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Ali R, Connolly ID, Tang OY, Mirza FN, Johnston B, Abdulrazeq HF, Lim RK, Galamaga PF, Libby TJ, Sodha NR, Groff MW, Gokaslan ZL, Telfeian AE, Shin JH, Asaad WF, Zou J, Doberstein CE. Author Correction: Bridging the literacy gap for surgical consents: an AI-human expert collaborative approach. NPJ Digit Med 2024; 7:93. [PMID: 38609435 PMCID: PMC11015017 DOI: 10.1038/s41746-024-01099-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Affiliation(s)
- Rohaid Ali
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Norman Prince Neurosciences Institute, Providence, RI, USA.
| | - Ian D Connolly
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Oliver Y Tang
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Fatima N Mirza
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Benjamin Johnston
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Hael F Abdulrazeq
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Norman Prince Neurosciences Institute, Providence, RI, USA
| | - Rachel K Lim
- Department of Surgery & Division of Cardiothoracic Surgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Tiffany J Libby
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Neel R Sodha
- Department of Surgery & Division of Cardiothoracic Surgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael W Groff
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Norman Prince Neurosciences Institute, Providence, RI, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Norman Prince Neurosciences Institute, Providence, RI, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Wael F Asaad
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - James Zou
- Departments of Electrical Engineering, Biomedical Data Science, and Computer Science, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Curtis E Doberstein
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Norman Prince Neurosciences Institute, Providence, RI, USA
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Ali R, Connolly ID, Tang OY, Mirza FN, Johnston B, Abdulrazeq HF, Lim RK, Galamaga PF, Libby TJ, Sodha NR, Groff MW, Gokaslan ZL, Telfeian AE, Shin JH, Asaad WF, Zou J, Doberstein CE. Bridging the literacy gap for surgical consents: an AI-human expert collaborative approach. NPJ Digit Med 2024; 7:63. [PMID: 38459205 PMCID: PMC10923794 DOI: 10.1038/s41746-024-01039-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/14/2024] [Indexed: 03/10/2024] Open
Abstract
Despite the importance of informed consent in healthcare, the readability and specificity of consent forms often impede patients' comprehension. This study investigates the use of GPT-4 to simplify surgical consent forms and introduces an AI-human expert collaborative approach to validate content appropriateness. Consent forms from multiple institutions were assessed for readability and simplified using GPT-4, with pre- and post-simplification readability metrics compared using nonparametric tests. Independent reviews by medical authors and a malpractice defense attorney were conducted. Finally, GPT-4's potential for generating de novo procedure-specific consent forms was assessed, with forms evaluated using a validated 8-item rubric and expert subspecialty surgeon review. Analysis of 15 academic medical centers' consent forms revealed significant reductions in average reading time, word rarity, and passive sentence frequency (all P < 0.05) following GPT-4-faciliated simplification. Readability improved from an average college freshman to an 8th-grade level (P = 0.004), matching the average American's reading level. Medical and legal sufficiency consistency was confirmed. GPT-4 generated procedure-specific consent forms for five varied surgical procedures at an average 6th-grade reading level. These forms received perfect scores on a standardized consent form rubric and withstood scrutiny upon expert subspeciality surgeon review. This study demonstrates the first AI-human expert collaboration to enhance surgical consent forms, significantly improving readability without sacrificing clinical detail. Our framework could be extended to other patient communication materials, emphasizing clear communication and mitigating disparities related to health literacy barriers.
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Affiliation(s)
- Rohaid Ali
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Norman Prince Neurosciences Institute, Providence, RI, USA.
| | - Ian D Connolly
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Oliver Y Tang
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Fatima N Mirza
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Benjamin Johnston
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Hael F Abdulrazeq
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Norman Prince Neurosciences Institute, Providence, RI, USA
| | - Rachel K Lim
- Department of Surgery & Division of Cardiothoracic Surgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Tiffany J Libby
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Neel R Sodha
- Department of Surgery & Division of Cardiothoracic Surgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael W Groff
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Norman Prince Neurosciences Institute, Providence, RI, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Norman Prince Neurosciences Institute, Providence, RI, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Wael F Asaad
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - James Zou
- Departments of Electrical Engineering, Biomedical Data Science, and Computer Science, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Curtis E Doberstein
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Norman Prince Neurosciences Institute, Providence, RI, USA
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Bagley SJ, Binder ZA, Lamrani L, Marinari E, Desai AS, Nasrallah MP, Maloney E, Brem S, Lustig RA, Kurtz G, Alonso-Basanta M, Bonté PE, Goudot C, Richer W, Piaggio E, Kothari S, Guyonnet L, Guerin CL, Waterfall JJ, Mohan S, Hwang WT, Tang OY, Logun M, Bhattacharyya M, Markowitz K, Delman D, Marshall A, Wherry EJ, Amigorena S, Beatty GL, Brogdon JL, Hexner E, Migliorini D, Alanio C, O'Rourke DM. Repeated peripheral infusions of anti-EGFRvIII CAR T cells in combination with pembrolizumab show no efficacy in glioblastoma: a phase 1 trial. Nat Cancer 2024; 5:517-531. [PMID: 38216766 DOI: 10.1038/s43018-023-00709-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 12/13/2023] [Indexed: 01/14/2024]
Abstract
We previously showed that chimeric antigen receptor (CAR) T-cell therapy targeting epidermal growth factor receptor variant III (EGFRvIII) produces upregulation of programmed death-ligand 1 (PD-L1) in the tumor microenvironment (TME). Here we conducted a phase 1 trial (NCT03726515) of CAR T-EGFRvIII cells administered concomitantly with the anti-PD1 (aPD1) monoclonal antibody pembrolizumab in patients with newly diagnosed, EGFRvIII+ glioblastoma (GBM) (n = 7). The primary outcome was safety, and no dose-limiting toxicity was observed. Secondary outcomes included median progression-free survival (5.2 months; 90% confidence interval (CI), 2.9-6.0 months) and median overall survival (11.8 months; 90% CI, 9.2-14.2 months). In exploratory analyses, comparison of the TME in tumors harvested before versus after CAR + aPD1 administration demonstrated substantial evolution of the infiltrating myeloid and T cells, with more exhausted, regulatory, and interferon (IFN)-stimulated T cells at relapse. Our study suggests that the combination of CAR T cells and PD-1 inhibition in GBM is safe and biologically active but, given the lack of efficacy, also indicates a need to consider alternative strategies.
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Affiliation(s)
- Stephen J Bagley
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Zev A Binder
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- GBM Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Lamia Lamrani
- Clinical Immunology Laboratory, Institut Curie, Paris, France
- INSERM U932, PSL University, Immunity and Cancer, Institut Curie Research Center, Paris, France
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - Eliana Marinari
- Agora Cancer Research Center, Lausanne, Switzerland
- Center for Translational Research in Onco-Hematology, University of Geneva, Geneva, Switzerland
- Swiss Cancer Center Léman, Lausanne and Geneva, Geneva, Switzerland
- Department of Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Arati S Desai
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - MacLean P Nasrallah
- GBM Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Eileen Maloney
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Steven Brem
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- GBM Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert A Lustig
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Goldie Kurtz
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle Alonso-Basanta
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Pierre-Emmanuel Bonté
- INSERM U932, PSL University, Immunity and Cancer, Institut Curie Research Center, Paris, France
| | - Christel Goudot
- INSERM U932, PSL University, Immunity and Cancer, Institut Curie Research Center, Paris, France
| | - Wilfrid Richer
- INSERM U932, PSL University, Immunity and Cancer, Institut Curie Research Center, Paris, France
- Department of Translational Research, PSL Research University, Institut Curie Research Center, Paris, France
| | - Eliane Piaggio
- INSERM U932, PSL University, Immunity and Cancer, Institut Curie Research Center, Paris, France
| | - Shawn Kothari
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Lea Guyonnet
- Cytometry Platform, CurieCoreTech, Institut Curie, Paris, France
| | - Coralie L Guerin
- Cytometry Platform, CurieCoreTech, Institut Curie, Paris, France
| | - Joshua J Waterfall
- Department of Translational Research, PSL Research University, Institut Curie Research Center, Paris, France
- INSERM U830, PSL University, Institut Curie Research Cente, Paris, France
| | - Suyash Mohan
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Wei-Ting Hwang
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Oliver Y Tang
- GBM Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Meghan Logun
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- GBM Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Meghna Bhattacharyya
- GBM Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Kelly Markowitz
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Devora Delman
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Amy Marshall
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - E John Wherry
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Institute for Immunology and Immune Health, Cambridge, MA, USA
| | - Sebastian Amigorena
- INSERM U932, PSL University, Immunity and Cancer, Institut Curie Research Center, Paris, France
| | - Gregory L Beatty
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- GBM Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Elizabeth Hexner
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Denis Migliorini
- Agora Cancer Research Center, Lausanne, Switzerland
- Center for Translational Research in Onco-Hematology, University of Geneva, Geneva, Switzerland
- Swiss Cancer Center Léman, Lausanne and Geneva, Geneva, Switzerland
- Department of Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Cecile Alanio
- Clinical Immunology Laboratory, Institut Curie, Paris, France.
- INSERM U932, PSL University, Immunity and Cancer, Institut Curie Research Center, Paris, France.
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA.
| | - Donald M O'Rourke
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- GBM Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Mirza FN, Lim RK, Yumeen S, Wahood S, Zaidat B, Shah A, Tang OY, Kawaoka J, Seo SJ, DiMarco C, Muglia J, Goldbach HS, Wisco O, Qureshi AA, Libby TJ. Performance of Three Large Language Models on Dermatology Board Examinations. J Invest Dermatol 2024; 144:398-400. [PMID: 37541614 DOI: 10.1016/j.jid.2023.06.208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 08/06/2023]
Affiliation(s)
- Fatima N Mirza
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Rachel K Lim
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sara Yumeen
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Samer Wahood
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Bashar Zaidat
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Asghar Shah
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Oliver Y Tang
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - John Kawaoka
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Su-Jean Seo
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Christopher DiMarco
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jennie Muglia
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Hayley S Goldbach
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Oliver Wisco
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Abrar A Qureshi
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Tiffany J Libby
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Bearnot CJ, Mbong EN, Muhayangabo RF, Laghari R, Butler K, Gainey M, Perera SM, Michelow IC, Tang OY, Levine AC, Colubri A, Aluisio AR. Derivation and Internal Validation of a Mortality Prognostication Machine Learning Model in Ebola Virus Disease Based on Iterative Point-of-Care Biomarkers. Open Forum Infect Dis 2024; 11:ofad689. [PMID: 38379568 PMCID: PMC10878059 DOI: 10.1093/ofid/ofad689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/03/2024] [Indexed: 02/22/2024] Open
Abstract
Background Although multiple prognostic models exist for Ebola virus disease mortality, few incorporate biomarkers, and none has used longitudinal point-of-care serum testing throughout Ebola treatment center care. Methods This retrospective study evaluated adult patients with Ebola virus disease during the 10th outbreak in the Democratic Republic of Congo. Ebola virus cycle threshold (Ct; based on reverse transcriptase polymerase chain reaction) and point-of-care serum biomarker values were collected throughout Ebola treatment center care. Four iterative machine learning models were created for prognosis of mortality. The base model used age and admission Ct as predictors. Ct and biomarkers from treatment days 1 and 2, days 3 and 4, and days 5 and 6 associated with mortality were iteratively added to the model to yield mortality risk estimates. Receiver operating characteristic curves for each iteration provided period-specific areas under curve with 95% CIs. Results Of 310 cases positive for Ebola virus disease, mortality occurred in 46.5%. Biomarkers predictive of mortality were elevated creatinine kinase, aspartate aminotransferase, blood urea nitrogen (BUN), alanine aminotransferase, and potassium; low albumin during days 1 and 2; elevated C-reactive protein, BUN, and potassium during days 3 and 4; and elevated C-reactive protein and BUN during days 5 and 6. The area under curve substantially improved with each iteration: base model, 0.74 (95% CI, .69-.80); days 1 and 2, 0.84 (95% CI, .73-.94); days 3 and 4, 0.94 (95% CI, .88-1.0); and days 5 and 6, 0.96 (95% CI, .90-1.0). Conclusions This is the first study to utilize iterative point-of-care biomarkers to derive dynamic prognostic mortality models. This novel approach demonstrates that utilizing biomarkers drastically improved prognostication up to 6 days into patient care.
