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Implementation of a Preoperative Huddle at a Level 1 Trauma Center

J Patient Saf. 2021 Nov 27. doi: 10.1097/PTS.0000000000000943. Online ahead of print.

ABSTRACT

OBJECTIVE: Medical errors resulting in patient harm still occur at an alarmingly high rate. Surgery is a high-risk area that can frequently result in patient harm if errors occur. There is a need for standardization of communication and processes to decrease errors. We sought to determine whether the implementation of a preoperative huddle at our hospital could standardize communication and decrease medical errors.

METHODS: A unique preoperative huddle was developed and implemented at a level 1 trauma center. We reviewed data before and after the implementation of the preoperative huddle including patient surveys and comments, the percentage of on-time operating room (OR) starts, OR turnover times, and the number of sentinel events.

RESULTS: After huddle implementation, we observed a trend of improvement in our patient survey results on patient's perception that the doctors/nurses explained the procedure understandably after huddle implementation. There was a statistically yet limited clinically significant increase in OR turnover time from 37 to 40 minutes (P < 0.001). There was also an increase in on-time OR starts from 37% to 45% (P < 0.001). We observed a decrease in the number of sentinel events, with only 1 occurring each year since implementation.

CONCLUSIONS: A preoperative huddle was successfully implemented at a level 1 trauma hospital and helped standardize communication without significantly disrupting workflow. To our knowledge, this method of preoperative huddling has not been previously described in the literature.

PMID:35576394 | DOI:10.1097/PTS.0000000000000943

Combat-Related Invasive Fungal Wound Infections

Mil Med. 2022 May 4;187(Supplement_2):34-41. doi: 10.1093/milmed/usab074.

ABSTRACT

INTRODUCTION: During Operation Enduring Freedom in Afghanistan, an outbreak of combat-related invasive fungal wound infections (IFIs) emerged among casualties with dismounted blast trauma and became a priority issue for the Military Health System.

METHODS: In 2011, the Trauma Infectious Disease Outcomes Study (TIDOS) team led the Department of Defense IFI outbreak investigation to describe characteristics of IFIs among combat casualties and provide recommendations related to management of the disease. To support the outbreak investigation, existing IFI definitions and classifications utilized for immunocompromised patients were modified for use in epidemiologic research in a trauma population. Following the conclusion of the outbreak investigation, multiple retrospective analyses using a population of 77 IFI patients (injured during June 2009 to August 2011) were conducted to evaluate IFI epidemiology, wound microbiology, and diagnostics to support refinement of Joint Trauma System (JTS) clinical practice guidelines. Following cessation of combat operations in Afghanistan, the TIDOS database was comprehensively reviewed to identify patients with laboratory evidence of a fungal infection and refine the IFI classification scheme to incorporate timing of laboratory fungal evidence and include categories that denote a high or low level of suspicion for IFI. The refined IFI classification scheme was utilized in a large-scale epidemiologic assessment of casualties injured over a 5.5-year period.

RESULTS: Among 720 combat casualties admitted to participating hospitals (2009-2014) who had histopathology and/or wound cultures collected, 94 (13%) met criteria for an IFI and 61 (8%) were classified as high suspicion of IFI. Risk factors for development of combat-related IFIs include sustaining a dismounted blast injury, experiencing a traumatic transfemoral amputation, and requiring resuscitation with large-volume (>20 units) blood transfusions. Moreover, TIDOS analyses demonstrated the adverse impact of IFIs on wound healing, particularly with order Mucorales. A polymerase chain reaction (PCR)-based assay to identify filamentous fungi and support earlier IFI diagnosis was also assessed using archived formalin-fixed, paraffin-embedded tissue specimens. Although the PCR-based assay had high specificity (99%), there was low sensitivity (63%); however, sensitivity improved to 83% in tissues collected from sites with angioinvasion. Data obtained from the initial IFI outbreak investigation (37 IFI patients) and subsequent TIDOS analyses (77 IFI patients) supported development and refinement of a JTS clinical practice guideline for the management of IFIs in war wounds. Furthermore, a local clinical practice guideline to screen for early tissue-based evidence of IFIs among blast casualties at the Landstuhl Regional Medical Center was critically evaluated through a TIDOS investigation, providing additional clinical practice support. Through a collaboration with the Uniformed Services University Surgical Critical Care Initiative, findings from TIDOS analyses were used to support development of a clinical decision support tool to facilitate early risk stratification.

CONCLUSIONS: Combat-related IFIs are a highly morbid complication following severe blast trauma and remain a threat for future modern warfare. Our findings have supported JTS clinical recommendations, refined IFI classification, and confirmed the utility of PCR-based assays as a complement to histopathology and/or culture to promote early diagnosis. Analyses underway or planned will add to the knowledge base of IFI epidemiology, diagnostics, prevention, and management.

