Tag: pubmed

Am J Gastroenterol. 2021 Dec 1;116(Suppl 1):S4. doi: 10.14309/01.ajg.0000798660.28005.68.

ABSTRACT

BACKGROUND: Persons with inflammatory bowel diseases (IBD) endure the uncomfortable symptomatology of the disease, while trying to carry out daily activities. Given that IBD is not physically distinctive, it may be overlooked and lead to discrimination in the workplace and school. We aim to describe work and study experiences from patients with IBD.

METHODS: A questionnaire containing sociodemographic, psychological, and medical inquiries was administered to patients with IBD in a tertiary care clinic. The survey captured past and present employment and scholarly status. Productivity was established by the number of early leaves or absences patients experienced due to disease symptomatology. Qualitative and quantitative data were analyzed using descriptive statistics. The study is approved by the UPR-MSC IRB.

RESULTS: A total of 120 patients, 59 males and 61 females, with a mean age of 27.00 ± 9.71 were recruited. 91 participants had CD, while 29 had UC. 94% of subjects had some form of income. At the time of interview, 83 patients were working. 19% did not tell the employer of their IBD, while 19% felt discriminated at work due to their condition. 38% said the disease has limited their work goals. Of those working, 74 had to leave early or absent themselves due to disease manifestation. In the last year, 39% of patients had absented themselves for 1-2 days, 27% for 3-4 days, 9% for 5-6 days, 4% for 7-8 days, 3% for 9-10 days and 18% for more than 10 days. The mean of absences from work was 4.4 days. Patients with UC were significantly more prone to work absences than patients with CD (P = 0.0243). 69 patients were studying while having the condition. 67% achieved a college or higher degree, while 33% had high school or less. 34% had to drop a course during their school years. Of the 23 patients who experienced withdrawals, 74% had a total withdrawal from school, while 26% had a partial withdrawal at some point. 14% did not inform of their IBD at school, 12% felt discriminated because of their condition and 32% said the disease has limited their educational goals. 87% of those studying had to miss or leave school early due to disease manifestation. In the last year, 24% of patients had absented themselves for 1-2 days, 29% for 3-4 days, 7% for 5-6 days, 7% for 7-8 days, 3% for 9-10 days and 30% for more than 10 days. The mean of absences was 5.6 days. School absences were not significantly different between subjects with CD and UC (P = 0.384). 22% of participants deemed themselves as a person with a disability given their condition, while 8% did not know whether they should consider themselves as such. Perception of disability was not significantly different between patients with CD and UC (P = 0.870).

CONCLUSION: Absenteeism is a significant factor affecting productivity in patients with IBD. Perception of disability may also impact work and study experiences. Raising awareness is essential for patient support in these settings.

PMID:37461935 | DOI:10.14309/01.ajg.0000798660.28005.68

Am J Gastroenterol. 2021 Dec 1;116(Suppl 1):S3-S4. doi: 10.14309/01.ajg.0000798656.34221.7f.

ABSTRACT

BACKGROUND: Up to 80% of patients with Crohn’s disease (CD) undergo intestinal resection at one point. However, the risk of post-operative recurrence (POR) increases with time, with half of these patients developing recurrence at five years after surgery. Treatment with anti-tumor necrosis factor (anti-TNF) agents has been shown to decrease the risk of clinical and endoscopic recurrence post-operatively. This meta-analysis aims to compare the rate of the two mostly commonly used anti-TNF agents (infliximab (IFX) and adalimumab (ADA)) and their efficacy in maintaining clinical and endoscopic remission in CD patients who were treated with adalimumab versus infliximab after surgery.

METHODS: A comprehensive search of Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Scopus was conducted from each database’s inception to May 29th 2021. Comparative studies assessing the efficacy and safety of infliximab and adalimumab for postoperative CD patients were included. Primary outcomes included postoperative clinical and endoscopic remission. Secondary outcome was the risk of adverse events due to anti-TNF agents. Pooled event rates were calculated per person-year of follow-up.

