20966 research outputs found
Sort by
Global prevalence and risk factors of irritable bowel syndrome from 2006 to 2024 using the Rome III and IV criteria: a meta-analysis
No full textFunctional gastrointestinal disorders impact 40% of the global population, with irritable bowel syndrome (IBS) standing out due to its complexity, quality-of-life effects, and economic impact. Our meta-analysis explored the global prevalence of IBS, considering diagnostic criteria, subtypes, sampling methods, geographical variations, and risk factors. The literature search used databases like PubMed and Cochrane Library, focusing on IBS studies from 2006 to June 2024. Eligibility criteria included studies on individuals aged ≥18, based on Rome III/IV criteria, using random or convenience sampling. Data on IBS prevalence, subtypes, and sampling methods were extracted, and statistical analysis was performed using Open MetaAnalyst and the review manager. The study reviewed 96 articles on IBS prevalence using Rome III and IV criteria across 52 countries, revealing a global prevalence of 14.1%. Prevalence varied by subtype: IBS-C (26.1%), IBS-D (26.5%), IBS-M (31.4%), and IBS-U (8.3%). IBS-D was more prevalent under Rome III (26.2%), while IBS-C was more common under Rome IV (34.2%). First-world countries like the UK, China, and Japan had the highest prevalence. Females [odds ratios (OR): 1.49], stress (OR: 2.47), anxiety (OR: 2.93), and depression (OR: 2.24) were significantly more prevalent in IBS patients, while no significant differences were found in smoking, alcohol use, or education levels. This meta-analysis reveals regional and subtype variations in IBS prevalence, with psychological factors significantly impacting its development. The influence of sampling techniques and Rome III/IV criteria on prevalence estimates highlights the need for a multidisciplinary treatment approach, with important implications for IBS management
Real world analysis of long-term eff icacy of isovolemic red cell exchange in sickle cell disease: a single center experience
No full textIncreasing Olanzapine Prescribing for Patients Undergoing Highly Emetogenic Chemotherapy
No full textIMPORTANCE: Olanzapine as part of a 4-drug antiemetic regimen is highly effective at preventing nausea and vomiting in patients receiving highly emetogenic chemotherapy (HEC). National prescribing rates of olanzapine in eligible patients have, however, remained persistently low.
OBJECTIVE: To describe efforts to increase the guideline-concordant use of olanzapine in patients receiving HEC in a statewide oncology collaborative.
DESIGN, SETTING, AND PARTICIPANTS: The Michigan Oncology Quality Consortium (MOQC) is a collaborative of Michigan-based oncology practices whose mission is to advance the care of patients with cancer and their caregivers through comprehensive, patient- and practice-led quality improvement initiatives. Participants were patients receiving HEC at 38 MOQC member practices during an initiative from 2019 to 2023 to improve guideline-concordant inclusion of olanzapine as part of a 4-drug antiemetic regimen in HEC prophylaxis.
INTERVENTIONS: Interventions included performance audit and feedback to practices along with peer comparison, learning collaboratives of practices, education by experts at collaborative meetings, creation of patient-facing materials, and the addition of value-based reimbursement beginning in 2021. Measure performance was assessed using the American Society of Clinical Oncology\u27s Quality Oncology Practice Initiative.
MAIN OUTCOMES AND MEASURES: Proportion of patients receiving olanzapine for the first cycle of HEC as part of a 4-drug antiemetic regimen for chemotherapy-induced nausea and vomiting.
RESULTS: Between 2019 and 2024, data were manually collected from the medical records of 8662 patients treated with HEC at 38 medical oncology practices at 71 sites across the state. Individual patient-level demographic data are not available from the QOPI database. For patients from years 2021 through 2024, the median (IQR) age was 62 (52-69) years; 4434 were female (65.5%); 814 were Black or African American (12.0%), 121 were Hispanic or Latino (1.8%), and 5385 were White (79.7%). The use of olanzapine as part of a 4-drug antiemetic increased from 7.2% in 2019 to 63.4% in 2024 (χ21 = 553.61; P \u3c .001).
