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Health care utilisation and costs associated with different treatment protocols for newly diagnosed childhood acute lymphoblastic leukaemia: A population-based study in Ontario, Canada.

Eur J Cancer 2021 May 9;151:126-135. Epub 2021 May 9.

Institute for Health Policy, Evaluation and Management, University of Toronto, 155 College St, Toronto, ON, M5T 3MG, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, M4N 3M5, Canada; Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada.

Background: Although different treatment protocols for childhood acute lymphoblastic leukaemia (ALL) all achieve high cure rates, their health care utilisation and costs have not been rigorously compared.

Methods: Disease, treatment, and outcome data were chart abstracted for all children with ALL in Ontario, Canada, diagnosed 2002-2012. Linkage to population-based databases identified health care utilisation. Read More

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Fate of Preserved Aortic Root Following Acute Type A Aortic Dissection Repair.

Semin Thorac Cardiovasc Surg 2021 May 9. Epub 2021 May 9.

Aortic Institute at Yale New-Haven, Yale University School of Medicine, New Haven, CT, USA. Electronic address:

We examined the long-term fate of the preserved aortic root after emergent repair of acute Type A aortic dissection. 144 patients (60% males, mean age 60.5 years) underwent supracoronary ascending aortic replacement for acute Type A aortic dissection. Read More

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Industry Sectors Highly Affected by Worksite Outbreaks of Coronavirus Disease, Los Angeles County, California, USA, March 19-September 30, 2020.

Emerg Infect Dis 2021 May 12;27(7). Epub 2021 May 12.

Worksites with on-site operations have experienced coronavirus disease (COVID-19) outbreaks. We analyzed data for 698 nonresidential, nonhealthcare worksite COVID-19 outbreaks investigated in Los Angeles County, California, USA, during March 19, 2020‒September 30, 2020, by using North American Industry Classification System sectors and subsectors. Nearly 60% of these outbreaks occurred in 3 sectors: manufacturing (n = 184, 26. Read More

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Positioning As-needed Budesonide-Formoterol for Mild Asthma: Effect of Pre-study Treatment in Pooled Analysis of SYGMA 1 and 2.

Ann Am Thorac Soc 2021 May 12. Epub 2021 May 12.

Woolcock Institute of Medical Research, University of Sydney, Dept of Respiratory Medicine, Royal Prince Alfred Hospital, Sidney, New South Wales, Australia.

Rationale: The SYGMA studies evaluated the efficacy and safety of as-needed budesonide-formoterol (BUD-FORM) in patients whose asthma was uncontrolled on as-needed inhaled short-acting bronchodilators (Subgroup 1) or controlled on inhaled corticosteroid (ICS) or leukotriene receptor antagonist (Subgroup 2).

Objective: To assess the influence of pre-study treatment in a post hoc analysis of the SYGMA studies.

Methods: In the SYGMA 1 (NCT022149199) and SYGMA 2 (NCT02224157) 52-week, double-blind, randomized, parallel-group studies, 6,735 mild asthma patients were randomized to as-needed BUD-FORM, low-dose budesonide + as-needed terbutaline (BUD maintenance), or as-needed terbutaline (SYGMA 1 only). Read More

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Endocystectomy as a conservative surgical treatment for hepatic cystic echinococcosis: A systematic review with single-arm meta-analysis.

PLoS Negl Trop Dis 2021 May 12;15(5):e0009365. Epub 2021 May 12.

Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.

Background: In patients with hepatic cystic echinococcosis (CE), treatment effectiveness, outcomes, complications, and recurrence rate are controversial. Endocystectomy is a conservative surgical approach that adequately removes cyst contents without loss of parenchyma. This conservative procedure has been modified in several ways to prevent complications and to improve surgical outcomes. Read More

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Topical oxygen therapy in the treatment of diabetic foot ulcers: a multicentre, open, randomised controlled clinical trial.

J Wound Care 2021 May;30(Sup5):S7-S14

Cardiff University, UK.

