Tag: pubmed

Cancer Med. 2024 Dec;13(23):e70436. doi: 10.1002/cam4.70436.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Prior work has demonstrated racial disparities in surgical outcomes for solid organ cancers. We sought to assess the relationship between hospital quality and racial disparities in achievement of textbook outcomes among patients undergoing surgery for prostate, kidney, and bladder cancer.

METHODS: We used 100% national Medicare Provider Analysis and Review files from 2017 to 2020 to assess textbook outcomes in Patients undergoing bladder (i.e., radical cystectomy), kidney (i.e., radical or partial nephrectomy), and prostate (i.e., radical prostatectomy) surgery for genitourinary malignancies. Our exposure was hospital-level quality, assessed by the predicted to expected ratio of achievement of textbook outcomes, agnostic to social and economic determinants of health. Our main outcome was achievement of textbook outcomes in White and Black patients. We defined the textbook outcome as the absence of in-hospital mortality, mortality within 30 days of surgery, readmission within 30 days of discharge, a postoperative complication, and prolonged length of stay. The secondary outcome was percentage of Black and White patients treated at the highest quality hospitals.

RESULTS: As hospital quality increased, disparities in the receipt of textbook outcome for White and Black patients narrowed. For every 0.1 increment increase in the predicted to expected ratio of hospital quality, Black-White disparities in the odds of achieving textbook outcomes decreased by 5.7% (interaction OR: 1.06; 95% CI 1.01-1.11 p = 0.026). Black patients were less likely to be treated at the highest quality hospitals compared to White patients (45.2% vs. 49.5% p = < 0.001%).

CONCLUSIONS: Compared to White patients, Black patients had lower odds of textbook outcomes after surgery for prostate, kidney, and bladder cancer. The racial differences in achieving textbook outcomes were narrowed as hospital quality increased. Black patients were less likely than White patients to be treated at the highest-quality hospitals. Our findings underscore the importance of improved access to high quality care among Black patients.

PMID:39624952 | DOI:10.1002/cam4.70436

Pulmonology. 2025 Dec 31;31(1):2429911. doi: 10.1080/25310429.2024.2429911. Epub 2024 Dec 3.

ABSTRACT

Alpha-1 Antitrypsin Deficiency (AATD) is a co-dominant condition associated with an increased risk of lung and liver disease. Since it is commonly thought that 95% of severe cases of AATD have PI*ZZ genotype, most studies about AATD have been focused on the Z variant. Nevertheless, over 500 single nucleotide variations in the SERPINA1 gene have been identified. We investigated the clinical presentation of subjects with severe AAT deficiency due to rare genotypes of the SERPINA1 gene. We enrolled patients from the Italian Registry for AATD (RIDA1) with the following inclusion criteria: diagnosis of severe AATD; age >18 years; full clinical data available at diagnosis; three years of follow-up respiratory function data. A total of 281 patients were enrolled from the RIDA1 Registry and subdivided into 3 cohorts: PI*ZZ genotype (n = 160), PI*SZ genotype (n = 54), and rare genotypes PI*R (n = 67). We did not observe any statistical differences among the cohorts regarding sex, smoking habits, occupational exposure and age at diagnosis. Patients with severe AATD due to rare genotypes have clinical characteristics and respiratory profiles similar to PI*ZZ subjects, and differed from the PI*SZ patient group. Early and accurate diagnosis of PI*R subjects is therefore important for their appropriate clinical management.

PMID:39624947 | DOI:10.1080/25310429.2024.2429911

Int J Med Robot. 2024 Dec;20(6):e70016. doi: 10.1002/rcs.70016.

ABSTRACT

BACKGROUND: Most patients present at high risk of perioperative pressure injury. Patients may experience severe agony from pressure injuries, which can also result in potentially fatal infections and increase hospital stays and medical expenses. This is a critical issue that requires immediate attention and resolution.

METHODS: From December 2019 to August 2023, 335 patients receiving Da vinci surgery in a grade A tertiary hospital were chosen to serve as the participants, and univariate analysis and patients undergoing Da vinci surgery had their risk factors for pressure injuries screened using logistic regression analysis, and in patients having Da vinci surgery, a pressure injury risk prediction model was developed.

