Tag: pubmed

Microsurgery. 2024 May;44(4):e31185. doi: 10.1002/micr.31185.

ABSTRACT

BACKGROUND: Recent CMS billing changes have raised concerns about insurance coverage for deep inferior epigastric perforator (DIEP) flap breast reconstruction. This study compared the costs and utilization of transverse rectus abdominis myocutaneous (TRAM), DIEP, and latissimus dorsi (LD) flaps in breast reconstruction.

METHOD: The study utilized the National Inpatient Sample database to identify female patients who underwent DIEP, TRAM, and LD flap procedures from 2016 to 2019. Key data such as patient demographics, length of stay, complications, and costs (adjusted to 2021 USD) were analyzed, focusing on differences across the flap types.

RESULTS: A total of 17,770 weighted patient encounters were identified, with the median age being 51. The majority underwent DIEP flaps (73.5%), followed by TRAM (14.2%) and LD (12.1%) flaps. The findings revealed that DIEP and TRAM flaps had a similar length of stay (LOS), while LD flaps typically had a shorter LOS. The total hospital charges to costs using cost-to-charge ratio were also comparable between DIEP and TRAM flaps, whereas LD flaps were significantly less expensive. Factors such as income quartile, primary payer of hospitalization, and geographic region significantly influenced flap choice.

CONCLUSION: The study’s results appear to contradict the prevailing notion that TRAM flaps are more cost-effective than DIEP flaps. The total hospital charges to costs using cost-to-charge ratio and hospital stays associated with TRAM and DIEP flaps were found to be similar. These findings suggest that changes in the insurance landscape, which may limit the use of DIEP flaps, could undermine patient autonomy while not necessarily reducing healthcare costs. Such policy shifts could favor less costly options like the LD flap, potentially altering the landscape of microvascular breast reconstruction.

PMID:38716656 | DOI:10.1002/micr.31185

Cancer Control. 2024 Jan-Dec;31:10732748241251712. doi: 10.1177/10732748241251712.

ABSTRACT

INTRODUCTION: Esophageal cancer was the eighth and sixth leading cause of morbidity of all cancers in the world, and the 15th and 12th in Ethiopia, respectively. There is a lack of comprehensive data regarding Ethiopia’s esophageal cancer hotspot, treatment outcome clustering, and other factors.

OBJECTIVE: This scoping review was designed to understand the extent and type of existing evidence regarding spatiotemporal distribution, time to treatment outcome clustering, and determinants of esophageal cancer in Ethiopia up to March 28, 2023.

METHODS: Three-step search strategies were employed for the scoping review from March 15 to 28, 2023. Targeted databases included PubMed/Medline, PubMed Central (PMC), Google Scholar, Hinari, and Cochrane for published studies and different websites for unpublished studies for evidence synthesis. Data were extracted using the Joanna Briggs Institute (JBI) manual format.

RESULTS: Our final analysis comprised 17 (16 quantitative and 1 qualitative) studies. Three studies attempted to depict the country’s temporal distribution, whereas 12 studies showed the spatial distribution of esophageal cancer by proportion. The regional state of Oromia recorded a high percentage of cases. Numerous risk factors linked to the tumor have been identified in 8 investigations. Similarly, 5 studies went into detail regarding the likelihood of survival and the factors that contribute to malignancy, while 2 studies covered the results of disease-related treatments.

CONCLUSIONS: The substantial body of data that underpins this finding supports the fact that esophageal cancer has several risk factors and that its prevalence varies greatly across the country and among regions. Surgery, radiotherapy, or chemotherapy helped the patient live longer. However, no research has investigated which treatment is best for boosting patient survival and survival clustering. Therefore, research with robust models for regional distribution, clustering of time to treatment outcomes, and drivers of esophageal cancer will be needed.

PMID:38716644 | DOI:10.1177/10732748241251712

J Dermatol. 2024 May 8. doi: 10.1111/1346-8138.17253. Online ahead of print.