PMID:35512377 | DOI:10.1093/milmed/usab074

Enhancing Addictions Education in Patient Care and Medical Knowledge Competencies for General Psychiatry Residents

Dustin DeMoss, DO - Fri, 04/29/2022 - 05:00

Acad Psychiatry. 2022 Apr 29:1-6. doi: 10.1007/s40596-022-01634-z. Online ahead of print.

NO ABSTRACT

PMID:35486361 | PMC:PMC9053118 | DOI:10.1007/s40596-022-01634-z

Factors Associated with Reducing Disparities in Electronic Personal Heath Records Use Among Non-Hispanic White and Hispanic Adults

Hao Wang, MD - Wed, 04/27/2022 - 05:00

J Racial Ethn Health Disparities. 2022 Apr 27. doi: 10.1007/s40615-022-01307-5. Online ahead of print.

ABSTRACT

OBJECTIVES: Personal health records (PHR) use has improved individuals' health outcomes. The adoption of PHR remains low with documented racial disparities. We aim to determine factors associated with reducing racial and ethnic disparities among Hispanic adults in PHR use.

METHODS: Participants included non-Hispanic White (NHW) and Hispanic adults (age ≥ 18 years) enrolled in Health Information National Trends Survey in 2018 and 2019. We identified PHR use as online medical record access in the last 12 months. We considered three factors (1. accessing mHealth Apps on the phone, 2. having a usual source of care, and 3. electronically communicating (e-communication) with healthcare providers) as facilitating PHR use. Multivariable logistic regressions with replicate weights were analyzed to determine factors associated with racial/ethnic disparities in PHR use after controlling for general characteristics (i.e., sex, age, education, insurance status, and income).

RESULTS: A lower percentage of Hispanics than NHWs used PHR (42.0% vs. 53.5%, P < .001). When adjusted for individual general characteristics, the adjusted odds ratio (AOR) of e-communication with healthcare providers associated with PHR use was 1.49 (1.19-1.86, P < .001), AOR was 2.06 (1.62-2.6, P < .001) on accessing to mHealth App, and 2.60 (1.86-3.63, P < .001) on having a usual source of care. However, the racial difference was not statistically significant after adjusting three factors promoting PHR use (AOR = 0.90, 95% CI = 0.66, 1.22, P = .48).

CONCLUSIONS: Ethnic disparities were reduced when PHR use was facilitated by having a usual source of care, active e-communication, and having access to mHealth apps. Interventions focusing on these three factors may potentially reduce racial/ethnic disparities.

PMID:35476224 | DOI:10.1007/s40615-022-01307-5

Factors Associated with Reducing Disparities in Electronic Personal Heath Records Use Among Non-Hispanic White and Hispanic Adults

J Racial Ethn Health Disparities. 2022 Apr 27. doi: 10.1007/s40615-022-01307-5. Online ahead of print.

ABSTRACT

OBJECTIVES: Personal health records (PHR) use has improved individuals' health outcomes. The adoption of PHR remains low with documented racial disparities. We aim to determine factors associated with reducing racial and ethnic disparities among Hispanic adults in PHR use.

METHODS: Participants included non-Hispanic White (NHW) and Hispanic adults (age ≥ 18 years) enrolled in Health Information National Trends Survey in 2018 and 2019. We identified PHR use as online medical record access in the last 12 months. We considered three factors (1. accessing mHealth Apps on the phone, 2. having a usual source of care, and 3. electronically communicating (e-communication) with healthcare providers) as facilitating PHR use. Multivariable logistic regressions with replicate weights were analyzed to determine factors associated with racial/ethnic disparities in PHR use after controlling for general characteristics (i.e., sex, age, education, insurance status, and income).

RESULTS: A lower percentage of Hispanics than NHWs used PHR (42.0% vs. 53.5%, P < .001). When adjusted for individual general characteristics, the adjusted odds ratio (AOR) of e-communication with healthcare providers associated with PHR use was 1.49 (1.19-1.86, P < .001), AOR was 2.06 (1.62-2.6, P < .001) on accessing to mHealth App, and 2.60 (1.86-3.63, P < .001) on having a usual source of care. However, the racial difference was not statistically significant after adjusting three factors promoting PHR use (AOR = 0.90, 95% CI = 0.66, 1.22, P = .48).

CONCLUSIONS: Ethnic disparities were reduced when PHR use was facilitated by having a usual source of care, active e-communication, and having access to mHealth apps. Interventions focusing on these three factors may potentially reduce racial/ethnic disparities.

PMID:35476224 | DOI:10.1007/s40615-022-01307-5

The impact of COVID-19 on incidence and outcomes from out-of-hospital cardiac arrest (OHCA) in Texas

Veer Vithalani, MD - Mon, 04/25/2022 - 05:00

Am J Emerg Med. 2022 Apr 13;57:1-5. doi: 10.1016/j.ajem.2022.04.006. Online ahead of print.

