Characteristics and key differences between patient populations receiving imaging modalities for coronary artery disease diagnosis in the US.

BACKGROUND: There are limited data on the impact of imaging modality selection for the assessment of coronary artery disease (CAD) risk on downstream resource utilisation. This study sought to identify differences between patient populations in the US undergoing stress echocardiography, single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), positron emission tomography (PET) MPI, and coronary computed tomography angiography (cCTA) for the assessment of CAD risk, and associated physician referral patterns. METHODS: Claims and electronic health records data for 2.5 million US patients who received stress echocardiography, cCTA, SPECT MPI or PET MPI between January 2016 and March 2018, from the Decision Resources Group Real-World Evidence US Data Repository, were analysed. Patients were stratified into suspected and existing CAD cohorts, and further stratified by pre-test risk and presence and recency of interventions or acute cardiac events (within 1-2 years pre-index test). Linear and logistic regression were used to compare numeric and categorical variables. RESULTS: Physicians were more likely to refer patients to standalone SPECT MPI (77%) and stress echocardiography (18%) than PET MPI (3%) and cCTA (2%). Overall, 43% of physicians referred more than 90% of their patients to standalone SPECT MPI. Just 3%, 1% and 1% of physicians referred more than 90% of their patients to stress echocardiography, PET MPI or cCTA. At the aggregated imaging level, patients who underwent stress echocardiography or cCTA had similar comorbidity profiles. Comorbidity profiles were also similar for patients who underwent SPECT MPI and PET MPI. CONCLUSION: Most patients underwent SPECT MPI at the index date, with very few undergoing PET MPI or cCTA. Patients who underwent cCTA at the index date were more likely to undergo additional imaging tests compared with those who underwent other imaging modalities. Further evidence is needed to understand factors influencing imaging test selection across patient populations.

High Tibial Osteotomy: An Update for Radiologists.

High tibial osteotomy (HTO) is a surgical procedure to treat symptomatic unicompartmental osteoarthritis (OA) associated with knee malalignment. There has been a recent resurgence of interest in HTO in patients who prefer joint-preserving surgery because HTO shifts the knee's mechanical axis from the arthritic compartment to a neutral position, thereby reducing knee pain, slowing progression of OA, and delaying the need for a total knee arthroplasty. The ideal candidates for HTO are patients who are young, active, and nonobese who have isolated varus deformity of the knee resulting from medial compartment OA. Radiography is critical in the preoperative evaluation for HTO and can help expand surgical indications to include a wider variety of patients. Radiography is also routinely obtained in postoperative assessment and is typically the first test to indicate complications. This review describes the radiologic aspects of HTO, including preoperative imaging assessment and normal and abnormal postoperative imaging appearances. Surgical techniques and osteotomy fixation devices are described, with a focus on the medial opening wedge approach. Given the growing interest in HTO, radiologists should become familiar with the basics of the procedure and the role of imaging in preoperative and postoperative evaluation.

Genome-wide meta-analysis of macronutrient intake of 91,114 European ancestry participants from the cohorts for heart and aging research in genomic epidemiology consortium.

Macronutrient intake, the proportion of calories consumed from carbohydrate, fat, and protein, is an important risk factor for metabolic diseases with significant familial aggregation. Previous studies have identified two genetic loci for macronutrient intake, but incomplete coverage of genetic variation and modest sample sizes have hindered the discovery of additional loci. Here, we expanded the genetic landscape of macronutrient intake, identifying 12 suggestively significant loci (P < 1 × 10-6) associated with intake of any macronutrient in 91,114 European ancestry participants. Four loci replicated and reached genome-wide significance in a combined meta-analysis including 123,659 European descent participants, unraveling two novel loci; a common variant in RARB locus for carbohydrate intake and a rare variant in DRAM1 locus for protein intake, and corroborating earlier FGF21 and FTO findings. In additional analysis of 144,770 participants from the UK Biobank, all identified associations from the two-stage analysis were confirmed except for DRAM1. Identified loci might have implications in brain and adipose tissue biology and have clinical impact in obesity-related phenotypes. Our findings provide new insight into biological functions related to macronutrient intake.