ABSTRACT

Small plaque psoriasis is the typical form of chronic plaque psoriasis affecting adults in South Korea. The effectiveness of calcipotriol/betamethasone dipropionate (Cal/BD) aerosol foam for large and small psoriasis plaques has not previously been examined. We performed a post hoc analysis of a recent, 4-week observational study of Cal/BD aerosol foam use in routine clinical practice in South Korea. Investigator Global Assessment response ([IGA] 0/1 at week 4), Patient Global Assessment response ([PaGA] 0/1 at week 4), change in Psoriasis Area and Severity Index (PASI), changes in psoriasis symptom scores, change in the Dermatology Life Quality Index (DLQI), and the proportion of patients achieving DLQI ≤5 were analyzed for patients with small (≤5 cm; n = 131) or large (>5 cm; n = 35) baseline plaque size. IGA response rates were similar for patients with small and large plaques (59.5% and 51.4% respectively). Similarly, there was no significant difference between the small and large groups in mean change in PASI (-2.20 vs -3.34), the proportions of patients with DLQI ≤5 (62.3% vs 54.3%) or PaGA 0/1 (29.2% vs 40.0%). Mean improvements in DLQI (-4.04 vs -6.20) and in psoriasis symptoms including itching (-1.50 vs -2.83), sleep loss (-0.67 vs -1.89), dryness (-1.57 vs -2.97), scaling (-1.21 vs -3.57), and redness (-1.17 vs -3.11) were greater in patients with large plaques than those with small plaques. Itching and DLQI differences were not statistically significant after adjustment for baseline characteristics. Stratification by body surface area affected eliminated statistically significant differences between the groups for most outcomes. In conclusion, this analysis suggests that Cal/BD aerosol foam is an effective, well-accepted treatment for adult patients with the small plaques typical of chronic plaque psoriasis in South Korea, as well as for those with large plaques.

PMID:38716641 | DOI:10.1111/1346-8138.17253

Cancer Med. 2024 May;13(9):e7085. doi: 10.1002/cam4.7085.

ABSTRACT

AIMS: To investigate the effect of Self-designed Metabolic Equivalent Exercises (SMEE) on cancer-related fatigue in patients with gastric cancer.

METHODS: 130 patients with gastric cancer admitted to Department of Oncology of a tertiary hospital in Shanghai were enrolled and assessed for eligibility. After excluding 1 patient who declined to participate, 129 eligible patients were randomly assigned into SMEE (n = 65) and control (n = 64) groups. The Revised Piper Fatigue Scale (RPFS) and EORTC QLQ-C30 Quality of Life Scale were used to measure cancer-caused fatigue and quality of life, respectively, in both groups at the first admission and after 3 months.

RESULTS: After excluding patients who did not receive allocated intervention due to medical (n = 3) and personal (n = 2) reasons, those who were lost to follow-up (n = 3), and those who had discontinued intervention (n = 2), 119 patients (64 in the SMEE group and 55 in the control group) were included for analysis. There were no statistically significant differences in the RPFS or QLQ-C30 score between the two groups at baseline. After 3 months, the total RPFS score of the SMEE group was significantly lower than that of the control group (2.86 ± 1.75 vs. 4.65 ± 1.29, p = 0.009), with significant improvements in affective meaning (0.83 ± 0.92 vs. 1.13 ± 0.77, p = 0.044) and sensory (0.70 ± 0.71 vs. 1.00 ± 0.54, p < 0.001) subscales; in the SMEE group, QLQ-C30 scores in somatic (2.00 ± 0.27 vs. 1.31 ± 0.26, p < 0.001), emotional (2.67 ± 0.58 vs. 2.07 ± 0.48, p < 0.001), and social (3.23 ± 0.58 vs. 1.64 ± 0.51, p < 0.001) functioning were significantly higher than those in the control group, with significant improvements in fatigue (p < 0.001), nausea/vomiting (p = 0.014), shortness of breath (p < 0.001), constipation (p < 0.001), and diarrhea (p = 0.001) dimensions.

CONCLUSION: The self-programmed metabolic equivalent manipulation as an exercise intervention could effectively reduce the degree of cancer-caused fatigue and improve quality of life in patients with gastric cancer.

PMID:38716637 | DOI:10.1002/cam4.7085

Urol J. 2024 May 7. doi: 10.22037/uj.v20i.8036. Online ahead of print.

ABSTRACT

PURPOSE: The quantitative objective of the current systematic review was to identify the potential role of urinary microbiota in bladder cancer (BC) carcinogenesis, invasiveness, progression, and metastasis.

MATERIALS AND METHODS: The proposed systematic review was conducted in accordance with critical review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, and the Joanna Briggs Institute (JBI) methodology for systematic reviews. The search strategy aimed to find both published and unpublished studies up to the January 2024. A JBI appraisal checklist was used to assess possible biases.

