Category: Statistics

J Drugs Dermatol. 2024 Nov 1;23(11):965-971. doi: 10.36849/JDD.8159.

ABSTRACT

BACKGROUND: Iron oxides, antioxidants, and pigmentary titanium dioxide are sunscreen additive ingredients that enhance visible light protection, reduce associated hyperpigmentation, and protect against certain photosensitive dermatoses There are currently no standardized recommendations for visible light protection with these additive ingredients, leading to varied clinical recommendations.

OBJECTIVES: This study aimed to evaluate dermatology practitioners’ counseling practices for visible light protection.

METHODS: An electronic survey was distributed to dermatology practitioners. Survey responses were compiled for analysis, and statistical significance was calculated using a standard 95% confidence interval.

RESULTS: 91.68% of 974 respondents actively counsel patients about visible light protection, primarily emphasizing its role in exacerbating pigmentation in patients with melanin-rich skin (70.92%). Of these, 10.34% recommended sunscreens with visible light protective additive ingredients specifically for patients with melanin-rich skin, and 48.89% recommended them for managing melasma or post-inflammatory hyperpigmentation. Iron oxide additive ingredients were most frequently recommended (90.92%), followed by antioxidants (69.08%) and pigmentary TiO2, (58.85%). 8.32% of respondents reported not counseling patients about visible light protection, with major reasons encompassing the lack of standardized guidelines (50.62%), challenges in recommending suitably tinted sunscreens (27.16%), limited availability of sunscreen options (23.46%), and insufficient supportive data (18.52%).

CONCLUSION: There is a need for increased education and awareness regarding visible light protection strategies and the identification of patients who may benefit the most from a targeted photoprotective strategy. Establishing standardized guidelines and broadening the availability of sunscreen options conferring visible light protection may help address these gaps. J Drugs Dermatol. 2024;23(11):965-971. doi:10.36849/JDD.8159.

PMID:39496128 | DOI:10.36849/JDD.8159

J Drugs Dermatol. 2024 Nov 1;23(11):986-991. doi: 10.36849/JDD.7985.

ABSTRACT

BACKGROUND: Tyrosinase is the rate-limiting enzyme of melanogenesis and thus an ideal inhibitory target for treating hyperpigmentation. There are many commercially available tyrosinase inhibitors with limited clinical efficacy. A recent screen of 50,000 compounds found isobutylamido thiazolyl resorcinol (ITR) to be the most potent inhibitor of human tyrosinase.

OBJECTIVE: To summarize the current evidence on the efficacy and adverse effects of ITR in treating hyperpigmentation.

METHODS: A literature search was conducted using PubMed and Google Scholar databases in June 2022. Fourteen clinical studies investigating the use of topical ITR in hyperpigmentation treatment or prevention were identified.

RESULTS: Most studies (n=13) investigated topical ITR as a treatment, while only one investigated ITR as a preventative measure against hyperpigmentation. All studies (n=14) found ITR to provide statistically significant improvements to hyperpigmentation conditions, including facial hyperpigmentation (n=3), melasma (n=5), post-inflammatory hyperpigmentation (PIH) (n=3), and UV-induced hyperpigmentation (n=3). Evidence suggests that the effective dosage and duration of topical ITR appears to be 0.1% to 0.2% ITR 2 to 4 times daily for 12 to 24 weeks. Successful prevention of UVB-induced hyperpigmentation has been seen following twice-daily topical ITR application for 3 weeks (P<0.001).

CONCLUSION: Topical ITR can significantly reduce hyperpigmentation, however, the evidence for its use is limited. Further investigation is warranted to identify the optimal dosage and application schedule of ITR, as well as compare the efficacy of ITR vs hydroquinone to determine if ITR is superior to the current standard of care. J Drugs Dermatol. 2024;23(11):986-991.  doi:10.36849/JDD.7985.

PMID:39496126 | DOI:10.36849/JDD.7985

J Drugs Dermatol. 2024 Nov 1;23(11):972-978. doi: 10.36849/JDD.8239.

ABSTRACT

BACKGROUND: Artificial intelligence chatbots (AIC) have sharply risen in popularity. Dermatology, heavily involving visual, clinical, and pathological pattern-recognition techniques, will be impacted by AIC. Thus, this study aims to categorize the attitudes and beliefs of American dermatologists towards AIC and their potential uses, benefits, and risks.

