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Exploratory analysis of electronic patient-reported outcomes collection: comparing online and in-clinic modalities in cancer care
No full textPURPOSE: Patient reported outcome measures (PROMs) have been shown to improve cancer survival but are generally underutilized in cancer care. It is unclear whether electronic-PROMS (ePROMs) modality (online vs. in-clinic) may address barriers to completion. We examined whether patient sociodemographic and clinical factors differed by completion modality.
METHODS: Patients with cancer who had an oncologic provider visit from January 2021 to March 2023 at a tertiary cancer center were assigned the National Institute of Health\u27s computer adaptive technology Patient-Reported Outcomes Measurement Information System instruments. Patients completed ePROMs either through online patient portal (online) up to 7 days before the visit or used a tablet at the clinic visit (in-clinic) if not completed online. Multivariable logistic regression model estimated associations between patient sociodemographic and clinical factors and completion modality.
RESULTS: A total of 8556 patients completed ePROMs (43.3% completed in-clinic). Females were less likely than males to complete ePROMs in-clinic (aOR = 0.89, 0.84-0.93) as were patients with commercial insurance (aOR = 0.83, 0.77-0.89) vs. Medicare; or saw radiation oncologist (aOR = 0.89, 0.83-0.96) vs. medical oncologist. However, patients were more likely to complete ePROMs in-clinic if they identified as Black race (aOR = 1.41, 1.33-1.49) vs. White; were single (aOR = 1.21, 1.14-1.29) or divorced/separated/widowed (aOR = 1.11, 1.04-1.18) vs. married; or saw a provider located in rural (aOR = 1.33, 1.25-1.42) vs. urban area.
CONCLUSIONS: Patients who were males, Blacks, unmarried, Medicare insured or saw providers located in rural area were more likely to complete ePROMs in-clinic. Given the preference for online completion before visits for real-time symptom monitoring, targeted efforts are needed to boost online PROMs completion.
PLAIN MESSAGE: This is a cross-sectional analysis of the associations between sociodemographic and clinical factors with two electronic patient reported outcome measures completion modalities. The results indicate that about half of patients completed online and half completed in-clinic, with males, Blacks, patients who were divorced/separated/widowed, had Medicare insurance and saw a medical oncologist completing electronic patient reported outcome measures in-clinic. We support offering both options while addressing barriers to either modality
Discrepancies Between Subjective and Objective Evaluation of Sleep: Potential Marker for Mild Cognitive Impairment
No full textBackground and Objective: Discrepancies between objective and subjective evaluations of sleep efficiency have been observed in individuals with pathological and healthy aging. Objective sleep evaluation using actigraphy has been proposed as a potential tool for the clinical assessment of mild cognitive impairment (MCI).
Methods: Habitual sleep at home was evaluated using actigraphy (objective measure) and sleep diaries (subjective measure) in 45 participants (between 28 and 72 years old). Participants were divided into four groups by age and by diagnosis (MCI and Alzheimer desease). Cognitive and sleep measures were analyzed for comparisons and correlations.
Results: Significant discrepancies between objective and subjective sleep efficiency were observed in healthy and pathological ages. The MCI group showed the lowest sleep efficiency compared to other groups. Correlation analysis revealed a significant relationship between cognitive impairments and sleep efficiency in MCI and AD groups.
Conclusions: Objective sleep evaluation, with a particular focus on sleep efficiency, should be considered as a potential marker for MCI
Frailty and Survival for Diagnoses Feasibly Managed Operatively or Nonoperatively
No full textOBJECTIVE: Compare outcomes, stratified by frailty, of patients with eight common conditions with plausible operative and nonoperative management strategies.
SUMMARY BACKGROUND DATA: A surgical pause, evaluating potential adverse outcomes among frail patients, improves postoperative outcomes; however, the outcomes among patients opting for nonoperative management are unknown.
