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91.
Shemille A. Collingwood Russell B. McBride Michael Leapman Adele R. Hobbs Young Suk Kwon Kristian D. Stensland Rebecca M. Schwartz Matthew E. Pollard David B. Samadi 《Urologic oncology》2014,32(4):419-425
ObjectivesLongitudinal studies report racial disparities in prostate cancer (PCa) including greater incidence, more aggressive tumor biology, and increased cancer-specific mortality in African American (AA) men. Regret concerning primary treatment selection is underevaluated in patients with PCa. We investigated the relationships between clinicopathologic variables across racial and socioeconomic lines following robotic-assisted laparoscopic prostatectomy.Materials and methodsWe assessed treatment decisional regret using a validated questionnaire in a total of 484 white and 72 AA patients with PCa who were followed up for a median of 16.6 months post–robotic-assisted laparoscopic prostatectomy. Socioeconomic status (SES) information was aggregated from 2010 US census zip code data. Perioperative clinicopathologic characteristics and functional outcomes were compared between groups. Univariate and multivariate regression analyses were used to evaluate the influence of race, aggregate SES, and other clinical and demographic characteristics on decisional regret.ResultsThe majority (87.7%) of the population was not regretful of their decision to undergo treatment. However, a greater proportion of AA vs. white patients were regretful (20.6% vs. 11.2%, respectively; P = 0.03). AA and white men were similar on all functional, clinical, and pathologic features with the exception of younger age among AA men (56 vs. 60 y, respectively; P<0.001). Although there were significant differences in SES by race (P<0.001), regret did not differ by SES (β =?1.53; P = 0.15). Race, postoperative sexual dysfunction, pad usage, and length of hospital stay, however, were significantly associated with decisional regret.ConclusionsAA men were more regretful than white men, after adjusting for clinicopathologic characteristics and postoperative functional outcomes. 相似文献
92.
Joshua A. Cohn Chihsiung E. Wang Justin C. Lakeman Jonathan C. Silverstein Charles B. Brendler Kristian R. Novakovic Michael S. McGuire Brian T. Helfand 《Urologic oncology》2014,32(1):41.e23-41.e30
ObjectivesIn May 2012, United States Preventive Services Task Force (USPSTF) finalized its recommendation against prostate-specific antigen (PSA) screening in all men. We aimed to assess trends in PSA screening frequency amongst primary care physicians (PCPs) surrounding the May 2012 USPSTF recommendation.Methods and materialsThe electronic data warehouse was used to identify men aged between 40 and 79 years with no history of prostate cancer or urology visit who were evaluated by an internal medicine or family practice physician between 2007 and 2012. Analyses were directed toward PSA testing within 6-month time period from June to November, with particular focus on the 2011 (pre-USPSTF recommendation) and 2012 (post-USPSTF recommendation) cohorts. The primary outcome measure was proportion of men with at least 1 PSA test during the 6-month pre- and post-USPSTF recommendation periods.ResultsA total of 112,221 men met inclusion criteria. There was a significant decrease in screening frequency between the 2011 and 2012 cohorts (8.6% vs. 7.6%, P = 0.0001; adjusted odds ratio 0.89, 95% confidence interval 0.83–0.95). This decrease was most evident amongst patients aged 40 to 49 years (5.6% vs. 4.6%, P = 0.004) and 70 to 79 years (7.9% vs. 6.2%, P = 0.01). A significant decrease was also observed in patients with highest previous PSA value<1.0 (P<0.0001) and 1.0 to 2.49 ng/ml (P = 0.0074).ConclusionsSince the USPSTF recommendation was finalized, there is evidence of continuing decreases in PSA testing by PCPs. PCPs may be shifting toward more selective screening practices, as decreases in screening are most pronounced in the youngest and oldest patients and in those with history of PSA values<2.5 ng/ml. 相似文献
93.
Kim K. B. Clemmensen MD Martin B. Blond PhD Hanan Amadid PhD Lea Bruhn MSc Dorte Vistisen PhD Kristian Karstoft PhD Frederik Persson DMSc Mathias Ried-Larsen PhD Jens J. Holst DMSc Nicolai J. Wewer Albrechtsen PhD Signe S. Torekov PhD Jonas S. Quist PhD Marit E. Jørgensen PhD Kristine Færch PhD 《Diabetes, obesity & metabolism》2021,23(2):530-539
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Tele‐Health Followup Strategy for Tight Control of Disease Activity in Rheumatoid Arthritis: Results of a Randomized Controlled Trial 下载免费PDF全文
Annette de Thurah Kristian Stengaard‐Pedersen Mette Axelsen Ulrich Fredberg Liv M. V. Schougaard Niels H. I. Hjollund Mogens Pfeiffer‐Jensen Trine B. Laurberg Ulrik Tarp Kirsten Lomborg Thomas Maribo 《Arthritis care & research》2018,70(3):353-360
Objective
To test the effect of patient‐reported outcome (PRO)–based tele‐health followup for tight control of disease activity in patients with rheumatoid arthritis (RA), and the differences between tele‐health followup performed by rheumatologists or rheumatology nurses.Methods
A total of 294 patients were randomized (1:1:1) to either PRO‐based tele‐health followup carried out by a nurse (PRO‐TN) or a rheumatologist (PRO‐TR), or conventional outpatient followup by physicians. The primary outcome was a change in the Disease Activity Score in 28 joints (DAS28) after week 52. Secondary outcomes were physical function, quality of life, and self‐efficacy. The noninferiority margin was a DAS28 score change of 0.6. Mean differences were estimated following per protocol, intent‐to‐treat (ITT), and multivariate imputation analysis.Results
Overall, patients had low disease activity at baseline and end followup. Demographics and baseline characteristics were similar between groups. Noninferiority was established for the DAS28. In the ITT analysis, mean differences in the DAS28 score between PRO‐TR versus control were ?0.10 (90% confidence interval [90% CI] ?0.30, 0.13) and ?0.19 (90% CI ?0.41, 0.02) between PRO‐TN versus control. When including 1 yearly visit to the outpatient clinic, patients in PRO‐TN had mean ± SD 1.72 ± 1.03 visits/year, PRO‐TR had 1.75 ± 1.03 visits/year, and controls had 4.15 ± 1.0 visits/year. This included extra visits due to inflammatory flare.Conclusion
Among RA patients with low disease activity or remission, a PRO‐based tele‐health followup for tight control of disease activity in RA can achieve similar disease control as conventional outpatient followup. The degree of disease control did not differ between patients seen by rheumatologists or rheumatology nurses.97.
