共查询到20条相似文献，搜索用时 31 毫秒
1.
Matthew R. Walker Ashraf N. El Naga Omar H. Atassi Christopher H. Perkins Scott A. Mitchell 《Injury》2019,50(3):686-689
Objectives
Hip dislocations are highly morbid injuries necessitating prompt reduction and post-reduction assessment for fracture and incarcerated fragments. Recent literature has questioned the need for initial pelvic radiographs for acute trauma patients, resulting in computed tomography (CT) scans as the initial evaluation. This study investigates the relationship between choice of pre-reduction imaging and treatment of acute hip dislocations.Design
Retrospective Case-Control.Setting
Single Academic Level I Trauma Center.Methods
All acute hip dislocations from 2011 to 2016 were reviewed. Exclusion criteria were diagnosis of dislocation at another facility, death prior to reduction, emergent surgical or ICU intervention, and periprosthetic dislocation. Patients were grouped by those with only a radiograph prior to reduction, Group I, versus those with a pre-reduction CT scan, Group II. The primary outcomes were time to reduction and the acquisition of a second CT scan.Results
Of the 123 hip dislocations identified, 35 patients were excluded, mostly for transfer with a known dislocation. Group I included 29 patients and Group II included 59 patients. The mean time to reduction was 74?min in Group I and 129?min in Group II for a difference of 55?min (p?<?0.001). The rate of repeat CT scan was 0 in Group I versus 48 (81%) in Group II (p?<?0.001).Conclusion
Initial trauma pelvic radiography prior to CT is still important in the setting of suspected hip pathology to decrease time to hip reduction and unnecessary radiation exposure.Level of evidence
Prognostic Level III. 相似文献2.
K. Young A. Aquilina T.J.S. Chesser M.L. Costa S. Hettiaratchy M.B. Kelly C.G. Moran I. Pallister M. Woodford 《Injury》2019,50(2):497-502
Aims
To assess current national practice in the management of severe open tibial fractures against national standards, using data collected by the Trauma and Audit Research Network.Materials and methods
Demographic, injury-specific, and outcome data were obtained for all grade IIIB/C fractures admitted to Major Trauma Centres in England from October 2014 to January 2016.Results
Data was available for 646 patients with recorded grade IIIB/C fractures. The male to female ratio was 2.3:1, mean age 47 years. 77% received antibiotics within 3?h of admission, 82% were debrided within 24?h. Soft tissue coverage was achieved within 72?h of admission in 71%. The amputation rate was 8.7%. 4.3% of patients required further theatre visits for infection during the index admission. The timing of antibiotics and surgery could not be correlated with returns to theatre for early infection. There were significant differences in the management and outcomes of patients aged 65 and over, with an increase in mortality and amputation rates.Conclusions
Good outcomes are reported from the management of IIIB/C fractures in Major Trauma Centres in England. Overall compliance with national standards is particularly poor in the elderly. Compliance did not appear to affect rates of returning to theatre or early infection. Appropriately applied patient reported outcome measures are needed to enhance the evidence-base for management of these injuries. 相似文献3.
Federico Coccolini Marco Ceresoli Yoram Kluger Andrew Kirkpatrick Giulia Montori Fracensco Salvetti Paola Fugazzola Matteo Tomasoni Massimo Sartelli Luca Ansaloni Fausto Catena Ionut Negoi Monica Zese Savino Occhionorelli Sergei Shlyapnikov Christian Galatioto Massimo Chiarugi Zaza Demetrashvili Rao Ivatury 《Injury》2019,50(1):160-166
Introduction
No definitive data describing associations between cases of Open Abdomen (OA) and Entero-atmospheric fistulae (EAF) exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) thus analyzed the International Register of Open Abdomen (IROA) to assess this question.Material and methods
A prospective analysis of adult patients enrolled in the IROA.Results
Among 649 adult patients with OA 58 (8.9%) developed EAF. Indications for OA were peritonitis (51.2%) and traumatic-injury (16.8%). The most frequently utilized temporary abdominal closure techniques were Commercial-NPWT (46.8%) and Bogotà-bag (21.9%). Mean OA days were 7.9?±?18.22. Overall mortality rate was 29.7%, with EAF having no impact on mortality. Multivariate analysis associated cancer (p?=?0.018), days of OA (p?=?0.003) and time to provision-of-nutrition (p?=?0.016) with EAF occurrence.Conclusion
Entero-atmospheric fistulas are influenced by the duration of open abdomen treatment and by the nutritional status of the patient. Peritonitis, intestinal anastomosis, negative pressure and oral or enteral nutrition were not risk factors for EAF during OA treatment. 相似文献4.
