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991.
Walker Harris V Sutcliffe CG Araujo AB Chiu GR Travison TG Mehta S Sulkowski MS Higgins Y Thomas DL Dobs AS Beck TJ Brown TT 《Osteoporosis international》2012,23(6):1779-1787
Summary
People with both HIV and hepatitis C are more likely than those with HIV alone to have wrist, hip, and spine fractures. We compared hip strength between HIV/HCV-co-infected men and healthy men and found that HIV/HCV-co-infected men had decreased hip strength due to lower lean body mass.Introduction
Hepatitis C co-infection is a risk factor for fragility fracture among HIV-infected populations. Whether bone strength is compromised in HIV/HCV-co-infected patients is unknown.Methods
We compared dual-energy x-ray absorptiometry (DXA)-derived hip geometry, a measure of bone strength, in 88 HIV/HCV-co-infected men from the Johns Hopkins HIV Clinic to 289 men of similar age and race and without HIV or HCV from the Boston Area Community Health Survey/Bone Survey. Hip geometry was assessed at the narrow neck, intertrochanter, and shaft using hip structural analysis. Lean body mass (LBM), total fat mass (FM), and fat mass ratio (FMR) were measured by whole-body DXA. Linear regression was used to identify body composition parameters that accounted for differences in bone strength between cohorts.Results
HIV/HCV-co-infected men had lower BMI, LBM, and FM and higher FMR compared to controls (all p?0.05). At the narrow neck, significant differences were observed between HIV/HCV-co-infected men and controls in bone mineral density, cross-sectional area, section modulus, buckling ratio, and centroid position. After adjustment for race, age, smoking status, height, and weight, only buckling ratio and centroid position remained significantly different between cohorts (all p?0.05). Substituting LBM, FM, and FMR for weight in the multivariate model revealed that differences in LBM, but not FM or FMR, accounted for differences in all narrow neck parameters between cohorts, except buckling ratio and centroid position.Conclusion
HIV/HCV-co-infected men have compromised hip strength at the narrow neck compared to uninfected controls, which is attributable in large part to lower lean body mass. 相似文献992.
Marvin Omar Delgado Guay Silvia Tanzi Maria Teresa San Miguel Arregui Gary Chisholm Maxine de la Cruz Eduardo Bruera 《Supportive care in cancer》2014,22(10):2869-2874
Background
Missed appointments (MA) are frequent, but there are no studies on the effects of the first MA at supportive care outpatient clinics on clinical outcomes.Methods
We determined the frequency of MA among all patients referred to our clinic from January–December 2011 and recorded the clinical and demographic data and outcomes of 218 MA patients and 217 consecutive patients who kept their first appointments (KA).Results
Of 1,352 advanced-cancer patients referred to our clinic, 218 (16 %) had an MA. The MA patients’ median age was 57 years (interquartile range, 49–67). The mean time between referral and appointment was 7.4 days (range, 0–71) for KA patients vs. 9.1 days (range, 0–89) for MA patients (P?=?0.006). Reasons for missing included admission to the hospital (17/218 [8 %]), death (4/218 [2 %]), appointments with primary oncologists (37/218 [18 %]), other appointments (19/218 [9 %]), visits to the emergency room (ER) (9/218 [9 %]), and unknown (111/218 [54 %]). MA patients visited the ER more at 2 weeks (16/214 [7 %] vs. 5/217 [2 %], P?=?0.010) and 4 weeks (17/205 [8 %] vs. 8/217 [4 %], P?=?0.060). Median-survival duration for MA patients was 177 days (range, 127–215) vs. 253 days (range, 192–347) for KA patients (P?=?0.013). Multivariate analysis showed that MAs were associated with longer time between referral and scheduled appointment (odds ratio [OR], 1.026/day, P?=?0.030), referral from targeted therapy services (OR, 2.177, P?=?0.004), living in Texas/Louisiana regions (OR, 2.345, P?=?0.002), having an advanced directive (OR, 0.154, P?0.0001), and being referred for symptom control (OR, 0.024, P?=?0.0003).Conclusion
MA patients with advanced cancer have worse survival and increased ER utilization than KA patients. Patients at higher risk for MA should undergo more aggressive follow-up. More research is needed. 相似文献993.
