Tag: pubmed

JAMA Dermatol. 2024 Dec 23. doi: 10.1001/jamadermatol.2024.5286. Online ahead of print.

ABSTRACT

IMPORTANCE: Clinical productivity measures may incentivize clinical care to specific patient populations and thus perpetuate inequitable care. Before the 2021 Medicare physician fee schedule changes, outpatient dermatology encounters for patients who were younger, female, and races other than White systematically generated fewer work relative value units (wRVUs).

OBJECTIVE: To examine the association of patient race, age, and sex with wRVUs generated by outpatient dermatology encounters after 2021.

DESIGN, SETTING, AND PARTICIPANTS: This multi-institutional cross-sectional study evaluated demographic and billing data for outpatient dermatology encounters across 3 academic dermatology practices. The study compared wRVUs generated by outpatient general dermatology encounters in 6-month periods before and after the 2021 fee schedule updates (March 1 to August 31, 2019, and March 1 to August 31, 2021). Eligibility required an age of 18 years or older and available age, race, and sex data. Data analysis was performed from September 2022 to March 2024.

MAIN OUTCOMES AND MEASURES: The primary outcome was wRVUs generated per encounter.

RESULTS: This study included 89 656 encounters (47 607 before the 2021 Medicare physician fee schedule update and 42 049 after the update). Across all encounters, the mean (SD) patient age was 56.3 (17.8) years; 55 460 encounters (61.9%) were with female patients and 34 196 (38.1%) were with male patients; and 3457 encounters (3.9%) were with Asian patients, 10 478 (11.7%) with Black patients, 72 894 (81.3%) with White patients, and 2287 (3.2%) with patients of other race or ethnicity (Latino and multiracial). The mean (SD) wRVUs per outpatient dermatology encounter was 1.44 (0.88) before the update and 1.80 (0.99) after (P < .001). After 2021, adjusted analyses demonstrated significantly fewer wRVUs per encounter for female (β, -0.11; 95% CI, -0.13 to -0.10) compared with male patients, and for younger (β, 0.04 [95% CI, 0.04 to 0.05] per 10-year increase in age) compared with older patients. After the update, compared with White patients, visits with Asian patients generated fewer wRVUs (β, -0.12; 95% CI, -0.17 to -0.08) as did visits with Black patients (β, -0.14; 95% CI, -0.17 to -0.11), both statistically significant reductions compared with prior comparisons (P < .001 for both). After 2021, mediation analysis identified that premalignant destructions and biopsies mediated many of the remaining differences in wRVU generation by patient age, race, and sex.

CONCLUSIONS AND RELEVANCE: This study found that after the 2021 Medicare fee schedule updates, there was a persistent, albeit reduced, gap between wRVU productivity in outpatient dermatology visits for Asian and Black compared with White patients. These persisting differences were attributable to skin biopsies and cryotherapy of premalignant lesions.

PMID:39714835 | DOI:10.1001/jamadermatol.2024.5286

JAMA Pediatr. 2024 Dec 23. doi: 10.1001/jamapediatrics.2024.5089. Online ahead of print.

ABSTRACT

IMPORTANCE: Injuries from firearms and motor vehicle crashes (MVCs) are the leading causes of death among US children and youths aged 0 to 19 years. Examining the intersections of age group, sex, race, and ethnicity is essential to focus prevention efforts.

OBJECTIVE: To examine firearm and motor vehicle fatality rates by population subgroups and analyze changes over time.

DESIGN, SETTING, PARTICIPANTS: This cross-sectional study of firearm and MVC fatalities among US children and youths aged 0 to 19 years from the Centers for Disease Control and Prevention Web-Based Injury Statistics and Query Reporting System from 2011 to 2021. Participants included American Indian and Alaska Native; Asian, Hawaiian Native, and Pacific Islander; Black; Hispanic; and White youths. Data analysis was conducted from July 2023 to May 2024.

EXPOSURE: Firearm or MVC fatality.

MAIN OUTCOME MEASURES: Firearm and MVC fatality rates by year and over time, as measured by the Joinpoint regression annual percent change (APC).

