Jewish Hospital Of Cincinnati

The majority of patients refer to online patient education content before elective surgeries, including Vertebral Body Tethering (VBT). The purpose of this study was to evaluate the quality, contemporaneity, and readability of patient information web pages across different sources (teaching hospital, private HCF, commercial/news, and non-profit organization) on VBT. The search results from Google and Bing were analyzed using a systematic approach, excluding peer-reviewed articles, insurance policy documents, and videos. Forty-seven web pages were reviewed for quality based on preoperative, operative, and postoperative information, alongside compliance with Journal of American Medical Association (JAMA) benchmark criteria. The web page content was assessed using a contemporaneity score, which evaluated the inclusion of the latest research. Readability was assessed using the Flesch–Kincaid Grade level and Gunning-Fog Index. The overall mean quality score, JAMA score, and contemporaneity scores were 7.63 (95% CI 6.63–8.64) out of 16, one (95% CI 0.68–1.32) out of four, and 0.61 (95% CI 0.33–0.9) out of five, respectively. The mean Flesch–Kincaid grade level and Gunning-Fog index were 11.7 (95% CI 10.88–12.55) and 14.94 (95% CI 14.12–15.75), respectively. Higher Quality scores also correlated with better Flesch–Kincaid and Gunning-Fox readability scores (Quality score-Flesch–Kincaid grade level: ρ = − 0.38, p = 0.0074; Quality score-Gunning-Fog index: ρ = − 0.354, p = 0.0161). Existing patient education material contains limited and fragmentary information, lacks essential details, does not reflect the current limitations of VBT, and is written at a much advanced reading level than recommended. The material requires thorough revision, given that VBT is a relatively new surgical procedure with evolving indications and outcomes.

Purpose To describe a case of occlusive retinal vasculitis (ORV) following intravitreal aflibercept 8mg injection for wet macular degeneration. Methods Retrospective, interventional case report Results A 72-year-old female presented with classic ORV 11 days after intravitreal aflibercept 8mg injection in her left eye for wet macular degeneration. Visual acuity (VA) declined from 20/30 to 20/400. Laboratory investigations including Gram stain and cultures of vitreous aspirate, studies for infectious and non-infectious uveitis and hypercoagulable state were all negative. Oral prednisone, sub-Tenon’s triamcinolone acetonide (STTA), intravitreal dexamethasone and antibiotic injections, and topical steroids resulted in visual and anatomic improvement. ORV recurred when prednisone was tapered to 10mg/day and was controlled with additional STTA, oral solumedrol, and a 0.18mg fluocinolone acetonide implant. Subsequently exudation from wet macular degeneration recurred and responded to intravitreal faricimab with recovery to 20/30. Conclusions ORV is a rare complication of some intravitreal anti-VEGF medications and infectious causes of endophthalmitis. It can be managed with aggressive steroid treatment for an excellent visual outcome in some cases, although the disease may be chronic or recurrent.

Study Objectives Central sleep apnea (CSA) is common in heart failure (HF) patients but its treatment's impact on cardiac function is unclear. Transvenous phrenic nerve stimulation (TPNS) is an emerging CSA therapy that may improve long-term left ventricular systolic function (LVEF) in HF. Given the cardiovascular risk of sleep apnea appears contingent on respiratory-event-related heart rate surges (“high ∆HR”), we hypothesized that TPNS treatment may preferentially improve LVEF in CSA patients with high ∆HR. Methods In the remedē® System pivotal trial, ∆HR was calculated from baseline polysomnography in patients with HF. Primary analysis quantified whether treatment-related change in left ventricular ejection fraction (∆LVEF; echocardiography, biplane method) vs. control was greater in “high ∆HR” (>14.6 beats/min, i.e.,fourth quartile) vs. “low ∆HR (≤4.2 beats/min, i.e., first quartile)” at 6 months (treatment-by-“high ∆HR” interaction). Longitudinal analysis quantified whether favorable LVEF changes from baseline were maintained longer term (6-12 months). Results In primary analysis (N=79, M:F=74:5, LVEF=34±12% [mean±SD]), TPNS vs. control was associated with a markedly greater improvement in LVEF in patients with high ∆HR vs. low ∆HR (estimate [95%CI]: +7.8[0.37,15.2]%, P-interaction=0.04). In longitudinal analysis, LVEF increased in patients with high ∆HR at 6, 9, and 12 months (+2.5[-0.1,5.1]%, +3.9[1.2,6.5]%, +3.7[1.0,6.4]% from baseline, respectively) but not among low ∆HR (-0.1[-2.8, 2.6]%; -0.3[-3.1, 2.4]%; -0.8[-3.7, 2.1]%). Conclusions Compared to low ∆HR, patients with high ∆HR showed greater LVEF improvement with TPNS for CSA. High ∆HR, a potential reflection of CSA-related sympathetic overactivity, may identify those who benefit most from CSA treatment.