Objectives: Perfusion and blood oxygen levels are frequently insufficient in patients with hard-to-heal wounds due to poor circulation, vascular disruption and vasoconstriction, reducing the wound's capacity to heal. This study aimed to investigate the effect of topical oxygen on healing rates in patients with hard-to-heal diabetic foot ulcers (DFUs) (i.e. Read More

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Evolution of Disparities in Prostate Cancer Treatment: Is This a New Normal?

Am Soc Clin Oncol Educ Book 2021 Mar;41:1-12

Winship Cancer Institute, Emory University, Atlanta, GA.

Despite notable screening, diagnostic, and therapeutic advances, disparities in prostate cancer incidence and outcomes remain prevalent. Although commonly discussed in the context of men of African descent, disparities also exist based on socioeconomic level, education level, and geographic location. The factors in these disparities span systemic access issues affecting availability of care, provider awareness, and personal patient views and mistrust. Read More

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Surgical Results of Ahmed Glaucoma Valve Implantation in One-Chamber Eyes.

J Glaucoma 2021 May 12. Epub 2021 May 12.

Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan (Tanito, Tsutsui), Division of Ophthalmology, Matsue Red Cross Hospital, Matsue, Japan (Manabe, Matsuoka).

Prcis: Ahmed Glaucoma Valve implantation in eyes with damaged iris-lens diaphragms ("one-chamber" eyes) resulted in mean intraocular pressure and antiglaucoma medications decreases of 66% and 59% (P<0.0001 for both), respectively, at the mean 23-month follow-up.

Purpose: To report the results of Ahmed Glaucoma Valve (AGV) implantation with pars plana tube insertion to control intraocular pressure (IOP) in glaucomatous eyes with damaged iris-lens diaphragms ("one-chamber" eyes). Read More

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Value of transcranial color-code Doppler in evaluating intracranial atherosclerotic stenosis in patients with diabetes mellitus type 2: a comparison of transcranial Doppler and computed tomography angiography.

Minerva Endocrinol (Torino) 2021 May 12. Epub 2021 May 12.

Department of Physical Examination, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China -

Background: There are several imaging assessment methods for intracranial atherosclerotic stenosis (ICAS). This study investigated the most efficient method by which to diagnose ICAS in patients with diabetes mellitus.

Methods: One hundred seven patients with type 2 diabetes mellitus were enrolled as the experimental group and 68 healthy subjects were designated as the control group. Read More

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Measuring quality of hepatitis B care in a remote Australian Aboriginal community; opportunities for improvement.

Intern Med J 2021 May 12. Epub 2021 May 12.

Hepatology and Liver Transplantation Medicine Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia.

Background: Chronic hepatitis B (CHB) infection remains a significant public health issue for Indigenous Australians, in particular for remote communities.

Aim: This study aimed to evaluate the spectrum of hepatitis B virus (HBV) care provided to a remote Aboriginal community. Measures studied included screening, seroprevalence, vaccination rates and efficacy, and HCC risk and surveillance adherence. Read More

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Economic impact on direct healthcare costs of missing opportunities for diagnosing HIV within healthcare settings.

HIV Med 2021 May 12. Epub 2021 May 12.

Southern Alberta Clinic, Calgary, AB, Canada.

Background: The economic consequences of a missed opportunity for HIV testing at an earlier stage of infection within a healthcare setting are poorly described.

Methods: For all newly diagnosed HIV patients followed at the Southern Alberta HIV/AIDS Clinic (SAC), Calgary, Canada, between 1 April 2011 and 1 April 2016, all clinical encounters occurring < 3 years prior to diagnosis within the region were obtained. The direct costs of HIV care after diagnosis to 31 March 2019 were determined from a payers' perspective and reported as mean cost per patient per month (PPPM) in 2019 Canadian dollars (CDN$). Read More

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Real-World Treatment Escalation from Metformin Monotherapy in Youth-Onset Type 2 Diabetes Mellitus: A Retrospective Cohort Study.

Pediatr Diabetes 2021 May 12. Epub 2021 May 12.

