Lung Cancer Screening in Clinical Practice: A 5-Year Review of Frequency and Predictors of Lung Cancer in the Screened Population.

PURPOSE: The aims of this study were to evaluate (1) frequency, type, and lung cancer stage in a clinical lung cancer screening (LCS) population and (2) the association between patient characteristics and Lung CT Screening Reporting & Data System (Lung-RADS®) with lung cancer diagnosis. METHODS: This retrospective study enrolled individuals undergoing LCS between January 1, 2015, and June 30, 2020. Individuals' sociodemographic characteristics, Lung-RADS scores, pathology-proven lung cancers, and tumor characteristics were determined via electronic health record and the health system's tumor registry. Associations between the outcome of lung cancer diagnosis within 1 year after LCS and covariates of sociodemographic characteristics and Lung-RADS score were determined using logistic regression. RESULTS: Of 3,326 individuals undergoing 5,150 LCS examinations, 102 (3.1%) were diagnosed with lung cancer within 1 year of LCS; most of these cancers were screen detected (97 of 102 [95.1%]). Over the study period, there were 118 total LCS-detected cancers in 113 individuals (3.4%). Most LCS-detected cancers were adenocarcinomas (62 of 118 [52%]), 55.9% (65 of 118) were stage I, and 16.1% (19 of 118) were stage IV. The sensitivity, specificity, positive predictive value, and negative predictive value of Lung-RADS in diagnosing lung cancer within 1 year of LCS were 93.1%, 83.8%, 10.6%, and 99.8%, respectively. On multivariable analysis controlling for sociodemographic characteristics, only Lung-RADS score was associated with lung cancer (odds ratio for a one-unit increase in Lung-RADS score, 4.68; 95% confidence interval, 3.87-5.78). CONCLUSIONS: The frequency of LCS-detected lung cancer and stage IV cancers was higher than reported in the National Lung Screening Trial. Although Lung-RADS was a significant predictor of lung cancer, the positive predictive value of Lung-RADS is relatively low, implying opportunity for improved nodule classification.

Prognostic Model for Intracranial Progression after Stereotactic Radiosurgery: A Multicenter Validation Study.

Stereotactic radiosurgery (SRS) is a standard of care for many patients with brain metastases. To optimize post-SRS surveillance, this study aimed to validate a previously published nomogram predicting post-SRS intracranial progression (IP). We identified consecutive patients completing an initial course of SRS across two institutions between July 2017 and December 2020. Patients were classified as low- or high-risk for post-SRS IP per a previously published nomogram. Overall survival (OS) and freedom from IP (FFIP) were assessed via the Kaplan−Meier method. Assessment of parameters impacting FFIP was performed with univariable and multivariable Cox proportional hazard models. Among 890 patients, median follow-up was 9.8 months (95% CI 9.1−11.2 months). In total, 47% had NSCLC primary tumors, and 47% had oligometastatic disease (defined as ≤5 metastastic foci) at the time of SRS. Per the IP nomogram, 53% of patients were deemed high-risk. For low- and high-risk patients, median FFIP was 13.9 months (95% CI 11.1−17.1 months) and 7.6 months (95% CI 6.4−9.3 months), respectively, and FFIP was superior in low-risk patients (p < 0.0001). This large multisite BM cohort supports the use of an IP nomogram as a quick and simple means of stratifying patients into low- and high-risk groups for post-SRS IP.

Language proficiency and biologics access: a population study of psoriasis patients in the United States.

BACKGROUND: Language proficiency plays an important role in healthcare choices and access. Differences in access to biologic medications exist, but it is unknown how much English proficiency influences access in US psoriasis patients. OBJECTIVE: To compare biologic medication use for psoriasis patients with differing English proficiency levels. METHODS: Population study of US psoriasis patients using the 2013-2017 Medical Expenditure Survey. RESULTS: Among a total of 4,470,820 US psoriasis patients (weighted), 4,028,119 (90.1%) had perfect English proficiency, and 442,700 (9.9%) had less than perfect English proficiency. Among the total population, 422,523 (9.5%) had access to biologics. Among those who received biologics, 411,411 (97.4%) of those had perfect English proficiency, and 11,112 (2.6%) of those had less than perfect English proficiency. Multivariate logistic regression found that patients with less than perfect English proficiency were significantly less likely to have access to biologics [OR 0.015 (95% CI: 0.001-0.179); p = .002], after adjusting for insurance status, income, education, healthcare utilization, and other sociodemographic and clinical factors. LIMITATIONS: Psoriasis disease severity not specified. CONCLUSIONS: Psoriasis patients with low English proficiency are significantly less likely to receive biologics than those with high English proficiency. Those with higher English proficiency are 61 times more likely to access biologics.