RESULTS: This systematic review was centered on 27 studies comprising 926 BC patients. Overall, 412 control individuals were compared with BC patients. The most common sampling method was midstream urine collection. Regarding microbial alpha diversity, there was no statistically significant difference between cancerous and healthy samples (n=8), recurrent and not recurrent (n=1), responders versus non-responders(n=1), tumor grades (n=1), and collection methods (n=1). However, five studies reported higher diversity in controls, and five other studies reported, conversely, high levels of alpha diversity in BC patients or recurrent cases. Furthermore, a responder (RE) to treatment and a non-muscle invasive bladder cancer (NMIBC) groups demonstrated significant difference with non-responder (NR) and muscle invasive bladder cancer (MIBC), respectively. In terms of beta-diversity, nine studies reported significant diversity between BC patients and controls, one article demonstrated difference between recurrent and not recurrent patients, a study reported significant difference in RE and NR groups whereas another showed opposite, and others (n=4) did not find any difference between BC, controls, MIBC and NMIBC patients, or between tumor grades. One study reported a difference between the collection method and beta-diversity in males and another reported the difference in females.

CONCLUSION: The included studies demonstrate that the composition of urinary microbiota is altered in patients with BC. However, the differentially enriched genera in the urine of these patients vary between studies, and there is too much heterogeneity across studies to make any reliable and valid conclusions. Furthermore, well-designed research is necessary to assess the role of microbiota in the carcinogenesis and progression of BC.

PMID:38716613 | DOI:10.22037/uj.v20i.8036

Zhonghua Xue Ye Xue Za Zhi. 2024 Mar 14;45(3):233-241. doi: 10.3760/cma.j.cn121090-20230815-00067.

ABSTRACT

Objective: To retrospectively analyze the clinical characteristics and prognosis of 85 newly diagnosed patients with follicular lymphoma (FL), as well as the prognostic value of comprehensive geriatric assessment (CGA) in patients with FL aged ≥ 60 years old. Methods: The clinical data and prognosis of 85 newly diagnosed FL patients admitted from August 2011 to June 2022 were collected. The clinical features, laboratory indicators, therapeutic efficacy, survival and prognostic factors of patients were statistically analyzed, and the prognosis of patients was stratified using various geriatric assessment tools. Results: ① The patients with FL were mostly middle-aged and older, with a median age of 59 (20-87) years, including 41 patients (48.2%) aged ≥60 years. The ratio of male to female was 1∶1.36. Overall, 77.6% of the patients were diagnosed with Ann Arbor stage Ⅲ-Ⅳ, and 17 cases (20.0%) were accompanied by B symptoms. Bone marrow involvement was the most common (34.1%). ②Overall, 71 patients received immunochemotherapy. The overall response rate was 86.6%, and the complete recovery rate was 47.1% of 68 evaluated patients. Disease progression or relapse in the first 2 years was observed in 23.9% of the patient. Overall, 14.1% of the patients died during follow-up. ③Of the 56 patients receiving R-CHOP-like therapies, the 3-year and 5-year progression-free survival (PFS) rates were 85.2% and 72.8%, respectively, and the 3-year and 5-year overall survival (OS) rates were 95.9% and 88.8%, respectively. The univariate analysis showed that age ≥60 years old (HR=3.430, 95% CI 1.256-9.371, P=0.016), B symptoms (HR=5.030, 95% CI 1.903-13.294, P=0.016), Prognostic Nutritional Index (PNI) <45.25 (HR=3.478, 95% CI 1.299-9.310, P=0.013), Follicular Lymphoma International Prognostic Index (FLIPI) high-risk (HR=2.918, 95% CI 1.074-7.928, P=0.036), and PRIMA-prognostic index (PRIMA-PI) high-risk (HR=2.745, 95% CI 1.057-7.129, P=0.038) significantly predicted PFS. Moreover, age ≥60 years old and B symptoms were independent risk factors for PFS. Progression of disease within 24 months (POD24) significantly predicted OS in the univariate analysis. Conclusions: FL is more common among middle-aged and older women. Age, B symptoms, PNI score, FLIPI high-risk, PRIMA-PI high-risk, and POD24 influenced PFS and OS. The CGA can be used for treatment selection and risk prognostication in older patients with FL.

PMID:38716594 | DOI:10.3760/cma.j.cn121090-20230815-00067

Lakartidningen. 2024 May 8;121:23140.

ABSTRACT

Hip and knee arthroplasties are mostly successful procedures; however, patient injuries may occur and should be reported to Löf, the Swedish patient insurance. This study investigated the incidence of patient injuries after primary total hip and knee arthroplasty in the Swedish regions, differences in incidence depending on annual surgical volume, and types of approved injuries. Approved patient injuries were related to the total number of hip and knee arthroplasties registered in the Swedish Arthroplasty Register 2012-2021. The national incidence was 11.4 and 8.1 per 1,000 hip and knee arthroplasties respectively and varied in the regions from 30.4 to 4.9 and 15.4 to 5.4 per 1,000 hip and knee arthroplasties respectively. Orthopedic departments with higher annual volumes of performed arthroplasties had a lower proportion of patient injuries. Infection was the most common patient injury, followed by nerve lesions and mechanical complications. The differences may be due to underreporting and varying quality of care in the regions. A centralization of hip and knee arthroplasties may be beneficial.