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Affiliation(s)
- Courtney J Bearnot
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Eta N Mbong
- International Medical Corps, Goma, Democratic Republic of Congo
| | | | - Razia Laghari
- International Medical Corps, Goma, Democratic Republic of Congo
| | - Kelsey Butler
- Program in Bioinformatics and Integrative Biology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | | | - Ian C Michelow
- Division of Infectious Diseases and Immunology, Department of Pediatrics, School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Oliver Y Tang
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Adam C Levine
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Andrés Colubri
- Program in Bioinformatics and Integrative Biology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Adam R Aluisio
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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6
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Ali R, Tang OY, Connolly ID, Abdulrazeq HF, Mirza FN, Lim RK, Johnston BR, Groff MW, Williamson T, Svokos K, Libby TJ, Shin JH, Gokaslan ZL, Doberstein CE, Zou J, Asaad WF. Demographic Representation in 3 Leading Artificial Intelligence Text-to-Image Generators. JAMA Surg 2024; 159:87-95. [PMID: 37966807 PMCID: PMC10782243 DOI: 10.1001/jamasurg.2023.5695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/25/2023] [Indexed: 11/16/2023]
Abstract
Importance The progression of artificial intelligence (AI) text-to-image generators raises concerns of perpetuating societal biases, including profession-based stereotypes. Objective To gauge the demographic accuracy of surgeon representation by 3 prominent AI text-to-image models compared to real-world attending surgeons and trainees. Design, Setting, and Participants The study used a cross-sectional design, assessing the latest release of 3 leading publicly available AI text-to-image generators. Seven independent reviewers categorized AI-produced images. A total of 2400 images were analyzed, generated across 8 surgical specialties within each model. An additional 1200 images were evaluated based on geographic prompts for 3 countries. The study was conducted in May 2023. The 3 AI text-to-image generators were chosen due to their popularity at the time of this study. The measure of demographic characteristics was provided by the Association of American Medical Colleges subspecialty report, which references the American Medical Association master file for physician demographic characteristics across 50 states. Given changing demographic characteristics in trainees compared to attending surgeons, the decision was made to look into both groups separately. Race (non-White, defined as any race other than non-Hispanic White, and White) and gender (female and male) were assessed to evaluate known societal biases. Exposures Images were generated using a prompt template, "a photo of the face of a [blank]", with the blank replaced by a surgical specialty. Geographic-based prompting was evaluated by specifying the most populous countries on 3 continents (the US, Nigeria, and China). Main Outcomes and Measures The study compared representation of female and non-White surgeons in each model with real demographic data using χ2, Fisher exact, and proportion tests. Results There was a significantly higher mean representation of female (35.8% vs 14.7%; P < .001) and non-White (37.4% vs 22.8%; P < .001) surgeons among trainees than attending surgeons. DALL-E 2 reflected attending surgeons' true demographic data for female surgeons (15.9% vs 14.7%; P = .39) and non-White surgeons (22.6% vs 22.8%; P = .92) but underestimated trainees' representation for both female (15.9% vs 35.8%; P < .001) and non-White (22.6% vs 37.4%; P < .001) surgeons. In contrast, Midjourney and Stable Diffusion had significantly lower representation of images of female (0% and 1.8%, respectively; P < .001) and non-White (0.5% and 0.6%, respectively; P < .001) surgeons than DALL-E 2 or true demographic data. Geographic-based prompting increased non-White surgeon representation but did not alter female representation for all models in prompts specifying Nigeria and China. Conclusion and Relevance In this study, 2 leading publicly available text-to-image generators amplified societal biases, depicting over 98% surgeons as White and male. While 1 of the models depicted comparable demographic characteristics to real attending surgeons, all 3 models underestimated trainee representation. The study suggests the need for guardrails and robust feedback systems to minimize AI text-to-image generators magnifying stereotypes in professions such as surgery.
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Affiliation(s)
- Rohaid Ali
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Oliver Y. Tang
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ian D. Connolly
- Department of Neurosurgery, Massachusetts General Hospital, Boston
| | - Hael F. Abdulrazeq
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Fatima N. Mirza
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Rachel K. Lim
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Michael W. Groff
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Konstantina Svokos
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Tiffany J. Libby
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - John H. Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston
| | - Ziya L. Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Curtis E. Doberstein
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - James Zou
- Department of Biomedical Data Science and, by courtesy, Computer Science and Electrical Engineering, Stanford University, Stanford, California
| | - Wael F. Asaad
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Neuroscience, Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence
- Department of Neuroscience, Brown University, Providence, Rhode Island
- Department of Neuroscience, Carney Institute for Brain Science, Brown University, Providence, Rhode Island
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7
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Abdulrazeq H, Leary OP, Tang OY, Karimi H, McElroy A, Gokaslan Z, Punsoni M, Donahue JE, Klinge PM. The Surgical Histopathology of the Filum Terminale: Findings from a Large Series of Patients with Tethered Cord Syndrome. J Clin Med 2023; 13:6. [PMID: 38202013 PMCID: PMC10779556 DOI: 10.3390/jcm13010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/16/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024] Open
Abstract
This study investigated the prevalence of embryonic and connective tissue elements in the filum terminale (FT) of patients with tethered cord syndrome (TCS), examining both typical and pathological histology. The FT specimens from 288 patients who underwent spinal cord detethering from 2013 to 2021 were analyzed. The histopathological examination involved routine hematoxylin and eosin staining and specific immunohistochemistry when needed. The patient details were extracted from electronic medical records. The study found that 97.6% of the FT specimens had peripheral nerves, and 70.8% had regular ependymal cell linings. Other findings included ependymal cysts and canals, ganglion cells, neuropil, and prominent vascular features. Notably, 41% showed fatty infiltration, and 7.6% had dystrophic calcification. Inflammatory infiltrates, an underreported finding, were observed in 3.8% of the specimens. The research highlights peripheral nerves and ganglion cells as natural components of the FT, with ependymal cell overgrowth and other tissues potentially linked to TCS. Enlarged vessels may suggest venous congestion due to altered FT mechanics. The presence of lymphocytic infiltrations and calcifications provides new insights into structural changes and mechanical stress in the FT, contributing to our understanding of TCS pathology.
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Affiliation(s)
- Hael Abdulrazeq
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA; (O.P.L.); (J.E.D.)
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI 02903, USA
| | - Owen P. Leary
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA; (O.P.L.); (J.E.D.)
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI 02903, USA
| | - Oliver Y. Tang
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (O.Y.T.)
| | - Helen Karimi
- Department of Neurosurgery, Tufts Medical School, Boston, MA 02111, USA;
| | - Abigail McElroy
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (O.Y.T.)
| | - Ziya Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA; (O.P.L.); (J.E.D.)
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI 02903, USA
| | - Michael Punsoni
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA; (O.P.L.); (J.E.D.)
- Laboratory Medicine, Department of Pathology, Rhode Island Hospital, Providence, RI 02903, USA
| | - John E. Donahue
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA; (O.P.L.); (J.E.D.)
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI 02903, USA
- Laboratory Medicine, Department of Pathology, Rhode Island Hospital, Providence, RI 02903, USA
| | - Petra M. Klinge
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA; (O.P.L.); (J.E.D.)
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI 02903, USA
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8
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Chen J, Aluisio AR, Tang OY, Nwakibu UA, Hunold KM, Wangara AA, Kiruja J, Maingi A, Mutiso V, Thompson P, Wachira B, Dunlop SJ, Martin IBK, Myers JG. Diagnostic Accuracy of the World Health Organization Pediatric Emergency Triage, Assessment and Treatment Tool Plus Among Patients Seeking Care in Nairobi, Kenya: A Cross-sectional Study. Pediatr Emerg Care 2023:00006565-990000000-00360. [PMID: 38048556 DOI: 10.1097/pec.0000000000003093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
INTRODUCTION The World Health Organization developed Emergency Triage Assessment and Treatment Plus (ETAT+) guidelines to facilitate pediatric care in resource-limited settings. ETAT+ triages patients as nonurgent, priority, or emergency cases, but there is limited research on the performance of ETAT+ regarding patient-oriented outcomes. This study assessed the diagnostic accuracy of ETAT+ in predicting the need for hospital admission in a pediatric emergency unit at Kenyatta National Hospital in Nairobi, Kenya. METHODS This was a secondary analysis of a cross-sectional study of pediatric emergency unit patients enrolled over a 4-week period using fixed random sampling. Diagnostic accuracy of ETAT+ was evaluated using receiver operating curves (ROCs) and respective 95% confidence intervals (CIs) with associated sensitivity and specificity (reference category: nonurgent). The ROC analysis was performed for the overall population and stratified by age group. RESULTS A total of 323 patients were studied. The most common reasons for presentation were upper respiratory tract disease (32.8%), gastrointestinal disease (15.5%), and lower respiratory tract disease (12.4%). Two hundred twelve participants were triaged as nonurgent (65.6%), 60 as priority (18.6%), and 51 as emergency (15.8%). In the overall study population, the area under the ROC curve was 0.97 (95% CI, 0.95-0.99). The ETAT+ sensitivity was 93.8% (95% CI, 87.0%-99.0%), and the specificity was 82.0% (95% CI, 77.0%-87.0%) for admission of priority group patients. The sensitivity and specificity for the emergency patients were 66.0% (95% CI, 55.0%-77.0%) and 98.0% (95% CI, 97.0%-100.0%), respectively. CONCLUSIONS ETAT+ demonstrated diagnostic accuracy for predicting patient need for hospital admission. This finding supports the utility of ETAT+ to inform emergency care practice. Further research on ETAT+ performance in larger populations and additional patient-oriented outcomes would enhance its generalizability and application in resource-limited settings.
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Affiliation(s)
- Josephine Chen
- From the Division of Biology and Medicine, Brown University
| | - Adam R Aluisio
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Oliver Y Tang
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Uzoma A Nwakibu
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Jason Kiruja
- Accident and Emergency Department, Kenyatta National Hospital
| | - Alice Maingi
- Department of Emergency Medicine, Ohio State University, Columbus, OH
| | - Vincent Mutiso
- University of Nairobi School of Medicine, Nairobi, Kenya
| | - Peyton Thompson
- Division of Infectious Disease, Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | | | - Stephen J Dunlop
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Ian B K Martin
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Justin G Myers
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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9
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Lin JC, Younessi DN, Kurapati SS, Tang OY, Scott IU. Comparison of GPT-3.5, GPT-4, and human user performance on a practice ophthalmology written examination. Eye (Lond) 2023; 37:3694-3695. [PMID: 37156862 PMCID: PMC10686407 DOI: 10.1038/s41433-023-02564-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023] Open
Affiliation(s)
- John C Lin
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David N Younessi
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sai S Kurapati
- Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Oliver Y Tang
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ingrid U Scott
- Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
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10
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Shao B, Chen JS, Kozel OA, Tang OY, Amaral-Nieves N, Sastry RA, Watson-Smith D, Monteagudo J, Luks FI, Carr SR, Klinge PM, Weil RJ, Svokos KA. Postnatal Myelomeningocele Repair in the United States: Rates and Disparities Before and After the Management of Myelomeningocele Study Trial. Neurosurgery 2023; 93:1374-1382. [PMID: 37477441 DOI: 10.1227/neu.0000000000002604] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/16/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Evolving technologies have influenced the practice of myelomeningocele repair (MMCr), including mandatory folic acid fortification, advances in prenatal diagnosis, and the 2011 Management of Myelomeningocele Study (MOMS) trial demonstrating benefits of fetal over postnatal MMCr in select individuals. Postnatal MMCr continues to be performed, especially for those with limitations in prenatal diagnosis, health care access, anatomy, or personal preference. A comprehensive, updated national perspective on the trajectory of postnatal MMCr volumes and patient disparities is absent. We characterize national trends in postnatal MMCr rates before and after the MOMS trial publication (2000-2010 vs 2011-2019) and examine whether historical disparities persist. METHODS This retrospective, cross-sectional analysis queried Nationwide Inpatient Sample data for postnatal MMCr admissions. Annual and race/ethnicity-specific rates were calculated using national birth registry data. Time series analysis assessed for trends relative to the year 2011. Patient, admission, and outcome characteristics were compared between pre-MOMS and post-MOMS cohorts. RESULTS Between 2000 and 2019, 12 426 postnatal MMCr operations were estimated nationwide. After 2011, there was a gradual, incremental decline in the annual rate of postnatal MMCr. Post-MOMS admissions were increasingly associated with Medicaid insurance and the lowest income quartiles, as well as increased risk indices, length of stay, and hospital charges. By 2019, race/ethnicity-adjusted rates seemed to converge. The mortality rate remained low in both eras, and there was a lower rate of same-admission shunting post-MOMS. CONCLUSION National rates of postnatal MMCr gradually declined in the post-MOMS era. Medicaid and low-income patients comprise an increasing majority of MMCr patients post-MOMS, whereas historical race/ethnicity-specific disparities are improving. Now more than ever, we must address disparities in the care of MMC patients before and after birth.
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Affiliation(s)
- Belinda Shao
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Jia-Shu Chen
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Olivia A Kozel
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Oliver Y Tang
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Natalie Amaral-Nieves
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Rahul A Sastry
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Debra Watson-Smith
- Fetal Treatment Program of New England, Hasbro Children's Hospital, Women & Infants Hospital, Providence , Rhode Island , USA
- Division of Pediatric Surgery, Department of Surgery, Warren Alpert Medical School of Brown University, and Hasbro Children's Hospital, Providence , Rhode Island , USA
| | - Julie Monteagudo
- Fetal Treatment Program of New England, Hasbro Children's Hospital, Women & Infants Hospital, Providence , Rhode Island , USA
- Division of Pediatric Surgery, Department of Surgery, Warren Alpert Medical School of Brown University, and Hasbro Children's Hospital, Providence , Rhode Island , USA
| | - Francois I Luks
- Fetal Treatment Program of New England, Hasbro Children's Hospital, Women & Infants Hospital, Providence , Rhode Island , USA
- Division of Pediatric Surgery, Department of Surgery, Warren Alpert Medical School of Brown University, and Hasbro Children's Hospital, Providence , Rhode Island , USA
| | - Stephen R Carr
- Fetal Treatment Program of New England, Hasbro Children's Hospital, Women & Infants Hospital, Providence , Rhode Island , USA
- Division of Maternal-Fetal Medicine, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Petra M Klinge
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Fetal Treatment Program of New England, Hasbro Children's Hospital, Women & Infants Hospital, Providence , Rhode Island , USA
| | - Robert J Weil
- Southcoast Health Brain & Spine, Dartmouth , Massachusetts , USA
| | - Konstantina A Svokos
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Fetal Treatment Program of New England, Hasbro Children's Hospital, Women & Infants Hospital, Providence , Rhode Island , USA
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11
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Ali R, Tang OY, Connolly ID, Zadnik Sullivan PL, Shin JH, Fridley JS, Asaad WF, Cielo D, Oyelese AA, Doberstein CE, Gokaslan ZL, Telfeian AE. Performance of ChatGPT and GPT-4 on Neurosurgery Written Board Examinations. Neurosurgery 2023; 93:1353-1365. [PMID: 37581444 DOI: 10.1227/neu.0000000000002632] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/19/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Interest surrounding generative large language models (LLMs) has rapidly grown. Although ChatGPT (GPT-3.5), a general LLM, has shown near-passing performance on medical student board examinations, the performance of ChatGPT or its successor GPT-4 on specialized examinations and the factors affecting accuracy remain unclear. This study aims to assess the performance of ChatGPT and GPT-4 on a 500-question mock neurosurgical written board examination. METHODS The Self-Assessment Neurosurgery Examinations (SANS) American Board of Neurological Surgery Self-Assessment Examination 1 was used to evaluate ChatGPT and GPT-4. Questions were in single best answer, multiple-choice format. χ 2 , Fisher exact, and univariable logistic regression tests were used to assess performance differences in relation to question characteristics. RESULTS ChatGPT (GPT-3.5) and GPT-4 achieved scores of 73.4% (95% CI: 69.3%-77.2%) and 83.4% (95% CI: 79.8%-86.5%), respectively, relative to the user average of 72.8% (95% CI: 68.6%-76.6%). Both LLMs exceeded last year's passing threshold of 69%. Although scores between ChatGPT and question bank users were equivalent ( P = .963), GPT-4 outperformed both (both P < .001). GPT-4 answered every question answered correctly by ChatGPT and 37.6% (50/133) of remaining incorrect questions correctly. Among 12 question categories, GPT-4 significantly outperformed users in each but performed comparably with ChatGPT in 3 (functional, other general, and spine) and outperformed both users and ChatGPT for tumor questions. Increased word count (odds ratio = 0.89 of answering a question correctly per +10 words) and higher-order problem-solving (odds ratio = 0.40, P = .009) were associated with lower accuracy for ChatGPT, but not for GPT-4 (both P > .005). Multimodal input was not available at the time of this study; hence, on questions with image content, ChatGPT and GPT-4 answered 49.5% and 56.8% of questions correctly based on contextual context clues alone. CONCLUSION LLMs achieved passing scores on a mock 500-question neurosurgical written board examination, with GPT-4 significantly outperforming ChatGPT.
