Background:The average readability level in the USA is a sixth grade level and for patients with chronic disease it is lower. Cirrhosis is a prevalent chronic disease that requires complex knowledge and instructions to manage. No research has been done about the understandability of online educational content for cirrhotic patients. Patients can find online materials curated by both general health platforms and high-volume liver transplant centers, and thus these materials were analyzed.Methods: After determining exclusion criteria, the websites of the top 20 general health platform results and the websites of the top 20 high-volume hepatology centers were analyzed. Readability was assessed using the Patient Education Materials Assessment Tool (Audiovisual Materials) (PEMAT-A/V), Flesch-Kincaid Grade Level tests, word counts, sentence counts, words per sentence, and time for an average sixth grader to read. Results:The mean grade level readabilities were 12.3 and 11.
Introduction The RANK ligand inhibitor denosumab has been used to treat cases of unresectable giant cell tumors of bone (GCTB) or preoperatively to facilitate intralesional curettage. However, there are no clear guidelines for use of denosumab prior to en bloc resection. Case Presentation In this study, a 26-year-old patient presented with atraumatic lateral knee pain. X-rays demonstrated a destructive lesion within the proximal fibula, and biopsy confirmed the diagnosis of GCTB. Management and Outcomes The patient received 3 months of neoadjuvant denosumab with complete resolution of his pain and cortical rim formation surrounding the tumor. The tumor was removed en bloc with negative margins. At 6-month follow-up, the patient had returned to his functional baseline with no evidence of tumor recurrence. Conclusion Neoadjuvant denosumab can mitigate symptoms related to GCTB and promotes cortical bone formation, facilitating en bloc resection and permitting acceptable functional outcomes in select cases.
Introduction Subcutaneous injection of testosterone has been investigated as a method of testosterone replacement therapy (TRT) in hypogonadal men. We have been investigating the use of a non-proprietary subcutaneous (SubQ) injection of testosterone cypionate using a ½ inch 27g needle for replacement to treat hypogonadism. This is an update on our work which includes a larger sample size and longer follow up. Objective To assess the use of non-proprietary SubQ TRT as treatment in hypogonadal men and its effect on HCT, PSA, and patient satisfaction. Methods This study is a retrospective chart review of patients receiving SubQ TRT with a mean follow up length of 9.8 months (range 0-24 months). Patient data was collected prior to initiation of therapy and at subsequent visits. Testosterone, HCT, and PSA were determined through regular blood draws and a patient satisfaction survey was performed over the phone. Univariate analysis and paired t-tests were used to analyze study variables. Results 41 total patients received SubQ TRT. Mean changes in total testosterone level (increased 281.3 + 81.1, p-value=0.0008), hematocrit (increased 1.5 + 1.0), PSA (increased 0.4 + 0.4), SHIM score (increased 3.8 + 1.4, p-value=0.0088) and AUA symptom score (decreased 0.9 + 1.6) were calculated at the patients’ initial visit and most recent follow up while still on SubQ TRT (Table 1). A total of 30 patients had been on various combinations of TRT before switching to SubQ including IM (13), CC (13) Testopel (8), HCG (2) SubQ (2), T gel (1) and Anastrozole (1). Data on the most frequent TRTs is demonstrated in Table 2. Patient satisfaction surveys were completed by 32 patients (78%), with 26 (81.2%) patients reporting overall satisfaction with SubQ TRT versus 45% (9/20) with past forms of TRT. 93.7% (15/16) reported SubQ TRT was both easier and less painful, and 73.6% (14/19) preferred SubQ injections over their previous form of TRT. Reasons for stopping SubQ TRT included unrelated stroke (1), prostate cancer (1), development of scar tissue (1) or bruising (1), ineffective therapy (1), difficulty drawing up the syringe (1), cost (1), and trouble obtaining medication from the pharmacy (1). Conclusions The use of non-proprietary testosterone cypionate SubQ as treatment for hypogonadism results in an elevation in serum total testosterone and improvement on both SHIM and AUA symptom scores at follow up. PSA and HCT rose over the span of treatment, but the rises were not statistically significant, and no patient developed erythrocytosis. Our data demonstrate SubQ TRT is easier and less painful to use and scores higher on overall patient satisfaction compared to other forms of TRT. Disclosure No