ABSTRACT

INTRODUCTION: Emerging research demonstrates lower rates of bystander cardiopulmonary resuscitation (BCPR), public AED (PAD), worse outcomes, and higher incidence of OHCA during the COVID-19 pandemic. We aim to characterize the incidence of OHCA during the early pandemic period and the subsequent long-term period while describing changes in OHCA outcomes and survival.

METHODS: We analyzed adult OHCAs in Texas from the Cardiac Arrest Registry to Enhance Survival (CARES) during March 11-December 31 of 2019 and 2020. We stratified cases into pre-COVID-19 and COVID-19 periods. Our prehospital outcomes were bystander cardiopulmonary resuscitation (BCPR), public AED use (PAD), sustained ROSC, and prehospital termination of resuscitation (TOR). Our hospital survival outcomes were survival to hospital admission, survival to hospital discharge, good neurological outcomes (CPC Score of 1 or 2) and Utstein bystander survival. We created a mixed effects logistic regression model analyzing the association between the pandemic on outcomes, using EMS agency as the random intercept.

RESULTS: There were 3619 OHCAs (45.0% of overall study population) in 2019 compared to 4418 (55.0% of overall study population) in 2020. Rates of BCPR (46.2% in 2019 to 42.2% in 2020, P < 0.01) and PAD (13.0% to 7.3%, p < 0.01) decreased. Patient survival to hospital admission decreased from 27.2% in 2019 to 21.0% in 2020 (p < 0.01) and survival to hospital discharge decreased from 10.0% in 2019 to 7.4% in 2020 (p < 0.01). OHCA patients were less likely to receive PAD (aOR = 0.5, 95% CI [0.4, 0.8]) and the odds of field termination increased (aOR = 1.5, 95% CI [1.4, 1.7]).

CONCLUSIONS: Our study adds state-wide evidence to the national phenomenon of long-term increased OHCA incidence during COVID-19, worsening rates of BCPR, PAD use and survival outcomes.

PMID:35468504 | PMC:PMC9005367 | DOI:10.1016/j.ajem.2022.04.006

Resuscitative Endovascular Balloon Occlusion of the Aorta in Penetrating Trauma

J Am Coll Surg. 2022 May 1;234(5):872-880. doi: 10.1097/XCS.0000000000000136.

ABSTRACT

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) achieves temporary hemorrhage control via aortic occlusion. Existing REBOA literature focuses on blunt trauma without a clearly defined role in penetrating trauma. This study compared clinical/injury data and outcomes after REBOA in penetrating vs blunt trauma.

STUDY DESIGN: All patients in the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) database, an observational American Association for the Surgery of Trauma dataset of trauma patients requiring aortic occlusion, who underwent REBOA were included (January 2014 through February 2021). Study groups were defined by mechanism: penetrating vs blunt. Subgroup analysis was performed of patients arriving with vital signs. Univariable/multivariable analyses compared injuries and outcomes.

RESULTS: Seven hundred fifty-nine patients underwent REBOA: 152 (20%) penetrating and 607 (80%) blunt. Patients undergoing penetrating REBOA were less severely injured (injury severity score 25 vs 34; p < 0.001). The most common hemorrhage source was abdominal in penetrating REBOA (79%) and pelvic in blunt REBOA (31%; p = 0.002). Penetrating REBOA was more likely to occur in the operating room (36% vs 17%) and less likely in the emergency department (63% vs 81%; p < 0.001). Penetrating REBOA used more zone I balloon deployment (76% vs 64%) and less zone III (19% vs 34%; p = 0.001). Improved or stabilized hemodynamics were less frequent after penetrating REBOA (41% vs 62%, p < 0.001; 23% vs 41%, p < 0.001). On subgroup analysis of patients arriving alive, improvement or stabilization in hemodynamics was similar between groups (87% vs 86%, p = 0.388; 77% vs 72%, p = 0.273). Penetrating REBOA was not independently associated with mortality (odds ratio 1.253; p = 0.776).

CONCLUSIONS: Despite lower injury severity, REBOA was significantly less likely to improve or stabilize hemodynamics after penetrating trauma. Among patients arriving alive, however, outcomes were comparable, suggesting that penetrating REBOA may be most beneficial among patients with vital signs. Because hemorrhage source, catheter insertion setting, and deployment zone varied significantly between groups, existing blunt REBOA data may not be appropriately extrapolated to penetrating trauma. Further study of REBOA as a means of aortic occlusion in penetrating trauma is needed.

PMID:35426399 | DOI:10.1097/XCS.0000000000000136

Attracting Medical Students to Family Medicine: An Historical View

Richard Young, MD - Thu, 04/14/2022 - 05:00

Fam Med. 2022 Apr;54(4):290-293. doi: 10.22454/FamMed.2022.279855.

