Citations

ABSTRACT Objective We sought to characterize patients presenting to emergency departments (EDs) with abdominal pain and to validate risk categories defined by the Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE‐2) for low‐risk recurrent abdominal pain. Methods We conducted a retrospective cohort study of patients presenting with abdominal pain between November 2019 and November 2023 across 21 EDs in Arizona, the Midwest, and Florida. Patients were categorized per GRACE‐2 into recurrent and non‐recurrent pain as well as low‐ and high‐risk groups. Primary outcomes included 72‐h returns and mortality at 30 and 90 days. Results The study included 162,494 visits (112,896 unique patients; median age 46 years; 61.2% female). Among these, 4.3% had low‐risk recurrent abdominal pain. Patients with recurrent and non‐recurrent low‐risk pain had similar ED length of stay and discharge rates to each other, compared to patients with high‐risk pain who had longer length of stay and lower discharge rates. At 30 days after the ED encounter, patients with low‐risk recurrent abdominal pain had similar mortality to patients with low‐risk non‐recurrent pain (0.4% vs. 0.3%; adjusted RR = 1.31, 95% CI: 0.85–2.03), while they had significantly lower mortality than patients with high‐risk recurrent abdominal pain (0.4% vs. 2.3; adjusted RR = 3.14, 95% CI: 2.02–4.89). Conclusions This study highlights the heterogeneity in patients presenting to the ED with abdominal pain. Among these patients, those with low‐risk recurrent pain demonstrated similar lengths of stay, discharges, and mortality rates to those with low‐risk non‐recurrent pain and less favorable lengths of stay, discharges, and mortality rates compared to those with any high‐risk features. These findings suggest that low‐ and high‐risk features may be more useful than recurrent or non‐recurrent pain in identifying patients who could benefit from more robust ED evaluations.

Limited studies have explored the effects of individual and environmental factors on sleep disturbance in individuals with inflammatory bowel disease (IBD), which is vital for informing future sleep interventions. Thus, the purpose of this study was to explore the possible mediated effects of potential precipitating and/or perpetuating factors on the relationship between sleep disturbance and symptoms in adults with IBD. This is a correlational study of adults with IBD recruited from ResearchMatch. Survey questions asked about demographics, clinical characteristics, sleep hygiene, sleep beliefs and attitudes, sleep environment, sleep control, and symptoms (sleep disturbance, abdominal pain, anxiety, depression, fatigue). Data analysis included descriptive statistics, Pearson correlations, and mediation analysis. We included 250 adults with IBD ( M = 37.9 years old, 64.8% female, 72.4% white). Fifty-four percent of the sample self-reported having a diagnosed sleep disorder. Sleep hygiene and sleep beliefs and attitudes significantly mediated the relationship between sleep disturbance and symptoms (i.e., fatigue, depression, anxiety, and abdominal pain). Whereas the sleep environment and sleep control did not significantly mediate the relationship between sleep disturbance and symptoms. Individuals with IBD experience sleep disturbances, alongside symptoms of anxiety, depression, abdominal pain, and fatigue. Mediation analysis identified sleep hygiene and sleep beliefs, and attitudes as partial mediators. Considering cognitive-behavioral therapy for insomnia is recommended for restructuring these mediating factors. Participants also faced moderate environmental disturbances, suggesting a need for further investigation in this population.

