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In June 2020 when elective total knee arthroplasty (TKA) resumed after the initial COVID-19 surge, we adapted our TKA pathway focusing on a shorter hospitalization, increased home discharge, and use of post-discharge telemedicine and telerehabilitation. The purpose of this study was to evaluate if changes in postoperative care affected early TKA outcomes.Five hundred and fifty-four patients who underwent elective primary unilateral TKA for primary osteoarthritis between June and August 2020 (study group) were matched 1:1 for age, sex, body mass index, and Charlson comorbidity index with control patients who underwent surgery between August and November 2019. Study patients were discharged 25 h earlier on average compared to controls, more frequently on the same-day or postoperative day-1 (24.9% vs. 16.1%; p = 0.001), and more frequently home (97.3% vs. 83.8%; p 0.001). Study patients used telemedicine (11.7% vs. 0%; p 0.001) and telerehabilitation (19.7% vs. 2.5%; p 0.001) at higher rates than controls. Generalized estimating equations, Mann-Whitney U, and Chi-Square tests were used to compare outcomes between groups including unscheduled office visits, ER visits, readmissions, Center for Medicare and Medicaid Services (CMS) complications, manipulation under anesthesia (MUA), and patient-reported outcomes measures (PROMs).Rates of emergency room visits, readmissions, CMS complications, MUA, and improvements in PROMs were similar between cohorts. Study patients experienced higher rates of unscheduled outpatient visits (9.2% vs. 4.9%; p = 0.004), predominantly due to wound complications.A protocol implemented during the COVID-19 pandemic that leveraged a shortened hospitalization, higher rates of home discharge, and increased use of telemedicine and telerehabilitation was safe and effective.

OBJECTIVES: Screening subjects for drug-drug interactions (DDI) prior to enrollment in oncology clinical trials is integral to ensuring safety, but standard procedures or tools are not readily available to screen DDI in this setting. Our objective was to develop a DDI screening tool for use during oncology clinical trial enrollment and to test usability in single-center and multi-center pilot studies. METHODS: A multi-stage approach was utilized for this quality improvement intervention. Semi-structured interviews with individuals responsible for DDI screening were conducted to develop a prototype tool. The tool was used for screening DDI in subjects enrolling in National Clinical Trials Network trials of commercially available agents during a single-center 3-month feasibility pilot. Improvements were made, and a 3-month multi-center pilot was conducted at volunteer SWOG Cancer Research Network sites. Participants were surveyed to determine tool usability and efficiency. RESULTS: A screening tool was developed from semi-structured interviews. A critical feature was reporting which medications had specific pharmacokinetic and pharmacodynamic characteristics including transporter and CYP450 substrates, inhibitors, or inducers and QT prolongation. In the 12-site study, average DDI screening time for each patient decreased 15.7 minutes (SD: 10.2, range 3–35 minutes, p90% agreeing with all positive usability characterizations and disagreeing with all negative complexity characterizations. CONCLUSIONS: A DDI screening tool for oncology clinical trial enrollment was created and its usability confirmed. Pending further testing, this tool could be used during eligibility screening to improve safety and data accuracy collected within clinical trials.

PURPOSE: Preclinical data suggest the combination of an anti-programmed death receptor 1 antibody plus dabrafenib and trametinib to have superior antitumor activity compared with dabrafenib plus trametinib alone. These observations are supported by translational evidence suggesting that immune checkpoint inhibitors plus targeted therapy may improve treatment outcomes in patients with BRAF V600-mutant metastatic melanoma. COMBI-i is a phase III trial evaluating spartalizumab, an anti-programmed death receptor 1 antibody, in combination with dabrafenib and trametinib (sparta-DabTram), versus placebo plus dabrafenib and trametinib (placebo-DabTram) in patients with BRAF V600-mutant unresectable or metastatic melanoma. METHODS: Patients received spartalizumab 400 mg intravenously every 4 weeks plus dabrafenib 150 mg orally twice daily and trametinib 2 mg orally once daily or placebo-DabTram. Participants were age ≥ 18 years with unresectable or metastatic BRAF V600-mutant melanoma. The primary end point was investigator-assessed progression-free survival. Overall survival was a key secondary end point (ClinicalTrials.gov identifier: NCT02967692). RESULTS: At data cutoff (July 1, 2020), the median progression-free survival was 16.2 months (95\% CI, 12.7 to 23.9 months) in the sparta-DabTram arm versus 12.0 months (95\% CI, 10.2 to 15.4 months) in the placebo-DabTram arm (hazard ratio, 0.82 [95\% CI, 0.66 to 1.03]; P = .042 [one-sided; nonsignificant]). The objective response rates were 69\% (183 of 267 patients) versus 64\% (170 of 265 patients), respectively. Grade ≥ 3 treatment-related adverse events occurred in 55\% (146 of 267) of patients in the sparta-DabTram arm and 33\% (88 of 264) in the placebo-DabTram arm. CONCLUSION: The study did not meet its primary end point; broad first-line use of sparta-DabTram is not supported by these results. Further biomarker-driven investigation may identify patient subpopulations who could benefit from checkpoint inhibitor plus targeted therapy combinations.

