Testing telediagnostic thyroid ultrasound in Peru: a new horizon in expanding access to imaging in rural and underserved areas

Abstract Purpose Thyroid ultrasound is a key tool in the evaluation of the thyroid, but billions of people around the world lack access to ultrasound imaging. In this study, we tested an asynchronous telediagnostic ultrasound system operated by individuals without prior ultrasound training which may be used to effectively evaluate the thyroid and improve access to imaging worldwide. Methods The telediagnostic system in this study utilizes volume sweep imaging (VSI), an imaging technique in which the operator scans the target region with simple sweeps of the ultrasound probe based on external body landmarks. Sweeps are recorded and saved as video clips for later interpretation by an expert. Two operators without prior ultrasound experience underwent 8 h of training on the thyroid VSI protocol and the operation of the telemedicine platform. After training, the operators scanned patients at a health center in Lima. Telediagnostic examinations were sent to the United States for remote interpretation. Standard of care thyroid ultrasound was performed by an experienced radiologist at the time of VSI examination to serve as a reference standard. Results Novice operators scanned 121 subjects with the thyroid VSI protocol. Of these exams, 88% were rated of excellent image quality showing complete or near complete thyroid visualization. There was 98.3% agreement on thyroid nodule presence between VSI teleultrasound and standard of care ultrasound (Cohen’s kappa 0.91, P < 0.0001). VSI measured the thyroid size, on average, within 5 mm compared to standard of care. Readers of VSI were also able to effectively characterize thyroid nodules, and there was no significant difference in measurement of thyroid nodule size (P = 0.74) between VSI and standard of care. Conclusion Thyroid VSI telediagnostic ultrasound demonstrated both excellent visualization of the thyroid gland and agreement with standard of care thyroid ultrasound for nodules and thyroid size evaluation. This system could be deployed for evaluation of palpable thyroid abnormalities, nodule follow-up, and epidemiological studies to promote global health and improve the availability of diagnostic imaging in underserved communities.

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0646 Evaluation of Increased CPAP Compliance After Electronic Learning Video Aimed at Troubleshooting Common CPAP Related Problems

SLEEP ◽

10.1093/sleep/zsaa056.642 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A246-A247

Author(s):

K A Slota ◽

W Wasey ◽

B K Dredla ◽

P Castillo

Keyword(s):

Placebo Group ◽

Mayo Clinic ◽

Intervention Group ◽

Standard Of Care ◽

Sleep Study ◽

Obstructive Sleep ◽

Common Diagnosis ◽

Significant Difference ◽

Cpap Compliance

Abstract Introduction Obstructive sleep apnea(OSA) is a common diagnosis associated with immediate and long-term health consequences. Due to increasing awareness, the demand for treatment with CPAP is increasing. However, CPAP compliance remains a problem, and may be improved by initial patient education targeted at common CPAP problems Methods A 10 min video depicting common CPAP related problems was created in the Mayo Clinic Florida Simulation Center using standardized patients. Newly diagnosed patients with OSA requiring CPAP were randomized into two arms: (i) the intervention arm was shown the video and received standard of care; or (ii) in the “placebo” or standard of care alone. Our standard of care includes a review of the sleep study, discussion of diagnosis and recommendation for CPAP therapy along with Mayo OSA information packet, followed by compliance visit at 3 months. Compliance is defined as >4 hours of CPAP use per night gathered from machine’s SD card. The two groups were compared for statistically significant difference in compliance at 3 months. Results 47 patients diagnosed between 10/2018-5/2019 were included in the study(21:intervention, 26:placebo). 7 (33%) and 7 (26%) patients in the intervention and the placebo came back for follow up visit (p=0.63). Among them, median CPAP usage was 362.5 min (236.0, 480.0) in intervention arm vs 351.0 min (125.0, 466.0) in placebo group and the difference was not significant. Average nightly use of >than 4 hours was 12(57.1%) in the intervention group and 17(65.4%) in placebo group. Conclusion In this group addition of an educational video to standard of care did not show benefit in CPAP compliance. There was a tendency toward greater median nightly usage. Patients receiving the video had a higher likelihood of making their follow up appointment which is pivotal, as it provides an opportunity for further intervention and enhancement of adherence. Support Mayo Clinic Jacksonville

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Clinical Significance of Indeterminate Lupus Anticoagulant (LAC) Results.