RESULTS: Among 335 patients, 195 patients acquired pressure injuries, and the results of logistic regression analysis showed that age, length of surgery, BMI, and nasogastric tube (NGT) were independent risk factors for pressure injuries (p < 0.05).

CONCLUSIONS: With great risk prediction ability, the risk prediction model for pressure injuries in patients undergoing Da vinci surgery established in this study can be used as an effective assessment tool.

PMID:39624938 | DOI:10.1002/rcs.70016

Clin Transplant. 2024 Dec;38(12):e70047. doi: 10.1111/ctr.70047.

ABSTRACT

INTRODUCTION: Half of all female kidney transplant (KT) recipients are reproductive-aged, though data on reproductive practices and counseling are limited.

METHODS: This cross-sectional survey evaluated patient experiences, practices, and preferences surrounding contraception and pregnancy in female KT patients (listed or post-transplant) ages 14-45 years.

RESULTS: A total of 152/682 eligible participants (22%; 50 pre- and 102 post-KT) completed the survey with 26% unaware at the time of KT that future pregnancy was possible. The majority (72%) of sexually active patients used contraception during the first year post-KT, though 24% exclusively used high failure-rate methods. Less than half (48%) felt their pre-KT reproductive counseling was adequate to guide decision-making, although 63% reported satisfaction with post-KT counseling. Discussions with transplant providers were the single most favored counseling modality at 74%. Misconceptions of intrauterine device safety and efficacy were identified.

CONCLUSION: Reproductive counseling commonly occurred, although information was inadequate for guiding pregnancy and contraceptive decisions in most pre-KT patients. Misconceptions about pregnancy potential and contraceptive efficacy and safety were common, as well as patient reliance on high-failure contraceptive methods. Improving patient knowledge and access to contraception and pregnancy planning is essential for honoring patients’ reproductive wishes while lowering obstetric, graft, and perinatal risks in post-KT pregnancies.

PMID:39624937 | DOI:10.1111/ctr.70047

Clin Transplant. 2024 Dec;38(12):e70048. doi: 10.1111/ctr.70048.

ABSTRACT

Kidney transplant ultrasonography is an important diagnostic tool in the care of transplant recipients. This modality of nonradiation-based imaging allows for precise and expedient reporting of allograft architecture, which can inform clinical decision-making. However, as with any diagnostic tool, overuse may lead to unnecessary interventions and costs on the healthcare system. To better understand the use of ultrasonography in hospitalized kidney transplant recipients and outcomes of subsequent interventions, we conducted a single-center retrospective study at a large transplant program in Ontario, Canada. We noted that over 30% of admissions resulted in a ultrasonographic survey within the first 24 h of presentation; however, most of these did not change clinical management or lead to a subsequent procedural intervention. Using multivariable logistic regression, we identified predictors for receiving an ultrasound, including time from transplantation, elevated serum creatinine and infectious diagnosis. Procedural interventions (e.g., drain or biopsy) resulted from less than 20% of all ultrasound investigations, with patients closer to the time of index transplant or with elevated serum creatinine values more likely to receive an intervention. In conducting a cost analysis, we estimated that approximately $80 000 CAD per year could be saved with more selective decisions on ultrasound requisitions. Overall, our results indicate that despite being an informative tool, the broad use of ultrasonography in the kidney transplant population may not yield significant changes to transplant care.

PMID:39624933 | DOI:10.1111/ctr.70048

Clin Transplant. 2024 Dec;38(12):e70026. doi: 10.1111/ctr.70026.

ABSTRACT

BACKGROUND: Living kidney donor (LKD) candidates of African ancestry are increasingly asked to undergo Apolipoprotein L1 (APOL1) genetic testing during the donor evaluation process to better understand their risk of kidney disease. LKD candidates’ attitudes about using a clinical chatbot on APOL1 remain unknown. This study builds on prior work to culturally adapt the Gia (Genetic Information Assistant) chatbot on APOL1 by assessing donor, recipient, and community member attitudes about the Gia chatbot for enhancing the integration of APOL1 testing into the LKD clinical evaluation workflow.

