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Retrospective Cohort (retrospective + cohort)
Terms modified by Retrospective Cohort Selected AbstractsHyperglycemia as a Predictor of In-Hospital Mortality in Elderly Patients without Diabetes Mellitus Admitted to a Sub-Intensive Care UnitJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2008Intissar Sleiman MD OBJECTIVES: To investigate the association between hyperglycemia and in-hospital and 45-day mortality in acutely ill elderly patients. DESIGN: Retrospective cohort. SETTING: Hospital medical patients admitted to a sub-intensive care unit (sub-ICU) for elderly patients, which is a level of care between ordinary wards and intensive care. PARTICIPANTS: One thousand two hundred twenty-nine patients (mean age 79.6±8.4) admitted to the sub-ICU from January 2003 to January 2006. Forty patients with acute myocardial infarction and 34 patients with extreme fasting glucose values (<60 or >500 mg/dL) were excluded. Eight hundred twenty-two patients without a history of diabetes mellitus (DM) and 333 patients with a diagnosis of DM were selected and subdivided into three categories according to serum fasting blood glucose: 60 to 126 mg/dL (Group A), 127 to 180 mg/dL (Group B), and 181 to 500 mg/dL (Group C). MEASUREMENTS: Age, sex, mental and functional status, Acute Physiology Score, comorbid conditions, serum albumin, serum cholesterol, fasting serum glucose, and length of stay. In-hospital mortality was the primary outcome, and 45-day mortality was the secondary outcome. RESULTS: Total in-hospital mortality was 14.5%. In patients with and without DM, mortality was 8.8% and 11.3%, respectively, in Group A; 13.6% and 17.3% in Group B, and 12.6% and 34.3% in Group C. After controlling for confounders, newly recognized hyperglycemia (>181 mg/dL) was independently associated with in-hospital mortality (adjusted odds ratio=2.7, 95% confidence interval=1.6,4.8). Forty-five-day mortality in newly recognized hyperglycemic patients was 17.5%, 25.7%, and 42% in Groups A, B, and C, respectively, whereas it was 21.2% in patients with DM. CONCLUSION: In elderly patients, newly recognized hyperglycemia was associated with a higher mortality rate than in those with a prior history of DM. These data suggest that further randomized clinical trials are needed to assess the efficacy and the risk of a target glucose of greater than 180 mg/dL. [source] Severe obstructive sleep apnea: Sleepy versus nonsleepy patientsTHE LARYNGOSCOPE, Issue 3 2010Arie Oksenberg PhD Abstract Objectives/Hypothesis: To compare demographic and polysomnographic data of sleepy versus nonsleepy severe obstructive sleep apnea (OSA) patients according to the Epworth Sleepiness Scale (ESS). Study Design: Retrospective cohort. Methods: Six hundred forty-four consecutive severe (apnea-hypopnea index [AHI] , 30) adult OSA patients who underwent a polysomnographic evaluation in our sleep disorders unit. ESS data were available in 569 (88.3%). Three hundred twenty-seven (57.5%) patients had ESS > 10. Results: Sleepy severe OSA patients are slightly younger and more obese than nonsleepy patients. These sleepy patients have shorter sleep latency and lower percentage of slow wave sleep. They consistently show a higher AHI, both supine and lateral AHI, have a higher number of short arousals, and a higher arousal index. They also have higher snoring loudness in the supine and both lateral positions and a lower minimal SaO2 in rapid eye movement and non-rapid eye movement sleep. After adjusting for confounders, a logistic regression model points to apnea index as a significant prognostic factor for excessive daytime sleepiness. Conclusions: Severe OSA sleepy patients have a syndrome that is significantly more severe than nonsleepy patients. Sleepy patients have worse sleep-related breathing parameters, and their sleep patterns are lighter and more fragmented than nonsleepy patients. Apnea index appears as an important prognostic factor for excessive daytime sleepiness. Laryngoscope, 2010 [source] Excision of the Preauricular Sinus: A Comparison of Two Surgical TechniquesTHE LARYNGOSCOPE, Issue 2 2001Henry Chuen Kwong Lam FRCS Abstract Objectives To compare the long-term recurrence rate of the standard technique (simple sinectomy) and the supra-auricular approach (wide local excision) for the surgical management of preauricular sinuses. Study Design Retrospective cohort. Methods Fifty-four patients with a preauricular sinus excised between May 1986 and December 1996 were included in this study. All patients were categorized into one of two groups based on the type of surgery performed: the standard technique or the supra-auricular approach. The medical records were then reviewed and the latest information concerning the recurrence of a preauricular sinus were updated by phone interview. The recurrence rate of these two groups was statistically analyzed by the Fisher exact