Multimorbidity (≥ 2 co-occurring chronic health conditions) affects > 50% of US adults aged 65 and older. Building on emerging work suggesting greater risk of multimorbidity in more recent cohorts of aging Americans, we examine heterogeneity in cohort-patterns of multimorbidity by race/ethnicity and nativity. Observations were drawn from the Health and Retirement Study (1998–2018) including adults aged 51 and older across 7 birth cohorts (born < 1924, 1924–1930, 1931–1941, 1942–1947, 1948–1953, 1954–1959, and 1960–1965). Multimorbidity was measured using a sum of 9 possible chronic conditions (heart disease, hypertension, stroke, diabetes, arthritis, lung disease, cancer, high depressive symptomatology, and cognitive impairment). Linear mixed models adjusting for age, period, and cohort effects tested whether cohort-specific multimorbidity risk varied for US-born White, US-born Black/African American, US-born Hispanic/Latino, and foreign-born Hispanic/Latino older adults. 30,607 adults contributed 158,727 total observations, grand mean age was 65.40 (SD=10.07), and mean multimorbidity was 2.18 (SD=1.60). US-born Black/African Americans had the greatest multimorbidity burden regardless of cohort. US-born Hispanic/Latinos experienced the highest cohort-related increases in multimorbidity, followed by US-born Black/African Americans. For example, compared to US-born Hispanic/Latinos born 1931–1941, US-born Hispanic/Latinos born 1954–1959 had 1.03 (CI: 0.78;1.28) more expected chronic conditions. Foreign-born Hispanic/Latinos had the smallest cohort-related increases in multimorbidity. Our results document heterogeneity in rising rates of multimorbidity across cohorts, suggest that US-born minority adults in Baby Boom cohorts may be at especially high risk of multimorbidity, and confirm protective effects of immigrant status among Hispanic/Latino older adults.

We examined age, sex, and race/ethnicity differences in trajectories of depressive symptom from adolescence to early adulthood; we also tested whether socioeconomic status and acculturation were associated with the differences. The findings suggest that adolescents over age 15 had a higher level and faster decline in depressive symptoms than their younger counterparts; females had higher level and a faster decline in depressive symptoms than males. Chinese American females had the highest depressive symptoms sustained across 7 years; Chinese American males over age 15 had higher depressive symptoms than their White male counterparts. Neither socioeconomic status nor acculturation was significantly associated with the differences in the trajectories. Our findings suggest a need for greater attention to Chinese American adolescents’ psychological well-being.

Little information in the literature exists regarding the outcome of total knee arthroplasty (TKA) in patients who are on workers' compensation (WC). Twenty-one WC patients who underwent 23 TKA procedures (cases) were compared with 16 randomly selected, age-matched control patients (controls) undergoing 21 TKA procedures. The mean follow-up was 56 months (34-112 months) for both groups. The results were evaluated using the scoring system of the Knee Society (KSS). Significant improvements in KSS were noted in both groups, and all subjects indicated that they would undergo the procedure again. The KSS were statistically better in the control group relative to the WC group. There was no difference in range of motion, stability, or radiographic alignment. Despite high satisfaction with the results of surgery in both groups, only 5 of 21 patients in the WC group returned to their previous occupation. TKA improves pain and function scores in WC patients with end-stage knee disease. Understanding how WC issues affect the results of TKA is critical to the selection of appropriate surgical candidates.