Background Screening options for pancreatic ductal adenocarcinoma (PDAC) are limited. New-onset t... more Background Screening options for pancreatic ductal adenocarcinoma (PDAC) are limited. New-onset type 2 diabetes (NoD) is associated with subsequent diagnosis of PDAC in observational studies and may afford an opportunity for PDAC screening. We evaluated this association using a large administrative database. Methods Patients were identified using claims data from the OptumLabs ® Data Warehouse. Adult patients with NoD diagnosis were matched 1:3 with patients without NoD using age, sex and chronic obstructive pulmonary disease (COPD) status. The event of PDAC diagnosis was compared between cohorts using the Kaplan-Meier method. Factors associated with PDAC diagnosis were evaluated with Cox's proportional hazards modeling. Results We identified 640 421 patients with NoD and included 1 921 263 controls. At 3 years, significantly more PDAC events were identified in the NoD group vs control group (579 vs 505; P < 0.001). When controlling for patient factors, NoD was significantly associated with elevated risk of PDAC (HR 3.474, 95% CI 3.082-3.920, P < 0.001). Other factors significantly associated with PDAC diagnosis were increasing age, increasing age among Black patients, and COPD diagnosis (P ≤ 0.05). Conclusions NoD was independently associated with subsequent diagnosis of PDAC within 3 years. Future studies should evaluate the feasibility and benefit of PDAC screening in patients with NoD.
OBJECTIVE This study sought to compare trends in the development of cirrhosis between patients wi... more OBJECTIVE This study sought to compare trends in the development of cirrhosis between patients with NAFLD who underwent bariatric surgery and a well-matched group of nonsurgical controls. SUMMARY OF BACKGROUND DATA Patients with NAFLD who undergo bariatric surgery generally have improvements in liver histology. However, the long-term effect of bariatric surgery on clinically relevant liver outcomes has not been investigated. METHODS From a large insurance database, patients with a new NAFLD diagnosis and at least 2 years of continuous enrollment before and after diagnosis were identified. Patients with traditional contraindications to bariatric surgery were excluded. Patients who underwent bariatric surgery were identified and matched 1:2 with patients who did not undergo bariatric surgery based on age, sex, and comorbid conditions. Kaplan-Meier analysis and Cox proportional hazards modeling were used to evaluate differences in progression from NAFLD to cirrhosis. RESULTS A total of 2942 NAFLD patients who underwent bariatric surgery were identified and matched with 5884 NAFLD patients who did not undergo surgery. Cox proportional hazards modeling found that bariatric surgery was independently associated with a decreased risk of developing cirrhosis (hazard ratio 0.31, 95% confidence interval 0.19-0.52). Male gender was associated with an increased risk of cirrhosis (hazard ratio 2.07, 95% confidence interval 1.31-3.27). CONCLUSIONS Patients with NAFLD who undergo bariatric surgery are at a decreased risk for progression to cirrhosis compared to well-matched controls. Bariatric surgery should be considered as a treatment strategy for otherwise eligible patients with NAFLD. Future bariatric surgery guidelines should include NAFLD as a comorbid indication when determining eligibility.
Objective: The objective of this study is to assess whether vertical sleeve gastrectomy (VSG) inc... more Objective: The objective of this study is to assess whether vertical sleeve gastrectomy (VSG) increases the incidence of gastroesophageal reflux disease (GERD), esophagitis and Barrett esophagus (BE) relative to patients under- going Roux-en-Y gastric bypass (RYGB) in patients with and without preoperative GERD. Summary of Background Data: Concerns for potentiation of GERD, sup- ported by multiple high-quality retrospective studies, have hindered greater adoption of the VSG.
Methods: From the OptumLabs Data Warehouse, VSG and RYGB patients with 2 years enrollment were identified and matched by follow-up time. GERD [reflux esophagitis, prescription for acid reducing medication (Rx) and/or diagnosis of BE], upper endoscopy (UE), and re-admissions were evaluated beyond 90 days.