Quirine M.J. van der Vliet Oscar E.C. van Maarseveen Diederik P.J. Smeeing Roderick M. Houwert Karlijn J.P. van Wessem Rogier K.J. Simmermacher Geertje A.M. Govaert Mirjam B. de Jong Ivar G.J. de Bruin Luke P.H. Leenen Falco Hietbrink 《Injury》2019,50(1):20-26
Introduction
There is continuous drive to optimize healthcare for the most severely injured patients. Although still under debate, a possible measure is to provide 24/7 in-house (IH) coverage by trauma surgeons. The aim of this study was to compare process-related outcomes for severely injured patients before and after transition of attendance policy from an out-of-hospital (OH) on-call attending trauma surgeon to an in-house attending trauma surgeon.Methods
Retrospective before-and-after study using prospectively gathered data in a Level 1 Trauma Center in the Netherlands. All trauma patients with an Injury Severity Score (ISS) >24 presenting to the emergency department for trauma before (2011–2012) and after (2014–2016) introduction of IH attendings were included. Primary outcome measures were the process-related outcomes Emergency Department length of stay (ED-LOS) and time to first intervention.Results
After implementation of IH trauma surgeons, ED-LOS decreased (p?=? 0.009). Time from the ED to the intensive care unit (ICU) for patients directly transferred to the ICU was significantly shorter with more than doubling of the percentage of patients that reached the ICU within an hour. The percentage of patients undergoing emergency surgery within 30?min nearly doubled as well, with a larger amount of patients undergoing CT imaging before emergency surgery.Conclusions
Introduction of a 24/7 in-house attending trauma surgeon led to improved process-related outcomes for the most severely injured patients. There is clear benefit of continuous presence of physicians with sufficient experience in trauma care in hospitals treating large numbers of severely injured patients. 相似文献5.
6.
Objective
Symptomatic distal interlocking screws in retrograde femoral nailing are common due the difficulties of imaging the trapezoidal femur. Screws appearing to have appropriate length on imaging may possibly be prominent, creating symptoms. Screw trajectory may influence the degree of this radiographic error. We hypothesize that external rotation of screw trajectory will increase measurement error of screw length.Design
Retrospective.Setting
Urban Level I Tertiary Trauma Center.Participants
283 patients with Computer Tomography (CT) scans of the native knee were retrospectively identified. Simulation was done of the trajectory of an interlock at 20?mm and 40?mm proximal to the nail entry point, which represent common screw positions associated/not associated respectively, with removal. The distance between the radiographic medial cortex and the tip of the transverse screw was calculated (D). The angle (Ψ) between the transverse trajectory and a modified trajectory aimed at the most medial cortex to avoid radiographic measurement error was calculated. Geometric modeling was utilized to calculate the measurement error (D) in the event of accidental external rotation. The angle of the medial slope was also measured (Θ).Intervention
Review of CT imaging of normal distal femora.Main Outcome Measurements
CT measurements of distal femora.Results
The mean distance (D) at 20/40?mm was 4.21 [95%CI 4.02–4.402] and 2.03?mm [95%CI 1.78–2.83], respectively (p?<?0.0001). The mean angle (Ψ) between the transverse and modified trajectory at 20/40?mm was 12° [95%CI 11.5–12.5] and 9.60° [95%CI 9–10.2], respectively (p?<?0.0001). External rotation by a similar amount nearly triples the measured difference (D). The measured medial slope was significantly increased as screws were placed more proximal (Θ20 mm 46.5 vs Θ40 mm: 48.7?°, p?<?0.00001).Conclusion
The distance between the perceived medial cortex and the tip of the most transverse screw is 4.21?mm and could account for painfully prominent screws. In more proximal screws this distance is decreased. Internal rotation of the screw trajectory 12° can reduce this distance (D), which has implications in nail design. External rotation, amplifies this difference nearly three-fold. Surgeons should avoid external rotation of the aiming arm to prevent prominent screws. 相似文献7.