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Affiliation(s)
- Rohaid Ali
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Oliver Y Tang
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Ian D Connolly
- Department of Neurosurgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Patricia L Zadnik Sullivan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - John H Shin
- Department of Neuroscience, Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
| | - Jared S Fridley
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Wael F Asaad
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Department of Neuroscience, Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
- Department of Neuroscience, Brown University, Providence , Rhode Island , USA
- Department of Neuroscience, Carney Institute for Brain Science, Brown University, Providence , Rhode Island , USA
| | - Deus Cielo
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Curtis E Doberstein
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Albert E Telfeian
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
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12
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Ganga A, Kim EJ, Tang OY, Shao B, Svokos K, Klinge PM, Cielo DJ, Fridley JS, Gokaslan ZL, Toms SA, Sullivan PZ. The epidemiology of crib-related head injuries: A ten-year nationwide analysis. Am J Emerg Med 2023; 74:78-83. [PMID: 37793196 DOI: 10.1016/j.ajem.2023.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/28/2023] [Accepted: 09/23/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Falls from cribs resulting in head injury are understudied and poorly characterized. The purpose of this study was to advance current understanding of the prevalence, descriptive characteristics of injury victims, and the types of crib fall-related head injuries (CFHI) using queried patient cases from the National Electronic Injury Surveillance System (NEISS) database. METHODS Using the US Consumer Product Safety Commission's System NEISS database, we queried all CFHIs among children from over 100 emergency departments (EDs). Patient information regarding age, race, sex, location of the incident, diagnoses, ED disposition, and sequelae were analyzed. The number of CFHI from all US EDs during each year was also collected from the database. RESULTS There were an estimated 54,799 (95% CI: 30,228-79,369) total visits to EDs for CFHIs between 2012 and 2021, with a decrease in incidence of approximately 20% during the onset of the COVID-19 pandemic (2019: 5616 cases, 2020: 4459 cases). The annual incidence of injuries showed no significant trend over the 10-year study period. An available subset of 1782 cases of head injuries from approximately 100 EDs was analyzed, and 1442 cases were included in final analysis. Injuries were sorted into three primary categories: unspecified closed head injury (e.g., closed head injury, blunt head trauma, or traumatic brain injury), concussion, or open head injury and skull fracture. Unspecified closed head injuries were the most common of all head injuries (95.4%, 1376/1442). Open head injuries (14/1442, 0.97%) and concussions 3.6% (52/1442, 3.6%) were rare. Most injuries involved children under the age of 1 (42.6%) compared to children who were 1, 2, 3, or 4-years old. About a fourth of patients had other diagnoses in addition to their primary injury including scalp/forehead hematomas, emesis, and contusions. Female patients were more likely to present with other diagnoses in addition to their primary head injury (Difference: 12.3%, 95% CI: 9.87%-15.4%, p < .0001). CONCLUSION Despite minimum rail height requirements set by the Consumer Safety Product Commission (CPSC), head injuries associated with crib falls are prevalent in the United States. However, most injuries were minor with a vast majority of patients being released following examination and treatment.
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Affiliation(s)
- Arjun Ganga
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Eric J Kim
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Oliver Y Tang
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Belinda Shao
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Konstantina Svokos
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Petra M Klinge
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Deus J Cielo
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Jared S Fridley
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Ziya L Gokaslan
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Steven A Toms
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Patricia Zadnik Sullivan
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America.
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13
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Ali R, Tang OY, Connolly ID, Fridley JS, Shin JH, Zadnik Sullivan PL, Cielo D, Oyelese AA, Doberstein CE, Telfeian AE, Gokaslan ZL, Asaad WF. Performance of ChatGPT, GPT-4, and Google Bard on a Neurosurgery Oral Boards Preparation Question Bank. Neurosurgery 2023; 93:1090-1098. [PMID: 37306460 DOI: 10.1227/neu.0000000000002551] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/09/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES General large language models (LLMs), such as ChatGPT (GPT-3.5), have demonstrated the capability to pass multiple-choice medical board examinations. However, comparative accuracy of different LLMs and LLM performance on assessments of predominantly higher-order management questions is poorly understood. We aimed to assess the performance of 3 LLMs (GPT-3.5, GPT-4, and Google Bard) on a question bank designed specifically for neurosurgery oral boards examination preparation. METHODS The 149-question Self-Assessment Neurosurgery Examination Indications Examination was used to query LLM accuracy. Questions were inputted in a single best answer, multiple-choice format. χ 2 , Fisher exact, and univariable logistic regression tests assessed differences in performance by question characteristics. RESULTS On a question bank with predominantly higher-order questions (85.2%), ChatGPT (GPT-3.5) and GPT-4 answered 62.4% (95% CI: 54.1%-70.1%) and 82.6% (95% CI: 75.2%-88.1%) of questions correctly, respectively. By contrast, Bard scored 44.2% (66/149, 95% CI: 36.2%-52.6%). GPT-3.5 and GPT-4 demonstrated significantly higher scores than Bard (both P < .01), and GPT-4 outperformed GPT-3.5 ( P = .023). Among 6 subspecialties, GPT-4 had significantly higher accuracy in the Spine category relative to GPT-3.5 and in 4 categories relative to Bard (all P < .01). Incorporation of higher-order problem solving was associated with lower question accuracy for GPT-3.5 (odds ratio [OR] = 0.80, P = .042) and Bard (OR = 0.76, P = .014), but not GPT-4 (OR = 0.86, P = .085). GPT-4's performance on imaging-related questions surpassed GPT-3.5's (68.6% vs 47.1%, P = .044) and was comparable with Bard's (68.6% vs 66.7%, P = 1.000). However, GPT-4 demonstrated significantly lower rates of "hallucination" on imaging-related questions than both GPT-3.5 (2.3% vs 57.1%, P < .001) and Bard (2.3% vs 27.3%, P = .002). Lack of question text description for questions predicted significantly higher odds of hallucination for GPT-3.5 (OR = 1.45, P = .012) and Bard (OR = 2.09, P < .001). CONCLUSION On a question bank of predominantly higher-order management case scenarios for neurosurgery oral boards preparation, GPT-4 achieved a score of 82.6%, outperforming ChatGPT and Google Bard.
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Affiliation(s)
- Rohaid Ali
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Oliver Y Tang
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Ian D Connolly
- Department of Neurosurgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Jared S Fridley
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Patricia L Zadnik Sullivan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Deus Cielo
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Curtis E Doberstein
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Albert E Telfeian
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Wael F Asaad
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
- Department of Neuroscience, Brown University, Providence , Rhode Island , USA
- Carney Institute for Brain Science, Brown University, Providence , Rhode Island , USA
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Abstract
Chimeric antigen receptor T-cell therapies have transformed the management of hematologic malignancies but have not yet demonstrated consistent efficacy in solid tumors. Glioblastoma is the most common primary malignant brain tumor in adults and remains a major unmet medical need. Attempts at harnessing the potential of chimeric antigen receptor T-cell therapy for glioblastoma have resulted in glimpses of promise but have been met with substantial challenges. In this focused review, we discuss current and future strategies being developed to optimize chimeric antigen receptor T cells for efficacy in patients with glioblastoma, including the identification and characterization of new target antigens, reversal of T-cell dysfunction with novel chimeric antigen receptor constructs, regulatable platforms, and gene knockout strategies, and the use of combination therapies to overcome the immune-hostile microenvironment.
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Affiliation(s)
- Oliver Y Tang
- Warren Alpert Medical School, Brown University, Providence, RI, 02903, USA
| | - Zev A Binder
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Donald M O'Rourke
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Stephen J Bagley
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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15
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Tang OY, Ali R, Connolly ID, Fridley JS, Zadnik Sullivan PL, Cielo D, Oyelese AA, Doberstein CE, Telfeian AE, Gokaslan ZL, Shin JH, Asaad WF. Letter: The Urgency of Neurosurgical Leadership in the Era of Artificial Intelligence. Neurosurgery 2023; 93:e69-e70. [PMID: 37319400 DOI: 10.1227/neu.0000000000002576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/03/2023] [Indexed: 06/17/2023] Open
Affiliation(s)
- Oliver Y Tang
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Rohaid Ali
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
| | - Ian D Connolly
- Department of Neurosurgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Jared S Fridley
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
| | - Patricia L Zadnik Sullivan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
| | - Deus Cielo
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
| | - Curtis E Doberstein
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
| | - Albert E Telfeian
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Wael F Asaad
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence , Rhode Island , USA
- Department of Neuroscience, Brown University, Providence , Rhode Island , USA
- Carney Institute for Brain Science, Brown University, Providence , Rhode Island , USA
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16
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Ali R, Tang OY, Moldovan K, Torabi R, Furie K, Roye GD, Gokaslan ZL, Telfeian A, Yaghi S, Doberstein CE, Jayaraman MV. Letter: A Stroke Admissions Navigator Improves Adherence to Joint Commission Specifications for Hunt-Hess and Intracerebral Hemorrhage Scores. Neurosurgery 2023; 92:e118-e119. [PMID: 36942963 DOI: 10.1227/neu.0000000000002461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/23/2023] Open
Affiliation(s)
- Rohaid Ali
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Oliver Y Tang
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Krisztina Moldovan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Radmehr Torabi
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Karen Furie
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - G Dean Roye
- Department of Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Albert Telfeian
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Shadi Yaghi
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Curtis E Doberstein
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mahesh V Jayaraman
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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17
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Ganga A, Kim EJ, Tang OY, Feler JR, Sastry RA, Anderson MN, Keith SE, Fridley JS, Gokaslan ZL, Cielo DJ, Toms SA, Sullivan PZ. The burden of unhelmeted motorcycle injury: A nationwide scoring-based analysis of helmet safety legislation. Injury 2023; 54:848-856. [PMID: 36646531 DOI: 10.1016/j.injury.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/28/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Motorcycle collisions comprise a large portion of motor vehicle injuries and fatalities with over 80,000 injuries and 5,500 fatalities per year in the United States. Unhelmeted riders have poor medical outcomes and generate billions in costs. Despite helmet use having been shown to lower the risk of neurological injury and death, helmet compliance is not universal, and legislation concerning helmet use also varies widely across the United States. METHODS In this study, we systematically reviewed helmet-related statutes from all US jurisdictions. We evaluated the stringency of these statutes using a legislative scoring system termed the Helmet Safety Score (HSS) ranging from 0-7 points, with higher scores denoting more stringent statutes. Regression modeling was used to predict unhelmeted mortality using our safety scores. RESULTS The mean score across all jurisdictions was 4.73. We found jurisdictions with higher HSS's generally had lower percentages of unhelmeted fatalities in terms of total fatalities as well as per 100,000 people and 100,000 registered motorcycles. In contrast, some lower-scoring jurisdictions had over 100 times more unhelmeted fatalities than higher-scoring jurisdictions. Our HSS significantly predicted unhelmeted motorcycle fatalities per 100,000 people (β = -0.228 per 1-point increase, 95% CI: -0.288 to -0.169, p < .0001) and per 100,000 registered motorcycles (β = -6.17 per 1-point increase, 95% CI: -8.37 to -3.98, p < .0001) in each state. Aspects of our score concerning helmet exemptions for riders and motorcycle-type vehicles independently predicted higher fatalities (p < .0001). Higher safety scores predicted lower unhelmeted fatalities. CONCLUSION Stringent helmet laws may be an effective mechanism for decreasing unhelmeted mortality. Therefore, universal helmet laws may be one such mechanism to decrease motorcycle-related neurological injury and fatality burden. In states with existing helmet laws, elimination of exemptions for certain riders and motorcycle-type vehicles may also decrease fatalities.
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Affiliation(s)
- Arjun Ganga
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Eric J Kim
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Oliver Y Tang
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Joshua R Feler
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Rahul A Sastry
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Matthew N Anderson
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Sharonda E Keith
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Jared S Fridley
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Ziya L Gokaslan
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Deus J Cielo
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Steven A Toms
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Patricia Zadnik Sullivan
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States.
