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Recent Research Articles from JPS Health Network

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Lower Bone Mineral Density is Associated with Intertrochanteric Hip Fracture.

Tue, 01/15/2019 - 10:54
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Lower Bone Mineral Density is Associated with Intertrochanteric Hip Fracture.

Arch Bone Jt Surg. 2018 Nov;6(6):517-522

Authors: Bernstein DN, Davis JT, Fairbanks C, McWilliam-Ross K, Ring D, Sanchez HB

Abstract
Background: A better understanding of how bone mineral density and vitamin D levels are associated with femoral neck and intertrochanteric hip fractures may help inform healthcare providers. We asked: 1) In patients age ≥ 55 years, is there a difference in quantitative ultrasound of the heel (QUS) t-score between patients with fractures of the femoral neck and those with fractures of the intertrochanteric region, accounting for other factors 2) In patients age ≥ 55 years, is there a difference in vitamin D level between those with fractures of the femoral neck and those with fractures of the intertrochanteric region, accounting for other factors? 3) Is there an association between vitamin D level and QUS t-score?
Methods: In this retrospective cohort study, 1,030 patients were identified using CPT codes for fixation of hip fractures between December 2010 and September 2013. Patients ≥ 55 years of age who underwent operative management for a hip fracture following a fall from standing height were included. Three orthopaedic surgeons categorized fracture type using patient radiographs. Upon hospital admission, QUS t-scores and vitamin D levels were determined. Descriptive statistics, bivariate analyses and multivariable regression were performed.
Results: Accounting for potential confounders, patients with lower QUS t-scores were more likely to have intertrochanteric femur fractures than femoral neck fractures. In a bivariate analysis, there was no association between vitamin D level and either fracture type. There was no association between vitamin D level and bone mineral density.
Conclusion: Patients with lower bone density that fracture their hips are more likely to fracture in the intertrochanteric region than the femoral neck, but vitamin D levels are unrelated. Awareness of this association emphasizes the importance of bone mineral density screening to assist with intertrochanteric hip fracture prevention.
Level of evidence: III.

PMID: 30637307 [PubMed]

Longer Length of Stay Increases 1-year Readmission Rate in Patients Undergoing Hip Fracture Surgery.

Tue, 01/15/2019 - 10:54
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Longer Length of Stay Increases 1-year Readmission Rate in Patients Undergoing Hip Fracture Surgery.

Arch Bone Jt Surg. 2018 Nov;6(6):492-500

Authors: Crijns TJ, Caton T, Teunis T, Davis JT, McWilliam-Ross K, Ring D, Sanchez HB

Abstract
Background: Proximal femur fractures are prevalent among the elderly and associated with substantial morbidity, mortality, and early readmission. Early readmission is gaining popularity as a measure of quality of hospital care and can lower reimbursement. A better understanding of the patient and treatment characteristics associated with readmission may help inform program improvement initiatives. This study tested the primary null hypothesis that length of stay is not associated with higher rates of readmission within 30 days and 1 year in patients having operative treatment of a proximal femur fracture, accounting for discharge destination and other factors.
Methods: We performed a secondary analysis on a database of 1,061 adult patients, age 55 years or older, admitted for treatment of a proximal femoral fracture in an urban level 2 trauma center. Multivariable logistic and linear regression models were created to account for the influence of age, sex, race, BMI, American Society of Anesthesiologists score (ASA), fracture type (AO/OTA), fixation type, operating surgeon, operative duration, and discharge destination.
Results: In multivariable logistic regression analysis, treatment by surgeon 4 was independently associated with a lower 30-day readmission rate. Higher one-year readmission rate was associated with a longer length of stay, ASA class 3, 4 and 5.
Conclusion: The observation that patients cared for by specific surgeons are more likely to experience readmission within one year of surgery for a fracture of the proximal femur, suggests that program improvements to identify and disseminate best practices might reduce readmission rates.
Level of evidence: III.

PMID: 30637304 [PubMed]

Knowledge, awareness, and attitude towards infection prevention and management among surgeons: identifying the surgeon champion.

Tue, 01/15/2019 - 10:54
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Knowledge, awareness, and attitude towards infection prevention and management among surgeons: identifying the surgeon champion.

World J Emerg Surg. 2018;13:37

Authors: Sartelli M, Kluger Y, Ansaloni L, Coccolini F, Baiocchi GL, Hardcastle TC, Moore EE, May AK, Itani KMF, Fry DE, Boermeester MA, Guirao X, Napolitano L, Sawyer RG, Rasa K, Abu-Zidan FM, Adesunkanmi AK, Atanasov B, Augustin G, Bala M, Cainzos MA, Chichom-Mefire A, Cortese F, Damaskos D, Delibegovic S, Demetrashvili Z, De Simone B, Duane TM, Ghnnam W, Gkiokas G, Gomes CA, Hecker A, Karamarkovic A, Kenig J, Khokha V, Kong V, Isik A, Leppäniemi A, Litvin A, Lostoridis E, Machain GM, Marwah S, McFarlane M, Mesina C, Negoi I, Olaoye I, Pintar T, Pupelis G, Rems M, Rubio-Perez I, Sakakushev B, Segovia-Lohse H, Siribumrungwong B, Talving P, Ulrych J, Vereczkei AG, Labricciosa FM, Catena F