Ahmed Latif Baljinder S. Dhinsa Benjamin Lau Ali Abbasian 《Foot and Ankle Surgery》2019,25(2):132-136
Background
This study reports the outcome of a plating system for arthrodesis of the first metatarsophalangeal joint (1st MTPJ) that incorporates a lag compression screw within a low profile titanium plate with a predetermined contour. This is the first report of the outcomes of this implant from a non-affiliated centre.Patient and methods
This is a prospective cohort study of 40 consecutive primary 1st MTPJ arthrodesis procedures. The mean age of the cohort was 56 years (range, 20–74 years). The diagnosis was hallux rigidus in 31 patients and inflammatory arthropathy in 7 patients.Results
All patients achieved clinical union at 6 weeks and radiological union was confirmed on plain radiographs between 6–16 weeks. One case of hardware removal was reported.Conclusion
The cohort achieved consistently satisfactory results with a reliable and reproducible MTPJ position and a 100% union rate. There was a low rate of hardware removal.Level of evidence
Level IV evidence. Prospective cohort study. 相似文献8.
Giorgio Gandaglia Guillaume Ploussard Massimo Valerio Agostino Mattei Cristian Fiori Nicola Fossati Armando Stabile Jean-Baptiste Beauval Bernard Malavaud Mathieu Roumiguié Daniele Robesti Paolo Dell’Oglio Marco Moschini Stefania Zamboni Arnas Rakauskas Francesco De Cobelli Francesco Porpiglia Francesco Montorsi Alberto Briganti 《European urology》2019,75(3):506-514
Background
Available models for predicting lymph node invasion (LNI) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP) might not be applicable to men diagnosed via magnetic resonance imaging (MRI)-targeted biopsies.Objective
To assess the accuracy of available tools to predict LNI and to develop a novel model for men diagnosed via MRI-targeted biopsies.Design, setting, and participants
A total of 497 patients diagnosed via MRI-targeted biopsies and treated with RP and extended pelvic lymph node dissection (ePLND) at five institutions were retrospectively identified.Outcome measurements and statistical analyses
Three available models predicting LNI were evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analyses. A nomogram predicting LNI was developed and internally validated.Results and limitations
Overall, 62 patients (12.5%) had LNI. The median number of nodes removed was 15. The AUC for the Briganti 2012, Briganti 2017, and MSKCC nomograms was 82%, 82%, and 81%, respectively, and their calibration characteristics were suboptimal. A model including PSA, clinical stage and maximum diameter of the index lesion on multiparametric MRI (mpMRI), grade group on targeted biopsy, and the presence of clinically significant PCa on concomitant systematic biopsy had an AUC of 86% and represented the basis for a coefficient-based nomogram. This tool exhibited a higher AUC and higher net benefit compared to available models developed using standard biopsies. Using a cutoff of 7%, 244 ePLNDs (57%) would be spared and a lower number of LNIs would be missed compared to available nomograms (1.6% vs 4.6% vs 4.5% vs 4.2% for the new nomogram vs Briganti 2012 vs Briganti 2017 vs MSKCC).Conclusions
Available models predicting LNI are characterized by suboptimal accuracy and clinical net benefit for patients diagnosed via MRI-targeted biopsies. A novel nomogram including mpMRI and MRI-targeted biopsy data should be used to identify candidates for ePLND in this setting.Patient summary
We developed the first nomogram to predict lymph node invasion (LNI) in prostate cancer patients diagnosed via magnetic resonance imaging-targeted biopsy undergoing radical prostatectomy. Adoption of this model to identify candidates for extended pelvic lymph node dissection could avoid up to 60% of these procedures at the cost of missing only 1.6% patients with LNI. 相似文献9.
10.