RESULTS: Four studies with total of 361 CD patients were included in the final analysis. Our meta-analysis showed no statistically significant difference in maintaining clinical and endoscopic remission rates between patients treated with infliximab and those with adalimumab (Pooled incidence rate ratio of 0.75 (95% CI 0.43-1.3), and 0.94 (95% CI 0.71-1.2), respectively) (Figure 1A, 2A). There were low to moderate heterogeneities (I2 = 57.1% for clinical remission and I2 = 0% for endoscopic remission). The funnel plot in each analysis indicated no publication bias, which was supported by Begg’s and Egger’s tests (Figure 1B, 2B). There was also no significant difference in the risk of adverse events between the two groups (RR= 0.56, 95% CI 0.068-4.5) (Figure 3).

CONCLUSION: Our meta-analysis demonstrated comparable efficacy of infliximab and adalimumab in maintaining post-operative clinical and endoscopic remission in Crohn’s disease, with similar rates of adverse events. Our meta-analysis was limited by the small number of total studies and patients included and the lack of randomized controlled trials.

PMID:37461934 | DOI:10.14309/01.ajg.0000798656.34221.7f

Am J Gastroenterol. 2021 Dec 1;116(Suppl 1):S3. doi: 10.14309/01.ajg.0000798648.44410.c4.

ABSTRACT

BACKGROUND: Clinical remission can be achieved with exclusive enteral nutrition (EEN) in patients with Crohn’s Disease with different sites of involvement, varying severity, and complications such as abscess and fistula. In the CHARM study, weekly or every other week administration of adalimumab (ADA) did not provide a significant difference in remission rates. Nevertheless, the subgroup analysis showed that in patients with anti-TNF experience, moderate-to-severely active disease, and high CRP values, rates of remission were significantly higher with weekly doses. Our aim was to determine the efficacy of EEN and weekly adalimumab combination in Crohn’s patients with fibroinflammatory stenosis.

METHODS: Seven consecutive patients with newly diagnosed severe disease and fibro-inflammatory stenosis were included in this retrospective study. The PRO-2 score was used to assess clinical remission, the SES-CD score to determine the severity of endoscopic activity, the Nancy score to determine the severity of inflammation in tissue samples, and the MaRIA score to determine changes in magnetic resonance enterography (MRE). Nestle Modulen® (35kcal/kg) was used for twelve weeks as the EEN solution. In addition to the formulation, patients were only allowed to consume water. At the end of the 12th week, the patients gradually switched to a standard diet. Concomitantly initiated ADA was continued at 40 mg weekly after standard loading doses of 160 mg-80 mg-40 mg. The patients were evaluated with clinical and laboratory findings at the 1st, 4th and 8th weeks of the treatment, and also with colonoscopy and MRE at the 12th week.

RESULTS: The difference between mean PRO-2 score (24.7 ± 1.97, 20.1 ± 1.63, 15.3 ± 1.81,11.4 ± 2.15, 5 ± 1.1, p = 0.031), CRP (14.3 ± 4.54, 11.2 ± 3.31, 6.92 ± 2.88, 2.16 ± 1.14, 0.25 ± 0.13, p = 0.022), albumin (2.9 ± 0.21, 3.05 ± 0.33, 3.4 ± 0.29, 4.1 ± 0.45, 4.6 ± 0.27, p = 0.044), hemoglobin (11.38 ± 0.97, 12.65 ± 0.87, 13.41 ± 0.91, 13.89 ± 0.76, 14.44 ± 0.65, p = 0.063), SES-CD score (17.14 ± 4.87, 7.66 ± 5.98, p = 0.014), MaRIA score (21.13 ± 7.42, 9.91 ± 4.55, p = 0.003) and Nancy score (3.71±0.48, 1.71±0.36, p=0.028) were all statistically significant. The stenotic segment endoscopically passed at week 12 in every patient but one, which had minimally invasive surgery (ileoascendostomy) because of ileus that developed at the eighth week of therapy. Of note, the patient who underwent surgery had perianal involvement.

CONCLUSION: Despite the extremely limited number of patients and short-term follow-up results, 12-week EEN and concurrent weekly ADA therapy may be effective in inducing remission in this group of patients. There is a need for large-scale, prospective studies on this subject.