Abstract
Despite evidence supporting the effectiveness of best practices of infection prevention and management, many surgeons worldwide fail to implement them. Evidence-based practices tend to be underused in routine practice. Surgeons with knowledge in surgical infections should provide feedback to prescribers and integrate best practices among surgeons and implement changes within their team. Identifying a local opinion leader to serve as a champion within the surgical department may be important. The "surgeon champion" can integrate best clinical practices of infection prevention and management, drive behavior change in their colleagues, and interact with both infection control teams in promoting antimicrobial stewardship.

PMID: 30140304 [PubMed - indexed for MEDLINE]

The role of the built environment and private rooms for reducing central line-associated bloodstream infections.

Tue, 01/15/2019 - 10:54
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The role of the built environment and private rooms for reducing central line-associated bloodstream infections.

PLoS One. 2018;13(7):e0201002

Authors: O'Neill L, Park SH, Rosinia F

Abstract
Private hospital rooms are believed to offer some protective effect against hospital-acquired infections, including central line-associated bloodstream infections. Yet a recent meta-analysis found the evidence-base to be lacking from a policy perspective. We sought to determine whether private rooms were associated with a lower risk of central-line infections. We examined the discharge records of more than one million inpatients from 335 Texas hospitals to determine patients that stayed in private rooms. Patients who stayed in bay rooms had 64 percent more central line infections than patients who stayed in private rooms. Even after adjusting for relevant covariates, patients assigned to bay rooms had a 21 percent greater relative risk of a central line infection (p = 0.005), compared with patients assigned to private rooms. At the hospital level, a 10% increase in private rooms was associated with an 8.6% decrease in central line infections (p<0.001), regardless of individual patients' room assignment. This study demonstrates and validates the use of private rooms as a structural measure and independent predictor of hospital quality.

PMID: 30052672 [PubMed - indexed for MEDLINE]

Choosing Wisely at the End of Life: Use of Shorter Courses of Palliative Radiation Therapy for Bone Metastasis.

Thu, 01/10/2019 - 08:00
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Choosing Wisely at the End of Life: Use of Shorter Courses of Palliative Radiation Therapy for Bone Metastasis.

Int J Radiat Oncol Biol Phys. 2018 10 01;102(2):320-324

Authors: Wallace AS, Fiveash JB, Williams CP, Kvale E, Pisu M, Jackson BE, Rocque GB

Abstract
PURPOSE: American Society for Radiation Choosing Wisely guidelines recommend ≤10 fractions of radiation therapy (RT) for bone metastasis, with consideration for 1 fraction in patients with a poor prognosis. The purpose of this analysis was to evaluate characteristic differences in guideline concordance to fractionation regimens in a modern cohort of older patients with a diagnosis of bone metastasis.
METHODS AND MATERIALS: Medicare beneficiaries aged ≥65 years treated with RT for bone metastasis from 2012 to 2015 were identified. Guideline-concordant RT fractionation was defined in the entire cohort as ≤10 fractions. Utilization of 1 fraction versus ≥2 fractions was analyzed in deceased patients. Patient demographic, disease, and facility characteristics associated with shorter fractionation were analyzed.
RESULTS: In 569 patients treated with RT, the median age at diagnosis was 73 years. The most common cancer types were lung (37%), genitourinary (26%), breast (15%), and gastrointestinal (10%). Among all patients, 34%, 30%, and 36% received 1 fraction, 2 to 10 fractions, and ≥11 fractions, respectively. In comparison with receipt of 1 to 10 fractions, receipt of ≥11 fractions was associated with a $1467 increase in per-patient cost to Medicare during the calendar quarter of RT. Almost two-thirds of patients who died within 30 days of RT completion were treated with >1 fraction.
CONCLUSIONS: Although guideline concordance was high overall, a large number of patients received longer courses of RT at the end of life. Strong consideration should be made for utilization of shorter courses, particularly in patients with a limited prognosis.

PMID: 30191866 [PubMed - indexed for MEDLINE]

The EGS Grading Scale For Skin And Soft Tissue Infections Is Predictive Of Poor Outcomes : A Multicenter Validation Study.

Thu, 01/03/2019 - 07:38
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The EGS Grading Scale For Skin And Soft Tissue Infections Is Predictive Of Poor Outcomes : A Multicenter Validation Study.

