M'hamed Temkit

Trends in multiple myeloma presentation, management, cost of care, and outcomes in the Medicare population: A comprehensive look at racial disparities

Outcomes have improved significantly in multiple myeloma (MM), but racial disparities in health care access and survival exist. A comprehensive analysis exploring MM care and racial disparities is warranted.

Racial disparity in utilization of therapeutic modalities among multiple myeloma patients: A SEER-medicare analysis

Outcomes have improved considerably in multiple myeloma (MM), but disparities among racial‐ethnic groups exist. Differences in utilization of novel therapeutics are likely contributing factors. We explored such differences from the SEER‐Medicare database. A utilization analysis of lenalidomide, thalidomide, bortezomib, and stem cell transplant (SCT) was performed for patients diagnosed with MM between 2007 and 2009, including use over time, use by race, time‐dependent trends for each racial subgroup, and survival analysis. A total of 5338 MM patients were included with median 2.4‐year follow‐up. Within the first year of MM diagnosis, utilization of lenalidomide, bortezomib, SCT, and more than one novel agent increased over time while utilization of thalidomide decreased. There was significantly lower utilization of lenalidomide among African‐Americans (P < 0.01), higher thalidomide use among Hispanics and Asians (P < 0.01), and lower bortezomib use among Asians (P < 0.01). Hispanics had the highest median number of days to first dose of bortezomib (P = 0.02) and the lowest utilization of SCT (P < 0.01). Hispanics and Asians were the only groups without notable increases in lenalidomide and bortezomib use, respectively. SCT utilization increased over time for all except African‐Americans. SCT use within the first year after diagnosis was associated with better overall survival (HR 0.52; 95% CI: 0.4–0.68), while bortezomib use was associated with inferior survival (HR 1.14; 95% CI 1.02–1.28). We noted considerable variability in MM therapeutics utilization with seeming inequity for racial‐ethnic minorities. These trends should be considered to eliminate drug access and utilization disparities and achieve equitable benefit of therapeutic advances across all races.

Resilience Training for Work-Related Stress among Health Care Workers

Objective: The aim of this study was to assess whether an in-person mindfulness-based resilience training (MBRT) program or a smartphone-delivered resiliency-based intervention improved stress, well-being, and burnout in employees at a major tertiary health care institution. Methods: Sixty participants were randomized to a 6-week MBRT, a resiliency-based smartphone intervention, or an active control group. Stress, well-being, and burnout were assessed at baseline, at program completion, and 3 months postintervention. Results: Both the MBRT and the smartphone groups showed improvements in well-being, whereas only the MBRT group showed improvements in stress and emotional burnout over time. The control group did not demonstrate sustained improvement on any outcome. Conclusion: Findings suggest that brief, targeted interventions improve psychological outcomes and point to the need for larger scale studies comparing the individual and combined treatments that can inform development of tailored, effective, and low-cost programs for health care workers.

Prediction Model For Cardiac Allograft Vasculopathy: Comparison of Three Multivariable Methods

Cardiac allograft vasculopathy (CAV) remains an important cause of graft failure after heart transplantation (HT). Although many risk factors for CAV have been identified, there are no clinical prediction models that enable clinicians to determine each recipients risk of CAV.

Does valvuloarterial impedance impact prognosis after surgery for severe aortic stenosis in the elderly