Blood ◽

10.1182/blood.v114.22.3988.3988 ◽

2009 ◽

Vol 114 (22) ◽

pp. 3988-3988

Author(s):

Khaldoun J. Alkayed ◽

Kandice Kottke-Marchant

Keyword(s):

Autoimmune Disease ◽

Clinical Significance ◽

Lupus Anticoagulant ◽

Statistical Significance ◽

The United States ◽

Test Results ◽

Clinical Variables ◽

Significant Difference ◽

Initial Cohort

Abstract 3988 Poster Board III-924 Abstract: Introduction The International Society of Thrombosis and Hemostasis (ISTH) criteria for the diagnosis of the lupus anticoagulant (LAC) include: Screening test that demonstrates the prolongation of a phospholipid-dependent (PL-D) clotting time; mixing test that confirms the presence of an inhibitor; the confirmation that the inhibitor is PL-D and exclusion of other coagulopathies. Test results that do not fulfill all the criteria are considered indeterminate. These indeterminate results are common (Kottke-Marchant et al. J Thromb Haemost. 2007; 5 Supplement 2: P-M-455), still there is no published data regarding clinical significance. Patients/methods This study investigated the prevalence of thrombotic events in an initial cohort of unselected patients (n=256) from one tertiary hospital in the United States, who were tested for LAC and other antiphospholipid (aPL) antibodies from a 2 month period in 2006. The laboratory results (PT/INR, aPTT, dilute Russell's viper venom time (DRVVT), STACLOT and platelet neutralization (PNP)) were evaluated. The profile included 3 separate PL -D assays (DRVVT confirm, STACLOT, PNP). Samples containing heparin (>0.1U/ml) were pre-treated with Hepadsorb. The LAC profile was considered indeterminate if PL test results were positive, but without a positive aPTT or DRVVT mixing study. The initial cohort included 83 patients with indeterminate results. From this group, 18 patients were excluded: Four due to incomplete data, 2 due to high heparin level (anti Xa>1.0 U/ml), 5 due to other prothrombotic etiologies and 7 with other positive aPL antibodies. For an assessment of thrombotic history, we performed retrospective chart reviews and tabulated all Sapporo clinical features, malignancy and auto-immune disorders within 5 years before and 2 years after the index laboratory testing. Events that did not fulfill diagnostic criteria for thrombosis, ischemic events or obstetrical complications were excluded. The final analysis sample included 65 patients with indeterminate LAC, 106 with negative and 27 with positive LAC. Results The final indeterminate LAC cohort included 65 patients, with mean follow-up of 18 months. Malignancy was present in 29% and autoimmune disease in 25% of patients. The most common thrombotic events were deep vein thrombosis (DVT) (28%), cerebral ischemic stroke (14%) and pulmonary embolism (14%). When compared to those with negative tests, indeterminate group patients were more likely males, relatively older, and more likely to have DVT, superficial thrombosis (ST) or myocardial infarction (MI) (P= 0.049, 0.021, 0.044, 0.005 and 0.045 respectively). Concurrent coumadin (warfarin) therapy was more prevalent in the indeterminate group, but it did not reach statistical significance (p=0.15). There was no statistical significant difference in the prevalence of cancer or autoimmune disease (P=0.19 and 0.48 respectively). In the multivariate analysis model none of the previous variables reached any statistical significance between the two groups. When compared the above clinical variables between indeterminate results and positive LAC results groups from the same cohort, we failed to show any major statistically significant differences. We noticed very poor retesting rate in the indeterminate group during the follow up period of 2 years (15% only). Conclusions Indeterminate results are common among patients referred for LAC testing. When compared to those with negative results, patients with indeterminate results are more likely to have a history of DVT, superficial thrombosis or MI, but none of the clinical variables reached statistical significance in a multivariate model. On the other hand, patients in the indeterminate group shared demographic and clinical profiles with those in the positive results group. This further highlights the need to study the clinical significance of indeterminate LAC results in a prospective study. Disclosures: No relevant conflicts of interest to declare.

