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Background: Since the introduction of BCR::ABL1 tyrosine kinase inhibitors (TKIs) in 2000, the treatment of Philadelphia chromosome (Ph)‐positive chronic myeloid leukemia (CML) has improved significantly. Methods: This study aimed to evaluate Ph‐positive CML outcomes in the TKI therapy era, considering factors like age, ethnicity, and income. Using the Surveillance, Epidemiology, and End Results (SEER) database, 2857 patients with Ph‐positive CML diagnosed from 2000 to 2019 were analyzed. Results: The overall 5‐year survival rates in Ph‐positive CML increased to above 80%, compared with pre‐TKIs historical data reporting 5‐year overall survival (OS) rates of less than 50%. The 5‐year OS rate was 73% for patients diagnosed in 2000–2004, 82% in 2005–2009, and 78% in 2010–2014; the 4‐year OS rate was 83% in 2015–2019. The 5‐year OS rate for younger patients (<60 years old) was 88% in 2000–2009 and 90% in 2010–2019 (p value.426). In older patients (60+ years old), the 5‐year OS rates were 64% and 65%, respectively (p value,.303). Lower household income was associated with inferior survival across the 2000–2019. These results are inferior to European studies where TKIs are universally available and affordable, and relative OS in CML is similar to age‐matched normal populations. Conclusions: Although the outcome of Ph‐positive CML has improved significantly since 2000, the SEER data still shows differences in outcomes among patient subsets, some anticipated (worse OS in older patients accounted by the relative OS), but others that suggest less than universal access and affordability of this therapy (among poorer patients) in the United States. Although the outcome of Ph‐positive chronic myeloid leukemia has improved significantly since 2000, the Surveillance, Epidemiology, and End Results data still shows differences in outcomes among patient subsets, some anticipated (worse survival in older patients accounted by the relative survival), but others that suggest less than universal access and affordability of this therapy (among poorer patients) in the United States. [ABSTRACT FROM AUTHOR]

