Nevin Manimala

Clin Lung Cancer. 2021 Nov 11:S1525-7304(21)00278-3. doi: 10.1016/j.cllc.2021.11.001. Online ahead of print.

ABSTRACT

INTRODUCTION: Patients with EGFR-mutant lung cancer who have had disease progression on osimertinib commonly receive platinum doublet chemotherapy, but whether adding immunotherapy or bevacizumab provides additional benefit is unknown.

MATERIALS AND METHODS: This was a retrospective analysis at 2 university-affiliated institutions. Patients with EGFR-mutant lung cancer who had progression on osimertinib and received next-line therapy with platinum doublet chemotherapy (chemo), platinum doublet chemotherapy plus immunotherapy (chemo-IO), or platinum doublet chemotherapy plus bevacizumab (chemo-bev), were identified; patients who continued osimertinib with these regimens were included. Efficacy outcomes including duration on treatment (DOT) and overall survival (OS) from the start of chemotherapy were assessed. Associations of treatment regimen with outcomes were evaluated using adjusted Cox regression models, using pairwise comparisons between groups.

RESULTS: 104 patients were included: 57 received chemo, 12 received chemo-IO, and 35 received chemo-bev. In adjusted models, patients who received chemo-IO had worse OS than did those who received chemo (hazard ratio (HR) 2.66, 95% CI 1.25-5.65; P= .011) or those who received chemo-bev (HR 2.37, 95% CI 1.09-5.65; P= .030). A statistically significant difference in OS could not be detected in patients who received chemo-bev versus those who received chemo (HR 1.50, 95% CI 0.84-2.69; P= .17).

CONCLUSION: In this retrospective study, giving immunotherapy with platinum doublet chemotherapy after progression on osimertinib was associated with a worse OS compared with platinum doublet chemotherapy alone. Platinum doublet chemotherapy without immunotherapy (with consideration of continuation of osimertinib, in selected cases) is a reasonable choice in this setting, while we await results of clinical trials examining optimal next-line chemotherapy-based regimens in EGFR-mutant lung cancer.

PMID:34887193 | DOI:10.1016/j.cllc.2021.11.001

Wilderness Environ Med. 2021 Dec 6:S1080-6032(21)00196-4. doi: 10.1016/j.wem.2021.10.002. Online ahead of print.

ABSTRACT

INTRODUCTION: Those who work and recreate outdoors experience woodsmoke exposure during fire season. Exercise during woodsmoke exposure harms the cardiovascular system, but the acute physiologic and biochemical responses are understudied. The purpose of this pilot laboratory-based study was to examine the effect of exercise during woodsmoke exposure on acute indicators of cardiovascular function, including heart rate variability (HRV), pulse wave velocity (PWV), blood pressure (BP), augmentation index (AIx), and blood oxidative stress.

METHODS: Ten participants performed 2 moderate-intensity exercise (70% V˙O_2max) trials (clean air 0 μg·m^-3, woodsmoke 250 μg·m^-3) in a crossover design. HRV, PWV, BP, AIx, and blood oxidative stress were measured before, after, and 90 min after exercise for each trial. Blood oxidative stress was quantified through lipid damage (LOOH, 8-ISO), protein damage (3-NT, PC), and antioxidant capacity (TEAC).

RESULTS: A 45-min woodsmoke exposure combined with moderate-intensity exercise did not result in a statistically significant difference in HRV, PWV, BP, AIx, or oxidative stress (P>0.05).

CONCLUSIONS: Despite the known deleterious effects of smoke inhalation, moderate-intensity aerobic exercise while exposed to woodsmoke particulate matter (250 μg·m^-3) did not result in a statistically significant difference in HRV, PWV, or blood oxidative stress in this methodologic context. Although findings do not negate the negative impact of woodsmoke inhalation, additional research approaches are needed to better understand the acute effects of smoke exposure on the cardiovascular system.

PMID:34887190 | DOI:10.1016/j.wem.2021.10.002

J Am Pharm Assoc (2003). 2021 Nov 17:S1544-3191(21)00475-1. doi: 10.1016/j.japh.2021.11.014. Online ahead of print.

ABSTRACT

BACKGROUND: Pharmacists with competency in writing, publishing, and peer review are essential to continue advancing the pharmacy profession, but structured training of these skills may vary.

OBJECTIVE: The authors set out to implement and assess the impact of a structured learning experience into a postgraduate year 1 pharmacy residency training program that provides tangible experience in the processes of scientific writing, publishing, and peer reviewing.