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18
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Tang OY, Uwamahoro C, González Marqués C, Beeman A, Odoom E, Ndebwanimana V, Uwamahoro D, Niyonsaba M, Nzabahimana A, Munyanziza S, Nshuti S, Jarmale S, Stephen AH, Aluisio AR. Trends in Neurotrauma Epidemiology, Management, and Outcomes during the COVID-19 Pandemic in Kigali, Rwanda. J Neurotrauma 2023; 40:536-546. [PMID: 36326212 PMCID: PMC9986007 DOI: 10.1089/neu.2022.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
National regulations to curb the coronavirus disease 2019 (COVID-19) transmission and health care resource reallocation may have impacted incidence and treatment for neurotrauma, including traumatic brain injury (TBI) and spinal trauma, but these trends have not been characterized in Sub-Saharan Africa. This study analyzes differences in epidemiology, management, and outcomes preceding and during the COVID-19 pandemic for neurotrauma patients in a Rwandan tertiary hospital. The study setting was the Centre Hospitalier Universitaire de Kigali (CHUK), Rwanda's national referral hospital. Adult injury patients presenting to the CHUK Emergency Department (ED) were prospectively enrolled from January 27, 2020 to June 28, 2020. Study personnel collected data on demographics, injury characteristics, serial neurological examinations, treatment, and outcomes. Differences in patients before (January 27, 2020 to March 21, 2020) and during (June 1, 2020 to June 28, 2020) the COVID-19 pandemic were assessed using chi-squared and Mann-Whitney U tests. The study population included 216 patients with neurotrauma (83.8% TBI, 8.3% spine trauma, and 7.9% with both). Mean age was 34.1 years (standard deviation [SD] = 12.5) and 77.8% were male. Patients predominantly experienced injury following a road traffic accident (RTA; 65.7%). Weekly volume for TBI (mean = 16.5 vs. 17.1, p = 0.819) and spine trauma (mean = 2.0 vs. 3.4, p = 0.086) was similar between study periods. During the pandemic, patients had lower Glasgow Coma Scale (GCS) scores (mean = 13.8 vs. 14.3, p = 0.068) and Kampala Trauma Scores (KTS; mean = 14.0 vs. 14.3, p = 0.097) on arrival, denoting higher injury severity, but these differences only approached significance. Patients treated during the pandemic period had higher occurrence of hemorrhage, contusion, or fracture on computed tomography (CT) imaging (47.1% vs. 26.7%, p = 0.003) and neurological decline (18.6% vs. 7.5%, p = 0.016). Hospitalizations also increased significantly during COVID-19 (54.6% vs. 39.9%, p = 0.048). Craniotomy rates doubled during the pandemic period (25.7% vs. 13.7%, p = 0.003), but mortality was unchanged (5.5% vs. 5.7%, p = 0.944). Neurotrauma volume remained unchanged at CHUK during the COVID-19 pandemic, but presenting patients had higher injury acuity and craniotomy rates. These findings may inform care during pandemic conditions in Rwanda and similar settings.
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Affiliation(s)
- Oliver Y Tang
- Division of Global Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Chantal Uwamahoro
- Department of Anesthesia, Emergency Medicine, and Critical Care, University of Rwanda, Kigali, Rwanda
| | | | - Aly Beeman
- Division of Global Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Enyonam Odoom
- Division of Global Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Vincent Ndebwanimana
- Department of Anesthesia, Emergency Medicine, and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Doris Uwamahoro
- Department of Anesthesia, Emergency Medicine, and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Mediatrice Niyonsaba
- Department of Anesthesia, Emergency Medicine, and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Apollinaire Nzabahimana
- Department of Anesthesia, Emergency Medicine, and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Silas Munyanziza
- Department of Anesthesia, Emergency Medicine, and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Steven Nshuti
- Department of Neurosurgery, King Faisal Hospital, Kigali, Rwanda
| | - Spandana Jarmale
- Division of Global Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Andrew H Stephen
- Division of Global Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adam R Aluisio
- Division of Global Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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19
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Tang OY, Shao B, Kimata AR, Sastry RA, Wu J, Asaad WF. The Impact of Frailty on Traumatic Brain Injury Outcomes: An Analysis of 691 821 Nationwide Cases. Neurosurgery 2022; 91:808-820. [PMID: 36069524 DOI: 10.1227/neu.0000000000002116] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/12/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Frailty, a decline in physiological reserve, prognosticates poorer outcomes for several neurosurgical conditions. However, the impact of frailty on traumatic brain injury outcomes is not well characterized. OBJECTIVE To analyze the association between frailty and traumatic intracranial hemorrhage (tICH) outcomes in a nationwide cohort. METHODS We identified all adult admissions for tICH in the National Trauma Data Bank from 2007 to 2017. Frailty was quantified using the validated modified 5-item Frailty Index (mFI-5) metric (range = 0-5), with mFI-5 ≥2 denoting frailty. Analyzed outcomes included in-hospital mortality, favorable discharge disposition, complications, ventilator days, and intensive care unit (ICU) and total length of stay (LOS). Multivariable regression assessed the association between mFI-5 and outcomes, adjusting for patient demographics, hospital characteristics, injury severity, and neurosurgical intervention. RESULTS A total of 691 821 tICH admissions were analyzed. The average age was 57.6 years. 18.0% of patients were frail (mFI-5 ≥ 2). Between 2007 and 2017, the prevalence of frailty grew from 7.9% to 21.7%. Frailty was associated with increased odds of mortality (odds ratio [OR] = 1.36, P < .001) and decreased odds of favorable discharge disposition (OR = 0.72, P < .001). Frail patients exhibited an elevated rate of complications (OR = 1.06, P < .001), including unplanned return to the ICU (OR = 1.55, P < .001) and operating room (OR = 1.17, P = .003). Finally, frail patients experienced increased ventilator days (+12%, P < .001), ICU LOS (+11%, P < .001), and total LOS (+13%, P < .001). All associations with death and disposition remained significant after stratification for age, trauma severity, and neurosurgical intervention. CONCLUSION For patients with tICH, frailty predicted higher mortality and morbidity, independent of age or injury severity.
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Affiliation(s)
- Oliver Y Tang
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Belinda Shao
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Anna R Kimata
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Neuroscience, Brown University, Providence, Rhode Island, USA
| | - Rahul A Sastry
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Joshua Wu
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Wael F Asaad
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Neuroscience, Brown University, Providence, Rhode Island, USA.,Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, Rhode Island, USA.,Carney Institute for Brain Science, Brown University, Providence, Rhode Island, USA
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20
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Tang OY, Bajaj AI, Zhao K, Rivera Perla KM, Mary Ying YL, Jyung RW, Liu JK. In Reply: Association of Patient Frailty With Vestibular Schwannoma Resection Outcomes and Machine Learning Development of a Vestibular Schwannoma Risk Stratification Score. Neurosurgery 2022; 91:e141-e142. [DOI: 10.1227/neu.0000000000002155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/19/2022] Open
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21
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Beeman A, Gonzalez Marques C, Tang OY, Uwamahoro C, Jarmale S, Mutabazi Z, Ndebwanimana V, Uwamahoro D, Niyonsaba M, Stephen A, Aluisio AR. Factors associated with HIV testing among patients seeking emergent injury care in Kigali, Rwanda. Afr J Emerg Med 2022; 12:281-286. [PMID: 35782195 PMCID: PMC9240989 DOI: 10.1016/j.afjem.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/11/2022] [Accepted: 05/05/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Emergency centres (ECs) can be important access points for HIV testing. In Rwanda, one in eight people with HIV are unaware of their infection status, which impedes epidemic control. This could be addressed via increased testing. This cross-sectional study evaluated factors associated with EC-based HIV testing among injured patients at the Centre Hospitalier Universitaire de Kigali (CHUK), in Kigali, Rwanda. Methods Adult injury patients were prospectively enrolled between January-June 2020. Trained study personnel collected data on demographics, injury aspects, treatments, HIV testing, and disposition. The primary outcome was the completion of EC-based HIV testing. Differences between those receiving and those not receiving testing were assessed. Regression models yielding adjusted odds ratios with associated 95% confidence intervals (CI) were calculated to quantify magnitudes of effect. Results Among 579 patients, the majority were under 45 years of age (78.1%) and male (74.4%). The most common mechanism of injury was road traffic accidents (50.3%). EC discharge occurred in 54.4% of cases. HIV testing was performed in 221 (38.2%) cases, of which 5.9% had a positive result. HIV testing was more likely among males (aOR=1.69, 95% CI: 1.02-2.78; p=0.04), cases transported by prehospital services (aOR=2.07, 95% CI: 1.28-3.35; p=0.003) and those receiving surgical consultation (aOR=3.13, 95% CI: 1.99-4.94; p<0.001). Cases with lower acuity were less likely to be tested (OR=0.70, 95% CI: 0.55-0.90; p=0.004), as were those discharged (OR=0.28, 95% CI: 0.18-0.43; p<0.001). Conclusion In the population studied, most patients did not undergo HIV testing. EC-based physician directed testing was more likely among male patients and patients with greater care needs. These results may inform approaches to increase EC-based testing services in Rwanda and other similar settings with high HIV burdens.
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Affiliation(s)
- Aly Beeman
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA,Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, KN 4 Ave, Kigali, Rwanda
| | | | - Oliver Y. Tang
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Chantal Uwamahoro
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, KN 4 Ave, Kigali, Rwanda,Corresponding author.
| | - Spandana Jarmale
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Zeta Mutabazi
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, KN 4 Ave, Kigali, Rwanda
| | - Vincent Ndebwanimana
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, KN 4 Ave, Kigali, Rwanda
| | - Doris Uwamahoro
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, KN 4 Ave, Kigali, Rwanda
| | - Mediatrice Niyonsaba
- Rwanda Biomedical Center, Kigali, Rwanda,Service d'Aide Médicale Urgente (SAMU), Rwanda Ministry of Health, Kigali, Rwanda
| | - Andrew Stephen
- Department of Surgery, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Adam R. Aluisio
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA,Department of Emergency Medicine, Brigham & Women's Hospital, Boston, MA, USA
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22
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Lee DJ, Ahmed SA, Tang OY, Yang DS, Alsoof D, McDonald CL, Eltorai AE, Daniels AH. Comparative Effectiveness of Sacroiliac Belt versus Lumbar Orthosis Utilization on Nonspecific Low Back Pain: a Crossover Randomized Clinical Trial. Orthop Rev (Pavia) 2022; 14:37471. [DOI: 10.52965/001c.37471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Back braces are commonly utilized in the management of low back pain (LBP). Objective The aim of this study is to evaluate (1) user satisfaction with a sacroiliac belt versus a lumbar orthosis and (2) the effect of a sacroiliac belt versus a lumbar orthosis on pain, functional disability status, and analgesic use for subjects with subacute or chronic non-specific LBP. Methods This is a prospective randomized crossover study. For the two-week study period, control group subjects wore the Horizon 627 Lumbar Brace (“lumbar orthosis”) during the first week and the Serola Sacroiliac Belt (“sacroiliac belt”) during the second week; experimental group subjects wore the sacroiliac belt during the first week and the lumbar orthosis during the second week. User satisfaction (Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 [QUEST 2.0] score), functional disability status (Oswestry Disability Index [ODI]), pain, and analgesic use were recorded. Results Overall, the sacroiliac belt demonstrated significantly higher user satisfaction than the Horizon brace (QUEST Score = 20.31 vs. 16.17, p = 0.0375) for the entire study period. Significant negative correlations were identified between user satisfaction and functional disability (t = -4.71, p < 0.0001), pain magnitude (t = -6.81, p < 0.0001) as well as pain frequency (t = -6.66, p < 0.0001). Conclusion In this prospective randomized crossover study, subject satisfaction was associated with improvements in functional disability, pain magnitude and pain frequency. The sacroiliac belt demonstrated significantly higher user satisfaction and similar effectiveness compared to the lumbar orthosis.
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Affiliation(s)
- David J. Lee
- The Warren Alpert Medical School of Brown University
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23
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Tang OY, Sullivan PZ, Tubre T, Feler J, Shao B, Hart J, Gokaslan ZL. Navigation-assisted resection of tumoral calcinosis of the lumbosacral spine: illustrative case. Journal of Neurosurgery: Case Lessons 2022; 4:CASE22213. [PMID: 36046265 PMCID: PMC9329862 DOI: 10.3171/case22213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Tumoral calcinosis is an uncommon disease resulting from dystrophic calcium phosphate crystal deposition, with only 7% of cases involving the spine, and it may diagnostically mimic neoplasms.
OBSERVATIONS
In this case, a 54-year-old woman with history of systemic scleroderma presented with 10 months of progressive left lumbosacral pain. Imaging revealed an expansile, 4 × 7-cm, well-circumscribed mass in the lumbosacral spine with L5–S1 neuroforaminal compression. Because intractable pain and computed tomography (CT)-guided needle biopsy did not entirely rule out malignancy, operative management was pursued. The patient underwent L4–S2 laminectomies, left L5–S1 facetectomy, L5 and S1 pediculectomies, and en bloc resection, performed under stereotactic CT-guided intraoperative navigation. Subsequently, instrumented fusion was performed with L4 and L5 pedicle screws and S2 alar-iliac screws. Pathological examination was consistent with tumoral calcinosis, with multiple nodules of amorphous basophilic granular calcified material lined by histiocytes. There was no evidence of recurrence or neurological deficits at 5-month follow-up.
LESSONS
Because spinal tumoral calcinosis may mimic neoplasms on imaging or gross intraoperative appearance, awareness of this clinical entity is essential for any spine surgeon. A review of all case reports of lumbosacral tumoral calcinosis (n = 14 from 1952 to 2016) was additionally performed. The case featured in this report presents the first known case of navigation-assisted resection of lumbosacral tumoral calcinosis.
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Affiliation(s)
| | | | - Teddi Tubre
- Pathology, Rhode Island Hospital, The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | | | | | - Jesse Hart
- Pathology, Rhode Island Hospital, The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
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24
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Alanio C, Binder ZA, Chang RB, Nasrallah MP, Delman D, Li JH, Tang OY, Zhang LY, Zhang JV, Wherry EJ, O’Rourke DM, Beatty GL. Immunologic Features in De Novo and Recurrent Glioblastoma Are Associated with Survival Outcomes. Cancer Immunol Res 2022; 10:800-810. [PMID: 35507919 PMCID: PMC9250610 DOI: 10.1158/2326-6066.cir-21-1050] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/09/2022] [Accepted: 04/29/2022] [Indexed: 01/03/2023]
Abstract
Glioblastoma (GBM) is an immunologically "cold" tumor characterized by poor responsiveness to immunotherapy. Standard of care for GBM is surgical resection followed by chemoradiotherapy and maintenance chemotherapy. However, tumor recurrence is the norm, and recurring tumors are found frequently to have acquired molecular changes (e.g., mutations) that may influence their immunobiology. Here, we compared the immune contexture of de novo GBM and recurrent GBM (rGBM) using high-dimensional cytometry and multiplex IHC. Although myeloid and T cells were similarly abundant in de novo and rGBM, their spatial organization within tumors differed and was linked to outcomes. In rGBM, T cells were enriched and activated in perivascular regions and clustered with activated macrophages and fewer regulatory T cells. Moreover, a higher expression of phosphorylated STAT1 by T cells in these regions at recurrence was associated with a favorable prognosis. Together, our data identify differences in the immunobiology of de novo GBM and rGBM and identify perivascular T cells as potential therapeutic targets. See related Spotlight by Bayik et al., p. 787.