Background: Continuous ibrutinib administration is needed to maintain efficacy in patients with chronic lymphocytic leukemia (CLL) and, as such, long‐term toxicity is a concern. The authors report the 5‐year follow‐up of patients with CLL who received treatment with ibrutinib with a focus on hypertension and cardiovascular toxicities. Methods: Patient characteristics were assessed, including blood pressure, cardiovascular disease, disease progression, and death. Univariate logistic regression analysis assessed the relation of patient characteristics and the development of new or worsened hypertension. The incidence of hypertensive outcomes was evaluated using competing risk. Survival was estimated using the Kaplan–Meier method. Results: Three hundred patients with CLL who were treated with ibrutinib on clinical trials were included. The median patient age at study enrollment was 65 years (range, 29–83 years). Seventy percent of patients were men, and 88% were Caucasian. Sixty‐nine percent of patients had hypertension at baseline, and 47% were on antihypertensive medication. Eighty‐eight percent had relapsed or refractory CLL. New‐onset and worsening hypertension were common, occurring in 68.5% and 38% of patients, respectively. Systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg was observed in 16.9% of patients. Hypertension was reversible after ibrutinib discontinuation. Older age, male sex, tobacco use, and chronic kidney disease were associated with ibrutinib‐related hypertension. Baseline hypertension was not associated with major adverse cardiovascular events in ibrutinib‐treated patients nor with event‐free or overall survival. Conclusions: Hypertension is a common toxicity in patients with CLL who receive ibrutinib but is manageable in most patients. Other than chronic kidney disease, baseline cardiovascular disease did not affect ibrutinib‐related hypertension nor was hypertension associated with major adverse cardiovascular events or survival. Plain Language Summary: Ibrutinib is an effective treatment for patients with chronic lymphocytic leukemia.Ibrutinib is a well tolerated therapy, however hypertension can develop or worsen in patients receiving ibrutinib and other cardiovascular events are significant challenges to the use of this drug.This may be particularly true in patients with heart disease.Short‐term side effects may worsen heart disease, but the long‐term impact is unknown.The long‐term results of ibrutinib on heart disease and hypertension are described. In this cohort study of 300 adults with chronic lymphocytic leukemia who were followed for 5 years after ibrutinib initiation, hypertension was common but did not affect major cardiovascular event rates or survival. The cardiovascular toxicity associated with ibrutinib is manageable in most patients with chronic lymphocytic leukemia, including older patients with baseline vascular disease. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to develop a prognostic model for survival in older/unfit patients with newly diagnosed acute myeloid leukemia (AML) who were treated with lower‐intensity chemotherapy regimens. Methods: The authors reviewed all older/unfit patients with newly diagnosed AML who received lower‐intensity chemotherapy from 2000 until 2020 at their institution. A total of 1462 patients were included. They were divided (3:1 basis) into a training (n = 1088) and a validation group (n = 374). Results: In the training cohort of 1088 patients (median age, 72 years), the multivariate analysis identified 11 consistent independent adverse factors associated with survival: older age, therapy‐related myeloid neoplasm, existence of previous myelodysplastic syndrome or myeloproliferative neoplasms, poor performance status, pulmonary comorbidity, anemia, thrombocytopenia, elevated lactate dehydrogenase, cytogenetic abnormalities, and the presence of infection at diagnosis, and therapy not containing venetoclax. The 3‐year survival rates were 52%, 24%, 10%, and 1% in favorable, intermediate, poor, and very poor risk, respectively. This survival model was validated in an independent cohort. In a subset of patients in whom molecular mutation profiles were performed in more recent times, adding the mutation profiles after accounting for the effects of previous factors identified IDH2 (favorable), NPM1 (favorable), and TP53 (unfavorable) mutations as molecular prognostic factors. Conclusion: The proposed survival model with lower‐intensity chemotherapy in older/unfit patients with newly diagnosed AML may help to advise patients on their expected outcome, to propose different strategies in first complete remission, and to compare the results of different existing or future investigational therapies. Plain Language Summary: Lower intensity therapy can be considered for older patients to avoid severe toxicities and adverse events.However, survival prediction in AML was commonly developed in patients who received intensive chemotherapy.In this study, we have proposed a survival model to guide therapeutic approach in older patients who received lower‐intensity therapy. The proposed survival model with lower‐intensity chemotherapy in older/unfit patients with newly diagnosed acute myeloid leukemia may help to advise patients on their expected outcome, to propose different strategies in first complete remission, and to compare the results of different existing or future investigational therapies. [ABSTRACT FROM AUTHOR]

Background: Nelarabine is a purine nucleoside analogue prodrug approved for the treatment of relapsed and refractory T‐cell acute lymphoblastic leukemia (R/R T‐ALL) and lymphoblastic lymphoma (T‐LBL). Although effective in R/R T‐ALL, significant neurotoxicity is dose‐limiting and such neurotoxicity associated with nucleoside analogues can be related to dosing schedule. Methods: The authors conducted a phase 1 study to evaluate the pharmacokinetics and toxicity of nelarabine administered as a continuous infusion (CI) for 5 days (120 hours), rather than the standard, short‐infusion approach. Results: Twenty‐nine patients with R/R T‐ALL/LBL or T‐cell prolymphocytic leukemia (T‐PLL) were treated, with escalating doses of nelarabine from 100 to 800 mg/m2/day × 5 days. The median age of the patients was 39 years (range, 14–77 years). The overall response rate was 31%, including 27% complete remission (CR) or CR with incomplete platelet recovery (CRp). Peripheral neuropathy was observed in 34% of patients, including four ≥grade 3 events related to nelarabine. Notably, there was no nelarabine‐related central neurotoxicity on study. The maximum tolerated dose was not reached. Pharmacokinetic data suggested no relationship between dose of nelarabine and accumulation of active intracellular ara‐GTP metabolite. Higher intracellular ara‐GTP concentrations were statistically associated with a favorable clinical response. Conclusion: Preliminary evaluation of continuous infusion schedule of nelarabine suggests that the safety profile is acceptable for this patient population, with clinical activity observed even at low doses and could broaden the use of nelarabine both as single agent and in combinations by potentially mitigating the risk of central nervous system toxicities. Nelarabine administered as continuous infusion is safe and has significant clinical activity in patients with T‐cell leukemia. The continuous infusion schedule of nelarabine was not associated with central neurotoxicity in this study. [ABSTRACT FROM AUTHOR]