Background Valvuloarterial impedance (Zva) was introduced as a prognostic measure in patients with aortic stenosis (AS). However, it is unclear whether Zva has a prognostic impact on survival after surgical aortic valve replacement (AVR) in patients with severe AS with preserved ejection fraction (EF). Methods We retrospectively reviewed 929 consecutive patients who had AVR. We investigated 170 elderly patients (age >65 years, mean 76 years) who had AVR secondary to severe AS (mean gradient ≥40 mm Hg; aortic valve area ≤1 cm2; peak velocity ≥4 m/s). Patients with EF <50%, greater than moderate aortic regurgitation, prior heart surgery and concomitant mitral or tricuspid valve surgery were excluded. Zva was calculated and the patients were divided into two groups; low Zva, Zva <4.3 (n=82) and high Zva, Zva ≥4.3 (n=88). The end point was all-cause of death. Survival curves were calculated according to Kaplan-Meier method. Results Age, prevalence of hypertension, diabetes, chronic kidney disease (CKD), atrial fibrillation, symptoms, EF, E/e′ and concomitant coronary artery bypass graft were not different between the groups. Survival was not different between the groups at 5 years (70% in low Zva and 81% in high Zva; p=0.21) and for the entire follow-up period (p=0.23). Only age was a significant factor in predicting survival by multivariate analyses in Cox proportional hazards model after adjusting for Zva, CKD, atrial fibrillation and hypertension. Conclusions Our results suggest that preoperative Zva does not have a prognostic impact on postoperative survival in elderly patients with severe AS with preserved EF. Further investigation is needed to elucidate the controversial results.

An Evidence-Based Clinical Prediction Algorithm for the Musculoskeletal Infection Society Minor Criteria

BACKGROUND The diagnosis of a periprosthetic joint infection (PJI) remains a clinical challenge, as there is no uniformly accepted gold standard. In 2011, the Musculoskeletal Infection Society (MSIS) convened a work group to create a standardized definition for a PJI that could be universally adopted. Based on the MSIS criteria, the diagnosis of a PJI can be made with 1 of the 2 major criteria, or 3 of the 5 minor criteria. The purpose of this study was to determine the likelihood of having a PJI based on the number of positive minor criteria and thereby develop a prediction algorithm for differentiating between a chronic PJI and a non-PJI based on the number of positive MSIS minor criteria. METHODS We retrospectively reviewed 297 patients who presented to a tertiary care center between 2004 and 2014 with a failed total joint arthroplasty and subsequently underwent a PJI workup to exclude chronic PJI. Patients were divided into 2 groups: (1) PJI group and (2) non-PJI group. Patients who had a positive PJI workup and subsequently underwent a 2-stage revision for infection were included in the PJI group. Patients who had a negative clinical and diagnostic workup were included in the non-PJI group. One hundred eighty-two patients met the criteria for inclusion in the study, 91 in each group. Univariate and multiple logistic regression analyses were used to evaluate 21 independent variables in each of the 2 groups. A prediction algorithm for differentiating between a chronic PJI and a non-PJI based on independent multivariate variables was created. RESULTS Patients who had a PJI differed significantly (P < .05) from those who did not have a PJI with regard to 10 independent variables, which included all the MSIS minor criteria we evaluated. Five independent multivariate variables were identified to differentiate between the 2 groups: positive cultures, elevated synovial white blood cell count, elevated synovial polymorphonuclear neutrophil percentage, elevated erythrocyte sedimentation rate, and elevated C-reactive protein. The predictive probability of a PJI for all 32 combinations of these 5 variables was: 3.6% for 1 positive variable, 19.3% for 2, 58.7% for 3, 83.8% for 4, and 97.8% for 5. The chi-squared test for trend and the area under the receiver-operating characteristic curve (0.977) suggest that the model is highly predictive, with an excellent diagnostic performance in identifying a PJI. CONCLUSIONS Diagnosing a PJI remains a clinical challenge as there is no gold standard for diagnosis. The development of the MSIS criteria, which is based on a consensus of over 400 of the worlds experts in musculoskeletal infection, was a major step forward in defining the diagnosis of a PJI. However, to our knowledge, the likelihood of having a PJI based on the number of positive minor criteria has yet to be validated or quantified. Of the 20 independent variables that were evaluated, 10 were found to be significantly associated with a PJI, including all the MSIS minor criteria evaluated. In addition, a diagnostic prediction algorithm was constructed to determine the likelihood of a PJI based on 5 binary independent multivariate variables. The relationship was also examined with a receiver-operating characteristic curve analysis. The area under the curve was 0.98, indicating excellent diagnostic performance for the MSIS minor criteria in identifying a PJI. LEVEL OF EVIDENCE III.