METHODS: In an observational cohort study across a multi-hospital healthcare system including adults presenting to outpatient surgical clinics (2016-2023) for evaluation of eight conditions feasibly managed operatively or nonoperatively as defined by modified Delphi consensus. In a landmarked analysis, we compared 2-year survival by management strategies across frailty categories (robust, normal, frail, very frail) as defined by the Risk Analysis Index (RAI). Secondarily we compared 365-day hospital free days (HFD-365), postoperative length of stay, and discharge disposition.
RESULTS: Among 49,169 patients (mean±SD age, 60.4±14.6 y; 54.6% female), operative management was associated with lower observed and adjusted mortality (1.3% vs 2.5%; aHR=0.55 [95% CI, 0.47-0.66], P\u3c 0.0001) overall and among all frailty categories expect the very frail (8.1% vs 12.1%, P=0.1). Additionally, operative management was associated with fewer HFD-365 again overall which was specifically prominent among the very frail (median 365 [IQR, 358-365] vs 361 days [IQR, 357-363], P\u3c 0.0001). Postoperatively, frailty portended more protracted recoveries with greater postoperative lengths of stay (1.7±2.6 vs 1.2±2.1) days, P\u3c 0.0001) and fewer discharges home (370 [85.1%] vs 5,087 [91.8%], P\u3c 0.0001; odds ratio=2.0 [95%CI 1.5-2.6]).
CONCLUSIONS: Considering the protracted postoperative recovery of very frail patients, nonoperative management might be the preferred treatment option for those presenting with these eight clinical conditions
Global Andrology Forum Clinical Guidelines on the Relevance of Sperm DNA Fragmentation in Reproductive Medicine
No full textPURPOSE: To evaluate the evidence on sperm DNA fragmentation (SDF) and its clinical applications in reproductive medicine, highlighting benefits, limitations, and guidelines for its use to assist clinicians in objective decision-making.
MATERIALS AND METHODS: A multidisciplinary team of clinicians and reproductive experts from the Global Andrology Forum (GAF) reviewed the latest evidence on SDF, covering indications, testing methods, recurrent pregnancy loss, varicocele and its repair, assisted reproductive technologies (ART), treatment of associated conditions, antioxidant therapy, and sperm selection for ART. Expert statements and recommendations were developed and graded with the GRADE system using a modified Delphi process.
RESULTS: Based on the GAF surveys, systematic reviews, and meta-analyses related to SDF, 52 experts introduced and scored 24 statements and recommendations using the GRADE system. Of these, 87.5% (21/24) achieved strong ratings, reflecting broad consensus, while 12.5% (3/24) were rated weak. The guidelines provide evidence-based recommendations for clinical scenarios, including the role of SDF in infertility, recurrent pregnancy loss, and ART outcomes.
CONCLUSIONS: While there is growing interest and evidence regarding the clinical benefit of SDF testing and its utility in managing male infertility, significant gaps in the literature limit its routine use in clinical practice. The guidelines offer a structured framework for integrating SDF testing into male infertility management, emphasizing a tailored approach based on individual clinical scenarios. Clinicians must balance the benefits and limitations of SDF testing and antioxidant treatment to optimize care in reproductive medicine. These guidelines are critical for advancing evidence-based practices in male infertility management
Hidden Wounds: Exploring Racial and Gender Disparities in the Impact of Mass Shooting Events on Suicide Risk Among U.S. High School Students
No full textThis study examines the impact of mass shooting events (MSEs) on youth suicide-related behaviors in schools, focusing on heterogeneity across age, race, and gender. Suicide is the second leading cause of death among adolescents and has increased by 63% in the last two decades. Using individual-level data from the Youth Risk Behavior Surveillance System (YRBS) and state-level data from the Gun Violence Archive (GVA) from 2013 to 2019, a difference-in-differences approach is employed to analyze the impact of MSEs on suicide consideration, suicide planning, suicide attempt, and injury from attempted suicide among high school students. Our findings indicate that MSEs lead to a significant increase in the likelihood of suicide attempts (5.1 pp) and injury from suicide (1.9 pp). We particularly observe NH-Black students show a dramatic increase in all measured behaviors, indicating a heightened vulnerability. Notable variations by race and gender suggest that targeted strategies and policies are necessary in addressing students\u27 suicide risk following MSEs. Our findings also reveal lagged effects, demonstrating that the behavioral impacts of MSEs persist over a year, highlighting the importance of investigating longer-term consequences. Strategies targeting the progression from suicide ideation to suicide attempts are particularly crucial to effectively mitigate the long-lasting and detrimental impact that exposure to MSEs can have on youth mental health and well-being
Relationship between opioid use disorder during pregnancy, delivery-related outcomes, and healthcare utilization in Michigan Medicaid, 2012-2021
No full textINTRODUCTION: Pregnant individuals with opioid use disorder (OUD) deliver \u3e20,000 infants annually in the United States, with serious health consequences for perinatal individuals and their infants. This study compares delivery-related outcomes and healthcare utilization among Michigan Medicaid-enrolled perinatal individuals with and without an OUD diagnosis.