RESULTS: From 2011 to 2021 there were 35 684 firearm and 40 735 MVC fatalities among US youths aged 0 to 19 years. For firearm fatalities, there were 21 332 homicides (59.8%), 12 113 suicides (33.9%), 1359 unintentional shootings (3.8%), 277 by legal enforcement (0.8%), and 603 from unknown intents (1.6%). When considering the intersections of age group, sex, race, and ethnicity, for firearm homicides among youths aged 15 to 19 years, the APCs were similar for Black (21.8%) and Hispanic (22.2%) males from 2018 to 2021, although with different peak rates (104.22 per 100 000 individuals and 17.80 per 100 000 individuals, respectively, in 2021). Black females aged 15 to 19 years demonstrated a dramatic APC increase of 40.7% from 2019 to 2021 (peak rate, 14.07 per 100 000 individuals). For firearm suicide in youths aged 10 to 19 years by sex, Black females had the greatest APC increase of 22.0% from 2016 to 2021. For MVC fatalities, the highest APC increase of 24.9% occurred among American Indian and Alaska Native females aged 15 to 19 years from 2018 to 2021. The highest MVC fatality rates occurred in 2021 among American Indian and Alaska Native males (38.16 per 100 000 individuals) and females (29.31 per 100 000 individuals) aged 15 to 19 years.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, US youths aged 0 to 19 years experienced important disparities in firearm and MVC fatality rates and increases over time when considering the intersectionality by age group, sex, race, and ethnicity. These findings suggest that a multipronged strategy focused on individual, community, and policy level approaches for specific high-risk groups for each injury mechanism is necessary to address these leading causes of death in US youths.

PMID:39714814 | DOI:10.1001/jamapediatrics.2024.5089

Ned Tijdschr Geneeskd. 2024 Dec 26;168:D8275.

ABSTRACT

Healthcare research into patient volumes and volume-outcome relations can have far-reaching consequences. By means of a thought experiment, five core elements of valid research into patient volumes are identified: variation in numbers of patients, scalability of capacity, comparability regarding quality of care, comparability regarding groups of patients, and statistical precision. Practical challenges are described for each of these aspects as well as their possible impact on research quality. This is illustrated using the example of volume-outcome relations in the field of pediatric cardiac surgery.

PMID:39714806

Ned Tijdschr Geneeskd. 2024 Dec 31;8:D8402.

ABSTRACT

OBJECTIVE: To evaluate the effect of ferritin-guided donation intervals on haemoglobin (Hb) and ferritin levels, iron deficiency and low Hb deferrals in whole-blood donors.

DESIGN: A cluster-randomized stepped-wedge trial.

METHODS: In 2017-2019, Sanquin gradually implemented ferritin-guided donation intervals. Ferritin levels are measured in new donors and at every fifth donation. Donors with ferritin levels ≤ 30 ng/mL are deferred for 6-12 months. Additionally, we assessed donor return within six months.

RESULTS: In the 36 months following the implementation of the policy, the percentage of donors with iron deficiency, low ferritin, and low Hb decreased. Additionally, Hb and ferritin levels increased significantly compared to the previous policy. In males, odds of return decreased significantly after implementation of the new policy.

CONCLUSION: Ferritin-guided donation intervals effectively improve donors’ iron status, but necessitate additional efforts in donor recruitment and retention.

PMID:39714800

Med Phys. 2024 Dec 23. doi: 10.1002/mp.17590. Online ahead of print.

ABSTRACT

BACKGROUND: Carbon-ion radiotherapy provides steep dose gradients that allow the simultaneous application of high tumor doses as well as the sparing of healthy tissue and radio-sensitive organs. However, even small anatomical changes may have a severe impact on the dose distribution because of the finite range of ion beams.

PURPOSE: An in-vivo monitoring method based on secondary-ion emission could potentially provide feedback about the patient anatomy and thus the treatment quality. This work aims to prove that a clinically relevant anatomical change in an anthropomorphic head phantom may be detected via charged-fragment tracking during a treatment fraction.