Division of Endocrinology & Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Background: Due to high rates of comorbidities and rapid progression, youth with type 2 diabetes may benefit from early and aggressive treatment. However, until 2019, the only approved medications for this population were metformin and insulin.

Objective: To investigate patterns and predictors of treatment escalation within 5 years of metformin monotherapy initiation for youth with type 2 diabetes in clinical practice. Read More

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Pangenotypic direct-acting antiviral agents for mixed genotype hepatitis C infection: A real-world effectiveness analysis.

J Gastroenterol Hepatol 2021 May 12. Epub 2021 May 12.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.

Background: Pangenotypic direct-acting antiviral agents (DAAs) glecaprevir/pibrentasvir (GLE/PIB) and sofosbuvir/velpatasvir (SOF/VEL) are effective against all hepatitis C virus (HCV) genotype infections. However, data on pangenotypic DAA treatment for mixed genotype HCV infection are sparse.

Methods: This is a retrospective, single site cohort study analyzing all patients with mixed HCV genotype infections treated with GLE/PIB or SOF/VEL from August 2018 to August 2020 in Chiayi Chang Gung Memorial Hospital, Taiwan. Read More

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Detection of microaneurysms and hemorrhages based on improved Hessian matrix.

Int J Comput Assist Radiol Surg 2021 May 12. Epub 2021 May 12.

School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China.

Purpose: Knowing the early lesion detection of fundus images is very important to prevent blindness, and accurate lesion segmentation can provide doctors with diagnostic evidence. This study proposes a method based on improved Hessian matrix eigenvalue analysis to detect microaneurysms and hemorrhages in the fundus images of diabetic patients.

Methods: A two-step method including identification of lesion candidate regions and classification of candidate regions is adopted. Read More

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Non-dynamic graciloplasty is an effective treatment for patients with passive fecal incontinence.

Tech Coloproctol 2021 May 12. Epub 2021 May 12.

Department of Surgery, Groene Hart Ziekenhuis, Bleulandweg 10, 2803 HH, Gouda, The Netherlands.

Background: Fecal incontinence is a multifactorial problem and its etiology is complex. Various therapies are available and different success rates have been described. The aim of this study was to assess the effectiveness and safety of non-dynamic graciloplasty in patients with passive fecal incontinence. Read More

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Preoperative REM sleep is associated with complication development after colorectal surgery.

Surg Endosc 2021 May 12. Epub 2021 May 12.

Department of Surgery, University of Virginia Health System, Charlottesville, USA.

Background: While total sleep duration and rapid eye movement (REM) sleep duration have been associated with long-term mortality in non-surgical cohorts, the impact of preoperative sleep on postoperative outcomes has not been well studied.

Methods: In this secondary analysis of a prospective observational cohort study, patients who recorded at least 1 sleep episode using a consumer wearable device in the 7 days before elective colorectal surgery were included. 30-day postoperative outcomes among those who did and did not receive at least 6 h of total sleep, as well as those who did and did not receive at least 1 h of rapid eye movement (REM) sleep, were compared. Read More

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Infection prevention plan to decrease surgical site infections in bariatric surgery patients.

Surg Endosc 2021 May 12. Epub 2021 May 12.

Department of Surgery, Washington University, Saint Louis, USA.

Background: Surgical site infections (SSI) are one of the most common complications of bariatric surgery. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement (QI) Program (MBSAQIP) allows accredited programs to develop processes for quality improvement based on data collection. The objective of this study was to decrease SSI rates in patients undergoing bariatric surgery at an accredited MBSAQIP center. Read More

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Convalescent plasma therapy and mortality in COVID-19 patients admitted to the ICU: a prospective observational study.

Ann Intensive Care 2021 May 12;11(1):73. Epub 2021 May 12.

Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria.

Background: This study aimed to quantify the potential survival benefit of convalescent plasma therapy (CVP) in critically ill patients with acute respiratory failure related to coronavirus disease-2019 (COVID-19).

Methods: This is a single-center prospective observational cohort study in COVID-19 patients with acute respiratory failure. Immediately after intensive care unit (ICU) admission patients were allocated to CVP treatment following pre-specified criteria to rapidly identify those patients potentially susceptible for this treatment. Read More

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Survival advantage of Asian metastatic prostate cancer patients treated with external beam radiotherapy over other races/ethnicities.