METHODS: We conducted a retrospective cohort study among Michigan Medicaid enrollees aged 15-44 who delivered a live infant between 2012 and 2021.
RESULTS: The cohort included 218,890 deliveries among 170,002 individuals enrolled continuously in Michigan Medicaid for nine months before delivery and up to three months postpartum. Of those, 3.26 % had an OUD diagnosis during this analytic period. Perinatal individuals with OUD identified primarily as White (82.9 %), lived in urban areas (77.2 %), and had a lower income (68.6 %). Among individuals with OUD, 31 % had another behavioral health diagnosis and 55.1 % received a prescription for a psychotropic medication. Of those with OUD, 47.4 % received a prescription for medication for OUD. Deliveries with OUD versus without OUD had a lower probability of cesarean delivery (aOR = 0.89) but higher odds of preterm delivery (aOR = 1.31). Those with OUD had higher likelihood of ambulatory (aOR = 1.99), ED/observational (aOR = 1.19), psychotherapy (aOR = 5.48), and substance use disorder care (aOR = 27.05) visits than those without OUD.
CONCLUSIONS: Medicaid-enrolled perinatal individuals in Michigan with OUD had higher rates of preterm birth and healthcare utilization compared to those without OUD. Clinicians and policymakers should target early detection and tailored, coordinated treatment to better address the needs of these individuals
Perspectives on a Technology-Based Smoking Cessation Intervention Among Youth Exiting Foster Care
No full textYouth in foster care are at increased risk for tobacco-related disease and burden, with very little research and access to evidence-based care. This vulnerable population is also less likely to be involved in the creation of systems and programs that impact their health and well-being. As part of the initial trial of a technology-based smoking cessation program specifically targeting youth exiting foster care, participants (n = 18) provided feedback on their experiences with the approach, including strengths, barriers to cessation, and suggestions for improvement. Results indicated that young people enjoyed their experience with the intervention, as it was both easy to use and provided much needed support in their journey to reduce cigarette use. Participants cited a lack of coping skills and having many family members and friends who smoke as significant impediments to quitting. Finally, respondents suggested a connection to a tobacco quitline, further support from former foster youth, and additional resources for handling comorbid mental health issues as needed adaptations to the intervention. Overall, technology-based smoking cessation may be a feasible and scalable approach to addressing tobacco-related health disparities among youth exiting foster care
A Narrative Review of Key Risk Factors for Severe Illness Following SARS-CoV-2, Influenza Virus, and Respiratory Syncytial Virus Infection
No full textSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza, and respiratory syncytial virus (RSV) are highly infectious respiratory viruses that affect people of all ages and are typically associated with mild symptoms and few complications in immunocompetent individuals. However, the risk of severe outcomes (e.g., hospitalization and death) following infection with these respiratory viruses is higher in certain populations, including older adults and individuals of certain race/ethnic and sociodemographic groups. Additionally, immunocompromising conditions and pre-existing comorbidities, including underlying cardiovascular (e.g., congestive heart failure) and respiratory diseases (e.g., chronic obstructive pulmonary disease), diabetes, chronic kidney disease, and obesity, are key factors that predispose individuals to SARS-CoV-2-, influenza-, and RSV-related severe outcomes. Increased risk for severe outcomes associated with advancing age and comorbidities is compounded by residence in long-term care facilities due to the enhanced spread of respiratory infections in congregate living environments. In this narrative review, risk factors associated with severe outcomes following infection with SARS-CoV-2, influenza, and RSV in adult populations are explored. Additionally, distinct