This population-based cohort study aimed to explore the impact of doctor-shopping behavior (DSB) on the survival of new patients with lung cancer in Korea to make policy suggestions for the efficient use of medical care for cancer patients.

The cancer cohort data used in this study were obtained from the Korean National Health Insurance Service database, which contains claim records for all cancer patients in Korea between 2009 and 2021. After setting the washout period and exclusion criteria, 280,030 patients were found to be eligible for the analysis. The outcome variables were death within 30 days, 90 days, 1 year, and survival over 5 years after the first diagnosis. DSB, a variable of interest, was defined as the number of visits from the first diagnosis to the first treatment, and was classified into four quartiles. A multiple logistic regression model was used to examine the effects of DSB on the survival of patients with lung cancer.

Compared to patients who visited the doctor less than once (Q1), those with 2-9 visits (Q2, Q3) had a lower likelihood of death within 30 days, 90 days, and 1 year, and a higher probability of survival over 5 years. However, patients with more than 10 visits (Q4) had significantly increased odds of death. Moreover, those with excessive doctor shopping had about a 12% decrease in the likelihood of surviving beyond 5 years compared to those with minimal visits (95% CI: 0.85-0.92). Stratified analysis revealed that, especially when patients who are middle class or higher living in metropolitan cities engage in excessive doctor shopping, the likelihood of death within 1 year increases by 14-18%, and the survival rate over 5 years decreases by 12-18%, compared to those who rarely doctor shopped.

For patients with lung cancer, moderate doctor shopping can positively affect survival, while excessive visits can increase mortality. This effect was more notable among patients with middle or higher incomes and those living in metropolitan cities. These results highlight the need for policies that regulate the use of medical resources, especially among patients with greater access to medical care, to ensure the efficient utilization of medical care for improved health outcomes.

This study investigated the clinical benefit of counseling as a complement to buprenorphine treatment for opioid use disorder (OUD). The research addresses a critical gap in understanding whether counseling, when received concurrently with buprenorphine, can enhance patient outcomes.

We conducted a retrospective cohort study using data from the Massachusetts Department of Public Health's Public Health Data Warehouse (PHD). The study included patients who initiated buprenorphine treatment between January 2015 and December 2019. Investigators measured outcomes including medication adherence, treatment discontinuation, and opioid-related overdose over a 12-month period. We evaluated the effectiveness of counseling based on whether patients attended a minimum of three sessions in the first three months of buprenorphine treatment. We employed multivariate logistic regression and propensity score matching to analyze the data.

The study sample comprised 32,688 patients with 8871 (27 %) receiving counseling concomitantly with buprenorphine. Results from the regression analyses showed that counseling was associated with 17 % lower likelihood of poor medication continuity (OR = 0.83, 95 % CI = 0.78-0.87) and 21 % lower likelihood of treatment discontinuation (OR = 0.79, 95 % CI = 0.75-0.83). Counseling was not associated with the odds of opioid-related overdose. Additional results from sensitivity analyses pointed to a dose-response relationship for counseling within the parameters studied.

Findings suggest that counseling, when combined with buprenorphine treatment for OUD is associated with better patient outcomes in terms of medication continuity and treatment retention. However, the impact of counseling on opioid-related overdose risk was inconclusive, highlighting the need for further research to understand its role in overdose prevention.

Background/Objectives: Chronic obstructive pulmonary disease (COPD) remains a leading cause of death worldwide, with emphysema progression providing valuable insights into disease development. Clinical assessment approaches, including pulmonary function tests and high-resolution computed tomography, are limited by accessibility constraints and radiation exposure. This study, therefore, proposed an alternative approach by integrating the novel biomarker long non-coding interleukin-7 receptor α-subunit gene (lnc-Il7R), along with other easily accessible clinical and biochemical metrics, into machine learning (ML) models. Methods: This cohort study collected baseline characteristics, COPD Assessment Test (CAT) scores, and biochemical details from the enrolled participants. Associations with emphysema severity, defined by a low attenuation area percentage (LAA%) threshold of 15%, were evaluated using simple and multivariate-adjusted models. The dataset was then split into training and validation (80%) and test (20%) subsets. Five ML models were employed, with the best-performing model being further analyzed for feature importance. Results: The majority of participants were elderly males. Compared to the LAA% <15% group, the LAA% ≥15% group demonstrated a significantly higher body mass index (BMI), poor pulmonary function, and lower expression levels of lnc-Il7R (all p < 0.01). Fold changes in lnc-IL7R were strongly and negatively associated with LAA% (p < 0.01). The random forest (RF) model achieved the highest accuracy and area under the receiver operating characteristic curve (AUROC) across datasets. A feature importance analysis identified lnc-IL7R fold changes as the strongest predictor for emphysema classification (LAA% ≥15%), followed by CAT scores and BMI. Conclusions: Machine learning models incorporated accessible clinical and biochemical markers, particularly the novel biomarker lnc-IL7R, achieving classification accuracy and AUROC exceeding 75% in emphysema assessments. These findings offer promising opportunities for improving emphysema classification and COPD management.

Identifying risk factors associated with non-home discharge (NHD) following revision hip and knee total joint arthroplasty (TJA) could reduce the rate of preventable discharge to rehabilitation or skilled nursing facilities. Neighborhood-level deprivation indices are becoming an increasingly important measure of socioeconomic disadvantage as these indices consider multiple social determinants of health. This study aimed to compare the utility of widely used neighborhood social vulnerability indices in predicting NHD following revision TJA patients.

This study included 1,043 consecutive patients who underwent revision TJA at a single tertiary health system. There were three multivariate logistic regression analyses with the outcome of NHD performed using the area deprivation index (ADI), social deprivation index (SDI), and social vulnerability index while controlling for other demographic variables. Neighborhood-level indices were included in the analysis as continuous variables and categorical quartiles, with the lowest quartile representing the least deprived neighborhoods of the patient cohort. The strength of the association of significant indices was measured.

Patients in the highest ADI and SDI quartiles demonstrated higher odds of NHD compared to the cohort with the lowest quartile (ADI OR [odds ratio] = 1.93, 95% CI [confidence interval] = 1.23 to 3.03, P = 0.005; SDI OR = 1.86, 95% CI = 1.18 to 2.91, P = 0.007). Discharge disposition was more strongly associated with ADI than SDI (0.68 versus 0.26). Age, American Society of Anesthesiologist status, and alcohol use were independent determinants of discharge disposition. No significant association was seen between social vulnerability index and discharge disposition.