METHODS: An online cross-sectional survey was distributed to dermatologists across the United States. Questions explored opinions on AIC along with perceived benefits, risks, and important considerations for the incorporation of AIC into the practice of dermatology. Demographic data and self-reported understanding of AIC were also collected.

RESULTS: 192 complete responses were received. 53.6% of respondents were female. 44.3% were between ages 30 to 39. 41.1% had 0 to 10 years of experience as attending physicians. 76.5% of participants believed it is somewhat or very likely that AIC will be formally incorporated into dermatology. Higher self-reported understanding of AIC was associated with an increased perceived likelihood of AIC implementation as well as decreased perceived risk associated with AIC. Notably, 86% of respondents believed AIC would impact “patient education,” while concerns regarding “misinformation” and “incorrect diagnoses” were prevalent (89% and 78.5%, respectively). Participants anticipated AIC’s role primarily in administrative tasks, with 75.7% citing “reduced work burden on physicians” as a potential benefit.

CONCLUSION: Dermatologists in the United States foresee the integration of AIC into their practice, emphasizing its potential in administrative roles. Concerns revolve around the complexity of medical understanding and effective patient communication. As AIC continues to evolve, ongoing studies are crucial to evaluate their safety and efficacy in dermatological practice. J Drugs Dermatol. 2024;23(11):972-978. doi:10.36849/JDD.8239.

PMID:39496117 | DOI:10.36849/JDD.8239

Clin Spine Surg. 2024 Nov 4. doi: 10.1097/BSD.0000000000001713. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort study.

OBJECTIVE: To identify factors predictive of returning to work within 90 days of laminoplasty for degenerative cervical myelopathy (DCM).

BACKGROUND: DCM is a debilitating condition resulting from spinal canal stenosis and spinal cord compression. One surgical option for cord decompression is cervical laminoplasty. Factors influencing return to work (RTW) postsurgery are unknown.

METHODS: This study included adult patients previously employed, undergoing primary elective laminoplasty for DCM, and with documented RTW status. Variables included demographic information, medical history, illness characteristics, and baseline patient-reported outcomes. The primary outcome of interest was RTW status at 90 days. Statistical analyses were conducted to identify predictors.

RESULTS: Forty-six patients (67.6%) returned to work within 90 days, whereas 22 (32.3%) either RTW between 90 and 365 days (n = 3) or did not RTW within 365 days (n = 19). Significantly more patients who RTW within 90 days worked full-time (90.9% vs 64.3%, P = 0.030). Patients who RTW within 90 days had significantly lower preoperative Neck Disability Index scores (23.7 ± 17.5 vs 35.6 ± 14.3, P = 0.008) and higher preoperative modified Japanese Orthopedic Association scores (13.7 ± 2.5 vs 12.2 ± 2.7, P = 0.018) compared with those who did not RTW. No differences were found in other baseline patient-reported outcomes. Patients who RTW within 90 days had significantly lower postoperative 3-month neck pain (2.0 ± 2.1 vs 3.8 ± 2.6, P = 0.007), 3-month arm pain (1.3 ± 1.9 vs 3.6 ± 2.8, P < 0.001), 12-month neck pain (1.4 ± 1.6 vs 3.1 ± 2.4, P = 0.019) and 12-month arm pain (1.1 ± 1.8 vs 2.4 ± 2.4, P = 0.048) compared with those who did not RTW within 90 days. Higher preoperative modified Japanese Orthopedic Association scores were significantly associated with truncated time to RTW (HR: 1.14, 95% CI: 1.01-1.29, P = 0.034).

CONCLUSION: Patients with better preoperative neck and arm pain and functional scores were more likely to RTW within 90 days postlaminoplasty. Preoperative functional status plays an important role in assessing RTW postlaminoplasty. This information is valuable for preoperative patient counseling.

PMID:39496115 | DOI:10.1097/BSD.0000000000001713

Neurology. 2024 Nov 26;103(10):e210005. doi: 10.1212/WNL.0000000000210005. Epub 2024 Nov 4.

ABSTRACT

BACKGROUND AND OBJECTIVES: Epidemiologic studies suggest increasing incidence and prevalence of myasthenia gravis (MG) among the elderly population outside the United States. We aimed to provide an estimation of MG incidence and prevalence and their trend among the Medicare Fee-For-Service (FFS)-covered elderly US population.