METHODS: A quarterly pharmacy newsletter process was augmented to include an editorial board that consisted of residency trained pharmacists with varying levels of experience in scientific writing, publishing, and peer reviewing. The process was designed to provide a structured writing learning experience, to reinforce important concepts and terminology, and to simulate the process of submitting a manuscript to a peer-reviewed publication. Impact of the learning experience on quality of article submissions was assessed by comparing first quarter and last quarter writing submission scores for residents between 2017 and 2020.

RESULTS: A statistically significant difference was observed in both raw scores (27 vs. 42.5 points out of 50 points possible, P < 0.05) and the proportion of pass or fail when comparing writing submission scores from the first quarter of the learning experience to submission scores from the last quarter (25% passing rate vs. 83% passing rate, P = 0.007).

CONCLUSION: This novel learning experience was successfully integrated into a quarterly pharmacy newsletter and resulted in improved writing scores. This structured writing learning experience can be readily integrated into pharmacy residency training programs, and it provides hands-on training in scientific writing, publishing, and peer review for both residents and preceptors.

PMID:34887188 | DOI:10.1016/j.japh.2021.11.014

J Am Pharm Assoc (2003). 2021 Nov 18:S1544-3191(21)00477-5. doi: 10.1016/j.japh.2021.11.016. Online ahead of print.

ABSTRACT

BACKGROUND: The provision of enhanced services within community-based pharmacy is increasing. However, an opportunity remains to improve efficient documentation of services, and barriers to implementation exist. Electronic care (eCare) planning is the act of using health information technology to submit a pharmacist eCare plan for a patient encounter, similar to a Subjective, Objective, Assessment, Plan note.

OBJECTIVE: The primary objective was to identify barriers and best practices related to documentation of eCare plans within community-based pharmacies participating in 4 Community Pharmacy Enhanced Services Networks (CPESN).

METHODS: One of two 24-question electronic surveys was distributed to pharmacies in CPESN Florida, Georgia, Mississippi, and Ohio. Pharmacies submitting fewer than 10 eCare plans in the previous quarter received a survey to assess barriers to implementation; pharmacies submitting 10 or more eCare plans received a survey to assess best practices for implementation. Surveys remained open for 14 days, with a reminder sent on days 7 and 12. Data were analyzed using descriptive statistics. An independent-samples t test assessed for between-group differences in the overall knowledge.

RESULTS: A total of 63 responses were received (Barriers = 19; Best Practices = 44). Best Practices pharmacies earned a higher overall knowledge score than Barriers pharmacies (9.26 vs. 7.26 out of 13 points, P = 0.001). Frequently reported barriers were staffing resources (n = 11, 57.9%), perceived time commitment (n = 8, 42.1%), and lack of payment (n = 8, 42.1%). Most Best Practices pharmacies agreed or strongly agreed that they involve pharmacists (n = 36, 81.8%) and student pharmacists (n = 33, 75.5%) in eCare planning processes. Common foci of eCare plans by Best Practice pharmacies were medication synchronization (n = 35, 79.5%), drug therapy problems (n = 29, 65.9%), adherence assessment (n = 28, 63.6%).

CONCLUSIONS: A difference in knowledge and perceptions exists between pharmacies who regularly eCare plan and those who do not. Observed trends in knowledge, perceptions, barriers, and best practices should be used to create a training to increase eCare planning quality and consistency.

PMID:34887187 | DOI:10.1016/j.japh.2021.11.016

J Pediatr Urol. 2021 Nov 19:S1477-5131(21)00532-5. doi: 10.1016/j.jpurol.2021.11.009. Online ahead of print.

ABSTRACT

BACKGROUND: Caudal epidural block (CEB) in hypospadias surgery has the benefit of reducing post-operative pain and possibly intra-operative bleeding. Some studies, however, have suggested that this technique may increase the rate of post-operative complications. Considering the uncertainty about the effect of CEB on surgical complications of hypospadias repair, the current study was performed.

OBJECTIVE: The aim of this randomized clinical trial was to compare the complication rates between patients who receive CEB after hypospadias surgery and those who did not.

STUDY DESIGN: This double-blind randomized controlled trial was conducted on boys aged 6-35 months, who underwent hypospadias repair surgery in a university hospital from March 2018 to March 2019. Sixty patients were randomly divided into two groups (group A: 31 and group B: 29). In group B, CEB was performed, using 0.5 mg/kg of 0.125% bupivacaine (Marcaine). Postoperative complications including fistula, meatal stenosis, dehiscence, and occurrence of bleeding were assessed during six months after surgery.

