Northridge Hospital Medical Center

BACKGROUND: Low molecular weight heparins (LMWHs) have become routine thromboprophylaxis in general surgery. However, their actual clinical effect, its magnitude relative to that of unfractionated heparin (UFH), and the optimal dose are still debated. METHODS: A meta-analysis was performed of all available randomized trials in general surgery comparing LMWH with placebo or no treatment, or with UFH. RESULTS: Comparison versus placebo or no treatment confirmed that the significant reduction in asymptomatic deep vein thrombosis (DVT) obtained with LMWH (n = 513; relative risk (RR) 0.28 (95 per cent confidence interval 0.14-0.54)) was associated with a significant reduction in clinical pulmonary embolism (n = 5456; RR 0.25 (0.08-0.79)) and clinical venous thromboembolism (VTE) (n = 4890; RR 0.29 (0.11-0.73)), and a trend towards a reduction in overall mortality rate. Comparison versus UFH showed a trend in favour of LMWH, with a significant reduction in clinical VTE (P = 0.049), a trend also found for cancer surgery. LMWH at doses below 3400 anti-Xa units seemed to be as effective as, and safer than, UFH, while higher doses yielded slightly superior efficacy but increased haemorrhagic risk, including that of major haemorrhage. CONCLUSION: Asymptomatic DVT may be regarded as a reliable surrogate endpoint for clinical outcome in studies investigating thromboprophylaxis in general surgery. LMWH seems to be as effective and safe as UFH. Determination of the optimal dose regimen of LMWH for this indication requires further investigation.

PURPOSE: The use of 90Y-microspheres to treat unresectable liver metastases originating from a variety of neuroendocrine tumors was reviewed. MATERIALS AND METHODS: This is a retrospective review from 10 institutions of patients given 90Y-microsphere therapy for neuroendocrine hepatic metastases. Physical, radiographic, biochemical, and clinical factors associated with treatment and response were examined. All patients were followed with laboratory and imaging studies at regular intervals until death, or censured whether other therapy was given after brachytherapy. Toxicities (acute and late) were recorded, and survival of the group determined. RESULTS: A total of 148 patients were treated with 185 separate procedures. The median age was 58 years (26-95 years) at treatment with median performance status of Eastern Cooperative Oncology Group (0). The median activity delivered was 1.14 GBq (0.33-3.30 GBq) with a median of 99% of the planned activity able to be given (38.1%-147.4%). There were no acute or delayed toxicity of Common Terminology Criteria for Adverse Events v3.0 grade 3 in 67% of patients, with fatigue (6.5%) the most common side effect. Imaging response was stable in 22.7%, partial response in 60.5%, complete in 2.7% and progressive disease in 4.9%. No radiation liver failure occurred. The median survival is 70 months. CONCLUSION: Radioembolization with 90Y-microspheres to the whole liver, or lobe with single or multiple fractions are safe and produce high response rates, even with extensive tumor replacement of normal liver and/or heavy pretreatment. The acute and delayed toxicity was very low without a treatment related grade 4 acute event or radiation induced liver disease in this modest-sized cohort. The significant objective response suggests that further investigation of this approach is warranted.

OBJECTIVE: To study, for the first time, service utilization and costs in fibromyalgia, a prevalent syndrome associated with high levels of pain, functional disability, and emotional distress. METHODS: Five hundred thirty-eight fibromyalgia patients from 6 rheumatology centers were enrolled in a 7-year prospective study of fibromyalgia outcome. Patients were assessed every 6 months with validated, mailed questionnaires which included questions regarding fibromyalgia symptoms and severity, utilization of services, and work disability. RESULTS: Fibromyalgia patients averaged almost 10 outpatient medical visits per year, and when nontraditional treatments were considered, this number increased to approximately 1 visit per month. Patients were hospitalized at a rate of 1 hospitalization every 3 years. In each 6-month study period, patients used a mean of 2.7 fibromyalgia-related drugs. Costs increased over the course of the study. The mean yearly per-patient cost in 1996 dollars was $2,274. However, results were skewed by high utilizers, and many patients used few services and had limited costs. Total costs and utilization were independently associated with the number of self-reported comorbid or associated conditions, functional disability, and global disease severity. Compared with patients with other rheumatic disorders, those with fibromyalgia were more likely to have lifetime surgical interventions, including back or neck surgery, appendectomy, carpal tunnel surgery, gynecologic surgery, abdominal surgery, and tonsillectomy, and were more likely than other rheumatic disease patients to report comorbid or associated conditions. Almost 50% of hospitalizations occurring during the study were related to fibromyalgia-associated symptoms. CONCLUSION: The average yearly cost for service utilization among fibromyalgia patients is $2,274. Fibromyalgia patients have high lifetime and current rates of utilization of all types of medical services. They report more symptoms and comorbid or associated conditions than patients with other rheumatic conditions, and symptom reporting is linked to service utilization and, to a lesser extent, functional disability and global disease severity.