Background
The response to first-line, platinum-based treatment of muscle-invasive bladder cancer has not improved in 3 decades.Objective
To identify genes that influence cisplatin resistance in bladder cancer.Design, setting, and participants
We performed a whole-genome CRISPR screen in a bladder cancer cell line to identify genes that mediate resistance to cisplatin.Outcome measurements and statistical analysis
Targeted validation was performed in two bladder cancer cell lines. The top gene candidate was validated in a publicly available bladder cancer dataset.Results and limitations
From the CRISPR screen, we identified MSH2 as the most significantly enriched gene and mismatch repair as the most significantly enriched pathway that promoted resistance to cisplatin. Bladder cancer cells with knockdown of MSH2 showed a reduction in cisplatin-mediated apoptosis. MSH2 loss did not impact the sensitivity to other chemotherapies, including the cisplatin analog oxaliplatin. Bladder tumors with low MSH2 protein levels, quantified using reverse-phase protein array, showed poorer survival when treated with cisplatin- or carboplatin-based therapy; these results require future validation using immunohistochemistry. Additionally, results are retrospective from patients with primarily high-grade tumors; thus, validation in a controlled clinical trial is needed.Conclusions
We generated in vitro evidence that bladder cancer cell lines depleted of MSH2 are more resistant to cisplatin. We additionally found an association between low MSH2 in bladder tumors and poorer patient survival when treated with platinum-based chemotherapy. If successfully validated prospectively, MSH2 protein level could assist in the selection of patients for chemotherapy.Patient summary
We report the first evidence that MSH2 protein level may contribute to chemotherapy resistance observed in muscle-invasive bladder cancer. MSH2 has potential as a biomarker predictive of response to platinum-based therapy. 相似文献11.
Ben A. Hickey Andrew Cleves Raza Alikhan Neil Pugh Len Nokes Anthony Perera 《Foot and Ankle Surgery》2019,25(1):59-62
Background
Our aim was to determine whether plasma levels of Tissue Factor (TF), Vascular Cell Adhesion Molecule 1 (VCAM-1), Interleukin 6 (IL-6) or D-dimer after foot and ankle injury could predict which patients would develop deep vein thrombosis (DVT).Methods
Patients aged 18–60 years with acute foot and ankle injury had venous blood sample to measure TF, VCAM-1, IL-6 and D-dimer within 3 days of injury. Patients had bilateral lower limb venous ultrasound to assess for DVT on discharge from clinic.Results
21 of 77 patients were found to have DVT (27%). There was no statistically significant association between levels of TF, VCAM-1, IL-6 or D-dimer and subsequent development of DVT.Conclusion
Tissue Factor (TF), Vascular Cell Adhesion Molecule-1 (VCAM-1), Interleukin-6 (IL-6) and D-dimer levels were not associated with development deep vein thrombosis in patients with acute foot and ankle injury. 相似文献12.
Background
Traumatic injury is a leading cause of deaths worldwide, and designated trauma centers are crucial to preventing these. In the US, trauma centers can be designated as level I-IV by states and/or the American College of Surgeons (ACS), reflecting the resources available for care. We examined whether state- and ACS-verified facilities of the same level (I-IV) had differences in mortality, complications, and disposition, and whether differences varied by center level.Materials and methods
Using all admissions reported to the National Trauma Data Bank 2010–2015, we estimated risk ratios for the association between current ACS verification (vs. state designation) and patient mortality and complications, adjusting for trauma level and facility, injury, and demographic characteristics. We tested the interaction between trauma level and ACS verification, stratifying by trauma level in the presence of significant statistical interaction.Results
Overall, patients admitted to ACS-verified vs state-designated facilities had similar adjusted mortality risk [RR 1.00; 95% CI 0.91–1.03] and lower risk of discharge to intermediate care facilities [RR 0.58; 95% CI 0.44 to 0.78]. However, Level III and IV facilities had lower adjusted mortality risk when ACS-verified, with much lower mortality risk in ACS-verified Level IV facilities [RR 0.25; 95% CI 0.12 to 0.54].Discussion
Findings suggest that while outcomes are similar between ACS-verified and state-designated Level I and II centers, state-designated Level III and particularly Level IV centers show poorer outcomes relative to their ACS-verified counterparts. Further research could explore mechanisms for these differences, or inform potential changes to state designation processes for lower-level centers. 相似文献13.