ABSTRACT

BACKGROUND AND OBJECTIVES: In 2018, the 25 x 2030 Collaborative was created. Its goal is to "increase the proportion of US medical school graduates who choose family medicine (FM) to 25% by 2030." The purpose of this study was to take a deeper look at the history of medical student interest in FM from the earliest data to the present, both after the match and those who are FM interns after July 1.

METHODS: We used publicly available match data, primarily from the National Resident Matching Program website, a series of articles published for nearly 30 years in Family Medicine on match results, and the American Academy of Family Physicians website.

RESULTS: The total number of FM residents is growing (4,493 matched in 2021). After the managed care era in the mid-1990s, there was a collapse in interest among allopathic graduates that bottomed out at 6.8% graduates matching in FM by 2009; this rate has only slowly increased to 8.1% in 2021. Interest has been essentially flat for the last 10 years, and is lower than the percentage match rate prior to the managed care era (9.9% to 14.0%). There was more variability among osteopathic students, but interest has never been greater than 23%. Including the allopathic and osteopathic students who join FM residencies after the match does not appreciably alter these results.

CONCLUSIONS: The 25 x 30 Collaborative will likely fail to reach its goal.

PMID:35421244 | DOI:10.22454/FamMed.2022.279855

The impact of Loa loa microfilaraemia on research subject retention during a whole sporozoite malaria vaccine trial in Equatorial Guinea

Trans R Soc Trop Med Hyg. 2022 Apr 8:trac019. doi: 10.1093/trstmh/trac019. Online ahead of print.

ABSTRACT

Loa loa microfilariae were found on thick blood smears (TBSs) from 8 of 300 (2.7%) residents of Bioko Island, Equatorial Guinea, during a Plasmodium falciparum sporozoite malaria vaccine clinical trial. Only one subject was found to have microfilaraemia on his first exam; parasites were not discovered in the other seven until subsequent TBSs were performed, at times many weeks into the study. All infected individuals were asymptomatic, and were offered treatment with diethylcarbamazine, per national guidelines. L. loa microfilaraemia complicated the enrolment or continued participation of these eight trial subjects, and only one was able to complete all study procedures. If ruling out loiasis is deemed to be important during clinical trials, tests that are more sensitive than TBSs should be performed.

PMID:35394038 | DOI:10.1093/trstmh/trac019

Predicting breast cancer risk in a racially diverse, community-based sample of potentially high-risk women

Cancer Med. 2022 Apr 6. doi: 10.1002/cam4.4721. Online ahead of print.

ABSTRACT

BACKGROUND: Identifying women with high risk of breast cancer is necessary to study high-risk experiences and deliver risk-management care. Risk prediction models estimate individuals' lifetime risk but have rarely been applied in community-based settings among women not yet receiving specialized care. Therefore, we aimed: (1) to apply three breast cancer risk prediction models (i.e., Gail, Claus, and IBIS) to a racially diverse, community-based sample of women, and (2) to assess risk prediction estimates using survey data.

METHODS: An online survey was administered to women who were determined by a screening instrument to have potentially high risk for breast cancer. Risk prediction models were applied using their self-reported family and medical history information. Inclusion in the high-risk subsample required ≥20% lifetime risk per ≥1 model. Descriptive statistics were used to compare the proportions of women identified as high risk by each model.

RESULTS: N = 1053 women were initially eligible and completed the survey. All women, except one, self-reported the information necessary to run at least one model; 90% had sufficient information for >1 model. The high-risk subsample included 717 women, of which 75% were identified by one model only; 96% were identified by IBIS, 3% by Claus, <1% by Gail. In the high-risk subsample, 20% were identified by two models and 3% by all three models.

CONCLUSIONS: Assessing breast cancer risk using self-reported data in a community-based sample was feasible. Different models identify substantially different groups of women who may be at high risk for breast cancer; use of multiple models may be beneficial for research and clinical care.

PMID:35388639 | DOI:10.1002/cam4.4721

Validation of a simplified comorbidity evaluation predicting clinical outcomes among patients with coronavirus disease 2019 - A multicenter retrospective observation study

James d'Etienne, MD - Sat, 04/02/2022 - 05:00

Am J Emerg Med. 2022 Mar 10;56:57-62. doi: 10.1016/j.ajem.2022.03.011. Online ahead of print.

ABSTRACT

OBJECTIVES: We compared and validated the performance accuracy of simplified comorbidity evaluation compared to the Charlson Comorbidity Index (CCI) predicting COVID-19 severity. In addition, we also determined whether risk prediction of COVID-19 severity changed during different COVID-19 pandemic outbreaks.

METHODS: We enrolled all patients whose SARS-CoV-2 PCR tests were performed at six different hospital Emergency Departments in 2020. Patients were divided into three groups based on the various COVID-19 outbreaks in the US (first wave: March-May 2020, second wave: June-September 2020, and third wave: October-December 2020). A simplified comorbidity evaluation was used as an independent risk factor to predict clinical outcomes using multivariate logistic regressions.