OBJECTIVE: To determine the intermediate and long-term outcomes of fibromyalgia in patients seen in rheumatology centers in which there is special interest in the syndrome. METHODS: We conducted a longitudinal outcome study by mailed comprehensive Health Assessment Questionnaire administered every 6 months to 538 patients, from 6 rheumatology centers, whose median duration of disease at first assessment was 7.8 years. The final assessment took place after 7 years. In addition, there was study followup on 85 patients who had attended the Wichita center for > 10 years. RESULTS: Although functional disability worsened slightly and health satisfaction improved slightly, measures of pain, global severity, fatigue, sleep disturbance, anxiety, depression, and health status were markedly abnormal at study initiation and were essentially unchanged over the study period. Correlations between first and last assessment values were as high as r = 0.82. For some variables, abnormalities were 3 times greater at one center compared with another. CONCLUSION: Patients with established fibromyalgia, seen in rheumatology centers in which there a special interest in the disease and followed up for as long as 7 years, have markedly abnormal scores for pain, functional disability, fatigue, sleep disturbance, and psychological status, and these values do not change substantially over time. Half the patients are dissatisfied with their health, and 59% rate their health as fair or poor. There are marked differences in disease severity among the various centers, but < 14% of the variance in outcomes can be explained by demographic or center factors. Values at the first assessment are predictive of final values.

STUDY DESIGN: An in vitro biomechanical investigation to quantify the endplates resistance to compressive loads, in the thoracic and lumbar spine. Comparisons were made to determine the regional strength of the endplate, the optimal size and geometry of interbody support, and the effects of endplate removal on structural strength. OBJECTIVES: To biomechanically assess the regional variation of endplate strength in the thoracic and lumbar spine, the optimal geometry and cross-sectional area for structural interbody support, and endplate preparation techniques with respect to endplate failure or subsidence. SUMMARY OF BACKGROUND DATA: Anterior column interbody support plays an important role in spinal reconstruction. Subsidence of interbody structural support is a common problem and may be related to regional weakness of the endplate, the size and/or geometry of structural support, and the preparation of the endplate. Biomechanical data related to these issues should be of importance to spine surgeons and reduce the risk of subsidence and its inherent complications. METHODS: The indentation tests were performed in three subgroups, each with a different set of test variables. The first test consisted of 65 vertebrae at six different endplate test positions using a 9.53-mm diameter indenter. The second test was performed on 48 vertebrae at a central endplate test site using three hollow and two solid cylindrical indenters of varying diameter. The third test was done using 24 vertebrae with the endplate intact, partially removed, or fully removed. All tests were run using human cadaveric specimen using both the superior and inferior endplates. The maximum load to failure (MLF) was determined for each test performed. RESULTS: For all levels tested, the highest MLF occurred in the posterolateral region of the endplate. The lowest value occurred in the central and anterocentral regions for levels T7-L5 and T1-T6, respectively. Hollow indenters with a small diameter had the lowest MLF, whereas solid large-diameter indenters had the highest MLF. The ultimate compressive strength for all hollow indenters was significantly higher than all solid indenters. There was a significant reduction in the endplate strength with the complete removal of the endplate. CONCLUSIONS: The posterolateral region of the endplate provides the greatest resistance to subsidence while the central region provides the least resistance. A larger-diameter solid support has the greater MLF and the lower the risk of subsidence, suggesting a more efficient transfer of force to the endplate with the hollow indenters. Parameters such as the geometry of structural support and the position and preparation of the endplate can influence the resistance of an interbody support to subside. Partial removal of the endplate may provide both, for adequate mechanical advantage and a highly vascular site for fusion.