METHODS: This study involved focus groups and a post-focus group survey in two US cities about the APOL1 Gia chatbot. Qualitative data were analyzed via thematic analysis, and descriptive statistics were used for demographic data.

RESULTS: We conducted 10 focus groups including 54 participants (25 LKDs, 23 community members, and 6 living donor kidney transplant recipients of African ancestry). Five themes emerged: (1) participants supported LKD candidates using the Gia chatbot before the nephrologist clinic visit, (2) participants were interested in undergoing APOL1 testing after using Gia, (3) APOL1 testing costs may influence LKD candidates’ willingness to get tested, (4) patients of African ancestry may hold varying preferences for using chatbots in the healthcare setting, and (5) individual-level barriers may limit the use of Gia in the healthcare setting.

CONCLUSIONS: Individuals of African ancestry were highly receptive to integrating the APOL1 chatbot into LKD candidate clinical evaluation, which bodes well for integrating chatbots into the APOL1 clinical genetic testing process.

PMID:39624929 | DOI:10.1111/ctr.70026

Otolaryngol Head Neck Surg. 2024 Dec 3. doi: 10.1002/ohn.1073. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyse the clinical, radiological, and surgical management of temporal bone aneurysmal bone cysts (ABCs) and identify factors affecting outcomes.

STUDY DESIGN: Ambispective study.

SETTING: A single tertiary care institution.

METHODS: This study reviewed 6 cases of temporal bone ABCs treated between 2017 and 2024. Patient demographics, clinical presentation, imaging characteristics, surgical details, and outcomes were collected. A systematic review of the literature was conducted, adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, to compare institutional cases with published data. Statistical analyses were performed to identify predictors of treatment success and recurrence.

RESULTS: The cohort had a mean age of 27.5 years. Presenting symptoms included scalp swelling, aural fullness, tinnitus, and hearing impairment. Imaging showed expansile lesions with fluid-fluid levels and bone erosion. All patients underwent gross total excision, with a mean intraoperative blood loss of 230.6 ml. One patient experienced temporary grade III facial palsy, which resolved within 3 months. No recurrences were observed during a mean follow-up of 35 months. A pooled analysis of 45 cases from the literature revealed that swelling in the temporal region was the most common presenting feature, and gross total resection was the most frequently employed treatment. Recurrences were rare and typically associated with subtotal resections or advanced-stage tumors.

CONCLUSION: Surgical excision, particularly gross total resection, is the treatment of choice for temporal bone ABCs, with a low recurrence rate. Stage and extent of resection are critical factors in predicting outcomes. This study enhances understanding of the diagnostic and therapeutic approaches for this rare condition.

PMID:39624923 | DOI:10.1002/ohn.1073

Otolaryngol Head Neck Surg. 2024 Dec 3. doi: 10.1002/ohn.1072. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop and validate a patient-reported outcome measure (PROM) to evaluate the quality of life (QoL) among patients with obstructive sleep apnea (OSA).

STUDY DESIGN: A prospective cohort study.

SETTINGS: Tertiary referral center.

METHODS: We developed a 15-item English questionnaire that was administered to 176 adults with OSA and 22 adult controls without symptoms of OSA in a tertiary sleep surgery clinic between June 2021 and December 2021. The internal consistency and test-retest reliability were measured using the Cronbach’s α and the intraclass correlation coefficient, respectively. The 2-sample Wilcoxon rank-sum (Mann-Whitney) test was applied to compare the 2 groups. Convergent validity of the test scores of the questionnaire was compared to previously validated outcome measures and objective sleep study outcomes using the Spearman correlation coefficient.

RESULTS: Of the 198 respondents (176 cases and 22 controls); 71% were men and 29% were women. The internal consistency was excellent with the α of .92 (lower 95% confidence limit of 0.90). All the test-retest correlations were positive, significant, and strong ranging from 0.50 to 0.90. The differences between cases and controls were statistically significant for all the items and for the total score. The total score of the questionnaire with the Epworth Sleepiness Scale and objective OSA measures was moderate to strong.