J Trauma Acute Care Surg. 2018 Dec 28;:

Authors: Savage SA, Li SW, Utter GH, Cox JA, Wydo SM, Cahill K, Sarani B, Holzmacher J, Duane TM, Gandhi RR, Zielinski MD, Ray-Zack M, Tierney J, Chapin T, Murphy PB, Vogt KN, Schroeppel TJ, Callaghan E, Kobayashi L, Coimbra R, Schuster KM, Gillaspie D, Timsina L, Louis A, Crandall M

Abstract
INTRODUCTION: Over the last five years, the American Association for the Surgery of Trauma (AAST) has developed grading scales for Emergency General Surgery (EGS) diseases. In a prior validation study using diverticulitis, the grading scales were predictive of complications and length of stay. As EGS encompasses diverse diseases, the purpose of this study was to validate the grading scale concept against a different disease process with a higher associated mortality. We hypothesized that the grading scale would be predictive of complications, length of stay and mortality in skin and soft tissue infections (STI).
METHODS: This multi-institutional trial encompassed 12 centers. Data collected included demographic variables, disease characteristics and outcomes such as mortality, overall complications, hospital and ICU length of stay. The EGS scale for STI was used to grade each infection and two surgeons graded each case to evaluate inter-rater reliability.
RESULTS: 1170 patients were included in this study. Inter-rater reliability was moderate (kappa coefficient 0.472-0.642, with 64-76% agreement). Higher grades (IV and V) corresponded to significantly higher LRINEC scores when compared with lower EGS grades. Patients with grade IV and V STI had significantly increased odds of all complications, as well as ICU and overall length of stay. These associations remained significant in logistic regression controlling for age, gender, comorbidities, mental status and hospital-level volume. Grade V disease was significantly associated with mortality as well.
CONCLUSION: This validation effort demonstrates that Grade IV and V STI are significantly predictive of complications, hospital length of stay and mortality. Though predictive ability does not improve linearly with STI grade, this is consistent with the clinical disease process, in which lower grades represent cellulitis and abscess and higher grades are invasive infections. This second validation study confirms the EGS grading scale as predictive, and easily used, in disparate disease processes.
STUDY TYPE: Prognostic/Epidemiologic retrospective multicenter trial LEVEL OF EVIDENCE: III.

PMID: 30601458 [PubMed - as supplied by publisher]

Failed Early Intervention of Pyomyositis in an Immunocompetent Individual.

Tue, 01/01/2019 - 08:58
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Failed Early Intervention of Pyomyositis in an Immunocompetent Individual.

Case Rep Infect Dis. 2018;2018:4296976

Authors: Al-Dossari R, Zekri S

Abstract
Pyomyositis is a purulent infection of striated muscle tissue that usually leads to an abscess, commonly due to S. aureus. Pyomyositis is typically found in tropic regions, but it is increasingly being recognized in temperate climates, especially in immunocompromised individuals. Patient presentation ranges from afebrile with mildly elevated WBC to frank sepsis. In many reported cases, patients may develop multiple abscesses at different sites. We report a case of a 54-year-old male with a history of chronic obstructive pulmonary disease (COPD) presenting with right pectoral infection. This case demonstrates the possibility that antibiotic therapy in early presentations may not effectively prevent abscess formation, contrary to treatment suggestions found in the literature.

PMID: 30595930 [PubMed]

Network proteomics of human dermal wound healing.

Fri, 12/14/2018 - 14:16
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Network proteomics of human dermal wound healing.

Physiol Meas. 2018 Nov 05;:

Authors: Gao X, Petricoin Iii EF, Ward KR, Goldberg SR, Duane TM, Bonchev D, Arodz T, Diegelmann RF

Abstract
Healing of wounds is critical to maintaining protection of human body against environmental factors. The mechanisms involving protein expression during this complex physiological process have not been fully elucidated. Here, we use the reverse-phase protein microarrays involving 94 phosphoproteins to study tissue samples from tubes implanted into healing dermal wounds in 7 human subjects tracked over 2 weeks. We compare the proteomic profiles to proteomes of controls obtained from skin biopsy from the same subjects. Compared to previous proteomic studies of wound healing, our approach is focused on wound tissue instead of wound fluid, and has the sensitivity to go beyond measuring only high-abundance proteins. To study the temporal dynamics of networks involved in wound healing, we applied two network analysis methods that integrate the experimental results with prior knowledge about protein-protein physical and regulatory interactions, as well as higher-level biological processes and associated pathways. We uncovered densely connected networks of proteins that are up- or down-regulated during human wound healing, as well as their relationships to microRNAs and to proteins outside of our set of targets we measured with proteomic microarrays.

PMID: 30524050 [PubMed - as supplied by publisher]

Prevention of Dopamine Dysregulation Syndrome in Parkinson's Disease: A Case Report.

Fri, 12/14/2018 - 14:16
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Prevention of Dopamine Dysregulation Syndrome in Parkinson's Disease: A Case Report.

Prim Care Companion CNS Disord. 2018 Apr 26;20(2):

Authors: Luchsinger WT, Gambhir N, DeMoss D

PMID: 29701928 [PubMed - indexed for MEDLINE]

Potential Overestimation of Racial Disparities in Response to the 8-Week Ledipasvir/Sofosbuvir Regimen for Hepatitis C Virus Genotype 1 Infection.

Wed, 12/12/2018 - 11:45
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Potential Overestimation of Racial Disparities in Response to the 8-Week Ledipasvir/Sofosbuvir Regimen for Hepatitis C Virus Genotype 1 Infection.