PURPOSE: The aromatase inhibitor anastrozole is a highly effective well-tolerated treatment for postmenopausal endocrine-responsive breast cancer. However, its use is associated with accelerated bone loss and an increase in fracture risk. The ARIBON trial is a double-blind, randomized, placebo-controlled study designed to evaluate the impact of bisphosphonate treatment on bone mineral density (BMD) in women taking anastrozole. EXPERIMENTAL DESIGN: BMD was assessed in 131 postmenopausal, surgically treated women with early breast cancer at two U.K. centers. Of these, 50 patients had osteopenia (T score -1.0 to -2.5) at either the hip or lumbar spine. All patients were treated with anastrozole 1 mg once a day and calcium and vitamin D supplementation. In addition, osteopenic patients were randomized to receive either treatment with ibandronate 150 mg orally every month or placebo. RESULTS: After 2 years, osteopenic patients treated with ibandronate gained +2.98% (range -8.9, +19.9) and +0.60% (range -9.0, +6.9) at the lumbar spine and hip, respectively. Patients treated with placebo, however, lost -3.22% (range -16.0, +4.3) at the lumbar spine and -3.90% (range -12.3, +7.2) at the hip. The differences between the two treatment arms were statistically significant at both sites (P < 0.01). At 12 months, urinary n-telopeptide, serum c-telopeptide, and serum bone-specific alkaline phosphatase levels declined in patients receiving ibandronate (30.9%, 26.3%, and 22.8%, respectively) and increased in those taking placebo (40.3%, 34.9%, and 37.0%, respectively). CONCLUSIONS: Monthly oral ibandronate improves bone density and normalizes bone turnover in patients treated with anastrozole.

The purposes of this study were to expand the data base of active range of motion (ROM) in the upper and lower extremities of older persons measured by goniometry and to determine if differences exist related to age, sex, and physical activity. Active ROM was measured with a clinical goniometer in 28 joint motions of the upper and lower extremities of the right side in 60 older subjects. Thirty men and 30 women were equally divided in two age groups of 60 to 69 and 75 to 84 years of age. Multivariate analysis of variance showed no significant differences in ROM that were attributable to sex and age. In univariate tests, however, 12 motions were significantly different (p less than .05) between the sexes, but only in 4 motions was the difference greater than intertester error. Physical activity, as assessed by a questionnaire and a rating scale, was not related to specific changes of joint range. Within the older subjects, however, a significant relationship between ROM and age or ROM and physical activity cannot be assumed. These results suggest that a data base of normative values is needed for older individuals.

OBJECTIVE: A subset of patients with fibromyalgia (FM) exhibit a large fiber demyelinating peripheral polyneuropathy akin to that seen in chronic inflammatory demyelinating polyneuropathy (CIDP). It has been suggested that this demyelinating process is likely to be immune mediated. Because it is known that similar large fiber neuropathic lesions may be associated with a cutaneous small fiber neuropathy, we sought to determine the prevalence of small fiber neuropathy, as measured by epidermal nerve fiber density (ENFD), in a series of patients with FM and clinically healthy control subjects. METHODS: Forty-one consecutive patients with FM and 47 control subjects underwent a 3-mm punch skin biopsy at the proximal thigh and distal leg near the ankle, for analysis of the ENFD. Patients with FM who had clinical evidence of a disorder known to be associated with small fiber neuropathy were excluded. The patients with FM also underwent pinwheel testing and vibratory testing for hypesthesia and serologic testing for a series of cytokine, circulating immune complex, and complement measurements. RESULTS: All patients with FM had evidence of stocking hypesthesia. The ENFD of patients with FM was lower than that of control subjects at both the calf (mean ± SD 5.8 ± 2.8 versus 7.4 ± 1.9; P = 0.0002) and thigh (9.3 ± 3.2 versus 11.3 ± 2.0; P = 0.0007). There was an inverse correlation between calf ENFD and age at the time of skin biopsy in patients with FM (r = -0.29, P = 0.03) but not in control subjects; however, analysis of covariance showed that this relationship could not be explained by aging alone. Serologic evaluation showed an inverse correlation between calf ENFD in patients with FM and the interleukin-2 receptor (IL-2R) level (r = -0.28, P = 0.04). However, an inverse correlation between thigh ENFD and serum IL-2R levels did not reach significance (P = 0.08). Analysis of thigh-to-calf ENFD ratios suggested that the ENFD decline in FM is affected by both a diffuse and a length-dependent process. CONCLUSION: The calf and thigh ENFD in patients with FM is significantly diminished compared with that in control subjects. Advancing age alone cannot explain this finding. Calf ENFD was inversely correlated, although weakly, with serum levels of IL-2R. These findings suggest that small fiber neuropathy is likely to contribute to the pain symptoms of FM; that pain in this disorder arises, in part, from a peripheral immune-mediated process; and that measurement of ENFD may be a useful clinical tool in FM.