Results: A total of 8362 patients undergoing VSG were matched 1:1 to patients undergoing RYGB, on the basis of post-operative follow-up interval. Age, sex, and follow-up time were similar between the 2 groups (P > 0.05). Among all patients, postoperative GERD was more frequently observed in VSG patients relative to RYGB patients (60.2% vs 55.6%, respectively; P < 0.001), whereas BE was more prevalent in RYGB patients (0.7% vs 1.1%; P 1⁄4 0.007). Postoperatively, de novo esophageal reflux symptomatology was more common in VSG patients (39.3% vs 35.3%; P < 0.001), although there was no difference in development of the histologic diagnoses reflux esophagitis and BE. Further- more, postoperative re-admission was higher in the RYGB cohort (38.9% vs 28.9%; P < 0.001).
Conclusions: Compared to RYGB, VSG may not have inferior long-term GERD outcomes, while also leading to fewer re-hospitalizations. These data challenge the prevailing opinion that patients with GERD should undergo RYGB instead of VSG.
This study sought to compare trends in the development of cirrhosis between patients with NAFLD w... more This study sought to compare trends in the development of cirrhosis between patients with NAFLD who underwent bariatric surgery and a well-matched group of nonsurgical controls. Summary of Background Data: Patients with NAFLD who undergo bariatric surgery generally have improvements in liver histology. However, the long-term effect of bariatric surgery on clinically relevant liver outcomes has not been investigated. Methods: From a large insurance database, patients with a new NAFLD diagnosis and at least 2 years of continuous enrollment before and after diagnosis were identified. Patients with traditional contraindications to bariatric surgery were excluded. Patients who underwent bariatric surgery were identified and matched 1:2 with patients who did not undergo bariatric surgery based on age, sex, and comorbid conditions. Kaplan-Meier analysis and Cox proportional hazards modeling were used to evaluate differences in progression from NAFLD to cirrhosis. Results: A total of 2942 NAFLD patients who underwent bariatric surgery were identified and matched with 5884 NAFLD patients who did not undergo surgery. Cox proportional hazards modeling found that bariatric surgery was independently associated with a decreased risk of developing cirrhosis (hazard ratio 0.31, 95% confidence interval 0.19-0.52). Male gender was associated with an increased risk of cirrhosis (hazard ratio 2.07, 95% confidence interval 1.31-3.27). Conclusions: Patients with NAFLD who undergo bariatric surgery are at a decreased risk for progression to cirrhosis compared to well-matched controls. Bariatric surgery should be considered as a treatment strategy for otherwise eligible patients with NAFLD. Future bariatric surgery guidelines should include NAFLD as a comorbid indication when determining eligibility.
Purpose: The aims of this study were to determine if a remotely-delivered, internet-based auditor... more Purpose: The aims of this study were to determine if a remotely-delivered, internet-based auditory training program improves speech-in-noise understanding and if the number of hours spent engaged in the program influences post-intervention speech-in-noise understanding.
Method: Twenty-nine first-time hearing aid users were randomized into an auditory training (AT) group (hearing aids + 3 week remotely-delivered, internet-based auditory training program) or a control group (hearing aids alone). The Hearing in Noise Test (HINT) and the Words-in- Noise Test (WIN) were administered to both groups at baseline + 1 week and immediately at the completion of the 3 weeks of auditory training.
Results: Speech-in-noise understanding improved for both groups at the completion of the study;
however there was not a statistically significant difference in post-intervention improvement
between the AT and control groups. Although the number of hours the participants engaged in the AT
program was far fewer than prescribed, time-on-task influenced the post-intervention WIN, but not HINT, scores.
Conclusion: While remotely-delivered, internet-based, auditory training programs represent an attractive alternative to resource-intensive clinic-based interventions, their demonstrated efficacy continues to remain a challenge due, in part, to issues associated with compliance.