Differences in health care resource utilization and costs for keratinocyte carcinoma among racioethnic groups: A population-based study.

BACKGROUND: As the United States becomes more diverse, determining differences in health care utilization and costs in the management of skin cancers is fundamental to decision-making in health care resource allocation and improving care for underserved populations. OBJECTIVE: To compare health care use and costs among non-Hispanic White, Hispanic White, and non-Hispanic Black patients with keratinocyte carcinoma. METHODS: A nationwide cross-sectional study was performed using Medical Expenditure Panel Survey data from 1996 to 2015. RESULTS: Among 54,503,447 patients with keratinocyte carcinoma (weighted) over a 20-year period, 53,134,351 (97%) were non-Hispanic White; 836,030 (1.5%) were Hispanic White; and 170,755 (0.3%) were non-Hispanic Black. Compared to non-Hispanic White patients, Hispanic White patients had significantly more ambulatory visits per person per year (5.4 vs 3.5, P = .003). Compared to non-Hispanic White patients, non-Hispanic Black patients had significantly more ambulatory visits (13.1 vs 3.5, P = .027) and emergency department visits (2.3 vs 1.1, P < .001), and incurred significantly higher ambulatory costs ($5089 vs $1131, P = .05), medication costs ($523 vs $221, P = .022), and total costs per person per year ($13,430 vs $1290, P = .032). LIMITATIONS: Data for squamous cell carcinomas and basal cell carcinomas are combined. CONCLUSIONS: Keratinocyte carcinoma was more costly to treat and required more health care resources in non-Hispanic Black and Hispanic White patients than in non-Hispanic White patients.

Mental health outcomes in White patients versus patients with skin of color with psoriasis.

OBJECTIVE: To evaluate the relationship between psoriasis and mental health in patients from different racial backgrounds. METHODS: We performed a nationwide, cross-sectional study evaluating 7,519,662 (weighted) patients, comparing White patients versus patients with skin of color (SOC), using the 2004-2017 Medical Expenditure Panel Survey (MEPS). RESULTS: Psychological distress (measured by Kessler 6-Item Psychological Distress Scale) was similar between White and SOC patients (4.132 [95% CI,3.679-4.586] and 3.710 [95% CI,2.932-4.488], P=0.407). Depression (measured by Patient Health Questionnaire 2) was similar between White and SOC patients (0.886 [95% CI,0.744-1.027] and 0.748 [95% CI,0.506-0.989], P=0.385). Overall mental health (measured by Mental Component Summary) was similar between White and SOC patients (49.959 [95% CI,48.979-50.939] and 50.257 [95% CI,48.449-52.065], P=0.789). Perceived mental health state (measured by Perceived Mental Health Status) was similar between White and SOC patients (2.159 [95% CI,2.065-2.253] and 2.103 [95% CI,1.911-2.294], P=0.603). CONCLUSION: There were no significant differences in mental health outcome scores between White and SOC patients with psoriasis. Clinicians should screen for and manage mental health comorbidities in psoriasis patients of all racial backgrounds.

Vitiligo Health Education: A Study of Accuracy and Engagement of Online Educational Materials.

INTRODUCTION: Many vitiligo patients seek healthcare information online. However, the accuracy and quality of this information is unknown. OBJECTIVE: To determine the accuracy, quality, viewer engagement, and viewer experience of vitiligo videos on social media. METHODS: We searched the term “vitiligo” on YouTube. Videos were stratified based on source categories. Video accuracy was assessed using DAS and ANDI. Video quality was assessed using GQS. Viewer experience was assessed using AVA. RESULTS: Sixty videos were evaluated for inclusion and exclusion criteria. We evaluated 49 videos with a total of 28.2 million views, 431,416 likes, and 61,976 comments. Of these videos, 27 (55%) were from healthcare sources, and 22 (45%) were from non-healthcare sources. When compared to videos from non-healthcare sources, videos from healthcare sources had significantly higher accuracy scores (ANDI = 3.69 ± 0.16 vs 2.77 ± 0.36; P=0.017 and DAS = 3.72 ± 0.13 vs 3.07 ± 0.28; P=0.029) but significantly fewer views (38,883 vs 1,231,947; P=0.005). Videos from alternative medicine sources had the lowest accuracy scores when compared to the remainder of the videos (ANDI = 0.5 ± 0.13 vs 3.66 ± 0.14; P<0.001 and DAS = 1.25 ± 0.11 vs 3.73 ± 0.11; P<0.001). CONCLUSION: Inaccurate videos on vitiligo are prevalent on social media. Misinformation can lead to potentially harmful interventions and delay in seeking evidence-based care. Videos from healthcare sources were more accurate but were viewed less than those from non-healthcare sources. Further efforts are needed to improve the visibility and viewer experience of accurate healthcare content on social media. J Drugs Dermatol. 2021;20(6):623-629. doi:10.36849/JDD.5835.