test. Results Forty-nine of 54 patients were successfully contacted with data updated and analyzed. The 32% recurrence rate of the standard excision (n = 25) was significantly higher than the 3.7% recurrence rate of the supra-auricular approach (n = 27; two-tailed test, P = .01). Conclusion The supra-auricular approach for excision of a preauricular sinus has a statistically lower recurrence rate in comparison to the standard technique. [source] Reclassification of unexplained stillbirths using clinical practice guidelinesAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2009Elizabeth HEADLEY Background: Twenty-eight per cent of stillbirths in Australia remain unexplained. A clinical practice guideline (CPG) produced by the Perinatal Society of Australia and New Zealand (PSANZ) Perinatal Mortality Special Interest Group is in use to assist clinicians in the investigation and audit of perinatal deaths. Aims: To describe in a tertiary hospital using the PSANZ stillbirth investigation guidelines: (i) the distribution and classification of stillbirths, and (ii) the compliance with suggested stillbirth core investigations. Methods: Retrospective cohort of all stillbirths delivered between November 2005 and March 2008. Stillbirths were defined as no sign of life on delivery at , 20 weeks gestation or 400 g birthweight if gestation is unknown. Data were collected via the hospital Perinatal Mortality Audit Committee (PMAC). Cause of death was classified by the PSANZ Perinatal Death Classification. Results: There were 86 stillbirths (rate 7.2 per 1000 births). The percentage of unexplained stillbirths was 34% and 13% before and after CPG investigations, respectively. Unexplained stillbirths had the highest compliance with the recommended investigations. The initial cause of death documented on the death certificate was changed by the PMAC in 19 cases. The investigations most likely to prompt a change in the cause of death classification were autopsy and placental pathology. Conclusions: The percentage of unexplained stillbirths is lower than the national average in a hospital using the Perinatal Mortality Audit Guidelines. However, overall compliance is low, suggesting a targeted approach to investigation is used by clinicians despite a policy that aims to be non-selective. Autopsy and placental examination are the most useful investigations in assisting formal classification of cause of death. [source] Who remains undelivered more than seven days after a single course of prenatal corticosteroids and gives birth at less than 34 weeks?AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2002KJ McLaughlin ABSTRACT Minimal information exists as to how women who give birth more than seven days after initial corticosteroid treatment, who may benefit from repeat prenatal corticosteroids, differ from women who give birth within seven days, at < 34 weeks gestation. OBJECTIVES To examine the differences, if any, between women who received a single course of prenatal corticosteroids and remained undelivered more than seven days later and women who gave birth within seven days of treatment, at < 34 weeks gestation. DESIGN Retrospective cohort. Setting Women's and Children's Hospital, Adelaide. Population Women who gave birth at < 34 weeks gestation from 1 January 1994 to 31 December 1996. Methods Data were extracted from medical records and retrieved from the hospital's database. Main potential predictors collected Prenatal corticosteroid exposure, reason for risk of preterm birth, maternal demographics and previous and current obstetric history. Results Of the 506 women, 122 (24%) remained undelivered more than seven days following prenatal corticosteroid therapy. Initial corticosteroid treatment was given on average 1.6 weeks earlier to women who remained undelivered more than seven days after treatment. Women who were given prenatal corticosteroids for placenta praevia (RR 6.03, 95% CI 2.67-13.61, p < 0.01) or cervical incompetence (RR 3.40, 95% CI 1.06-10.95, p = 0.04) were more likely to give birth more than seven days after corticosteroid treatment. Conclusions Women who give birth very preterm, who remain undelivered more than seven days after prenatal corticosteroids, differ in the reasons for and timing of their first course from women who give birth within seven days. [source] Hepatitis C virus infection and its clearance alter circulating lipids: Implications for long-term follow-up,HEPATOLOGY, Issue 4 2009Kathleen E. Corey Hepatitis C associated hypolipidemia has been demonstrated in studies from Europe and Africa. In two linked studies, we evaluated the relationship between hepatitis C infection and treatment with lipid levels in an American cohort and determined the frequency of clinically significant posttreatment hyperlipidemia. First, a case-control analysis of patients with and without hepatitis C was performed. The HCV Group consisted of 179 infected patients. The Uninfected Control Group consisted of 180 age-matched controls. Fasting cholesterol, low density lipoprotein (LDL), high density lipoprotein and triglycerides were compared. Next was a retrospective cohort study (Treated Hepatitis C Group) of 87 treated hepatitis C patients with lipid data before and after therapy was performed. In the case-control analysis, the HCV Group had significantly lower LDL and cholesterol than the Uninfected Control Group. In the retrospective cohort, patients in the Treated Hepatitis C Group who achieved viral clearance had increased LDL and cholesterol from baseline compared to patients without viral clearance. These results persisted when adjusted for age, sex, and genotype. 