PMID:37461932 | DOI:10.14309/01.ajg.0000798648.44410.c4

Am J Gastroenterol. 2021 Dec 1;116(Suppl 1):S3. doi: 10.14309/01.ajg.0000798644.60076.bb.

ABSTRACT

BACKGROUND: The prevalence of cannabis use has been increasing in the United States in recent years. We examined the prevalence and predictors of cannabis use disorder among IBD hospitalizations and its effect on length of stay.

METHODS: Using the 2017 National Inpatient Sample, cannabis use disorder was identified using ICD-10-CM code F12.xxx in adult IBD patients. Other variables of interest included age, sex, race, Crohn’s disease (vs. ulcerative colitis), region, metropolitan status, zip code household income, primary insurance, and length of stay. Multivariate logistic and Poisson regressions were used in statistical analysis.

RESULTS: Of the 17,857 IBD hospitalizations, 565 (3.1%) had cannabis use disorder. Patients with cannabis use disorder were younger (mean ± standard deviation [years]: 35.1 ± 11.8 vs. 45.6 ± 18.1), less likely female (32.7% vs. 54.1%), more likely African American (24.8% vs. 13.9%), and more likely Crohn’s disease (72.0% vs. 62.2%) (all p < 0.001). There were also significant differences by region, income, and insurance. Multivariate logistic regression confirmed age (odds ratio [95% confidence interval]: 0.964 [0.957, 0.971]), female (0.444 [0.369, 0.531]), African American (1.405 [1.124, 1.750]), and Crohn’s disease (1.363 [1.126, 1.657]) as predictors of cannabis use disorder. There was no association between cannabis use disorder and length of stay, confirmed in multivariate Poisson regression.

CONCLUSION: Young age, male sex, African American race, and Crohn’s disease were positively associated with cannabis use disorder in IBD hospitalizations. There was no effect of cannabis use disorder on length of stay.

PMID:37461931 | DOI:10.14309/01.ajg.0000798644.60076.bb

Am J Gastroenterol. 2021 Dec 1;116(Suppl 1):S2. doi: 10.14309/01.ajg.0000798628.18430.be.

ABSTRACT

BACKGROUND: Anxiety and depression occur in a significant number of patients with inflammatory bowel diseases (IBD). The prevalence of anxiety and / or depression is 13-44.4% in patients with IBD compared to 4.4% among the world population.

OBJECTIVE: To identify the frequency of anxiety and depression in patients with inflammatory bowel diseases in the Moscow Clinical Scientific Center named after A. S. Loginov.

METHODS: A questionnaire was conducted on the Hospital Anxiety and Depression Scale (HADS) questionnaire for 370 patients with moderate to severe UC during the period of exacerbation of the disease.

RESULTS: Of the 370 patients with UC, 283 (76.48%) had clinical and subclinical signs of anxiety and depression. Subclinical depression was noted in 76 (26.8%), clinically pronounced depression – 11 (3.4%), signs of anxiety had higher indicators-subclinical anxiety was found in 172 (60.8%) of the surveyed patients, pronounced clinical anxiety – in 24 (8.4%) patients with UC. Statistically significant correlations of average strength between the indicators of adherence according to the Morisky – Green questionnaire with scores on the HADS scale, both for anxiety and depression (p < 0.001, r – 0.6299) were revealed Among patients with anxiety and depression, the ratio of patients with high adherence to therapy (HAT) and low adherence to therapy (LAT) was 204 (55,1%) 79 (21,4%), accordingly. When comparing the degree of adherence depending on the presence of anxiety and depression, we found that HAT was associated with anxiety and depression in patients with UC (OR = 0.024; 95% CI 0.003-0.186; p < 0.001).

CONCLUSION: The prevalence of anxiety and/or depression is 77% in patients with IBD during an exacerbation in the Moscow Clinical Scientific Center named after A. S. Loginov.

PMID:37461927 | DOI:10.14309/01.ajg.0000798628.18430.be

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Jul 15;37(7):788-795. doi: 10.7507/1002-1892.202303008.

ABSTRACT

OBJECTIVE: To assess the effectiveness of supramalleolar osteotomy (SMOT) as a therapeutic intervention for varus-type ankle arthritis, while also examining the associated risk factors that may contribute to treatment failure.