Purpose : Embryonal tumor with multilayered rosettes (ETMR) is a rare pediatric CNS embryonal tumor with poor survival. The Pediatric Proton/Photon Consortium Registry (PPCR) was queried for outcomes data from prospectively consenting pediatric patients with ETMR treated with proton radiation therapy (RT). Methods : 20 patients (2013-2021) at 9 institutions had ETMR; 2 with prior RT were excluded from statistical analyses (PPCR ETMR, N=18). Overall Survival (OS) and Event Free Survival (EFS) analyses were performed using the Kaplan-Meier method and log-rank values. Median follow-up was calculated using the reverse Kaplan-Meier method. Results : Median age at RT was 3.0 years (1.7-12.2); median follow-up was 55.5 months (2.6-119.4). 8 patients (44%) expired and 6 patients (33%) are surviving ≥55 months. 11 (61%) patients received systemic therapy with stem cell support. The majority (89%) had focal RT, while 2 patients received craniospinal irradiation (CSI). 4-year OS and EFS were 59.6% and 54.2%, respectively. Local control (LC) at 4 years was 81%. No differences in OS or EFS were observed for receipt of systemic therapy with stem cell support (p=0.361, p=0.57), progression prior to RT (p=0.127, p=0.18), or surgery to RT ≥200 days (p=0.35, p=0.254). Symptomatic radionecrosis was not reported. Conclusion : Focal proton RT provided effective local control as part of multimodality therapy for ETMR, with encouraging survival for this rare and often infant age tumor. Outcomes for CSI were limited to 2 patients treated upfront, and 1 patient receiving salvage CSI for disseminated relapse after focal RT who is surviving >1 year. Trial: DFCI protocol 12-103, clinicaltrials.gov NCT01696721, date of registration 9/27/2012

Background: Tuberculosis (TB) elimination in the U.S. will require increased screening among at-risk groups. Nontraditional immigration destinations (NTIDs) are those which have historically not been home to large Latino immigrant populations, and which have less culturally relevant services available. Methods: Interviews were performed with Latino immigrants in an NTID to understand health beliefs relevant to TB screening. A community advisory board (CAB) was formed to suggest interventions consistent with health beliefs using the RE-AIM framework for planning. Based on the CAB's suggestions, educational videos were developed. A survey was used to assess the impact of the videos in a pilot study. Results: Community members had low perceived susceptibility to TB, high perceived severity of disease, were unfamiliar with indications for screening, and had attitudes which supported screening, particularly if there was knowledge of treatment options. The CAB suggested making an educational video and helped to recruit participants to pilot the video which was made. Watching the video increased participants’ perceived importance of screening and intention to be screened. Conclusion: Partnering with community members and community-serving organizations in an NTID helped to co-create an educational initiative which increased intention to be screened for TB among Latino immigrant groups and provided information on where this could be accomplished.

559 Background: Renal cell carcinoma (RCC) with brain metastases presents a clinical challenge. Management remains unclear, as systemic therapy data are limited and many trials exclude patients with active brain metastases. Current treatment primarily involves CNS-targeted radiation (e.g., stereotactic radiosurgery and whole-brain radiation therapy), while systemic therapies like tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) are underexplored. This meta-analysis evaluates the efficacy of systemic treatments and whether these patients should continue to be excluded from clinical trials. Methods: A systematic search of PubMed, CENTRAL, MEDLINE, and Google Scholar was conducted through October 2024, focusing on studies of mRCC patients with brain metastases treated with ICIs, TKIs, or their combination. ICI therapies included nivolumab, ipilimumab, pembrolizumab, atezolizumab, and avelumab, while TKIs included sorafenib, sunitinib, and cabozantinib. Case reports, ongoing trials, narrative reviews, and meta-analyses were excluded. Primary endpoints were complete response (CR), partial response (PR), objective response rate (ORR), and overall survival (OS). Statistical analyses used fixed/random-effects models based on heterogeneity. Results: Nineteen studies involving 947 mRCC patients with brain metastases were included. The pooled analysis showed an ORR for ICIs of 29.9%, with a CR of 3.4% and PR of 28.9%. Brain-specific ORR, CR, and PR for ICIs were 27.5%, 10.8%, and 17.9%. TKIs alone showed a pooled ORR of 11.7%, with a CR of 1.3% and PR of 11.6%. Brain-specific ORR, CR, and PR for TKIs alone were 38.1%, 6.9%, and 29.5%. Only one study reported on ICI-TKI combinations, with an ORR of 0%. Survival analysis showed significantly worse OS for brain metastasis patients treated with ICIs plus TKIs (HR: 2.06, p=0.001) and TKIs alone (HR: 2.51, p=0.02) compared to those without brain metastases. Conclusions: ICIs had superior overall response rates compared to TKIs and ICI-TKI combinations in mRCC patients with brain metastases. Brain-specific response rates were similar between ICIs and TKIs. Given the poor prognosis of brain metastasis patients treated with TKIs, further research is needed to determine if they should continue to be excluded from trials. Larger prospective studies are required to confirm these findings and optimize treatment.