Introduction
As the population ages, growing numbers of individuals are turning to assisted mobility devices (AMDs) to maintain independence. These devices often place users in a seated position. Like ambulatory pedestrians, pedestrians seated in an AMD are at risk for involvement in an automobile versus pedestrian crash. The purpose of this study is to compare the injury pattern and comorbidities of standing pedestrians struck by an automobile versus those of seated pedestrians.Methods
The Arizona State Trauma Registry was queried for pedestrians struck by an automobile between 2010 and 2015. Using ICD 9 and 10 codes as well as other available documentation, seated pedestrians were identified and matched based on age and gender to standing pedestrians. Presence of co-morbidities, injury pattern, Injury Severity Score (ISS), hospital length of stay (LOS), and mortality were compared between the two groups.Results
There were 70 seated pedestrians identified, matched to 140 standing pedestrians. Co-morbidities were present in 89% of seated pedestrians vs 66% of standing pedestrians (p?=?0.002). Functional dependence was more prevalent in the seated pedestrians (21% vs 1%, p?=?0.004). There were not significant differences in the proportion of AIS injuries by body region. However, within the thoracic region, seated pedestrians were more likely to suffer pulmonary contusions: 14% vs 4%, p?=?0.05.Conclusions
The injury pattern for seated pedestrians differs slightly from that of standing pedestrians struck by an automobile. However, seated pedestrians are more likely to have co-morbid conditions that may complicate care. These findings are important when caring for the injured pedestrian and performing injury prevention outreach. 相似文献14.
A. Guerrero Gómez N. González Jaramillo J.A. Castro Pérez 《Revista espa?ola de anestesiología y reanimación》2019,66(1):10-17
Introduction
The fast track / ultra-fast-track protocols are techniques used to optimise the patient care process and a quick recovery after cardiac surgery. They are one of the mainstays of efficient practice. With their use, the length of hospital and intensive care unit (ICU) stays are reduced, with a direct impact on costs and the quality of the health service.Objective
To compare the length of stay in the ICU, length of hospital stay, and post-operative mortality in ultra-fast-track extubated (uFTE) patients and those with conventional extubation (CE) after cardiac surgery.Methods
Longitudinal, analytical, retrospective study was conducted, with the period between the time of surgery and discharge being included as the study period.Results
A total of 396 patients older than 18 years who required cardiac surgery were included, of whom 207 patients had (uFTE) and 189 had CE. Although the groups were not comparable due to the statistical differences found, when performing the multivariate adjustment, uFTE maintained its statistical independence and was associated with lower cardiovascular morbidity, such as myocardial ischaemia (95% CI: 0.37-0.86; P = .01) and lower post-surgical vasopressor requirement (95% CI: 0.18-0.49; P < .01). No significant differences were found in the length of hospital stay, ICU stay, or post-operative mortality in the ICU.Conclusion
Implementing the uFTE strategy, decreases cardiovascular morbidity and vasopressor requirement. The change to uFTE should be accompanied by changes in models and practices in patient recovery to standardised protocols. This study shows that uFTE did not reduce the length of ICU stay, hospital stay, or mortality. 相似文献15.
Byung-Ki Cho Ji-Kang Park Seung-Myung Choi Nelson F. SooHoo 《Foot and Ankle Surgery》2019,25(2):127-131
Background
This study was performed to evaluate the intermediate-term clinical outcomes after proximal chevron osteotomy for hallux valgus in patients with generalized ligamentous laxity, and to determine the effect on postoperative recurrence of deformity.Methods
There were 23 cases in laxity group (Beighton score ≥5 points) and 175 in non-laxity group with a mean followup of 46.3 months. Clinical evaluation consisted of the AOFAS score, Foot and Ankle Ability Measure (FAAM), and radiographic measurement of hallux alignment. Risk factors associated with postoperative recurrence were evaluated using univariate analysis.Results
Recurrence rates were 21.7% in the laxity group and 17.1% in non-laxity group (P = .218). There were no significant differences in clinical and radiographic measurements at final followup between the 2 groups. Preoperative HVA and IMA were found to be predictive factors of recurrence (OR = 6.3, 4.2; P = .001, .018, respectively).Conclusion
There were no statistical differences in the clinical and radiographic outcomes between hallux valgus with and without generalized ligamentous laxity. Generalized ligamentous laxity demonstrated no definitive effects on postoperative recurrence of hallux valgus deformity. 相似文献16.