Gastroenterology. 2018 11;155(5):1646-1647.e2

Authors: Ojha RP, MacDonald BR, Chu TC, Marcus JL

PMID: 30118741 [PubMed - indexed for MEDLINE]

Improving shared decision-making in chronic lymphocytic leukemia through multidisciplinary education.

Tue, 11/27/2018 - 07:55
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Improving shared decision-making in chronic lymphocytic leukemia through multidisciplinary education.

Transl Behav Med. 2018 03 01;8(2):175-182

Authors: Rocque GB, Williams CP, Halilova KI, Borate U, Jackson BE, Van Laar ES, Pisu M, Butler TW, Davis RS, Mehta A, Knight SJ, Safford MM

Abstract
New treatments for chronic lymphocytic leukemia (CLL) with excellent response rates and varying toxicity profiles have emerged in recent years, creating an opportunity for a patient's personal preferences to contribute to treatment decisions. We conducted a prospective, quasi-experimental pre- and post-evaluation of a multilevel educational program and its impact on knowledge of CLL and shared decision-making (SDM). We educated patients, lay navigators, nurses/advanced practice providers (APPs), and physicians. Patients were evaluated for change in patient activation, distress, desired role in decision-making, perception of decision-making, satisfaction with oncologist explanation of treatment choice, and knowledge of CLL. Lay navigators, nurses/APPs, and physicians were evaluated for change in CLL knowledge and perception of decision-making. Forty-four patients, 33 lay navigators, 27 nurses/APPs, and 27 physicians participated in the educational program. We observed trends toward improved patient activation, with 68% before education versus 76% after education reporting a Patient Activation Measure (PAM) score of 3 or 4. The percentage of patients desiring and perceiving SDM trended upward from 47% to 67% and from 35% to 49%, respectively. The percentage of patients understanding that CLL is incurable increased from 80% to 90%, as did reporting awareness of signs of progression (64% to 76%). Patients' satisfaction with their oncologists' explanations of therapy increased significantly from 83% to 95% (p = .03). CLL knowledge increased after education for lay navigators (36% vs 63%) and nurses/APPs (35% vs 69%), and remained high for physicians (85% vs 87%). Nurses/APPs and physicians perceived at least some patient involvement in decision-making at baseline, whereas 12% of patients and 23% of lay navigators perceived that physicians made decisions independently. This project demonstrated trends toward improvements in patient engagement, prognostic awareness, knowledge of signs of progression, and SDM. These promising findings should be tested in larger samples. There remains an opportunity for further improvement in SDM.

PMID: 29390159 [PubMed - indexed for MEDLINE]

Preoperative Vascular Interventions to Improve Donor Leg Perfusion: A Report of Two Fibula Free Flaps Used in Head and Neck Reconstruction.

Mon, 11/26/2018 - 07:42
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Preoperative Vascular Interventions to Improve Donor Leg Perfusion: A Report of Two Fibula Free Flaps Used in Head and Neck Reconstruction.

J Oral Maxillofac Surg. 2018 Nov 01;:

Authors: Kim RY, Burkes JN, Broker HS, Williams FC

Abstract
PURPOSE: For reconstruction of head and neck defects, the fibula free flap is the first choice at many institutions. The main contraindication for fibula harvest is the lack of 3-vessel runoff, which leads to postoperative vascular compromise of the lower extremity. Atherosclerosis is the most common disease, which can limit the use of this donor site. In general, vascular interventions, which include angioplasty, atherectomy, and stenting, have been used to fix arterial supplies using endovascular methods. The purpose of this study was to report on the outcome of a preliminary cohort of patients after vascular interventions to re-establish vessel patency to allow safe use of the free fibula free flap in head and neck reconstruction.
MATERIALS AND METHODS: A single-institution retrospective case review using electronic medical records was designed. The study population was composed of patients who underwent a fibula free flap procedure for head and neck reconstruction from 2015 through 2017. Inclusion criteria were patients who underwent conventional angiography and required vascular interventions. There were no specific exclusion criteria. The primary outcome of interest was vascular compromise of the donor site. Additional variables of interest included success of reconstruction and perioperative donor or recipient site complications.
RESULTS: Two patients who underwent preoperative vascular interventions of the superficial femoral artery and posterior tibial artery were identified. The mean age was 65 years, and these patients underwent resection and reconstruction for mandibular carcinoma. For these patients, fibula flaps were harvested from the left lower extremity and included skin paddles. The fibula flaps survived and the donor feet maintained adequate perfusion. One patient had poor take of the split-thickness skin graft. No long-term functional deficit was noted.
CONCLUSIONS: Vascular interventions could be a safe method to re-establish vascular flow and 3-vessel runoff for select patients initially unable to undergo fibula free flap harvest.

PMID: 30471961 [PubMed - as supplied by publisher]

Financial planning and satisfaction across life domains among retired emergency physicians in the United States.

Wed, 11/21/2018 - 07:41
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Financial planning and satisfaction across life domains among retired emergency physicians in the United States.