RESULTS: A total of 22,248 patients were included, for which 7023 (32%) patients tested COVID-19 positive. Higher percentages of COVID-19 patients with more than three chronic conditions had worse clinical outcomes (i.e., hospital and intensive care unit admissions, receiving invasive mechanical ventilations, and in-hospital mortality) during all three COVID-19 outbreak waves.

CONCLUSIONS: This simplified comorbidity evaluation was validated to be associated with COVID clinical outcomes. Such evaluation did not perform worse when compared with CCI to predict in-hospital mortality.

PMID:35366439 | PMC:PMC8907112 | DOI:10.1016/j.ajem.2022.03.011

Validation of a simplified comorbidity evaluation predicting clinical outcomes among patients with coronavirus disease 2019 - A multicenter retrospective observation study

Hao Wang, MD - Sat, 04/02/2022 - 05:00

Am J Emerg Med. 2022 Mar 10;56:57-62. doi: 10.1016/j.ajem.2022.03.011. Online ahead of print.

ABSTRACT

OBJECTIVES: We compared and validated the performance accuracy of simplified comorbidity evaluation compared to the Charlson Comorbidity Index (CCI) predicting COVID-19 severity. In addition, we also determined whether risk prediction of COVID-19 severity changed during different COVID-19 pandemic outbreaks.

METHODS: We enrolled all patients whose SARS-CoV-2 PCR tests were performed at six different hospital Emergency Departments in 2020. Patients were divided into three groups based on the various COVID-19 outbreaks in the US (first wave: March-May 2020, second wave: June-September 2020, and third wave: October-December 2020). A simplified comorbidity evaluation was used as an independent risk factor to predict clinical outcomes using multivariate logistic regressions.

RESULTS: A total of 22,248 patients were included, for which 7023 (32%) patients tested COVID-19 positive. Higher percentages of COVID-19 patients with more than three chronic conditions had worse clinical outcomes (i.e., hospital and intensive care unit admissions, receiving invasive mechanical ventilations, and in-hospital mortality) during all three COVID-19 outbreak waves.

CONCLUSIONS: This simplified comorbidity evaluation was validated to be associated with COVID clinical outcomes. Such evaluation did not perform worse when compared with CCI to predict in-hospital mortality.

PMID:35366439 | PMC:PMC8907112 | DOI:10.1016/j.ajem.2022.03.011

Validation of a simplified comorbidity evaluation predicting clinical outcomes among patients with coronavirus disease 2019 - A multicenter retrospective observation study

Chet Schrader, MD - Sat, 04/02/2022 - 05:00

Am J Emerg Med. 2022 Mar 10;56:57-62. doi: 10.1016/j.ajem.2022.03.011. Online ahead of print.

ABSTRACT

OBJECTIVES: We compared and validated the performance accuracy of simplified comorbidity evaluation compared to the Charlson Comorbidity Index (CCI) predicting COVID-19 severity. In addition, we also determined whether risk prediction of COVID-19 severity changed during different COVID-19 pandemic outbreaks.

METHODS: We enrolled all patients whose SARS-CoV-2 PCR tests were performed at six different hospital Emergency Departments in 2020. Patients were divided into three groups based on the various COVID-19 outbreaks in the US (first wave: March-May 2020, second wave: June-September 2020, and third wave: October-December 2020). A simplified comorbidity evaluation was used as an independent risk factor to predict clinical outcomes using multivariate logistic regressions.

RESULTS: A total of 22,248 patients were included, for which 7023 (32%) patients tested COVID-19 positive. Higher percentages of COVID-19 patients with more than three chronic conditions had worse clinical outcomes (i.e., hospital and intensive care unit admissions, receiving invasive mechanical ventilations, and in-hospital mortality) during all three COVID-19 outbreak waves.

CONCLUSIONS: This simplified comorbidity evaluation was validated to be associated with COVID clinical outcomes. Such evaluation did not perform worse when compared with CCI to predict in-hospital mortality.

PMID:35366439 | PMC:PMC8907112 | DOI:10.1016/j.ajem.2022.03.011

Validation of a simplified comorbidity evaluation predicting clinical outcomes among patients with coronavirus disease 2019 - A multicenter retrospective observation study

Am J Emerg Med. 2022 Mar 10;56:57-62. doi: 10.1016/j.ajem.2022.03.011. Online ahead of print.

ABSTRACT

OBJECTIVES: We compared and validated the performance accuracy of simplified comorbidity evaluation compared to the Charlson Comorbidity Index (CCI) predicting COVID-19 severity. In addition, we also determined whether risk prediction of COVID-19 severity changed during different COVID-19 pandemic outbreaks.

