Outcomes of human immunodeficiency virus-associated Burkitt lymphoma and diffuse large B-cell lymphoma treated in Australia: A report from the Australasian Lymphoma Alliance.

Antiretroviral therapy (ART) has improved outcomes for human immunodeficiency virus-associated non-Hodgkin lymphoma (HIV-NHL). This is an analysis of 44 patients with HIV with Burkitt lymphoma (HIV-BL) and diffuse large B-cell lymphoma (HIV-DLBCL) treated in Australia over a 10-year period (2009-2019) during the ART and rituximab era. At HIV-NHL diagnosis, the majority of presenting patients had adequate CD4 counts and undetectable HIV viral load <50 copies/mL. More than 80% of patients received chemotherapy with curative intent, rituximab, and concurrent ART with chemotherapy (immunotherapy). R-CODOX-M/IVAC or R-Hyper-CVAD (55%) were most commonly used in HIV-BL. CHOP (58%) was the most commonly used chemotherapy backbone for HIV-DLBCL, although 45% of patients received more intense chemotherapy regimens. Overall, 93% of patients who received curative therapy completed their intended course. The 2-year progression-free survival (PFS) and overall survival (OS) for the HIV-BL cohort was 67% and 67% respectively. The 2-year PFS and OS for the HIV-DLBCL cohort was 77% and 81% respectively. Treatment related mortality was 5%. In all, 83% of patients achieved a CD4 count of >0.2 ×109 /L 6 months after the end of treatment. Current Australian practice favours the treatment of HIV-BL and HIV-DLBCL similarly to the HIV-negative population with the use of concurrent ART, achieving outcomes comparable to the HIV-negative population.

Clinical application and diagnostic accuracy of artificial intelligence in colonoscopy for inflammatory bowel disease: systematic review.

Background and aims Artificial intelligence (AI) technology is being evaluated for its potential to improve colonoscopic assessment of inflammatory bowel disease (IBD), particularly with computer-aided image classifiers. This review evaluates the clinical application and diagnostic test accuracy (DTA) of AI algorithms in colonoscopy for IBD. Methods A systematic review was performed on studies evaluating AI in colonoscopy of adult patients with IBD. MEDLINE, Embase, Emcare, PsycINFO, CINAHL, Cochrane Library and Clinicaltrials.gov databases were searched on 28 th April 2021 for English language articles published between January 1, 2000 and April 28, 2021. Risk of bias and applicability were assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Diagnostic accuracy was presented as median (interquartile range). Results Of 1029 records screened, nine studies with 7813 patients were included for review. AI was used to predict endoscopic and histologic disease activity in ulcerative colitis, and differentiation of Crohn's disease from Behcet's disease and intestinal tuberculosis. DTA of AI algorithms ranged between 52-91 %. The sensitivity and specificity for AI algorithms predicting endoscopic severity of disease were 78 % (range 72-83, interquartile range 5.5) and 91 % (range 86-96, interquartile range 5), respectively. Conclusions AI has been primarily used to assess disease activity in ulcerative colitis. The diagnostic performance is promising and suggests potential for other clinical application of AI in IBD colonoscopy such as dysplasia detection. However, current evidence is limited by retrospective data and models trained on still images only. Future prospective multicenter studies with full-motion videos are needed to replicate the real-world clinical setting.

Experiencing the "Michigan difference" in predental advising.

African-American dental students at the University of Michigan are engaged in identifying, guiding, and preparing promising predental students for a career in dentistry. Collaborating with the Student National Dental Association (SNDA), the Predental Association at the school, and with the help of faculty members and the administration, students have developed an Impressions Day and participate in a Research Day, a golf outing, an Elementary School Outreach program, a Dental Initiatives activity, the Scholars Program for Dental Leadership, and participation in the school's Mentor Program. All of these activities engage current students in helping those at various stages in the predental education pipeline learn about, evaluate their potential for, and prepare for careers in dentistry.

The Virtual Hospitalist: A Single-Site Implementation Bringing Hospitalist Coverage to Critical Access Hospitals.

BACKGROUND: On-site hospitalist care can improve patient care, but it is economically infeasible for small critical access hospitals (CAHs). A telemedicine "virtual hospitalist" may expand CAH capabilities at a fractional cost of an on"site provider. OBJECTIVE: To evaluate the impact of a virtual hospitalist on transfers from a CAH to outside hospitals. DESIGN, SETTING, PATIENTS: A 6-month pilot program providing "virtual hospitalist" coverage to patients at a CAH in rural Iowa. MEASUREMENTS: The primary outcome was the rate of outside transfers from the CAH Emergency Department (ED). The secondary outcomes included transfer from either the ED or the inpatient wards, daily census, length of stay, transfers after admission, virtual hospitalist time commitment, and patient and staff satisfaction. The preceding 24-week baseline was compared with 24 weeks after implementation, excluding a 2-week transition period. RESULTS: At baseline, there were 947 ED visits and 176 combined inpatient and observation encounters, compared to 930 and 176 after implementation, respectively. Outside transfers from the ED decreased from 16.6% to 10.5% (157/947 to 98/930, P < .001), and transfers at any time decreased from 17.3% to 11.9% (164/947 to 111/930, P < .001). Daily census, length of stay, and transfers after admission were unchanged. Time commitment for a virtual hospitalist was 35 minutes per patient per day. The intervention was well received by the CAH staff and patients. CONCLUSIONS: The virtual hospitalist model increased the percentage of ED patients who could safely receive their care locally. A single virtual hospitalist may be able to cover multiple CAHs simultaneously. FUNDING: Development of this project was funded through the University of Iowa Hospitalist group and the Signal Center for Health Innovations at UI Health Ventures. Virtual hospitalist clinical time was paid for by the CAH on a fractional basis of a traditional hospitalist based on projected patient volumes through analysis of baseline data. Patients were not directly billed for virtual hospitalist service but were charged for the services provided by CAH providers.

TRENDS IN DENTAL VISITS AMONG THE US NON-INSTITUTIONALIZED CIVILIAN POPULATION: FINDINGS FROM BRFSS 1995 - 2008.

OBJECTIVE: To examine the 13-year trend in annual dental care utilization among the US non-institutionalized civilian population. METHODS: Data from the BRFSS from 1995-2008 for adults' age 18 and older were abstracted and analyzed using the NIDCR/CDC data query system. Point-estimates, confidence-intervals, trends and differences in trends for self-reported annual dental visits by socio-demographic factors and behavioral factor (smoking) were tested with chi-square tests using Stata® (v11). RESULTS: The overall, median percent of reported dental visits increased marginally (1.3%; p=0.99) from 68.6% (66.2%, 70.9%) in 1995 to 69.9% (69.1%, 71.7%) in 2008. Trend lines remained flat for most age groups except for those aged 65 and older, which showed a steady rise from 58.9% (52.9%, 64.9%) in 1995 to 66.3% (63.9%, 68.7%) in 2008. Disparities in median annual dental visits between non-Hispanic whites and other racial/ethnic groups increased from a range of a 2-7% point difference (1995) to a 7-11% point difference (2008). A higher percentage of women relative to men reported a visit 70.1% (66.9%, 73.2%) vs. 66.6 % (63.8%, 69.3%) in 1995 and 71.2% (69.2%, 73.2%) vs. 67.4% (65.0%, 69.7%) in 2008; trends and differences in trends among gender remained similar over time (4-5%). No meaningful change in reported dental visit by race/ethnicity; income, education or smoking was seen. CONCLUSION: Over 13 years, the proportion of persons visiting a dentist has remained relatively constant. Of note is that disparities in dental visits by socio-demographic factors also remained the same over time.