Prevalence of skin cancer in Native American kidney transplant recipients

Skin cancer prevalence is well‐characterized for white solid organ transplant recipients. Although the prevalence of skin cancer in non‐white (Black, Asian, Hispanic) kidney transplant recipients (KTRs) has been assessed, no study has reported the prevalence of skin cancer in Native American (NA) KTRs. The aim of this study is to determine if the prevalence of skin cancer in NAKTRs is the same as in white KTRs.

Routine pelvic examinations: A descriptive cross-sectional survey of women's attitudes and beliefs after new guidelines.

Routine pelvic examinations have been a fundamental part of the annual female examination. The 2014 American College of Physicians (ACP) guideline recommends against routine pelvic examinations in asymptomatic, nonpregnant, average-risk women. Our aim was to evaluate womens attitudes and beliefs about pelvic examinations and how knowledge of the new guidelines contributes to attitudes and beliefs. A descriptive cross-sectional study was performed using a self-administered written survey developed through literature review and pretested and revised on the basis of staff suggestions. Nonpregnant women age≥21years presenting to outpatient clinics at Mayo Clinic in Arizona or Mayo Clinic in Rochester, Minnesota, received the survey. After being asked about pelvic examination practices and beliefs, participants were informed of the ACP guideline, to determine effect on attitudes and beliefs. Demographic characteristics and pertinent medical history questions were collected from participants. In total, 671 women who were predominantly white, married, and educated completed surveys. Participants described pelvic examinations as reassuring, and a majority believed the examinations were useful in detecting ovarian cancer (74.6%), necessary for screening for sexually transmitted infections (STIs) (71.0%), or necessary before initiating contraception (67.0%). After reading the 2014 ACP guideline, significantly fewer women planned to continue yearly pelvic examinations (P<0.001). Despite evidence to the contrary, women believed pelvic examinations were necessary for STI screening, contraception initiation, and ovarian cancer detection. After education on the ACP screening guideline, fewer women planned to continue yearly pelvic examinations.

Preoperative radiographic valgus alignment predicts the extent of lateral soft tissue release and need for constraint in valgus total knee arthroplasty

Background In total knee arthroplasty (TKA) for valgus knees, the decision to use a constrained implant is often made intraoperatively depending on the extent of soft tissue releases performed and residual soft tissue imbalance. The purpose of this study is to determine if preoperative radiographic criteria of valgus knees can predict the extent of soft tissue releases required and the level of constraint needed to balance the knee during TKA. Methods A single surgeons 807 consecutive TKA standing hip-knee-ankle radiographs from 2007-2012 were analyzed. One hundred eighty-seven valgus knees were identified and annotated. Statistical univariate and multivariate analyses were performed for both outcomes, lateral release and articulation, to assess the association with risk factors of gender, age, and preoperative radiographic markers of valgus deformity. A P-value <.05 represented a significant difference between groups. Results Use of a constrained articulation was associated with increased valgus deformity (mechanical hip-knee-ankle angle, P < .0001) and extent of lateral soft tissue release (P < .0001). No relationship existed between the use of a constrained articulation and age or gender (P > .05). A preoperative anatomic tibiofemoral valgus angle of >16.8° was associated with the use of a constrained articulation during surgery. Conclusions Our data demonstrate that preoperative radiographic characteristics of the valgus knee can be utilized to predict the extent of lateral soft tissue release and whether a constrained articulation will be required in TKA. This will provide surgeons with useful information to offer accurate preoperative counseling to patients and to ensure that the appropriate prosthetic parts are available during surgery.

DNN-Based Approach for Recognition of Human Activity Raw Data in Non-Controlled Environment

In this paper, we ask whether accurate recognition of activity can be obtained by using a network of smart objects. The approach consists in the classification of certain activities of the subjects: walking, standing, sitting and lying down. The study uses a network of commonly connected objects: a smart watch, a smartphone and a remote control and transported by the participants during an uncontrolled experiment. The sensor data of the three devices were classified by a deep neural networks (DNN) algorithm without prior pre-processing of the data. We show that (DNN) provides better results compared to Decision Tree (DT) and Support Vector Machine (SVM) algorithms. The results also show that the activities of the participants were classified with an accuracy of more than 98.53%, on average.