PMID:38716590

J Oral Implantol. 2024 May 8. doi: 10.1563/aaid-joi-D-24-00040. Online ahead of print.

ABSTRACT

The present study aims to evaluate the trends of oral implant-related research in design and topics between the range of 2016 to the end of 2022. The electronic search was conducted in MEDLINE via Pubmed. Papers published in Clinical Oral Implant Research, Clinical Implant Dentistry and Related Research, International Journal of Oral Implantology and previously, European Journal of Oral Implantology, International Journal of Oral and Maxillofacial Implants, and Journal of Oral Implantology, Between January 1, 2016, to December 30, 2022, were retrieved. Articles were classified according to their study design and major subjects. The Joinpoint regression model was used to determine changes in the trends of study designs and topics. Statistical significance was defined as a p-value < 0.05. A total of 3,382 articles were analyzed in this study. In the specified period, in vivo, prospective cohort, retrospective case-control, randomized clinical studies, in the design; and prosthetic complications, peri-implant hard tissue studies, in the topic, experienced a significant decreasing pattern in the number of published articles as well as the total number of articles. Case reports and series, retrospective cohort, non-randomized clinical studies, in the design; and outcomes of implant-related treatment plans, immediate implant placement, peri- implantitis, in the topic, experienced a significant decreasing pattern followed by a significant increasing pattern with a turning point between 2017 to 2020. Considering the limitations of this scientific topical trends analysis, it can be concluded that the recent pandemic affected the research path in oral implantology in many ways.

PMID:38716583 | DOI:10.1563/aaid-joi-D-24-00040

Hosp Pediatr. 2024 May 8:e2023007385. doi: 10.1542/hpeds.2023-007385. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Intravenous infusions have the potential to cause significant harm in patients and are associated with a high rate of adverse drug events and medication errors. Infusion pumps with dose error reduction software (DERS) can be used to reduce errors by establishing safe infusion parameters. In 2019, a quality improvement project was initiated with the aim to increase DERS compliance from 46% to 75% at our specialty institution by October 1, 2022.

METHODS: An interdisciplinary group was tasked with improving compliance with DERS by identifying key drivers, including informed staff, engaged staff, and an accurate smart pump library. We used the Model for Improvement framework to guide this improvement project, and Plan-Do-Study-Act (PDSA) cycles were used to plan for interventions. PDSA cycles included drug library updates, education, and unit-level compliance reporting. Weekly average DERS compliance was monitored as the outcome measure, and weekly pump alerts per 100 infusions were monitored as a balancing measure; statistical process control charts were used to monitor measures from 2018 to 2022.

RESULTS: Over the course of 25 months, 8 PDSA cycles resulted in 5 centerline improvements from a baseline mean of 46% to a final mean of 78%. Pump alerts per 100 infusions decreased from 15.9 to 6.4 with the first PDSA cycle and then continued to decrease to 3.9 with subsequent interventions.

CONCLUSIONS: Although features like DERS can help ensure safe medication administration, continuous improvement efforts to increase DERS compliance without increasing alert burden are needed to ensure that benefits of this technology are optimized.

PMID:38716570 | DOI:10.1542/hpeds.2023-007385

J Public Health Dent. 2024 May 8. doi: 10.1111/jphd.12623. Online ahead of print.

ABSTRACT

OBJECTIVES: This pilot study examined the association between food insecurity and edentulism among older adults in Washington State.

METHODS: This study focused on adults aged 50 years and older, who were recruited through seven community-based organizations in Washington State. The exposure variable was food security level (high, marginal, and low/very low food security) assessed using the 10-item U.S. Adult Food Security Survey. The outcome was edentulism, defined as having zero natural teeth. Confounder-adjusted odds ratios (OR) and 95% confidence intervals (CIs) were generated using binary logistic regression models (α = 0.05).

RESULTS: Of the 216 participants, 28.7% (n = 62) had low/very low food security and 7.9% (n = 17) had zero teeth. Older adults with low or very low food security had greater odds of being edentulous compared to those with marginal or high food security, although the difference was not statistically significant (OR: 1.39; 95% CI: 0.46, 4.20; p = 0.56).

CONCLUSIONS: Future research should explore food insecurity-focused interventions aimed at preventing edentulism in older adults in a broader effort to address oral health inequities.

PMID:38716566 | DOI:10.1111/jphd.12623