Background Screening options for pancreatic ductal adenocarcinoma (PDAC) are limited. New-onset t... more Background Screening options for pancreatic ductal adenocarcinoma (PDAC) are limited. New-onset type 2 diabetes (NoD) is associated with subsequent diagnosis of PDAC in observational studies and may afford an opportunity for PDAC screening. We evaluated this association using a large administrative database. Methods Patients were identified using claims data from the OptumLabs ® Data Warehouse. Adult patients with NoD diagnosis were matched 1:3 with patients without NoD using age, sex and chronic obstructive pulmonary disease (COPD) status. The event of PDAC diagnosis was compared between cohorts using the Kaplan-Meier method. Factors associated with PDAC diagnosis were evaluated with Cox's proportional hazards modeling. Results We identified 640 421 patients with NoD and included 1 921 263 controls. At 3 years, significantly more PDAC events were identified in the NoD group vs control group (579 vs 505; P < 0.001). When controlling for patient factors, NoD was significantly associated with elevated risk of PDAC (HR 3.474, 95% CI 3.082-3.920, P < 0.001). Other factors significantly associated with PDAC diagnosis were increasing age, increasing age among Black patients, and COPD diagnosis (P ≤ 0.05). Conclusions NoD was independently associated with subsequent diagnosis of PDAC within 3 years. Future studies should evaluate the feasibility and benefit of PDAC screening in patients with NoD.
OBJECTIVE This study sought to compare trends in the development of cirrhosis between patients wi... more OBJECTIVE This study sought to compare trends in the development of cirrhosis between patients with NAFLD who underwent bariatric surgery and a well-matched group of nonsurgical controls. SUMMARY OF BACKGROUND DATA Patients with NAFLD who undergo bariatric surgery generally have improvements in liver histology. However, the long-term effect of bariatric surgery on clinically relevant liver outcomes has not been investigated. METHODS From a large insurance database, patients with a new NAFLD diagnosis and at least 2 years of continuous enrollment before and after diagnosis were identified. Patients with traditional contraindications to bariatric surgery were excluded. Patients who underwent bariatric surgery were identified and matched 1:2 with patients who did not undergo bariatric surgery based on age, sex, and comorbid conditions. Kaplan-Meier analysis and Cox proportional hazards modeling were used to evaluate differences in progression from NAFLD to cirrhosis. RESULTS A total of 2942 NAFLD patients who underwent bariatric surgery were identified and matched with 5884 NAFLD patients who did not undergo surgery. Cox proportional hazards modeling found that bariatric surgery was independently associated with a decreased risk of developing cirrhosis (hazard ratio 0.31, 95% confidence interval 0.19-0.52). Male gender was associated with an increased risk of cirrhosis (hazard ratio 2.07, 95% confidence interval 1.31-3.27). CONCLUSIONS Patients with NAFLD who undergo bariatric surgery are at a decreased risk for progression to cirrhosis compared to well-matched controls. Bariatric surgery should be considered as a treatment strategy for otherwise eligible patients with NAFLD. Future bariatric surgery guidelines should include NAFLD as a comorbid indication when determining eligibility.
Objective: The objective of this study is to assess whether vertical sleeve gastrectomy (VSG) inc... more Objective: The objective of this study is to assess whether vertical sleeve gastrectomy (VSG) increases the incidence of gastroesophageal reflux disease (GERD), esophagitis and Barrett esophagus (BE) relative to patients under- going Roux-en-Y gastric bypass (RYGB) in patients with and without preoperative GERD. Summary of Background Data: Concerns for potentiation of GERD, sup- ported by multiple high-quality retrospective studies, have hindered greater adoption of the VSG.
Methods: From the OptumLabs Data Warehouse, VSG and RYGB patients with 2 years enrollment were identified and matched by follow-up time. GERD [reflux esophagitis, prescription for acid reducing medication (Rx) and/or diagnosis of BE], upper endoscopy (UE), and re-admissions were evaluated beyond 90 days.
Results: A total of 8362 patients undergoing VSG were matched 1:1 to patients undergoing RYGB, on the basis of post-operative follow-up interval. Age, sex, and follow-up time were similar between the 2 groups (P > 0.05). Among all patients, postoperative GERD was more frequently observed in VSG patients relative to RYGB patients (60.2% vs 55.6%, respectively; P < 0.001), whereas BE was more prevalent in RYGB patients (0.7% vs 1.1%; P 1⁄4 0.007). Postoperatively, de novo esophageal reflux symptomatology was more common in VSG patients (39.3% vs 35.3%; P < 0.001), although there was no difference in development of the histologic diagnoses reflux esophagitis and BE. Further- more, postoperative re-admission was higher in the RYGB cohort (38.9% vs 28.9%; P < 0.001).