Am J Emerg Med. 2018 Mar;36(3):508-510

Authors: Kuhn GJ, Marco CA, Mallory MNS, Blanda M, Kaplan JA, Schneider SM, Joldersma KB, Martin SI, Choo EK

PMID: 28784258 [PubMed - indexed for MEDLINE]

Reliability of the classification of proximal femur fractures: Does clinical experience matter?

Sun, 11/18/2018 - 08:20
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Reliability of the classification of proximal femur fractures: Does clinical experience matter?

Injury. 2018 Apr;49(4):819-823

Authors: Crijns TJ, Janssen SJ, Davis JT, Ring D, Sanchez HB, Science of Variation Group

Abstract
BACKGROUND: Radiographic fracture classification helps with research on prognosis and treatment. AO/OTA classification into fracture type has shown to be reliable, but further classification of fractures into subgroups reduces the interobserver agreement and takes a considerable amount of practice and experience in order to master.
QUESTIONS/PURPOSES: We assessed: (1) differences between more and less experienced trauma surgeons based on hip fractures treated per year, years of experience, and the percentage of their time dedicated to trauma, (2) differences in the interobserver agreement between classification into fracture type, group, and subgroup, and (3) differences in the interobserver agreement when assessing fracture stability compared to classifying fractures into type, group and subgroup.
METHODS: This study used the Science of Variation Group to measure factors associated with variation in interobserver agreement on classification of proximal femur fractures according to the AO/OTA classification on radiographs. We selected 30 anteroposterior radiographs from 1061 patients aged 55 years or older with an isolated fracture of the proximal femur, with a spectrum of fracture types proportional to the full database. To measure the interobserver agreement the Fleiss' kappa was determined and bootstrapping (resamples = 1000) was used to calculate the standard error, z statistic, and 95% confidence intervals. We compared the Kappa values of surgeons with more experience to less experienced surgeons.
RESULTS: There were no statistically significant differences in the Kappa values on each classification level (type, group, subgroup) between more and less experienced surgeons. When all surgeons were combined into one group, the interobserver reliability was the greatest for classifying the fractures into type (kappa, 0.90; 95% CI, 0.83 to 0.97; p < 0.001), reflecting almost perfect agreement. When comparing the kappa values between classes (type, group, subgroup), we found statistically significant differences between each class. Substantial agreement was found in the clinically relevant groups stable/unstable trochanteric, displaced/non-displaced femoral neck, and femoral head fractures (kappa, 0.60; 95% CI, 0.53 to 0.67, p < 0.001).
CONCLUSIONS: This study adds to a growing body of evidence that relatively simple distinctions are more reliable and that this is independent of surgeon experience.

PMID: 29549969 [PubMed - indexed for MEDLINE]

An international perspective on hospitalized patients with viral community-acquired pneumonia.

Thu, 11/08/2018 - 07:46
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An international perspective on hospitalized patients with viral community-acquired pneumonia.

Eur J Intern Med. 2018 Nov 03;:

Authors: Radovanovic D, Sotgiu G, Jankovic M, Mahesh PA, Marcos PJ, Abdalla MI, Di Pasquale MF, Gramegna A, Terraneo S, Blasi F, Santus P, Aliberti S, Reyes LF, Restrepo MI, GLIMP Study Group, Aruj PK, Attorri S, Barimboim E, Caeiro JP, Garzón MI, Cambursano VH, Ceccato A, Chertcoff J, Cordon Díaz A, de Vedia L, Ganaha MC, Lambert S, Lopardo G, Luna CM, Malberti AG, Morcillo N, Tartara S, Pensotti C, Pereyra B, Scapellato PG, Stagnaro JP, Shah S, Lötsch F, Thalhammer F, Anseeuw K, Francois CA, Van Braeckel E, Vincent JL, Djimon MZ, Aranha Nouér S, Chipev P, Encheva M, Miteva D, Petkova D, Balkissou AD, Pefura Yone EW, Mbatchou Ngahane BH, Shen N, Xu JF, Bustamante Rico CA, Buitrago R, Pereira Paternina FJ, Kayembe Ntumba JM, Vladic-Carevic V, Jakopovic M, Matkovic Z, Mitrecic I, Bouchy Jacobsson ML, Bro Christensen A, Heitmann Bødtger UC, Meyer CN, Vestergaard Jensen A, El-Said Abd El-Wahhab I, Elsayed Morsy N, Shafiek H, Sobh E, Abdulsemed KA, Bertrand F, Brun-Buisson C, de Montmollin E, Fartoukh M, Messika J, Tattevin P, Khoury A, Ebruke B, Dreher M, Kolditz M, Meisinger M, Pletz MW, Hagel S, Rupp J, Schaberg T, Spielmanns M, Creutz P, Suttorp N, Siaw-Lartey B, Dimakou K, Papapetrou D, Tsigou E, Ampazis D, Kaimakamis E, Bhatia M, Dhar R, D'Souza G, Garg R, Koul PA, Jayaraj BS, Narayan KV, Udnur HB, Krishnamurthy SB, Kant S, Swarnakar R, Salvi S, Limaye S, Golshani K, Keatings VM, Martin-Loeches I, Maor Y, Strahilevitz J, Battaglia S, Carrabba M, Ceriana P, Confalonieri M, d'Arminio Monforte A, Del Prato B, De Rosa M, Fantini R, Fiorentino G, Gammino MA, Menzella F, Milani G, Nava S, Palmiero G, Petrino R, Gabrielli B, Rossi P, Sorino C, Steinhilber G, Zanforlin A, Franzetti F, Carone M, Patella V, Scarlata S, Comel A, Kurahashi K, Aoun Bacha Z, Barajas Ugalde D, Ceballos Zuñiga O, Villegas JF, Medenica M, van de Garde EMW, Raj Mihsra D, Shrestha P, Ridgeon E, Ishola Awokola B, Nwankwo ONO, Olufunlola AB, Olumide S, Ukwaja KN, Irfan M, Minarowski L, Szymon S, Froes F, Leuschner P, Meireles M, Ferrão C, Leuschner P, Neves J, Ravara SB, Brocovschii V, Ion C, Rusu D, Toma C, Chirita D, Dorobat CM, Birkun A, Kaluzhenina A, Almotairi A, Bukhary ZAA, Edathodu J, Fathy A, Mushira Abdulaziz Enani A, Eltayeb Mohamed N, Ulhadi Memon J, Bella A, Bogdanović N, Milenkovic B, Pesut D, Borderìas L, Bordon Garcia NM, Cabello Alarcón H, Cilloniz C, Torres A, Diaz-Brito V, Casas X, Encabo González A, Fernández-Almira ML, Gallego M, Gaspar-GarcÍa I, González Del Castillo J, Javaloyes Victoria P, Laserna Martínez E, Malo de Molina R, Menéndez R, Pando-Sandoval A, Prat Aymerich C, Lacoma de la Torre A, García-Olivé I, Rello J, Moyano S, Sanz F, Sibila O, Rodrigo-Troyano A, Solé-Violán J, Uranga A, van Boven JFM, Vendrell Torra E, Pujol JA, Feldman C, Kee Yum H, Fiogbe AA, Yangui F, Bilaceroglu S, Dalar L, Yilmaz U, Bogomolov A, Elahi N, Dhasmana DJ, Feneley A, Hancock C, Hill AT, Rudran B, Ruiz-Buitrago S, Campbell M, Whitaker P, Youzguin A, Singanayagam A, Allen KS, Brito V, Dietz J, Dysart CE, Kellie SM, Franco-Sadud RA, Meier G, Gaga M, Holland TL, Bergin SP, Kheir F, Landmeier M, Lois M, Nair GB, Patel H, Reyes K, Rodriguez-Cintron W, Saito S, Soni NJ, Noda J, Hinojosa CI, Levine SM, Angel LF, Anzueto A, Scott Whitlow K, Hipskind J, Sukhija K, Totten V, Wunderink RG, Shah RD, Mateyo KJ, Carugati M, Morosi M, Monge E

Abstract
BACKGROUND: Who should be tested for viruses in patients with community acquired pneumonia (CAP), prevalence and risk factors for viral CAP are still debated. We evaluated the frequency of viral testing, virus prevalence, risk factors and treatment coverage with oseltamivir in patients admitted for CAP.
METHODS: Secondary analysis of GLIMP, an international, multicenter, point-prevalence study of hospitalized adults with CAP. Testing frequency, prevalence of viral CAP and treatment with oseltamivir were assessed among patients who underwent a viral swab. Univariate and multivariate analysis was used to evaluate risk factors.
RESULTS: 553 (14.9%) patients with CAP underwent nasal swab. Viral CAP was diagnosed in 157 (28.4%) patients. Influenza virus was isolated in 80.9% of cases. Testing frequency and viral CAP prevalence were inhomogeneous across the participating centers. Obesity (OR 1.59, 95%CI: 1.01-2.48; p = 0.043) and need for invasive mechanical ventilation (OR 1.62, 95%CI: 1.02-2.56; p = 0.040) were independently associated with viral CAP. Prevalence of empirical treatment with oseltamivir was 5.1%.
CONCLUSION: In an international scenario, testing frequency for viruses in CAP is very low. The most common cause of viral CAP is Influenza virus. Obesity and need for invasive ventilation represent independent risk factors for viral CAP. Adherence to recommendations for treatment with oseltamivir is poor.

PMID: 30401576 [PubMed - as supplied by publisher]

Lay navigation across the cancer continuum for older cancer survivors: Equally beneficial for Black and White survivors?

Tue, 11/06/2018 - 07:30
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Lay navigation across the cancer continuum for older cancer survivors: Equally beneficial for Black and White survivors?