CONCLUSIONS AND RELEVANCE: In this quality improvement study of olanzapine prescribing in eligible patients, MOQC deployed quality improvement methods to increase the prescribing of olanzapine as part of a 4-drug regimen in patients receiving HEC, well above both the baseline and national levels of prescribing. This work suggests that efforts to improve patient care can be effective across diverse practice types, locations, and sizes in a statewide collaborative. Ongoing efforts include supporting change in those practices with low rates of prescribing and demonstrating the importance of this work for patient outcomes
A Scoping Review on Barriers to Cancer Diagnosis and Care in Low- and Middle-Income Countries
No full textCancer remains a significant global health challenge, with low- and middle-income countries (LMIC) disproportionately burdened by high mortality rates despite a lower overall incidence. Barriers to timely diagnosis and care exacerbate these disparities. This scoping review synthesizes existing literature on barriers for women in LMICs following the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines. Studies on women in LMICs reporting barriers to accessing care for breast, colorectal, lung, cervix uteri, thyroid, corpus uteri, and stomach cancers were included. Twenty-nine studies involving 7,031 participants were included. The most common barriers included financial challenges (65.5%), geographic obstacles (34.5%), health system limitations (55.2%), and low health literacy (51.7%). Patients experienced significant delays, averaging 7.4 months from symptom onset to diagnosis and 4.9 months from diagnosis to treatment initiation. Structural issues such as limited diagnostic services, inadequate healthcare infrastructure, and healthcare provider shortages were widespread. Addressing the multifaceted barriers to cancer care in LMICs requires comprehensive strategies, including increasing financial support, decentralizing care services, improving healthcare infrastructure, and enhancing education for patients and providers. Policymakers and stakeholders should prioritize investments in cancer care to reduce disparities and improve outcomes. These findings will inform strategies for improving cancer care in low-resource settings globally
Synthesis of 3-Carboxy-6-sulfamoylquinolones and Mefloquine-Based Compounds as Panx1 Blockers: Molecular Docking, Electrophysiological and Cell Culture Studies
No full textThe membrane channel protein Panx1 is a promising therapeutic target since its involvement was demonstrated in a variety of pathologies such as neuropathic pain, ischemic stroke and cancer. As a continuation of our previous work in this field, we report here the synthesis and biological evaluation of two classes of compounds as Panx1 blockers: 3-carboxy-6-sulphonamidoquinolone derivatives and new Mefloquine analogs. The series of 3-carboxy-6-sulphonamidoquinolones gave interesting results, affording powerful Panx1 channel blockers with 73.2 \u3c I% \u3c 100 at 50 µM. In particular, 12f was a more potent Panx1 blocker than the reference compound CBX (IC(50) = 2.7 µM versus IC(50) = 7.1 µM), and its profile was further investigated in a cell culture model of polycystic kidney disease. Finally, interesting results have been highlighted by new molecular modeling studies
Risk of De Novo Inflammatory Bowel Disease in Patients With Psoriasis and Psoriatic Arthritis Treated With IL-17A Inhibitors: A Population-Based Study
No full textIL-17 inhibitors effectively treat psoriasis and psoriatic arthritis but may increase the risk of inflammatory bowel disease (IBD). We assessed their association with IBD compared to apremilast. Utilising the TriNetX database, we analysed patients with psoriasis or ankylosing spondylitis initiating IL-17 inhibitors or apremilast. We used propensity score matching and Cox models to estimate IBD risk. Among 13,216 matched patients per group, 142 developed IBD with IL-17 inhibitors versus 60 with apremilast (aHR = 2.50, 95% CI: 1.85-3.39). IL-17 inhibitors increase IBD risk, necessitating careful patient selection and monitoring
Retrospective cohort study of oral switch versus intravenous antibiotics for carbapenem-resistant enterobacterales and Pseudomonas aeruginosa infections on hospital discharge
No full textOBJECTIVES: To compare outcomes of oral switch versus intravenous antibiotics for the treatment of carbapenem-resistant Enterobacterales (CRE) and Pseudomonas aeruginosa (CRPA) infections at hospital discharge.
METHODS: Institutional review board approved, retrospective cohort of adults infected with CRE or CRPA who received oral switch or intravenous antibiotics at hospital discharge from January 1, 2017, to April 30, 2024. Patients were included if they were eligible for oral switch and infected with an isolate susceptible to one or more oral antibiotics; non-bacteremic urinary tract infections were excluded. The primary outcome was 30-day clinical success at end of therapy, defined as lack of infection-related hospitalization, infection-related recurrence, or change/escalation of therapy. Secondary outcomes included hospital length of stay (LOS) and 30-day all-cause mortality from end of therapy.
RESULTS: Fifty-five patients were included; 51% received oral switch antibiotics and 49% received intravenous antibiotics. Thirty-three percent of patients had CRE, 67% had CRPA, and 38% of cultures were polymicrobial. The most common infection types were pneumonia (33%), intra-abdominal (26%), and bone/joint (22%). The median (interquartile range [IQR]) duration of outpatient therapy was 12 (6-25) days versus 20 (4-34) days for the oral switch and intravenous antibiotic groups, respectively (p = 0.341). 30-day clinical success was 61% in the oral switch and 48% in the intravenous antibiotic groups (p = 0.349); the median (IQR) hospital LOS for the oral switch and intravenous antibiotic groups was 14 (9-25) days and 16 (9-49) days, respectively (p = 0.165); 30-day mortality was 4% in the oral switch group and 15% in the intravenous antibiotic group (p = 0.193).