CONCLUSIONS AND RELEVANCE: The new tool provides a validated PROM to evaluate the QoL among OSA patients specifically, with excellent internal consistency, reasonable test-retest reliability, discriminant validity, and construct validity.

LEVEL OF EVIDENCE: Level 4.

PMID:39624914 | DOI:10.1002/ohn.1072

Otolaryngol Head Neck Surg. 2024 Dec 3. doi: 10.1002/ohn.1056. Online ahead of print.

ABSTRACT

OBJECTIVE: We aim to compare the diagnostic accuracy of the different methodologies used in the detection of cell-free human papillomavirus (HPV) DNA in HPV-associated head and neck squamous cell carcinoma detection using bivariate analysis methods.

DATA SOURCES: Pubmed, Embase, and Scopus were queried using a broad search strategy to search for relevant studies.

REVIEW METHODS: Test characteristics were extracted from 33 studies following literature screening, and underwent analyses utilizing a bivariate approach. Summary statistics were identified for each type of methodology, and forest plots and summary receiver operating characteristic curves were constructed. Bias was estimated using Deek’s Funnel Plot and the QUADAS-2 tool.

RESULTS: In terms of diagnostic accuracy, digital droplet polymerase chain reaction (ddPCR) based testing exhibited the highest diagnostics odds ratio at 138 (59.5, 318), followed closely by next-generation sequencing (NGS) at 120 (39.7, 362), then by polymerase chain reaction (PCR) at 31.4 (14.4, 68.6), and quantitative PCR at 8.74 (4.63, 16.5).

CONCLUSION: NGS and ddPCR are comparable in overall diagnostic accuracy, bringing into question their relative roles in diagnosis and screening. Cost-effective ddPCR assays may serve as useful diagnostic and screening tests in the clinic with their low false positive rates and high sensitivity. However, NGS assays also offer high sensitivity and companion metrics, suggesting they may have a more precise role in disease monitoring. Importantly, assay development and benchmarking need further standardization to improve comparison between assays. Finally, saliva-based testing needs to be further investigated using NGS and ddPCR to further understand its limitations in disease detection and monitoring.

PMID:39624913 | DOI:10.1002/ohn.1056

Iran J Immunol. 2024 Dec 3;21(4). doi: 10.22034/iji.2024.100817.2710. Online ahead of print.

ABSTRACT

BACKGROUND: Clinical features of SARS-CoV-2 infection vary, ranging from asymptomatic cases to pneumonia, and other serious complications. Some populations have been observed to be at higher risk for severe disease and death compared to other ethnical groups.

OBJECTIVE: To evaluate two parameters of the innate immune system, that play a significant role in viral immunity.

METHODS: In samples of peripheral blood from sixteen patients with severe COVID-19, ten with asymptomatic to mild illness, and fifteen healthy subjects, the percentage of NK and NKT cells, the expression of different NK cell receptors and the blood levels of pro-inflammatory cytokines were tested.

RESULTS: We observed that patients with severe COVID-19 showed significantly lower frequencies of both CD56dim and CD56bright NK cells compared to patients with mild illness or healthy controls. Furthermore, patients with severe manifestation of COVID-19 exhibited an aberrant expression of the natural cytotoxicity receptors NKp30, NKp44 and NKp46. Similarly, NK cells from these patients showed statistically significant differences in the expression of various killer immunoglobulin-like receptors (KIRs) in the two main cell subsets (CD56bright, CD56dim) compared to controls or patients with mild disease. Moreover, patients with severe illness displayed decreased frequency of NKT cells (defined as CD3+CD56+) and elevated blood levels of the cytokines IL-6 and IL-8.

CONCLUSION: This study suggests that the abnormal features of NK and NKT cells observed in patients with severe SARS-CoV-2 infection may play an important role in the outcome of this infectious disease in various population groups.

PMID:39624905 | DOI:10.22034/iji.2024.100817.2710