People with spinal cord injury (SCI) are at high risk of developing a pressure injury. It is unclear why some people with SCI develop pressure injury while others with similar predisposing risk factors do not during acute hospitalisation. This may hinder healthcare utilisation to prevent pressure injuries. The purpose of the study was to examine the proof‐of‐concept objective bedside skin blood flow measurements before a pressure injury develops in spinal cord injured patients during acute hospitalisation. This was an observational study. All participants had acute traumatic SCI and were pressure injury‐free upon enrollment. Skin blood flow patterns were collected at both heels under two circumstances: localised pressure for reactive hyperemia, and localised heating for heat hyperemia. Our results showed that reactive and heat hyperemia were successfully induced in all eleven participants. Two participants developed pressure injury and nine did not have pressure injury at discharge. Heat hyperemia was smaller in participants with pressure injury. No difference was observed in reactive hyperemia between the groups. In conclusion, skin blood flow measurements could be obtained at bedside during acute hospitalisation of SCI for the purpose of research. Further examination of a larger group is warranted to determine clinical use of heat hyperemia pattern as predictor for pressure injury development. [ABSTRACT FROM AUTHOR]

Progress is occurring at a dizzying rate across all leukemias. Since the authors' review of the topic in Cancer in 2018, numerous discoveries have been made that have improved the therapy and outcomes of several leukemia subsets. Hairy cell leukemia is potentially curable with a single course of cladribine followed by rituximab (10‐year survival, ≥90%). Acute promyelocytic leukemia is curable at a rate of 80% to 90% with a nonchemotherapy regimen of all‐trans retinoic acid and arsenic trioxide. The cure rate for core‐binding factor acute myeloid leukemia (AML) is ≥75% with fludarabine, high‐dose cytarabine, and gemtuzumab ozogamicin. Survival for patients with chronic myeloid leukemia is close to that for an age‐matched normal population with BCR‐ABL1 tyrosine kinase inhibitors (TKIs). Chronic lymphocytic leukemia, a previously incurable disease, may now be potentially curable with a finite duration of therapy with Bruton tyrosine kinase inhibitors and venetoclax. The estimated 5‐year survival rate for patients with Philadelphia chromosome–positive acute lymphoblastic leukemia (ALL) exceeds 70% with intensive chemotherapy and ponatinib, a third‐generation BCR‐ABL1 TKI, and more recent nonchemotherapy regimens using dasatinib or ponatinib with blinatumomab are producing outstanding results. Survival in both younger and older patients with ALL has improved with the addition of antibodies targeting CD20, CD19 (blinatumomab), and CD22 (inotuzumab) to chemotherapy. Several recent drug discoveries (venetoclax, FLT3 and IDH inhibitors, and oral hypomethylating agents) are also improving outcomes for younger and older patients with AML and for those with higher risk myelodysplastic syndrome. Major progress is occurring at a very rapid pace in leukemia. This review summarizes the important recent discoveries in these disorders. [ABSTRACT FROM AUTHOR]