Differences in Depression and Distress Between Acne Patients on Isotretinoin vs Oral Antibiotics.

BACKGROUND: Little is known regarding differential effects of systemic anti-acne treatments on mental health. OBJECTIVE: To determine whether differences exist in mental health outcomes between acne patients treated with isotretinoin versus oral antibiotics (doxycycline, minocycline, or tetracycline). METHODS: Population study utilizing the 2004-2017 Medical Expenditure Panel Survey. Depressive symptoms were assessed using Patient Health Questionnaire 2 (PHQ-2); psychological distress was measured by the Kessler 6-Item Psychological Distress Scale (K6). Acne patients completed both the PHQ-2 and K6 during treatment with isotretinoin or oral antibiotics. Lower scores on both measures indicate better mental health outcomes. RESULTS: After adjusting for socio-demographic characteristics, patients on isotretinoin had fewer depressive symptoms than patients on oral antibiotics, as measured by mean PHQ-2 scores (isotretinoin 0.280 vs oral antibiotics 0.656, difference=0.337, P<0.01). The adjusted comparison also showed patients on isotretinoin had less psychological distress than patients on oral antibiotics, as measured by K6 scores (isotretinoin 2.494 vs oral antibiotics 3.433, difference=0.759, P=0.043). LIMITATIONS: No direct assessment of acne severity. CONCLUSION: Acne patients on isotretinoin experienced less depressive symptoms and psychological distress as compared to oral antibiotics. J Drugs Dermatol. 2021;20(2):172-177. doi:10.36849/JDD.5559.

Pathophysiology, Clinical Presentation, and Treatment of Psoriasis: A Review.

IMPORTANCE: Approximately 125 million people worldwide have psoriasis. Patients with psoriasis experience substantial morbidity and increased rates of inflammatory arthritis, cardiometabolic diseases, and mental health disorders. OBSERVATIONS: Plaque psoriasis is the most common variant of psoriasis. The most rapid advancements addressing plaque psoriasis have been in its pathogenesis, genetics, comorbidities, and biologic treatments. Plaque psoriasis is associated with a number of comorbidities including psoriatic arthritis, cardiometabolic diseases, and depression. For patients with mild psoriasis, topical agents remain the mainstay of treatment, and they include topical corticosteroids, vitamin D analogues, calcineurin inhibitors, and keratolytics. The American Academy of Dermatology-National Psoriasis Foundation guidelines recommend biologics as an option for first-line treatment of moderate to severe plaque psoriasis because of their efficacy in treating it and acceptable safety profiles. Specifically, inhibitors to tumor necrosis factor α (TNF-α) include etanercept, adalimumab, certolizumab, and infliximab. Other biologics inhibit cytokines such as the p40 subunit of the cytokines IL-12 and IL-13 (ustekinumab), IL-17 (secukinumab, ixekizumab, bimekizumab, and brodalumab), and the p19 subunit of IL-23 (guselkumab, tildrakizumab, risankizumab, and mirikizumab). Biologics that inhibit TNF-α, p40IL-12/23, and IL-17 are also approved for the treatment of psoriatic arthritis. Oral treatments include traditional agents such as methotrexate, acitretin, cyclosporine, and the advanced small molecule apremilast, which is a phosphodiesterase 4 inhibitor. The most commonly prescribed light therapy used to treat plaque psoriasis is narrowband UV-B phototherapy. CONCLUSIONS AND RELEVANCE: Psoriasis is an inflammatory skin disease that is associated with multiple comorbidities and substantially diminishes patients' quality of life. Topical therapies remain the cornerstone for treating mild psoriasis. Therapeutic advancements for moderate to severe plaque psoriasis include biologics that inhibit TNF-α, p40IL-12/23, IL-17, and p19IL-23, as well as an oral phosphodiesterase 4 inhibitor.

Association Between the Mental Health of Patients With Psoriasis and Their Satisfaction With Physicians.

