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Endovascular aneurysm repair for patients with disseminated cancer: A propensity-score matched study from ACS-NSQIP database from 2012-2022
No full textBackgroundDisseminated cancer may complicate decision-making processes for major surgical interventions, including endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). However, the postoperative outcomes of EVAR in patients with disseminated cancer have not been well-established. This study aimed to explore the impact of preoperative disseminated cancer on 30-day outcomes of non-ruptured EVAR.MethodsPatients who underwent infrarenal EVAR were identified in ACS-NSQIP targeted database from 2012 to 2022. Exclusion criteria included age \u3c18 years, ruptured aneurysm, acute intraoperative conversion to open repair, and emergency cases. A 1:3 propensity-score matching was used to match demographics, baseline characteristics, aneurysm diameter, distant aneurysm extent, anesthesia, and concomitant procedures between patients with and without preoperative disseminated cancer. Thirty-day postoperative EVAR outcomes were examined.ResultsThere were 154 (0.80%) patients with disseminated cancer who underwent non-ruptured EVAR. Meanwhile, 19,109 patients without disseminated cancer went under EVAR, where 462 of them were matched to all patients with disseminated cancer. After propensity-score matching, patients with and without disseminated cancer had comparable mortality rates (5.19% vs 4.76%, p = 0.83). However, patients with disseminated cancer had higher lower extremity ischemia (2.60% vs 0.43%, p = 0.04), unplanned reoperation (9.74% vs 3.90%, p = 0.01), and 30-day readmission (19.48% vs 10.61%, p = 0.01).ConclusionDisseminated cancer is significantly more prevalent among patients undergoing EVAR than the general population (0.05%), likely due to shared pathophysiology between AAA development and the incidence and progression of cancer. While EVAR is relatively safe in terms of short-term outcomes in patients with disseminated cancer, the long-term prognosis for these patients needs further investigation
Patient-Centric Benefit-Risk Evaluation of Ticagrelor in Combination with Aspirin in Acute Ischemic Stroke or Transient Ischemic Attack: DOOR Analyses of the THALES Trial
Get PDFNeural (re)organisation of language and memory: implications for neuroplasticity and cognition
No full textBACKGROUND: In the presence of neurological insult, how language and memory networks jointly reorganise provides insights into mechanisms of neuroplasticity and can inform presurgical planning. As (re)organisation is often studied within a single cognitive modality, how language and memory interact during (re)organisation in response to epilepsy and the implications for memory outcomes is less clear. We investigated (1) the rates and patterns of joint (re)organisation and (2) their associations with pre- and postsurgical memory function. METHODS: Individuals with epilepsy (n=162) from three neurosurgical centres underwent the Wada procedure. We examined colateralisation patterns (ie, concordance/discordance) between language and both global and verbal memory (n=34), and associations with clinical characteristics and preoperative and postoperative memory outcomes. RESULTS: Overall concordance between language and memory colateralisation was minimal-to-weak across both global memory and verbal memory (kappa=0.28-0.44). Discordance was primarily observed in individuals with left-lateralised language, of whom 52% and 32% showed discordance in global and verbal memory, respectively. Discordance was most pronounced in left hemisphere epilepsy and mesial temporal sclerosis. Conversely, right-lateralised language consistently predicted right-lateralised memory (95%-100%), regardless of seizure laterality or memory type. While discordance was not associated with presurgical memory function, discordance predicted superior postsurgical memory outcomes following surgery in the language-dominant hemisphere (p\u3c0.05; η =0.30). CONCLUSIONS: When language dominance is atypical, memory tends to colateralise. However, when language remains typical, concordance with memory is weak, particularly for left hemisphere seizure onset. An interhemispheric shift in language may trigger a shift in memory, possibly to maintain efficient communication between medial temporal and neocortical language networks. In contrast, memory appears able to reorganise in isolation, with discordance predicting better postsurgical memory outcomes without detriment to presurgical function. Our findings support the continued need for separate presurgical mapping of language and memory lateralisation, particularly in the case of typical language dominance and left hemisphere seizures
Development of a mental health-related structural stigma measurement framework in the healthcare system setting: A modified Delphi study
No full textINTRODUCTION: There is a worldwide dearth in literature on the nature, causes, and consequences of structural stigma in mental healthcare. This study aimed to address this gap by exploring key components for measuring structural stigma in healthcare system settings. METHODS: We used a modified Delphi method consisting of 3 rounds with global experts (stigma researchers, persons with lived experiences of mental health conditions (PWLEs), and policymakers). In the first round, indicators identified through a literature review (n = 39 studies) were appraised through expert consultation workshops with 22 panellists, including 54.5% women, 41% PWLEs, and 68.2% from low-and-middle income countries (LMICs). Round 2 (n = 53 panellists; 51% women, 8.3% PWLEs, and 56.6% from LMICs) involved ranking indicators through an online survey, and Round 3 (n = 58 panellists; 46% women, 21.7% PWLEs, and 60.4% from LMICs) involved re-ranking the results from Round 2. Smith\u27s salience index was calculated to measure consensus and Kendall\u27s coefficient of concordance to determine the degree of agreement. Narrative opinions and feedback from panellists during all three Delphi rounds were also sought. RESULTS: A list of indicators within five core measurement domains was identified in Round 1. Round 2 results were heterogeneous as indicated by the low to moderate salience of most indicators. Round 3 resulted in 4-5 indicators in each domain, that were ranked as highly salient by the expert panellists. Experts also provided narrative feedback on the definition of structural stigma, barriers to its measurement, domain-specific comments, and indicators-specific comments. CONCLUSION: The framework aids in defining mental health-related structural stigma in healthcare and framing it in terms of inequities within healthcare system structures. These structures result in negative experiences of PWLEs and limit their access to quality healthcare. This conceptualization, informed by PWLE and stakeholders in LMICs, makes it easier to measure structural stigma and monitor changes in diverse healthcare settings around the world