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Reflex Immunohistochemistry and Microsatellite Instability Testing of Colorectal Tumors for Lynch Syndrome Among US Cancer Programs and Follow-Up of Abnormal Results

Journal of Clinical Oncology ◽

10.1200/jco.2011.38.4719 ◽

2012 ◽

Vol 30 (10) ◽

pp. 1058-1063 ◽

Cited By ~ 139

Author(s):

Laura C. Beamer ◽

Marcia L. Grant ◽

Carin R. Espenschied ◽

Kathleen R. Blazer ◽

Heather L. Hampel ◽

...

Keyword(s):

United States ◽

Lynch Syndrome ◽

Microsatellite Instability ◽

Community Hospital ◽

Response Rate ◽

Standard Of Care ◽

The United States ◽

Cancer Centers ◽

Abnormal Results

Purpose Immunohistochemistry (IHC) for MLH1, MSH2, MSH6, and PMS2 protein expression and microsatellite instability (MSI) are well-established tools to screen for Lynch syndrome (LS). Although many cancer centers have adopted these tools as reflex LS screening after a colorectal cancer diagnosis, the standard of care has not been established, and no formal studies have described this practice in the United States. The purpose of this study was to describe prevalent practices regarding IHC/MSI reflex testing for LS in the United States and the subsequent follow-up of abnormal results. Materials and Methods A 12-item survey was developed after interdisciplinary expert input. A letter of invitation, survey, and online-survey option were sent to a contact at each cancer program. A modified Dillman strategy was used to maximize the response rate. The sample included 39 National Cancer Institute–designated Comprehensive Cancer Centers (NCI-CCCs), 50 randomly selected American College of Surgeons–accredited Community Hospital Comprehensive Cancer Programs (COMPs), and 50 Community Hospital Cancer Programs (CHCPs). Results The overall response rate was 50%. Seventy-one percent of NCI-CCCs, 36% of COMPs, and 15% of CHCPs were conducting reflex IHC/MSI for LS; 48% of the programs used IHC, 14% of the programs used MSI, and 38% of the programs used both IHC and MSI. One program used a presurgical information packet, four programs offered an opt-out option, and none of the programs required written consent. Conclusion Although most NCI-CCCs use reflex IHC/MSI to screen for LS, this practice is not well-adopted by community hospitals. These findings may indicate an emerging standard of care and diffusion from NCI-CCC to community cancer programs. Our findings also described an important trend away from requiring written patient consent for screening.

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Will Real Time Visualization of Needle in Target Thyroid Nodules Minimize False Negative FNA Results?

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1846 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A904-A905

Author(s):

Vijaykumar Sekar ◽

Panadeekarn Panjawatanan ◽

Sofia Junaid Syed

Keyword(s):