World J Urol 2021 May 12. Epub 2021 May 12.

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.

Purpose: To assess the effect of race/ethnicity in cancer-specific mortality (CSM) adjusted for other-cause mortality (OCM) in metastatic prostate cancer patients (mPCa) treated with external beam radiotherapy (EBRT) to the prostate.

Methods: We relied on the Surveillance, Epidemiology, and End Results (SEER) database to identify Caucasian, African-American, Hispanic/Latino and Asian mPCa patients treated by EBRT between 2004 and 2016. Cumulative incidence plots displayed CSM after adjustment for OCM according to race/ethnicity. Read More

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A call for HoLEP: AEEP for mega-prostates (≥ 200 cc).

World J Urol 2021 May 12. Epub 2021 May 12.

Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.

Purpose: To evaluate the efficiency and efficacy of HoLEP, and methods of tissue retrieval, in patients with prostate volume (PV) ≥ 200 cc (Group 1) and to compare these to patients with PV 80-199 cc (Group 2).

Methods: A database of all cases performed under the care of two surgeons at a tertiary HoLEP centre was reviewed.

Results: 157 patients with PV ≥ 200 cc were compared to 157 of the most recent consecutive cases with PV 80-199 cc. Read More

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Incorporating Present-on-Admission Indicators in Medicare Claims to Inform Hospital Quality Measure Risk Adjustment Models.

JAMA Netw Open 2021 May 3;4(5):e218512. Epub 2021 May 3.

Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut.

Importance: Present-on-admission (POA) indicators in administrative claims data allow researchers to distinguish between preexisting conditions and those acquired during a hospital stay. The impact of adding POA information to claims-based measures of hospital quality has not yet been investigated to better understand patient underlying risk factors in the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision setting.

Objective: To assess POA indicator use on Medicare claims and to assess the hospital- and patient-level outcomes associated with incorporating POA indicators in identifying risk factors for publicly reported outcome measures used by the Centers for Medicare & Medicaid Services (CMS). Read More

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Intrathoracic vs Cervical Anastomosis After Totally or Hybrid Minimally Invasive Esophagectomy for Esophageal Cancer: A Randomized Clinical Trial.

JAMA Surg 2021 May 12. Epub 2021 May 12.

Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.

Background: Transthoracic minimally invasive esophagectomy (MIE) is increasingly performed as part of curative multimodality treatment. There appears to be no robust evidence on the preferred location of the anastomosis after transthoracic MIE.

Objective: To compare an intrathoracic with a cervical anastomosis in a randomized clinical trial. Read More

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Understanding the Meaning of Recovery to Patients Undergoing Abdominal Surgery.

JAMA Surg 2021 May 12. Epub 2021 May 12.

Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Québec, Canada.

Importance: Postoperative recovery is difficult to define or measure. Research addressing interventions aimed to improve recovery after abdominal surgery often focuses on measures such as duration of hospital stay and complication rates. Although these clinical parameters are relevant, understanding patients' perspectives regarding postoperative recovery is fundamental to guiding patient-centered care. Read More

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Seatbelts Save Lives, and Spines, in Motor Vehicle Accidents: A Review of the National Trauma Data Bank in the Pediatric Population.

Spine (Phila Pa 1976) 2021 Apr 12. Epub 2021 Apr 12.

Cohen Children's Medical Center, New Hyde Park, NY New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY Texas Back Institute, Plano, TX Plainview Hospital, Northwell Health, Plainview, NY Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY Department of Surgery, Hofstra Northwell School of Medicine, Cohen Children's Medical Center, New Hyde Park, NY.

Study Design: Database Study.

Objective: The purpose of this study was to use a large, nationwide database to determine prevalence of pediatric spine fractures in the US, associated injuries, mechanisms of injury, use of safety devices and mortality rates.