Summary: Programmed cell death protein 1 (PD‐1) and PD‐ligand 1 (PD‐L1) expression is upregulated in cluster of differentiation 34 (CD34)+ bone marrow cells from patients with myelodysplastic syndromes (MDS). Hypomethylating agent (HMA) treatment results in further increased expression of these immune checkpoints. We hypothesised that combining an anti‐PD‐1 antibody with HMAs may have efficacy in patients with MDS. To test this concept, we designed a phase II trial of the combination of azacitidine and pembrolizumab with two cohorts. In the 17 previously untreated patients, the overall response rate (ORR) was 76%, with a complete response (CR) rate of 18% and median overall survival (mOS) not reached after a median follow‐up of 12·8 months. For the HMA‐failure cohort (n = 20), the ORR was 25% and CR rate was 5%; with a median follow‐up of 6·0 months, the mOS was 5·8 months. The most observed toxicities were pneumonia (32%), arthralgias (24%) and constipation (24%). Immune‐related adverse events requiring corticosteroids were required in 43%. Overall, this phase II trial suggests that azacitidine and pembrolizumab is safe with manageable toxicities in patients with higher‐risk MDS. This combined therapy may have anti‐tumour activity in a subset of patients and merits further studies in the front‐line setting. [ABSTRACT FROM AUTHOR]

Background: The outcome of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone plus ofatumumab hyper-CVAD + ofatumumab (hyper-CVAD + ofatumumab) has not been compared with the outcome of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone plus ofatumumab hyper-CVAD plus rituximab (hyper-CVAD + Rituximab) in Philadelphia chromosome-negative acute lymphoblastic leukemia (ALL) in a randomized clinical trial.Methods: The authors compared the outcomes of 69 patients treated with hyper-CVAD + ofatumumab and 95 historical-control patients treated with hyper-CVAD + Rituximab. Historical-control patients were treated with hyper-CVAD + Rituximab if they had CD20 expression ≥ 20%. Ofatumumab (day 1 of course 1, 300 mg intravenously; subsequent doses, 2000 mg intravenously) was administered on days 1 and 11 of courses 1 and 3 and on days 1 and 8 of courses 2 and 4 for a total of 8 doses. A propensity score analysis with inverse probability of treatment weighting (IPTW) was performed to adjust for baseline covariates between groups.Results: The median event-free survival with stem cell transplantation (SCT) censoring was 33 and 65 months with hyper-CVAD + Rituximab and hyper-CVAD + ofatumumab, respectively (crude P = .064; IPTW P = .054). The median overall survival with SCT censoring was 52 months and not reached, respectively (crude P = .087; IPTW P = .097).Conclusions: Hyper-CVAD + ofatumumab was associated with better outcomes than hyper-CVAD + Rituximab among patients with newly diagnosed Philadelphia chromosome-negative ALL. [ABSTRACT FROM AUTHOR]

BACKGROUND: Dasatinib monotherapy has demonstrated modest clinical activity in chronic myeloid leukemia in lymphoid blastic phase (CML‐LBP). The outcome of Philadelphia chromosome (Ph)–positive acute lymphoblastic leukemia (ALL) has dramatically improved with hyperfractionated cyclophosphamide, vincristine sulfate, doxorubicin hydrochloride, and dexamethasone (hyper‐CVAD) in combination with tyrosine kinase inhibitors (TKIs). METHODS: The authors reviewed 85 patients (23 with CML‐LBP and 62 with newly diagnosed Ph‐positive ALL) who received hyper‐CVAD plus dasatinib. RESULTS: In the CML‐LBP cohort, 19 had prior chronic myeloid leukemia as chronic phase (n = 17; 74%), accelerated phase (n = 1; 4%), or myeloid blastic phase (n = 1; 4%); 4 (17%) presented with de novo CML‐LBP. The BCR‐ABL1 transcript was p210 in 22 patients (96%) and p190 in 1 patient (4%). In the Ph‐positive ALL cohort, p210 and p190 transcripts were detected in 13 patients (21%) and 48 patients (77%), respectively. Patients with CML‐LBP were less likely to achieve deep molecular remission than patients with Ph‐positive ALL: the major molecular response (MMR) rates were 70% and 95%, respectively (P =.007), and the complete molecular response (CMR) rates were 55% and 74%, respectively (P =.16). Survival outcomes were similar for CML‐LBP and Ph‐positive ALL: the 5‐year overall survival (OS) rates were 59% and 48%, respectively (P =.97). Allogeneic stem cell transplantation was associated with a better outcome in CML‐LBP (5‐year OS rate, 88% vs 57%; P =.04). In Ph‐positive ALL, the outcome was driven by deeper molecular remission: the 5‐year OS rates were 63% and 25% with CMR and MMR, respectively (P =.002). CONCLUSIONS: The outcome of CML‐LBP has improved with hyper‐CVAD plus dasatinib therapy with survival comparable to that of Ph‐positive ALL. Further improvement may be achieved with the use of novel TKIs and targeted agents. The outcome of chronic myeloid leukemia in lymphoid blastic phase (CML‐LBP) treated with hyperfractionated cyclophosphamide, vincristine sulfate, doxorubicin hydrochloride, and dexamethasone plus dasatinib is similar to the outcome of Philadelphia chromosome (Ph)–positive acute lymphoblastic leukemia (ALL). Allogeneic stem cell transplantation offers better survival for patients with CML‐LBP, whereas for patients with Ph‐positive ALL, the outcome is driven by deeper molecular remission. [ABSTRACT FROM AUTHOR]