CONCLUSION: A limited sample of patients who received oral switch antibiotics had similar outcomes to intravenous outpatient treatment of carbapenem-resistant organisms, with a shorter hospital LOS
Safety and Sample Adequacy for Comprehensive Biomarker Testing of Bronchoscopic Biopsies: An American Association of Bronchology and Interventional Pulmonology and International Association for the Study of Lung Cancer Clinical Practice Guideline
No full textLinear endobronchial ultrasound-guided sampling of accessible mediastinal lesions is well established as a first-choice modality for lung cancer mediastinal staging. Parenchymal lung lesions, however, are routinely accessed by either a percutaneous (computed tomography guided) or a bronchoscopic approach. Direct comparisons between the percutaneous approach and bronchoscopy, endobronchial ultrasound, or mediastinoscopy are sparse in regard to diagnostic accuracy, and it remains unknown which sampling technique is the safest and offers the most adequate material for comprehensive biomarker testing. This guideline addresses new evidence and aims to answer these questions relevant to contemporary lung cancer clinical practice. A multidisciplinary expert panel from the American Association of Bronchology and Interventional Pulmonology and the Early Detection and Screening Committee of the International Association for the Study of Lung Cancer was convened to address four Patient, Intervention, Comparison, and Outcome questions pertaining to the safety and adequacy of comprehensive biomarker testing for frequently used intrathoracic biopsy techniques. The panel included 24 experts in thoracic procedures, including 18 pulmonologists, two radiologists, one pathologist, and three thoracic surgeons from 22 hospitals across 12 countries. All panel members participated in the development of the final recommendations using a modified Delphi technique. Specific recommendations are provided on safety and adequacy of minimally invasive thoracic interventions on patients with confirmed or suspected lung cancer for which comprehensive biomarker testing is needed for standard of care or clinical trial participation
Association of Area of Deprivation Index With Active Surveillance (AS) Utilization and Adherence to as Guidelines: Results From a Contemporary North American Cohort
No full textBACKGROUND: Active Surveillance (AS) for Prostate Cancer (PCa) requires regular follow-up, raising concerns that socioeconomic barriers may result in underutilization or decreased adherence to AS guidelines. We examined the relationship between socioeconomic factors, measured by the Area Deprivation Index (ADI), and AS habits in a contemporary North American cohort.
METHODS: We included all the patients aged ≤ 75 years and diagnosed with low (ISUP GG = 1, PSA ≤ 10 ng/mL and cT1N0M0) and intermediate risk (ISUP GG = 2, PSA 10-20 ng/mL or cT2N0M0) PCa at Henry Ford Health (HFH) between 1995 and 2023. An ADI score was assigned to each patient based on their residential census block group, ranked as a percentile of deprivation relative to the national level. The higher the ADI, the more the area has a socioeconomic disadvantage. Logistic regression analysis tested the impact of ADI on AS utilization and adherence to AS guidelines. Only patients who underwent at least 1 PSA test per year and at least 1 biopsy every 4 years were considered as adherent to guidelines .
RESULTS: Our final cohort consisted of 4376 patients eligible for AS, 919 of whom actually underwent AS. Older patients (66 vs. 62 years, p \u3c 0.0001) and those diagnosed in more recent years (2017 vs. 2010, p \u3c 0.0001) had higher probability to undergo AS. Moreover, patients in the AS group more likely to be NHB (36% vs. 25%, p \u3c 0.0001), had higher ADI score (61 vs. 55, p \u3c 0.0001), more comorbidities according to Charlson Comorbidity Index (CCI) score, (19.5%% vs. 13.8%, p \u3c 0.0001) and higher probability to harbor low risk PCa (65.7% vs. 26.6%, p \u3c 0.0001), compared to patients who underwent active treatment. Among the 919 patients in AS, only 410 were adherent to guidelines . Patients following guidelines were more likely to be NHW (64.1% vs. 52.8%, p \u3c 0.003), and had lower ADI percentile (55.5 vs. 66, p \u3c 0.0003). Furthermore, AS patients managed according to the prevailing guidelines received more PSAs tests (1.8 vs. 0.8, p \u3c 0.0001) and prostate biopsies (0.3 vs. 0.0, p \u3c 0.0001) per year, thus reporting both higher upgrading rates during AS (35.6% vs. 23%, p \u3c 0.0001) and an increased probability to undergo active treatment (48% vs. 27%, p \u3c 0.0001). At MVA, patients with a higher ADI score reported higher probability to undergo AS (OR: 1.06, 95% CI: 1.02-1.10, p = 0.004), but at the same time they were less likely to follow AS\u27 guidelines (OR: 0.94, 95% CI: 0.89-0.99, p = 0.02).
CONCLUSIONS: Patients in the most deprived areas had a higher likelihood of undergoing AS but were more prone to receive guideline-discordant care. This should be taken into consideration by physicians when recommending AS for those men living in the least advantaged neighborhoods. Our study highlights the need for targeted community reforms to enhance proper and informed AS utilization among socioeconomically disadvantaged populations