994.
Lughezzani G Zorn KC Budäus L Sun M Lee DI Shalhav AL Zagaya GP Shikanov SA Gofrit ON Thong AE Albala DM Sun L Cronin A Vickers AJ Karakiewicz PI 《European urology》2012,62(4):590-596
Background
Statistical prediction tools are increasingly common, but there is considerable disagreement about how they should be evaluated. Three tools—Partin tables, the European Society for Urological Oncology (ESUO) criteria, and the Gallina nomogram—have been proposed for the prediction of seminal vesicle invasion (SVI) in patients with clinically localized prostate cancer who are candidates for a radical prostatectomy.Objectives
Using different statistical methods, we aimed to determine which of these tools should be used to predict SVI.Design, settings, and participants
The independent validation cohort consisted of 2584 patients treated surgically for clinically localized prostate cancer at four North American tertiary care centers between 2002 and 2007.Interventions
Robot-assisted laparoscopic radical prostatectomy.Outcome measurements and statistical analysis
Primary outcome was the presence of SVI. Traditional (area under the receiver operating characteristic [ROC] curve, calibration plots, the Brier score, sensitivity and specificity, positive and negative predictive value) and novel (decision curve analysis and predictiveness curves) statistical methods quantified the predictive abilities of the three models.Results and limitations
Traditional statistical methods (ie, ROC plots and Brier scores) could not clearly determine which one of the three SVI prediction tools should be preferred. For example, ROC plots and Brier scores seemed biased against the binary decision tool (ESUO criteria) and gave discordant results for the continuous predictions of the Partin tables and the Gallina nomogram. The results of the calibration plots were discordant with those of the ROC plots. Conversely, the decision curve indicated that the Partin tables represent the best strategy for stratifying the risk of SVI, resulting in the highest net benefit within the whole range of threshold probabilities.Conclusions
When predicting SVI, surgeons should prefer the Partin tables over the ESUO criteria and the Gallina nomogram because this tool provided the highest net benefit. In contrast to traditional statistical methods, decision curve analysis gave an unambiguous result applicable to both continuous and binary models, providing an insight into clinical utility. 相似文献995.
996.
997.
Abdo A Trinh QD Sun M Schmitges J Bianchi M Sammon J Shariat SF Sukumar S Zorn K Jeldres C Perrotte P Rogers CG Peabody JO Menon M Karakiewicz PI 《International urology and nephrology》2012,44(2):343-351
Background
Privately insured patients may have favorable health outcomes when compared to those covered by federally funded initiatives. This study explored the effect of insurance status on five short-term outcomes after partial nephrectomy (PN).Methods
Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS), we focused on PNs performed between 1998 and 2007. We tested the rates of in-hospital mortality, blood transfusions, prolonged length of stay, as well as intraoperative and postoperative complications, stratified according to insurance status. Multivariable logistic regression analyses fitted with general estimation equations for clustering among hospitals further adjusted for confounding factors.Results
Overall, 8,513 PNs were identified. Of those, most patients were privately insured (53.5%), followed by Medicare (37.5%), uninsured (4.6%) and Medicaid (4.4%). Medicare and Medicaid patients had higher rates of transfusions (P?0.001) and overall postoperative complications (P?0.001). In multivariable analyses, when compared to privately insured patients, Medicaid patients had higher rates of transfusions (OR?=?1.91, P?0.001) and prolonged length of stay (OR?=?1.49, P?0.001). Medicare patients had higher rates of overall postoperative complications (OR?=?1.24, P?=?0.015) and length of stay beyond the median (OR?=?1.4, P?0.001).Conclusion
Patients with private insurance undergoing PN have better short-term outcomes, when compared to their publicly insured counterparts. 相似文献998.