METHODS: We enrolled all patients whose SARS-CoV-2 PCR tests were performed at six different hospital Emergency Departments in 2020. Patients were divided into three groups based on the various COVID-19 outbreaks in the US (first wave: March-May 2020, second wave: June-September 2020, and third wave: October-December 2020). A simplified comorbidity evaluation was used as an independent risk factor to predict clinical outcomes using multivariate logistic regressions.

RESULTS: A total of 22,248 patients were included, for which 7023 (32%) patients tested COVID-19 positive. Higher percentages of COVID-19 patients with more than three chronic conditions had worse clinical outcomes (i.e., hospital and intensive care unit admissions, receiving invasive mechanical ventilations, and in-hospital mortality) during all three COVID-19 outbreak waves.

CONCLUSIONS: This simplified comorbidity evaluation was validated to be associated with COVID clinical outcomes. Such evaluation did not perform worse when compared with CCI to predict in-hospital mortality.

PMID:35366439 | DOI:10.1016/j.ajem.2022.03.011

Performance status (PS) as a predictor of poor response to immune checkpoint inhibitors (ICI) in recurrent/metastatic head and neck cancer (RMHNSCC) patients

Cancer Med. 2022 Mar 29. doi: 10.1002/cam4.4722. Online ahead of print.

ABSTRACT

BACKGROUND: Anti-PD1 checkpoint inhibitors (ICI) represent an established standard-of-care for patients with recurrent/metastatic head and neck squamous cell carcinoma (RMHNSCC). Landmark studies excluded patients with ECOG performance status (PS) ≥2; the benefit of ICI in this population is therefore unknown.

METHODS: We retrospectively reviewed RMHNSCC patients who received 1+ dose of ICI at our institution between 2013 and 2019. Demographic and clinical data were obtained; the latter included objective response (ORR), toxicity, and any unplanned hospitalization (UH). Associations were explored using uni- and multivariate analysis. Overall survival (OS) was estimated using a Cox proportional hazards model; ORR, toxicity, and UH were evaluated with logistic regression.

RESULTS: Of the 152 patients, 29 (19%) had an ECOG PS ≥2. Sixty-six (44%) experienced toxicity; 54 (36%) had a UH. A multivariate model for OS containing PS, smoking status, and HPV status demonstrated a strong association between ECOG ≥2 and shorter OS (p < 0.001; HR = 3.30, CI = 2.01-5.41). An association between OS and former (vs. never) smoking was also seen (p < 0.001; HR = 2.17, CI = 1.41-3.35); current smoking did not reach statistical significance. On univariate analysis, poor PS was associated with inferior ORR (p = 0.03; OR = 0.25, CI = 0.06-0.77) and increased UH (p = 0.04; OR = 2.43, CI = 1.05-5.71). There was no significant association between toxicity and any patient characteristic.

CONCLUSIONS: We observed inferior OS, ORR, and rates of UH among ICI-treated RMHNSCC patients with ECOG 2/3. Our findings help frame discussion of therapeutic options in this poor-risk population.

PMID:35349227 | DOI:10.1002/cam4.4722

Using HEART2 score to risk stratify chest pain patients in the Emergency Department: an observational study

Hao Wang, MD - Sat, 03/05/2022 - 05:00

BMC Cardiovasc Disord. 2022 Mar 4;22(1):79. doi: 10.1186/s12872-022-02528-6.

ABSTRACT

BACKGROUND: A significant number of chest pain patients had previous cardiac imaging tests (CIT) performed before being presented to the Emergency Department (ED). The HEART (history, electrocardiogram, age, risk factors, and troponin) score has been used to risk-stratify chest pain patients in the ED, but not particularly for patients with CIT performed. We aim to modify the current HEART score with the addition of most recent CIT findings (referred to as HEART2 score), to predict a 30-day major adverse cardiac event (MACE) among ED chest pain patients, compare the performance accuracy of using HEART versus HEART2 score for 30-day MACE outcome predictions, and further determine the value of HEART2 in a subset group of ED chest pain patients (i.e., ones with previous CIT).

METHODS: This is a single-center observational study. We included chest pain patients with HEART scores calculated during their index ED visits. A modified HEART2 score was developed with the addition of CIT findings as one of the HEART2 components. Patients were divided into three groups, including low (≤ 3), moderate (4-6), and high-risk HEART/HEART2 scores (≥ 7). MACE occurrence of a patient with different risks of HEART and HEART2 scores and overall performance accuracy of HEART versus HEART2 score predicting MACE outcomes were compared.

RESULTS: We included a total of 9419 chest pain patients at ED, among which one out of five patients (1874/9419) had previous CIT performed. Fewer (38.2%) of such patients had low-risk HEART scores in comparison to 55.5% of low-risk HEART2 scores (p < 0.001). The MACE outcomes were similar in low-risk HEART patients compared with low-risk HEART2 patients (2.2% versus 3.1%, p = 0.3021). The overall performance accuracy of using the HEART2 score to stratify chest pain patients with previous CIT was better than using the HEART score's (AUC 0.74 versus 0.71, p = 0.0082).