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Affiliation(s)
- Cécile Alanio
- INSERM U932, PSL University, Institut Curie, Paris 75005, France,Laboratoire d'immunologie clinique, Institut Curie, Paris 75005, France,Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Parker Institute for Cancer Immunotherapy at University of Pennsylvania, Philadelphia, PA, 19104 USA,Glioblastoma Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Correspondence: Gregory L. Beatty, MD, PhD, University of Pennsylvania, Perelman Center for Advanced Medicine, South Pavilion, Room 8-107, 3400 Civic Center Blvd., Philadelphia, PA 19104-5156, , Cecile Alanio, MD, PhD, Deputy Director of the Clinical Immunology Laboratory at Institut Curie, Scientist in the U932 INSERM “Immunity and Cancer” Unit, Center for Cancer Immunotherapy, Hopital - 2ème Etage, 26 rue d’Ulm, 75248 Paris Cedex 05, France,
| | - Zev A. Binder
- Glioblastoma Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA
| | - Renee B. Chang
- Glioblastoma Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA
| | - MacLean P. Nasrallah
- Glioblastoma Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA
| | - Devora Delman
- Glioblastoma Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA
| | - Joey H. Li
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA
| | - Oliver Y. Tang
- Glioblastoma Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Warren Alpert Medical School of Brown University, Brown University, Providence, RI, 02903
| | - Logan Y. Zhang
- Glioblastoma Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA
| | - Jiasi Vicky Zhang
- Glioblastoma Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA
| | - E. John Wherry
- Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Parker Institute for Cancer Immunotherapy at University of Pennsylvania, Philadelphia, PA, 19104 USA,Glioblastoma Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA
| | - Donald M. O’Rourke
- Glioblastoma Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA
| | - Gregory L. Beatty
- Glioblastoma Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104 USA,Correspondence: Gregory L. Beatty, MD, PhD, University of Pennsylvania, Perelman Center for Advanced Medicine, South Pavilion, Room 8-107, 3400 Civic Center Blvd., Philadelphia, PA 19104-5156, , Cecile Alanio, MD, PhD, Deputy Director of the Clinical Immunology Laboratory at Institut Curie, Scientist in the U932 INSERM “Immunity and Cancer” Unit, Center for Cancer Immunotherapy, Hopital - 2ème Etage, 26 rue d’Ulm, 75248 Paris Cedex 05, France,
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Tang OY, Bajaj AI, Zhao K, Liu JK. Patient frailty association with cerebral arteriovenous malformation microsurgical outcomes and development of custom risk stratification score: an analysis of 16,721 nationwide admissions. Neurosurg Focus 2022; 53:E14. [DOI: 10.3171/2022.4.focus2285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Patient frailty is associated with poorer perioperative outcomes for several neurosurgical procedures. However, comparative accuracy between different frailty metrics for cerebral arteriovenous malformation (AVM) outcomes is poorly understood and existing frailty metrics studied in the literature are constrained by poor specificity to neurosurgery. This aim of this paper was to compare the predictive ability of 3 frailty scores for AVM microsurgical admissions and generate a custom risk stratification score.
METHODS
All adult AVM microsurgical admissions in the National (Nationwide) Inpatient Sample (2002–2017) were identified. Three frailty measures were analyzed: 5-factor modified frailty index (mFI-5; range 0–5), 11-factor modified frailty index (mFI-11; range 0–11), and Charlson Comorbidity Index (CCI) (range 0–29). Receiver operating characteristic curves were used to compare accuracy between metrics. The analyzed endpoints included in-hospital mortality, routine discharge, complications, length of stay (LOS), and hospitalization costs. Survey-weighted multivariate regression assessed frailty-outcome associations, adjusting for 13 confounders, including patient demographics, hospital characteristics, rupture status, hydrocephalus, epilepsy, and treatment modality. Subsequently, k-fold cross-validation and Akaike information criterion–based model selection were used to generate a custom 5-variable risk stratification score called the AVM-5. This score was validated in the main study population and a pseudoprospective cohort (2018–2019).
RESULTS
The authors analyzed 16,271 total AVM microsurgical admissions nationwide, with 21.0% being ruptured. The mFI-5, mFI-11, and CCI were all predictive of lower rates of routine discharge disposition, increased perioperative complications, and longer LOS (all p < 0.001). Their AVM-5 risk stratification score was calculated from 5 variables: age, hydrocephalus, paralysis, diabetes, and hypertension. The AVM-5 was predictive of decreased rates of routine hospital discharge (OR 0.26, p < 0.001) and increased perioperative complications (OR 2.42, p < 0.001), postoperative LOS (+49%, p < 0.001), total LOS (+47%, p < 0.001), and hospitalization costs (+22%, p < 0.001). This score outperformed age, mFI-5, mFI-11, and CCI for both ruptured and unruptured AVMs (area under the curve [AUC] 0.78, all p < 0.001). In a pseudoprospective cohort of 2005 admissions from 2018 to 2019, the AVM-5 remained significantly associated with all outcomes except for mortality and exhibited higher accuracy than all 3 earlier scores (AUC 0.79, all p < 0.001).
CONCLUSIONS
Patient frailty is predictive of poorer disposition and elevated complications, LOS, and costs for AVM microsurgical admissions. The authors’ custom AVM-5 risk score outperformed age, mFI-5, mFI-11, and CCI while using threefold less variables than the CCI. This score may complement existing AVM grading scales for optimization of surgical candidates and identification of patients at risk of postoperative medical and surgical morbidity.
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Affiliation(s)
- Oliver Y. Tang
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ankush I. Bajaj
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kevin Zhao
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey
- Department of Neurological Surgery, New Jersey Medical School, Newark, New Jersey
- Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston, New Jersey
| | - James K. Liu
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey
- Department of Neurological Surgery, New Jersey Medical School, Newark, New Jersey
- Department of Otolaryngology–Head and Neck Surgery, New Jersey Medical School, Newark, New Jersey; and
- Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston, New Jersey
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Tang OY, Tian L, Yoder T, Xu R, Kulikovskaya I, Gupta M, Melenhorst JJ, Lacey SF, O’Rourke DM, Binder ZA. PD1 Expression in EGFRvIII-Directed CAR T Cell Infusion Product for Glioblastoma Is Associated with Clinical Response. Front Immunol 2022; 13:872756. [PMID: 35603165 PMCID: PMC9120664 DOI: 10.3389/fimmu.2022.872756] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/12/2022] [Indexed: 12/11/2022] Open
Abstract
The epidermal growth factor receptor variant III (EGFRvIII) has been investigated as a therapeutic target for chimeric antigen receptor (CAR) T cell therapy in glioblastoma. Earlier research demonstrated that phenotypic and genotypic characteristics in T cells and CAR T product predicted therapeutic success in hematologic malignancies, to date no determinants for clinical response in solid tumors have been identified. We analyzed apheresis and infusion products from the first-in-human trial of EGFRvIII-directed CAR T for recurrent glioblastoma (NCT02209376) by flow cytometry. Clinical response was quantified via engraftment in peripheral circulation and progression-free survival (PFS), as determined by the time from CAR T infusion to first radiographic evidence of progression. The CD4+CAR T cell population in patient infusion products demonstrated PD1 expression which positively correlated with AUC engraftment and PFS. On immune checkpoint inhibitor analysis, CTLA-4, TIM3, and LAG3 did not exhibit significant associations with engraftment or PFS. The frequencies of PD1+GZMB+ and PD1+HLA-DR+ CAR T cells in the CD4+ infusion products were directly proportional to AUC and PFS. No significant associations were observed within the apheresis products. In summary, PD1 in CAR T infusion products predicted peripheral engraftment and PFS in recurrent glioblastoma.
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Affiliation(s)
- Oliver Y. Tang
- GBM Translational Center of Excellence, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Center for Cellular Immunotherapies, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Lifeng Tian
- Center for Cellular Immunotherapies, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Todd Yoder
- Center for Cellular Immunotherapies, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Rong Xu
- Center for Cellular Immunotherapies, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Irina Kulikovskaya
- Center for Cellular Immunotherapies, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Minnal Gupta
- Center for Cellular Immunotherapies, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jan Joseph Melenhorst
- GBM Translational Center of Excellence, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Center for Cellular Immunotherapies, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Simon F. Lacey
- Center for Cellular Immunotherapies, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Donald M. O’Rourke
- GBM Translational Center of Excellence, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Center for Cellular Immunotherapies, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Zev A. Binder
- GBM Translational Center of Excellence, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Center for Cellular Immunotherapies, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- *Correspondence: Zev A. Binder,
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Rivera Perla KM, Tang OY, Zeyl VG, Lim R, Rao V, Toms SA, Svokos KA, Woo AS. Predicting the Impact of Race and Socioeconomic Status on Cranioplasty Materials and Outcomes. World Neurosurg 2022; 164:e463-e480. [DOI: 10.1016/j.wneu.2022.04.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
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Tang OY, Barrios-Anderson A, Hobbs K, Palumbo M, Bajaj AI, Pugacheva A, Leary OP, Anderson MN, Feler JR, Pucci FG, Gokaslan ZL. Letter: The Brown Student Neurosurgery & Neurology Research Conference: A Model for Student-Centric Neurosurgical Research Dissemination in the Virtual Conference Era. Neurosurgery 2022; 90:e133-e136. [PMID: 35275103 DOI: 10.1227/neu.0000000000001930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/18/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Oliver Y Tang
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Adriel Barrios-Anderson
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Katherine Hobbs
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Marina Palumbo
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ankush I Bajaj
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Alisa Pugacheva
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Owen P Leary
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Matthew N Anderson
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Joshua R Feler
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Francesco G Pucci
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
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Tang OY, Bajaj AI, Zhao K, Rivera Perla KM, Ying YLM, Jyung RW, Liu JK. Association of Patient Frailty With Vestibular Schwannoma Resection Outcomes and Machine Learning Development of a Vestibular Schwannoma Risk Stratification Score. Neurosurgery 2022; 91:312-321. [PMID: 35411872 DOI: 10.1227/neu.0000000000001998] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/12/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Patient frailty is predictive of higher neurosurgical morbidity and mortality. However, existing frailty measures are hindered by lack of specificity to neurosurgery. OBJECTIVE To analyze the association between 3 risk stratification scores and outcomes for nationwide vestibular schwannoma (VS) resection admissions and develop a custom VS risk stratification score. METHODS We identified all VS resection admissions in the National Inpatient Sample (2002-2017). Three risk stratification scores were analyzed: modified Frailty Index-5, modified Frailty Index-11(mFI-11), and Charlson Comorbidity Index (CCI). Survey-weighted multivariate regression evaluated associations between frailty and inpatient outcomes, adjusting for patient demographics, hospital characteristics, and disease severity. Subsequently, we used k-fold cross validation and Akaike Information Criterion-based model selection to create a custom risk stratification score. RESULTS We analyzed 32 465 VS resection admissions. High frailty, as identified by the mFI-11 (odds ratio [OR] = 1.27, P = .021) and CCI (OR = 1.72, P < .001), predicted higher odds of perioperative complications. All 3 scores were also associated with lower routine discharge rates and elevated length of stay (LOS) and costs (all P < .05). Our custom VS-5 score (https://skullbaseresearch.shinyapps.io/vs-5_calculator/) featured 5 variables (age ≥60 years, hydrocephalus, preoperative cranial nerve palsies, diabetes mellitus, and hypertension) and was predictive of higher mortality (OR = 6.40, P = .001), decreased routine hospital discharge (OR = 0.28, P < .001), and elevated complications (OR = 1.59, P < .001), LOS (+48%, P < .001), and costs (+23%, P = .001). The VS-5 outperformed the modified Frailty Index-5, mFI-11, and CCI in predicting routine discharge (all P < .001), including in a pseudoprospective cohort (2018-2019) of 3885 admissions. CONCLUSION Patient frailty predicted poorer inpatient outcomes after VS surgery. Our custom VS-5 score outperformed earlier risk stratification scores.