METHODS: A clinically representative carbon-ion treatment plan was created for a skull-base tumor in an anthropomorphic head phantom. In order to imitate an inter-fractional anatomical change – for example, through tissue swelling or mucous accumulation – a piece of silicone was inserted into the nasopharynx. Fragment distributions with and without the silicone insert were subsequently acquired with a mini-tracker made of four hybrid silicon pixel detectors. Experimental irradiations were carried out at the Heidelberg Ion Beam Therapy Centre (HIT, Germany). FLUKA Monte Carlo simulations were performed to support the interpretation of the experimental results.

RESULTS: It was found that the silicone causes a significant change in the fragment emission that was clearly distinguishable from statistical fluctuations and setup uncertainties. Two regions of fragment loss were observed upstream and downstream of the silicone with similar amplitude in both the measurement and the simulation. Monte Carlo simulations showed that the observed signature is a consequence of a complex interplay of fragment production, scattering, and absorption.

CONCLUSIONS: Carbon-ion therapy monitoring with charged nuclear fragments was shown to be capable of detecting clinically relevant density changes in an anthropomorphic head phantom under realistic clinic-like conditions. The complexity of the observed signal requires the development of advanced analysis techniques and underscores the importance of Monte Carlo simulations. The findings have strong implications for the ongoing InViMo clinical trial at HIT, which investigates the feasibility of secondary-ion monitoring for skull-base cancer patients.

PMID:39714780 | DOI:10.1002/mp.17590

Cell Oncol (Dordr). 2024 Dec 23. doi: 10.1007/s13402-024-01030-9. Online ahead of print.

ABSTRACT

PURPOSE: Renal cell carcinoma (RCC), exhibiting remarkable heterogeneity, can be highly infiltrated by regulatory T cells (Tregs). However, the relationship between Treg and the heterogeneity of RCC remains to be explored.

METHODS: We acquired single-cell RNA-seq profiles and 537 bulk RNA-seq profiles of TCGA-KIRC cohort. Through clustering, monocle2 pseudotime and prognostic analyses, we identified Treg states-related prognostic genes (TSRPGs), then constructing the RCC Treg states-related prognostic classification (RCC-TSC). We also explored its prognostic significance and multi-omics landmarks. Additionally, we utilized correlation analysis to establish regulatory networks, and predicted candidate inhibitors. More importantly, in Xinhua cohort of 370 patients with kidney neoplasm, we used immunohistochemical (IHC) staining for classification, then employing statistical analyses including Chi-square tests and multivariate Cox proportional hazards regression analysis to explore its clinical relevance.

RESULTS: We defined 44 TSRPGs in four different monocle states, and identified high immune infiltration RCC (HIRC, LAG3+, Mki67+) as the highly exhausted subtype with the worst prognosis in RCC-TSC (p < 0.001). BATF-LAG3-immune cells axis might be its underlying metastasis-related mechanism. Immunotherapy and inhibitors including sunitinib potentially conferred best therapeutic effects for HIRC. Furthermore, we successfully validated HIRC subtype as an independent prognostic factor within the Xinhua cohort (OS, HR = 16.68, 95% CI = 1.88-148.1, p = 0.011; PFS, HR = 4.43, 95% CI = 1.55-12.6, p = 0.005).

CONCLUSION: Through integrated bioinformatics analysis and a large-sample retrospective clinical study, we successfully established RCC-TSC and a diagnostic kit, which could stratify RCC patients with different prognosis and to guide personalized treatment.

PMID:39714755 | DOI:10.1007/s13402-024-01030-9

Tech Coloproctol. 2024 Dec 23;29(1):34. doi: 10.1007/s10151-024-03055-6.

ABSTRACT

BACKGROUND: Reduced-port laparoscopic surgery (RPLS) uses the minimum possible number of ports or small-sized ports in laparoscopic surgery. The combination of RPLS and natural orifice specimen extraction (NOSE) minimizes the procedural damage.