Conclusions: Compared to RYGB, VSG may not have inferior long-term GERD outcomes, while also leading to fewer re-hospitalizations. These data challenge the prevailing opinion that patients with GERD should undergo RYGB instead of VSG.
This study sought to compare trends in the development of cirrhosis between patients with NAFLD w... more This study sought to compare trends in the development of cirrhosis between patients with NAFLD who underwent bariatric surgery and a well-matched group of nonsurgical controls. Summary of Background Data: Patients with NAFLD who undergo bariatric surgery generally have improvements in liver histology. However, the long-term effect of bariatric surgery on clinically relevant liver outcomes has not been investigated. Methods: From a large insurance database, patients with a new NAFLD diagnosis and at least 2 years of continuous enrollment before and after diagnosis were identified. Patients with traditional contraindications to bariatric surgery were excluded. Patients who underwent bariatric surgery were identified and matched 1:2 with patients who did not undergo bariatric surgery based on age, sex, and comorbid conditions. Kaplan-Meier analysis and Cox proportional hazards modeling were used to evaluate differences in progression from NAFLD to cirrhosis. Results: A total of 2942 NAFLD patients who underwent bariatric surgery were identified and matched with 5884 NAFLD patients who did not undergo surgery. Cox proportional hazards modeling found that bariatric surgery was independently associated with a decreased risk of developing cirrhosis (hazard ratio 0.31, 95% confidence interval 0.19-0.52). Male gender was associated with an increased risk of cirrhosis (hazard ratio 2.07, 95% confidence interval 1.31-3.27). Conclusions: Patients with NAFLD who undergo bariatric surgery are at a decreased risk for progression to cirrhosis compared to well-matched controls. Bariatric surgery should be considered as a treatment strategy for otherwise eligible patients with NAFLD. Future bariatric surgery guidelines should include NAFLD as a comorbid indication when determining eligibility.
Purpose: The aims of this study were to determine if a remotely-delivered, internet-based auditor... more Purpose: The aims of this study were to determine if a remotely-delivered, internet-based auditory training program improves speech-in-noise understanding and if the number of hours spent engaged in the program influences post-intervention speech-in-noise understanding.
Method: Twenty-nine first-time hearing aid users were randomized into an auditory training (AT) group (hearing aids + 3 week remotely-delivered, internet-based auditory training program) or a control group (hearing aids alone). The Hearing in Noise Test (HINT) and the Words-in- Noise Test (WIN) were administered to both groups at baseline + 1 week and immediately at the completion of the 3 weeks of auditory training.
Results: Speech-in-noise understanding improved for both groups at the completion of the study;
however there was not a statistically significant difference in post-intervention improvement
between the AT and control groups. Although the number of hours the participants engaged in the AT
program was far fewer than prescribed, time-on-task influenced the post-intervention WIN, but not HINT, scores.
Conclusion: While remotely-delivered, internet-based, auditory training programs represent an attractive alternative to resource-intensive clinic-based interventions, their demonstrated efficacy continues to remain a challenge due, in part, to issues associated with compliance.
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Summary of Background Data: Concerns for potentiation of GERD, sup- ported by multiple high-quality retrospective studies, have hindered greater adoption of the VSG.
Methods: From the OptumLabs Data Warehouse, VSG and RYGB patients with 2 years enrollment were identified and matched by follow-up time. GERD [reflux esophagitis, prescription for acid reducing medication (Rx) and/or diagnosis of BE], upper endoscopy (UE), and re-admissions were evaluated beyond 90 days.