Thyroid Cancer ◽

Thyroid Nodule ◽

Thyroid Nodules ◽

False Negative ◽

Thyroid Ultrasound ◽

Papillary Thyroid ◽

Ultrasound Guided ◽

Real Time Visualization ◽

The Right

Abstract Introduction: Prevalence of thyroid nodules in the adult population based on detection by ultrasonography is about 20-76% of which only 5% account for thyroid cancer. All patients with a suspected thyroid nodule either on physical examination or noted incidentally on other imaging should be evaluated with thyroid ultrasound. Any thyroid nodule >= 1 cm on ultrasound should be investigated with FNAC. Ultrasound guided FNAC techniques are used to reduce false negative results. We present a patient with suspicious finding on initial thyroid ultrasound and subsequent negative FNAC presenting a few years later with papillary thyroid cancer. Case Presentation: A 32 y.o. female with history of thyroid nodule and thyroiditis presented to the endocrine clinic for follow-up of her thyroid nodule. 5 years ago, she was diagnosed with thyroid nodule, which was found on an ultrasound scan for workup of her dysphagia. The thyroid ultrasound then showed diffusely heterogeneous thyroid gland with an ill-defined area of decreased echogenicity in the right lobe and left superior lobe and possible nodule in the lower pole left thyroid. Blood work showed TSH of 1.71 (n 0.34-3.00 uIU/ml) and thyroid peroxidase antibody levels was 27.8 (n < 9.0 IU/ml). A CT scan of neck with contrast was done and no concerning mass was seen. The patient had a follow-up ultrasound after 8 months which showed small bilateral thyroid lesions, somewhat ill-defined. The patient had an FNA biopsy of the right thyroid nodule: the results were consistent with a benign follicular nodule. A follow-up thyroid ultrasound was done in a year, and the findings were unchanged. The patient came back 3 years later for follow-up with complaints of a new palpable nodule in the neck. Ultrasound showed unchanged right thyroid nodule and some new cervical adenopathy. The ultrasound showed a 2.2 cm heterogeneous lymph node with punctate echogenic foci along the right lateral margin of the right internal jugular vein at the level of the thyroid gland, Subsequently FNA biopsy of the right cervical node and right thyroid node were done. The cells from lymph nodes were positive for malignancy and cells from the right thyroid nodule were atypical. Overall the appearance was consistent with papillary thyroid carcinoma. Subsequently the patient underwent total thyroidectomy and right modified lymph node dissection and the pathology results came back as multifocal papillary thyroid cancer right side 1.2 cm and left side 0.4 cm, with metastasis to 2 lymph nodes. Conclusion: The reported false negative rate of ultrasound-guided FNAC is variable. Success of US-FNA depends on experience of operator and cyto-pathologist and the intrinsic nature of the nodule. Malignancy rates of only 1-2% are reported with repeat FNA in prior benign nodules. Good FNA techniques and real-time visualization of needle in target nodules can further decrease false negatives.

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Loss to follow-up of cancer patients in the poorest district of the United States.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.6123 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 6123-6123 ◽

Cited By ~ 1

Author(s):

Antranik Mangardich ◽

Aleksandra Mamorska-Dyga ◽

Doru Paul ◽

Ghulam Khan ◽

Svetlana Vassel ◽

...

Keyword(s):

Cancer Patients ◽

Retention Rate ◽

Mental Health Center ◽

The United States ◽

Stage At Diagnosis ◽

South Bronx ◽

Loss To Follow Up ◽

Significant Difference ◽

Cancer Types

6123 Background: Loss to follow-up (LFU) of cancer patients is a serious dilemma, and has only been narrowly studied. Lincoln Medical and Mental Health Center (LMMHC) serves South Bronx (SB), the poorest district in the nation. The purpose of this study was to assess rates of LFU and correlate it with age, sex, ethnicity, race, cancer types, and stage at diagnosis. Methods: We collected data from 1,552 patients diagnosed with invasive cancer in LMMHC between 2006-2010. The data collected were age, sex, ethnicity, race, type of cancer, stage, LFU, treatment, and vital status. Results: From the 1,552 patients, roughly 25 % were LFU, with 50% receiving some initial form of treatment. The remaining percentages are shown below (Table). A higher rate of LFU was with patients younger than 65 (OR: 1.38, 95% CI: 1.08-1.76). There was no correlation between sex and LFU. Non-Hispanics were more likely to be LFU compared to Hispanics (OR: 1.39, 95% CI: 1.07 – 1.8). Blacks were more likely to be LFU compared to non-Blacks (OR: 1.43, 95% CI: 1.12–1.82). There was no significance between LFU and stage at diagnosis. Looking at cancer specific data, colon cancer (C) and head and neck cancers (HN) had the highest percentage of LFU (30% each). There was higher LFU rate for C compared to breast cancer (B) (OR: 1.7, 95% CI: 1.03-2.8), prostate cancer (P) (OR: 1.88, 95% CI: 1.18-3.02), and lung cancer (L) (OR: 1.64 95% CI: 0.94- 2.8). HN patients were more likely LFU compared to B (OR: 2.4, 95% CI: 1.13-5.2), P (OR: 2.69, 95 % CI: 1.28-5.68), and L (OR: 2.3, 95% CI: 1.05-5.19) patients. There was no significant difference between C and HN patients in respect to LFU. Conclusions: In the SB, LFU rates are related to age, ethnicity, race, and type of cancer. Younger patients, blacks, non-Hispanics, and those with C and HN cancers were most likely to be LFU, the latter likely due to the lack of a HN surgeon at LMMHC. We hope that with focus on race, ethnicity, and cancer-specific disparities in LFU rates, we will improve the retention rate of our cancer patients in the future. [Table: see text]