In Brief Study Design. This is a retrospective multicenter analysis of a subset of 375 patients with thoracic adolescent idiopathic scoliosis (AIS) treated with either anterior (238) or posterior (137) fusion with preoperative or postoperative distal junctional kyphosis (DJK) ≥10°. Objectives. To determine the incidence of DJK before and after surgery in patients with AIS undergoing either anterior or posterior thoracic fusion, and provide recommendations for prevention. Summary of Background Data. DJK following surgical treatment for AIS may result in pain, imbalance, and unacceptable deformity. The true incidence of DJK following selective anterior or posterior instrumentation and fusion is unknown, as are “risk factors” for its development. Methods. Mean age at surgery was 14.4 years (range 9.1–20.9) in the anterior group and 14.7 years (range 10.2–20.7) in the posterior. Analysis included the Cobb and instrumented levels of the thoracic curves, and sagittal measurements, all on preoperative and 2-year follow-up standing 36-in radiographs. Results. In the anterior group, the incidence of preoperative DJK was 4.2%, and postoperative DJK was 7.1%. In the posterior group, the incidence of preoperative DJK was 5.0% and 14.6% after surgery. When postoperative DJK developed in the posterior group, mean postoperative T10–L2 was +17° kyphosis compared to +2° in the posterior group without DJK (P < 0.001). When postoperative DJK developed in the anterior group, mean postoperative T10–L2 was +12° kyphosis compared to +2° for the anterior group without DJK (P = 0.006). DJK was significantly more likely to occur in the posterior group if the Cobb was instrumented to less than Cobb +1 (P < 0.001). Conclusions. It appears that both posterior and anterior instrumentation for thoracic curves must include the junctional level to prevent postoperative DJK when postoperative DJK is present. The presence of increased kyphosis after surgery in the T10–L2 region seen in both anterior and posterior groups that had postoperative DJK develop constitutes a “risk factor” for the development of DJK. The radiographs of a subset of patients with thoracic adolescent idiopathic scoliosis curves with either preoperative or postoperative distal junctional kyphosis (DJK) were analyzed to identify “risk factors” for the development of DJK. “Risk factors” that were identified included a kyphotic T10−L2 region, along with a distal instrumented level short of Cobb +1 when posterior instrumentation is used and Cobb +0 when anterior instrumentation is being considered. When preoperative DJK is present, instrumentation should always include the kyphotic level.

Tunable photoluminescent nitrogen-doped graphene and graphitic carbon nitride (g-C₃N₄) quantum dots are synthesized <italic>via</italic> a facile solid-phase microwave-assisted (SPMA) technique utilizing the pyrolysis of citric acid and urea precursors.