RESULTS: The patients were assessed for possible complications at 24 h, one week, one, three and six months after surgery. No remarkable differences were observed between the patients in the two groups in terms of the frequency of dehiscence, fistula, and meatal stenosis (P > 0.05). Moreover, the difference in complication rates between the patients with proximal and distal hypospadias did not reach statistical significance (P = 0.549).

DISCUSSION: Assessment of complications showed no significant difference between the two study groups in terms of dehiscence, fistula, and meatal stenosis (Clavien type III). In addition, complication rate was not significantly different according to severity of hypospadias between the two groups. Our study had limitations such as short follow up and small sample size, which resulted in insignificant difference in complication rate between proximal and distal hypospadias. These limitations request large studies with long term follow up.

CONCLUSION: The current study showed that the use of caudal block anesthesia in comparison with general anesthesia did not increase surgical complications, which approved CEB protocol as a safe method in hypospadias repair.

PMID:34887183 | DOI:10.1016/j.jpurol.2021.11.009

J Craniomaxillofac Surg. 2021 Dec 4:S1010-5182(21)00262-6. doi: 10.1016/j.jcms.2021.11.015. Online ahead of print.

ABSTRACT

The purpose of this study was to determine the expression patterns of specific desmosomal cadherins (desmogleins [DSG] 1/2/3) in oral squamous cell carcinoma (OSCC), and to examine possible associations with clinicopathological parameters and recurrence rates. Changes in desmosomal cadherin assembly may promote tumor metastasis formation. Patients with surgically treated OSCC with 36-60 months of follow-up (median 46 months) qualified for inclusion in this retrospective cohort study. Demographic, clinical and pathohistological data were collected. DSG-1/2/3 expression patterns were determined by an immunohistochemical approach on tissue microarrays. Descriptive and inferential statistics and survival analyses were computed (p ≤ 0.05). The study sample consisted of 88 patients (female: 38; male: 50; average age: 63.02 ± 17.5 years). DSG-3 overexpression was detected in 45 of 88 specimens. The expression rates for DSG-1 (28/88) and DSG-2 (14/88) were low and inconspicuous. DSG-3 overexpression was significantly associated with poor histologic differentiation (G3, p = 0.001), the presence of cervical node metastasis at primary diagnosis (N+ status, p = 0.001) and early recurrence (p = 0.001). Due to its possible relevance for lymph node metastasis formation and early OSCC recurrence, determination of DSG-3 expression in OSCC specimens may be a valuable tool for treatment planning and post-therapeutic risk assessment.

PMID:34887169 | DOI:10.1016/j.jcms.2021.11.015

Eur J Surg Oncol. 2021 Dec 3:S0748-7983(21)00948-3. doi: 10.1016/j.ejso.2021.12.001. Online ahead of print.

ABSTRACT

BACKGROUND: Surgery for intraductal papillary mucinous neoplasm (IPMN) in older adults requires a careful balance of risk and benefit. We sought to analyze patient outcomes in the older individuals after pancreatic resection for IPMN.

METHODS: Retrospective analysis of a prospectively maintained database was performed for patients 65 years or older undergoing IPMN resection between January 1, 2012 and December 31, 2017. Statistical analysis was performed based on age and Memorial Sloan Kettering Frailty Index (MSKFI) score.

RESULTS: 148 patients underwent resection of an IPMN, including five patients who required two operations for recurrent disease. Median age at surgery was 74 (range, 65-90 years), and 52% were male. Most patients underwent pancreaticoduodenectomy (53%) or distal pancreatectomy/splenectomy (35%). An associated adenocarcinoma was seen on pathology for 56 patients (37%). Median hospital length of stay was 7 days (range, 4-46 days). Grade 3 or higher post-operative complications on the Clavien-Dindo classification scale were seen in 20%. No patient died within 30-days. Patient outcomes were evaluated by age, split at age ≥75 (considered “elderly”), and separately by MSKFI score. No differences in post-operative morbidity or mortality was seen when stratified by age (65 – 74 vs > 75 years) or by MSKFI frailty score.

CONCLUSION: Pancreatic resection can be safely performed in selected patients 65 years and older with low morbidity and mortality. More analysis is needed to determine if MSKFI score is a useful predictor of complications in older individuals.

PMID:34887167 | DOI:10.1016/j.ejso.2021.12.001

Curr Probl Diagn Radiol. 2021 Nov 11:S0363-0188(21)00173-0. doi: 10.1067/j.cpradiol.2021.09.005. Online ahead of print.

ABSTRACT

OBJECTIVE: To help quantify the potential microeconomic impact of patient satisfaction in radiology, we tested the hypothesis that patient volume trends reflect patient satisfaction trends in outpatient magnetic resonance imaging (MRI).