Myhre AG Undlien DE Løvås K Uhlving S Nedrebø BG Fougner KJ Trovik T Sørheim JI Husebye ES 《The Journal of clinical endocrinology and metabolism》2002,87(2):618-623
Autoimmune destruction of the adrenal cortex is the most common cause of primary adrenocortical insufficiency (Addison's disease) in industrialized countries. We have investigated a large Norwegian cohort of patients with Addison's disease in terms of clinical manifestations, autoantibodies, and human leukocyte antigen (HLA) class II haplotypes. The study comprised 94 patients (54 females) of ages 6-85 yr (mean 45 yr) with, either isolated Addison's disease or part of autoimmune polyendocrine syndrome type II. Among those diagnosed before the age of thirty, 53% were men, while among those diagnosed at 30 or above, 30% were men. Altogether 77 (82%) of the 94 patients had autoantibodies against 21-hydroxylase (21OH). Thirty-eight of the 40 patients with disease duration 5 yr or less had such autoantibodies. This frequency fell to 60% among patients with a disease duration greater than 35 yr. Five women had gonadal failure. This failure correlated with antibodies against side-chain cleavage enzyme (P = 0.03). Antibodies against glutamic acid decarboxylase and IA2 correlated with the presence of type 1 diabetes (P < 0.005 and P = 0.003, respectively). The frequency of the HLA DRB1*03-DQA1*05-DQB1*02 (DR3-DQ2) and DRB1*04-DQA1*03-DQB1*0302 (DR4-DQ8) haplotypes were positively correlated to Addison's disease, whereas the DRB1*01-DQA1*0101-DQB1*0501 (DR1-DQ5) haplotype was negatively correlated. In addition, the DRB1*04 subtype DRB1*0404 was increased among Addison patients relative to controls. We verify that autoimmunity is the main cause of Addison's disease in our cohort. In younger patients, the disease is equally common in men and women. Measurement of autoantibodies against 21OH is a valuable tool in establishing the etiological diagnosis, especially in patients with a short disease duration. Addison's disease is associated with the DR3-DQ2 and DR4 (0404)-DQ8 haplotypes. A particularly high risk for disease development is observed when these occur in a heterozygous combination (DR3-DQ2/DR4-DQ8). 相似文献
98.
Background
Microvascular decompression (MVD) is a documented effective treatment of trigeminal neuralgia (TN). Lately, reports on endoscopy-assisted microvascular decompression (eaMVD) with better outcome and less risk have emerged. This study was undertaken to verify under which circumstances the endoscope proved essential in identifying the neurovascular conflict (NVC) during eaMVD for TN, and to assess the possibility to predict the need for the endoscope on preoperative magnetic resonance imaging (MRI).Methods
Retrospective analysis of 97 patients with TN undergoing eaMVD at the Oslo University Hospital – Rikshospitalet, 1999–2009. To assess the NVC and anatomical variations, surgical reports were evaluated. MRI was available in 66 patients. The MRIs were evaluated by a blinded neuroradiologist.Results
In 27 of the 97 patients (27.8 %), the endoscope was a significant aid in identifying the NVC, due to a bony ridge obscuring the view of the fifth nerve, a very distal vascular compression, or a combination of both. The preoperative MRI over-diagnosed the presence of a bony ridge. However, the MRI-based fraction of microscopically visible trigeminal nerve (FVN) in the cerebellopontine angle cistern proved diagnostic (ROC curve, AUC 0.89, p?=?<0.001) with an optimal cut-off value of 0.35. Hence, if less than 35 % of the trigeminal nerve is visible on preoperative MRI, the endoscope will be needed to identify the NVC.Conclusions
The endoscope is a valuable tool during MVD for TN, especially under anatomical circumstances such as a bony ridge hiding the direct microscopic view of the NVC. These anatomical circumstances can be predicted with good accuracy on preoperative MRI. 相似文献99.
Casper N. Bang Anders M. Greve Lars Køber Anne B. Rossebø Simon Ray Kurt Boman Christoph A. Nienaber Richard B. Devereux Kristian Wachtell 《International journal of cardiology》2014