This study hypothesized that battered women compared with nonbattered women use more violence, receive lower levels of social support, and experience higher levels of self-blame. Also hypothesized is that these three variables are interrelated. A sample of 95 women constituted 3 groups: battered women, nonbattered women in counseling, and nonbattered, noncounseled women. The women completed the Conflict Tactics Scales, the Multidimensional Scale of Perceived Social Support, and a 61-item self-blame scale. Results supported all of the major hypotheses and revealed that female-to-male violence in battered women is negatively related with level of perceived social support and positively linked with level of self-blame. The latter correlation rested primarily on the association between nonphysical CTS abuse items and self-blame measures. These findings help provide further specificity about battered women's perceived lack of social support and help to clarify reported inconsistencies about self-blame.

We study the patterns that short strands of single-stranded DNA form on the top graphene surface of graphite. We find that the DNA assembles into two distinct patterns, small spherical particles and elongated networks. Known interaction models based on DNA-graphene binding, hydrophobic interactions, or models based on the purine/pyrimidine nature of the bases do not explain our observed crossover in pattern formation. We argue that the observed assembly behavior is caused by a crossover in the competition between base-base pi stacking and base-graphene pi stacking and we infer a critical crossover energy of 0.3-0.5 eV. The experiments therefore provide a projective measurement of the base-base interaction strength.

BACKGROUND: Electric scooters are popular in Southern California due to their ease of use, affordability, and availability. The objective of this study was to characterize how hospital admissions and outcomes varied due to electric scooter injury among Southern California trauma centers. STUDY DESIGN: Trauma registry data from 9 urban trauma centers were queried for patients sustaining injury while operating an electric scooter from January to December 2018. Data collection included patient demographics, diagnoses, interventions, and outcomes. RESULTS: During the 1-year study period, 87 patients required trauma surgeon care due to scooter-related injury, with a mean age of 35.1 years; 71.3% were male with 20.7% and 17.2% of patients requiring ICU admission and a surgical intervention, respectively. One (1.1%) patient died. The head and face were most commonly injured, followed by the extremities. Helmet use was uncommon (71.3%). High variability in patient volume was noted, with 2 centers considered high-incidence and the remaining low-incidence. CONCLUSIONS: Injuries from electric scooter crashes are primarily to the head, face, and extremities, with approximately 1 in 5 patients requiring ICU admission and/or a surgical intervention. There is significant variation in patient volume among Southern California trauma centers that could affect the delivery of care with the abrupt introduction of this technology. Targeted public health interventions and policies might better address community use of the electric scooter.

BACKGROUND: Lactose intolerance is a form of lactose maldigestion where individuals experience symptoms such as diarrhea, abdominal cramping, flatulence, vomiting and bowel sounds following lactose consumption. Lactobacillus acidophilus is a species of bacteria known for its sugar fermenting properties. Preclinical studies have found that Lactobacillus acidophilus supplementation may assist in breaking down lactose; however, no human clinical trials exist evaluating its efficacy in alleviating symptoms related to lactose intolerance. OBJECTIVE: The aim of this randomized, double-blind, placebo-controlled, crossover study was to evaluate the effect of a proprietary strain of Lactobacillus acidophilus on relieving discomfort related to lactose intolerance. METHODS: The study enrolled healthy volunteers between 18 and 75 years of age who complained of lactose intolerance. Screening visits included a lactose challenge visit to confirm eligibility based on a score of 10 or higher on subjective assessment of the following symptoms after lactose challenge: diarrhea, abdominal cramping, vomiting, audible bowel sounds, flatulence, and overall symptoms. Qualified subjects participated in a 2-arm crossover design, with each arm consisting of 4 weeks of intervention of either active or placebo product, with a 2-week washout period during crossover. The study product consisted of the DDS-1 strain of Lactobacillus acidophilus (Nebraska Cultures, Walnut Creek, California). The placebo was formulated from maltodextrin. Study participants were instructed to take the product once daily for 4 weeks. Data collected included subjective symptom scores related to lactose intolerance. RESULTS: Longitudinal comparison between the DDS-1 group and placebo group demonstrated statistically significant reductions in abdominal symptom scores during the 6-h Lactose Challenge at week 4 for diarrhea (p = 0.033), abdominal cramping (p = 0.012), vomiting (p = 0.0002), and overall symptom score (p = 0.037). No adverse events were reported. CONCLUSIONS: The present study has found that this unique DDS-1 strain of Lactobacillus acidophilus, manufactured by Nebraska Cultures, is safe to consume and improves abdominal symptom scores compared to placebo with respect to diarrhea, cramping, and vomiting during an acute lactose challenge.