J Geriatr Oncol. 2018 Oct 30;:

Authors: Pisu M, Rocque GB, Jackson BE, Kenzik KM, Sharma P, Williams CP, Kvale EA, Taylor RA, Williams GR, Azuero A, Li Y, Acemgil A, Martin MY, Demark-Wahnefried W, Turkman Y, Fouad M, Rocconi RP, Sullivan M, Cantuaria G, Partridge EE, Meneses K

Abstract
OBJECTIVES: The Patient Care Connect Program (PCCP), through lay navigators' distress assessments and assistance, was shown to lower healthcare utilization and costs in older cancer survivors. PCCP benefits and assistance needs for disadvantaged minorities (e.g., Black) vs. Whites are unknown.
MATERIALS AND METHODS: We examined the PCCP impact with retrospective analyses of Medicare claims (2012-2015). Outcomes were quarterly costs and utilization (emergency room (ER), hospitalizations) for navigated and matched survivors. Repeated measures generalized linear models with normal (costs), and Poisson (utilization) distributions assessed differences in trends overall and separately for Blacks and Whites. With distress data for navigated survivors, we assessed high distress (score > 3), ≥1 distress cause (overall, by domain), and ≥ 1 assistance request by minority group.
RESULTS: Beneficiaries were: 772 Black and 5350 White navigated, and 770 Black and 5348 White matched survivors. Impact was: i) costs: -$557.5 Blacks (p < .001), -$813.4 Whites (p < .001); ii) ER: Incidence Rate Ratio (IRR) 0.97 Blacks (NS), 0.93 Whites (p < .001); iii) hospitalizations: IRR 0.97 Blacks (NS), 0.91 Whites (p < .001). There was no significant difference in impact across minority groups. No significant differences were found in high distress (29% Black, 25.1% White), ≥1 distress cause (61.6% Black, 57.8% White), or ≥ 1 assistance request (64.5% Black, 59.1% White). Blacks were more likely to have ≥1 distress cause in the Practical domain.
CONCLUSION: The PCCP may benefit both Black and White older cancer survivors. Programs should consider the proportion of older survivors with high distress, and the specific needs of minorities.

PMID: 30389494 [PubMed - as supplied by publisher]

Clinical Outcomes for Diabetic Foot Ulcers Treated with Clostridial Collagenase Ointment or with a Product Containing Silver.

Wed, 10/31/2018 - 07:56
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Clinical Outcomes for Diabetic Foot Ulcers Treated with Clostridial Collagenase Ointment or with a Product Containing Silver.

Adv Wound Care (New Rochelle). 2018 Oct 01;7(10):339-348

Authors: Motley TA, Caporusso JM, Lange DL, Eichelkraut RA, Cargill DI, Dickerson JE

Abstract
Objective: To compare outcomes of diabetic foot ulcers (DFUs) treated with clostridial collagenase ointment (CCO) or silver-containing products, both in combination with sharp debridement as needed. Approach: One hundred two subjects with qualifying DFUs were randomized to daily treatment with either CCO or a silver-containing product for 6 weeks followed by a 4 -week follow-up period. The primary outcome was the mean percent reduction in DFU area. A secondary outcome was the incidence of ulcer infections between groups. Results: At the end of treatment, the mean percent reduction in area from baseline of DFUs treated with CCO was 62% (p < 0.0001) and with silver was 40% (p < 0.0001). The difference between groups-22%-was not statistically significant (p = 0.071). Among ulcers closed by the end of treatment, the mean time to closure was 31.1 ± 9.0 days versus 37.1 ± 7.7 days, respectively (not statistically significant). There was a numerically greater incidence of target ulcer infections in the silver group (11, 21.6%) than in the CCO group (5, 9.8%; p = 0.208). No clinically relevant safety signals were identified in either group. Innovation: CCO treatment can progress a wound toward closure. Ulcer infection prophylaxis may not be sacrificed when treating DFU with CCO in lieu of silver-containing products. Conclusion: Both CCO and silver-containing products promote significant reduction in DFU area over 6 weeks of treatment with no clinically relevant safety concerns. Mean percent reduction in lesion area was numerically (22%) but not significantly greater with CCO compared to silver, as was time to ulcer closure, with an incidence of ulcer infection at least as low as for silver-containing products.

PMID: 30374419 [PubMed]

Measuring childhood cancer late effects: evidence of a healthy survivor effect.

Wed, 10/31/2018 - 07:56
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Measuring childhood cancer late effects: evidence of a healthy survivor effect.

Eur J Epidemiol. 2017 12;32(12):1089-1096

Authors: Asdahl PH, Ojha RP, Winther JF, Holmqvist AS, de Fine Licht S, Gudmundsdottir T, Madanat-Harjuoja L, Tryggvadottir L, Andersen KK, Hasle H, ALiCCS study group