clinical outcomes based on underlying comorbidities following infection are discussed in the context of high-risk populations. Factors unique to each virus that underpin distinct risk profiles are described and suggest the potential for tailored surveillance and healthcare approaches to target and ultimately mitigate SARS-CoV-2-, influenza-, and RSV-associated disease burden in vulnerable populations. Mutual risk factors for severe outcomes are also highlighted; these similarities indicate that cohesive risk reduction strategies may also be feasible, particularly since vaccines are available for each of these respiratory viruses. Ultimately, a more thorough understanding of the risk factors that predispose individuals to develop SARS-CoV-2-, influenza-, and RSV-related severe outcomes may improve risk reduction strategies, inform healthcare policy, and contribute to the expansion and refinement of existing surveillance approaches to ultimately mitigate disease burden in vulnerable populations
Comparative Postoperative Complications of Acellular Dermal Matrix and Mesh Use in Prepectoral and Subpectoral One-Stage Direct to Implant Reconstruction: A Retrospective Cohort Study
No full textBACKGROUND: One-stage direct-to-implant (DTI) breast reconstruction is increasingly popular with the use of prepectoral reconstruction leading to increased demand for structural scaffolds. It is vital to determine if differences in safety profiles exist among scaffolds.
METHODS: We performed a retrospective cohort study of consecutive patients in our breast cancer center undergoing DTI reconstruction. Outcomes relating to postoperative infections, wound complications, and implant related complications were extracted. Outcomes were grouped into major, minor, and long-term complications. Univariate and multivariate analysis determined outcome differences and accounted for confounding variables.
RESULTS: Two hundred forty-two patients (404 breasts) underwent DTI reconstruction. One hundred ninety-two breasts were reconstructed with FlexHD Pliable Preformed (PP; MTF Biologics, Edison, NJ), 122 with AlloDerm Ready To Use (RTU; Allergan Aesthetics, Irvine, CA), 22 with DermACELL (LifeNet Health, Virginia Beach, VA), 21 with Galaflex (Galatea Surgical, Lexington, MA), 22 with Meso BioMatrix (MTF Biologics), and 25 with autologous dermal flaps alone. Univariate analysis demonstrated statistically significant differences among scaffolds in the incidence of cellulitis treated with oral antibiotics, capsular contracture, explantation for capsular contracture, seroma requiring operative drainage, minor complications, and long-term complications. On multivariate regression, FlexHD PP had reduced rates of capsular contracture, explantation for capsular contracture, minor complications, and long-term complications compared to AlloDerm RTU. Reconstruction with Galaflex had increased rates of capsular contracture when compared to FlexHD PP.
CONCLUSIONS: Certain structural scaffolds have differing safety profiles that should be considered when selecting, which product to use in DTI reconstruction
American Association of Bronchology and Interventional Pulmonology Essential Knowledge in Interventional Pulmonology Series: Selected Topics in Malignant Pleural Disease
No full textThe goal of the American Association of Bronchology and Interventional Pulmonology Essential Knowledge in Interventional Pulmonology Series is to provide clinicians with concise, up-to-date reviews of important topics in the field of interventional pulmonology. This 3-year alternating rotation of primary topics will start with a focus on selected topics in malignant pleural disease. In this article, we update the reader on malignant pleural effusion in 3 parts: part 1-diagnosis, focusing on imaging and fluid biomarkers; part 2-management, with review of multimodal approaches, cost considerations, and evolving targeted therapies; and part 3-pleural mesothelioma. These reviews complement the Essential Knowledge in Interventional Pulmonology Lecture Series presented at the 2023 AABIP Annual Conference, available for viewing on the AABIP website (https://aabip.memberclicks.net/essential-knowledge-in-interventional-pulmonology-series)