BACKGROUND: UC-II contains a patented form of undenatured type II collagen derived from chicken sternum. Previous preclinical and clinical studies support the safety and efficacy of UC-II in modulating joint discomfort in osteoarthritis and rheumatoid arthritis. The purpose of this study was to assess the efficacy and tolerability of UC-II in moderating joint function and joint pain due to strenuous exercise in healthy subjects. METHODS: This randomized, double-blind, placebo-controlled study was conducted in healthy subjects who had no prior history of arthritic disease or joint pain at rest but experienced joint discomfort with physical activity. Fifty-five subjects who reported knee pain after participating in a standardized stepmill performance test were randomized to receive placebo (n = 28) or the UC-II (40 mg daily, n = 27) product for 120 days. Joint function was assessed by changes in degree of knee flexion and knee extension as well as measuring the time to experiencing and recovering from joint pain following strenuous stepmill exertion. RESULTS: After 120 days of supplementation, subjects in the UC-II group exhibited a statistically significant improvement in average knee extension compared to placebo (81.0 ± 1.3º vs 74.0 ± 2.2º; p = 0.011) and to baseline (81.0 ± 1.3º vs 73.2 ± 1.9º; p = 0.002). The UC-II cohort also demonstrated a statistically significant change in average knee extension at day 90 (78.8 ± 1.9º vs 73.2 ± 1.9º; p = 0.045) versus baseline. No significant change in knee extension was observed in the placebo group at any time. It was also noted that the UC-II group exercised longer before experiencing any initial joint discomfort at day 120 (2.8 ± 0.5 min, p = 0.019), compared to baseline (1.4 ± 0.2 min). By contrast, no significant changes were seen in the placebo group. No product related adverse events were observed during the study. At study conclusion, five individuals in the UC-II cohort reported no pain during or after the stepmill protocol (p = 0.031, within visit) as compared to one subject in the placebo group. CONCLUSIONS: Daily supplementation with 40 mg of UC-II was well tolerated and led to improved knee joint extension in healthy subjects. UC-II also demonstrated the potential to lengthen the period of pain free strenuous exertion and alleviate the joint pain that occasionally arises from such activities.

A 2D ferromagnetic Fe₂I₂ layer with a robust QAH effect towards the low-power switching of PMA in multiferroic Fe₂I₂/BaTiO₃ bilayers.

In a previous pilot study, we demonstrated that adjunctive treatment with hyperbaric oxygen (HBO) appears to be feasible and safe in patients with acute myocardial infarction (AMI) and may result in an attenuated rise in creatine phosphokinase (CPK), more rapid resolution of pain and ST changes. This randomized multicenter trial was organized to further assess the safety and feasibility of this treatment in human subjects. Patients with an AMI treated with recombinant tissue plasminogen activator (rTPA) or streptokinase (STK), were randomized to treatment with HBO combined with either rTPA or STK, or rTPA or STK alone. An analysis included 112 patients, 66 of whom had inferior AMIs (p = NS). The remainder of the patients had anterior AMIs. The mean CPK at 12 and 24 h was reduced in the HBO patients by approximately 7.5% (p = NS). Time to pain relief was shorter in the HBO group. There were 2 deaths in the control and 1 in those treated with HBO. The left ventricle ejection fraction (LVEF) on discharge was 51.7% in the HBO group as compared to 48.4% in the controls (p = NS). The LVEF of the controls was 43.4 as compared to 47.6 for those treated, approximately 10% better (no significant difference). Treatment with HBO in combination with thrombolysis appears to be feasible and safe for patients with AMI and may result in an attenuated CPK rise, more rapid resolution of pain and improved ejection fractions. More studies are needed to assess the benefits of this treatment.