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Affiliation(s)
- Oliver Y Tang
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ankush I Bajaj
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Kevin Zhao
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, USA.,Department of Neurological Surgery, New Jersey Medical School, Newark, New Jersey, USA.,Saint Barnabas Medical Center, RWJBarnabas Health, Livingston, New Jersey, USA
| | - Krissia M Rivera Perla
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Plastic Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yu-Lan Mary Ying
- Saint Barnabas Medical Center, RWJBarnabas Health, Livingston, New Jersey, USA.,Department of Otolaryngology-Head and Neck Surgery, New Jersey Medical School, Newark, New Jersey, USA
| | - Robert W Jyung
- Saint Barnabas Medical Center, RWJBarnabas Health, Livingston, New Jersey, USA.,Department of Otolaryngology-Head and Neck Surgery, New Jersey Medical School, Newark, New Jersey, USA
| | - James K Liu
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, USA.,Department of Neurological Surgery, New Jersey Medical School, Newark, New Jersey, USA.,Saint Barnabas Medical Center, RWJBarnabas Health, Livingston, New Jersey, USA.,Department of Otolaryngology-Head and Neck Surgery, New Jersey Medical School, Newark, New Jersey, USA
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Tang OY, Hsueh WD, Eloy JA, Liu JK. Giant Pituitary Adenoma – Special Considerations. Otolaryngol Clin North Am 2022; 55:351-379. [DOI: 10.1016/j.otc.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tang OY, Pugacheva A, Bajaj AI, Rivera Perla KM, Weil RJ, Toms SA. The National Inpatient Sample: A Primer for Neurosurgical Big Data Research and Systematic Review. World Neurosurg 2022; 162:e198-e217. [PMID: 35247618 DOI: 10.1016/j.wneu.2022.02.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The National Inpatient Sample - the largest all-payer inpatient database in the United States - is an important instrument for big data analysis of neurosurgical inquiries. However, earlier research has determined that many NIS studies are limited by common methodological pitfalls. In this study, we provide the first primer of NIS methodological procedures in the setting of neurosurgical research and review all published neurosurgical studies utilizing the NIS. METHODS We designed a protocol for neurosurgical big data research using the NIS, based on the authors' subject matter expertise, NIS documentation, and input and verification from the Healthcare Cost and Utilization Project. We subsequently used a comprehensive search strategy to identify all neurosurgical studies utilizing the NIS in the PubMed and MEDLINE, Embase, and Web of Science databases from inception to August 2021. Studies underwent qualitative categorization (years of the NIS studied, neurosurgical subspecialty, age group, and thematic focus of study objective) and analysis of longitudinal trends. RESULTS We identified a canonical, four-step protocol for NIS analysis: study population selection, defining additional clinical variables, identification and coding of outcomes, and statistical analysis. Methodological nuances discussed include identifying neurosurgery-specific admissions, addressing missing data, calculating additional severity and hospital-specific metrics, coding perioperative complications, and applying survey weights to make nationwide estimates. Inherent database limitations and common pitfalls of NIS studies discussed include lack of disease process-specific variables and data following the index admission, inability to calculate certain hospital-specific variables after 2011, performing state-level analyses, conflating hospitalization charges and costs, and not following proper statistical methodology for performing survey-weighted regression. In a systematic review, we identified 647 neurosurgical studies utilizing the NIS. While almost 60% of studies were published after 2015, <10% of studies analyzed NIS data after 2015. The average sample size of studies was 507,352 patients (standard deviation=2,739,900). Most studies analyzed cranial procedures (58.1%) and adults (68.1%). The most prevalent topic areas analyzed were surgical outcome trends (35.7%) and health policy and economics (17.8%), while patient disparities (9.4%) and surgeon or hospital volume (6.6%) were the least studied. CONCLUSIONS We present a standardized methodology to analyze the NIS, systematically review the state of the NIS neurosurgical literature, suggest potential future directions for neurosurgical big data inquiries, and outline recommendations to improve the design of future neurosurgical data instruments.
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Affiliation(s)
- Oliver Y Tang
- The Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Alisa Pugacheva
- The Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Ankush I Bajaj
- The Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Krissia M Rivera Perla
- The Warren Alpert Medical School of Brown University, Providence, RI, USA; Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Robert J Weil
- Southcoast Brain & Spine, Southcoast Health, Dartmouth, MA, USA
| | - Steven A Toms
- The Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA.
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Tang OY, Uwamahoro C, Marqués CG, Beeman A, Nshuti S, Jarmale S, Aluisio A. 176 Changes in Brain and Spine Trauma Volume, Management, and Outcomes During the COVID-19 Pandemic in Kigali, Rwanda. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Tang OY, Karanfilian KM, Zhao K, Liu JK. Letter to the Editor Regarding "Transfrontal-Sinus-Subcranial Approach to Olfactory Groove Meningiomas: Surgical Results and Clinical and Functional Outcome in a Consecutive Series of 21 Patients". World Neurosurg 2022; 159:240-242. [PMID: 35255621 DOI: 10.1016/j.wneu.2021.10.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 10/18/2022]
Affiliation(s)
- Oliver Y Tang
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Katrice M Karanfilian
- Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Neurosurgery, Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston, New Jersey, USA
| | - Kevin Zhao
- Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Neurosurgery, Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston, New Jersey, USA
| | - James K Liu
- Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Neurosurgery, Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston, New Jersey, USA.
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Tang OY, Shao B, Kimata A, Sastry R, Asaad W. 473 The Impact of Frailty on Traumatic Brain Injury Outcomes: An Analysis of 691,821 Nationwide Cases. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Tang OY, Clarke RA, Rivera Perla KM, Corcoran Ruiz KM, Toms SA, Weil RJ. Brain tumor craniotomy outcomes for dual-eligible medicare and medicaid patients: a 10-year nationwide analysis. J Neurooncol 2022; 156:387-398. [PMID: 35023004 DOI: 10.1007/s11060-021-03922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Dual-eligible (DE) patients, simultaneous Medicare and Medicaid beneficiaries, have been shown to have poorer clinical outcomes while incurring higher resource utilization. However, neurosurgical oncology outcomes for DE patients are poorly characterized. Accordingly, we examined the impact of DE status on perioperative outcomes following glioma, meningioma, or metastasis resection. METHODS We identified all admissions undergoing a craniotomy for glioma, meningioma, or metastasis resection in the National Inpatient Sample from 2002 to 2011. Assessed outcomes included inpatient mortality, complications, discharge disposition, length of stay (LOS), and hospital costs. Multivariable regression adjusting for 13 patient, severity, and hospital characteristics assessed the association between DE status and outcomes, relative to four reference insurance groups (Medicare-only, Medicaid-only, private insurance, self-pay). RESULTS Of 195,725 total admissions analyzed, 3.0% were dual-eligible beneficiaries (n = 5933). DEs were younger than Medicare admissions (P < 0.001) but older than Medicaid, private, and self-pay admissions (P < 0.001). Relative to other insurance groups, DEs also exhibited higher severity of illness, risk of mortality, and Charlson Comorbidity Index scores as well as treatment at low-volume hospitals (all P < 0.001). DEs had lower mortality than self-pay admissions (odds ratio [OR] 0.47, P = 0.017). Compared to Medicare, Medicaid, private, and self-pay admissions, DEs had lower rates of discharge disposition (OR 0.53, 0.50, 0.34, and 0.27, respectively, all P < 0.001). DEs also had higher complications (OR 1.23 and 1.20, respectively, both P < 0.05) and LOS (β = 1.06 and 1.13, respectively, both P < 0.01) than Medicare and private insurance beneficiaries. Differences in discharge disposition remained significant for all three tumor subtypes, but only glioma DE admissions continued to exhibit higher complications and LOS. CONCLUSIONS DEs undergoing definitive craniotomy for brain tumor had higher rates of unfavorable discharge disposition compared to all other insurance groups and, especially for glioma surgery, had higher inpatient complication rates and LOS. Practice and policy reforms to improve outcomes for this vulnerable clinical population are warranted.
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Affiliation(s)
- Oliver Y Tang
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Ross A Clarke
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Krissia M Rivera Perla
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Harvard T.H Chan School of Public Health, Boston, MA, USA
| | | | - Steven A Toms
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Robert J Weil
- Southcoast Brain & Spine, Southcoast Health, Dartmouth, MA, USA
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Danussi C, Bose P, Parthasarathy PT, Silberman PC, Van Arnam JS, Vitucci M, Tang OY, Heguy A, Wang Y, Chan TA, Riggins GJ, Sulman EP, Lang FF, Creighton CJ, Deneen B, Miller CR, Picketts DJ, Kannan K, Huse JT. Author Correction: Atrx inactivation drives disease-defining phenotypes in glioma cells of origin through global epigenomic remodeling. Nat Commun 2022; 13:190. [PMID: 34987156 PMCID: PMC8733027 DOI: 10.1038/s41467-021-27820-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Carla Danussi
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Promita Bose
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Prasanna T Parthasarathy
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Pedro C Silberman
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - John S Van Arnam
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Mark Vitucci
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, 27516, USA
| | - Oliver Y Tang
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Adriana Heguy
- Department of Pathology, New York University School of Medicine, New York, NY, 10016, USA
| | - Yuxiang Wang
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Timothy A Chan
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA.,Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Gregory J Riggins
- Departments of Neurosurgery, Oncology, and Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21231, USA
| | - Erik P Sulman
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.,Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Frederick F Lang
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Chad J Creighton
- Department of Medicine and Dan L. Duncan Comprehensive Cancer Center Division of Biostatistics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Benjamin Deneen
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, 77030, USA
| | - C Ryan Miller
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, 27516, USA.,Departments of Pharmacology and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, NC, 27516, USA
| | - David J Picketts
- Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON, K1H 8L6, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Kasthuri Kannan
- Department of Pathology, New York University School of Medicine, New York, NY, 10016, USA
| | - Jason T Huse
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA. .,Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
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Aluisio AR, Lim RK, Tang OY, Sugut J, Kinuthia J, Bosire R, Guthrie KM, Katz DA, Farquhar C, Mello MJ. Acceptability and uptake of HIV self-testing in emergency care settings: A systematic review and meta-analysis. Acad Emerg Med 2022; 29:95-104. [PMID: 34133822 PMCID: PMC8674381 DOI: 10.1111/acem.14323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/25/2021] [Accepted: 06/10/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Emergency departments (ED) interface with large numbers of patients that are often missed by conventional HIV testing approaches. ED-based HIV self-testing (HIVST) is an innovative engagement approach which has potential for testing gains among populations that have failed to be reached. This systematic review and meta-analysis evaluated acceptability and uptake of HIVST, as compared to standard provider-delivered testing approaches, among patients seeking care in ED settings. METHODS Six electronic databases were systematically searched (Dates: January 1990-May 2021). Reports with data on HIVST acceptability and/or testing uptake in ED settings were included. Two reviewers identified eligible records (κ= 0.84); quality was assessed using formalized criteria. Acceptability and testing uptake metrics were summarized, and pooled estimates were calculated using random-effects models with assessments of heterogeneity. RESULTS Of 5773 records identified, seven met inclusion criteria. The cumulative sample was 1942 subjects, drawn from three randomized control trials (RCTs) and four cross-sectional studies. Four reports assessed HIVST acceptability. Pooled acceptability of self-testing was 92.6% (95% confidence interval [CI]: 88.0%-97.1%). Data from two RCTs demonstrated that HIVST significantly increased testing uptake as compared to standard programs (risk ratio [RR] = 4.41, 95% CI: 1.95-10.10, I2 = 25.8%). Overall, the quality of evidence was low (42.9%) or very low (42.9%), with one report of moderate quality (14.2%). CONCLUSIONS Available data indicate that HIVST may be acceptable and may increase testing among patients seeking emergency care, suggesting that expanding ED-based HIVST programs could enhance HIV diagnosis. However, given the limitations of the reports, additional research is needed to better inform the evidence base.
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Affiliation(s)
- Adam R. Aluisio
- Department of Emergency Medicine, Alpert Medical School of
Brown University, Providence, USA
| | | | - Oliver Y. Tang
- Alpert Medical School of Brown University, Providence,
USA
| | - Janet Sugut
- Department of Accident and Emergency, Kenyatta National
Hospital, Nairobi, Kenya
| | - John Kinuthia
- Department of Research & Programs, Kenyatta National
Hospital, Nairobi, Kenya
| | - Rose Bosire
- Center for Public Health Research, Kenya Medical Research
Institute (KEMRI), Nairobi, Kenya
| | - Kate M. Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical
School, Brown University, Providence, RI, USA
| | - David A. Katz
- Department of Global Health, University of Washington,
Seattle, US
| | - Carey Farquhar
- Department of Global Health, University of Washington,
Seattle, US
- Department Epidemiology, University of Washington, Seattle,
USA
- Department Medicine, University of Washington, Seattle,
USA
| | - Michael J. Mello
- Department of Emergency Medicine, Alpert Medical School of
Brown University, Providence, USA
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Uwamahoro C, Gonzalez Marques C, Beeman A, Mutabazi Z, Twagirumukiza FR, Jing L, Ndebwanimana V, Uwamahoro D, Nkeshimana M, Tang OY, Naganathan S, Jarmale S, Stephen A, Aluisio AR. Injury burdens and care delivery in relation to the COVID-19 pandemic in Kigali, Rwanda: A prospective interrupted cross-sectional study. Afr J Emerg Med 2021; 11:422-428. [PMID: 34513579 PMCID: PMC8415735 DOI: 10.1016/j.afjem.2021.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/07/2021] [Accepted: 06/26/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction Injuries cause significant burdens in sub-Saharan Africa. In Rwanda, national regulations to reduce COVID-19 altered population mobility and resource allocations. This study evaluated epidemiological trends and care among injured patients preceding and during the COVID-19 pandemic at the Centre Hospitalier Universitaire de Kigali (CHUK) in Kigali, Rwanda. Methods This prospective interrupted cross-sectional study enrolled injured adult patients (≥15 years) presenting to the CHUK emergency department (ED) from January 27th-March 21st (pre-COVID-19 period) and June 1st-28th (intra-COVID-19 period). Trained study personnel continuously collected standardized data on enrolled participants through the first six-hours of ED care. The Kampala Trauma Score (KTS) was calculated as a metric of injury severity. Case characteristics prior to and during the pandemic were compared, statistical differences were assessed using χ2 or Fisher's exact tests. Results Data were collected from 409 pre-COVID-19 and 194 intra-COVID-19 cases. Median age was 32, with a male predominance (74.3%). Road traffic injuries (RTI) were the most common injury mechanism pre-COVID-19 (47.8%) and intra-COVID-19 (53.6%) (p = 0.27). There was a significant increase in the number of transfer cases during the intra-COVID-19 period (52.1%) versus pre-COVID-19 (41.3%) (p = 0.01). KTS was significantly lower among intra-COVID-19 patients (p = 0.04), indicating higher severity of presentation. In the intra-COVID-19 period, there was a significant increase in the number of surgery consultations (40.7%) versus pre-COVID-19 (26.7%) (p < 0.001). The number of hospital admissions increased from 35.5% pre-COVID-19 to 46.4% intra-COVID-19 (p = 0.01). There was no significant mortality difference pre-COVID-19 as compared to the intra-COVID-19 period among injured patients (p = 0.76). Conclusion Emergency injury care showed increased injury burden, inpatient admission and resource requirements during the pandemic period. This suggests the spectrum of disease may be more severe and that greater resources for injury management may continue to be needed during the ongoing COVID-19 pandemic in Rwanda and other similar settings.