METHODS: A total of 17 patients diagnosed with right colon cancer were included: 5 patients in the RPLS + NOSE group and 12 patients in the conventional laparoscopic surgery (CL) + mini-laparotomy (ML) group. We highlight the key steps of the RPLS + NOSE procedure and compare the clinicopathological characteristics and short-term postoperative outcomes of the two groups.

RESULTS: Compared to CL + ML, RPLS + NOSE was associated with short hospitalization (8.80 ± 1.30 vs 13.75 ± 2.63, p = 0.001), faster first flatus (1.80 ± 0.45 vs 3.4 ± 0.90, p = 0.020) and less postoperative pain on the first day (2.40 ± 0.55 vs 4.25 ± 1.60, p = 0.025). Regarding operation time, intraoperative bleeding, tumor size, proximal and distal margin, number of lymph nodes harvested, number of positive lymph nodes, R0 resection, bowel movements, postoperative complications, Clavien-Dindo classification, Benz’s classification and postoperative pain on day 1, day 3 and day 5, no significant difference was observed.

CONCLUSION: In selected patients, RPLS with D3 lymph node dissection and transvaginal specimen extraction results in fast recovery and is indicated for colon cancer patients.

PMID:39714748 | DOI:10.1007/s10151-024-03055-6

Ophthalmologie. 2024 Dec 23. doi: 10.1007/s00347-024-02154-x. Online ahead of print.

ABSTRACT

BACKGROUND: The proportion of female ophthalmologists in Germany has risen to approximately 50% in recent years, and approximately 66% of medical students are women. This represents a reversal of the past situation with a male predominance. Despite this change, many international studies show that women are still underrepresented at scientific conferences, particularly among invited speakers, chairpersons, and program committees. This study aims to investigate whether these differences in gender representation are also reflected at German ophthalmological congresses and whether the situation has changed in recent years.

METHODS: Data collection covered the years 2013, 2022, and 2023 and included the congresses of the five large German ophthalmological associations: the German Ophthalmological Society (DOG), German Ophthalmic Surgical Society (DOC), German Ophthalmological Academy (AAD), German Society of Cataract and Refractive Surgery (DGII) and the German Retinological Society (RG). Data were collected based on online programs and information provided by the offices and the managing committees. The numbers of female and male speakers and chairpersons were identified, as were the gender distributions of the specific program committees.

RESULTS: Overall, the percentage of female speakers across all years and conferences surveyed averaged 25%, while female chairs averaged 17%. The percentage of females in the program committees ranged from 0% to 17%. There was an increase in the percentage of female speakers over 10 years (2013-2023). For the DOG (p_trend < 0.01) and the DOC (p_trend = 0.01) there was a significant rise, while it was highest at the DOG (37%) and lowest at the DGII (11%). The percentage of female chairs was in general lower than the percentage of female speakers for all conferences (between 11% and 26% in 2023). Only for the DOG was there a statistically significant increase over the 10 years (p_trend < 0.01).

CONCLUSION: The representation of women as speakers and chairpersons at German ophthalmology conferences is low; these continue to be predominantly male dominated. Although there has been an increase in female representation over time, it remains lower than the overall proportion of women in the profession in 2023. Significant differences are observed between the various ophthalmological conferences. Further investigation into the underrepresentation of women at these conferences is necessary, and measures to encourage greater female participation at congresses should be implemented.

PMID:39714740 | DOI:10.1007/s00347-024-02154-x

Arch Orthop Trauma Surg. 2024 Dec 23;145(1):89. doi: 10.1007/s00402-024-05723-6.

ABSTRACT

OBJECTIVES: Distal femur fractures (DFF) are frequently treated surgically with single traditional constructs (STC), such as with a lateral plate or intramedullary nail, although nail-plate combination constructs (NPCC) are gaining attention. The purpose of this study is to compare outcomes between NPCC and STC for surgical fixation of DFF to guide surgeon decision-making.

METHODS: Data Sources: This study is a systematic review and meta-analysis using PubMed, CINAHL, MEDLINE, Web of Science, Science Direct, and SPORTDiscus from database inception until January 10th, 2024.