In-lab polysomnography (PSG) is the gold standard in diagnosis of pediatric obstructive sleep apnea (OSA). However, PSG is expensive, cumbersome, and not easily accessible. Home sleep testing (HST) has emerged as a reasonable and sometimes mandatory first step in the diagnosis of OSA in adults, but it is not yet recommended for use in children. We sought to identify patient characteristics associated with caregiver interest in HST over in-lab PSG. METHODS: Retrospective chart review of all in-lab pediatric PSG completed in 2018 at Rush Children's Hospital. Inclusion criteria was based on completion of pre-and post-PSG questionnaires (English and Spanish in single handout) and baseline PSG. Exclusion was based on age (<2 or >18 years of age) and completion of titration PSG. Univariate analysis then multivariate logistic regression analysis was used to determine association of patient characteristics (demographics, indication for PSG, comorbid conditions), patient symptoms reported by caregiver, and parent preference for HST (yes/no for question: "If available and appropriate, would you prefer an at-home sleep test for your child?"). RESULTS: Analysis of 136 questionnaires that met inclusion and exclusion criteria. Cohort characteristics include: 41% female (41 of 101), 39% Hispanic/Latino (52 of 134), 18% had prior PSG (23 of 130), 51% seen by ENT prior to PSG (69 of 136), 31% with history of adenotonsillectomy (28 of 90), 42% obese (40 of 95), 9% with attention deficit hyperactivity disorder (8 of 87), 38% reported snoring nightly (51 of 135), 26% witnessed apnea (35 of 135), 19% reported gasping/choking episodes (25 of 135), and 24% report of co-sleeping (33 of 136). Of those, majority 60.3% (n¼82) preferred in-lab PSG over HST for their child. Those who were completing PSG for pre-operative purposes also prefer in-lab PSG over HST (p ¼0.02). Alternatively, HST preference was indicated by caregivers who reported that their child had symptoms of gasping/choking (p ¼0.01) or startle/jumping (p ¼ 0.046) during sleep. No differences were found with gender, ethnicity, prior PSG, snoring nightly, apnea, or co-sleeping. CONCLUSIONS: The majority of caregivers surveyed would prefer in-lab PSG over HST, especially in the preoperative setting. Alternatively, symptoms of gasping/choking and startle/jumping are associated with an increased caregiver predilection for HST. While HST may prove a valuable diagnostic tool in pediatric OSA, parental perceptions of this modality may be a barrier to widespread use. CLINICAL IMPLICATIONS: While HST may prove a valuable diagnostic tool in pediatric OSA, parental perceptions of this modality may be a barrier to widespread use.
Surgical complications were classified as arterial, venous, ureteral, lymphatic, suture dehiscence, and/or need for early graft removal (defined as removal in the first 3 months after transplantation). The cause of early graft removal was noted and categorized as either a surgical or non-surgical complication.RESULTS: A total of 100 kidneys were implanted from DCD/ ECMO, 108 from DBD/SCD and 115 from DBD/ECD.Despite a higher rate of DGF in DCD/ECMO groups vs DBD/SCD and DBD/EDC (65,9% vs 28,1% vs 30,8%; p<0,001), there were no differences in renal function between groups 12 months after transplantation. There were no statistically significant differences in surgical complications. Early graft removal was lower in DBD-SCD group. DCD/ECMO group had a significantly more early graft removals of non-surgical cause due to tubular necrosis, humoral rejection or infection, while DBD/ECD had a significantly more early graft removals of surgical cause due to arterial/ venous thrombosis and hemorrhage.CONCLUSIONS: Kidney transplantation from DCD/ECMO can be a viable option. Despite higher rates of DGF in DCD/ECMO, those whose grafts survive have a similar renal function in the medium-to-long term. Early graft removal was mainly associated with a non-surgical cause, probably related to ischemia lesion caused by prolonged warm ischemia time and/or ischemia-reperfusion injury induced by the ECMO.
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