Health problems associated with post-acute COVID-19, also known as “Long COVID,” range from mild to severe. The best defense against this potentially serious condition is to prevent COVID-19 infection and reinfection. The same preventive measures for COVID-19 may be used to help prevent the spread of Long COVID. This study used the Health Belief Model (HBM) to examine whether and how public understanding and awareness of Long COVID and its prevention shape the adoption of COVID-19 preventive behaviors. N = 605 English-speaking U.S.-based adults were recruited via Qualtrics. Predictors of intention to carry out COVID-19 preventive behaviors were investigated. Outcomes included behaviors relevant to preventing both acute and Long COVID. Across all models, except the one examining intent to get a vaccine booster, Black respondents were more likely than White respondents to express intent to carry out COVID-19 preventive behaviors. In addition, HBM constructs added significantly to the regression models. Susceptibility to Long COVID was significant for all behavioral outcomes (all p s < .05), self-efficacy for wearing a mask ( p < .001), and self-efficacy for testing for COVID-19 after exposure and before a social event ( p s < .001). In addition, perceived benefits for Long COVID prevention predicted intent of mask-wearing ( p < .001), testing before a social event ( p = .002), and getting a vaccine booster ( p = .001). Perceived severity of Long COVID did not significantly predict adherence to preventive behaviors. U.S. adults are more likely to express intent to carry out COVID-19 preventive behaviors, such as masking and receiving booster vaccines, when they report feeling greater susceptibility to Long COVID as well as greater self-efficacy for engaging in these preventive behaviors. Public health messaging about Long COVID with incorporation of HBM constructs may be an effective means of increasing continued recommended COVID-19 preventive behaviors, which also hold co-benefits for prevention of infections, such as influenza and measles, as well as emerging viruses such as avian flu.

Abstract The treatment patterns and clinical outcomes for patients experiencing progression of disease (POD) following CD19-directed chimeric antigen receptor (CAR) T-cell therapy for relapsed or refractory (R/R) mantle cell lymphoma (MCL) are undefined. We identified all patients who received CD19-directed CAR T-cell therapy for R/R MCL therapy across 15 international centers, and studied those experiencing POD post–CAR T-cell therapy in detail. We extracted clinical/treatment/pathologic variables, and associated these features with survival outcomes. In total, 384 patients received CAR T-cell therapy, and 135 (35%) experienced POD. POD occurred at a median of 6 months following CAR T-cell therapy infusion, and most (64%) patients with POD had complete response as best response to CAR T-cell therapy. Tumor features at POD included blastoid/pleomorphic morphology in 29 of 78 (37%) patients, and TP53 mutation in 21 of 41 (51%) patients. Following POD, 17 patients received no further therapy, 13 underwent local therapy, and 105 received systemic therapy. The most common first-line systemic therapies were chemo(immuno)therapy (22 patients; overall response rate [ORR], 40%), pirtobrutinib (17 patients; ORR, 36%), and bispecific antibodies (13 patients; ORR, 67%). Among patients experiencing POD, the median progression-free survival and overall survival (OS) were 2.5 months and 5.4 months, respectively, from POD. Lack of response to CAR T-cell therapy and short time from CAR T-cell therapy infusion to POD (&lt;3 vs 3-6 vs &gt;6 months), among other factors, were associated with inferior OS after POD. In conclusion, we confirm the challenging prognosis for patients experiencing POD following CD19 CAR T-cell therapy for R/R MCL, and establish a benchmark for future investigations in this patient population.

Objectives: To investigate the association between hormone therapy use and severe outcomes due to COVID-19 in perimenopausal and postmenopausal women. Methods: Using the Rochester Epidemiology Project, we retrospectively searched for the records of women aged 40-65 years who had a documented case of COVID-19 between March 12 and September 29, 2020. We further identified those who were perimenopausal or postmenopausal. The rates of emergency department visits, hospitalizations, and deaths were compared by hormone therapy use. Logistic regression models were used to assess the odds of the combined outcome based on hormone therapy use. Results: Among the 689 patients included in this study, the median age was 56 years, and 77.5% were White. Compared with patients currently using hormone therapy, those with past/never use of hormone therapy were significantly older, had more risk factors for severe COVID-19, and had a higher incidence of diabetes. A total of 102 emergency department visits/hospitalizations/deaths occurred among both groups. Participants with current hormone therapy use had similar rates and risk of emergency department/hospitalization/death outcomes as those without hormone therapy, even after adjusting for age and severe COVID-19 risk factors. Conclusions: Severe COVID-19 outcomes were not significantly different between women with current versus past/never use of hormone therapy. Our study adds to the data suggesting no harm with hormone therapy use in women with severe symptoms of COVID-19.