STUDY SELECTION: Inclusion criteria were comparative studies that examined clinical outcomes and complications for NPCC versus STC for DFF in adult patients.

DATA EXTRACTION: Data included operative time, estimated blood loss (EBL), length of stay (LOS), as well as likelihood of total complications, total unplanned reoperations, and malunion.

DATA SYNTHESIS: Statistical analysis included a random-effects model using unstandardized mean difference or odds ratio (OR).

RESULTS: Five retrospective comparative studies (n = 1,368 patients; mean age: 52.3 ± 8.1 years; 134 patients in the NPCC group) were included. There was no statistically significant difference in operative time (p = 0.696), EBL (p = 0.408), or LOS (p = 0.963) between patients in the NPCC group as compared to patients in the STC group after DFF. Patients in the NPCC group had a statistically significant lower number of total complications (p = 0.009; OR: 0.31; 10.6% versus 16.0%) and total unplanned reoperations (p = 0.027; OR: 0.42; 8.2% versus 14.8%) as compared to patients in the STC group after DFF. However, there was no statistically significant difference in the number of malunion cases between groups (p = 0.130), although the NPCC group had far fewer cases than the STC group (2.9% versus 10.5%).

CONCLUSION: Patients treated with NPCC had significantly fewer cases of total complications and total unplanned reoperations without significant differences in operative time, EBL, or LOS as compared to patients treated with STC for DFF, although these associations are limited by sample size.

LEVEL OF EVIDENCE: Level IV.

PMID:39714731 | DOI:10.1007/s00402-024-05723-6

Pulm Ther. 2024 Dec 23. doi: 10.1007/s41030-024-00281-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Asthma is a complex condition characterized by airway inflammation. Interleukin-6 (IL-6) plays a significant role in asthma pathogenesis through its effects on T cells and its association with pro-inflammatory responses. Both lung and circulating IL-6 levels are elevated in asthma. IL-6 is positively associated with disease severity, frequent exacerbations, and impaired lung function, all of which can be observed clinically. We developed an IL-6 cut-off model to examine the association between high IL-6, race, high body mass index (BMI), metabolic disease, and asthma severity as assessed by reduced lung function.

METHODS: This study utilized the Coronary Artery Risk Development in Young Adults (CARDIA) database, comprised of 5115 adults, to investigate the relationship between IL-6 levels, asthma, race, and metabolic dysfunction. A “healthy” subset of 427 patients was used to compute the IL-6 cut-off. IL-6 levels within detection limits (0.15-12 pg/mL) were analyzed. The IL-6 cut-off was determined using the 95th percentile of log-transformed IL-6 values for lean (BMI < 25) and healthy individuals. Specific cut-offs were established for racial groups. Statistical analyses involved comparing patient characteristics between high and low IL-6 groups, regression analyses, and assessment of factors influencing lung function changes.

RESULTS: Using an IL-6 cut-off of 4.979 pg/mL, the cohort was divided into high and low IL-6 groups. High IL-6 correlated with Black race, higher BMI, hypertension, and markers of metabolic dysfunction, e.g., elevated HbA1c, C-reactive protein (CRP), and reduced lung function. Multivariable analysis linked high IL-6 with male gender, high BMI, Black race, HbA1c, CRP, and inversely with lung function and total cholesterol. Obesity showed a consistent positive association with elevated IL-6, regardless of the presence or absence of asthma. Patients with asthma and high IL-6 were more likely to be Black and showed increased CRP. Lung function was lowest in non-lean, high IL-6 patients with asthma, with similar trends in non-lean (BMI ≥ 25) patients without asthma.

CONCLUSION: This study underscores the significant association between IL-6, asthma, obesity, and metabolic dysfunction. Elevated IL-6 correlates with asthma severity, particularly in individuals with obesity. Future research should explore anti-IL-6 therapies for specific phenotypes, such as obesity-related asthma. These findings advance our understanding of asthma and the role of IL-6 in its pathogenesis.

PMID:39714726 | DOI:10.1007/s41030-024-00281-z