Area-level indices can be utilized to identify patients at higher risk of NHD following revision TJA. This study highlights the important differences between these indices' utility when evaluating their effects on clinical outcomes in this patient population. The findings shed light on the potential of integrating these tools into policy development, clinical preoperative programs, and research to better understand and address the health disparities in arthroplasty outcomes.

The health benefit of surgery in older adults may be outweighed by negative effects on cognitive or physical function. Physical resilience is defined as the potential for recovery after a stressor such as surgery. We assessed associations between physical resilience measured by orthostatic blood pressure (BP) and cerebral oxygenation recovery or grip work (sustained hand grip strength; GW) and postoperative outcome in two cohorts of (older) surgical patients. The first cohort (CTC) consisted of patients undergoing complex cardiothoracic surgery. The second cohort (GRR) held geriatric outpatients undergoing various surgical procedures. Outcome measures were length of stay (LoS) and postoperative complications. Negative binomial (LoS) and ordinal (complications) regression models were used to determine associations. 261 patients (113 CTC and 148 GRR) underwent surgery. Median LoS was 10 (CTC) and 5 days (GRR). Postoperative complications occurred in 80% (CTC) and 45% (GRR) of patients. In CTC, 10 mmHg higher systolic BP recovery was associated with a 12% shorter LoS (incidence rate ratio (IRR) 0.88 (95% CI 0.78-0.98)). 10 s longer sustained hand grip was associated with a 5% shorter LoS in GRR (IRR 0.95 (0.90-1.00)), but a 7% longer LoS in CTC (IRR 1.07 (1.03-1.11)). No significant associations were found with postoperative complications. Orthostatic cerebral oxygenation recovery in CTC was not significantly associated with any postoperative outcome. Our results imply that resilience indicators might be associated with LoS after surgery. Future research should seek to replicate our findings and investigate whether adding resilience parameters to preoperative assessment can support postoperative outcome prediction.

Renal cell carcinoma (RCC) accounts for 2%-3% of adult cancers globally. In Argentina, RCC is the fifth most common cancer, with over 2,000 new patients annually. This study aims to evaluate treatment trends for patients with metastatic renal cell carcinoma (mRCC) in Argentina.

A retrospective study was conducted involving 689 patients with mRCC treated in Argentina between 2015 and 2022. The study analyzed treatment patterns and outcomes over time.

Access to combination treatments for mRCC in Argentina has increased significantly, with 87% of patients receiving such therapies during the 2021-2022 period. The real-world data demonstrated that combination treatments in this Latin American population resulted in prolonged progression-free survival and improved overall response rate.

The results underscore the importance of ensuring access to combination therapies for patients with mRCC in Latin America. These findings should inform public health policies aimed at guaranteeing access to effective combination therapies.

Prior evidence suggests that patients' Health Related Quality of Life (HRQoL) worsens after COVID-19. This study aimed to investigate HRQoL in Italian patients post-hospitalization for COVID-19, focusing on changes in physical and mental HRQoL over time since COVID-19 diagnosis.

A cohort of patients hospitalized for COVID-19 at Molinette Hospital in Turin, Italy, was contacted post-discharge to assess HRQoL using the SF-36 questionnaire. Patients completed the questionnaire only once at a different time since diagnosis. This design allowed for the analysis of responses up to three years after diagnosis. Measured scores were compared with normative data from the Italian population using z-scores. HRQoL differences by gender, comorbidities, and self-perception of health status before and after COVID-19 were tested. The effect of time since diagnosis on physical (PCS) and mental (MCS) SF-36 scores was analysed using multiple linear models and stratified analyses.

A total of 601 patients completed the questionnaire. HRQoL was significantly lower compared to the normative Italian population. Men and individuals without comorbidities had better HRQoL, and self-perceptions of health status before and after COVID-19 influenced HRQoL. Time since diagnosis was associated with improved PCS, but MCS remained unaffected. Mental health declined in patients using anxiolytics post-COVID-19, and increasing age negatively affected physical health.

Our findings highlight the impact of time since diagnosis on HRQoL post-COVID-19 in an Italian population and suggest the need for further investigation into the pandemic's effects on HRQoL. Physicians should implement measures to improve mental HRQoL post-COVID-19.

To examine the impact of coping styles in older adults with asthma on the prospective relationship between depressive symptoms and asthma outcomes, and how their perceptions of social support influenced their coping styles.

Adults 60 and over with asthma were recruited and interviewed about their experiences of asthma, depression, and other psychosocial factors over three time points (Baseline, 6-month, and 12-month visits). Structural equation models examined the mediating roles of coping styles in the relationship between depressive symptoms (assessed by BDI-II) and asthma outcomes (i.e., asthma control, asthma quality of life, asthma-related distress, asthma-related hospitalizations, and oral corticosteroid use) and the mediating role of perceived social support in the relationship between depressive symptoms and coping style.

455 participants were included in this study. Overall, 33.9% of the study population self-identified as Black and 32.8% as Hispanic. Depressive symptoms at baseline predicted less spiritual coping at 6 months (β =  - 0.15, p = 0.03), more negative coping at 6 months (β = 0.44, p < .0001), and worse asthma outcomes at 12 months (β = 0.31, p < .0001). None of the coping styles significantly mediated the relationship between depressive symptoms and asthma outcomes. Perceived social support mediated the relationship between depressive symptoms and positive coping, such that more depressive symptoms predicted less perceived social support, which in turn resulted in less positive coping engagement (β =  - 0.06, p = 0.03).

This study demonstrates that in older adults with asthma depressive symptoms impact perceived social support, coping strategy selection (including spiritual coping), and subsequent asthma outcomes.

This study examined three common treatment options for arthrofibrosis treatment after total knee arthroplasty (TKA)-manipulation under anesthesia (MUA), arthroscopic lysis of adhesions (LOA), and revision TKA (rTKA)-and evaluated differences in medical outcomes, orthopedic outcomes, and revision free survivorship.

The TriNetX platform was queried to identify patients with arthrofibrosis after TKA. Cohorts were stratified by treatment and matched based on demographics and comorbidities. Differences in short-term medical complications, long-term orthopedic complications, and revision free survivorship were assessed. Odds ratios were used to compare outcomes, and Kaplan-Meier analysis was conducted to determine survivorship.

