Acta Med Port. 2024 Sep 2;37(9):668-669. doi: 10.20344/amp.21782. Epub 2024 Sep 2.
NO ABSTRACT
PMID:39226557 | DOI:10.20344/amp.21782
Tag: pubmed
JMIR Form Res. 2024 Sep 3;8:e52120. doi: 10.2196/52120.
ABSTRACT
BACKGROUND: The COVID-19 pandemic sparked a surge of research publications spanning epidemiology, basic science, and clinical science. Thanks to the digital revolution, large data sets are now accessible, which also enables real-time epidemic tracking. However, despite this, academic faculty and their trainees have been struggling to access comprehensive clinical data. To tackle this issue, we have devised a clinical data repository that streamlines research processes and promotes interdisciplinary collaboration.
OBJECTIVE: This study aimed to present an easily accessible up-to-date database that promotes access to local COVID-19 clinical data, thereby increasing efficiency, streamlining, and democratizing the research enterprise. By providing a robust database, a broad range of researchers (faculty and trainees) and clinicians from different areas of medicine are encouraged to explore and collaborate on novel clinically relevant research questions.
METHODS: A research platform, called the Yale Department of Medicine COVID-19 Explorer and Repository (DOM-CovX), was constructed to house cleaned, highly granular, deidentified, and continually updated data from over 18,000 patients hospitalized with COVID-19 from January 2020 to January 2023, across the Yale New Haven Health System. Data across several key domains were extracted including demographics, past medical history, laboratory values during hospitalization, vital signs, medications, imaging, procedures, and outcomes. Given the time-varying nature of several data domains, summary statistics were constructed to limit the computational size of the database and provide a reasonable data file that the broader research community could use for basic statistical analyses. The initiative also included a front-end user interface, the DOM-CovX Explorer, for simple data visualization of aggregate data. The detailed clinical data sets were made available for researchers after a review board process.
RESULTS: As of January 2023, the DOM-CovX Explorer has received 38 requests from different groups of scientists at Yale and the repository has expanded research capability to a diverse group of stakeholders including clinical and research-based faculty and trainees within 15 different surgical and nonsurgical specialties. A dedicated DOM-CovX team guides access and use of the database, which has enhanced interdepartmental collaborations, resulting in the publication of 16 peer-reviewed papers, 2 projects available in preprint servers, and 8 presentations in scientific conferences. Currently, the DOM-CovX Explorer continues to expand and improve its interface. The repository includes up to 3997 variables across 7 different clinical domains, with continued growth in response to researchers’ requests and data availability.
CONCLUSIONS: The DOM-CovX Data Explorer and Repository is a user-friendly tool for analyzing data and accessing a consistently updated, standardized, and large-scale database. Its innovative approach fosters collaboration, diversity of scholarly pursuits, and expands medical education. In addition, it can be applied to other diseases beyond COVID-19.
PMID:39226547 | DOI:10.2196/52120
JMIR Hum Factors. 2024 Sep 3;11:e55852. doi: 10.2196/55852.
ABSTRACT
BACKGROUND: Stroke may lead to various disabilities, and a structured follow-up visit is strongly recommended within a few months after an event. To facilitate this visit, the digital previsit tool “Strokehealth” was developed for patients to fill out in advance. The concept Strokehälsa (or Strokehealth) was initially developed in-house as a Windows application, later incorporated in 1177.se.
OBJECTIVE: The study’s primary objective was to use a patient satisfaction survey to evaluate the digital previsit tool Strokehealth when used before a follow-up visit, with a focus on feasibility and relevance from the perspective of people with stroke. Our secondary objective was to explore the extent to which the previsit tool identified stroke-related health problems.
METHODS: Between November 2020 and June 2021, a web-based survey was sent to patients who were scheduled for a follow-up visit after discharge from a stroke unit and had recently filled in the previsit tool. The survey covered demographic characteristics, internet habits, and satisfaction rated using 5 response options. Descriptive statistics were used to present data from both the previsit tool and the survey. We also compared the characteristics of those who completed the previsit tool and those who did not, using nonparametric statistics. Free-text responses were thematically analyzed.