Sex Differences in the Presentation, Care, and Outcomes of Transient Ischemic Attack: Results From the Ontario Stroke Registry.

BACKGROUND AND PURPOSE: Little is known about whether sex differences exist in the presentation, management, and outcomes of transient ischemic attack. METHODS: We conducted a cohort study of 5991 consecutive patients with transient ischemic attack admitted to 11 stroke centers in Ontario, Canada, between July 1, 2003, and March 31, 2008 and compared presenting symptoms, processes of care, and outcomes in women and men. We used linkages to administrative databases to evaluate mortality and recurrent vascular events within 30 days and 1 year of the initial presentation, with multivariable analyses to assess whether sex differences persisted after adjustment for age and comorbid conditions. RESULTS: The most common presenting symptoms for both sexes were weakness, speech impairment, and sensory deficit, with headache being slightly more frequent in women. Women were less likely than men to undergo carotid imaging, carotid endarterectomy, or receive lipid-lowering therapy. One-year mortality was slightly lower in women than in men (adjusted hazard ratio, 0.77; 95% confidence interval, 0.63-0.94). CONCLUSIONS: We found only minor sex differences in the presentation and management of transient ischemic attack, suggesting that current public awareness campaigns focusing on classic warning signs are appropriate for both women and men. Future work should focus on evaluating whether lower rates of carotid imaging, endarterectomy, and lipid-lowering therapy in women reflect undertreatment of women or are appropriate based on patient eligibility.

Understanding the use and tolerance of a pediatric and an adult commercial blenderized enteral formula through real-world data.

BACKGROUND: Home enteral nutrition (HEN) is frequently prescribed to individuals who cannot consume adequate food orally. Commercial blenderized enteral formulas (CBEF) containing real-food ingredients are becoming more popular and more widely available; however, the demographics of patients receiving these formulas have rarely been evaluated, and little data are available on patient tolerance in the community. METHODS: US claims data were obtained for children and adolescents/adults who used the CBEF of interest as the sole source of nutrition via enteral feeding tube in the community setting following discharge from acute care. Demographics, concomitant medications, clinical diagnoses, and Charlson Comorbidity Index scores were tabulated using descriptive statistics. Gastrointestinal (GI) symptoms before and after hospital discharge were compared using significance tests. RESULTS: The study included 231 participants (180 children, 51 adolescents/adults). CBEFs were prescribed to patients with a variety of diagnoses, of which the most common were digestive and respiratory disorders. Children experienced significantly lower rates of diarrhea, nausea, vomiting, constipation, and abdominal distension in the weeks following hospital discharge compared with the baseline (all P < 0.001). Adolescents/adults experienced significantly lower rates of constipation, nausea, and vomiting (all P < 0.05). Neither group increased their usage of GI medications following hospital discharge. CONCLUSION: These CBEFs, based on real-food ingredients, were prescribed to diverse patients in the community and were well tolerated. These formulas offer an alternative to standard polymeric formulas and an alternative or adjunct to homemade blenderized formulas.

Resection of a Large Hemorrhagic Mediastinal Lymphangioma in an Adult Patient: A Radiologic-Pathologic Correlation.

Lymphangiomas are rare benign lesions resulting from abnormal proliferation and sequestration of lymphatic tissues that are disconnected from the rest of the lymphatic system. This is a case of a 50-year-old woman with an unusually large mediastinal lymphangioma complicated by hemorrhage. The substantial mass effect and unstable clinical status necessitated urgent operative management. The use of preoperative multimodality radiologic assessment, including CT and MRI, is illustrated throughout this case. Keywords: CT, MR Imaging, Thorax, Lung © RSNA, 2022.

A Retrospective Real-World Evidence Evaluation of the Characteristics of Exocrine Pancreatic Insufficiency in Patients With Chronic Pancreatitis and Type 2 Diabetes Treated With Pancrelipase in the United States.

