e13883 Background: The standard of care for fever detection in oncology relies on oral thermometer measurements, which contributes to delayed detection of complications due to episodic measurement and non-compliance. Remote patient monitoring (RPM) with a wearable thermometer would enable earlier detection; however, there remains uncertainty around reimbursement policies and the feasibility of deployment at community medical centers. To address these concerns, this study developed an RPM program at a community oncology hospital based on the AION TempShield™, a wearable thermometer that transmits continuous body temperature to a web portal. Methods: Patients starting chemotherapy were enrolled for up to six months of RPM. Fever alerts were configured to trigger if the temperature exceeded 100.4°F for one hour during the day or three hours at night. Measurement accuracy was assessed by comparison to oral thermometer readings. A comparison of acute care utilization and mortality rates between RPM-compliant participants and those that were non-compliant or declined RPM was used to assess clinical effectiveness; compliance was defined as wearing the TempShield for at least one hour for more than 50% of outpatient days. Economic impact and patient satisfaction were evaluated through tabulation of billable CPT code claims and surveys, respectively. Results: Of 123 participants, 85 were compliant and 38 were non-compliant; an additional 15 participants declined RPM but agreed to be part of the comparator. Compliant participants were retained for an average of 120 days and wore the device for 85% of days, averaging 18 hours of wear per day. Overall, TempShield measurements showed concordance with the oral thermometer, with a mean difference of 0.2°F (95% limits of agreement from -1.0°F to 1.4°F). Compared to the non-compliant participants, the compliant cohort showed a significant reduction in mean inpatient days over a 30-day exposure (1.43 to 0.31; p < 1e-04) and 60-day mortality (15.1% to 1.2%; p = 0.008). CPT claims were successfully generated, with 71% of enrolled participants meeting the criteria for CPT 99453 (device setup) and 311 claims generated for CPT 99454 (data transmission). Overall, reimbursement through insurance was approved for 99% of participants, with an average copay of $15 and 54% incurring no out-of-pocket cost. Satisfaction surveys indicated that 98% of participants would recommend the device, with 69% experiencing increased peace of mind. Conclusions: Compliance with long-term temperature monitoring was associated with significantly improved outcomes. The program achieved favorable reimbursement rates and was highly rated by patients. While future studies would be beneficial, this work demonstrates that remote monitoring with TempShield can be successfully deployed at a community cancer center, marking a significant step toward a new standard of care in oncology.
Body condition scoring (BCS) is a critical management tool in beef cattle production. Cows with optimal body condition are more likely to conceive, maintain pregnancy, and calve successfully. Monitoring and maintaining appropriate BCS can enhance herd fertility, reduce production costs, and support long-term profitability in beef operations. A six-year observational study was conducted in order to evaluate the role of BCS and conception in the breeding season for commercial beef herds in western Oklahoma. A single evaluator collected body condition scores on commercial beef heifers (n = 3247) and cows (n = 2121) over a period of six years (2018-2023). Body condition scores in beef cattle range from 1 (extremely emaciated) to 9 (obese). Body condition scores were collected on heifers and cows synchronized for timed artificial insemination (TAI) at the time of TAI and again approximately 80d later at the time of ultrasound. Following TAI, heifers and cows were exposed to natural service herd sires for the remainder of the producer-identified breeding season. At the time of transrectal ultrasonography (US), fetal size (crown-rump length) was used to determine the time of conception (pregnant via TAI or natural service bull breeding). A multiple, linear regression equation was used to determine the relative influence of BCS at TAI and change in BCS between TAI and US. As expected, there was an effect of BCS measured at TAI on heifer pregnancy to AI (P=0.02) as heifers with a higher BCS were more likely to become pregnant to AI. During the first 21-d of the breeding season following TAI, a greater number of heifers with higher BCS measured at TAI (P=0.03) became pregnant than those with a lower BCS. As the breeding season continued, the positive effect of BCS measured at TAI was no longer observed (P=0.19). For the cows observed, there was no effect (P=0.26) of BCS at TAI on pregnancy to AI, however, each one unit increase in BCS at TAI was associated with 1.6 fewer days to conception (P=0.02) and each one unit change in BCS between TAI and US resulted in 3.7 fewer days to conception (P < 0.01). This study highlights the critical role of body condition scoring (BCS) in influencing reproductive performance in beef cattle, demonstrating that higher BCS at TAI positively impacts conception rates in heifers and reduces days to conception in cows, underscoring the importance of energy balance in optimizing reproductive success.