RESULTS: All patients filling out the previsit tool (80/171; age: median 67, range 32-91 years) were community-dwelling. Most had experienced a mild stroke and reported a median of 2 stroke-related health problems (range 0-8), and they were significantly younger than nonresponders (P<.001). The survey evaluating the previsit tool was completed by 73% (58/80; 39 men). The majority (48/58, 83%) reported using the internet daily. Most respondents (56/58, 97%) were either satisfied (n=15) or very satisfied (n=41) with how well the previsit tool captured their health problems. The highest level of dissatisfaction was related to the response options in Strokehealth (n=5). Based on the free-text answers to the survey, we developed 4 themes. First, Strokehealth was perceived to provide a structure that ensured that issues would be emphasized and considered. Second, user-friendliness and accessibility were viewed as acceptable, although respondents suggested improvements. Third, participants raised awareness about being approached digitally for communication and highlighted the importance of how to be approached. Fourth, their experiences with Strokehealth were influenced by their perceptions of the explanatory texts, the response options, and the possibility of elaborating on their answers in free text.
CONCLUSIONS: People with stroke considered the freely available previsit tool Strokehealth feasible for preparing in advance for a follow-up visit. Despite high satisfaction with how well the tool captured their health problems, participants indicated that additional free-text responses and revised information could enhance usability. Improvements need to be considered in parallel with qualitative data to ensure that the tool meets patient needs.
TRIAL REGISTRATION: Researchweb 275135; https://www.researchweb.org/is/vgr/project/275135.
PMID:39226546 | DOI:10.2196/55852
Clin Orthop Relat Res. 2024 Sep 1;482(9):1642-1655. doi: 10.1097/CORR.0000000000003106. Epub 2024 May 14.
ABSTRACT
BACKGROUND: Spinopelvic stiffness (primarily in the sagittal plane) has been identified as a factor associated with inferior patient-reported outcomes (PROs) and increased dislocation risk after THA. Incorporating preoperative spinopelvic characteristics into surgical planning has been suggested to determine a patient-specific cup orientation that minimizes dislocation risk. Sagittal plane radiographic analysis of static postures indicates that patients exhibit a degree of normalization in their spinopelvic characteristics after THA. It is not yet known whether normalization is also evident during dynamic movement patterns, nor whether it occurs in the coronal and axial planes as well.
QUESTIONS/PURPOSES: (1) Does motion capture analysis of sagittal spinopelvic motion provide evidence of normalization after THA? (2) Do changes in coronal and axial plane motion accompany those in the sagittal plane?
METHODS: Between April 2019 and February 2020, 25 patients agreed to undergo motion capture movement analysis before THA for the treatment of hip osteoarthritis (OA). Of those, 20 underwent the same assessment between 8 and 31 months after THA. Five patients were excluded because of revision surgery (n = 1), contralateral hip OA (n = 1), and technical issues with a force plate during post-THA assessment (n = 3), leaving a cohort total of 15 (median age [IQR] 65 years [10]; seven male and eight female patients). A convenience sample of nine asymptomatic volunteers, who were free of hip and spinal pathology, was also assessed (median age 51 years [34]; four male and five female patients). Although the patients in the control group were younger than those in the patient group, this set a high bar for our threshold of spinopelvic normalization, reducing the possibility of false positive results. Three-dimensional motion capture was performed to measure spinal, pelvic, and hip motion while participants completed three tasks: seated bend and reach, seated trunk rotation, and gait on a level surface. ROM during each task was assessed and compared between pre- and post-THA conditions and between patients and controls. Statistical parametric mapping (SPM) was used to assess the timing of differences in motion during gait, and spatiotemporal gait parameters were also measured.
RESULTS: After THA, patients demonstrated improvements in sagittal spinal (median [IQR] 32° [18°] versus 41° [14°]; difference of medians 9°; p = 0.004), pelvis (25° [21°] versus 30° [8°]; difference of medians 5°; p = 0.02), and hip ROM (21° [18°] versus 27° [10°]; difference of medians 6°; p = 0.02) during seated bend and reach as well in sagittal hip ROM during gait (30° [11°] versus 44° [7°]; difference of medians 14°; p < 0.001) compared with their pre-THA results, and they showed a high degree of normalization overall. These sagittal plane changes were accompanied by post-THA increases in coronal hip ROM (12° [9°] versus 18° [8°]; difference of medians 6°; p = 0.01) during seated trunk rotation, by both coronal (6° [4°] versus 9° [3°]; difference of medians 3°; p = 0.01) and axial (10° [8°] versus 16° [7°]; difference of medians 6°; p = 0.003) spinal ROM, as well as coronal (8° [3°] versus 13° [4°]; difference of medians 5°; p < 0.001) and axial hip ROM (21° [11°] versus 34° [24°]; difference of medians 13°; p = 0.01) during gait compared with before THA. The SPM analysis showed these improvements occurred during the late swing and early stance phases of gait.