CONCLUSIONS: Using the HEART2 score might be suitable to stratify low-to-moderate risk chest pain patients at ED with a similar 30-days MACE occurrence compared to the HEART score. More importantly, with the use of similar low-risk criteria (HEART2 ≤ 3), over 45% more chest pain patients with previous CIT performed could be discharged directly from ED.

PMID:35246065 | DOI:10.1186/s12872-022-02528-6

Using HEART2 score to risk stratify chest pain patients in the Emergency Department: an observational study

Chet Schrader, MD - Sat, 03/05/2022 - 05:00

BMC Cardiovasc Disord. 2022 Mar 4;22(1):79. doi: 10.1186/s12872-022-02528-6.

ABSTRACT

BACKGROUND: A significant number of chest pain patients had previous cardiac imaging tests (CIT) performed before being presented to the Emergency Department (ED). The HEART (history, electrocardiogram, age, risk factors, and troponin) score has been used to risk-stratify chest pain patients in the ED, but not particularly for patients with CIT performed. We aim to modify the current HEART score with the addition of most recent CIT findings (referred to as HEART2 score), to predict a 30-day major adverse cardiac event (MACE) among ED chest pain patients, compare the performance accuracy of using HEART versus HEART2 score for 30-day MACE outcome predictions, and further determine the value of HEART2 in a subset group of ED chest pain patients (i.e., ones with previous CIT).

METHODS: This is a single-center observational study. We included chest pain patients with HEART scores calculated during their index ED visits. A modified HEART2 score was developed with the addition of CIT findings as one of the HEART2 components. Patients were divided into three groups, including low (≤ 3), moderate (4-6), and high-risk HEART/HEART2 scores (≥ 7). MACE occurrence of a patient with different risks of HEART and HEART2 scores and overall performance accuracy of HEART versus HEART2 score predicting MACE outcomes were compared.

RESULTS: We included a total of 9419 chest pain patients at ED, among which one out of five patients (1874/9419) had previous CIT performed. Fewer (38.2%) of such patients had low-risk HEART scores in comparison to 55.5% of low-risk HEART2 scores (p < 0.001). The MACE outcomes were similar in low-risk HEART patients compared with low-risk HEART2 patients (2.2% versus 3.1%, p = 0.3021). The overall performance accuracy of using the HEART2 score to stratify chest pain patients with previous CIT was better than using the HEART score's (AUC 0.74 versus 0.71, p = 0.0082).

CONCLUSIONS: Using the HEART2 score might be suitable to stratify low-to-moderate risk chest pain patients at ED with a similar 30-days MACE occurrence compared to the HEART score. More importantly, with the use of similar low-risk criteria (HEART2 ≤ 3), over 45% more chest pain patients with previous CIT performed could be discharged directly from ED.

PMID:35246065 | DOI:10.1186/s12872-022-02528-6

Using HEART2 score to risk stratify chest pain patients in the Emergency Department: an observational study

BMC Cardiovasc Disord. 2022 Mar 4;22(1):79. doi: 10.1186/s12872-022-02528-6.

ABSTRACT

BACKGROUND: A significant number of chest pain patients had previous cardiac imaging tests (CIT) performed before being presented to the Emergency Department (ED). The HEART (history, electrocardiogram, age, risk factors, and troponin) score has been used to risk-stratify chest pain patients in the ED, but not particularly for patients with CIT performed. We aim to modify the current HEART score with the addition of most recent CIT findings (referred to as HEART2 score), to predict a 30-day major adverse cardiac event (MACE) among ED chest pain patients, compare the performance accuracy of using HEART versus HEART2 score for 30-day MACE outcome predictions, and further determine the value of HEART2 in a subset group of ED chest pain patients (i.e., ones with previous CIT).

METHODS: This is a single-center observational study. We included chest pain patients with HEART scores calculated during their index ED visits. A modified HEART2 score was developed with the addition of CIT findings as one of the HEART2 components. Patients were divided into three groups, including low (≤ 3), moderate (4-6), and high-risk HEART/HEART2 scores (≥ 7). MACE occurrence of a patient with different risks of HEART and HEART2 scores and overall performance accuracy of HEART versus HEART2 score predicting MACE outcomes were compared.

RESULTS: We included a total of 9419 chest pain patients at ED, among which one out of five patients (1874/9419) had previous CIT performed. Fewer (38.2%) of such patients had low-risk HEART scores in comparison to 55.5% of low-risk HEART2 scores (p < 0.001). The MACE outcomes were similar in low-risk HEART patients compared with low-risk HEART2 patients (2.2% versus 3.1%, p = 0.3021). The overall performance accuracy of using the HEART2 score to stratify chest pain patients with previous CIT was better than using the HEART score's (AUC 0.74 versus 0.71, p = 0.0082).

