Outcomes and resource utilization in calcium pyrophosphate deposition disease patients who underwent total knee arthroplasty: a cross-sectional analysis.

This cross-sectional study aims to evaluate the predictors, outcomes, and resource utilization of total knee arthroplasty (TKA) in calcium pyrophosphate deposition disease (CPPD) patients. We used the US National Inpatient Sample database to identify CPPD and non-CPPD who underwent TKA from 2006 to 2014. Data collection included patient demographics and comorbidities. Outcomes following TKA included in-hospital mortality, complications, length of hospitalization, hospital charges, and disposition. Among the 5,564,005 patients who have undergone TKA, 11,529 (0.20%) had CPPD, with a median age of 72 years, and 53.7% were females. Compared with non-CPPD, patients with CPPD were more likely to be older (mean 72 vs 66 years; p < 0.001), male, white, and have Medicare insurance. CPPD patients were more likely to have ≥ 2 comorbidities calculated by the Charlson Comorbidity Index and discharge to an inpatient/rehabilitation facility. Regarding inpatient complications, myocardial infarction and knee reoperation were significantly more common in CPPD patients. TKA in CPPD patients was associated with significantly higher odds of increased length of stay (> 3 days) than those without CPPD (OR 1.43, 95% CI 1.37-1.49). There was no significant difference in the in-hospital mortality even after adjusting for possible confounders. CPPD patients who underwent TKA were more likely to have a longer hospital stay and discharge to a non-home setting than non-CPPD. Also, CPPD patients had a higher comorbidity burden and risk for myocardial infarction and reoperation.Key Points• This is the largest study to analyze data of CPPD patients who underwent TKA and compare them with non-CPPD patients, using a large nationwide database.• Compared to non-CPPD patients, TKA in CPPD patients is associated with a greater length of stay and disposition to a nursing/rehabilitation facility.• In-hospital complications such as myocardial infarction and reoperation were more frequently observed in CPPD patients than non-CPPD.• The results of this study should alert healthcare providers to develop strategies in order to improve outcomes of CPPD patients undergoing TKA.

Factors Associated with Survival of Hepatocellular Carcinoma (HCC) Patients at a Safety Net Hospital in Arizona without On-Site Liver Transplant Program.

BACKGROUND: With the rising incidence of hepatocellular carcinoma (HCC), ongoing efforts should be focused on providing equitable and state-of-the-art care to patients. PURPOSE: The aim of this study was to determine the survival of patients with HCC seen at a high-proportion Safety Net Hospital (h-SNH), where loco-regional therapy and hepatology services are available and liver transplantation (LT) is referred to outside facilities. PATIENTS AND METHODS: A retrospective cohort study was conducted on all patients with HCC seen at Valley Wise Health Center (VWHC) over a ten-year period. Clinical variables, treatment modalities, survival duration, hospice, and LT referrals of 161 patients were collected from the medical records. Survival analysis was used to determine the relationship of clinically relevant variables and survival among patients with HCC. A Log rank test was used to compare univariate variables. A Cox regression analysis was used to compare and control for multiple variables. RESULTS: Of the 161 patients included in the study, 33% were uninsured. The median age was 59 (21 to >89) years with 47% Hispanic, 31% Caucasian, 15% African American and 7% other races included for the analysis. The median survival for the cohort was 20.1 months. In the multivariate model, insurance status, final MELD, tumor within the Milan criteria and having received treatment for HCC were associated with survival. Surveillance for HCC was associated with HCC in the univariate analysis, but not in the multivariable model. Thirty percent of patients were referred for LT and 1.25% of the entire cohort received it. CONCLUSION: Despite the availability of treatment modalities available for HCC at VWHC and the option of liver transplantation for appropriate candidates at outside centers, OS was less than reported from programs with on-site liver transplant programs. Reasons for lower survival in centers without liver transplant programs should be further studied.

Severe acute respiratory syndrome coronavirus 2: a canary in the coal mine for public safety net hospitals.

BACKGROUND: The coronavirus disease 2019 pandemic has exposed disproportionate health inequities among underserved populations, including refugees. Public safety net healthcare systems play a critical role in facilitating access to care for refugees and informing coordinated public health prevention and mitigation efforts during a pandemic. OBJECTIVE: This study aimed to evaluate the prevalence ratios of severe acute respiratory syndrome coronavirus 2 infection between refugee women and nonrefugee parturient patients admitted to the hospital for delivery. Here, we suspected that the burden of infection was disproportionately distributed across refugee communities that may act as sentinels for community outbreaks. STUDY DESIGN: A cross-sectional study was conducted examining parturient women admitted to the maternity unit between May 6, 2020, and July 22, 2020, when universal testing for severe acute respiratory syndrome coronavirus 2 was first employed. Risk factors for severe acute respiratory syndrome 2 positivity were ascertained, disaggregated by refugee status, and other clinical and sociodemographic variables examined. Prevalence ratios were calculated and comparisons made to county-level community prevalence over the same period. RESULTS: The positive test percentage at the county-level during this study period was 21.6%. Of 350 women admitted to the hospital for delivery, 33 (9.4%) tested positive for severe acute respiratory syndrome 2. When refugee status was determined, 45 women (12.8%) were identified as refugees. Of the 45 refugee women, 8 (17.8%) tested positive for severe acute respiratory syndrome 2 compared with 25 nonrefugee patients (8.19%) who tested positive for severe acute respiratory syndrome 2 (prevalence ratio, 2.16; 95% confidence interval, 1.04-4.51). In addition, 7 of the refugee women who tested positive for severe acute respiratory syndrome coronavirus 2 were from Central Africa. CONCLUSION: The severe acute respiratory syndrome coronavirus 2 outbreak has disproportionately affected refugee populations. This study highlighted the utility of universal screening in mounting a rapid response to an evolving pandemic and how we can better serve refugee communities. Focused response may help achieve more equitable care related to severe acute respiratory syndrome 2 among vulnerable communities. The identification of such populations may help mitigate the spread of the disease and facilitate a timely, culturally, and linguistically enhanced public health response.

