2 Minute Medicine Rewind May 13th, 2024
1. Consumption of ultra-processed foods was associated with modestly higher all-cause mortality, with meat/poultry/seafood based ready-to-eat products showing the strongest associations.
2. No association between the consumption of ultra-high processed foods and mortality from cancer, cardiovascular disease and respiratory diseases was found.
Evidence Rating Level: 2 (Good)
Ultra-high processed foods are products made from substances extracted from whole foods. These products often have very low nutritional value and may even contain harmful substances in the form of additives and contaminants. In recent years, several prospective studies have indicated that the consumption of ultra-processed foods is associated with adverse health outcomes, but few such studies have investigated the association with all-cause mortality and also involved a follow-up time greater than 20 years. Researchers in this population-based cohort study therefore sought to evaluate the association between the consumption of total ultra-processed food and subgroups of ultra-processed food and mortality from all causes. The primary outcome was all-cause mortality and secondary outcomes included deaths from cancer, cardiovascular disease, and others. 74,563 women and 39,501 men from two prospective cohorts with a baseline of 1984 and 1986 were included, with diet being assessed via questionnaire every four years and outcomes verified via review of medical records and death certificates. Individuals in the highest quartile of ultra-processed food consumption had a 4% higher risk of total deaths (multivariable-adjusted hazard ratio = 1.04, 95% CI = 1.01 to 1.07, P = 0.005). The subgroup of ultra-high processed food with the strongest association with all-cause mortality was meat/poultry/seafood-based ready-to-eat products (hazard ratio = 1.13). Interestingly, there was no association for deaths due to cardiovascular diseases, cancer or respiratory diseases. However, an 8% higher risk of neurodegenerative deaths (hazard ratio = 1.08, P = 0.1) was observed. Overall, this study demonstrated an association between consumption of ultra-processed foods and all cause mortality and supports limiting the consumption of such foods to preserve overall health.
Intra-Articular Platelet-Rich Plasma Injection After Anterior Cruciate Ligament Reconstruction
1. At 12 months, patients with anterior cruciate ligament reconstruction randomized to receive postoperative intra-articular platelet-rich plasma injection were not found to have improved knee function compared to no postoperative injection.
Evidence Rating Level: 1 (Excellent)
Platelet-rich plasma (PRP), a product derived from autologous blood and rich in growth factors, has been viewed as a promising therapeutic option for various musculoskeletal disorders. However, there has been conflicting evidence for the efficacy of PRP use in patients undergoing anterior cruciate ligament reconstruction (ACLR), with recent studies showing that intraoperative injection was not associated with long term improvements. As there is a paucity of data to support the postoperative use of PRP for patients undergoing ACLR, this randomized controlled trial sought to compare the subjective outcomes and graft maturity in this patient population with and without postoperative intra-articular PRP injection. 60 patients (mean [SD] age = 30.0 [8.0] years) were assigned to the control group and 60 patients (mean [SD] age = 28.0 [7.9] years) to the PRP group, receiving 3 doses of intra-articular PRP injection at 4 weeks, 8 weeks and 3 months post operation. The primary outcome was the mean score obtained 12 months postoperatively from 4 subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS4). At 12 months, it was found that there was no statistical difference in KOOS4 scores between groups (78.3; SD = 12.0, 95% CI = 75.2 to 81.4 versus 76.8; SD = 11.9, 95% CI = 73.7 to 79.9, adjusted mean difference 2.0, 95% CI = -2.3 to 6.3, P = 0.36). Some participants in the PRP group reported intervention-related adverse events, such as pain at the injection site (6.7%) and knee swelling after injection (5.0%). Overall, postoperative intra-articular PRP injection in patients who underwent ACLR did not result in a significant improvement in knee symptoms or function.
Use of a Large Language Model to Assess Clinical Acuity of Adults in the Emergency Department
1. The large language model, GPT-4, was capable of assessing clinical acuity when presented with pairs of patient histories obtained from emergency department documentation with an accuracy comparable to a physician reviewer.