30,142 patients were identified with arthrofibrosis after TKA (3.61%). Within one year of diagnoses, 3,617 patients were treated with MUA, 2,022 with rTKA, 489 with LOA, and 635 patients with rTKA after MUA/LOA. At 90 days, rTKA had a higher risk of acute kidney injury, pulmonary embolism, wound dehiscence, emergency department visits, and readmission compared to MUA, and lower risk of readmission compared to patients with prior MUA/LOA (P < 0.05). At 2 years, rTKA had a higher risk of periprosthetic fracture, prosthetic dislocation, periprosthetic joint infection, and aseptic loosening compared to MUA but a lower risk of prosthetic dislocation and periprosthetic joint infection compared to patients with prior MUA/LOA (P < 0.05). Survivorship with rTKA was markedly lower than with MUA at 2-and 10-years but was comparable with prior MUA/LOA.

This study found that manipulation under anesthesia may be preferred as the first-line treatment in the management of early postoperative arthrofibrosis over rTKA due to decreased short-term and long-term complication risk and increased survival rate.

The prognostic significance of dynamic changes in the albumin-to-C-reactive protein ratio (ACR) in elderly patients with community-acquired pneumonia (CAP) has not been fully elucidated. This study aims to evaluate the utility of ACR as a dynamic biomarker for predicting 28-day mortality and enhancing risk stratification in this high-risk population.

A retrospective cohort study was conducted on 437 elderly CAP patients (≥65 years). Serum albumin and C-reactive protein (CRP) levels were measured at admission (T0), 24 hours (T1), and 3 days (T2) post-admission. ACR was calculated for each time point, and its prognostic value was assessed using advanced statistical methods.

The 28-day mortality rate was 16.7%. ACR levels were consistently lower in non-survivors across all time points (P < 0.001). RCS analysis revealed a nonlinear relationship between ACR and mortality risk. Time-varying ROC analysis demonstrated that ACR consistently outperformed CRP in predicting mortality, with superior area under the curve (AUC) values at all time points. Random-effects modeling indicated minimal inter-individual variability in ACR (random effects variance: 0.030; standard deviation: 0.175). Time-varying Cox regression confirmed a strong negative association between dynamic ACR changes and mortality risk, with a C-statistic of 0.833 (P < 0.001).

Dynamic monitoring of ACR is a robust and clinically applicable tool for predicting short-term mortality in elderly CAP patients. By integrating markers of inflammation and nutritional status, ACR facilitates early identification of high-risk patients and supports personalized treatment strategies. These findings highlight the potential of ACR as a novel biomarker for improving clinical outcomes in this vulnerable population.

Climate change is expected to disrupt weather patterns across the world, exposing older adults to more intense and frequent periods of hot weather. Meanwhile, lab-based studies have established a causal relationship between ambient temperature and cognitive abilities, suggesting the expected rise in temperature may influence older adults' cognitive functioning. Nevertheless, it is not clear whether, and to what extent, the temperature variations in older adults' own homes-which unlike lab settings are under their control-influence their cognitive functioning. Our objective was to provide proof of concept that home ambient temperature influences self-reported ability to maintain attention in older adults.

We conducted a longitudinal observational study, continuously monitoring the home ambient temperature and self-reported difficulty keeping attention for 12 months in 47 of community-dwelling older adults living in Boston, Massachusetts.

We observed a U-shaped relationship between home ambient temperature at the time of assessment and the odds ratio (OR) of reporting difficulty keeping attention such that the OR was lowest between 20°C and 24°C and doubled when moving away from this range by 4°C in either direction.

Our results suggest that even under the current climate, a considerable portion of older adults encounter indoor temperatures detrimental to their cognitive abilities. Climate change may exacerbate this problem, particularly among low-income and underserved older adults. Addressing this issue in public health and housing policy is essential to building climate resiliency in this vulnerable population.

The immune system's response to an invading pathogen is the critical determinant in recovery from illness. Here, we hypothesize that the immune response will swiftly follow classical activation and a resolution trajectory in patients with the rapid evolution of symptoms if challenged by a viral pathogen for the first time. Alternatively, a dysregulated response will be signified by a protracted clinical trajectory. Consequently, we enrolled 106 patients during the first wave of COVID-19 and collected their blood within 24 h, 48 h, 7 days, and over 28 days from symptoms onset. The pathogenic burden was measured via serum levels of the S-spike protein and specific immunoglobulin titers against the S and N proteins of SARS-CoV-2. The nonspecific immunological response was gauged using interleukin 6, leukocytosis, and C-reactive protein. Coagulation status was assessed. Several serum biomarkers were used as surrogates of clinical outcomes. We identified four clusters depending on the onset of symptoms (immediate [A], 6 days [B], 12 days [C], and over 21 days [D]). High variability in the S-spike protein in cluster A was present. The corresponding immunoglobulin titer was random. Only procalcitonin differentiated clusters in terms of markers of nonspecific inflammation. Coagulation markers were not significantly different between clusters. Serum surrogates on cardiomyopathy and neuronal pathology exhibited significant variability. Implementation of ECMO or noninvasive ventilation was more prominent in cluster C and D. Interestingly, SOFA or APACHE II scores were not different between nominal (A and B) versus dysregulated clusters (C and D).

Cognitive impairment, including dementia, and hip fracture are both common among older patients. Both conditions are associated with increased morbidity and mortality. Cognitive impairment is often underdiagnosed and may remain undetected in hip fracture patients. Little is known about the prevalence, specific characteristics, and outcomes of hip fracture patients with cognitive impairment. This analysis aimed to compare hip fracture patients with and without cognitive impairments regarding their health conditions, hospital care, and the risk of complications and mortality.

This study used data derived from the EMAAge project, a prospective multi-center cohort study conducted in Berlin, Germany. Patients aged 40 years and older with hip fracture were stratified into three cognitive status groups: no cognitive impairment (NCI), moderate cognitive impairment (MCI), and severe cognitive impairment (SCI). Categorization was based on patients' ability to engage in interviews and their performance on the 6-item Cognitive Impairment Test (6-CIT). Standardized mean differences were used to compare various health-related parameters and health care utilization measures. Regression models, both adjusted and unadjusted, were calculated for the number of complications and the mortality rate.