METHODS: Patient visits (N = 39,595) at distinct outpatient MRI sites within a university-affiliated hospital system during a 1-year period were retrospectively analyzed. Individual sites were grouped as having “decreasing,” “stable,” or “increasing” volume using an average quarterly volume change threshold of 5%. Based on Press Ganey outpatient services surveys, changes in satisfaction scores from the baseline quarter were calculated. Mood’s median tests were applied to assess statistical significance of differences in satisfaction score improvements among the three volume trend designations during the 3 post-baseline fiscal quarters.

RESULTS: Quarterly volume was stable at 6 sites, increased at 1 site (by 18%), and decreased at 2 sites (by 20%-24%). There was a statistically significant association between volume trend and net change in satisfaction scores for all 5 domains assessed on the Press Ganey survey: Overall assessment (P < 0.0001), Facilities (P = 0.026), Personal issues (P = 0.013), Registration (P = 0.0004), and Test or treatment (P < 0.0001), with median score changes generally higher at facilities with higher volume trends.

DISCUSSION: It can be inferred that patient satisfaction drives volume in this scenario, whereas the converse relationship of volume adversely affecting satisfaction is not observed. Patient satisfaction and volume at MRI sites are interrelated, and patient experiences or perceptions of quality may influence decisions regarding what imaging sites are preferentially utilized.

PMID:34887134 | DOI:10.1067/j.cpradiol.2021.09.005

Eur Urol. 2021 Dec 6:S0302-2838(21)02194-1. doi: 10.1016/j.eururo.2021.11.019. Online ahead of print.

ABSTRACT

A biopsy-free diagnostic pathway in prostate cancer (PC) is limited by the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI). The improved accuracy of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) raises the question whether this imaging modality can complement mpMRI to safely avoid biopsy prior to radical prostatectomy (RP). In this case series, we report the feasibility of primary RP without prior biopsy based on a high suspicion of significant PC in both mpMRI (Prostate Imaging Reporting and Data System [PI-RADS] score ≥4) and PSMA-PET (PET score ≥4 on a five-point Likert scale and maximum standardized uptake value ≥4.0) in 25 patients. All patients showed International Society of Urological Pathology (ISUP) grade ≥2 PC in postoperative histopathology. We report patient- and lesion-based comparisons with histopathology of the prostate specimen. Results of our case series may trigger the discussion about RP without prior biopsy as a possible option in well-selected patients. Our case series is limited by retrospective design and small sample size. We want to emphasize clearly that this practice should not be regarded as a standard procedure at the moment. Future studies with larger cohorts only inside a prospective, ethically approved study design are necessary to confirm these results.

PMID:34887117 | DOI:10.1016/j.eururo.2021.11.019

Surgery. 2021 Dec 6:S0039-6060(21)00941-7. doi: 10.1016/j.surg.2021.09.021. Online ahead of print.

ABSTRACT

BACKGROUND: Laparoscopic liver resection for hepatic lesions is increasingly performed worldwide. However, parenchyma-sparing laparoscopic liver resection for hepatic lesions in the right posterosuperior segments is very technically demanding. This study aimed to compare postoperative outcomes between patients undergoing laparoscopic liver resection and open liver resection for hepatic lesions in the right posterosuperior segments.

METHODS: In total, 617 patients who underwent liver resection of hepatic lesions in the right posterosuperior segments (segment Ⅶ or Ⅷ) at 8 centers were included in this study. We lessened the impact of confounders through propensity score matching, inverse probability weighting, and double/debiased machine learning estimations.

RESULTS: After matching and weighting, the imbalance between the 2 groups significantly decreased. Compared with open liver resection, laparoscopic liver resection was associated with a lower volume of intraoperative blood loss and incidence of postoperative complications in the matched and weighted cohorts. After surgery, the incidence of pulmonary complication and cardiac disease was lower in the laparoscopic liver resection group than in the open liver resection group in both the matched and weighted cohorts. The odds ratios of laparoscopic liver resection for postoperative complications in the matched and weighted cohorts were 0.49 (95% confidence interval, 0.29-0.83) and 0.40 (95% confidence interval, 0.25%-0.64%), respectively. The double/debiased machine learning risk difference estimator for postoperative complications of laparoscopic liver resection was -19.8% (95% confidence interval, -26.8% to -13.4%).

CONCLUSION: Parenchyma-sparing laparoscopic liver resection for hepatic lesions in the right posterosuperior segments had clinical benefits, including lower volume of intraoperative blood loss and incidence of postoperative complications.

PMID:34887090 | DOI:10.1016/j.surg.2021.09.021