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Patterns of Medical Care Cost by Service Type Associated With Lung Cancer Screening
No full textINTRODUCTION: Lung cancer screening (LCS) enhances early stage cancer detection; however, its impact on health care costs in real-world clinical settings is not well understood. The objective of this study was to assess changes in health care costs during the 12 months before LCS compared with the 12 months after.
METHODS: This retrospective study analyzed health care costs based upon Medicare\u27s fee-for-service reimbursement system using data from the Population-based Research to Optimize the Screening Process Lung Consortium. We included individuals who met age and smoking LCS eligibility criteria and were engaged within 4 health care systems between February 5, 2015, and December 31, 2021. Generalized linear models estimated health care costs from the payer perspective during 12 months prior and 12 months post baseline LCS. We compared these costs to eligible individuals who did not receive LCS. Secondary analyses examined costs among the sample who completed LCS by positive versus negative scan results. We reported mean predicted costs with average values for all other explanatory variables.
RESULTS: We identified 10,049 eligible individuals who received baseline LCS and 15,233 who did not receive LCS. Receipt of LCS was associated with additional costs of 11,664 among individuals with positive scans; however, no increases occurred among individuals with negative scans.
CONCLUSION: These findings suggest LCS was only associated with increased health care costs among patients with a positive scan. LCS is a potentially cost-effective approach to identify early stage lung cancer. Healthcare systems should prioritize strategies to improve LCS participation
Monte Carlo calculation of(119)Sb microscale absorbed dose using cascaded and averaged Auger electron spectra
No full textRadionuclides decaying by electron capture or internal transition produce a large number of Auger electrons in a cascade that follows their radioactive decay. A shortlist of the most potent Auger electron-emitters has appeared in the literature including103mRh,103Pd,111In,119Sb,123I,125I,165Er, and197Hg. Among them,119Sbhas been identified as the most potent for targeting micrometastases, yielding several tens of Auger electrons per decay with energies from a few eV up to 30 keV. In this paper, we recalculate Auger, Coster-Kronig, and super Coster-Kronig yields and transition probabilities as subshell-normalized relative transition probabilities and develop a new method to create radionuclide sources in TOPAS Monte Carlo, the code for which has been made publicly available. We then apply our method to encode the Auger electron spectra of119Sbfrom MIRD RADTABS and EADL into TOPAS and calculate the absorbed dose to water volumes of radius10nmup to10μm, finding that the averaged MIRD Auger electron spectrum underestimates the absorbed dose by a factor of 20 to 50 on this scale. We show that this result is not isolated to119Sband conclude that either the cascaded MIRD or EADL spectrum should be used for accurate microscale dosimetry. We compare with results obtained using the built-in Geant4 Atomic Relaxation for119Sbin TOPAS and find an unexpected continuum of low-energy electrons but no excess absorbed dose relative to either MIRD or EADL. We show that119Sbdoes not produce more absorbed dose in microscale volumes than103mRh,103Pd,111In,123I,125I,165Er, or197Hg, warranting future microdosimetry calculations of RBE and DNA damage to understand whether119Sbis the most potent Auger electron-emitter, as claimed in the literature
Global Andrology Forum Clinical Practice Guidelines: Because Male Reproductive Health Matters! Introducing a Novel Approach to Address Common Yet Controversial Aspects of Male Infertility
No full textAugmented Reality-aided Rescue Ultrasound Curriculum for Perioperative Crisis Management
No full textOBJECTIVE: To develop anesthesiology residents\u27 proficiency in ultrasound for managing hemodynamically unstable patients using an augmented reality-aided multimodal competency-based curriculum (rescue ultrasound [RUS] curriculum).
DESIGN: This prospective study used a quasi-experimental design, involving a nonrandomized, pre-post intervention assessment of the novel competency-based RUS curriculum.
SETTING: This study was conducted at a university hospital.
PARTICIPANTS: This single-center prospective study involved 10 attending anesthesiologists for baseline ultrasound data, 8 residents completing traditional training, and 15 residents completing the novel RUS curriculum.
INTERVENTIONS: This study enrolled third-year categorical anesthesia (CA-3) residents to evaluate the impact of a novel RUS curriculum. Competency benchmarks were defined using objective performance metrics derived from motion metrics data, with expert results as a reference. The study utilized task trainers and augmented reality (HoloLens) to teach RUS skills, and clinical transferability of the curriculum\u27s impact was evaluated through a standardized scenario with a simulated hemodynamically unstable patient. The time taken to request ultrasound was compared between the RUS-trained residents and the non-RUS-trained residents using the Mann-Whitney U test.