Cognitive impairment was present in 37% of the 310 hip fracture patients in the study cohort. Patients with cognitive impairment had a worse baseline health profile, delayed admission to the emergency department, a longer time to surgery, and were less likely to be referred to a rehabilitation program. In the adjusted regression model for the number of complications, the incidence rate ratio was 1.237 (p = 0.292) for MCI patients and 2.065 (p < 0.001) for SCI patients compared with NCI patients. The adjusted odds ratio for mortality was 1.046 (p = 0.942) for MCI patients and 2.875 (p = 0.060) for SCI patients.

Hip fracture patients with cognitive impairment, particularly severe impairment, arrive at the ED in a considerably poorer state of health and are at a higher risk of adverse outcomes, including complications and mortality. Timely identification of this at-risk group upon arrival appears to be essential to providing adequate care. This study highlights the need for interventions and research aimed at improving prevention, emergency care and outcomes for this vulnerable group, addressing their specific risk factors, and promoting the quality of care in hospital and after discharge.

Frailty indices are invaluable resources in risk stratification and predicting high-value care outcomes for neurosurgical patients. The Hospital Frailty Risk Score (HFRS) is a recently developed and validated method for evaluating frailty; however, its implementation has yet to be assessed in patients with non-functioning pituitary adenomas undergoing endoscopic endonasal resection. In this study, we aimed to evaluate HFRS's predictive ability for high-value care outcomes, namely postoperative complications, length of stay (LOS), and hospital charges, and to compare it to other traditionally used frailty indices.

A retrospective review of electronic medical records from 2017 to 2020. A total of 109 ICD-10 codes corresponding to various frailty-related conditions were used to identify the components of HFRS. These components were then used to calculate the HFRS for each patient, with higher scores indicative of elevated frailty. Standard multivariate logistic regression models were employed to explore the association between HFRS and high-value care outcomes. Model discrimination was assessed using the area under the ROC curves, and the DeLong test was used to compare AUCs.

A total of 172 patients were included, with a mean age of 57.27 ± 12.95 years and an average HFRS score of 3.65 ± 3.27. Among patients, 56% were male, 5.2% experience postoperative complications, 23.3% endured extended LOS, 25.0% incurred high hospital charges. In multivariate regression models, greater HFRS was significantly and independently associated with postoperative complications (OR = 1.51, P < 0.001), extended LOS (OR = 1.17, P = 0.006) and high hospital charges (OR = 1.18, P = 0.004). HFRS had the highest AUC compared to other frailty indices and was the most parsimonious model, with AUC values of 0.82, 0.64, and 0.63 for predicting complications, extended LOS, and higher charges, respectively.

Higher HFRS scores are significantly associated with postoperative complications, prolonged LOS, and high hospital charges for patients undergoing pituitary surgery.

Total knee arthroplasty (TKA) is a procedure associated with risks of electrolyte and kidney function disorders, which are rare but can lead to serious complications if not correctly identified. A routine check-up is very often carried out to assess the seric ionogram and kidney function after TKA, that rarely requires clinical intervention in the event of a disturbance. The aim of this study was to identify perioperative variables that would lead to the creation of a machine learning model predicting the risk of kalaemia disorders and/or acute kidney injury after total knee arthroplasty.

A predictive model could be constructed to estimate the risk of kalaemia disorders and/or acute kidney injury after total knee arthroplasty.

This single-centre retrospective study included 774 total knee arthroplasties (TKA) operated on between January 2020 and March 2023. Twenty-five preoperative variables were incorporated into the machine learning model and filtered by a first algorithm. The most predictive variables selected were used to construct a second algorithm to define the overall risk model for postoperative kalaemia and/or acute kidney injury (K+ A). Two groups were formed of K+ A and non-K+ A patients after TKA. A univariate analysis was performed and the performance of the machine learning model was assessed by the area under the curve representing the sensitivity of the model as a function of 1 - specificity.

Of the 774 patients included who had undergone TKA surgery, 46 patients (5.9%) had a postoperative kalaemia disorder requiring correction and 13 patients (1.7%) had acute kidney injury, of whom 5 patients (0.6%) received vascular filling. Eight variables were included in the machine learning predictive model, including body mass index, age, presence of diabetes, operative time, lowest mean arterial pressure, Charlson score, smoking and preoperative glomerular filtration rate. Overall performance was good with an area under the curve of 0.979 [CI95% 0.938-1.02], sensitivity was 90.3% [CI95% 86.2-94.4] and specificity 89.7% [CI95% 85.5-93.8]. The tool developed to assess the risk of impaired kalaemia and/or acute kidney injury after TKA is available on https://arthrorisk.com.

The risk of kalaemia disturbance and postoperative acute kidney injury after total knee arthroplasty could be predicted by a model that identifies low-risk and high-risk patients based on eight pre- and intraoperative variables. This machine learning tool is available on a web platform accessible for everyone, easy to use and has a high predictive performance. The aim of the model was to better identify and anticipate the complications of dyskalaemia and postoperative acute kidney injury in high-risk patients. Further prospective multicentre series are needed to assess the value of a systematic postoperative biochemical work-up in the absence of risk predicted by the model.

IV; retrospective study of case series.

Earlier studies revealed that 10%-50% of patients reported remaining complaints after treatment for Lyme neuroborreliosis (LNB). The aim of our study was to assess symptoms and quality of life in patients with diagnosed and treated LNB and to compare them with findings in the general population.

Adults with LNB receiving adequate antibiotics were included between 2015 and 2021 in 2 tertiary hospitals. Two controls without Lyme borreliosis history were included for each case patient, matched by age and geographic area. All participants were interviewed to answer a standardized questionnaire. Fatigue was assessed by the Fatigue Severity Scale (FSS) and quality of life by the 12-Item Short Form Survey, including physical component summary (PCS) and mental component summary (MCS) scores.

Fifty-three patients and 104 controls were included. The mean age (SD) was 62 (13) years in both groups; 66% were male in the LNB group and 44% in the control group (P = .01). Fatigue (68% vs 48%, respectively; P = .02), memory disorders (60% vs 38%; P < .01), and attention disorders (32% vs 17%; P = .05) were significantly more frequent in the LNB group than in controls. In multivariable analysis, no association was found between LNB and FSS scores (odds ratio, 1.6 [95% confidence interval, .9-3.0]; P = .15) or between LNB and MCS scores (0.8 [.4-1.5]; P = .45); however, patients with LNB had lower PCS scores (0.5 [.3-.9]; P = .03).

