Austin Regional Clinic

To evaluate the equivalence of immunogenicity, safety and efficacy of Gan & Lee (GL) Glargine (Basalin®; Gan & Lee Pharmaceutical) with that of the reference product (Lantus®) in adult participants with type 2 diabetes mellitus. This was a phase 3, multicenter, open-label, equivalence trial conducted across 57 sites. In total, 567 participants with type 2 diabetes mellitus were randomized in a 1:1 ratio to undergo treatment with either GL Glargine or Lantus® for 26 weeks. The primary endpoint was the proportion of participants in each treatment arm who manifested treatment-induced anti-insulin antibodies (AIA). Secondary endpoints included efficacy and safety metrics, changes in glycated haemoglobin levels, and a comparative assessment of adverse events. Results were analysed using an equivalence test comparing the limits of the 90% confidence interval (CI) for treatment-induced AIA development to the prespecified margins. The percentages of participants positive for treatment-induced glycated haemoglobin by week 26 were similar between the GL Glargine (19.2%) and Lantus® (21.3%) treatment groups, with a treatment difference of -2.1 percentage points and a 90% CI (-7.6%, 3.5%) (predefined similarity margins: -10.7%, 10.7%). The difference in glycated haemoglobin was -0.08% (90% CI, -0.23, 0.06). The overall percentage of participants with any treatment-emergent adverse events was similar between the GL Glargine (80.1%) and Lantus® (81.6%) treatment groups. GL Glargine was similar to Lantus® in terms of immunogenicity, efficacy,and safety, based on the current study.

Pulmonary hypertension secondary to left-sided valvular disease (VHD-PH) is associated with high morbidity and mortality. Angiotensin-receptor neprilysin inhibitor (ARNI) is a novel pharmacotherapy, which reduces afterload with natriuresis and peripheral vasodilation. Our cases demonstrate that ARNI may also have a role in the treatment of combined pre- and postcapillary pulmonary hypertension that is independent of its effect on pulmonary capillary wedge pressure and cardiac output. Future prospective trials are needed to evaluate role of ARNIs in treatment of VHD-PH.

<div>Abstract<p><b>Background:</b> Smoking experimentation in Mexican American youth is problematic. In light of the research showing that preventing smoking experimentation is a valid strategy for smoking prevention, there is a need to identify Mexican American youth at high risk for experimentation.</p><p><b>Methods:</b> A prospective population-based cohort of 1,179 adolescents of Mexican descent was followed for 5 years starting in 2005–06. Participants completed a baseline interview at a home visit followed by three telephone interviews at intervals of approximately 6 months and additional interviews at two home visits in 2008–09 and 2010–11. The primary endpoint of interest in this study was smoking experimentation. Information about social, cultural, and behavioral factors (e.g., acculturation, susceptibility to experimentation, home characteristics, and household influences) was collected at baseline using validated questionnaires.</p><p><b>Results:</b> Age, sex, cognitive susceptibility, household smoking behavior, peer influence, neighborhood influence, acculturation, work characteristics, positive outcome expectations, family cohesion, degree of tension, ability to concentrate, and school discipline were found to be associated with smoking experimentation. In a validation dataset, the proposed risk prediction model had an area under the receiver operating characteristic curve (AUC) of 0.719 (95% confidence interval, 0.637–0.801) for predicting absolute risk for smoking experimentation within 1 year.</p><p><b>Conclusions:</b> The proposed risk prediction model is able to quantify the risk of smoking experimentation in Mexican American adolescents.</p><p><b>Impact:</b> Accurately identifying Mexican American adolescents who are at higher risk for smoking experimentation who can be intervened will substantially reduce the incidence of smoking and thereby subsequent health risks. <i>Cancer Epidemiol Biomarkers Prev; 23(10); 2165–74. ©2014 AACR</i>.</p></div>

PurposeThis study aimed to investigate the complications of primary total hip arthroplasty based on immediate postoperative X-rays. The overall quality and cost of X-rays were assessed.MethodsThe institutional database was queried to identify all patients who underwent total hip arthroplasty in a single institution between January 1, 2018, and December 31, 2018. Immediate postoperative X-rays were reviewed to identify the complications such as periprosthetic fractures, dislocation, and fixation failure. The quality and cost of X-ray were assessed. The complications were categorized as "known" and "unknown" according to the intraoperative fluoroscopic results.ResultsA total of 518 total hip arthroplasties were included in this study. Based on intraoperative fluoroscopy, periprosthetic fractures were found in 10 (2%) THAs. Compared to the X-rays taken immediately after surgery, 9 periprosthetic fractures (recorded as "known") were found and 1 was not (recorded as "unknown"). There was no significant difference between intraoperative fluoroscopy and X-rays (P > 0.05). Of the 518 X-rays, 225 (43%) were of suboptimal quality. The cost of a single portable pelvic X-ray was $647.ConclusionIn total hip arthroplasty, X-rays taken immediately after surgery rarely reveal unknown complications. The X-rays are often of suboptimal quality, have minimal clinical utility, and are less cost-effective.

