Faculty Bibliography

BACKGROUND:The relationship between body weight and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) is unclear. OBJECTIVES:This study aimed to investigate the impact of obesity and morbid obesity on mortality and ERCP-related complications in patients who underwent ERCP. METHODS:We conducted a US population-based retrospective cohort study using the Nationwide Readmissions Databases (2013-2014). A total of 159,264 eligible patients who underwent ERCP were identified, of which 137,158 (86.12%) were normal weight, 12,522 (7.86%) were obese, and 9584 (6.02%) were morbidly obese. The primary outcome was in-hospital mortality. The secondary outcomes were the length of stay, total cost, and ERCP-related complications. Multivariate analysis and propensity score (PS) matching analysis were performed. The analysis was repeated in a restricted cohort to eliminate confounders. RESULTS:Patients with morbid obesity, as compared to normal-weight patients, were associated with a significantly higher in-hospital mortality (hazard ratio [HR]: 5.54; 95% confidence interval [CI]: 1.23-25.04). Obese patients were not associated with significantly different mortality comparing to normal weight (HR: 1.00; 95% CI: 0.14-7.12). Patients with morbid obesity were also found to have an increased length of hospital stay and total cost. The rate of ERCP-related complications was comparable among the three groups except for a higher cholecystitis rate after ERCP in obese patients. CONCLUSIONS:Morbid obesity but not obesity was associated with increased mortality, length of stay, and total cost in patients undergoing ERCP.

Background/UNASSIGNED:Calls to reform the US resident selection process are growing, given increasing competition and inefficiencies of the current system. Though numerous reforms have been proposed, they have not been comprehensively cataloged. Objective/UNASSIGNED:This scoping review was conducted to characterize and categorize literature proposing systems-level reforms to the resident selection process. Methods/UNASSIGNED:Following Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, searches of Embase, MEDLINE, Scopus, and Web of Science databases were performed for references published from January 2005 to February 2020. Articles were included if they proposed reforms that were applicable or generalizable to all applicants, medical schools, or residency programs. An inductive approach to qualitative content analysis was used to generate codes and higher-order categories. Results/UNASSIGNED:Of 10 407 unique references screened, 116 met our inclusion criteria. Qualitative analysis generated 34 codes that were grouped into 14 categories according to the broad stages of resident selection: application submission, application review, interviews, and the Match. The most commonly proposed reforms were implementation of an application cap (n = 28), creation of a standardized program database (n = 21), utilization of standardized letters of evaluation (n = 20), and pre-interview screening (n = 13). Conclusions/UNASSIGNED:This scoping review collated and categorized proposed reforms to the resident selection process, developing a common language and framework to facilitate national conversations and change.

[Figure: see text].

SOURCE CITATION/UNASSIGNED:BMJ. 2021;372:m4573. 33441402.

OBJECTIVE:F]NaF uptake in subchondral bone of individuals with and without knee osteoarthritis (OA). METHODS:) were evaluated using the Hawkins 3-compartment model. Measures were compared between structurally normal-appearing bone regions and those with structural findings. RESULTS:, and extraction fraction were significantly different between Healthy subjects and subjects with OA. Between-group differences in metabolic parameters were observed both in regions where the OA group had degenerative changes as well as in regions that appeared structurally normal. CONCLUSIONS:F]NaF PET imaging can complement assessments of structural abnormalities observed on MRI.

INTRODUCTION/BACKGROUND:Poor sleep is a pervasive problem for hospitalized patients and can contribute to adverse health outcomes. METHODS:We aimed to improve self-reported sleep for patients on a general medicine ward as measured by the Richards-Campbell Sleep Questionnaire (RCSQ) as well as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) question addressing quietness at night. We utilized a non-pharmacologic sleep hygiene bundle composed of a short script with sleep hygiene prompts, such as whether patients would like the shades closed or the lights turned off, as well as a sleep package including an eye mask, earplugs, lavender scent pad, and non-caffeinated tea. Relaxing music was played at bedtime and signs promoting the importance of quietness at night were placed around the unit. Front-line champions were identified to aid with implementation. RESULTS:A total of 931 patients received the intervention. In a sample of surveyed patients, we observed an increase in the RCSQ global score from 6.0 (IQR 3.0-7.0) to 6.2 (IQR 4.0-7.8) from the pre- to post- intervention periods (p = 0.041), as well as increases in three of the five individual survey components. Additionally, HCAHPS "quietness at night" score increased on the unit from 34.1% pre-intervention to 42.5% post-intervention. CONCLUSION/CONCLUSIONS:A nonpharmacologic sleep hygiene protocol paired with provider education and use of champions was associated with modest improvements in patients' perceived sleep and unit HCAHPS scores.