Evidence Rating Level: 2 (Good)
In recent years, the interest for the utility of large language models (LLMs) in healthcare has increased, with studies showing LLMs have achieved passing scores in the United States Licensing Medical Examination and can solve various clinical diagnostic challenges. However, few studies have examined LLMs in clinical practice with data derived from real electronic health records. This cross-sectional study therefore sought to evaluate the ability of the LLM, GPT-4 (OpenAI model = “gpt-4-0314”), in determining the clinical acuity of patients presenting to the emergency department (ED) as defined by the Emergency Severity Index (ESI). All adult visits to the University of California, San Francisco’s ED between January 1st, 2012 to January 17th, 2023 with a corresponding ED clinician note were identified to create a random pool of 10,000 pairs of ED visits with nonequivalent ESI scores. These pairs were used to query GPT-4 to return the patient with the higher clinical acuity among the pairs based on their individual clinical histories on ED presentation. A subsample of 500 pairs was also manually classified by a resident physician for comparison between LLM and human accuracy. The accuracy of the LLM was 0.89 (95% CI, 0.89-0.90) across the total sample, and the LLM’s accuracy was comparable to that of the physician for the 500 pair subsample (accuracy 0.88, [95% CI, 0.86-0.91] versus accuracy, 0.86, [95% CI, 0.83-0.89]). Overall, this study showed that the LLM, GPT-4, can accurately identify the higher acuity patient presentation when given a pair of patient presentations with an accuracy comparable to a trained physician.
1. Among patients on anticancer treatment with malignancy who were 75 years of age or older, the use of remote electronic patient-reported outcomes for monitoring had limited feasibility.
2. Feasibility was increased when considering only the subgroup of patients who agreed to test the web application, and not including the patients who declined.
Evidence Rating Level: 2 (Good)
In recent years, the use of telemedicine has expanded dramatically. Along with this has come many questions inquiring as to the efficacy of telemedicine and its feasibility. While the use of electronic patient-reported outcomes (ePROs) have been found to improve overall survival and quality of life in patients with cancer, there is a lack of data involving the feasibility of such technologies in patients who are 75 years of age or older. This multicenter prospective study therefore sought to investigate the feasibility of ePRO follow-up in patients with cancer aged 75 years or older. 473 patients (median age, 79 years [Q1-Q3 = 77-82]) within this age range who were on anticancer therapy for active malignancy were enrolled and asked to use the web-based application, ANA, for monitoring of their symptoms throughout their treatment. Those who declined were placed in the primary failure group while those who agreed were placed in the intent to treat (ITT) group. Feasibility was defined by the number of users who were active or used ANA at least once. The overall feasibility for the study population was 26%, but was higher at 66% when examining only the ITT group. Factors involved in primary failure included socioprofessional category, as univariate and multivariate analysis determined that the ITT population was significantly from a higher socioprofessional category (P = 0.002, P = 0.009 respectively). The ITT population also felt in better general condition according to the Geriatric 8-score (P = 0.002). Overall, this study found that the use of ePROs for symptom monitoring in patients 75 years or older has limited feasibility, which may be impacted by factors influencing compliance rate such as socioprofessional category.
1. The use of recombinant L-IFN adenovirus in patients with recurrent or refractory advanced solid tumours was well tolerated with few adverse events greater than Grade 3.
2. Recombinant L-IFN adenovirus injections showed preliminary efficacy against advanced solid tumours.
Evidence Rating Level: 2 (Good)
Oncolytic viruses are viruses that selectively induce cell lysis in tumour cells while preserving the health of normal cells. Prior studies have shown that the use of adenoviruses as a viral vector alone has limited efficacy in the management of tumours. This single-center open-label study aimed to investigate a novel strategy involving an adenovirus viral vector harboring a recombinant L-IFN genome (YSCH-01) which may allow for the expression of the anticancer L-IFN proteins within tumour cells to enhance tumour cell death. 14 subjects with advanced solid tumours were enrolled, with 9 undergoing a dose escalation phase and 5 undergoing a dose expansion phase with 13 participants being included in the full analysis set (mean age, 61.08±9.72 years). The primary endpoint of the study was the safety of YSCH-01 as determined by ratio of the incidence and characteristics of adverse events (AEs) compared to serious adverse events. During the dose escalation phase, no patient experienced dose-limiting toxicity. In total, 119 AEs were experienced in 12 subjects, with 71 resolving by the data cut-off date. The overall incidence for AEs was 92.3% while the incidence of AEs greater than Grade 3 was 7.7%, results comparable to safety data reported in studies of similar drugs. Preliminary efficacy was observed with an overall response rate of 27.3% (95% CI, 6.02% to 60.97%) and a disease control rate of 81.8% (95% CI, 48.22% to 97.72%). Overall, this study found that the novel recombinant L-IFN adenovirus drug, YSCH-01, is well tolerated in patients and has demonstrated preliminary efficacy with further study warranted.
Image: PD
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