A deep learning analysis for dual healthcare system users and risk of opioid use disorder
No full textThe opioid crisis has disproportionately affected U.S. veterans, leading the Veterans Health Administration to implement opioid prescribing guidelines. Veterans who receive care from both VA and non-VA providers-known as dual-system users-have an increased risk of Opioid Use Disorder (OUD). The interaction between dual-system use and demographic and clinical factors, however, has not been previously explored. We conducted a retrospective study of 856,299 patient instances from the Washington DC and Baltimore VA Medical Centers (2012-2019), using a deep neural network (DNN) and explainable Artificial Intelligence to examine the impact of dual-system use on OUD and how demographic and clinical factors interact with it. Of the cohort, 146,688(17%) had OUD, determined through Natural Language Processing of clinical notes and ICD-9/10 diagnoses. The DNN model, with a 78% area under the curve, confirmed that dual-system use is a risk factor for OUD, along with prior opioid use or other substance use. Interestingly, a history of other drug use interacted negatively with dual-system use regarding OUD risk. In contrast, older age was associated with a lower risk of OUD but interacted positively with dual-system use. These findings suggest that within the dual-system users, patients with certain risk profiles warrant special attention
A Comparison of Large Language Model Powered Search Tools Reveal Differences in Output Quality, Information Transparency, and Accessibility for Mohs Micrographic Surgery Inquiries
No full textLong-Term Revision-Free Survival Following Operative Fixation of Femoral Neck Fractures in Young Adults
No full textOBJECTIVES: To identify the rate of fixation failure following femoral neck fracture (FNF) fixation in young adults within a national database. METHODS: Design: Retrospective cohort study. SETTING: National all-payer claims database. PATIENT SELECTION CRITERIA: Adults between 18 and 49 years of age who underwent operative fixation for FNF (AO/OTA 31-B) between January 2010 and April 2019 were identified. OUTCOME MEASURES AND COMPARISONS: The primary outcome measure was five-year risk of revision surgery for fixation failure following operative management of FNF. Additional data variables included rate of fixation failure following open versus closed reduction techniques and the rate of revision fixation, intertrochanteric osteotomy for nonunion or malunion, and conversion to arthroplasty. RESULTS: A total of 3,534 young adults underwent operative fixation of a FNF during the study period. The mean age of the study population was 41.1 +/- 3.91 years (18-49) and a majority were male (52.6%). The five-year revision-free survival of young adults who underwent operative fixation for FNF was 86.1% (95% CI 85.5-89.1%). Four-hundred ninety-two patients (13.9%) required revision surgical intervention for fixation failure, including 210 (5.9%) revision fixation procedures and 21 (0.6%) intertrochanteric osteotomies; two hundred sixty-one (7.4%) patients underwent conversion to arthroplasty. There was no significant difference in rate of fixation failure when comparing open (n=392, 14.9%) and closed (n=100, 13.3%) reduction techniques (p=0.351). CONCLUSIONS: Following operative management of FNF in young adults, fixation failure due to avascular necrosis, nonunion/malunion, or posttraumatic arthritis occurred at a rate of 13.9%. There was no difference in the rate of treatment failure between open and closed reduction. LEVEL OF EVIDENCE: Therapeutic Level IV
Protocol for generating and characterizing a nasal epithelial model using imaging with application for respiratory viruses
No full textAir-liquid interface (ALI) culture can differentiate airway epithelial cells to recapitulate the respiratory tract in vitro. Here, we present a protocol for isolating and culturing nasal epithelial cells from turbinate tissues for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We describe steps to overcome challenges of imaging fragile cultures, detect the production of mucus, and quantify intracellular virus post-SARS-CoV-2 infection. We present data on the optimal duration of ALI maturation prior to experimentation and describe which steps can be altered to optimize testing of specific hypotheses
Efficacy of priming and commitment posters on urgent care patients\u27 antibiotic expectations and knowledge: a cluster randomized trial
No full textOBJECTIVE: Successfully educating urgent care patients on appropriate use and risks of antibiotics can be challenging. We assessed the conscious and subconscious impact various educational materials (informational handout, priming poster, and commitment poster) had on urgent care patients\u27 knowledge and expectations regarding antibiotics. DESIGN: Stratified Block Randomized Control Trial. SETTING: Urgent care centers (UCCs) in Colorado, Florida, Georgia, and New Jersey. PARTICIPANTS: Urgent care patients. METHODS: We randomized 29 UCCs across six study arms to display specific educational materials (informational handout, priming poster, and commitment poster). The primary intention-to-treat (ITT) analysis evaluated whether the materials impacted patient knowledge or expectations of antibiotic prescribing by assigned study arm. The secondary as-treated analysis evaluated the same outcome comparing patients who recalled seeing the assigned educational material and patients who either did not recall seeing an assigned material or were in the control arm. RESULTS: Twenty-seven centers returned 2,919 questionnaires across six study arms. Only 27.2% of participants in the intervention arms recalled seeing any educational materials. In our primary ITT analysis, no difference in knowledge or expectations of antibiotic prescribing was noted between groups. However, in the as-treated analysis, the handout and commitment poster were associated with higher antibiotic knowledge scores. CONCLUSIONS: Educational materials in UCCs are associated with increased antibiotic-related knowledge among patients when they are seen and recalled; however, most patients do not recall passively displayed materials. More emphasis should be placed on creating and drawing attention to memorable patient educational materials