METHODS: The clinical data of 82 patients (89 feet) diagnosed with varus-type ankle arthritis and treated with SMOT between January 2016 and December 2020 were retrospectively analyzed. The patient cohort consisted of 34 males with 38 feet and 48 females with 51 feet, with the mean age of 54.3 years (range, 43-72 years). The average body mass index was 24.43 kg/m ² (range, 20.43-30.15 kg/m ²). The preoperative tibial anterior surface angle (TAS) ranged from 77.6° to 88.4°, with a mean of 84.4°. The modified Takakura stage was used to classify the severity of the condition, with 9 feet in stage Ⅱ, 41 feet in stage Ⅲa, and 39 feet in stage Ⅲb. Clinical functional assessment was conducted using the Maryland sore, visual analogue scale (VAS) score, and psychological and physical scores in Health Survey 12-item Short From (SF-12). Radiology evaluations include TAS, talar tilt (TT), tibiocrural angle (TC), tibial medial malleolars (TMM), tibiocrural distance (TCD), tibial lateral surface angle (TLS), and hindfoot alignment angle (HAA). The results of clinical failure, functional failure, and radiology failure were statistically analyzed, and the related risk factors were analyzed.

RESULTS: The operation time ranged from 45 to 88 minutes, with an average of 62.2 minutes. No complication such as fractures and neurovascular injuries was found during operation. There were 7 feet of poor healing of the medial incision; 9 pin tract infections occurred in 6 feet using external fixator; there were 20 cases of allograft and 3 cases of autograft with radiographic bone resorption. Except for 1 foot of severe infection treated with bone cement, the remaining 88 feet were primary healing, and the healing area was more than 80%. All patients were followed up 24-82 months, with an average of 50.2 months. Maryland score, VAS score, SF-12 psychological and physiological scores, and TAS, TC, TLS, TCD, TT, TMM, HAA, and Takakura stage were significantly improved at last follow-up ( P<0.05). Postoperative clinical failure occurred in 13 feet, functional failure in 15 feet, and radiology failure in 23 feet. Univariate analysis showed that obesity, TT>10°, and Takakura stage Ⅲb were risk factors for clinical failure, HAA≥15° and Takakura stage Ⅲb were risk factors for functional failure, and TT>10° was risk factor for radiographic failure ( P<0.05). Further logistic regression analysis showed that TT>10°, HAA≥15°, and TT>10° were risk factors for clinical failure, functional failure, and radiographic failure, respectively ( P<0.05).

CONCLUSION: SMOT is effective in the mid- and long-term in the treatment of varus-type ankle arthritis, but it should be used with caution in patients with obesity, severe hindfoot varus, severe talus tilt, and preoperative Takakura stage Ⅲb.

PMID:37460173 | DOI:10.7507/1002-1892.202303008

Br J Sports Med. 2023 Jul 17:bjsports-2023-107200. doi: 10.1136/bjsports-2023-107200. Online ahead of print.

NO ABSTRACT

PMID:37460163 | DOI:10.1136/bjsports-2023-107200

CMAJ. 2023 Jul 17;195(27):E925-E931. doi: 10.1503/cmaj.221802.

ABSTRACT

BACKGROUND: Sensitivity and specificity are characteristics of a diagnostic test and are not expected to change as the prevalence of the target condition changes. We sought to evaluate the association between prevalence and changes in sensitivity and specificity.

METHODS: We retrieved data from meta-analyses of diagnostic test accuracy published in the Cochrane Database of Systematic Reviews (2003-2020). We used mixed-effects random-intercept linear regression models to evaluate the association between prevalence and logit-transformed sensitivity and specificity. The model evaluated all meta-analyses as nested within each systematic review.

RESULTS: We analyzed 6909 diagnostic test accuracy studies from 552 meta-analyses that were included in 92 systematic reviews. For sensitivity, compared with the lowest quartile of prevalence, the second, third and fourth quartiles were associated with significantly higher odds of identifying a true positive case (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.09-1.26; OR 1.32, 95% CI 1.23-1.41; OR 1.47, 95% CI 1.37-1.58; respectively). For specificity, compared with the lowest quartile of prevalence, the second, third and fourth quartiles were associated with significantly lower odds of identifying a true negative case (OR 0.74, 95% CI 0.69-0.80; OR 0.65, 95% CI 0.60-0.70; OR 0.47, 95% CI 0.44-0.51; respectively). Pooled regression coefficients from bivariate models conducted within each meta-analysis showed that prevalence was positively associated with sensitivity and negatively associated with specificity. Findings were consistent across subgroups.

