Baylor University Medical Center Proceedings最新文献

Background: Breast cancer is the most common cancer and the second leading cause of female cancer-related death in the US. Time to treatment initiation is often critical for improving cancer outcomes. Socioeconomic status (SES) is increasingly recognized as influential in cancer treatment efficacy.

Methods: This retrospective cohort study investigated associations between SES and delayed breast cancer treatment initiation across treatment modalities in Southeast Texas. Logistic regression models assessed the associations between delays and socioeconomic or clinical characteristics among 609 patients.

Results: Regarding overall treatment, males, unmarried patients, younger patients, and Medicaid users experienced increased delay odds, while females, widows, and Medicare users experienced decreased odds. For chemotherapy, Tricare coverage was associated with excessive delay odds. Regarding surgical intervention, African Americans, unmarried patients, younger patients, and Medicaid users experienced increased delay odds, while Caucasians, older patients, and Medicare users experienced decreased odds. For radiation therapy, divorcees and those with Medicare and Medicaid eligibility experienced increased delay odds. Regarding hormone therapy, younger patients and Medicaid users experienced increased delay odds, while older patients and Medicare users experienced decreased odds. For immunotherapy, unmarried patients experienced increased delay odds, while being married conferred lower odds.

Conclusion: These results indicate that certain SES factors significantly predict treatment delays in breast cancer care.

Background: Despite burgeoning evidence of elevated cardiovascular disease (CVD) risk among women veterans, relatively little is known about the current state of knowledge among non-Veterans Affairs (VA) primary care staff regarding CVD risk and care among women veterans.

Methods: This study assessed primary care staff within a large statewide, private, nonprofit hospital system to determine their baseline knowledge of general CVD risk factors and those specific to women veterans. We also evaluated staff awareness of their patients' veteran status, attitudes regarding health promotion and prevention practices, and perceptions of barriers to health promotion.

Results: As hypothesized, primary care staff demonstrated strong knowledge of general CVD risk factors, but most showed poor to moderate knowledge of women veteran-specific CVD risk factors. Further, only a minority of respondents reported knowing their female patients' veteran status, highlighting an important care gap for this population.

Conclusions: The current study highlights a knowledge gap among non-VA primary care staff that may contribute to the CVD diagnostic gap for women veterans. Implications for assessment and intervention in the primary care setting are discussed.

A 56-year-old man with known pancreatic adenocarcinoma presented to the emergency department with facial twitching and a left-sided facial droop. Magnetic resonance imaging of the brain and subsequent biopsy revealed metastatic pancreatic adenocarcinoma with no other metastatic sites shown on computed tomography of the chest, abdomen, and pelvis. Following craniotomy and tumor resection, the patient has shown clinical improvement with no deleterious complications to date.

Background: Pulmonary arterial hypertension (PAH) is a progressive condition that leads to right ventricular failure and reduced survival. Sotatercept, a fusion protein targeting the activin signaling pathway, may offer disease-modifying benefits.

Objective: This study aimed to evaluate the efficacy and safety of sotatercept compared to placebo in adults with PAH receiving background therapy.

Methods: A systematic literature search was conducted through April 2025 to identify randomized controlled trials (RCTs) comparing sotatercept with placebo in PAH. Data were pooled using risk ratios (RR) or mean differences (MD) with 95% confidence intervals, analyzed using R software.

Results: Three RCTs including 601 patients were analyzed. Sotatercept significantly improved 6-minute walk distance (MD: 38.4 m, P < 0.001), reduced NT-proBNP levels (MD: -852.85 pg/mL, P = 0.02), and lowered pulmonary vascular resistance (MD: -200.25 dyn·s·cm^-5, P < 0.001). World Health Organization functional class improved (RR: 2.04, P < 0.001), and mortality, right ventricular failure, and treatment discontinuation decreased. Overall adverse events were similar between groups (RR: 1.01, P = 0.65), but class-related events such as bleeding and hematologic abnormalities were more frequent.

Conclusion: Sotatercept significantly improves clinical outcomes in PAH but requires close monitoring for bleeding and hematologic adverse events.

Background: We aimed to design, implement, and evaluate three novel institutional resident-as-teacher (RAT) e-modules for postgraduate year (PGY) 1, 2, and 3 and compare them to previously utilized online trainings.

Methods: We utilized PICRAT, a model examining both students' relationship with technology (passive, interactive, creative) and instructors' use of technology (replaces, amplifies, or transforms) to create interactive experiences that amplified teaching methodologies. We compared evaluations of the previous and new trainings with an unpaired t test. New modules were assessed with one-way analysis of variance for specialty-based acceptability and content analysis of two open-ended questions.

Results: Response rates averaged 93.2% in 2019-2020 and 98.9% in 2023-2024 across PGY1-3 residents. The relevance of the training to the role of resident teacher improved significantly compared to the original training (ranging from 0.68 to 0.98; 5-point Likert; P < 0.01). In specialty comparisons, only PGY3 radiology residents rated relevance significantly lower (3.00 ± 1.04 vs 3.94 ± 1.02, P < 0.01). Open-ended comments revealed that residents most liked the teaching strategies, with coaching, 1-minute preceptor, and reporter-interpreter-manager-educator (RIME) being noted as relevant, respectively, by PGY1, PGY2, and PGY3 residents.

Conclusions: Interactive e-modules can be used to effectively deliver resident-as-teacher content across specialties and training levels. Tailoring content to the learner's training stage and the specialty's needs may further enhance relevance.

Background: Ambulatory esophageal reflux monitoring allows for objective differentiation of pathologic reflux, reflux hypersensitivity, and functional heartburn. Defining a diagnosis as the etiology of symptoms allows for appropriate medication management, and specifically de-escalation of acid suppression medications such as proton-pump inhibitors.

Methods: This retrospective chart review examined patients who underwent ambulatory esophageal reflux monitoring within a single health network between September 2021 and January 2024 to determine if appropriate postprocedure medication management occurred. Demographic data, acid suppressive therapy prior to monitoring, results of monitoring, and changes to therapy were reviewed and statistical analysis was performed.

Results: In the study group, 85 patients were diagnosed with pathologic reflux based on a DeMeester score of ≥14.72; Caucasians and those with a higher body mass index were significantly more likely to be diagnosed with pathologic reflux. Acid suppression was de-escalated in 11 of the 29 patients diagnosed with functional heartburn and 4 of the 33 with reflux hypersensitivity.

Conclusion: Opportunities remain to improve therapy de-escalation and adjustment in the nonpathologic reflux conditions of reflux hypersensitivity and functional heartburn.

Eosinophilic myocarditis is a rare inflammatory heart disease with a variety of etiologies and prevalence that varies geographically. The present case involves a 39-year-old patient from rural Arkansas with biopsy-proven eosinophilic myocarditis. He presented in acute decompensated heart failure with positive serology for Toxocara along with brisk myocardial infiltration of eosinophils and neutrophils. This case demonstrates the importance of history taking, the diagnostic complexity, and the wide variety of potential causes of eosinophilic heart disease, including from host response to infectious diseases.