BACKGROUND: The achievement of a 3‐month complete molecular response (CMR) is a major prognostic factor for survival in patients with Philadelphia chromosome (Ph)‐positive acute lymphoblastic leukemia (ALL). However, 25% of patients relapse during therapy with tyrosine kinase inhibitors (TKIs). METHODS: The authors reviewed 204 patients with Ph‐positive ALL who were treated between January 2001 and December 2018 using the combination of hyper‐CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone) plus a TKI (imatinib, 44 patients [22%]; dasatinib, 88 patients [43%]; or ponatinib, 72 patients [35%]). Progression‐free survival (PFS) was defined as the time from the start date of therapy to the date of relapse, death, or last follow‐up. Overall survival (OS) was defined as the time from the start date of therapy to the date of death or last follow‐up. RESULTS: Overall, a 3‐month CMR was observed in 57% of patients, including 32% of those who received imatinib, 52% of those who received dasatinib, and 74% of those who received ponatinib. The median follow‐up was 74 months (imatinib, 180 months; dasatinib, 106 months; ponatinib, 43 months). Among 84 patients in 3‐month CMR, 17 (20%) proceeded to undergo allogeneic stem cell transplantation (ASCT). The 5‐year PFS and OS rates were 68% and 72%, respectively. By multivariate analysis, ponatinib therapy was the only significant favorable independent factor predicting for progression (P =.028; hazard ratio, 0.388; 95% CI, 0.166‐0.904) and death (P =.042; hazard ratio, 0.379; 95% CI, 0.149‐0.966). ASCT was not a prognostic factor for PFS and OS by univariate analysis. CONCLUSIONS: In patients with Ph‐positive ALL, ponatinib is superior to other types of TKIs in inducing and maintaining a CMR, thus preventing disease progression. ASCT does not improve outcome once a 3‐month CMR is achieved. Ponatinib is superior to other types of tyrosine kinase inhibitors in inducing and maintaining a complete molecular response, thus preventing progression in patients with Philadelphia chromosome‐positive acute lymphoblastic leukemia. Allogeneic stem cell transplantation does not improve outcomes once a 3‐month complete molecular response is achieved. [ABSTRACT FROM AUTHOR]

Summary: Chronic lymphocytic leukaemia (CLL) rarely presents in adolescent and young adult (AYA) patients (patients aged 15–39 years). Disease characteristics and outcomes of AYA patients with CLL are not well understood, particularly in the era of novel oral targeted therapies. We analysed outcomes of 227 AYA patients with CLL diagnosed in the last two decades and evaluated at our institution. Median time to first treatment (TTFT) was 2·2 years, and five‐ and 10‐year overall survival (OS) were 90% and 78%, respectively. Pre‐treatment elevated beta 2‐microglobulin, advanced Rai stage, del(11q) or del(17p) by FISH, unmutated IGHV and CD38 positivity were associated with both shorter TTFT and OS. Within the subgroup of patients who received oral targeted therapy at any time, del(11q) or del(17p) and complex karyotype were associated with shorter OS. First‐line treatment choice was significantly associated with time to second treatment (P < 0·001). Patients harbouring del(11q) or del(17p) experienced shorter time to Richter transformation and were more likely to undergo an allogeneic stem cell transplant. There was a significant association between age and both OS and time to Richter transformation. Our study is the first analysis of AYA patients with CLL with a large number of patients treated with oral targeted therapies. [ABSTRACT FROM AUTHOR]