CONCLUSION: When restricted preoperatively, spinopelvic characteristics during daily tasks show normalization after THA, concurring with previous radiographic findings in the sagittal plane. Thus, spinopelvic characteristics change dynamically, and incorporating them into surgical planning would require predictive models on post-THA improvements to be of use.
LEVEL OF EVIDENCE: Level II, prognostic study.
PMID:39226524 | DOI:10.1097/CORR.0000000000003106
Neurology. 2024 Oct 8;103(7):e209793. doi: 10.1212/WNL.0000000000209793. Epub 2024 Sep 3.
ABSTRACT
BACKGROUND AND OBJECTIVES: Data on care home admission and survival rates of patients with syndromes associated with frontotemporal lobar degeneration (FTLD) are limited. However, their estimation is essential to plan trials and assess the efficacy of intervention. Population-based registers provide unique samples for this estimate. The aim of this study was to assess care home admission rate, survival rate, and their predictors in incident patients with FTLD-associated syndromes from the European FRONTIERS register-based study.
METHODS: We conducted a prospective longitudinal multinational observational registry study, considering incident patients with FTLD-associated syndromes diagnosed between June 1, 2018, and May 31, 2019, and followed for up to 5 years till May 31, 2023. We enrolled patients fulfilling diagnosis of the behavioral variant frontotemporal dementia (bvFTD), primary progressive aphasia (PPA), progressive supranuclear palsy (PSP) or corticobasal syndrome (CBS), and FTD with motor neuron disease (FTD-MND). Kaplan-Meier analysis and Cox multivariable regression models were used to assess care home admission and survival rates. The survival probability score (SPS) was computed based on independent predictors of survivorship.
RESULTS: A total of 266 incident patients with FTLD were included (mean age ± SD = 66.7 ± 9.0; female = 41.4%). The median care home admission rate was 97 months (95% CIs 86-98) from disease onset and 57 months (95% CIs 56-58) from diagnosis. The median survival was 90 months (95% CIs 77-97) from disease onset and 49 months (95% CIs 44-58) from diagnosis. Survival from diagnosis was shorter in FTD-MND (hazard ratio [HR] 4.59, 95% CIs 2.49-8.76, p < 0.001) and PSP/CBS (HR 1.56, 95% CIs 1.01-2.42, p = 0.044) compared with bvFTD; no differences between PPA and bvFTD were found. The SPS proved high accuracy in predicting 1-year survival probability (area under the receiver operating characteristic curve = 0.789, 95% CIs 0.69-0.87), when defined by age, European area of residency, extrapyramidal symptoms, and MND at diagnosis.
DISCUSSION: In FTLD-associated syndromes, survival rates differ according to clinical features and geography. The SPS was able to predict prognosis at individual patient level with an accuracy of ∼80% and may help to improve patient stratification in clinical trials. Future confirmatory studies considering different populations are needed.
PMID:39226519 | DOI:10.1212/WNL.0000000000209793
J Clin Oncol. 2024 Sep 3:JCO2302510. doi: 10.1200/JCO.23.02510. Online ahead of print.
ABSTRACT
PURPOSE: To investigate the use of radiation with radiosensitizing chemotherapy following repeated transurethral resection (trimodality therapy) as an alternative to radical cystectomy in T1 bladder cancer which has failed Bacillus Calmette-Guerin (BCG).
PATIENTS AND METHODS: Patients with recurrent T1 bladders who had failed BCG and were recommended to undergo cystectomy were treated with trimodality therapy. The primary end point was 3-year freedom from cystectomy. Secondary end points were distant metastasis at 3 and 5 years, local recurrence, disease-specific and overall survival (OS), and safety.
RESULTS: This single-arm phase II study enrolled 37 patients. Efficacy and safety were evaluated in 34 patients after three exclusions. The median follow-up was 5.1 years. The 3-year freedom from cystectomy rate was 88% (lower one-sided 97.5% confidence limit [CI], 72%), meeting the primary study goal. OS at 3 and 5 years was 69% (95% CI, 54 to 85) and 56% (95% CI, 39 to 74), respectively. The distant metastasis rates at 3 and 5 years were 12% (95% CI, 4 to 26) and 19% (95% CI, 7 to 34), respectively. Eight patients died due to urothelial cancer, 12 exhibited local recurrence at 3 years (cumulative incidence: 32%; 95% CI, 17 to 48), 18 experienced grade 3 adverse events, mostly hematological, and one developed grade 4 neutropenia.