Objective The objective of this study was to examine the association between race/ethnicity (including language subgroups among Hispanics) and disaster preparedness among Behavioral Risk Factor Surveillance System (BRFSS) survey respondents. Methods BRFSS data were obtained for eight states which implemented the optional general preparedness module from 2006 through 2010. Three dependent variables were analyzed including presence of four preparedness items (i.e., food, water, flashlight, and radio), emergency evacuation plan, and 3-d supply of medication. Primary independent variable included race/ethnicity accounting for language of survey. Data were analyzed in 2011 and accounted for BRFSS sampling design. Results Black (OR = 0.66, 95% CI = 0.56, 0.79), English-speaking Hispanic (OR = 0.48, 95% CI = 0.34, 0.69) and Spanish-speaking Hispanic respondents (OR = 0.20, 95% CI = 0.13, 0.29) were less likely than non-Hispanic white respondents to live in a household in which all members requiring medication had a 3-d supply. Results varied regarding presence of four preparedness items and an emergency evacuation plan. Conclusions Racial/ethnic minority groups were less likely to have medication supplies but only Spanish-speaking Hispanics were less likely to have an emergency evacuation plan than white respondents. Public health officials can use these findings to support targeting racial/ethnic minorities to increase the presence of preparedness items important to mitigate the effects of disasters, with particular emphasis on medication supplies and Spanish-speaking Hispanics.

BACKGROUND: As computer hardware becomes less expensive and computer software more sophisticated and easy to use, more physicians are using computers to take notes and keep records. Although computer use offers many benefits, there is concern about whether the use of computers in the examination room will interfere with the patient-physician relationship. This experiment surveyed patient satisfaction following examination by either of two physicians, one using pen-and-pencil note-taking, the other taking notes on a computer. METHODS: Sixty patients consented to participate in this prospective, randomized, crossover study. In the first phase, 15 randomly selected patients were examined by Physician A, who made a written record, and 15 by Physician B, who made a computer record. In the second phase, the physicians switched roles. After the examination, patients completed a questionnaire to assess their degree of satisfaction. RESULTS: There were no significant differences in satisfaction between the group whose physician made a handwritten record as compared with those whose physician used a computer, nor was there an interaction between type of note-taking and physician. There was also no correlation between patient satisfaction and previous patient exposure to and use of computers. CONCLUSIONS: This study demonstrated no decrease in patient satisfaction when a computerized patient record was introduced.

BACKGROUND: Based on interim analyses and modeling data, lower doses of bamlanivimab and etesevimab together (700/1400 mg) were investigated to determine optimal dose and expand availability of treatment. METHODS: This Phase 3 portion of the BLAZE-1 trial characterized the effect of bamlanivimab with etesevimab on overall patient clinical status and virologic outcomes in ambulatory patients ≥12 years old, with mild-to-moderate coronavirus disease 2019 (COVID-19), and ≥1 risk factor for progressing to severe COVID-19 and/or hospitalization. Bamlanivimab and etesevimab together (700/1400 mg) or placebo were infused intravenously within 3 days of patients' first positive COVID-19 test. RESULTS: In total, 769 patients were infused (median age [range]; 56.0 years [12, 93], 30.3% of patients ≥65 years of age and median duration of symptoms; 4 days). By day 29, 4/511 patients (0.8%) in the antibody treatment group had a COVID-19-related hospitalization or any-cause death, as compared with 15/258 patients (5.8%) in the placebo group (Δ[95% confidence interval {CI}] = -5.0 [-8.0, -2.1], P < .001). No deaths occurred in the bamlanivimab and etesevimab group compared with 4 deaths (all COVID-19-related) in the placebo group. Patients receiving antibody treatment had a greater mean reduction in viral load from baseline to Day 7 (Δ[95% CI] = -0.99 [-1.33, -.66], P < .0001) compared with those receiving placebo. Persistently high viral load at Day 7 correlated with COVID-19-related hospitalization or any-cause death by Day 29 in all BLAZE-1 cohorts investigated. CONCLUSIONS: These data support the use of bamlanivimab and etesevimab (700/1400 mg) for ambulatory patients at high risk for severe COVID-19. Evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants will require continued monitoring to determine the applicability of this treatment. CLINICAL TRIALS REGISTRATION: NCT04427501.