METHODS: We performed a retrospective longitudinal study using Medicare claims data (2006-2019). Study-eligible beneficiaries were aged 65 years and older, had at least 1 month of FFS Part A/B coverage, and were without any health maintenance organization insurance coverage. Study-eligible beneficiaries were aggregated into 2-year periods from 2006-2007 through 2018-2019. MG cases were ascertained using a validated algorithm of 2 MG claims within each 2-year period, from 2 outpatient office visits or a combination of 1 inpatient admission and 1 outpatient office visit, separated by ≥ 28 days. Period prevalence was calculated from MG-ascertained cases divided by FFS Part A/B beneficiaries and reported as cases per 100,000 population. Incident cases were determined among MG prevalent cases if the initial MG claim occurred in that period after a full calendar year since coverage initiation. Incidence was calculated as case counts per 100,000 at-risk beneficiary person-years (PYs) in each period excluding 2006-2007. Trends of prevalence and incidence over time were examined with Poisson regression. All-cause mortality of each 2-year period was calculated.

RESULTS: The period prevalence of MG increased from 81 to 119 per 100,000 FFS A/B population from 2006-2007 to 2018-2019 (p < 0.001). Increasing trends of prevalence were observed in all sex (male/female), age (65-69/70-74/75-79/80+), race/ethnic (African American/Asian/Hispanics of any race/non-Hispanic White/other), and census region (Northeast/Midwest/South/West) subgroups. MG incidence increased from 12.2 to 13.3 per 100,000 PYs from 2008-2009 to 2018-2019 (p < 0.05). Increasing incidence trends were significant in the following subgroups: men and women; all age groups except 75-79 years; White non-Hispanic race; Northeast, Midwest, and South census regions. All-cause mortality among MG beneficiaries was stable from 6.26 deaths per 100 PYs in 2006-2007 to 5.67 in 2018-2019 (p = 0.18).

DISCUSSION: Increasing trends in MG prevalence and incidence in the elderly US population, with variation in rates of certain subgroups, are confirmed in this 14-year period.

PMID:39496108 | DOI:10.1212/WNL.0000000000210005

Neurology. 2024 Dec 10;103(11):e209866. doi: 10.1212/WNL.0000000000209866. Epub 2024 Nov 4.

ABSTRACT

BACKGROUND AND OBJECTIVES: CSF biomarkers of Aβ42 and phosphorylated tau (p-tau181) are used clinically for the detection of Alzheimer disease (AD) pathology during life. CSF biomarker validation studies have largely used clinical diagnoses and/or amyloid PET imaging as the reference standard. The few existing CSF-to-autopsy studies have been restricted to late-stage AD. This CSF-to-autopsy study investigated associations between CSF biomarkers of AD and AD neuropathologic changes among brain donors who had normal cognition at the time of lumbar puncture (LP).

METHODS: This was a retrospective study of brain donors from the National Alzheimer’s Coordinating Center who had normal cognition at the time of LP and who had measurements of CSF Aβ42 and p-tau181 performed with Lumipulse assays. All brain donors were from Washington University Knight ADRC. Staging of AD neuropathologic change (ADNC) was made based on National Institute on Aging-Alzheimer’s Association criteria. For this study, participants were divided into 2 categories: “AD-” (no AD/low ADNC) and “AD+” (intermediate/high ADNC). Accuracy of each biomarker for discriminating AD status was evaluated using area under the curve (AUC) statistics generated using predicted probabilities from binary logistic regressions that controlled for age, sex, APOE ε4, and interval between LP and death.

RESULTS: The average age at LP was 79.3 years (SD = 5.6), and the average age at death was 87.1 years (SD = 6.5). Of the 49 brain donors, 24 (49%) were male and 47 (95.9%) were White. 20 (40.8%) had autopsy-confirmed AD. The average interval from LP until death was 7.76 years (SD = 4.31). CSF p-tau181/Aβ42 was the optimal predictor of AD, having excellent discrimination accuracy (AUC = 0.97, 95% CI 0.94-1.00, p = 0.003). CSF p-tau181 alone had the second-best discrimination accuracy (AUC = 0.92, 95% CI 0.84-1.00, p = 0.001), followed by CSF Aβ42 alone (AUC = 0.92, 95% CI 0.85-1.00, p = 0.007), while CSF t-tau had the numerically lowest discrimination accuracy (AUC = 0.87, 95% CI 0.76-0.97, p = 0.005). Effects remained after controlling for prevalent comorbid neuropathologies. CSF p-tau181/Aβ42 was strongly associated with CERAD ratings of neuritic amyloid plaque scores and Braak staging of NFTs.