INTERPRETATION: In this large sample of diagnostic studies, higher prevalence was associated with higher estimated sensitivity and lower estimated specificity. Clinicians should consider the implications of disease prevalence and spectrum when interpreting the results from studies of diagnostic test accuracy.

PMID:37460126 | DOI:10.1503/cmaj.221802

J Am Med Dir Assoc. 2023 Jul 14:S1525-8610(23)00554-6. doi: 10.1016/j.jamda.2023.06.007. Online ahead of print.

ABSTRACT

OBJECTIVES: Because of an increasing need to build capacity for end-of-life care, improving access to palliative care is a priority. Where a physician practices (eg, hospital, outpatient clinic, home) directly relates to the type of service provided and the stage of illness at which care is provided. In this study, we describe the physician palliative care specialist workforce and the settings of care within which they practice.

DESIGN: A retrospective cohort.

SETTING AND PARTICIPANTS: All physicians with palliative care billing codes who were practicing between April 1, 2018, and March 31, 2019, in Ontario, Canada.

METHODS: Descriptive statistics of physician billing location and frequency using linked population-based health administrative data.

RESULTS: We identified 8883 physicians who provided palliative care during the study period. Of those, 723 (8.1%) were classified as palliative care specialists (>10% of their billings encounters were palliative care). The majority (57.4%) of palliative care specialists worked in 1 setting more than 90% of their time, across home visits (27.1%), indirect care (22.4%), and office (7.9%). There were 61 of the palliative care specialists practicing in mixed locations who provided home visits, meaning 310 (42.9%) of the palliative care specialists delivered some home-based care.

CONCLUSIONS AND IMPLICATIONS: This research provides a comprehensive description of the current palliative care specialist physician workforce that can support efforts to build capacity for high-quality end-of-life care.

PMID:37460087 | DOI:10.1016/j.jamda.2023.06.007

J Vasc Interv Radiol. 2023 Jul 15:S1051-0443(23)00508-0. doi: 10.1016/j.jvir.2023.07.007. Online ahead of print.

ABSTRACT

PURPOSE: To present the 36-month outcomes of the prospective randomized IN.PACT AV Access Study of participants with obstructive de novo or restenotic native upper extremity arteriovenous dialysis fistula lesions treated with drug-coated balloon (DCB) or standard percutaneous transluminal angioplasty (PTA) following successful high-pressure PTA.

MATERIALS AND METHODS: Participants at 29 international sites were randomized 1:1 IN.PACT AV DCB (n=170): PTA (n=160). Outcomes through 36 months include target lesion and access circuit primary patency (TLPP, ACPP; composites of clinically driven target lesion or access circuit revascularization and/or access circuit thrombosis), number of reinterventions, and adverse events involving the access circuit.

RESULTS: TLPP was 52.1% in the DCB group compared to 36.7% in the PTA group through 24 months and 43.1% in the DCB group compared to 28.6% in the PTA group through 36 months (both log-rank p<0.001). ACPP was 39.4% in the DCB group compared to 25.3% in the PTA group through 24 months and 26.4% in the DCB group compared to 16.6% in the PTA group through 36 months (both log-rank p<0.001). Cumulative incidence of access circuit thrombosis through 36 months was 8.2% in the DCB group compared to 18.3% in the PTA group (log-rank p=0.040). Cumulative incidence of mortality through 36 months was 26.6% in the DCB group compared to 30.8% in the PTA group (log-rank p=0.71).

CONCLUSION: This study demonstrated superior TLPP and ACPP in DCB compared to PTA with no difference in mortality through 3 years. Access circuit thrombosis was statistically significantly higher in the PTA group at 3 years.

PMID:37460061 | DOI:10.1016/j.jvir.2023.07.007