Julien Dagenais Riccardo Bertolo Juan Garisto Matthew J. Maurice Pascal Mouracade Onder Kara Jaya Chavali Jianbo Li Ryan Nelson Amr Fergany Robert Abouassaly Jihad H. Kaouk 《European urology》2019,75(4):628-634
Background
Understanding physician-level discrepancies is increasingly a target of US healthcare reform for the delivery of quality-focused patient care.Objective
To estimate the relative contributions of patient and surgeon characteristics to the variability in key outcomes after partial nephrectomy (PN).Design, setting, and participants
Retrospective review of 1461 patients undergoing PN performed by 19 surgeons between 2011 and 2016 at a tertiary care referral center.Intervention
PN for a renal mass.Outcomes measurements and statistical analysis
Hierarchical linear and logistic regression models were built to determine the percentage variability contributed by fixed patient and surgeon factors on peri- and postoperative outcomes. Residual between- and within-surgeon variability was calculated while adjusting for fixed factors.Results and limitations
On null hierarchical models, there was significant between-surgeon variability in operative time, estimated blood loss (EBL), ischemia time, excisional volume loss, length of stay, positive margins, Clavien complications, and 30-d readmission rate (all p < 0.001), but not chronic kidney disease upstaging (p = 0.47) or percentage preservation of glomerular filtration rate (p = 0.49). Patient factors explained 82% of the variability in excisional volume loss and 0–32% of the variability in the remainder of outcomes. Quantifiable surgeon factors explained modest amounts (10–40%) of variability in intraoperative outcomes, and noteworthy amounts of variability (90–100%) in margin rates and patient morbidity outcomes. Immeasurable surgeon factors explained the residual variability in operative time (27%), EBL (6%), and ischemia time (31%).Conclusions
There is significant between-surgeon variability in outcomes after PN, even after adjusting for patient characteristics. While renal functional outcomes are consistent across surgeons, measured and unmeasured surgeon factors account for 18–100% of variability of the remaining peri- and postoperative variables. With the increasing utilization of value-based medicine, this has important implications for the goal of optimizing patient care.Patient summary
We reviewed our institutional database on partial nephrectomy performed for renal cancer. We found significant variability between surgeons for key outcomes after the intervention, even after adjusting for patient characteristics. 相似文献17.
Marthe Løvf Sen Zhao Ulrika Axcrona Bjarne Johannessen Anne Cathrine Bakken Kristina Totland Carm Andreas M. Hoff Ola Myklebost Leonardo A. Meza-Zepeda A. Kathrine Lie Karol Axcrona Ragnhild A. Lothe Rolf I. Skotheim 《European urology》2019,75(3):498-505
Background
Most primary prostate cancers are multifocal with individual tumors harboring different aggressiveness; however, the genomic heterogeneity among these tumors is poorly understood.Objective
To better understand the biological basis for clinical variability among different lesions, we sought to comprehensively characterize the heterogeneity of somatic gene mutations in multifocal prostate cancer.Design, setting, and participants
High-coverage whole-exome sequencing of 153 frozen tissue samples, taken from two to three distinct tumor foci and one non-cancerous area from each of 41 patients, covering a total of 89 tumor foci.Outcome measurements and statistical analysis
State-of-the-art bioinformatics tools for mutation calling and copy number determination from whole-exome sequencing data.Results and limitations
We found a very high degree of interfocal heterogeneity among tumors, that is, 76% of pairwise-compared tumor foci from the same prostatectomy specimen had no point mutations in common and DNA copy number changes were rarely shared across cancer foci. The few point mutations shared across tumor foci were seldom in cancer-critical genes.Conclusions
In this first large genomic heterogeneity study of primary prostate cancer, we observe that different tumor foci within the same patient are genetically distinct, only rarely sharing any somatic gene mutations, including those in cancer driver genes. This heterogeneity affects how genomics-based management of prostate cancer can be implemented, as information from all tumor foci is necessary to draw valid conclusions about the cancer's genomic alterations.Patient summary
Most primary prostate cancers consist of multiple tumors within the same organ, but little is known about their relationships. We have compared the sets of gene mutations among such tumors and found that they only exceptionally have any in common. This will influence treatment decisions in the future as each tumor's mutations will render it unique and have to be considered to gain the best treatment results. 相似文献18.