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Early implementation of stereoelectroencephalography in children: a multiinstitutional case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2021.5.peds20923 ◽

2021 ◽

pp. 1-8

Author(s):

Jacob R. Lepard ◽

Irene Kim ◽

Anastasia Arynchyna ◽

Sean M. Lew ◽

Robert J. Bollo ◽

...

Keyword(s):

Case Series ◽

The United States ◽

Postoperative Hemorrhage ◽

Pediatric Epilepsy ◽

Continuous Variables ◽

Early Implementation ◽

Significant Difference ◽

Normative Practice ◽

The Mean

OBJECTIVE Pediatric stereoelectroencephalography (SEEG) has been increasingly performed in the United States, with published literature being limited primarily to large single-center case series. The purpose of this study was to evaluate the experience of pediatric epilepsy centers, where the technique has been adopted in the last several years, via a multicenter case series studying patient demographics, outcomes, and complications. METHODS A retrospective cohort methodology was used based on the STROBE criteria. ANOVA was used to evaluate for significant differences between the means of continuous variables among centers. Dichotomous outcomes were assessed between centers using a univariate and multivariate logistic regression. RESULTS A total of 170 SEEG insertion procedures were included in the study from 6 different level 4 pediatric epilepsy centers. The mean patient age at time of SEEG insertion was 12.3 ± 4.7 years. There was no significant difference between the mean age at the time of SEEG insertion between centers (p = 0.3). The mean number of SEEG trajectories per patient was 11.3 ± 3.6, with significant variation between centers (p < 0.001). Epileptogenic loci were identified in 84.7% of cases (144/170). Patients in 140 cases (140/170, 82.4%) underwent a follow-up surgical intervention, with 47.1% (66/140) being seizure free at a mean follow-up of 30.6 months. An overall postoperative hemorrhage rate of 5.3% (9/170) was noted, with patients in 4 of these cases (4/170, 2.4%) experiencing a symptomatic hemorrhage and patients in 3 of these cases (3/170, 1.8%) requiring operative evacuation of the hemorrhage. There were no mortalities or long-term complications. CONCLUSIONS As the first multicenter case series in pediatric SEEG, this study has aided in establishing normative practice patterns in the application of a novel surgical technique, provided a framework for anticipated outcomes that is generalizable and useful for patient selection, and allowed for discussion of what is an acceptable complication rate relative to the experiences of multiple institutions.

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Abstract MP05: Impact of Gentrification on Cardiovascular Risk Factors and Outcomes in England: 2004-2018

Circulation ◽

10.1161/circ.141.suppl_1.mp05 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Nrupen A Bhavsar ◽

