Prognosis

Patients who develop anosmia with COVID-19 almost always recover some or all of their olfactory function over the course of a year. James W. Mold, MD, MPH

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Since the pandemic was declared in early 2020, COVID-19–related anosmia quickly emerged as a telltale sign of infection.1,2 However, the time course and reversibility of COVID-19–related olfactory disorders, which may persist and negatively affect patients’ lives, require further study. To clarify the clinical course and prognosis, we followed a cohort of patients with COVID-19–related anosmia for 1 year and performed repeated olfactory function evaluations for a subset of patients.

Author/s:

Renaud, Marion, Thibault, Claire, Normand, F. L., Mcdonald, E. G., Gallix, B., Debry, C., Venkatasamy, A.

Risk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary Care

Devin Evans — Wed, 24 Feb 2021 06:00:00 +0000

Date Added:

February 24, 2021

Journal/Publication:

Journal of the American Medical Association Network Open

Publication Date:

February 1, 2021

Issue:

Volume:

URL:

Risk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary Care

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2020.37371

Keywords

PMID (1):

33591367

MeSH

Patients with acute low back pain are more likely to progress to chronic low back pain if they are prescribed opioids or referred for imaging studies or subspecialists (after controlling for other risk factors). James W. Mold, MD, MPH

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Importance: Acute low back pain (LBP) is highly prevalent, with a presumed favorable prognosis; however, once chronic, LBP becomes a disabling and expensive condition. Acute to chronic LBP transition rates vary widely owing to absence of standardized operational definitions, and it is unknown whether a standardized prognostic tool (ie, Subgroups for Targeted Treatment Back tool [SBT]) can estimate this transition or whether early non-guideline concordant treatment is associated with the transition to chronic LBP.

Objective: To assess the associations between the transition from acute to chronic LBP with SBT risk strata; demographic, clinical, and practice characteristics; and guideline nonconcordant processes of care.

Design, setting, and participants: This inception cohort study was conducted alongside a multisite, pragmatic cluster randomized trial. Adult patients with acute LBP stratified by SBT risk were enrolled in 77 primary care practices in 4 regions across the United States between May 2016 and June 2018 and followed up for 6 months, with final follow-up completed by March 2019. Data analysis was conducted from January to March 2020.

Exposures: SBT risk strata and early LBP guideline nonconcordant processes of care (eg, receipt of opioids, imaging, and subspecialty referral).

Main outcomes and measures: Transition from acute to chronic LBP at 6 months using the National Institutes of Health Task Force on Research Standards consensus definition of chronic LBP. Patient demographic characteristics, clinical factors, and LBP process of care were obtained via electronic medical records.

Results: Overall, 5233 patients with acute LBP (3029 [58%] women; 4353 [83%] White individuals; mean [SD] age 50.6 [16.9] years; 1788 [34%] low risk; 2152 [41%] medium risk; and 1293 [25%] high risk) were included. Overall transition rate to chronic LBP at six months was 32% (1666 patients). In a multivariable model, SBT risk stratum was positively associated with transition to chronic LBP (eg, high-risk vs low-risk groups: adjusted odds ratio [aOR], 2.45; 95% CI, 2.00-2.98; P < .001). Patient and clinical characteristics associated with transition to chronic LBP included obesity (aOR, 1.52; 95% CI, 1.28-1.80; P < .001); smoking (aOR, 1.56; 95% CI, 1.29-1.89; P < .001); severe and very severe baseline disability (aOR, 1.82; 95% CI, 1.48-2.24; P < .001 and aOR, 2.08; 95% CI, 1.60-2.68; P < .001, respectively) and diagnosed depression/anxiety (aOR, 1.66; 95% CI, 1.28-2.15; P < .001). After controlling for all other variables, patients exposed to 1, 2, or 3 nonconcordant processes of care within the first 21 days were 1.39 (95% CI, 1.21-2.32), 1.88 (95% CI, 1.53-2.32), and 2.16 (95% CI, 1.10-4.25) times more likely to develop chronic LBP compared with those with no exposure (P < .001).

Conclusions and relevance: In this cohort study, the transition rate to chronic LBP was substantial

Author/s:

Stevans, Joel M., Delitto, Anthony, Khoja, Samannaaz, Patterson, Charity G., Smith, Clair N., Schneider, Michael J., Freburger, Janet K., Greco, Carol M., Freel, Jennifer A., Sowa, Gwendolyn A., Wasan, Ajay D., Brennan, Gerard P., Hunter, Stephen J., Minick, Kate I., Wegener, Stephen T., Ephraim, Patti L., Friedman, Michael", Jason M., Robert B.