Several symptoms were similar in patients with LNB and controls. Quality of life was slightly impaired in patients with LNB and PCS scores were lower, but there were no differences in MCS or FSS scores. Reassurance and specific rehabilitation measures could be provided to these patients.

Postoperative pain is the most common undesirable outcome after neurosurgery. Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that is administered parenterally and carries a theoretical increased risk of bleeding. Our study aims to determine whether ketorolac after craniotomy for tumor resection significantly changes the rate of postoperative adverse events, adequately controls pain, and decreases concurrent narcotic use.

We performed a retrospective chart review of all adult patients who underwent craniotomy for brain tumor resection from 2013 to 2022. Analysis of patients who received ketorolac and those who did not in the postoperative period were compared for adverse events associated with ketorolac use. Secondary outcomes included patient-reported pain scores and postoperative opioid use.

In total, 1114 patients were included, of whom 70 received ketorolac in the postoperative period. Ketorolac was typically administered to patients in whom narcotics had failed to provide sufficient pain relief. Patients receiving ketorolac were younger (P = 0.001) and had a lower comorbidity index (P = 0.041) compared with the nonketorolac group. Patients receiving ketorolac did not experience a significantly increased rate of bleeding events (P = 0.850). Patients receiving ketorolac had significantly greater baseline levels of pain (P = 0.018) and opioid use (P = 0.047). When matched for chronic comorbidities including pain disorders, the ketorolac group only displayed greater levels of pain early in the postoperative course (postoperative day 0-1) but not in latter part of the initial postoperative period.

Ketorolac is a safe and effective option for pain control after craniotomy for tumor resection. Prospective data are needed to better validate these retrospective observations.

Strategies for managing the elderly with acute cholecystitis need to be refined.

To examine additional procedures, hospital readmissions, and outpatient visits in the year following the index admission.

Single-institution retrospective study of fifty consecutive patients aged ≥70 years admitted with acute cholecystitis. A propensity score matching analysis adjusted for demographic and clinical variables was carried out.

The one-year rates of additional procedures were 0%, 47.4%, and 72.7% for surgery, supportive care (SC), and percutaneous gallbladder drainage (PCGD), respectively. The one-year readmission rate was 0%, 15.8%, and 50% after these index procedures, respectively. After propensity score analysis, patients who received SC (55.6% vs. 0%, P = .03) or PCGD (77.8% vs. 0%, P = .002) had a higher rate of additional procedures compared to those who underwent surgery. Additionally, patients receiving PCGD had a higher readmission rate than those undergoing surgery (55.6% vs. 0%, P = .03). Nine patients who received SC and nine patients who received PCGD could have potentially undergone surgery during the index admission. This would have resulted in improved one-year outcomes.

Cholecystectomy during the index hospitalization may provide better one-year outcomes than SC or PCGD in at least 50% of patients ≥70 years with acute cholecystitis.

Hospital Frailty Risk Score (HFRS) has recently been used to predict adverse health outcomes including length of stay (LOS) in hospital. LOS is an important indicator for patient quality of care, the measurement of hospital performance, efficiency and costs. Tools to predict LOS may enable earlier interventions in those identified at higher risk of a long stay. Previous work focused on patients over 75 years of age, but we explore the relationship between HFRS and LOS for all adults.

This is a retrospective cohort study using data from a large acute hospital during the period from 01/01/2010 to 30/06/2018. The study included patients aged 16 years and older. We calculated HFRS for patients who had been previously admitted to the hospital within the previous 2 years. The study developed Logistic Regression models (crude and adjusted) for nine prediction periods of LOS to assess association between (LOS and HFRS) and (LOS and Charlson Comorbidity Index-CCI), using odds ratios, and AUROC to assess model performance.

An increase in HFRS is associated with prolonged LOS. HFRS alone or combined with CCI were more important predictor of long LOS in most of periods to predict LOS. However, crude HFRS was superior to the models where HFRS was combined with any other variable for LOS in excess of 21 days, which had AUROCs ranging from 0·867 to 0·890. Regarding eight age groups, crude HFRS remained the first or second most effective predictor of long LOS. HFRS alone or combined with CCI was superior to other models for patients older than 44 years for all periods of LOS; whereas for patients younger than 44 years it was superior for all LOS except 45, 60, and 90 days.

This study has demonstrated the utility of HFRS to predict hospital LOS in patients across all ages.

The aims of this study were to describe survival outcomes in patients with ovarian cancer aged ≥80 years and to explore predictors of poor prognosis.

We collected clinical, demographic, histologic, surgical and follow-up data for patients with ovarian cancer aged ≥80 years from a multicenter French cohort (FRANCOGYN) who underwent surgery from 1999 to 2019. Primary endpoints were overall survival (OS) and disease-free survival (DFS). We performed a descriptive analysis of demographic and clinical data and a survival time analysis and comparison using the Kaplan Meier method and log-rank test.

Of 1671 patients treated for ovarian cancer during the study period, 83 were aged ≥80 years (median age at diagnosis, 83 years; range, 80-99). Median OS was 39.6 months (range, 23.64-60.24). Factors significantly associated with OS in the univariate analysis were adjusted Charlson comorbidity index (ACCI) (HR 2.32; 95 % CI, 1.00-5.42 for ACCI >4), FIGO stage (HR 4.07 for FIGO stage >IIA; 95 % CI, 1.43-11.54), debulking surgery (HR 0.40; 95 % CI, 0.20-0.78), residual disease after surgery (HR 3.00; 95 % CI, 1.31-6.87), and postoperative complications (HR 2.24; 95 % CI, 1.04-4.81). Significant independent predictors of worse OS in the multivariate analysis were ACCI >4 (HR 4.96; 95 % CI, 1.57-15.75), perioperative complications (HR 5.01; 95 % CI, 1.32-18.95), and residual tumor after surgical debulking (HR 3.78; 95 % CI, 1.23-11.61).

Age by itself should not refrain surgeons and oncologist from proposing surgical debulking and chemotherapy, as recommended by international guidelines for patients with ovarian cancer aged ≥80 years.

The impact of antibiotics (ATBs) on the risk of colorectal cancer (CRC) recurrence after curative resection remains unknown.