Danying Li ◽

Miguel Ramos ◽

Laura Richman

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

The United States ◽

Living Environment ◽

Length Of Residence ◽

Lower Odds ◽

Significant Difference ◽

The Impact

Introduction: Dynamic changes to neighborhoods due to forces such as gentrification impact the health of residents. Much of this research has been conducted within the United States, where racial disparities and access to healthcare impact risk for health outcomes. Internationally, other factors may play a more prominent role in the association between gentrification and cardiovascular risk factors and outcomes. Hypothesis: Residents living in gentrified vs. non-gentrified neighborhoods will have lower odds of diabetes (DM), hypertension (HTN), depression and cardiovascular disease (CVD). Methods: We defined gentrification using changes in domains of the Index of Multiple Deprivation (IMD) at the level of the Lower Layer Super Output Areas (LSOA) in England from 2004-2010. We used all IMD domains (income, employment, education, crime, barriers to housing, and living environment), except the health domain, from 2004 and 2010 to define LSOA deprivation. The IMD for each LSOA was standardized to the mean IMD of England using z-scores. LSOAs were eligible to be gentrified if they had a positive z-score in 2004 and were considered to gentrify if they had a negative change in the transformed IMD from 2004 to 2010. We linked these data to individual participants in the Understanding Society Study (USS). The USS is a nationally representative cohort study of 60,000 United Kingdom residents started in 2009 with follow-up ongoing. We limited the analysis to residents in England who lived in top and bottom 25% deprived LSOAs (n=8782). We used multivariable logistic regression to calculate the odds ratio for self-reported DM, HTN, depression, and CVD in residents in neighborhoods that did and did not gentrify, adjusting for race, sex, length of residence (LOR), baseline IMD score, and baseline prevalence of health conditions. Results were stratified by age (<65 & >=65 years) and median LOR (<13 & >=13 years). Results: At baseline, 8782 participants had a median age of 43 years, 4% were black and 55% were female. There was no significant difference in the prevalence of DM, HTN, depression, or CVD at baseline. At follow-up, overall, there were no significant difference in the odds of DM, HTN, or CVD between residents living in gentrified vs. non-gentrified neighborhoods. Residents in neighborhoods that gentrified had a 39% lower odds of depression as compared to participants living in neighborhoods that did not gentrify (p=0.01). Results were not significantly modified by age or length of residence. Conclusions: Residents living in gentrified neighborhoods did not have differential risk for most CVD risk factors and outcomes as compared to residents living in neighborhoods that did not gentrify. However, the impact of gentrification on health is not uniform across all conditions. The positive health impact seen may suggest gentrification increases access to resources not present prior to gentrification.

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Sending NHS Patients for Operations Abroad: Is the Holiday Over?

Annals of The Royal College of Surgeons of England ◽

10.1308/003588409x359411 ◽

2009 ◽

Vol 91 (2) ◽

pp. 128-130 ◽

Cited By ~ 9

Author(s):

Sammy A Hanna ◽

Joyti Saksena ◽

Stella Legge ◽

Howard E Ware

Keyword(s):

Total Joint Replacement ◽

Oxford Knee Score ◽

High Standard ◽

Standard Of Care ◽

Functional Results ◽

Number Of Patients ◽

Significant Difference ◽

Set Up ◽

The Uk

INTRODUCTION The UK Department of Health, in its attempt to help NHS trusts reduce long elective waiting lists, set up the overseas commissioning scheme in 2002. This allowed hospitals to send their patients abroad for their surgery. In theory, this was a win-win situation, where pressures upon surgeons were reduced, and trusts could reach UK Government targets and avoid breaches. At our hospital, a significant number of patients, who had undergone a total joint replacement abroad, were discharged after only one postoperative review and often had very little physiotherapy. A few presented to our clinic with more serious problems. PATIENTS AND METHODS This is a retrospective review of two matched groups of patients (22 each), all of whom underwent a total knee replacement in 2003. The first group (abroad, Belgium) included 10 males and 12 females with a mean age of 74.5 years and a mean follow-up of 37 months. The second group (local institution) included 10 males and 12 females with a mean age of 71.4 years and a mean follow-up of 34 months. All patients were evaluated using the Oxford Knee Score (OKS), Knee Society Score (KSS), and SF-12 systems. RESULTS OKS and KSS were similar in the two groups. However, SF-12 figures revealed a statistically significant difference in both the physical (PCS) and mental components (MCS). Belgium group – mean PCS 40, mean MCS 48: local group – mean PCS 47, mean MCS 57; P < 0.05. CONCLUSIONS The results demonstrate that, although the majority of patients operated upon abroad got comparable functional results to patients operated locally, they often felt dissatisfied with the overall experience of travelling for their operation. Furthermore, the issues of ‘patient ownership’ and long-term follow-up need to be fully addressed in order to safeguard the high standard of care we should offer our patients.