Association of household secondhand smoke exposure and mortality risk in patients with heart failure

John Bayhi — Fri, 03 Jan 2020 17:30:23 +0000

Date Added:

January 3, 2020

Journal/Publication:

BMC Cardiovascular Disorders

Publisher:

BioMed Central Ltd

Publication Date:

December 2, 2019

Issue:

Volume:

URL:

Association of household secondhand smoke exposure and mortality risk in patients with heart failure

Type:

Clinical Research Results

DOI (1):

10.1186/s12872-019-1269-y

Keywords

heart failure

mortality

secondhand smoke

PMID (1):

31791236

MeSH

Adult

Humans

self report

Proportional Hazards Models

risk factors

Tobacco Smoke Pollution

Nutrition Surveys

cardiovascular diseases

follow-up studies

Odds Ratio

health status

Surveys and Questionnaires

Prognosis

heart failure

Socioeconomic Factors

Second-hand smoke exposure appears to hasten death in patients with CHF. James W. Mold, MD, MPH

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BACKGROUND:

Secondhand smoke (SHS) exposure is a well-established cardiovascular risk factor, yet association between SHS and prognosis of heart failure remains uncertain.

METHOD:

Data were obtained from the US National Health and Nutrition Examination Surveys III from 1988 to 1994. Currently nonsmoking adults with a self-reported history of heart failure were included. Household SHS exposure was assessed by questionnaire. Participants were followed up through December 31, 2011. Cox proportional-hazards models were used to assess the association of household SHS exposure and mortality risk. Potential confounding factors were adjusted.

RESULTS:

Of 572 currently nonsmoking patients with heart failure, 88 were exposed to household SHS while 484 were not. There were totally 475 deaths during follow-up. In univariate analysis, household SHS was not associated with mortality risk (hazard ratio [HR]: 0.98, 95% confidence interval [CI]: 0.76-1.26, p = 0.864). However, after adjustment for demographic variables, socioeconomic variables and medication, heart failure patients in exposed group had a 43% increase of mortality risk compared with those in unexposed group (HR: 1.43, 95% CI: 1.10-1.86, p = 0.007). Analysis with further adjustment for general health status and comorbidities yielded similar result (HR: 1.47, 95% CI: 1.13-1.92, p = 0.005).

CONCLUSION:

Household SHS exposure was associated with increased mortality risk in heart failure patients.

Author/s:

He, X, Zhao, J, He, J, Dong, Y, Liu, C

Communication Strategies for Sharing Prognostic Information With Patients: Beyond Survival Statistics

Brian Desmarais — Mon, 19 Aug 2019 14:21:14 +0000

Date Added:

August 19, 2019

Journal/Publication:

JN Learning

Publisher:

Journal of the American Medical Association

Publication Date:

August 15, 2019

URL:

Communication Strategies for Sharing Prognostic Information With Patients: Beyond Survival Statistics

Type:

Clinical Decision Aids

Format:

Web Page

MeSH

Prognosis

patient care

This 37 ½ minute audiotape provides guidance regarding how to talk with patients about prognosis. James W. Mold, MD, MPH

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Interview with Joanna Paladino, MD, author of Communication Strategies for Sharing Prognostic Information With Patients: Beyond Survival Statistics

Communication Strategies for Sharing Prognostic Information With Patients: Beyond Survival Statistics

Brian Desmarais — Mon, 19 Aug 2019 14:07:29 +0000

Date Added:

August 19, 2019

Journal/Publication:

Journal of the American Medical Association

Publication Date:

August 15, 2019

URL:

Communication Strategies for Sharing Prognostic Information With Patients: Beyond Survival Statistics

Type:

Clinical Decision Aids

Format:

Article

DOI (1):

10.1001/jama.2019.11533

MeSH

Clinical Competence

Prognosis

Important suggestions regarding how to discuss prognosis with patients. (See also the audiotaped interview posted separately in RPR.) James W. Mold, MD, MPH

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Communicating prognosis, the anticipated course of living with an illness, is a core clinical skill and a foundation of the patient-clinician relationship. Clinicians find such communication challenging. Concerns about professional helplessness when caring for a patient with a disease with a poor prognosis and the desire to avoid difficult patient and personal emotions can lead to an understandable reluctance to share difficult news with patients and families. Clinicians also struggle to find the right words to balance hope with concern when sharing difficult news.1 While receiving prognostic information is difficult for patients, not receiving prognostic information can create anxiety and may distance patients from their clinicians, who are often aware of the prognosis but do not share it with patients. Delaying or avoiding communication about prognosis also risks patients not having the information they need to make decisions and leads to missed opportunities to set and achieve goals that reflect what matters most to them..

Author/s:

Paladino, J., Lakin, J.R., Sanders J.J.