Using the French nation-wide database of cancer patients, all newly diagnosed non-metastatic CRC patients resected between 01/2012 and 12/2014 were included. The perioperative ATB intake (from 6 months before surgery until 1 year after) was classified according to the class, the period of use (pre- vs post-resection), the disease stage (localized and locally advanced), and the primary tumor location (colon and rectum/junction). The primary endpoint was the 3-year disease-free survival (DFS). The impact of ATB was assessed using time-dependent multivariate Cox models.

A total of 35,496 CRC patients were included. Seventy-nine percent of patients had at least one ATB intake. Outpatient ATB intake after surgery was associated with unfavorable 3-year DFS. The ATBs associated with decreased 3-year DFS were cephalosporins, streptogramins, quinolones, penicillin A with beta-lactamase inhibitors, and antifungals with differential effects according to the primary tumor location and disease stage.

These findings suggest that ATBs modulate the risk of recurrence after early CRC resection with a differential impact of the ATB classes depending on disease stage and tumor site.

In the United States, there are disparities in access to care for patients with non-small cell lung cancer (NSCLC) on the basis of socioeconomic and racial/ethnic factors. This study investigates the association between race/ethnicity and the utilization of immune checkpoint inhibitor (ICI) therapy among older patients with advanced NSCLC (aNSCLC).

This retrospective study used data from the SEER-Medicare-linked database. The cohort included patients (age 66 years or older) diagnosed with aNSCLC (stage III/IV) between March 2015 and December 2017, and they were followed through December 2019. Race/ethnicity was categorized as non-Hispanic (NH)-White, NH-Black, Hispanic, and Other. ICI therapy utilization was determined by identifying any usage of ICI agents (nivolumab, pembrolizumab, atezolizumab, durvalumab, ipilimumab, and cemiplimab-rwlc) from the Medicare database. Multivariable logistic regression models assessed the association between race/ethnicity and ICI therapy utilization (yes, no). Effect measure modification analyses were conducted by sex, socioeconomic status, and comorbidity.

The final sample included 26,836 patients; 76.2% were NH-White, 10.1% NH-Black, 5.7% Hispanic, and 8.0% Other. The overall ICI therapy utilization proportion was 17.8%, varying across ethnicities: NH-Black 14.1%, Hispanic 16.3%, NH-White 18.4%, and Other 18.5%. In comparison with NH-White patients, NH-Black patients were 15% less likely to receive ICI therapy (adjusted odds ratio, 0.85 [95% CI, 0.75 to 0.96]). Furthermore, the association between race/ethnicity and utilization of ICI therapy was modified by comorbidity status, sex, and socioeconomic status.

NH-Black patients with aNSCLC were less likely to receive ICI therapy than their NH-White counterparts. Our findings indicate the racial/ethnic disparities in ICI therapy utilization and call for further interventions to optimize access to care.

Empirical antibiotic therapy is essential for treating bloodstream infections (BSI), yet there is limited evidence from resource-limited settings. We quantified the association of inappropriate empirical antibiotic therapy (IEAT) with in-hospital mortality and the associated burden on BSI patients in Chile.

We used a retrospective multicentre cohort study of BSI cases in three Chilean tertiary hospitals (2018-2022) to assess the impact of IEAT on 30-day and overall in-hospital mortality and quantify excess disease and economic burdens associated with IEAT. We determined the appropriateness of pathogen-antimicrobial pairings based on in vitro susceptibilities and pathogen-corresponding antibiotic treatment, allowing a 48-hour window after the initial blood culture. We addressed confounding using propensity scores and inverse probability weights (IPW). We used IPW-weighted logistic competing-risk survival models, including time-varying independent variables after blood tests as controls.

Among 1323 BSI episodes, 432 (33%) received IEAT, with an average time to adequate therapy of 4.6 days. Compared with adequate treatment, IEAT was associated with 30-day and overall mortality risks that were 1.31 and 1.24 times higher, respectively. These risks were further inflated between twofold and fourfold when antibiotic-resistant bacteria (ARB) was included. Competing-risk models showed associations between IEAT and IEAT-ARB combinations with in-hospital mortality. Accounting for time-varying variables yielded similar results. The economic burden of IEAT resulted in an additional cost of ~US$9900 from premature mortality and 0.46 disability-adjusted life-years per patient with BSI.

Approximately one in three patients received IEAT, often associated with ARB. IEAT was linked to increased mortality risk and higher economic costs. Timely appropriate treatment, early pathogen detection and resistance profiling are likely to improve health and financial outcomes at the population level.

Breast cancer (BC) is the most common malignant tumor in women. Between 20 % and 30 % of patients develop metastases from BC, 50 % of them in the liver. The mean survival rate reported in patients with liver metastases from BC (LMBC) ranges from 3 to 29 months. The role of surgery in LMBC is not clearly defined. The objective of the present study was to determine the long-term survival and disease-free survival of patients undergoing surgery for LMBC and to identify the patients who most likely benefit from surgery.

This retrospective multicenter cohort study included all consecutive patients undergoing LMBC surgery at the participating European centers from January 1, 2010, to December 31, 2015. The ClinicalTrials.gov ID is NCT04817813.

A hundred women (mean age 52.6 years) undergoing LMBC surgery were included. Five-year disease-free survival was 29 %, and 5-year overall survival was 60 %. Median survival after BC surgery was 12.4 years, and after LMBC surgery, 7 years. Patients with ECOG 1, ASA score I-II, metachronous LMBC, positive hormone receptors, and who had received neoadjuvant and adjuvant hormone treatment obtained the best overall and disease-free survival results.

In cases of correct patient selection and as part of a comprehensive onco-surgical strategy, surgery for LMBC improves overall long-term survival. In our series, certain factors were linked to better disease-free and overall survival; consideration of these factors could improve the selection of the best candidates for LMBC surgery.

NCT04817813.

Evaluate the effect of functional status and patient factors on delays in treatment with adjuvant therapy.

Retrospective chart review (2020-2022) was conducted at a single tertiary referral center. Data were collected between January 2020 and October 2022, and 63 patients underwent free flap reconstructive surgery of the head and neck due to the presence of cancer and received adjuvant radiation therapy (RT). The main outcomes measured were Area Deprivation Index (ADI), Beale scores, distance to radiation center, functional status, patient demographics, gender, and length from surgery to initiation of RT.