Objectives To examine associations between multimorbidity, the social determinants of health (SDoHs) and rheumatoid arthritis (RA) flare and remission. Methods All patients aged ≥18 years in Olmsted County, Minnesota, with incident RA in 1999–2014 were identified. Using a list of 55 chronic medical conditions, multimorbidity was defined as the presence of ≥2 conditions and substantial multimorbidity as ≥5 conditions. The Area Deprivation Index and Social Vulnerability Index (SVI) were used as proxies for adverse SDoH burden. Flare and remission were defined using Outcome Measures in Rheumatoid Arthritis Clinical Trials definitions. Mixed effects models were used to assess associations between flare/remission and multimorbidity, adverse SDoH burden and other patient characteristics. Results This study included 659 patients with incident RA. Multimorbidity and substantial multimorbidity predicted 29% (OR:1.29, 95% CI:1.04 to 1.59) and 26% (OR:1.26, 95% CI:1.03 to 1.53) higher odds of flare, respectively. Both were associated with 34% (OR:0.66, 95% CI:0.49 to 0.90) and 33% (OR:0.67, 95% CI:0.51 to 0.90) lower odds of remission, respectively. SVI predicted 8% lower odds of remission for every 0.1 increase above 0.3 (OR:0.92, 95% CI:0.85 to 0.99). Flare was also associated with female sex, smoking, younger age and shorter disease duration, but not seropositivity. Remission was also associated with male sex, never smoking, older age and longer disease duration, but not seropositivity. Conclusions Multimorbidity predicts higher odds of RA flare and lower odds of remission. Adverse SDoH burden predicts lower odds of remission. These findings have the potential to inform disease prognostication and clinician interventions.

Objective Literature is limited regarding the relationship between cochlear magnetic resonance imaging fluid-attenuated inversion recovery (FLAIR) signal and hearing preservation after resection of vestibular schwannoma (VS). We hypothesize that increased preoperative FLAIR signal is associated with decreased odds of hearing preservation. Study Design Retrospective cohort study. Setting Single academic tertiary/quaternary care center. Patients Subjects with histologically confirmed intracanalicular VS (without extension into the cerebellopontine angle). Intervention Microsurgical resection via middle fossa approach. Main Outcome Measures A review of demographic, clinical, radiographic, and audiometric outcomes were performed. Hearing preservation was defined as American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) class A or B hearing. Binary logistic regression analysis was performed with SPSS version 29. Results Twenty-seven subjects met inclusion criteria with median age at time of surgery of 47 (interquartile range [IQR]: 38–54) years; 92.60% were White; 66.67% had AAO-HNS class A, and 33.33% had class B hearing. Postoperatively, at median (IQR) of 11.50 (2.10–38.50) months, 44.40% had class A or B hearing. On logistic regression analysis, a ratio of cochlea-to-brainstem FLAIR signal greater than 0.6 was associated with decreased odds of hearing preservation at 11.50 months—odds ratio, 0.13; 95% confidence interval, 0.02–0.84. Age, sex, surgery duration, tumor volume and linear dimension, fundal cap of cerebrospinal fluid, and extent of resection were not associated with hearing preservation. Conclusion Increased cochlear FLAIR signal on preoperative imaging is associated with decreased likelihood of hearing preservation after resection of intracanalicular, sporadic VS via middle fossa approach.

Purpose of review Although effective patient safety education is critical to reducing medical errors, little guidance exists on best practices for patient safety curricula. This review explores the current state of patient safety education in anesthesiology and highlights emerging technologies as tools to enhance and personalize education. Recent findings Despite formal mandates from accrediting bodies, patient safety education in anesthesiology lacks standardization in content, delivery, and assessment. Structured clinical training, simulation, and quality improvement projects are common teaching strategies, but novel approaches such as immersive reality (IR), artificial intelligence (AI)-powered agents, gamification, and mobile platforms are gaining traction. AI shows promise in tailoring instruction and identifying high-risk learners, and IR offers tools for both technical and nontechnical skills training. Summary Patient safety education in anesthesiology is evolving with technology. AI and digital tools provide adaptive and interactive learning experiences that may help address current limitations in fixed, generalized curriculum structure and accessibility. However, these innovations require robust validation and thoughtful integration into educational frameworks to realize their full potential.