Perceptions of veterinarians and producers concerning Johne's disease prevalence and control in US beef cow-calf operations.

BACKGROUND: Efforts to educate producers and veterinarians in the United States regarding the management, prevention and control of Mycobacterium avium subspecies paratuberculosis (MAP) infection have increased over recent years. While nationwide awareness about MAP infection is improving, current level of awareness among beef producers and veterinarians is largely unknown. This study compares the perceptions of beef producers and veterinarians on the burden of MAP infection in cow-calf herds and on measures to control new infections. Questionnaires were mailed to 989 US beef producers through state Designated Johne's Coordinators and to 1080 bovine veterinarians belonging to a US nationwide professional association. RESULTS: Twenty-two percent (34/155) of producers reported having infected animals in their herds. The mean (minimum, median, maximum) prevalence reported by producers was 0.8% (0, 0, 10). Twenty-seven percent (27/100) of producers had at least one clinical animal during the previous year. Compared to the small herds (<50 head), the mean test-positive percentages and estimated prevalences were higher in medium (50-149) and highest in large (≥150) herds. Seedstock herds had a lower prevalence and these producers were more likely to enroll in Johne's disease (JD) control programs and test their herds. Veterinarians reported a mean overall animal level prevalence in their client herds of 5% (0, 2, 60). Similarly, 26% (0, 10, 100) of client herds had at least one infected animal. Mean percentage of infected cows within infected herds was 9% (0.01, 5, 80). Producers generally performed activities to control MAP transmission more frequently than perceived by veterinarians. Compared to veterinarians' opinions, producers were less likely to cull cows with signs consistent with JD (P < 0.01), but more likely to test purchased additions (P < 0.01). Testing recommendations by veterinarians (n = 277) for beef cow-calf herds were bacterial culture of feces (3%), PCR (14%), ELISA (35%) and a combination of these tests (47%). Seventy-nine percent of veterinarians recommended a 12-month interval between testing. CONCLUSIONS: Seedstock producers who had had JD risk assessments performed on their farms were more supportive of JD control programs and had a correspondingly lower prevalence. It is important to increase educational activities to provide relevant information to veterinarians and producers for better management and control of JD. Educational programs should target larger herds to maximize the impact.

Comparison of calf weaning weight and associated economic variables between beef cows with and without serum antibodies against or isolation from feces of Mycobacterium avium subsp paratuberculosis.

OBJECTIVE: To compare calf weaning weight and associated economic variables for beef cows with serum antibodies against Mycobacterium avium subsp paratuberculosis (MAP) or from which MAP was isolated from feces with those for cows that were seronegative for antibodies against or culture negative for MAP. DESIGN: Retrospective study. ANIMALS: 4,842 beef cows from 3 herds enrolled in the USDA National Johne's Disease Demonstration Herd Project. PROCEDURES: Individual cow ELISA and culture results were obtained from the project database. During each parity evaluated for each cow, the 205-day adjusted weaning weight (AWW) of its calf was calculated. The AWW was compared between test-positive and test-negative cows by use of multilevel mixed-effect models. The median value for feeder calves from 2007 to 2011 was used to estimate the economic losses associated with MAP test-positive cows. RESULTS: The AWW of calves from cows with strongly positive ELISA results was 21.48 kg (47.26 lb) less than that of calves from cows with negative ELISA results. The AWW of calves from cows classified as heavy or moderate MAP shedders was 58.51 kg (128.72 lb) and 40.81 kg (89.78 lb) less, respectively, than that of calves from MAP culture-negative cows. Associated economic losses were estimated as $57.49/calf for cows with strongly positive ELISA results and $156.60/calf and $109.23/calf for cows classified as heavy and moderate MAP shedders, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Calves from cows with MAP-positive test results had significantly lower AWWs than did calves from cows with MAP-negative test results, which translated into economic losses for MAP-infected beef herds.

Perceptions of veterinarians in bovine practice and producers with beef cow-calf operations enrolled in the US Voluntary Bovine Johne's Disease Control Program concerning economic losses associated with Johne's disease.

This study compares the perceptions of producers and veterinarians on the economic impacts of Mycobacterium avium subspecies paratuberculosis (MAP) infection in cow-calf herds. Questionnaires were mailed to beef producers through the Designated Johne's Coordinators and to veterinarians belonging to a nationwide professional organization. Important components of losses associated with MAP infected cows were used to estimate total loss per infected cow-year using an iterative approach based on collected survey data. Veterinarians were more likely to perceive a lower calving percentage in MAP infected cows compared to producers (P=0.02). Income lost due to the presence of Johne's disease (JD) in an infected cattle herd was perceived to be higher by veterinarians (P<0.01). Compared to veterinarians without JD certification, seedstock producers were more likely to perceive genetic losses due to culling cows positive for MAP (P<0.01). There were mixed opinions regarding the magnitude of lowered weaning weight in calves from infected cows and perceived differences in risk of other diseases or conditions in infected cows. An annual loss of $235 (95% CR: $89-$457) for each infected animal was estimated based on information from the producer survey. The analogous estimate using information inputs from veterinarians was $250 ($82-$486). Mean annual loss due to JD in a 100 cow herd with a 7% true prevalence was $1644 ($625-$3250) based on information provided by producers. Similarly, mean annual loss based on information collected from veterinarians was $1747 ($575-$3375).