MEASUREMENT AND RESULTS: Curriculum-trained residents averaged 72.3 seconds (standard deviation = 23.2) for ultrasound calls, compared with 294.9 seconds (standard deviation = 110.6) for nontrained residents. The motion metrics-derived data (path length, acceleration, and time) of curriculum-trained residents were comparable with those of experts.
CONCLUSION: An augmented reality-aided multimodal RUS curriculum was developed as a training modality. After completion of training, residents integrated ultrasound into clinical practice at an earlier stage of hemodynamic instability and developed RUS skills that were comparable with experts\u27 performance
Clinical Outcomes of Endoscopic Submucosal Dissection for Residual Neoplasia After Incomplete Resection of Large Non-Pedunculated Colorectal Polyps: A Large Multicenter Propensity Match Study
No full textBACKGROUND AND AIMS: Data on endoscopic submucosal dissection (ESD) for residual neoplasia after incomplete resection (ER) of large non-pedunculated colorectal polyps (LNPCPs) remains scarce. We aimed to evaluate and compare outcomes of ESD in treatment naïve (control) lesions vs. those with prior failed ER.
METHODS: Multicenter propensity-score (PS) match study of ESDs performed for LNPCPs between January 2021 to September 2024. The following covariates were used for PS calculation: age, sex, and lesion characteristics (size, location, morphology, histology). Endpoints included: rates of en-bloc and R0 resection, adverse events and neoplasia recurrence on surveillance.
RESULTS: A total of 1447 consecutive patients underwent ESD during the study period. PS match resulted in the selection of 361 (control) and 184 (prior failed ER) strictly matched 2:1 pairs. En-bloc and R0 resection rates were similar between the control and prior failed ER arms: 91.7% vs 89.7%; p=.44 and 80.9% vs. 81.0%; p=.98, respectively. There was no difference in the rate of perforation between the control and prior failed ER arms (4.7% vs. 4.4%; p=1.00), whereas there was non-statistically significant trend towards higher delayed bleeding in the prior failed ER group (1.63% vs. 0.83%, relative risk: 1.96; p=0.40). Neoplasia recurrence on surveillance was 3.6% in the control and 5.8% in the prior failed ER group (p=0.32).
CONCLUSIONS: ESD can be performed safely and effectively as a salvage therapy after failed attempt at ER of LNPCPs. ESD may be selectively considered as part of our endoscopic armamentarium for the management of these difficult-to-treat lesions. support current guideline endorsed indications for ESD for the treatment of residual neoplasia after incomplete ER
Assessing cognitive function in transplantation and chimeric antigen receptor t cell therapy recipients: Expert recommendations from the survivorship, aging and biobehavioral special interest groups of the American Society for Transplantation and Cellular Therapy
No full textCognitive impairment is a prevalent yet underexplored comorbidity and complication in hematopoietic stem cell transplantation (HCT) and chimeric antigen receptor T cell (CAR-T) therapy. Affecting up to one-half of patients, cognitive impairment may include acute phases, manifesting as transplantation-associated altered mentation and encephalopathy or immune effector cell-associated neurotoxicity syndrome, and may persist for years post-treatment as cancer-related cognitive impairment (CRCI). Such dysfunction undermines autonomy, healthcare management, work reintegration, and quality of life. This consensus review synthesizes current evidence on CRCI across the timeline of transplantation and cellular therapy (TCT), organized into pre-TCT, peri-TCT, and post-TCT phases, with additional focus on specific populations, including older adults and pediatric patients. It highlights gaps in the understanding of cognitive impairment risks, trajectory, and impact alongside the challenges of standardizing assessments in diverse practice settings. Key recommendations, endorsed by the American Society for Transplantation and Cellular Therapy\u27s Aging, Biobehavioral Research, and Survivorship Special Interest Groups, advocate for cognitive assessment pretherapy and post-therapy using validated instruments such as the Montreal Cognitive Assessment or Blessed Orientation-Memory-Concentration Test. We also recommend supplementation with patient-reported outcome measures for comprehensive evaluation. We recommend action items for cases in which cognitive impairment is identified, including exclusion of alternative etiologies, reconsideration of therapy or caregiving plans, and referrals for additional evaluation and rehabilitation, among others. Practical guidance for implementation across clinical and research settings is provided, emphasizing the need for multidisciplinary strategies to address identified impairments. This work aims to establish a framework for systematic cognitive monitoring, improving patient outcomes and quality of life while guiding future research to address significant knowledge and implementation gaps
Assessment of Failures of Long-acting Cabotegravir and Rilpivirine in a Real-world Treatment Setting
No full textFifty-eight people with HIV switched to long-acting cabotegravir and rilpivirine in a real-world clinic setting had higher discontinuation rates because of virologic failure, side effects, or nonadherence compared to clinical trials. Archived proviral genotype testing before long-active cabotegravir and rilpivirine switch should be considered to reduce virologic failure risk
Target Trial Emulation of Empiric Antibiotics on Clinical Outcomes in Moderately Immunocompromised Patients Hospitalized with Pneumonia
No full textBACKGROUND: Immunocompromised patients are often excluded from pneumonia trials, guidelines, and stewardship interventions.The objective of this study was to evaluate whether empiric broad-spectrum antibiotic treatment impacts mortality and other clinical outcomes in moderately immunocompromised patients without risk factors for multidrug-resistant organisms hospitalized with community-acquired pneumonia.