Summary Of Background Data: Spinal fractures account for 1- 2% of pediatric injuries. Read More

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Transplants for Acute Alcoholic Hepatitis: Controversies and Early Successes.

Clin Liver Dis 2021 Feb 17;25(1):229-252. Epub 2020 Oct 17.

Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 4th Floor MFCB, 1685 Highland Avenue, Madison, WI 53705, USA. Electronic address:

Liver transplant for severe alcohol-associated hepatitis remains a controversial practice despite evidence for a substantial survival benefit compared with medical therapy and posttransplant alcohol relapse rates comparable with previously published studies in alcohol-associated cirrhosis. The controversy stems in part from concern regarding patient selection practices, lack of long-term follow-up data, and the potential negative public perception of the practice affecting organ donation. Despite these concerns, it seems that early liver transplant for alcohol-associated hepatitis is increasingly being offered to selected patients across the United States and the world. Read More

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February 2021

From cellular function to global impact: the vascular perspective on COVID-19.

Can J Surg 2021 05 12;64(3):E289-E297. Epub 2021 May 12.

From the Division of Vascular Surgery, University of Ottawa at The Ottawa Hospital, Ottawa, Ont. (Strauss, Jetty); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Strauss, Seo, Carrier, Jetty); the Division of Hematology, Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. (Carrier); and the Ottawa Hospital Research Institute, Ottawa, Ont. (Carrier).

Since COVID-19 was declared a pandemic a year ago, our understanding of its effects on the vascular system has slowly evolved. At the cellular level, SARS-CoV-2 - the virus that causes COVID-19 - accesses the vascular endothelium through the angiotensin-converting enzyme 2 (ACE-2) receptor and induces proinflammatory and prothrombotic responses. At the clinical level, these pathways lead to thromboembolic events that affect the pulmonary, extracranial, mesenteric, and lower extremity vessels. Read More

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Perceptions, professional responsibility and management experiences of patients with alcohol, tobacco and opioid use disorder by residents in general practice and teaching general practitioners.

Eur J Gen Pract 2021 Dec;27(1):77-82

Département Universitaire de Médecine Générale, Université de Toulouse III Paul Sabatier, Faculté de Médecine, Toulouse, France.

Background: Substance use disorders (SUDs) are based on pathophysiological mechanisms common to all psychoactive substances. However, general practitioners (GPs) hold different views depending on the substance in question.

Objectives: To determine whether the perceptions that teaching GPs and final-year residents in general practice have of patients with a SUD vary according to the substance involved and explore their professional responsibility and management experiences. Read More

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December 2021

Thirty-day outcomes in frail older patients discharged home from the emergency department with acute heart failure: effects of high-risk criteria identified by the DEED FRAIL-AHF trial.

Emergencias 2021 Jun;33(3):165-173

Área de Urgencias, Hospital Clínic, Barcelona, Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España.

Objectives: To study the effect of high-risk criteria on 30-day outcomes in frail older patients with acute heart failure (AHF) discharged from an emergency department (ED) or an ED's observation and short-stay areas.

Material And Methods: Secondary analysis of discharge records in the Older AHF Key Data registry. We selected frail patients (aged > 70 years) discharged with AHF from EDs. Read More

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Outcomes among acute heart failure emergency department patients by preserved vs. reduced ejection fraction.

ESC Heart Fail 2021 May 12. Epub 2021 May 12.

Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.

Aims: This study aimed to assess short-term outcomes among emergency department (ED) patients with acute heart failure (AHF) by preserved (≥50%) vs. reduced (<50%) ejection fraction (EF).

Methods And Results: We conducted a retrospective, multicentre study of adult ED patients with AHF from 2017 to 2018 in an integrated healthcare system with 21 hospitals. Read More

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New Normal.

Colorectal Dis 2021 May 12. Epub 2021 May 12.

Department of Surgery, Elisabeth - TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands.

We read with great interest the recent study by Mirza et al. We would like to applaud the authors for their extensive analysis of the results of 150 consecutive Hartmann's reversal (HR) procedures in two academic tertiary referral centers between 2010-2019. In a study group with majority of open index cases (93. Read More

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