Results: A total of 8362 patients undergoing VSG were matched 1:1 to patients undergoing RYGB, on the basis of post-operative follow-up interval. Age, sex, and follow-up time were similar between the 2 groups (P > 0.05). Among all patients, postoperative GERD was more frequently observed in VSG patients relative to RYGB patients (60.2% vs 55.6%, respectively; P < 0.001), whereas BE was more prevalent in RYGB patients (0.7% vs 1.1%; P 1⁄4 0.007). Postoperatively, de novo esophageal reflux symptomatology was more common in VSG patients (39.3% vs 35.3%; P < 0.001), although there was no difference in development of the histologic diagnoses reflux esophagitis and BE. Further- more, postoperative re-admission was higher in the RYGB cohort (38.9% vs 28.9%; P < 0.001).
Conclusions: Compared to RYGB, VSG may not have inferior long-term GERD outcomes, while also leading to fewer re-hospitalizations. These data challenge the prevailing opinion that patients with GERD should undergo RYGB instead of VSG.
Method: Twenty-nine first-time hearing aid users were randomized into an auditory training (AT) group (hearing aids + 3 week remotely-delivered, internet-based auditory training program) or a control group (hearing aids alone). The Hearing in Noise Test (HINT) and the Words-in- Noise Test (WIN) were administered to both groups at baseline + 1 week and immediately at the completion of the 3 weeks of auditory training.
Results: Speech-in-noise understanding improved for both groups at the completion of the study;
however there was not a statistically significant difference in post-intervention improvement
between the AT and control groups. Although the number of hours the participants engaged in the AT
program was far fewer than prescribed, time-on-task influenced the post-intervention WIN, but not HINT, scores.
Conclusion: While remotely-delivered, internet-based, auditory training programs represent an attractive alternative to resource-intensive clinic-based interventions, their demonstrated efficacy continues to remain a challenge due, in part, to issues associated with compliance.
Summary of Background Data: Concerns for potentiation of GERD, sup- ported by multiple high-quality retrospective studies, have hindered greater adoption of the VSG.
Methods: From the OptumLabs Data Warehouse, VSG and RYGB patients with 2 years enrollment were identified and matched by follow-up time. GERD [reflux esophagitis, prescription for acid reducing medication (Rx) and/or diagnosis of BE], upper endoscopy (UE), and re-admissions were evaluated beyond 90 days.
Results: A total of 8362 patients undergoing VSG were matched 1:1 to patients undergoing RYGB, on the basis of post-operative follow-up interval. Age, sex, and follow-up time were similar between the 2 groups (P > 0.05). Among all patients, postoperative GERD was more frequently observed in VSG patients relative to RYGB patients (60.2% vs 55.6%, respectively; P < 0.001), whereas BE was more prevalent in RYGB patients (0.7% vs 1.1%; P 1⁄4 0.007). Postoperatively, de novo esophageal reflux symptomatology was more common in VSG patients (39.3% vs 35.3%; P < 0.001), although there was no difference in development of the histologic diagnoses reflux esophagitis and BE. Further- more, postoperative re-admission was higher in the RYGB cohort (38.9% vs 28.9%; P < 0.001).
Conclusions: Compared to RYGB, VSG may not have inferior long-term GERD outcomes, while also leading to fewer re-hospitalizations. These data challenge the prevailing opinion that patients with GERD should undergo RYGB instead of VSG.
Method: Twenty-nine first-time hearing aid users were randomized into an auditory training (AT) group (hearing aids + 3 week remotely-delivered, internet-based auditory training program) or a control group (hearing aids alone). The Hearing in Noise Test (HINT) and the Words-in- Noise Test (WIN) were administered to both groups at baseline + 1 week and immediately at the completion of the 3 weeks of auditory training.
Results: Speech-in-noise understanding improved for both groups at the completion of the study;
however there was not a statistically significant difference in post-intervention improvement
between the AT and control groups. Although the number of hours the participants engaged in the AT
program was far fewer than prescribed, time-on-task influenced the post-intervention WIN, but not HINT, scores.
Conclusion: While remotely-delivered, internet-based, auditory training programs represent an attractive alternative to resource-intensive clinic-based interventions, their demonstrated efficacy continues to remain a challenge due, in part, to issues associated with compliance.