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Affiliation(s)
- Chantal Uwamahoro
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
| | | | - Aly Beeman
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Zeta Mutabazi
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
| | | | - Ling Jing
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Vincent Ndebwanimana
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Doris Uwamahoro
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Menelas Nkeshimana
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Oliver Y. Tang
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Sonya Naganathan
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Spandana Jarmale
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Andrew Stephen
- Brown University Warren Alpert Medical School, Department of Surgery, Providence, RI, USA
| | - Adam R. Aluisio
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
- Brown University Warren Alpert Medical School, Providence, RI, USA
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Ruddell JH, Tang OY, Persaud B, Eltorai AE, Daniels AH, Ng T. Thoracic surgery program websites: Bridging the content gap for improved applicant recruitment. J Thorac Cardiovasc Surg 2021; 162:724-732. [DOI: 10.1016/j.jtcvs.2020.06.131] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/30/2020] [Accepted: 06/16/2020] [Indexed: 11/17/2022]
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Tang OY, Yoon JS, Durand WM, Ahmed SA, Lawton MT. The Impact of Interhospital Competition on Treatment Strategy and Outcomes for Unruptured Intracranial Aneurysms. Neurosurgery 2021; 89:695-703. [PMID: 34382663 DOI: 10.1093/neuros/nyab258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/08/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Interhospital competition has been shown to affect surgical outcomes and expenditures. However, interhospital competition's impact on neurosurgery is poorly characterized. OBJECTIVE To assess how interhospital competition is associated with treatment strategy and outcomes for unruptured intracranial aneurysms (UIAs). METHODS We identified all elective UIA admissions in the National Inpatient Sample from 2002 to 2011. Competitive intensity of each hospital market was quantified using the validated Herfindahl-Hirschman Index (HHI), with lower values denoting higher competition. We then obtained nationwide HHI values for 2012 to 2016 from the Health Care Cost Project. Outcomes included treatment modality (clipping, coiling, or nonoperative management), inpatient mortality, disposition, complications, length of stay (LOS), and costs. Multivariate regression assessed the association between HHI and outcomes, controlling for patient demographics, severity metrics, hospital characteristics, and treatment. RESULTS We studied 157 979 elective UIA admissions at 1435 hospitals from 2002 to 2011, with an increase in coiling admissions (13.4% to 33.7%) and decrease in clipping admissions (30.9% to 17.6%). Mean hospital HHI was 0.11 (range = 0.001-0.97). Competition decreased for 61.8% of hospitals from 2002 to 2011 and 68.1% of metropolitan localities from 2012 to 2016. Admissions in more competitive hospital markets exhibited increased odds of undergoing surgery (odds ratio [OR] = 1.37, P < .001), with preference toward coiling over clipping (OR = 1.27, P < .001). HHI was not associated with mortality, disposition, or LOS. However, increased interhospital competition was associated with more complications (OR = 1.09, P = .001) and greater hospital costs (β-coefficient = 1.06, P < .001). CONCLUSION For UIA patients, admission to hospitals in more competitive geographies was associated with increased rates of surgical intervention, coiling utilization, complications, and hospitalization costs.
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Affiliation(s)
- Oliver Y Tang
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - James S Yoon
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Wesley M Durand
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shaan A Ahmed
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.,Department of Medicine, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Corcoran Ruiz KM, Rivera Perla KM, Tang OY, Toms SA, Weil RJ. Outcomes after clipping and endovascular coiling for aneurysmal subarachnoid hemorrhage among dual-eligible beneficiaries. J Clin Neurosci 2021; 90:48-55. [PMID: 34275580 DOI: 10.1016/j.jocn.2021.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/24/2021] [Accepted: 05/02/2021] [Indexed: 11/26/2022]
Abstract
Dual-eligible beneficiaries, individuals with both Medicare and Medicaid coverage, represent a high-cost and vulnerable population; however, literature regarding outcomes is sparse. We characterized outcomes in dual-eligible beneficiaries treated for aneurysmal subarachnoid hemorrhage (aSAH) compared to Medicare only, Medicaid only, private insurance, and self-pay. A 10-year cross-sectional study of the National Inpatient Sample was conducted. Adult aSAH emergency admissions treated by neurosurgical clipping or endovascular coiling were included. Multivariable regression was used to adjust for confounders. A total of 57,666 patients met inclusion criteria. Dual-eligibles comprised 2.8% of admissions and were on average younger (62.4 years) than Medicare (70.0 years), older than all other groups, and had higher mean National Inpatient Sample-Subarachnoid Hemorrhage Severity Scores than all other groups (p ≤ 0.001). Among patients treated by clipping, dual-eligibles were less often discharged to home compared to Medicare (adjusted odds ratio (aOR) = 0.51, 95% CI = 0.30-0.87, p < 0.05) and all other insurance groups, p < 0.01. Likewise, those who received coiling were less often discharged to home compared to Medicaid (aOR = 0.41, 95% CI = 0.23-0.73), private (aOR = 0.42, 95% CI = 0.23-0.76) and self-pay patients (aOR = 0.24, 95% CI = 0.12-0.46). They also had increased odds of poor National Inpatient Sample-Subarachnoid Hemorrhage Outcome Measures compared to Medicaid, private, and self-pay patients, all p < 0.05. There were no differences in inpatient mortality or total complications. In conclusion, dual-eligible patients had higher aSAH severity scores, less often discharged home, and among patients who received coiling, dual-eligibles had increased odds of poor outcome. Dual-eligible patients with aSAH represent a vulnerable population that may benefit from targeted clinical and public policy initiatives.
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Affiliation(s)
- Kiara M Corcoran Ruiz
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Krissia M Rivera Perla
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Oliver Y Tang
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Steven A Toms
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Robert J Weil
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
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Ruddell JH, DePasse JM, Tang OY, Daniels AH. Timing of Surgery for Thoracolumbar Spine Trauma: Patients With Neurological Injury. Clin Spine Surg 2021; 34:E229-E236. [PMID: 33027090 DOI: 10.1097/bsd.0000000000001078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Large multicenter retrospective cohort study. OBJECTIVE The objective of this study was to analyze the effect of fusion timing on inpatient outcomes in a nationally representative population with thoracolumbar fracture and concurrent neurological injury. SUMMARY OF BACKGROUND DATA Among thoracolumbar trauma admissions, concurrent neurological injury is associated with greater long-term morbidity. There is little consensus on optimal surgical timing for these patients; previous investigations fail to differentiate thoracolumbar fracture with and without neurological injury. MATERIALS AND METHODS We analyzed 19,136 nonelective National Inpatient Sample cases (2004-2014) containing International Classifications of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes for closed thoracic/lumbar fracture with neurological injury and procedure codes for primary thoracolumbar/lumbosacral fusion, excluding open/cervical fracture. Timing classification from admission to fusion was same-day, 1-2-, 3-6-, and ≥7-day delay. Primary outcomes included in-hospital mortality, complications, and infection; secondary outcomes included total and postoperative length of stay and charges. Logistic regressions and generalized linear models with gamma distribution and log-link evaluated the effect of surgical timing on primary and secondary outcomes, respectively, controlling for age, sex, fracture location, fusion approach, multiorgan system injury severity score, and medical comorbidities. RESULTS Patients undergoing surgery ≤72 hours (n=12,845) had the lowest odds of in-hospital cardiac [odds ratio (OR)=0.595; 95% confidence interval (CI), 0.357-0.991] and respiratory complications (OR=0.495; 95% CI, 0.313-0.784) and infection (OR=0.615; 95% CI, 0.390-0.969). No differences were observed between same-day (n=4724) and 1-2-day delay (n=8121) (P>0.05). Lowest odds of hemorrhage or hematoma was observed following 3-6-day delay (OR=0.467; 95% CI, 0.236-0.922). A ≥7-day delay to fusion (n=2,002) was associated with greatest odds of hemorrhage/hematoma (OR=2.019; 1.107-3.683), respiratory complications (OR=1.850; 95% CI, 1.076-3.180), and infection (OR=3.155; 95% CI, 1.891-5.263) and greatest increases in mean postoperative length of stay (4.26% or 35.3% additional days) and charges (163,562 or 71.7% additional US dollars) (P<0.001). CONCLUSIONS Patients with thoracolumbar fracture and associated neurological injury who underwent surgery within 3 days of admission experienced fewer in-hospital complications. These benefits may be due to secondary injury mechanism avoidance and earlier mobilization. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - J Mason DePasse
- Division of Spine, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Alan H Daniels
- Division of Spine, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
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Shao B, Tang OY, Leary OP, Abdulrazeq H, Sastry RA, Brown S, Wilson IB, Asaad WF, Gokaslan ZL. Demand for Essential Nonambulatory Neurosurgical Care Decreased While Acuity of Care Increased During the Coronavirus Disease 2019 (COVID-19) Surge. World Neurosurg 2021; 151:e523-e532. [PMID: 33905912 PMCID: PMC8589108 DOI: 10.1016/j.wneu.2021.04.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 02/07/2023]
Abstract
Background In times of health resource reallocation, capacities must remain able to meet a continued demand for essential, nonambulatory neurosurgical acute care. This study sought to characterize the demand for and provision of neurosurgical acute care during the coronavirus disease 2019 (COVID-19) pandemic. Methods This single-center cross-sectional observational analysis compared nonambulatory neurosurgical consult encounters during the peri-surge period (March 9 to May 31, 2020) with those during an analogous period in 2019. Outcomes included consult volume, distribution of problem types, disease severity, and rate of acute operative intervention. Results A total of 1494 neurosurgical consults were analyzed. Amidst the pandemic surge, 583 consults were seen, which was 6.4 standard deviations below the mean among analogous 2016–2019 periods (mean 873; standard deviation 45, P = 0.001). Between 2019 and 2020, the proportion of degenerative spine consults decreased in favor of spinal trauma (25.6% vs. 34% and 51.9% vs. 41.4%, P = 0.088). Among aneurysmal subarachnoid hemorrhage cases, poor-grade (Hunt and Hess grades 4–5) presentations were more common (30% vs. 14.8%, P = 0.086). A greater proportion of pandemic era consults resulted in acute operative management, with an unchanged absolute frequency of acutely operative consults (123/583 [21.1%] vs. 120/911 [13.2%], P < 0.001). Conclusions Neurosurgical consult volume during the pandemic surge hit a 5-year institutional low. Amidst vast reallocation of health care resources, demand for high-acuity nonambulatory neurosurgical care continued and proportionally increased for greater-acuity pathologies. In our continued current pandemic as well as any future situations of mass health resource reallocation, neurosurgical acute care capacities must be preserved.
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Affiliation(s)
- Belinda Shao
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.
| | - Oliver Y Tang
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Owen P Leary
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Hael Abdulrazeq
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Rahul A Sastry
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Sarah Brown
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Ira B Wilson
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Wael F Asaad
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
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Perla KMR, Pertsch NJ, Leary OP, Garcia CM, Tang OY, Toms SA, Weil RJ. Outcomes of infratentorial cranial surgery for tumor resection in older patients: An analysis of the National Surgical Quality Improvement Program. Surg Neurol Int 2021; 12:144. [PMID: 33948314 PMCID: PMC8088538 DOI: 10.25259/sni_25_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Poorer outcomes for infratentorial tumor resection have been reported. There is a lack of large multicenter analyses describing infratentorial surgery outcomes in older patients. We characterized outcomes in patients aged ≥65 years undergoing infratentorial cranial surgery. Methods: The National Surgical Quality Improvement Project database was queried from 2012 to 2018 for patients ≥18 years undergoing elective infratentorial cranial surgery for tumor resection. Patients were grouped into 65–74 years, ≥75 years, and 18–64 years cohorts. Multivariable regressions compared outcome measures. Results: Of 2212 patients, 28.3% were ≥65 years, of whom 24.8% were ≥75 years. Both older subpopulations had worse American Society of Anesthesiologists classification compared to controls (P < 0.01) and more comorbidities. Patients 65–74 and ≥75 years had higher rates of major complication (adjusted odds ratio [aOR] = 1.77, 95% CI = 1.13–2.79 and aOR = 3.44, 95% CI = 1.96–6.02, respectively), prolonged length of stay (LOS) (aOR = 1.89, 95% CI = 1.15–3.12 and aOR = 3.00, 95% CI = 1.65–5.44, respectively), and were more likely to be discharged to a location other than home (aOR = 2.43, 95% CI =1.73–3.4 and aOR = 3.41, 95% CI = 2.18–5.33, respectively) relative to controls. Patients ≥75 had higher rates of readmission (aOR = 1.86, 95% CI = 1.13–3.08) and mortality (aOR = 3.28, 95% CI = 1.21–8.89) at 30 days. Conclusion: Patients ≥65 years experienced more complications, prolonged LOS, and were less often discharged home than adults <65 years. Patients ≥75 years had higher rates of 30-day readmission and mortality. There is a need for careful preoperative optimization in older patients undergoing infratentorial tumor cranial surgery.
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Affiliation(s)
- Krissia M Rivera Perla
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, United States
| | - Nathan J Pertsch
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, United States
| | - Owen P Leary
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, United States
| | - Catherine M Garcia
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, United States
| | - Oliver Y Tang
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, United States
| | - Steven A Toms
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, United States
| | - Robert J Weil
- Department of Neurosurgery, Rhode Island Hospital, Rhode Island, United States
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Zepecki JP, Karambizi D, Fajardo JE, Snyder KM, Guetta-Terrier C, Tang OY, Chen JS, Sarkar A, Fiser A, Toms SA, Tapinos N. miRNA-mediated loss of m6A increases nascent translation in glioblastoma. PLoS Genet 2021; 17:e1009086. [PMID: 33684100 PMCID: PMC7971852 DOI: 10.1371/journal.pgen.1009086] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 03/18/2021] [Accepted: 02/15/2021] [Indexed: 12/13/2022] Open
Abstract
Within the glioblastoma cellular niche, glioma stem cells (GSCs) can give rise to differentiated glioma cells (DGCs) and, when necessary, DGCs can reciprocally give rise to GSCs to maintain the cellular equilibrium necessary for optimal tumor growth. Here, using ribosome profiling, transcriptome and m6A RNA sequencing, we show that GSCs from patients with different subtypes of glioblastoma share a set of transcripts, which exhibit a pattern of m6A loss and increased protein translation during differentiation. The target sequences of a group of miRNAs overlap the canonical RRACH m6A motifs of these transcripts, many of which confer a survival advantage in glioblastoma. Ectopic expression of the RRACH-binding miR-145 induces loss of m6A, formation of FTO/AGO1/ILF3/miR-145 complexes on a clinically relevant tumor suppressor gene (CLIP3) and significant increase in its nascent translation. Inhibition of miR-145 maintains RRACH m6A levels of CLIP3 and inhibits its nascent translation. This study highlights a critical role of miRNAs in assembling complexes for m6A demethylation and induction of protein translation during GSC state transition.