OBJECTIVES: This retrospective real-world data analysis assessed clinical/health care professional characteristics of gastrointestinal symptom profiles in pancrelipase-treated patients with exocrine pancreatic insufficiency symptoms and chronic pancreatitis (CP) or type 2 diabetes (T2D). METHODS: Data were from the Decision Resources Group Real-World Evidence Data Repository US database. Patients 18 years and older receiving pancrelipase (Zenpep) between index dates August 2015 and June 2020 were included. Gastrointestinal symptoms were assessed 6, 12, and 18 months post-index versus baseline. RESULTS: A total of 10,656 pancrelipase-treated patients with CP (n = 3215) or T2D (n = 7441) were identified. Significant/sustained reductions in gastrointestinal symptoms were observed in both cohorts after pancrelipase treatment (P < 0.001) versus baseline. Significantly fewer patients with CP compliant with treatment for more than 270 days (n = 1553) reported abdominal pain (P < 0.001) and nausea/vomiting (P < 0.05) versus those compliant for less than 90 days (n = 1115). Significantly fewer patients with T2D compliant with treatment for more than 270 days (n = 2964) reported abdominal pain (P < 0.001) and diarrhea/steatorrhea (P < 0.05) versus those compliant for less than 90 days (n = 2959). CONCLUSIONS: Pancrelipase reduced exocrine pancreatic insufficiency symptoms in patients with CP or T2D, with greater treatment compliance associated with improved gastrointestinal symptom profiles.

Women in Interventional Radiology: Exploring the Gender Disparity in Canada.

Women now comprise half of medical students in Canada yet continue to be underrepresented in general radiology and its subspecialties. The underrepresentation of women in interventional radiology is even more profound. The literature has suggested various factors that might contribute to this gender disparity, including a lack of role models and mentors, exposure during early medical training, and decisions regarding work-life balance. This article explores the gender disparity among Canadian interventional radiologists, highlights the attrition of women through their radiology training, and discusses recruitment strategies to increase diversity in this rewarding field.

Evaluation of ceiling lifts in health care settings: patient outcome and perceptions.

Ceiling lifts have been introduced into health care settings to reduce manual patient lifting and thus occupational injuries. Although growing evidence supports the effectiveness of ceiling lifts, a paucity of research links indicators, such as quality of patient care or patient perceptions, to the use of these transfer devices. This study explored the relationship between ceiling lift coverage rates and measures of patient care quality (e.g., incidence of facility-acquired pressure ulcers, falls, urinary infections, urinary incontinence, and assaults [patient to staff] in acute and long-term care facilities), as well as patient perceptions of satisfaction with care received while using ceiling lifts in a complex care facility. Qualitative semi-structured interviews were used to generate data. A significant inverse relationship was found between pressure ulcer rates and ceiling lift coverage; however, this effect was attenuated by year. No significant relationships existed between ceiling lift coverage and patient outcome indicators after adding the "year" variable to the model. Patients generally approved of the use of ceiling lifts and recognized many of the benefits. Ceiling lifts are not detrimental to the quality of care received by patients, and patients prefer being transferred by ceiling lifts. The relationship between ceiling lift coverage and pressure ulcer rates warrants further investigation.

Evaluation of ceiling lifts: transfer time, patient comfort and staff perceptions.

Mechanical lifting devices have been developed to reduce healthcare worker injuries related to patient handling. The purpose of this study was to evaluate ceiling lifts in comparison to floor lifts based on transfer time, patient comfort and staff perceptions in three long-term care facilities with varying ceiling lift coverage. The time required to transfer or reposition patients along with patient comfort levels were recorded for 119 transfers. Transfers performed with ceiling lifts required on average less time (bed to chair transfers: 156.9 seconds for ceiling lift, 273.6 seconds for floor lift) and were found to be more comfortable for patients. In the three facilities, 143 healthcare workers were surveyed on their perceptions of patient handling tasks and equipment. For both transferring and repositioning tasks, staff preferred to use ceiling lifts and also found them to be less physically demanding. Further investigation is needed on repositioning tasks to ensure safe practice.