Background: Randomized controlled trials (RCTs) have shown variable cardiovascular (CV) outcomes in overweight or obese patients without diabetes mellitus (DM) who are treated with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) vs. placebo. We conducted a meta-analysis of the available studies. Methods: Online databases were searched for RCTs comparing GLP-1 RA to placebo in overweight or obese non-diabetic patients. The clinical endpoints of interest were major adverse CV events (MACE), CV death, all cause death, myocardial infarction (MI), stroke, revascularization, total adverse events and their subtypes. Pooled odds ratios (OR) and 95 % confidence intervals (CI) were calculated using a random-effects model. Results: A total of 10 RCTs with 29,325 patients (n =16,900 GLP-1 RA, n = 12,425 placebo) were included. The mean age was 48 years and 34 % of patients were men. As compared with placebo, the GLP-1 RA group was associated with significant reduction of MACE (OR 0.79, 95 % CI 0.710.89, p < 0.0001), all cause death (OR 0.80, 95 % CI 0.70-0.92, p = 0.002), MI (OR 0.72, 95 % CI 0.61-0.85, p = 0.0001) and revascularization (OR 0.76, 95 % CI 0.67-0.86, p < 0.0001), without any differences in CV death or stroke. Total adverse events, gastrointestinal and gallbladderrelated disorders were higher in the GLP-1 RA group, with a similar rate of renal adverse events, malignant neoplasms and acute pancreatitis to placebo. Conclusion: In overweight or obese patients without DM, patients treated with GLP-1 RAs had significantly reduced MACE, all cause death, MI and revascularization when compared with placebo.
Background Older adults with non–ST‐segment–elevation acute coronary syndrome are less likely to undergo an invasive strategy compared with younger patients. Randomized controlled trials traditionally exclude older adults because of their high burden of geriatric conditions. Methods and Results We searched for randomized controlled trials comparing invasive versus medical management or a selective invasive (conservative) strategy for older patients (age≥75 years) with non–ST‐segment–elevation acute coronary syndrome. Fixed effects meta‐analysis was conducted to estimate the odds ratio (OR) with 95% CI for the composite of death or myocardial infarction (MI) and individual secondary end points of all‐cause death, cardiovascular death, MI, revascularization, stroke, and major bleeding. Nine studies with 2429 patients (invasive: 1228 versus control: 1201) with a mean follow‐up of 21 months were included. An invasive strategy was associated with a significantly decreased risk of a composite of death and MI (OR, 0.67 [95% CI, 0.54–0.83], P <0.001), MI (OR, 0.56 [95% CI, 0.45–0.70], P <0.001) and subsequent revascularization (OR, 0.27 [95% CI, 0.16–0.48], P <0.001). There was no difference in all‐cause death (OR, 0.84 [95% CI, 0.65–1.10], P =0.21), cardiovascular death (OR, 0.85 [95% CI, 0.63–1.15], P =0.30), stroke (OR, 0.74 [95% CI, 0.38–1.47], P =0.39), or major bleeding (OR, 1.24 [95% CI, 0.42–3.66], P =0.70). Conclusions In older patients ≥75 years old with non–ST‐segment–elevation acute coronary syndrome, an invasive strategy reduced the risk of a composite of death and MI, MI, and subsequent revascularization compared with a conservative strategy alone. Older adults with higher burden of geriatric conditions should be included in future trials to improve generalizability to this growing population.
BACKGROUND:Cardiovascular and renal benefits of sodium glucose co-transporter 2 inhibitors (SGLT2i) have been clearly demonstrated. However, studies comparing the effects of dapagliflozin and empagliflozin are scarce. In addition, relatively few studies have analyzed the effects of SGLT2i in diabetic patients without established atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), or heart failure (HF), and current guidelines recommend SGLT2i and other antidiabetic drugs equally in this population. Therefore, we aimed to compare the clinical outcomes between dapagliflozin, empagliflozin, and dipeptidyl peptidase-4 inhibitors (DPP4i) in patients with type 2 diabetes without prior ASCVD, CKD, or HF. METHODS:Using a propensity-score matching method, we retrospectively analyzed 921 patients treated with dapagliflozin, 921 patients treated with empagliflozin, and 1842 patients treated with DPP4i (control group). Study outcomes comprised composite coronary events (acute coronary syndrome and coronary revascularization), composite ischemic events (coronary events and stroke), and composite heart failure and renal events. RESULTS:During follow up (median, 43.4 months), the incidence of composite coronary events was significantly lower in the SGLT2i groups than in the control group, and the incidence of composite ischemic events was lower in the dapagliflozin group than in the control group. Dapagliflozin and empagliflozin both demonstrated significant benefits in terms of HF and renal outcomes, supported by renoprotective effects, as assessed by the change in glomerular filtration rate. At 24-36 months of treatment, the empagliflozin group had higher low-density lipoprotein cholesterol levels, and lower glycated hemoglobin levels, compared to those in the dapagliflozin and control groups. CONCLUSION:SGLT2i use was associated with a significantly reduced risk of ASCVD, HF hospitalization, and renal events, compared to that with DPP4i use among diabetic patients without prior ASCVD, CKD, or HF. There were no significant differences in clinical outcomes between dapagliflozin and empagliflozin, supporting a SGLT2i class effect.