Importance: How patients' mental health is associated with their satisfaction with physicians is rarely studied among adults with skin conditions. Objective: To examine the association between mental health comorbidities in patients with psoriasis and their satisfaction with physicians. Design, Setting, and Participants: This retrospective survey analysis used 14 years of nationally representative longitudinal data on adults in the United States with psoriasis from the 2004-2017 Medical Expenditure Panel Survey. Statistical analysis was performed from October 1, 2018, to December 1, 2019. Mental health comorbidities were measured by performance on the Kessler 6-Item Psychological Distress Scale (score range, 0-24, where a score ≥13 is considered an indicator of a serious mental illness and significant psychological distress) and the Patient Health Questionnaire 2 (score range, 0-6, where a score ≥3 is considered a positive screening result for a depressive disorder). Main Outcomes and Measures: Patient satisfaction with physician, measured by the patient-physician communication composite score. Results: A weighted total of 8 876 767 US adults with psoriasis (unweighted total, 652 patients) (weighted; 54% women; mean [SEM] age, 52.1 [0.7] years) were analyzed; 27% of adults had moderate or severe symptoms of psychological distress, and 21% had moderate or severe symptoms of depression. Patients with moderate or severe psychological distress symptoms were less satisfied with their clinicians compared with those with no or mild psychological distress symptoms (mean Kessler 6-Item Psychological Distress Scale scores for no or mild symptoms, 14.3 [95% CI, 14.2-14.4]; moderate symptoms, 13.2 [95% CI, 13.0-13.4]; and severe symptoms, 13.1 [95% CI, 12.5-13.7]; P < .001). In addition, compared with patients with no or mild psychological distress symptoms, patients with moderate psychological distress symptoms were 2.8 times more likely to report low patient satisfaction (adjusted odds ratio, 2.8 [95% CI, 1.5-4.9]; P = .001), and patients with severe psychological distress symptoms were 2.3 times more likely to report low patient satisfaction (adjusted odds ratio, 2.3 [95% CI, 1.1-4.7]; P = .03). Furthermore, patients with moderate or severe depression symptoms were less satisfied with their clinicians compared with those with no or mild depression symptoms (mean Patient Health Questionnaire 2 scores for no or mild symptoms, 14.3 [95% CI, 14.2-14.4]; moderate symptoms, 13.2 [95% CI, 12.9-13.6]; and severe symptoms, 13.0 [95% CI, 12.6-13.4]; P = .002). In addition, compared with patients with no or mild depression symptoms, patients with moderate depression symptoms were 4.6 times more likely to report low patient satisfaction (adjusted odds ratio, 4.6 [95% CI, 2.1-10.0]; P < .001). Conclusions and Relevance: This study suggests that patients with greater psychological distress and depression report lower satisfaction with their clinicians than those without such mental health symptoms. Clinicians need to be adaptable and supportive when communicating with patients with mental health comorbidities. Evaluating clinician performance solely based on patient satisfaction can be problematic and incomplete.

Where you live matters: Regional differences in health care resource use for psoriasis in the United States.

BACKGROUND: It is unknown which U.S. Census region offers the best access to health care resources. OBJECTIVE: To compare health care resource use and costs for patients with psoriasis among the 4 U.S. Census regions. METHODS: Cross-sectional study using the 1996-2015 Medical Expenditure Panel Survey. RESULTS: In the United States the greatest access for biologic medications was in the South (9.1% receiving biologic medications/year), followed by the Northeast (7.4%), the West (6.8%), and the Midwest (5.2%). Ambulatory visits per patient per year were highest in the West (5.02), followed by the Northeast (3.81), the South (2.95), and the Midwest (2.84). The proportion of patients with ≥1 emergency department (ED) visits was highest in the Northeast (2.73%), followed by the West (2.17%), the South (1.19%), and the Midwest (1.17%). Compared with the remainder of the country, the West incurred the lowest total health care costs (P = .035) and the lowest drug costs (P = .023); and the Northeast incurred the highest total health care costs (P = .050) and the highest ambulatory costs (P < .001). Although the South had the greatest proportion of patients using biologic medications (9.1% vs 6.4%, P = .045), it also had 30% fewer ambulatory visits per patient per year and a 39% lower proportion of ED visits for psoriasis. LIMITATIONS: Data for psoriasis severity were unavailable. CONCLUSIONS: Southern U.S. states have the greatest access to biologic medications and incurred fewer ambulatory and ED visits. The Midwest had the lowest access to biologic medications and ambulatory and ED care. The West incurred the lowest total health care costs, while the Northeast incurred the highest total health care costs.

PET-CT imaging in patients with chronic sternal wound infections prior to reconstructive surgery: A case series.

Late presenting and recurrent sternal wound infections post-sternotomy are difficult to treat, with the clinical picture not necessarily reflecting the underlying problem. As a result of our experience, we suggest that these chronic cases should be managed using a different algorithm to acute sternal wound infection. Positron emission tomography combined with computerized tomography (PET-CT) imaging may be potentially useful in enabling accurate localization of disease sites, which guides adequate debridement prior to definitive reconstruction. It may also allow for disease surveillance and monitoring of the response to antimicrobial treatment. We present three cases which support the need for pre-operative imaging using PET-CT.