It is not uncommon for basic scientists to switch into public health research. Such career transitions present a variety of challenges and opportunities and can reinvigorate a career, lead to new skills, and provide the chance to contribute to individual and community health and social justice. Based on our respective experiences switching from applied physics to infectious disease modelling and from evolutionary physiology to cancer prevention and control, we propose ten simple rules intended to help researchers from other disciplines think about a transition to public health research. Together, these rules are largely about navigating between pairs of extremes related to why you want to move in a new direction, how to balance old and new expertise, and balancing humility with the confidence that you are bringing something important to the table. A career transition can also fulfill some of the basic motivators for a research career, including curiosity and a passion to try to solve important problems. Our career transitions proved deeply satisfying. We hope yours will as well.

Purpose Appalachian Kentucky, a 32-county region in the eastern part of the state, has elevated colon cancer mortality rates. While recommended as the standard of care, access to adjuvant chemotherapy treatment is limited in this region due to scarce health services and significant social and geographical barriers. The purpose of this investigation was to improve understanding of barriers that cancer patients residing in rural areas not served directly by tertiary medical systems must overcome in completing adjuvant therapy. Methods Participants were recruited from two medical centers: A tertiary care NCI designated Cancer Center and a regional hospital. Participants underwent a 15–20 minute interview to assess factors associated with adherence to adjuvant treatment recommendations. Grounded theory identified themes related to patient behaviors and non-adherence to standard of care recommendations. Results Data were collected in 45 telephone and in-person patient interviews, 26 from an NCI-designated cancer center and 19 from a rural hospital. Statistically the two groups were equivalent in terms of age, subjective health status, and medical comorbidities. Six themes were identified from analysis of the transcribed interviews including: confidence in my care provider, communication, treatment issues, distrust, faith, and barriers to obtaining healthcare. Participants completing adjuvant therapy were more likely to express trust in their provider and describe fewer barriers to obtaining healthcare than those not completing adjuvant therapy. Conclusion Barriers to completing adjuvant therapy may differ between rural and urban healthcare systems which may yield opportunities for targeted interventions to improve rates of completion of colon cancer adjuvant chemotherapy.

Kentucky faces the highest age-adjusted overall cancer incidence rates and the second highest overall cancer mortality rates in the United States, with the eastern Appalachian Region of the state contributing significantly to this burden. As one of 57 National Cancer Institute (NCI)-designated comprehensive cancer centers in the country, the University of Kentucky Markey Cancer Center is Kentucky’s only NCI-designated comprehensive cancer center. This designation is important for receiving the support necessary to fund programs that can further the cancer research, education, and community outreach opportunities for Kentuckians. The Markey Cancer Center’s Appalachian Career Training in Oncology program, created in 2016, offers cancer research, clinical, outreach, and educational experiences to Appalachian Kentucky high school students and undergraduate students enrolled at the University of Kentucky. The program creates multiple levels of mentorship designed to enrich students’ interest in pursuing a cancer-related career. Mentorship partners include cancer researchers, clinicians, workshop presenters, community members, program staff, and program peers. The program has demonstrated significant success, including a high matriculation rate, numerous student-authored publications, and influential community engagement initiatives. Implications for practice include the potential to implement similar programs for other populations around the country, thus furthering knowledge and fostering passion in underrepresented groups.

Central sleep apnea (CSA), a rare polysomnographic finding in the general population, is prevalent in certain cardiovascular conditions including systolic and diastolic left ventricular dysfunction, atrial fibrillation, coronary artery disease, carotid artery stenosis, stroke and use of certain cardiac-related medications. Polysomnographic findings of CSA with adverse cardiovascular impacts include nocturnal hypoxemia and arousals, which can lead to increased sympathetic activity both at night and in the daytime. Among cardiovascular diseases, CSA is most prevalent in patients with left ventricular systolic dysfunction; a large study of more than 900 treated patients has shown a dose dependent relationship between nocturnal desaturation and mortality. Multiple small randomized controlled trials have shown mitigation of sympathetic activity when CSA is treated with nocturnal oxygen, continuous positive airway pressure and adaptive servoventilation. However, two early randomized controlled trials with positive airway pressure devices have shown either neutral effect on survival or excess premature mortality in the active treatment arm, compared to untreated CSA. In contrast, the results of the most recent trial using an advanced adaptive servoventilation device showed improved quality of life and no signal for mortality suggesting that treatment of CSA was at least safe. In addition to positive airway pressure devices, multiple medications have been shown to improve CSA, but no long-term trials of pharmacologic therapy have been published. Currently, phrenic nerve stimulation is approved for treatment of CSA, and the results of a randomized controlled trial showed significant improvement in sleep metrics and quality of life.