Abstract
INTRODUCTION: Given considerable focus on health outcomes among childhood cancer survivors, we aimed to explore whether survivor bias is apparent during long-term follow-up of childhood cancer survivors.
METHODS: We identified all 1-year survivors of cancer diagnosed before 20 years of age in Denmark, Finland, Iceland, and Sweden. From the general population, we randomly sampled a comparison cohort. Study individuals were followed for hospitalizations for diseases of the gastroenterological tract, endocrine system, cardiovascular system, or urinary tract from the start of the cancer registries to 2010. We estimated cumulative incidence with death as competing risk and used threshold regression to compare the hazards of the diseases of interest at ages 20, 40, 60, and 75 years.
RESULTS: Our study included 27,007 one-year survivors of childhood cancer and 165,620 individuals from the general population. The cumulative incidence of all four outcomes was higher for childhood cancer survivors during early adulthood, but for three outcomes, the cumulative incidence was higher for the general population after age 55 years. The hazard ratios (HRs) decreased for all outcomes with increasing age, and for two of the outcomes, the hazards were higher for the general population at older ages (endocrine diseases: age-specific HRs = 3.0, 1.4, 1.0, 0.87; Cardiovascular diseases: age-specific HRs = 4.1, 1.4, 0.97, 0.84).
CONCLUSIONS: Our findings provide empirical evidence that survivor bias attenuates measures of association when comparing survivors with the general population. The design and analysis of studies among childhood cancer survivors, particularly as this population attains older ages, should account for survivor bias to avoid misinterpreting estimates of disease burden.

PMID: 29185125 [PubMed - indexed for MEDLINE]

Late-Onset T1DM and Older Age Predict Risk of Additional Autoimmune Disease.

Sat, 10/27/2018 - 08:12
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Late-Onset T1DM and Older Age Predict Risk of Additional Autoimmune Disease.

Diabetes Care. 2018 Oct 25;:

Authors: Hughes JW, Bao YK, Salam M, Joshi P, Kilpatrick CR, Juneja K, Nieves D, Bouhairie V, Jordan OJ, Blustein EC, Tobin GS, McGill JB

Abstract
OBJECTIVE: Type 1 diabetes (T1DM) is associated with other autoimmune diseases (AIDs), which may have serious health consequences. The epidemiology of AIDs in T1DM is not well defined in adults with T1DM. In this cross-sectional cohort study, we sought to characterize the incident ages and prevalence of AIDs in adults with T1DM across a wide age spectrum.
RESEARCH DESIGN AND METHODS: A total of 1,212 adults seen at the Washington University Diabetes Center from 2011 to 2018 provided informed consent for the collection of their age, sex, race, and disease onset data. We performed paired association analyses based on age onset of T1DM. Multivariate logistic regression was used to evaluate the independent effects of sex, race, T1DM age of onset, and T1DM duration on the prevalence of an additional AID.
RESULTS: Mean age of T1DM onset was 21.2 ± 14.4 years. AID incidence and prevalence increased with age. Female sex strongly predicted AID risk. The most prevalent T1DM-associated AIDs were thyroid disease, collagen vascular diseases, and pernicious anemia. T1DM age of onset and T1DM duration predicted AID risk. Patients with late-onset T1DM after 30 years of age had higher risks of developing additional AIDs compared with patients with younger T1DM onset.
CONCLUSIONS: The prevalence of AIDs in patients with T1DM increases with age and female sex. Later onset of T1DM is an independent and significant risk factor for developing additional AIDs. Individuals who are diagnosed with T1DM at older ages, particularly women, should be monitored for other autoimmune conditions.

PMID: 30361208 [PubMed - as supplied by publisher]

Healthcare utilization, Medicare spending, and sources of patient distress identified during implementation of a lay navigation program for older patients with breast cancer.

Wed, 10/24/2018 - 08:27
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Healthcare utilization, Medicare spending, and sources of patient distress identified during implementation of a lay navigation program for older patients with breast cancer.

Breast Cancer Res Treat. 2018 01;167(1):215-223

Authors: Rocque GB, Williams CP, Jones MI, Kenzik KM, Williams GR, Azuero A, Jackson BE, Halilova KI, Meneses K, Taylor RA, Partridge E, Pisu M, Kvale EA

Abstract
PURPOSE: Despite benefits for patients, sustainability of breast cancer navigation programs is challenging due to the lack of reimbursement for navigators. This analysis describes distress reported by breast cancer patients to navigators and the impact of navigation on healthcare utilization for older adults with breast cancer.
METHODS: We conducted a retrospective cohort study of Medicare administrative claims data and patient-reported distress assessments. The primary outcome was Medicare spending per beneficiary per quarter. Secondary outcomes included (1) the number of hospitalizations or ER visits in each quarter; (2) distress levels; and (3) causes of distress reported by patients to their navigators. A subset analysis was conducted for stage I/II/III versus stage IV patients.
RESULTS: 776 navigated and 776 control patients were included in the analysis. The average age at diagnosis was 74 years; 13% of the subjects were African American; 95% of patients had stage I-III. Medicare spending declined faster for the navigated group than the matched comparison group by $528 per quarter per patient (95% CL -$667, -$388). Stage I/II/III navigated patients showed a statistically significant decline in Medicare spending, ER visits, and hospitalizations over time compared to the matched comparison group. No differences were observed for stage IV patients. Eighteen percent of patients reported moderate distress. Informational and physical distress were more common in late stage than in early-stage breast cancer.
CONCLUSIONS: Lay navigation reduced healthcare utilization in older adults with breast cancer, with the greatest impact observed in early-stage breast cancer patients.

PMID: 28900752 [PubMed - indexed for MEDLINE]

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