Schmitges J Trinh QD Bianchi M Sun M Abdollah F Ahyai SA Jeldres C Steuber T Perrotte P Shariat SF Menon M Montorsi F Graefen M Karakiewicz PI 《International urology and nephrology》2012,44(3):799-806
Purpose
To examine the effect of annual surgical caseload (ASC) on contemporary in-hospital pneumonia (IHP) rates and three other in-hospital outcomes after radical prostatectomy (RP).Methods
Between 1999 and 2008, 34,490 open RPs were performed in the state of Florida. First, logistic regression models predicting the rate of IHP were fitted. Second, other logistic regression models examined the association between IHP and three other outcomes: in-hospital mortality, hospital charges within the highest quartile, and length of stay (LOS) within the highest quartile. Covariates included ASC, age, race, baseline Charlson Comorbidity Index (CCI), interval between admission and surgery, as well as blood transfusion.Results
The overall IHP rate was 0.5%. It was higher in patients operated within the low (0.7%) and intermediate (0.5%) ASC tertile versus high ASC tertile (0.2%, P?0.001). Mortality rate was 4.3% in IHP patients versus 0.1% in others (P?0.001). Median total hospital charges and median LOS were $55,350 versus $28,171 and 7 versus 3?days in IHP patients versus others, respectively (both P?0.001). In multivariable analyses predicting IHP, the likelihood was 3.2-fold in patients operated by low ASC surgeons versus high ASC surgeons (P?0.001). Second, in multivariable analyses, IHP patients were predisposed to 41-fold higher in-hospital mortality, were tenfold more likely to have total hospital charges >$37,333, and were 20-fold more likely to have a LOS >3?days (all P?0.001).Conclusions
RP by high ASC surgeons exerts a protective effect on IHP rates. Additionally, IHP is associated with higher in-hospital mortality, prolonged LOS, and higher hospital charges. 相似文献999.
Hanna N Sun M Trinh QD Hansen J Bianchi M Montorsi F Shariat SF Graefen M Perrotte P Karakiewicz PI 《European urology》2012,61(4):715-721
Background
Nephroureterectomy (NU) represents the primary management for patients with nonmetastatic upper tract urothelial carcinoma (UTUC). Either an open NU (ONU) or a laparoscopic NU (LNU) may be considered. Despite the presence of several reports comparing perioperative and cancer-control outcomes between the two approaches, no reports relied on a population-based cohort.Objectives
Examine intraoperative and postoperative morbidity of ONU and LNU in a population-based cohort.Design, setting, and participants
We relied on the US Nationwide Inpatient Sample (NIS) to identify patients with nonmetastatic UTUC treated with ONU or LNU between 1998 and 2009. Overall, 7401 (90.8%) and 754 (9.2%) patients underwent ONU and LNU, respectively. To adjust for potential baseline differences between the two groups, propensity-score-based matching was performed. This resulted in 3016 (80%) ONU patients matched to 754 (20%) LNU patients.Intervention
All patients underwent NU.Measurements
The rates of intra- and postoperative complications, blood transfusions, prolonged length of stay (pLOS), and in-hospital mortality were assessed for both procedures. Multivariable logistic regression analyses were performed within the cohort after propensity-score matching.Results and limitations
For ONU versus LNU respectively, the following rates were recorded: blood transfusions, 15% versus 10% (p < 0.001); intraoperative complications, 4.7% versus 2.1% (p = 0.002); postoperative complications, 17% versus 15% (p = 0.24); pLOS (≥5 d), 47% versus 28% (p < 0.001); in-hospital mortality, 1.3% versus 0.7% (p = 0.12). In multivariable logistic regression analyses, LNU patients were less likely to receive a blood transfusion (odds ratio [OR]: 0.6; p < 0.001), to experience any intraoperative complications (OR: 0.4; p = 0.002), and to have a pLOS (OR: 0.4; p < 0.001). Overall, postoperative complications were equivalent. However, LNU patients had fewer respiratory complications (OR: 0.4; p = 0.007). This study is limited by its retrospective nature.Conclusions
After adjustment for potential selection biases, LNU is associated with fewer adverse intra- and perioperative outcomes than ONU. 相似文献1000.
Briganti A Larcher A Abdollah F Capitanio U Gallina A Suardi N Bianchi M Sun M Freschi M Salonia A Karakiewicz PI Rigatti P Montorsi F 《European urology》2012,61(3):480-487