DISCUSSION: This study supports Lumipulse-measured CSF Aβ42 and p-tau181 and, particularly, the ratio of p-tau181 to Aβ42, for the early detection of AD pathophysiologic processes.

CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that Lumipulse measures of p-tau181/Aβ42 in the CSF accurately discriminated cognitively normal participants with and without Alzheimer disease neuropathologic change.

PMID:39496102 | DOI:10.1212/WNL.0000000000209866

Health Aff (Millwood). 2024 Nov;43(11):1538-1545. doi: 10.1377/hlthaff.2024.00398.

ABSTRACT

Although electronic health record (EHR) documentation burden is known to be associated with reduced clinician well-being and burnout, it may have even worse unintended consequences if documentation work also crowds out other high-value EHR tasks. We examined this possibility by assessing the relationship between documentation burden and a high-value but optional EHR task: the use of health information exchange (HIE) to view patient records from outside organizations. Our study took advantage of an exogenous shock to documentation time: appointment no-shows. We found that documentation time had a strong impact on HIE use, with each additional hour spent documenting resulting in a 7.1 percent reduction in the proportion of patients with an outside record viewed by the primary care physician seeing them that day. Our results point to the urgent need for policy makers to do more to reduce documentation burden.

PMID:39496090 | DOI:10.1377/hlthaff.2024.00398

Health Aff (Millwood). 2024 Nov;43(11):1597-1604. doi: 10.1377/hlthaff.2024.00461.

ABSTRACT

A long-standing policy prohibits the use of federal funds for Medicaid services in Institutions for Mental Diseases (facilities with more than sixteen beds that specialize in mental health or substance use disorder treatment). Beginning in 2015, states could apply for Section 1115 Medicaid waivers, which permit federal funding for Institutions for Mental Diseases services and require improvements in opioid use disorder (OUD) treatment. Using 2016-20 Medicaid data, we compared changes in the use of medications for OUD and nonfatal overdoses in seventeen states with waivers approved during 2017-19 to changes in eighteen states without waivers. Waiver implementation was not associated with improvements in overall medication treatment, buprenorphine and naltrexone prescribing, or rates of nonfatal overdoses among Medicaid enrollees with OUD. Waiver implementation was associated with a 2.3-percentage-point increase in the use of methadone with waiver implementation, as a result of coverage changes, and a 3.7-percentage-point increase in any medication treatment among Medicaid enrollees diagnosed with severe OUD who had an inpatient or residential stay. Our findings suggest that such waivers adopted by states during 2017-19 were not associated with significant improvements in medication treatment or reductions in nonfatal opioid-related overdoses among Medicaid enrollees with OUD. However, they may have moderately improved the use of medication treatment for those with severe OUD.

PMID:39496087 | DOI:10.1377/hlthaff.2024.00461

Health Aff (Millwood). 2024 Nov;43(11):1502-1507. doi: 10.1377/hlthaff.2024.00295.

ABSTRACT

We compared the generosity of Medicare plans in terms of out-of-pocket costs attributable to cost sharing and premiums, including both basic and supplemental services. From 2014 through 2019, projected out-of-pocket costs for a typical enrollee were 18-24 percent lower in Medicare Advantage than traditional fee-for-service Medicare.

PMID:39496086 | DOI:10.1377/hlthaff.2024.00295

Health Aff (Millwood). 2024 Nov;43(11):1587-1596. doi: 10.1377/hlthaff.2024.00307.

ABSTRACT

The Affordable Care Act Marketplaces may improve access to dental insurance, but little is known about the availability of such coverage. We used data from state and federal Marketplace sources to describe the availability of adult dental plans, including Stand-alone Dental Plans and those embedded in medical plans. We also examined the characteristics of counties with limited dental insurer participation and those that experienced a net loss of Stand-alone Dental Plan insurers between 2016 and 2023. We found that in 2023, at least one Stand-alone Dental Plan was offered in every state, and thirty-six states offered embedded dental plans. Most counties (63.6 percent) had access to more than five insurers offering adult dental plans, whereas approximately 4 percent had only one insurer offering adult dental plans. Counties in state-based Marketplaces, rural areas, and dentist shortage areas were more likely to be counties with limited dental insurer participation. The net loss of Stand-alone Dental Plans between 2016 and 2023 was more common in state-based Marketplaces and disadvantaged counties. Our findings can inform future policies to improve the dental insurance Marketplace and access to affordable dental care.

PMID:39496084 | DOI:10.1377/hlthaff.2024.00307