Biliary stent insertion during endoscopic retrograde cholangiopancreatography is a therapeutic intervention to relieve obstruction and facilitate flow through the biliary tree. In rare circumstances, these stents can migrate and result in distal gastrointestinal perforation, which may necessitate endoscopic or surgical intervention. We report a case involving a 79-year-old female who presented with peritonitis due to sigmoid colon perforation following biliary stent migration. The stent was placed to treat acute cholangitis with choledocholithiasis. Two weeks following stent placement, gastroenterology attempted scheduled stent removal, but was unable to visualize the stent on endoscopy. Eleven days later, the patient was emergently taken to the operating room for an exploratory laparotomy and a Hartmann’s procedure for stent migration and subsequent sigmoid perforation. No established protocol exists for managing migratory biliary stents to avoid perforations. We emphasize the need for follow-up imaging and individualized clinical decision-making based on patient stability.

Purpose of Review Central sleep apnea (CSA) is associated with increased mortality, particularly in heart failure. This review discusses current treatment options with a focus on different positive airway pressure (PAP) modalities, the clinical implication of continuous PAP (CPAP) failure, and key advancements in adaptive servo-ventilation (ASV). Recent Findings CPAP reduces CSA by about 50% in patients with heart failure with reduced ejection fraction. The remaining patients are considered non-responsive and chronic use of CPAP has been associated with excess mortality. ASV is effective in several forms of CSA. While secondary analyses of the SERVE-HF trial limited its use in patients with predominant CSA and left ventricular ejection fraction < 45%, more recent data from ADVENT-HF using a newer ASV generation targeting peak flow has shown promising results. Summary Physicians should consider the underlying pathophysiology, overall prognosis, and evidence base prior to selecting CSA treatment with CPAP or ASV. Promising pharmaceutical and novel device options require more studies and long-term evidence.

Anaplasma phagocytophilum is the causative agent of human granulocytic anaplasmosis (HGA), a tick-borne illness with increasing incidence since being described in the 1990s. Importantly, the presentation can be vague, yet prompt treatment is paramount. An 81-year-old Caucasian female was hospitalized in Cincinnati, Ohio, for fever and confusion following prolonged outdoor exposure in Emlenton, Pennsylvania. She initially was treated for sepsis from presumed community-acquired pneumonia; however, the combination of leukopenia, thrombocytopenia, and elevated liver enzymes prompted empiric tick-borne illness consideration and treatment with rapid resolution in symptoms. Early recognition of HGA can reduce unnecessary treatments and improve patient outcomes.

Background: Although calcium and vitamin D (CaD) supplementation may affect chronic disease in older women, evidence of long-term effects on health outcomes is limited. Objective: To evaluate long-term health outcomes among postmenopausal women in the Women's Health Initiative CaD trial. Design: Post hoc analysis of long-term postintervention follow-up of the 7-year randomized intervention trial of CaD. (ClinicalTrials.gov: NCT00000611). Setting: A multicenter (n = 40) trial across the United States. Participants: 36 282 postmenopausal women with no history of breast or colorectal cancer. Intervention: Random 1:1 assignment to 1000 mg of calcium carbonate (400 mg of elemental calcium) with 400 IU of vitamin D3 daily or placebo. Measurements: Incidence of colorectal, invasive breast, and total cancer; disease-specific and all-cause mortality; total cardiovascular disease (CVD); and hip fracture by randomization assignment (through December 2020). Analyses were stratified on personal supplement use. Results: For women randomly assigned to CaD versus placebo, a 7% reduction in cancer mortality was observed after a median cumulative follow-up of 22.3 years (1817 vs. 1943 deaths; hazard ratio [HR], 0.93 [95% CI, 0.87 to 0.99]), along with a 6% increase in CVD mortality (2621 vs. 2420 deaths; HR, 1.06 [CI, 1.01 to 1.12]). There was no overall effect on other measures, including all-cause mortality (7834 vs. 7748 deaths; HR, 1.00 [CI, 0.97 to 1.03]). Estimates for cancer incidence varied widely when stratified by whether participants reported supplement use before randomization, whereas estimates on mortality did not vary, except for CVD mortality. Limitation: Hip fracture and CVD outcomes were available on only a subset of participants, and effects of calcium versus vitamin D versus joint supplementation could not be disentangled. Conclusion: Calcium and vitamin D supplements seemed to reduce cancer mortality and increase CVD mortality after more than 20 years of follow-up among postmenopausal women, with no effect on all-cause mortality. Primary funding source: National Heart, Lung, and Blood Institute of the National Institutes of Health.