Background: The outcome of patients with relapsed/refractory (R/R) acute lymphoblastic leukemia (ALL) is poor. The combination of inotuzumab with low-intensity mini-hyper-CVD (mini-hyper-CVD; cyclophosphamide and dexamethasone at 50% dose reduction, no anthracycline, methotrexate at 75% dose reduction, cytarabine at 0.5 g/m2 × 4 doses) chemotherapy has shown encouraging results. The sequential addition of blinatumomab might improve outcome in patients with R/R ALL.Methods: We used lower intensity chemotherapy, mini-hyper-CVD (cyclophosphamide and dexamethasone at 50% dose reduction, no anthracycline, methotrexate at 75% dose reduction, cytarabine at 0.5 g/m2 x 4 doses) compared to conventional hyper-CVAD.Results: Ninety-six patients with a median age of 37 years (range, 18-87 years) were treated. Overall, 77 patients (80%) responded, 55 (57%) of whom achieved complete response. The overall measurable residual disease negativity rate among responders was 83%. Forty-four (46%) patients underwent later allogeneic stem cell transplantation. Veno-occlusive disease of any grade occurred in 10 (10%) patients. The rates were 13% with the original schedule and 3% with the use of lower-dose inotuzumab and sequential blinatumomab. With a median follow-up of 36 months, the median overall survival (OS) was 13.4 months, with 3-year OS rates of 33%. The 3-year OS rate for patients with CD22 expression ≥70% and without adverse cytogenetics (KMT2A rearrangements, low hypodiploidy/near triploidy) was 55%.Conclusion: The combination of inotuzumab and low-intensity mini-hyper-CVD chemotherapy with or without blinatumomab shows sustained efficacy in patients with R/R ALL. [ABSTRACT FROM AUTHOR]

Background: New drug combinations have led to significant improvements in remission rates for patients with acute myeloid leukemia (AML). However, many patients with high‐risk AML who respond to their initial treatment and are not candidates for allogeneic stem cell transplantation (ASCT) will eventually relapse with poor outcomes. Methods: In this phase 2 trial, the efficacy of lenalidomide maintenance was evaluated in patients with high‐risk AML who had achieved their first or second remission after induction chemotherapy and at least 1 consolidation cycle and who were not candidates for immediate ASCT. Lenalidomide was given orally at 10 to 20 mg daily on days 1 to 28 of a 28‐day cycle for up to 24 cycles. Results: A total of 28 patients were enrolled in this study with a median age of 61 years (range, 24‐87 years). The median number of cycles was 8 (range, 1‐24 cycles). Ten patients (36%) completed 24 months of maintenance treatment. With a median follow‐up of 22.5 months (range, 2.6‐55 months), 12 patients (43%) relapsed after a median of 3 months (range, 0.7‐23 months). The median duration of remission for all patients was 18.7 months (range, 0.7‐55.1 months). The 2‐year overall survival and relapse‐free survival rates from the time of enrollment were 63% and 50%, respectively. Overall, lenalidomide was well tolerated; serious adverse events of grade 3 or 4, including rash (n = 5), thrombocytopenia (n = 4), neutropenia (n = 4), and fatigue (n = 2), were observed in 13 patients (46%). Conclusions: Lenalidomide is a safe and feasible maintenance strategy in patients with high‐risk AML who are not candidates for ASCT, and it has beneficial effects for patients with negative measurable residual disease. Lenalidomide maintenance in patients with high‐risk acute myeloid leukemia results in a 2‐year overall survival rate of 63%. The beneficial effect is most profound in patients with negative minimal residual disease and in those without a history of prior myeloid or nonmyeloid neoplasms. [ABSTRACT FROM AUTHOR]