CONCLUSION: Trimodality therapy is an effective potential alternative to radical cystectomy for recurrent high-grade T1 urothelial cancer of the bladder. At 3 years, 88% of the patients remained free of cystectomy.
PMID:39226514 | DOI:10.1200/JCO.23.02510
Health Aff (Millwood). 2024 Sep;43(9):1263-1273. doi: 10.1377/hlthaff.2023.01637.
ABSTRACT
Bundled payments are increasingly used globally to move health care delivery in a value-based direction. However, evidence remains scant in key clinical areas. We evaluated bundled payments for maternity care in the Netherlands during the period 2016-18. We used a quasi-experimental difference-in-differences design to measure the association between the bundled payment model and changes in key clinical and economic outcomes. Bundled payments were associated with an increase in outpatient, midwife-led births and a reduction in in-hospital, obstetrician-led births, along with changes in the use of labor inductions and planned versus emergency cesarean deliveries. Total spending on maternity care decreased by US$328 (5 percent) per pregnancy. No changes in maternal or neonatal health outcomes were observed. Several policy lessons emerged. First, bundled payments appeared to help affect providers’ behavior in the maternity care setting. Second, bundled payments seemed to exert heterogeneous effects across participating maternity care networks, as the same financial incentive translated into different changes in clinical practices and outcomes. Third, alternative payment models should be designed with clear goals and definitions of success to guide evaluation and implementation.
PMID:39226512 | DOI:10.1377/hlthaff.2023.01637
Health Aff (Millwood). 2024 Sep;43(9):1209-1218. doi: 10.1377/hlthaff.2024.00230.
ABSTRACT
Value-based care models, such as Medicaid accountable care organizations (ACOs), have the potential to improve access to and quality of care for pregnant and postpartum Medicaid enrollees. We leveraged a natural experiment in Massachusetts to evaluate the effects of Medicaid ACOs on quality-of-care-sensitive measures and care use across the prenatal, delivery, and postpartum periods. Using all-payer claims data on Medicaid-covered live deliveries in Massachusetts, we used a difference-in-differences approach to compare measures before (the first quarter of 2016 through the fourth quarter of 2017) and after (the third quarter of 2018 through the fourth quarter of 2020) Medicaid ACO implementation among ACO and non-ACO patients. After three years of implementation, the Medicaid ACO was associated with statistically significant increases in the probability of a timely postpartum visit, postpartum depression screening, and number of all-cause office visits in the prenatal and postpartum periods, with no changes in severe maternal morbidity, preterm birth, postpartum glucose screening, or prenatal or postpartum emergency department visits. Changes in cesarean deliveries were inconclusive. Results suggest that implementing Medicaid ACOs in the thirty-eight states without them could improve maternal health care outpatient engagement, but alone it may be insufficient to improve maternal health outcomes.
PMID:39226509 | DOI:10.1377/hlthaff.2024.00230
Health Aff (Millwood). 2024 Sep;43(9):1311-1318. doi: 10.1377/hlthaff.2024.00052.
ABSTRACT
In this study of 2022 Medicare fee-for-service claims, we found that female physicians, primary care physicians, psychiatrists, and physicians in nonrural practices delivered relatively higher proportions of visits via telehealth.
PMID:39226507 | DOI:10.1377/hlthaff.2024.00052
Health Aff (Millwood). 2024 Sep;43(9):1244-1253. doi: 10.1377/hlthaff.2023.01547.
ABSTRACT
Legislative policies that criminalize immigrants have a “chilling effect” on public program participation among eligible immigrants. However, little is known about the effect of local enforcement actions by Immigration and Customs Enforcement (ICE). In this study, we linked county-level data on the number of detainer requests (or immigration holds) issued by ICE to individual-level data from the 2011, 2016, and 2019 American Community Surveys. We fit adjusted logistic regression models to assess the association between detainer requests and enrollment in Medicaid and the Supplemental Nutrition Assistance Program (SNAP) among those likely eligible for each program in US-born versus immigrant households. A higher volume of detainer requests was associated with lower enrollment in both Medicaid and SNAP, particularly among adults in households with at least one immigrant relative to US-born households. We observed the most pronounced effects in 2011 and 2019.
PMID:39226506 | DOI:10.1377/hlthaff.2023.01547