CONCLUSIONS: Using the HEART2 score might be suitable to stratify low-to-moderate risk chest pain patients at ED with a similar 30-days MACE occurrence compared to the HEART score. More importantly, with the use of similar low-risk criteria (HEART2 ≤ 3), over 45% more chest pain patients with previous CIT performed could be discharged directly from ED.

PMID:35246065 | DOI:10.1186/s12872-022-02528-6

Coronavirus Disease 2019 Pandemic Associated with Anxiety and Depression among Non-Hispanic Whites with Chronic Conditions in the US

Hao Wang, MD - Mon, 02/28/2022 - 05:00

J Affect Disord Rep. 2022 Feb 22:100331. doi: 10.1016/j.jadr.2022.100331. Online ahead of print.

ABSTRACT

OBJECTIVES: During the coronavirus 2019 (COVID-19) pandemic, increased anxiety and depression were reported, with mixed findings among individuals of different races/ethnicities. This study examines whether anxiety and depression increased during the COVID-19 pandemic compared to the pre-COVD-19 period among different racial/ethnic groups in the US.

METHODS: The Health Information National Trend Surveys 5 (HINTS 5) Cycle 4 data was analyzed. We used the time when the survey was administered as the pre-COVID-19 period (before March 11, 2020, weighted N = 77,501,549) and during the COVID-19 period (on and after March 11, 2020, weighted N = 37,222,019). The Patient Health Questionnaire (PHQ) was used to measure anxiety/depression and further compared before and during COVID-19. Separate multivariable logistic regression analyses were used to determine the association of the COVID-19 pandemic with anxiety/depression after adjusting for age, sex, insurance, income, and education.

RESULT: A higher percentage of Non-Hispanic Whites (NHW) with chronic conditions reported anxiety (24.3% vs. 11.5%, p=0.0021) and depression (20.7% vs. 9.3%, p=0.0034) during COVID-19 than pre-COVID-19. The adjusted odds ratio (AOR) of anxiety and depression for NHWs with chronic conditions during the COVID-19 pandemic was 2.02 (95% confidence interval of 1.10-3.73, p=0.025) and 2.33 (1.17-4.65, p=0.018) compared to NHWs who participated in the survey before the COVID-19.

LIMITATIONS: Limited to the NHW US population. PHQ can only be used as the initial screening tool.

CONCLUSION: The COVID-19 pandemic was associated with an increased prevalence of anxiety and depression among NHW adults with chronic conditions, but not among people of color.

PMID:35224528 | PMC:PMC8861147 | DOI:10.1016/j.jadr.2022.100331

Coronavirus Disease 2019 Pandemic Associated with Anxiety and Depression among Non-Hispanic Whites with Chronic Conditions in the US

J Affect Disord Rep. 2022 Feb 22:100331. doi: 10.1016/j.jadr.2022.100331. Online ahead of print.

ABSTRACT

OBJECTIVES: During the coronavirus 2019 (COVID-19) pandemic, increased anxiety and depression were reported, with mixed findings among individuals of different races/ethnicities. This study examines whether anxiety and depression increased during the COVID-19 pandemic compared to the pre-COVD-19 period among different racial/ethnic groups in the US.

METHODS: The Health Information National Trend Surveys 5 (HINTS 5) Cycle 4 data was analyzed. We used the time when the survey was administered as the pre-COVID-19 period (before March 11, 2020, weighted N = 77,501,549) and during the COVID-19 period (on and after March 11, 2020, weighted N = 37,222,019). The Patient Health Questionnaire (PHQ) was used to measure anxiety/depression and further compared before and during COVID-19. Separate multivariable logistic regression analyses were used to determine the association of the COVID-19 pandemic with anxiety/depression after adjusting for age, sex, insurance, income, and education.

RESULT: A higher percentage of Non-Hispanic Whites (NHW) with chronic conditions reported anxiety (24.3% vs. 11.5%, p=0.0021) and depression (20.7% vs. 9.3%, p=0.0034) during COVID-19 than pre-COVID-19. The adjusted odds ratio (AOR) of anxiety and depression for NHWs with chronic conditions during the COVID-19 pandemic was 2.02 (95% confidence interval of 1.10-3.73, p=0.025) and 2.33 (1.17-4.65, p=0.018) compared to NHWs who participated in the survey before the COVID-19.

LIMITATIONS: Limited to the NHW US population. PHQ can only be used as the initial screening tool.

CONCLUSION: The COVID-19 pandemic was associated with an increased prevalence of anxiety and depression among NHW adults with chronic conditions, but not among people of color.

PMID:35224528 | PMC:PMC8861147 | DOI:10.1016/j.jadr.2022.100331

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