METHODS: This was a target trial emulation including moderately immunocompromised (asplenia, hematologic malignancies, solid organ malignancy receiving chemotherapy, kidney transplant \u3e1 year prior, congenital/acquired immunodeficiency and receiving immunosuppressive medications) patients with pneumonia without risk factors for multidrug-resistant organisms at 69 hospitals in the Michigan Hospital Medicine Safety ConsortiumThis study compared the receipt of empiric broad-spectrum antibiotics against antibiotics targeting typical respiratory pathogens on hospital day 1 or 2.The primary outcome was mortality. Secondary outcomes included length of stay, transfer to the intensive care unit and 30-day readmission, emergency department visit, Clostridioides difficile infection and antibiotic-associated adverse events.
RESULTS: Of 2706 moderately immunocompromised patients with pneumonia, 59% (N=1596) received empiric broad-spectrum antibiotics. MRSA and resistant gram-negative bacteria were rare (94/2706, 3.5%). After adjustment, empiric broad-spectrum antibiotic treatment was not associated with mortality, but was associated with readmission (adjusted hazard ratio [aHR], 1.32 [1.05-1.66]), transfer to ICU (aHR, 2.65 [1.32-5.30]) and longer hospitalization (adjusted rate ratio [aRR], 1.14 [1.10-1.19]).
CONCLUSIONS: Immunocompromised patients hospitalized with pneumonia often receive empiric broad-spectrum antibiotics despite low rates of multidrug-resistant organisms. Empiric broad-spectrum antibiotic use was not associated with mortality, but was associated with harm, including 30-day readmission, transfer to ICU and longer duration of hospitalization
Clinical Outcomes of Decompressive Spine Surgery for Painless Cervical Myelopathy: Analysis of the Michigan Spine Surgery Improvement Collaborative Registry
No full textBACKGROUND AND OBJECTIVES: Although axial neck pain and radicular arm pain are often associated with cervical spondylotic myelopathy (CSM), some patients present or are discovered to have CSM without pain. Little is known regarding the surgical outcomes in these patients. Our objective is to describe the outcomes of decompressive spine surgery in a cohort of patients treated for painless CSM.
METHODS: This is a retrospective study of data from the Michigan Spine Surgery Improvement Collaborative registry. A total of 407 patients undergoing spine surgery for painless CSM between March 2014 and May 2022 were analyzed. Patient-reported outcomes (PROs), including minimal clinically important difference (MCID) in Modified Japanese Orthopedic Association, EuroQol-5 Dimension (EQ-5D), and Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF) scores, were assessed at baseline, and at 90 days, 1 year, and 2 years postoperatively. All analyses were conducted with a P-value of \u3c .05 being considered significant.
RESULTS: After surgery, the number of patients experiencing a clinically significant improvement in PROs was greatest at 1 year (49% PROMIS PF MCID, 36% Modified Japanese Orthopedic Association MCID, 42% EQ-5D MCID). When stratifying by preoperative CSM severity, patients with severe myelopathy were significantly more likely to have a poorer discharge disposition and readmission at 90 days compared with mild myelopathy patients. PROs also significantly varied by CSM severity, including patient satisfaction at 2 years (95% mild vs 80% moderate vs 74% severe, P \u3c .05), PROMIS PF MCID at 90 days (26% mild vs 53% moderate vs 45% severe, P = .02), and mean EQ-5D at 90 days (0.84 mild vs 0.80 moderate vs 0.69 severe, P \u3c .01), 1 year (0.85 mild vs 0.79 moderate vs 0.82 severe, P \u3c .01), and 2 years (0.85 mild vs 0.75 moderate vs 0.76 severe, P \u3c .01).
CONCLUSION: After surgery, a clinically significant improvement was seen in a modest number of patients. In addition to halting the progression of myelopathy, surgery may enhance functional status and quality of life in some with painless CSM