Rita Faria Marta O. Soares Eldon Spackman Hashim U. Ahmed Louise C. Brown Richard Kaplan Mark Emberton Mark J. Sculpher 《European urology》2018,73(1):23-30
Background
The current recommendation of using transrectal ultrasound-guided biopsy (TRUSB) to diagnose prostate cancer misses clinically significant (CS) cancers. More sensitive biopsies (eg, template prostate mapping biopsy [TPMB]) are too resource intensive for routine use, and there is little evidence on multiparametric magnetic resonance imaging (MPMRI).Objective
To identify the most effective and cost-effective way of using these tests to detect CS prostate cancer.Design, setting, and participants
Cost-effectiveness modelling of health outcomes and costs of men referred to secondary care with a suspicion of prostate cancer prior to any biopsy in the UK National Health Service using information from the diagnostic Prostate MR Imaging Study (PROMIS).Intervention
Combinations of MPMRI, TRUSB, and TPMB, using different definitions and diagnostic cut-offs for CS cancer.Outcome measurements and statistical analysis
Strategies that detect the most CS cancers given testing costs, and incremental cost-effectiveness ratios (ICERs) in quality-adjusted life years (QALYs) given long-term costs.Results and limitations
The use of MPMRI first and then up to two MRI-targeted TRUSBs detects more CS cancers per pound spent than a strategy using TRUSB first (sensitivity = 0.95 [95% confidence interval {CI} 0.92–0.98] vs 0.91 [95% CI 0.86–0.94]) and is cost effective (ICER = £7,076 [€8350/QALY gained]). The limitations stem from the evidence base in the accuracy of MRI-targeted biopsy and the long-term outcomes of men with CS prostate cancer.Conclusions
An MPMRI-first strategy is effective and cost effective for the diagnosis of CS prostate cancer. These findings are sensitive to the test costs, sensitivity of MRI-targeted TRUSB, and long-term outcomes of men with cancer, which warrant more empirical research. This analysis can inform the development of clinical guidelines.Patient summary
We found that, under certain assumptions, the use of multiparametric magnetic resonance imaging first and then up to two transrectal ultrasound-guided biopsy is better than the current clinical standard and is good value for money. 相似文献19.
Background
The purpose of this study was to compare the outcomes of trauma patients who were injured in a motor vehicle crash and tested positive for alcohol upon hospital arrival versus those who tested negative.Methods
Study data came from the US National Trauma Data Bank (2007–2010). Any blood alcohol concentration (BAC) found at or above the legal limit (≥0.08?g/dL) was considered “alcohol positive”, and if no alcohol was identified through testing, the patient was considered “alcohol negative”. Patients’ demographics including age >?=?14, race, gender, drug test results, systolic blood pressure, heart rate, injury severity score (ISS), and Glasgow Coma Scale (GCS) were included in the study. Propensity score and exact pair matching were performed between the groups using baseline characteristics.Results
From a total of 88,794 patients, 30.9% tested positive and 69.1% tested negative for alcohol. There were significant differences found between the groups regarding age, gender, race, and GCS (all p?<?0.001) as well as a significantly higher in-hospital mortality rate (3.5% vs. 2.7%, p?<?0.001) and median time to patient expiration (4 vs. 3 days, p?<?0.001) in the alcohol negative group. After running both matching scenarios, there was no evidence of a significant difference seen in the rates of in-hospital mortality or the median time to patient expiration between the alcohol groups in either matched comparison.Conclusion
Patients who tested positive for alcohol following a traumatic motor vehicle crash showed no significant increase in in-hospital mortality or time to expiration when compared to propensity score and exact matched patients who tested negative for alcohol. 相似文献20.
Giuseppe Simone Leonardo Misuraca Umberto Anceschi Francesco Minisola Mariaconsiglia Ferriero Salvatore Guaglianone Gabriele Tuderti Michele Gallucci 《European urology》2019,75(3):492-497