Purpose: To carry out a large international validation of how dose prediction quality translates to plan quality in a radiotherapy knowledge-based planning (KBP) process.
Method(s): We collected dose predictions for head-and-neck cancer radiotherapy from 21 different research groups internationally who participated in the OpenKBP Grand Challenge. Each research group used the same training dataset (n=200) and validation dataset (n=40) to develop their methods. These methods predicted dose on a testing dataset (n=100), and those 2100 unique dose predictions were input to a previously published plan optimization method to generate 2100 treatment plans. The predictions and plans were compared to the ground truth dose via: (1)error, the mean absolute voxel-by-voxel difference in dose; and (2) quality, the mean and maximum deviation across 23 dose-volume histogram (DVH) criteria.
Result(s): The range in median prediction error among the top 20 methods was 2.3Gy to 12.0Gy, which was 6.8Gy wider than the range in median plan error of 2.1Gy to 5.0Gy. One method also achieved significantly lower prediction error (P<0.05; one-sided Wilcoxon test) than all the other methods, however, it generated plans with error that was not significantly lower than 28.6% of the other methods. Additionally, predicted dose was consistently lower quality than plan dose. Half (n=1050) of all predictions and plans had an average deviation that was 0.1Gy worse and 0.8Gy better than the ground truth dose, respectively. Similarly, half of all predictions had a maximum deviation that was 3.7Gy worse than the ground truth dose, which was 1.0Gy worse than half of all plans.
Conclusion(s): Many dose prediction methods can achieve low error, however, optimization often improves upon the predictions and eliminates significant differences between prediction methods. Thus, it is critical that we improve the optimization stage in KBP to get better utility out of the existing high-quality dose prediction methods

Background: Gout affecting the spine is reported as a rare event presenting with neuropathy, spinal compression and acute back pain (1). Cases are often diagnosed by tissue confirmation of monosodium urate (MSU) deposition. The frequency of gout involving the spine asymptomatically or with milder, non-specific symptoms is likely higher than reported.
Objective(s): Using dual-energy CT (DECT), we are determining prevalence/ extent of MSU deposition in the lumbosacral spines of patients with gout and tophaceous gout, compared to non-gout controls.
Method(s): We are recruiting 25 controls, 25 non-tophaceous and 25 tophaceous gout patients, 45-80 years old. Exclusion criteria include CPPD disease, RA, spondyloarthropathy or spinal malignancy. All gout subjects meet ACR gout classification criteria with entry serum urate (sU) of >6.8 mg/dL, or sU >6.0 mg/dL on ULT for <6 months. Demographics, gout history, Aberdeen back pain scale, sU, ESR, and CRP are collected. DECT of the lumbosacral spine is used to assess MSU deposition and osteoarthritic changes.
Result(s): 63 subjects are enrolled and analyzed to date (25 control, 23 non-tophaceous and 15 tophaceous gout). Control, non-tophaceous gout, and tophaceous gout subjects have similar mean age in years (controls 61.8+/-3.8, non-tophaceous 64.0+/-6.2, tophaceous 63.5+/-9.2, p=0.45), but differ in BMI (controls 28.3+/-6.5 kg/ m2, non-tophaceous 32.1+/-6.7 kg/m², tophaceous 29.1+/-4.3 kg/m², p=0.01) and creatinine (controls 1.0+/-0.2 mg/dL, non-tophaceous 1.4+/-0.6 mg/dL, tophaceous 1.7+/-0.9 mg/dL, p=0.048). Mean sU and ESR are higher in gout subjects (sU-controls 5.3+/-1 mg/dL, non-tophaceous 8.3+/-1.4 mg/dL, tophaceous 8.4+/-2.0 mg/ dL, p<0.05; ESR-controls 13.7+/-13.8 mm/h, non-tophaceous 25.2+/-18.7 mm/h, tophaceous 22.5+/-15.1 mm/h, p<0.05). Using default threshold settings for MSU visualization, greater MSU deposition is observed in the spine of gout patients (controls 2.2+/-1.2 cm³, non-tophaceous 4.5+/-4.3 cm³, tophaceous 8.5+/-12.5 cm³, p<0.05; Table 1). Reanalysis of several scans using narrower threshold settings to limit possible artifact confirms increased MSU signal among gout patients. Although many subjects in each group do not have excessive MSU deposition, deposition is more common in both gout groups. No subject demonstrated a frank spinal tophus.
Conclusion(s): Based on preliminary results, gout patients have higher inflammatory markers and greater spinal MSU deposition than controls. Preliminary analyes with more stringent DECT threshold settings suggests these differences are not artifact, but analysis is ongoing. These data suggest that MSU deposition in the spine occurs in a subset of gout patients

Evidence-based strategies addressing comorbid hypertension and diabetes are needed among minority communities. We analyzed the outcome of blood pressure (BP) control using pooled data from two community health worker interventions in New York City conducted between 2011 and 2019, focusing on participants with comorbid hypertension and diabetes. The adjusted odds of controlled BP (< 140/90 mmHg) for the treatment group were significant compared with the control group (odds ratio = 1.4; 95% confidence interval = 1.1, 1.8). The interventions demonstrated clinically meaningful reductions in BP among participants with comorbid hypertension and diabetes.