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Effectiveness of mobile phone text message reminder interventions to improve adherence to antiretroviral therapy among adolescents living with HIV: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0254890 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254890

Author(s):

Nishant Mehra ◽

Abayneh Tunje ◽

Inger Kristensson Hallström ◽

Degu Jerene

Keyword(s):

Systematic Review ◽

Antiretroviral Therapy ◽

Meta Analysis ◽

Text Message ◽

Standard Of Care ◽

Art Adherence ◽

Significant Difference ◽

Text Message Reminder ◽

Living With Hiv

Background Poor adherence to antiretroviral therapy in adolescents living with HIV is a global challenge. One of the key strategies to improve adherence is believed to be the use of digital adherence tools. However, evidence is limited in this area. Our objective was to investigate the effectiveness of mobile phone text message reminders in improving ART adherence for adolescents. Methods The preferred reporting item for systematic review and meta-analysis guideline was followed. A literature search was done in five databases (PubMed, Web of Science, Embase, Global Health and Cochrane) in August 2020. Additional searches for studies and grey literature were performed manually. We included studies with quantitative design exploring the effectiveness of text message reminders, targeting adolescents aged 10–19 years. Studies were excluded if the intervention involved phone calls, phone-based applications, or other complex tech services. Mean differences between intervention and standard of care were computed using a random effects model. Subgroup analyses were performed to identify sources of heterogeneity between one-way and two-way text messages. Results Of 2517 study titles screened, seven eligible studies were included in the systematic review. The total number of participants in the included studies was 987, and the study sample varied from 14 to 332. Five studies showed a positive impact of text messaging in improving adherence, while no significant difference was found between the intervention and the control (standard of care) group in the remaining two studies. The pooled mean difference between the intervention and the control group was 0.05 (95% CI: –0.08 to 0.17). There was considerable heterogeneity among the studies (I2 = 78%). Conclusion and recommendation The meta-analysis of text message reminder interventions did not show a statistically significant difference in the improvement of ART adherence among adolescents living with HIV. The included studies were heterogeneous in the reported clinical outcomes, where the effectiveness of the intervention was identified in small studies which had a short follow-up period. Studies with bigger sample size and a longer follow-up period are needed.

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Cervical Disc Replacement: Trends, Costs, and Complications

Asian Spine Journal ◽

10.31616/asj.2019.0246 ◽

2020 ◽

Vol 14 (5) ◽

pp. 647-654 ◽

Cited By ~ 2

Author(s):

Nickul Saral Jain ◽

Ailene Nguyen ◽

Blake Formanek ◽

Ram Alluri ◽

Zorica Buser ◽

...

Keyword(s):

Small Sample Size ◽

National Level ◽

The United States ◽

Small Sample ◽

Disc Replacement ◽

Cervical Disc ◽

Cervical Disc Replacement ◽

Significant Difference ◽

Insurance Database

Study Design: Retrospective review of insurance database.Purpose: To investigate national trends, complications, and costs after cervical disc replacement (CDR) using an administrative insurance database representative of the United States population.Overview of Literature: As CDR continues to be used to treat patients with cervical stenosis, it is important to gain a better understanding of its use on a national level, potential complications, and cost. This information will allow for optimal patient counseling, risk stratification, and healthcare cost assessments. Several prior studies have investigated complications associated with CDR, but they have been limited by small sample size, single institution experiences, limited follow-up, and potential conflicts of interest.Methods: Patients who underwent single or multilevel CDR between 2007 and 2015 were identified using an insurance database. We collected data on annual trends, reimbursement costs, patient demographic information, hospital information, and information on complications from the time of operation to 1 year postoperative.Results: Total of 293 patients underwent either single or multilevel CDR. The number of procedures increased nonlinearly over time at an average of 17% per year, with a greater increase seen in the outpatient setting. Less than 3.7% of patients had new onset pain within 1 year after CDR. Within 1 year, 12.3% of patients reported a mechanical and/or bone-related complication. There were no patients who indicated a new nerve injury within 6 months of follow-up. Less than 3.7% of patients presented with dysphagia or dysphonia within 6 months, infection within 3 months, or a revision or reoperation within 1 year. Average reimbursement for single-level inpatient versus outpatient CDR was US $33,696.28 and US $34,675.12, respectively (p =0.29).Conclusions: This study demonstrated that the use of CDR continued to increase. The most common complication was mechanical and/or bone-related, and cost analysis demonstrated no significant difference between inpatient and outpatient CDR.

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