Background: Despite the enormous economic and societal impact of musculoskeletal disorders, detailed data on the patient demographics and visit characteristics of nonspine musculoskeletal ambulatory care are sparse. Such data are essential to inform policymakers on population health needs and to justify health care resource allocation. Objective: To determine the demographic, patient, and visit characteristics of adult musculoskeletal ambulatory clinic visits, with the exception of spine visits, in the United States. Design: Survey/registry. Setting: National Ambulatory Medical Care Survey (NAMCS), Centers for Disease Control and Prevention (CDC) 2009 to 2016. Patients: The NAMCS was designed to capture information regarding the provision and use of ambulatory medical care services in the United States. Nonfederally employed office‐based physicians reported data for this survey from 2009 to 2016. Interventions: None. Main Outcome Measure(s): Average annual estimated number (in 100 000s), Average annual estimated rate of ambulatory care musculoskeletal visits per 100 U.S. adults. Results: During 2009 to 2016, the leading cause of musculoskeletal visits was knee symptoms (15.3 million annually from 2009 to 2010, 14.0 million annually from 2011 to 2012, 12.5 million annually from 2013 to 2014, and 12.4 million annually from 2015 to 2016). Musculoskeletal visits were most frequent in patients that were 45 to 64 years of age (40.4% to 43.6% of visits were for patients 45 to 64 years of age depending on body region). Orthopedic surgeons conducted more musculoskeletal visits than any other physician specialty for all body regions. Among body regions, magnetic resonance imaging (MRI) studies were ordered most commonly for patients with shoulder (total visits in 100 000 ± standard error [SE] 47.00 ± 0.21; 12.5% of total visits for shoulders) and knee symptoms (61.85 ± 0.15; 11.4% of total visits for knees). Opioid and opioid analgesic combinations (9.2% to 14.8% of visits) were most commonly prescribed in visits related to hip complaints. Conclusions: Visits were most frequent for knee symptoms and in patients of working age groups, which likely affects work productivity. Orthopedic surgeons were the most common provider specialty. Opioid medications were prescribed most commonly for patients with hip symptoms, which may highlight an area for potential intervention given the ongoing opioid crisis. [ABSTRACT FROM AUTHOR]

In the military battlefield, maintaining high survivability of energy constraint wireless sensor network (WSN) when some nodes are destroyed by the foe troops is one of the prominent issues for the researchers. This study proposes the fuzzy and neuro‐fuzzy based relay selection schemes for cooperative WSN which reduce the bit error rate (BER) while improving the network lifetime. Meanwhile, the proposed model maintains the uninterrupted communication between military nodes in a warfare situation. The proposed proposed strategies are compared with the maximum residual energy‐based relay selection (MRERS), minimum energy consumption‐based relay selection (MECRS), and random relay selection (RRS) strategies. The performance of the proposed and existing strategies is evaluated on the basis of BER, network lifetime, number of dead nodes, and average energy of nodes in the network. The simulation results demonstrate that proposed schemes has 13.19–19.28% improvement in BER than the existing strategies. Moreover, 76.00–90.88% network lifetime improves when compared with the MECRS and RRS strategies. However, 6–7.76% is less than MRERS strategy. Furthermore, the results show that network survivability and average network energy is also better when the number of dead nodes in the network increases. [ABSTRACT FROM AUTHOR]

Objectives: Guideline recommended treatments for chronic conditions are thought to reduce ED presentations. Method: We used data from 1958 ED patients with dyspnoea to describe medication use in patients with chronic conditions. Results: A total of 1233 (63.5%) patients had one or more of: chronic obstructive pulmonary disease 547 (28%), asthma 454 (23%), atrial fibrillation 368 (19%) or heart failure 401 (21%). Approximately, 70% were prescribed appropriate preventative medication for their chronic condition when they presented to ED with dyspnoea. Conclusion: Prescription of guideline recommended therapies for chronic conditions in patients presenting to the ED in Australasia with acute dyspnoea is similar or higher than reported previously. [ABSTRACT FROM AUTHOR]