Of the 63 patients who were reviewed, the average age was 65.5 years old and 63.8% were male. The average ADI state score was 5.6 and the national percentile of 77.1. The average Beale score was 3.7. The average distance traveled was 101.1 miles. Thirty-five patients were living independently, 16 were living in assisted living or received home care, and 15 were dependent or lived in a nursing home. Mann-Whitney U analysis revealed a significant association of increasing levels of dependence to delays in treatment compared to on-time treatment (p = 0.002). The odds of treatment delay were increased almost 10-fold for every additional increase in dependency level (OR = 9.87, 95% CI = 1.42-68.83).

Degree of dependent functional status correlates with delays in postoperative adjuvant RT in patients undergoing free tissue transfer for head and neck cancer. Preoperative risk stratification allows for physicians to address barriers to adjuvant therapy prior to delay.

3 Laryngoscope, 134:4979-4984, 2024.

The spread of multi-drug-resistant organisms (MDROs) is a critical health issue. Isolation measures imposed to prevent transmission may result in adverse psychological effects among affected patients. This emphasizes the need for better communication and information to improve their hospital experience and mental well-being as well as to prevent inadequate treatment.

The present study examined whether tailored counselling sessions during contact isolation could enhance patients' understanding of their situation concerning the significance of their MDRO status and enhance their well-being.

A pre-post-intervention study was conducted in a German tertiary-care hospital in which N = 64 patients who were isolated due to MDROs received tailored counselling. The counselling included information about MDROs, the reason for hospital isolation measures, and appropriate behaviour during and after hospitalization. Participants completed questionnaires before and after the counselling sessions to assess its impact on their informedness, patient (dis)satisfaction and well-being measures.

Prior to the counselling session, patient dissatisfaction was associated with anxiety and inadequate informedness about MDROs. After the counselling, patients reported a significantly improved comprehension of their MDROs-related situation and a notable decrease in dissatisfaction with their hospital situation, primarily attributed to the acquired information.

This is the first German study to show how improved information about MDROs impacts patient satisfaction in hospitals. The findings stress the crucial need for improving healthcare workers' interaction and communication with patients affected by MDROs.

Revision hip and knee total joint arthroplasty (TJA) carries a high burden of postoperative complications, including surgical site infections (SSI), venous thromboembolism (VTE), reoperation, and readmission, which negatively affect postoperative outcomes and patient satisfaction. Socioeconomic area-level composite indices such as the area deprivation index (ADI) are increasingly important measures of social determinants of health (SDoH). This study aims to determine the potential association between ADI and SSI, VTE, reoperation, and readmission occurrence 90 days following revision TJA.

1047 consecutive revision TJA patients were retrospectively reviewed. Complications, including SSI, VTE, reoperation, and readmission, were combined into one dependent variable. ADI rankings were extracted using residential zip codes and categorized into quartiles. Univariate and multivariate logistic regressions were performed to analyze the association of ADI as an independent factor for complication following revision TJA.

Depression (p = 0.034) and high ASA score (p < 0.001) were associated with higher odds of a combined complication postoperatively on univariate logistic regression. ADI was not associated with the occurrence of any of the complications recorded following surgery (p = 0.092). ASA remained an independent risk factor for developing postoperative complications on multivariate analysis.

An ASA score of 3 or higher was significantly associated with higher odds of developing postoperative complications. Our findings suggest that ADI alone may not be a sufficient tool for predicting postoperative outcomes following revision TJA, and other area-level indices should be further investigated as potential markers of social determinants of health.

Patients who have sustained extensive burns frequently exhibit substantial damage to skeletal muscle and associated complications. The rehabilitation of these patients can be challenging due to the nature of the injury and the subsequent complications. Nevertheless, there is a possibility that functional proprioceptive stimulation (illusory movements) may facilitate effective rehabilitation in patients with limited physiotherapy options. Nevertheless, this approach has yet to be tested in patients with burn injuries.

A prospective, randomised, crossover trial was conducted at a burn centre in a tertiary teaching hospital. The objective was to assess the effects of illusory movements on energy metabolism, insulin sensitivity, and skeletal muscle biology in adult critically ill patients with deep burns covering 30 % or more of the total body surface area. Two 30-minute daily sessions of functional proprioceptive stimulation were administered in addition to the standard physical therapy or physical activity regimen. Subsequently, the patients proceeded to the next stage of the trial, which involved a two-week crossover period.

Daily indirect calorimetry and calculation of nitrogen balance. Skeletal muscle biopsies from vastus lateralis for high resolution respirometry and euglycemic clamps to assess whole body glucose disposal were performed three times: at baseline and then fortnightly after each intervention period. The intervention was feasible and well tolerated in both early and late stages of burn disease. It did not change energy expenditure (mean change -33 [95 % CI: -292;+227] kcal .24 h-1, p = 0.79), nitrogen balance (+2.0 [95 % CI: -3.1;+7.1] g N .1.73 m-2 BSA .24 h-1), or insulin sensitivity (mean change of insulin-mediated glucose disposal -0.33 [95 % CI: -1.18;+0.53] mmol.h-1). At the cellular level, the intervention increased the capacity of mitochondria to synthesize ATP by aerobic phosphorylation and tended to increase mitochondrial coupling. Functional capacities of fatty acid oxidation and electron transfer chain complexes I, II, and IV were unaffected.

Compared to physical therapy alone, two daily sessions of functional proprioceptive stimulation in addition to usual physical therapy in patients with extensive burns did not change energy expenditure, insulin sensitivity, nitrogen balance, or energy substrate oxidation. At cellular level, the intervention improved the capacity of aerobic phosphorylation in skeletal muscle mitochondria. Clinical effects remain to be demonstrated in adequately powered trials.

While moderate-intensity statin therapy is recommended for primary prevention, statins may not be utilized at a recommended intensity due to dose-dependent adverse events, especially in an Asian population. However, evidence supporting the use of low-intensity statins in primary prevention is limited.

We sought to compare clinical outcomes between a low-intensity statin plus ezetimibe and a moderate-intensity statin for primary prevention.

This population-based retrospective cohort study used the Korean nationwide claims database (2002-2019). We included adults without atherosclerotic cardiovascular diseases who received moderate-intensity statins or low-intensity statins plus ezetimibe. The primary outcome was a composite of all-cause mortality, myocardial infarction, and ischemic stroke. The safety outcomes were liver and muscle injuries and new-onset diabetes mellitus (DM). We used standardized inverse probability of treatment weighting (sIPTW) and propensity score matching (PSM).

