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Hereditary angioedema: Patient health care experiences within underrepresented racial and ethnic groups in the United States
No full textBACKGROUND: Hereditary angioedema (HAE) is a rare disorder in which unpredictable angioedema attacks significantly affect patient quality of life. Information on patient experiences and perspectives of HAE management within underrepresented racial and ethnic groups is limited.
OBJECTIVE: To gain insight into the experiences and perspectives of medical care and treatment of HAE among underrepresented racial and ethnic groups in the United States.
METHODS: Adult patients diagnosed with having HAE who self-identified as members of an underrepresented racial and/or ethnic group were recruited to participate in a noninterventional, observational, web-based patient survey. The questionnaire included questions on medical history, current and past treatments, resource utilization, and perceived disease severity. The patient-perceived impact of HAE on the quality of life was also measured.
RESULTS: Overall, 139 patients participated in the survey; 33.1% were identified solely as African American or Black and 30.2% solely as Hispanic, Latin American, Latin, or Latine, or Latinx. Before the diagnosis, 12.3% of the patients were satisfied with their HAE-related health care experiences. Many participants experienced difficulties obtaining an HAE diagnosis. Barriers to treatment include insufficient provider knowledge of HAE and misdiagnoses. More than 90% of the patients were satisfied with their care; however, patients reported 6 HAE attacks (median) in the past year and only 10.4% of the patients were attack free. Furthermore, 38.1% found it difficult or very difficult to cover the monthly out-of-pocket costs for HAE-related treatments and 24.6% felt that their provider sometimes/rarely/never considered their individual background when making medical decisions.
CONCLUSION: Barriers to HAE diagnosis and effective treatment persist among US patients from underrepresented racial and ethnic groups
Percentage contribution of anesthetic induction on total case fresh gas flow under inhalational anesthesia: A retrospective cohort study
No full textEvaluating Percutaneous Coronary Intervention Safety, Quality, and Appropriateness Across Michigan Using Blinded Cross-Institutional Peer Review
No full textBACKGROUND: Several quality improvement initiatives have focused on the quality gap in percutaneous coronary intervention (PCI), yet significant variations in quality persist. Our objective was to use a novel blinded peer review system to evaluate PCI quality, safety, and appropriateness across Michigan.
METHODS: Single-vessel PCI cases were randomly selected from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry across Michigan (2018-2020), and anonymized angiograms and pertinent case records were uploaded to a secure server. Cases were reviewed by blinded interventional cardiologists internal and external to the institution, using a standardized peer review form and rated on procedural quality, safety, and appropriateness. We compared appropriateness ratings between reviewers and registry-based appropriateness criteria.
RESULTS: We conducted 1627 independent peer reviews of 961 cases; 23.7% of cases were for non-ST-segment-elevation myocardial infarction, and 36.4% were for ST-segment-elevation myocardial infarction. The majority (96.4%) of reviewers rated angiogram quality as excellent or adequate. Reviewers noted a complication or suboptimal result in 11.1% of reviews; 44.0% of these were deemed avoidable. Most PCI procedures were considered appropriate or may be appropriate, (87.1%) by all those reviewing. Reviewers were less likely to categorize PCI cases as appropriate compared with registry-based appropriate use criteria definitions (73.1% versus 93.3%). The percentage of cases rated as both appropriate/may be appropriate and technically competent ranged from 76.7% to 100% across sites.
CONCLUSIONS: While the overall quality and appropriateness of PCI in Michigan are high, key opportunities to improve care were identified. Additional studies are needed to assess the utility of expanding this approach across the United States
State-Level Hospital Quality in the United States: Analyzing Variation and Trends From 2013 to 2021
No full textOBJECTIVE: This study develops a hospital quality index to analyze state-level variations in hospital quality in the United States from 2013 to 2021, using data from 3,000 hospitals from the Centers for Medicare & Medicaid Services (CMS) Hospital Compare data set.
DESIGN: The quality index combines three risk-adjusted measures from the CMS Hospital Compare: 30-day readmission rate, 30-day mortality rate, and patient experience. Each measure is converted into a z-score, weighted by hospital beds, and averaged to form the final index, which has a mean of 0 and a standard deviation of 1.
RESULTS: In 2021, the average U.S. hospital quality measures were 15.1% for readmissions, 11.2% for mortality, and 69.7% for patient experience. There was significant state-level heterogeneity. The quality index ranged from -0.54 to 0.57. Eight states notably outperformed the U.S. average, with Utah leading. Conversely, 14 states underperformed. From 2013 to 2021, there was an average annual improvement in readmissions (0.08pp) and mortality (0.12pp), but a decline in patient experience (0.27pp).