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Affiliation(s)
- John P. Zepecki
- Laboratory of Cancer Epigenetics and Plasticity, Brown University, Rhode Island Hospital, Providence Rhode Island, United States of America
| | - David Karambizi
- Laboratory of Cancer Epigenetics and Plasticity, Brown University, Rhode Island Hospital, Providence Rhode Island, United States of America
| | - J. Eduardo Fajardo
- Department of Systems and Computational Biology, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Kristin M. Snyder
- University of Minnesota, College of Veterinary Medicine, St. Paul, Minnesota, United States of America
| | - Charlotte Guetta-Terrier
- Laboratory of Cancer Epigenetics and Plasticity, Brown University, Rhode Island Hospital, Providence Rhode Island, United States of America
| | - Oliver Y. Tang
- Laboratory of Cancer Epigenetics and Plasticity, Brown University, Rhode Island Hospital, Providence Rhode Island, United States of America
| | - Jia-Shu Chen
- Laboratory of Cancer Epigenetics and Plasticity, Brown University, Rhode Island Hospital, Providence Rhode Island, United States of America
| | - Atom Sarkar
- Department of Neurosurgery, Drexel Neuroscience Institute, Philadelphia Pennsylvania, United States of America
| | - Andras Fiser
- Department of Systems and Computational Biology, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Steven A. Toms
- Department of Neurosurgery, Brown University, Providence Rhode Island, United States of America
| | - Nikos Tapinos
- Laboratory of Cancer Epigenetics and Plasticity, Brown University, Rhode Island Hospital, Providence Rhode Island, United States of America
- Department of Neurosurgery, Brown University, Providence Rhode Island, United States of America
- Cancer Biology Program, Brown University, Lifespan Cancer Institute, Providence RI, USA
- Carney Institute for Brain Science, Brown University, Providence, RI, USA
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Pertsch NJ, Darveau SC, Tang OY, Toms SA, Weil RJ. Urinary Tract Infection after Elective Spine Surgery: Timing, Predictive Factors, and Outcomes. Spine (Phila Pa 1976) 2021; 46:337-346. [PMID: 33534444 DOI: 10.1097/brs.0000000000003794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE The aim of this study was to investigate risk factors associated with the timing of urinary tract infection (UTI) after elective spine surgery, and to determine whether postoperative UTI timing affects short-term outcomes. SUMMARY OF BACKGROUND DATA Urinary tract infection (UTI) is a common post-surgical complication; however, the predominant timing, location, and potential differential effects have not been carefully studied. METHODS We analyzed elective spine surgery patients from 2012 to 2018 in the ACS National Surgical Quality Improvement Program (NSQIP). We grouped patients with postoperative UTI by day of onset relative to discharge, to create cohorts of patients who developed inpatient UTI and post-discharge UTI. We compared both UTI cohorts with a control (no UTI) population and with each other to identify differences in baseline characteristics including demographic, comorbidity and operative factors. We performed multivariate logistic regression to identify predictors of UTI in each cohort and to assess adjusted risks of poor outcomes associated with UTI timing. RESULTS A total of 289,121 patients met inclusion criteria and 0.88% developed UTI (n = 2553). Only 31.6% of UTIs occurred before discharge (n = 806), with 68.4% occurring after discharge (n = 1747). The inpatient UTI cohort had significantly longer operative time, more fusion procedures, more posterior procedures, and more procedures involving the lumbar levels than the post-discharge cohort. Predictors of inpatient UTI included procedure type, spine region, and approach. Predictors of post-discharge UTI included length-of-stay and discharge destination. Both UTI cohorts were significantly associated with sepsis; however, post-discharge UTI carried a higher odds (adjusted odds ratio [aOR] = 24.90, 95% confidence interval [CI] = 21.05-29.45, P < 0.001 vs. aOR = 14.31, 95% CI = 11.09-18.45, P < 0.001). Inpatient UTI was not associated with 30-day readmission, although post-discharge UTI was (aOR = 8.23, 95% CI = 7.36-9.20, P < 0.001). Conversely, inpatient UTI was associated with increased odds of 30-day mortality (aOR = 3.23, 95% CI = 1.62-6.41, P = 0.001), but post-discharge UTI was not. CONCLUSION Predictive factors and outcomes differ based on timing of UTI after elective spine surgery. Before discharge, procedure -specific details predict UTI, but after discharge they do not. These findings suggest that traditional thinking about UTI prevention may need modification.Level of Evidence: 3.
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Affiliation(s)
- Nathan J Pertsch
- The Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Spencer C Darveau
- The Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Oliver Y Tang
- The Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Steven A Toms
- The Warren Alpert School of Medicine, Brown University, Providence, RI
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI
| | - Robert J Weil
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI
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Tang OY, Rivera Perla KM, Lim RK, Weil RJ, Toms SA. The impact of hospital safety-net status on inpatient outcomes for brain tumor craniotomy: a 10-year nationwide analysis. Neurooncol Adv 2021; 3:vdaa167. [PMID: 33506205 PMCID: PMC7813162 DOI: 10.1093/noajnl/vdaa167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Outcome disparities have been documented at safety-net hospitals (SNHs), which disproportionately serve vulnerable patient populations. Using a nationwide retrospective cohort, we assessed inpatient outcomes following brain tumor craniotomy at SNHs in the United States. Methods We identified all craniotomy procedures in the National Inpatient Sample from 2002–2011 for brain tumors: glioma, metastasis, meningioma, and vestibular schwannoma. Safety-net burden was calculated as the number of Medicaid plus uninsured admissions divided by total admissions. Hospitals in the top quartile of burden were defined as SNHs. The association between SNH status and in-hospital mortality, discharge disposition, complications, hospital-acquired conditions (HACs), length of stay (LOS), and costs were assessed. Multivariate regression adjusted for patient, hospital, and severity characteristics. Results 304,719 admissions were analyzed. The most common subtype was glioma (43.8%). Of 1,206 unique hospitals, 242 were SNHs. SNH admissions were more likely to be non-white (P < .001), low income (P < .001), and have higher severity scores (P = .034). Mortality rates were higher at SNHs for metastasis admissions (odds ratio [OR] = 1.48, P = .025), and SNHs had higher complication rates for meningioma (OR = 1.34, P = .003) and all tumor types combined (OR = 1.17, P = .034). However, there were no differences at SNHs for discharge disposition or HACs. LOS and hospital costs were elevated at SNHs for all subtypes, culminating in a 10% and 9% increase in LOS and costs for the overall population, respectively (all P < .001). Conclusions SNHs demonstrated poorer inpatient outcomes for brain tumor craniotomy. Further analyses of the differences observed and potential interventions to ameliorate interhospital disparities are warranted.
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Affiliation(s)
- Oliver Y Tang
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Krissia M Rivera Perla
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rachel K Lim
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Robert J Weil
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Steven A Toms
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
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Tang OY, Ruddell JH, Hilliard RW, Schiffman FJ, Daniels AH. Improving the online presence of residency programs to ameliorate COVID-19's impact on residency applications. Postgrad Med 2021; 133:404-408. [PMID: 33412975 DOI: 10.1080/00325481.2021.1874195] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: The coronavirus disease 2019 (COVID-19) pandemic has created several challenges for residency programs and prospective interns alike during the upcoming application cycle, including the cancellation of away sub-internships and in-person interviews. Given prior research documenting that applicants' application and ranking decisions are significantly influenced by residency webpages, a potential solution to the loss of in-person experiences during the pandemic is the expansion of residency programs' online presence through their program websites, provision of virtual grand rounds and pseudo-away rotations, and enhancement of virtual interviews. This study seeks to summarize the existing literature on these areas and provide concrete suggestions for improving programs' virtual presence.Methods: The authors summarize earlier literature querying the content of program websites across 14 medical specialties, which documented significant gaps in the content of interest to applicants.Results: Among 14 analyzed specialties, the majority of programs had a functional website (>90%), with the exception of interventional radiology (73.9%). However, significant gaps in content were documented, with the percentage of content variables contained on websites ranging from 33.3% to 70.5% (median = 47.0%, interquartile range = 37.8-52.6%). Program websites were also limited by underrepresentation of content most valued by applicants as well as potential areas of inaccurate or outdated information.Conclusions: There are several interventions programs can undertake to address existing gaps in online presence. During an application cycle facing unprecedented resource strain, bolstering the online presence of programs may facilitate an improved fit between programs and future residents.
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Affiliation(s)
- Oliver Y Tang
- Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jack H Ruddell
- Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ross W Hilliard
- Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Fred J Schiffman
- Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Tang OY, Marqués CG, Ndebwanimana V, Uwamahoro C, Uwamahoro D, Lipsman ZW, Naganathan S, Karim N, Nkeshimana M, Levine AC, Stephen A, Aluisio AR. Performance of Prognostication Scores for Mortality in Injured Patients in Rwanda. West J Emerg Med 2021; 22:435-444. [PMID: 33856336 PMCID: PMC7972380 DOI: 10.5811/westjem.2020.10.48434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/12/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION While trauma prognostication and triage scores have been designed for use in lower-resourced healthcare settings specifically, the comparative clinical performance between trauma-specific and general triage scores for risk-stratifying injured patients in such settings is not well understood. This study evaluated the Kampala Trauma Score (KTS), Revised Trauma Score (RTS), and Triage Early Warning Score (TEWS) for accuracy in predicting mortality among injured patients seeking emergency department (ED) care at the Centre Hospitalier Universitaire de Kigali (CHUK) in Rwanda. METHODS A retrospective, randomly sampled cohort of ED patients presenting with injury was accrued from August 2015-July 2016. Primary outcome was 14-day mortality and secondary outcome was overall facility-based mortality. We evaluated summary statistics of the cohort. Bootstrap regression models were used to compare areas under receiver operating curves (AUC) with associated 95% confidence intervals (CI). RESULTS Among 617 cases, the median age was 32 years and 73.5% were male. The most frequent mechanism of injury was road traffic incident (56.2%). Predominant anatomical regions of injury were craniofacial (39.3%) and lower extremities (38.7%), and the most common injury types were fracture (46.0%) and contusion (12.0%). Fourteen-day mortality was 2.6% and overall facility-based mortality was 3.4%. For 14-day mortality, TEWS had the highest accuracy (AUC = 0.88, 95% CI, 0.76-1.00), followed by RTS (AUC = 0.73, 95% CI, 0.55-0.92), and then KTS (AUC = 0.65, 95% CI, 0.47-0.84). Similarly, for facility-based mortality, TEWS (AUC = 0.89, 95% CI, 0.79-0.98) had greater accuracy than RTS (AUC = 0.76, 95% CI, 0.61-0.91) and KTS (AUC = 0.68, 95% CI, 0.53-0.83). On pairwise comparisons, RTS had greater prognostic accuracy than KTS for 14-day mortality (P = 0.011) and TEWS had greater accuracy than KTS for overall (P = 0.007) mortality. However, TEWS and RTS accuracy were not significantly different for 14-day mortality (P = 0.864) or facility-based mortality (P = 0.101). CONCLUSION In this cohort of emergently injured patients in Rwanda, the TEWS demonstrated the greatest accuracy for predicting mortality outcomes, with no significant discriminatory benefit found in the use of the trauma-specific RTS or KTS instruments, suggesting that the TEWS is the most clinically useful approach in the setting studied and likely in other similar ED environments.
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Affiliation(s)
- Oliver Y Tang
- Brown University Warren Alpert Medical School, Department, Providence, Rhode Island
| | - Catalina González Marqués
- Brown University Warren Alpert Medical School, Department of Emergency Medicine, Providence, Rhode Island
| | - Vincent Ndebwanimana
- University of Rwanda, Department of Anesthesia, Emergency Medicine, and Critical Care, Kigali, Rwanda.,Centre Hospitalier Universitaire de Kigali, Department of Accident & Emergency, Kigali, Rwanda
| | - Chantal Uwamahoro
- University of Rwanda, Department of Anesthesia, Emergency Medicine, and Critical Care, Kigali, Rwanda.,Centre Hospitalier Universitaire de Kigali, Department of Accident & Emergency, Kigali, Rwanda
| | - Doris Uwamahoro
- University of Rwanda, Department of Anesthesia, Emergency Medicine, and Critical Care, Kigali, Rwanda.,Centre Hospitalier Universitaire de Kigali, Department of Accident & Emergency, Kigali, Rwanda
| | - Zachary W Lipsman
- Kaiser Permanente, GSAA, San Leandro & Fremont Medical Centers, San Leandro, California
| | - Sonya Naganathan
- Brown University Warren Alpert Medical School, Department of Emergency Medicine, Providence, Rhode Island
| | - Naz Karim
- Brown University Warren Alpert Medical School, Department of Emergency Medicine, Providence, Rhode Island
| | - Menelas Nkeshimana
- University of Rwanda, Department of Anesthesia, Emergency Medicine, and Critical Care, Kigali, Rwanda.,Centre Hospitalier Universitaire de Kigali, Department of Accident & Emergency, Kigali, Rwanda
| | - Adam C Levine
- Brown University Warren Alpert Medical School, Department of Emergency Medicine, Providence, Rhode Island
| | - Andrew Stephen
- Brown University Warren Alpert Medical School, Department of Surgery, Providence, Rhode Island
| | - Adam R Aluisio
- Brown University Warren Alpert Medical School, Department of Emergency Medicine, Providence, Rhode Island
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Rivera Perla KM, Tang OY, Durfey S, ReFaey K, Vivas-Buitrago TG, Parney IF, Toms SA, Quinones-Hinojosa A. Low Socioeconomic Status Predicts Decreased Access to Post-Operative Treatment After Glioblastoma Resection. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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