitioners. New technology such as ultrasound and other imaging has increased the number of tools available. This guidance was created using review of current practice and literature, as well as expert opinion. The result is a consensus document which provides practical advice on the safe insertion and removal of vascular access devices.
Collapse
|
41
|
Performance of two Askaryan Radio Array stations and first results in the search for ultrahigh energy neutrinos. Int J Clin Exp Med 2016. [DOI: 10.1103/physrevd.93.082003] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
42
|
A WHO reference reagent to standardize haemagglutination testing for anti-A and anti-B in serum and plasma: international collaborative study to evaluate a candidate preparation. Vox Sang 2016; 111:161-70. [DOI: 10.1111/vox.12399] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 12/18/2022]
|
43
|
Imaging in cancer immunology: Phenotyping of multiple immune cell subsets in-situ in FFPE tissue sections. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv514.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
44
|
3336 Phase II CALM extension study: Enhanced immune-cell infiltration within the tumour micro-environment of patients with advanced melanoma following intralesional delivery of Coxsackievirus A21. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31854-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
45
|
Cytokine release assays for the prediction of therapeutic mAb safety in first-in man trials--Whole blood cytokine release assays are poorly predictive for TGN1412 cytokine storm. J Immunol Methods 2015; 424:43-52. [PMID: 25960173 PMCID: PMC4768082 DOI: 10.1016/j.jim.2015.04.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 04/29/2015] [Accepted: 04/29/2015] [Indexed: 12/29/2022]
Abstract
The therapeutic monoclonal antibody (mAb) TGN1412 (anti-CD28 superagonist) caused near-fatal cytokine release syndrome (CRS) in all six volunteers during a phase-I clinical trial. Several cytokine release assays (CRAs) with reported predictivity for TGN1412-induced CRS have since been developed for the preclinical safety testing of new therapeutic mAbs. The whole blood (WB) CRA is the most widely used, but its sensitivity for TGN1412-like cytokine release was recently criticized. In a comparative study, using group size required for 90% power with 5% significance as a measure of sensitivity, we found that WB and 10% (v/v) WB CRAs were the least sensitive for TGN1412 as these required the largest group sizes (n = 52 and 79, respectively). In contrast, the peripheral blood mononuclear cell (PBMC) solid phase (SP) CRA was the most sensitive for TGN1412 as it required the smallest group size (n = 4). Similarly, the PBMC SP CRA was more sensitive than the WB CRA for muromonab-CD3 (anti-CD3) which stimulates TGN1412-like cytokine release (n = 4 and 4519, respectively). Conversely, the WB CRA was far more sensitive than the PBMC SP CRA for alemtuzumab (anti-CD52) which stimulates FcγRI-mediated cytokine release (n = 8 and 180, respectively). Investigation of potential factors contributing to the different sensitivities revealed that removal of red blood cells (RBCs) from WB permitted PBMC-like TGN1412 responses in a SP CRA, which in turn could be inhibited by the addition of the RBC membrane protein glycophorin A (GYPA); this observation likely underlies, at least in part, the poor sensitivity of WB CRA for TGN1412. The use of PBMC SP CRA for the detection of TGN1412-like cytokine release is recommended in conjunction with adequately powered group sizes for dependable preclinical safety testing of new therapeutic mAbs.
Collapse
|
46
|
Impact of Native Lung Pneumonectomy in Single-Lung Transplant Recipients. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
47
|
Abstract
Both the physical and physiochemical properties of domestic and wild silkworm silk fibroin were studied, including surface energy and surface energy heterogeneity.
Collapse
|
48
|
Tumor infiltrating immune cells as a prognostic biomarker in oral, head and neck squamous cell carcinoma. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2013.07.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
49
|
E-079 Retrospective multicentre analysis of treatment strategies and outcomes with Solitaire FF for acute ischaemic stroke after FDA approval. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
50
|
First results from the microwave air yield beam experiment (MAYBE): Measurement of GHz radiation for ultra-high energy cosmic ray detection. EPJ WEB OF CONFERENCES 2013. [DOI: 10.1051/epjconf/20135308008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|