In the sIPTW model, 1717 and 36 683 patients used a low-intensity statin plus ezetimibe and a moderate-intensity statin, respectively. In the PSM model, each group included 1687 patients. Compared with moderate-intensity statin use, low-intensity statin plus ezetimibe use showed similar risks of the primary outcome (hazard ratio [HR] = 0.92, 95% CI = 0.81-1.12 in sIPTW and HR = 1.16, 95% CI = 0.87-1.56 in PSM model). Low-intensity statin plus ezetimibe use was associated with decreased risks of liver and muscle injuries (subHR [sHR] = 0.84, 95% CI = 0.74-0.96 and sHR = 0.87, 95% CI = 0.77-0.97 in sIPTW; sHR = 0.84, 95% CI = 0.72, 0.96 and sHR = 0.82, 95% CI = 0.72-0.94 in PSM model, respectively). For new-onset DM and hospitalization of liver and muscle injuries, no difference was observed.

Low-intensity statin plus ezetimibe may be an alternative to moderate-intensity statin for primary prevention. Our findings provide evidence on safety and efficacy of statin therapy in Asian population.

Poor mental health significantly impacts people with HIV (PWH) and those who drink alcohol. Limited data exist on the combined effects of social determinants of health (social vulnerability) on mental health in PWH with unhealthy substance use. We investigated the relationship between social vulnerability and poor mental health in PWH and whether this relationship differed by race/ethnicity. We conducted a cross-sectional analysis using data from the Boston ARCH Cohort among PWH with current or past unhealthy substance use. We created a 23-item social vulnerability index (SVI) using a deficit accumulation approach comprised of social determinants of health indicators. We estimated whether higher SVI score is associated with anxiety and depressive symptoms using logistic regression analysis. Among 251 participants with a mean age of 52 (SD = 10) years, 67.3% were male, 52% Black, 21% Hispanic, 19% White, and 73% unemployed. The SVI had a mean of 9.30 (SD = 3.4) with a 1.5-18 range. Nearly two in five persons reported past month heavy alcohol use and 35% illicit drug use. The prevalence of anxiety and depressive symptoms was 34.4% and 54.2% respectively. Higher SVI score was associated with anxiety symptoms (adjusted odds ratio [aOR] = 2.01, 95% confidence interval [CI] 1.46, 2.76, p ≤ 0.001), and depressive symptoms (aOR = 2.42, 95% CI 1.74, 3.36, p ≤ 0.001). Race/ethnicity did not moderate the relationship between SVI and each mental health outcome. SVI was significantly associated with poor mental health across racial/ethnicity groups in this cohort. Interventions that address social vulnerability may improve well-being and quality of life for PWH.

Post-discharge adverse events, such as falls, hospitalizations, and death, are more prevalent among older adults with dementia, compared to their cognitively intact counterparts. This study aimed to test the association between physical resilience and post discharge adverse events in a sample of older adults with dementia.

Through phone calls with caregivers over one year, we obtained data on physical resilience and post-discharge adverse events through caregiver report among a sample of 314 recently discharged older adults with dementia. We performed negative binomial regression (falls and hospitalizations) and logistic regression (death), controlling for covariates.

Greater physical resilience at one month post discharge was significantly associated with less falls, hospitalizations, and death within one year.

This study highlights a particular patient profile, recently discharged older adults living with dementia who have low physical resilience, that could be targeted for intervention when discharged from the hospital.

Objectives Frailty is associated with significant mortality and morbidity in hospitalised patients. We describe physiotherapy and occupational therapy practices in hospitalised frail patients and examine the role of early intervention. Methods We performed a prospective, observational cohort study in a medical assessment unit in a tertiary care hospital. Patients with COVID-19 infection were excluded. Frailty was measured by the Clinical Frailty Scale (CFS). Early allied health intervention was defined as involvement within 48h of admission. Demographic data, clinical diagnoses, time spent with physiotherapy and occupational therapy, CFS, hospital length of stay and outcomes were recorded and analysed. Results A total of 356 patients were categorised into non-frail (CFS score <5) and frail (CFS score ≥5) groups. The prevalence of frailty was 68% (n =241). Physiotherapy (77.2%) and occupational therapy (75.5%) reviews were more frequent in frail patients than in non-frail patients. Frail patients who had allied health involvement within 48h of admission had a significant reduction in their hospital length of stay (mean reduction of 7.3days, 95% CI: 0.53, 14, P =0.035) and a 2.44% reduction in the relative risk of developing pressure injuries (95% CI: 1.31, 4.53). There was no statistically significant differences in outcomes with allied health intervention for non-frail patients and patients who require residential aged care facility level care. Conclusions Allied health have a key role in the management of frailty. Early allied health intervention was associated with a reduced hospital length of stay as well as a reduced incidence of pressure injury in frail patients.

Use of antihypertensive medications could be associated with an increased risk of kidney cancer. Despite their various mechanisms of action, whether this association differs between different classes of medications remains unclear.

The objective of this study is to compare the risk of kidney cancer between first-line treatment options of antihypertensive medications in a hypertensive population.

In this retrospective cohort study, we used the MarketScan Databases (2007-2021). We included individuals older than 30 years of age with a diagnosis of hypertension who received first-line medications for hypertension, which included three classes: angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and dihydropyridine calcium channel blockers (dCCB). We applied a propensity score matching method and created three separate cohorts: (1) ARB versus ACEI, (2) dCCB versus ACEI, and (3) dCCB versus ACEI. For non-dCCB, we repeated the analyses. The primary outcome was kidney cancer incidence. To assess kidney cancer risk, we applied multivariable conditional Cox proportional hazards models.

In the first cohort, ARB use was associated with an increased risk of kidney cancer compared to ACEI use (hazard ratio [HR] 1.10, 95% confidence interval [CI] 1.02-1.18). In the second cohort, dCCB use was associated with an increased risk of kidney cancer compared to ACEI use (HR 1.29, 95% CI 1.18-1.40). In the third cohort, dCCB use was associated with a higher risk of kidney cancer compared to ARB use (HR 1.17, 95% CI 1.08-1.28). Null association was shown when comparing non-dCCB with ACEI or ARB use.

Use of dCCB showed a higher risk of kidney cancer compared to ACEI or ARB use in patients with hypertension.