Research Spotlight

Reed, L. K., J. Wen, B. Liang, X. Wang, D. Feng and J. H. Huang (2020). “Safely performing neurosurgical procedures during COVID-19 pandemic.” Neurol Res: 1-7.

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INTRODUCTION: The novel coronavirus disease (COVID-19) pandemic poses a substantial threat to the health of healthcare personnel on the front line of caring for COVID-19 patients. The Centers for Medicare and Medicaid Services previously announced that all non-essential planned surgeries and procedures should be postponed until further notice and only urgent procedures should proceed. METHODS: We share our experiences with safely performing neurosurgical procedures on confirmed and suspected COVID-19 patients, to aide other neurosurgical teams in preparing for these high-risk cases, especially for neurosurgical interventions which are essential at saving a life or preserving functioning of the central nervous system that cannot be delayed. Perioperative and intraoperative strategies, considerations, as well as challenges arisen under the specific circumstance have been discussed: the hospital should be equipped with negative pressure areas and multiple areas to quarantine positive patients; the operating rooms should be negative pressure or have HEPA-filtration systems in place; all healthcare personnel who immediately participate in neurosurgical interventions for confirmed and suspected COVID-19 patients should take airborne precautions and wear enhanced personal protective equipment. RESULTS: Successful management of neurosurgical emergencies without healthcare personnel infection has been achieved during this pandemic crisis. CONCLUSION: Following the proposed guidance, urgent neurosurgical surgeries and procedures can be safely performed for the benefit of critical patients with or suspected for COVID-19.

High, R. A., W. Winkelman, J. Panza, D. J. Sanderson, H. Yuen, G. Halder, C. Shaver, E. T. Bird, R. G. Rogers and J. M. Danford (2020). “Sacral neuromodulation for overactive bladder in women: do age and comorbidities make a difference?” Int Urogynecol J Jun 25. [Epub ahead of print.].

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OBJECTIVE: To evaluate if age and comorbidities are associated with progression from trial phase to implantation of an implantable pulse generator in women with overactive bladder. METHODS: This multisite retrospective cohort included women with overactive bladder with or without urinary incontinence who had a trial phase for sacral neuromodulation. The primary outcome was progression to implantation. A sub-analysis of implanted patients was performed for the outcome of additional therapies or “implant only” for the duration of follow-up. Multivariate logistic regression models including potential predictors of implantation and post-implantation addition of therapies were performed. RESULTS: At six academic institutions, 91% (785/864) of patients progressed to implantation. Post-implantation success was achieved by 69% (536/782) of patients at median follow-up of 2 (range 0.3 to 15) years. Odds of implantation [OR 0.73 (CI 0.61, 0.88)] and post-implantation success [OR 0.78 (CI 0.98, 0.97)] were lower with increasing decades of age. Medical comorbidities evaluated did not affect implantation rates or post-implant success. CONCLUSIONS: Most women have successful sacral neuromodulation trials despite older age and comorbidities. Higher decade of age has a negative effect on odds of implantation and is associated with addition of therapies post-implantation. Comorbidities assessed in this study did not affect implantation or addition of therapies post-implantation. Most women add therapies to improve efficacy post-implantation, and explantation rates are low.

Gregg, A. R. (2020). “Message from ACMG President: overcoming disparities.” Genet Med Jun 30. [Epub ahead of print.].

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The ACMG vehemently opposes racism and supports all efforts to more fully understand and address the factors that lead not only to disparities in justice, but also those that lead to disparities in health-care delivery and access. The ACMG supports peaceful protest. The gains in health care brought on by advances in genetics and genomics technology and their introduction to clinical practice belong to all of humanity, not only the employed, insured, or wealthy. [No abstract; excerpt from article.].

Balasubramani, G. K., M. P. Nowalk, T. M. Sax, J. Suyama, E. Bobyock, C. R. Rinaldo, Jr., E. T. Martin, A. S. Monto, M. L. Jackson, M. J. Gaglani, B. Flannery, J. R. Chung and R. K. Zimmerman (2020). “Influenza vaccine effectiveness among outpatients in the US Influenza Vaccine Effectiveness Network by study site 2011-2016.” Influenza Other Respir Viruses 14(4): 380-390.

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BACKGROUND: Influenza vaccination is recommended for all US residents aged ≥6 months. Vaccine effectiveness (VE) varies by age, circulating influenza strains, and the presence of high-risk medical conditions. We examined site-specific VE in the US Influenza VE Network, which evaluates annual influenza VE at ambulatory clinics in geographically diverse sites. METHODS: Analyses were conducted on 27 180 outpatients ≥6 months old presenting with an acute respiratory infection (ARI) with cough of ≤7-day duration during the 2011-2016 influenza seasons. A test-negative design was used with vaccination status defined as receipt of ≥1 dose of any influenza vaccine according to medical records, registries, and/or self-report. Influenza infection was determined by reverse-transcription polymerase chain reaction. VE estimates were calculated using odds ratios from multivariable logistic regression models adjusted for age, sex, race/ethnicity, time from illness onset to enrollment, high-risk conditions, calendar time, and vaccination status-site interaction. RESULTS: For all sites combined, VE was statistically significant every season against all influenza and against the predominant circulating strains (VE = 19%-50%) Few differences among four sites in the US Flu VE Network were evident in five seasons. However, in 2015-16, overall VE in one site was 24% (95% CI = -4%-44%), while VE in two other sites was significantly higher (61%, 95% CI = 49%-71%; P = .002, and 53%, 95% CI = 33,67; P = .034). CONCLUSION: With few exceptions, site-specific VE estimates aligned with each other and overall VE estimates. Observed VE may reflect inherent differences in community characteristics of the sites and highlights the importance of diverse settings for studying influenza vaccine effectiveness.

Kim, S. S., B. Flannery, I. M. Foppa, J. R. Chung, M. P. Nowalk, R. K. Zimmerman, M. Gaglani, A. S. Monto, E. T. Martin, E. A. Belongia, H. Q. McLean, M. L. Jackson, L. A. Jackson and M. Patel (2020). “Effects of prior season vaccination on current season vaccine effectiveness in the US Flu VE Network, 2012-13 through 2017-18.” Clin Infect Dis Jun 7;ciaa706. [Epub ahead of print.].

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BACKGROUND: We compared effects of prior vaccination and added or lost protection from current season vaccination among those previously vaccinated. METHODS: Our analysis included data from the US Flu VE Network among participants ≥9 years old with acute respiratory illness from 2012-13 through 2017-18. Vaccine protection was estimated using multivariate logistic regression with an interaction term for effect of prior season vaccination on current season vaccine effectiveness. Models were adjusted for age, calendar time, high-risk status, site, and season for combined estimates. We estimated protection by combinations of current and prior vaccination compared to unvaccinated in both seasons or current vaccination compared to prior vaccinated. RESULTS: 31,819 participants were included. Vaccine protection against any influenza averaged 42% (38 to 47) among those vaccinated only the current season, 37% (33 to 40) among those vaccinated both seasons, and 26% (18 to 32) among those vaccinated only the prior season, compared to participants vaccinated neither season. Current season vaccination reduced the odds of any influenza among patients unvaccinated the prior season by 42% (37 to 46), including 57%, 27% and 55% against A(H1N1), A(H3N2) and influenza B, respectively. Among participants vaccinated the prior season, current season vaccination further reduced the odds of any influenza by 15% (7 to 23), including 29% against A(H1N1) and 26% against B viruses, but not against A(H3N2). CONCLUSION: Our findings support ACIP recommendations for annual influenza vaccination. Benefits of current season vaccination varied among participants with and without prior season vaccination, by virus type/subtype and season.