CONCLUSIONS: The study highlights improvements in hospital quality over time but underscores disparities at the state level. The quality index provides a valuable tool for understanding and addressing these variations in hospital care quality
Delay discounting data in the Adolescent Brain Cognitive Development (ABCD) study: Modeling and analysis considerations
No full textThis report provides a primer to delay discounting data in the context of the Adolescent Brain Cognitive Development (ABCD) Study. Delay discounting describes the tendency for organisms to devalue temporally constrained outcomes. This decision-making framework has garnered attention from multiple fields for its association with various behavioral health conditions like substance use disorder. Importantly, the literature on delay discounting describes many approaches to analyzing and interpreting discounting data. To be most beneficial to the broader scientific audience, consistency and reproducibility in how delay discounting data are operationalized, analyzed, and interpreted is key. We describe relevant data analysis methods for use with the ABCD Study, a large-cohort longitudinal study (N = 11,878) examining delay discounting among youth respondents across child and adolescent development. Particular attention is given to data collected from children and younger populations given their relevance to ABCD research and potential merit for unique analytic considerations (e.g., higher rates of atypical responding). We first provide a background on the broad theoretical and conceptual aspects of discounting research. We then review discounting assessment, describing conventional titration tasks and the more novel algorithm-based approaches to generating descriptive metrics. We conclude with recommendations for best practice modeling, data handling and exclusions based on nonsystematic data, and ensuing interpretations. Analytic pipelines and coding are provided for investigator use
Benzoyl peroxide acne treatment shows no significant association with benzene-related cancers: A multicenter retrospective analysis
No full textRecommendations to Improve Outcomes in Acne and Acne Sequelae: A Focus on Trifarotene and Other Retinoids
No full textAcne vulgaris affects nearly 50 million people in the USA, ranking as the eighth most prevalent disease globally. This chronic inflammatory skin condition often results in sequelae, including atrophic acne scars, acne-induced macular erythema and acne-induced hyperpigmentation, impacting patients\u27 quality of life. This commentary article reviews the use of topical retinoids, with a particular emphasis on trifarotene cream 0.005%, for managing both acne and acne sequelae. Topical retinoids are considered central to improving treatment outcomes because of their established efficacy, safety and tolerability. Adapalene, tretinoin and tazarotene have demonstrated efficacy in reducing acne and acne sequelae in several studies. Trifarotene has been extensively studied in Phase 3 trials, demonstrating notable success in treating mild-to-moderate acne. Recently, two large-scale, randomized, blinded, Phase 4 clinical trials investigated trifarotene cream 0.005% in patients with atrophic acne scarring and acne-induced hyperpigmentation across all Fitzpatrick phototypes. The START study found that there was a greater reduction in total atrophic acne scar count in the trifarotene group compared with the vehicle group at Week 24 (55.2% vs 29.9%) with statistical significance established as early as Week 2 (P = 0.001). Based on this evidence, we recommend that topical retinoids should be introduced as first-line therapy for the treatment of acne and acne sequelae. Retinoids should be implemented into a treatment routine as early as possible, especially for patients with darker Fitzpatrick phototypes or patients at risk of atrophic acne scarring. Furthermore, retinoids should be incorporated within a comprehensive skincare regimen that includes adequate photoprotection when treating patients with darker Fitzpatrick phototypes. Finally, management of acne and acne sequelae should include maintenance therapy with topical retinoids. This article supports the American Academy of Dermatology\u27s call for acne sequelae treatment guidance and emphasizes the need for continued research to optimize patient care
An evidence-driven classification of nonfiltering ingredients for topical photoprotection
No full textContraception Updates
No full textOver the past decade, contraception options in the United States have expanded to include an over-the-counter progestin-only pill, a drospirenone progestin-only pill, a vaginal acidifying gel, a low-dose contraceptive patch, and a new vaginal contraceptive ring. Clinical evidence supports expanding the duration of use of the 52 mg progestin intrauterine device (IUD) and the copper IUD. Contraception counseling should center patient priorities and preferences rather than promoting methods based on the provider’s beliefs. To employ a reproductive justice lens when counseling patients about their contraception options, providers should remain up to date on all available methods
SMURF2 facilitates GAP17 Isoform 1 membrane displacement to promote mutant p53-KRAS oncogenic synergy
No full textCooperativity between mutant p53 and mutant KRAS, although recognized, is poorly understood. In pancreatic cancer, mutant p53 induces splicing factor hnRNPK causing isoform switch producing overexpression of GTPase activating protein 17 isoform 1 (GAP17-1). GAP17-1 is mis-localized in the cytosol, instead of the membrane, due to insertion of exon 17 encoding a PPLP motif, thus allowing mutant KRAS to remain in the GTP bound hyperactive state. However, the role of PPLP in influencing GAP17-1 mis-localization remains unclear. We show that Smad Ubiquitination Regulatory Factor 2 (SMURF2), a known stabilizer of mutant KRAS, interacts with GAP17-1 via the PPLP motif and displaces it from the membrane, facilitating mutant p53 mediated mutant KRAS hyperactivation. We used cell lines with known KRAS and TP53 mutations, characterized Smurf2 expression in multiple pancreatic cancer mouse models (iKras*; iKras*, p53*, and p48-Cre; Kras*) and performed single cell RNAseq and tissue microarray on preclinical and clinical samples. We found that SMURF2 silencing profoundly reduces survival of mutant TP53; KRAS driven cells. We show that a GAP17-1 AALA mutant does not bind to SMURF2, stays in the membrane, and keeps mutant KRAS in the GDP bound state to inhibit downstream signaling. In mouse models, mutant KRAS and SMURF2 upregulation are correlated in pancreatic intraepithelial neoplasia (PanIN) and ductal adenocarcinoma (PDA) lesions. Furthermore, PDA patients who received neoadjuvant therapy and express moderate to high SMURF2 show decreased overall survival (p=0.04). Implications: In TP53 and KRAS double mutated pancreatic cancer, SMURF2 driven GAP17-1 membrane expulsion facilitates mutant p53-KRAS oncogenic synergy