Background:Despite marked improvements in stability after lateral ankle ligament repair, many patients do not return to their preinjury activity level. There are few studies addressing athletes’ assessment of their ability to return to play after lateral ankle ligament reconstruction for recurrent instability.Purpose:To determine the rate of return to the preinjury activity level among physically active patients after the modified Broström procedure (MBP) for recurrent lateral ankle instability.Study Design:Case series; Level of evidence, 4.Methods:Included were patients who had undergone a primary MBP by a single surgeon over a 6-year period and had a minimum 24 months of follow-up. A telephone questionnaire was conducted to ascertain the patient’s ability to return to sport and/or work activity at final follow-up. Activity levels were evaluated utilizing the Tegner activity score. Outcome scores and other measured variables were compared between patients who returned to their preinjury level and those who did not. The reasons for failing to return were also documented.Results:Of the 59 patients who met the inclusion criteria, 41 (69%; 20 men and 21 women) participated in the telephone interview. Results indicated that 22 (54%) returned to their prior level of activity (returners). The mean age of returners was 27.2 years; for nonreturners, the mean age was 27.1 years. Most patients (36/41; 88%) were satisfied with surgery and the overall outcome. Of the 19 nonreturners, 7 (37%) noted ankle-related reasons for not returning (pain: 57%; residual instability: 29%; decreased range of motion: 14%), and 12 (63%) cited non–ankle-related reasons. The mean preinjury and postoperative Tegner score for returners was 6.8. Moreover, 7 of 14 (50%) high-level athletes with preinjury Tegner scores ≥8 returned to their preinjury activity level. For high-level athletes who did not return to their previous level, the mean postoperative Tegner score was 6.6, and only 1 (7%) cited an ankle-related reason for not returning.Conclusion:A high patient satisfaction rate was reported after the MBP for recurrent lateral ankle instability. The majority of patients who did not return to their preinjury level cited a non–ankle-related factor as the reason for not returning to sport. This was especially true for the higher level athletes.

Given how smart phones, internet services, and social media have shown great potential for assisting smoking cessation, we constructed a Facebook chat application based on our previous work with SMS texting services. This report summarizes findings from 2,364 Spanish-speaking young adults recruited through Facebook advertising in South Texas during the 2020 New Year holiday season. Among these service users, 926 (39%) were ready to make a quit attempt, and 26 (3.1%) of those users reported that they were tobacco free 1 month later. There were no responses to a chat question survey 72 days after the dates selected for quitting. Although more research with longer follow up is needed, these findings show that social media chat applications may be helpful for at least prompting quit attempts and short-term cessation among young adult Spanish-speaking smokers. There is no evidence of an impact on long-term cessation, and more research is clearly needed.

IntroductionClinical settings are being encouraged to identify and address patients’ social needs within the clinic or through partner organizations. The purpose of this qualitative study was to describe the current practice of social needs-targeted care in 3 Texas safety net clinics, and facilitators and barriers to adopting new social needs-targeted care tools and practices.MethodsInterviews were conducted with staff at 3 safety net clinics serving small and mid-sized communities. Analysis focused on perspectives and decisions around adopting new tools or practices related to social needs-targeted care, including standardized screening tools and community resource referral platforms.ResultsNine staff across 3 organizations were interviewed. Two organizations were currently using a standard social needs screening tool in their routine practice, and a third was considering doing so. One organization had adopted a community resource referral platform in partnership with a large community collaboration. Three case studies illustrate a range of facilitators, barriers, perceived benefits, and drawbacks influencing social needs-targeted practices. Benefits of systematic data collection on social needs included the generation of data for community action. Drawbacks include concerns about data privacy. Community resource referral platforms were seen as valuable for creating accountability, but required an influential community partner and adequate community resources. Concerns about disempowering clients and blurring roles were voiced, and potential to increase provider job satisfaction was identified.ConclusionsBenefits and drawbacks of adopting new tools and practices related to social needs-targeted care are strongly influenced by the community context. For the adoption of community resource referral platforms, the outer setting is particularly relevant; adoption readiness is best assessed at the community or regional level rather than the clinic system level. While screening tools are much easier than referral platforms for clinics to adopt, the ability to address identified needs remains heavily based on the outer setting.

IntroductionAdverse events after a lower limb amputation (LLA) can negatively affect the rehabilitation process and may lead to emergency department (ED) visits. Earlier receipt of a prosthesis, as compared to delayed or not receiving a prosthesis, may decrease or moderate the risk of increased ED utilization. In addition, adverse events (ie, fall‐related injury [FRI]) may be associated with increased health care utilization as measured by ED use. The implication of the timing of prosthesis provision after amputation and reduced ED use is not well established. Obtaining data about ED utilization early post‐LLA could assist the rehabilitation team in ensuring timely and appropriate access to improve outcomes.ObjectiveTo determine the role that timing of prosthesis receipt has in ED utilization and the association of fall/FRI with health care utilization.DesignRetrospective observational cohort using commercial claims data. A logistic regression model was used to assess factors that influence ED utilization post‐LLA.SettingWatson/Truven administrative database 2014 to 2016.ParticipantsThe study sample consisted of 510 adults age 18 to 64 years with continuous enrollment for 3 years.InterventionsIndependent variables included age, sex, diabetes status, amputation level, fall diagnosis, and prosthesis receipt. Fall was defined as presence of a diagnosis code in any outpatient procedure after the amputation date.Main Outcome MeasureED use after amputation was defined as the presence of procedure codes that billed for ED services (99281 to 99285).ResultsIndividuals who receive a prosthesis early, within 0 to 3 months, post‐LLA were 48% (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.28 to 0.97) less likely to use the ED compared to those who did not receive a prosthesis. Individuals who experienced a fall/FRI had 2.8 (OR 2.86, 95% CI 1.23 to 6.66) times the odds of ED utilization.ConclusionReceipt of a prosthesis reduces the risk of ED use. The current study underscores the value of prostheses during the rehabilitation process after LLA.

A woman in her 40s with no significant medical history presented with a 1-year history of an umbilical nodule; she described occasional pain and intermittent bleeding from the site. What is your diagnosis?