13% of patients with viral clearance had increased LDL and 33% experienced increases in cholesterol to levels warranting lipid lowering therapy. Conclusion: Hepatitis C is associated with decreased cholesterol and LDL levels. This hypolipidemia resolves with successful hepatitis C treatment but persists in nonresponders. A significant portion of successfully treated patients experience LDL and cholesterol rebound to levels associated with increased coronary disease risk. Lipids should be carefully monitored in persons receiving antiviral therapy. (HEPATOLOGY 2009;50:1030,1037.) [source] Serum sodium predicts mortality in patients listed for liver transplantation,HEPATOLOGY, Issue 1 2005Scott W. Biggins With the implementation of the model for end-stage liver disease (MELD), refractory ascites, a known predictor of mortality in cirrhosis, was removed as a criterion for liver allocation. Because ascites is associated with low serum sodium, we evaluated serum sodium as an independent predictor of mortality in patients with cirrhosis who were listed for liver transplantation and whether the addition of serum sodium to MELD was superior to MELD alone. This is a single-center retrospective cohort of all adult patients with cirrhosis listed for transplantation from February 27, 2002, to December 26, 2003. Listing laboratories were those nearest the listing date ±2 months. Of the 513 patients meeting inclusion criteria, 341 were still listed, while 172 were removed from the list (105 for transplantation, 56 for death, 11 for other reasons). The median serum sodium and MELD scores were 137 mEq/L (range, 110-155) and 15 (range, 6-51), respectively, at listing. Median follow-up was 201 (range, 1-662) days. The risk of death with serum sodium < 126 mEq/L at listing or while listed was increased, with hazard ratios of 7.8 (P < .001) and 6.3 (P < .001), respectively, and the association was independent of MELD. The c-statistics of receiver operating characteristic curves for predicting mortality at 3 months based upon listing MELD with and without listing serum sodium were 0.883 and 0.897, respectively, and at 6 months were 0.871 and 0.905, respectively. In conclusion, serum sodium < 126 mEq/L at listing or while listed for transplantation is a strong independent predictor of mortality. Addition of serum sodium to MELD increases the ability to predict 3- and 6-month mortality in patients with cirrhosis. (HEPATOLOGY 2005;41:32,39.) [source] Analysis of serious non-AIDS events among HIV-infected adults at Latin American sitesHIV MEDICINE, Issue 9 2010WH Belloso Objective Acquired immune deficiency appears to be associated with serious non-AIDS (SNA)-defining conditions such as cardiovascular disease, liver and renal insufficiency and non-AIDS-related malignancies. We analysed the incidence of, and factors associated with, several SNA events in the LATINA retrospective cohort. Materials and methods Cases of SNA events were recorded among cohort patients. Three controls were selected for each case from cohort members at risk. Conditional logistic models were fitted to estimate the effect of traditional risk factors as well as HIV-associated factors on non-AIDS-defining conditions. Results Among 6007 patients in follow-up, 130 had an SNA event (0.86 events/100 person-years of follow-up) and were defined as cases (40 with cardiovascular events, 54 with serious liver failure, 35 with non-AIDS-defining malignancies and two with renal insufficiency). Risk factors such as diabetes, hepatitis B and C virus coinfections and alcohol abuse showed an association with events, as expected. The last recorded CD4 T-cell count prior to index date (P=0.0056, with an average difference of more than 100 cells/,L) and area under the CD4 cell curve in the year previous to index date (P=0.0081) were significantly lower in cases than in controls. CD4 cell count at index date was significantly associated with the outcome after adjusting for risk factors. Conclusions The incidence and type of SNA events found in this Latin American cohort are similar to those reported in other regions. We found a significant association between immune deficiency and the risk of SNA events, even in patients under antiretroviral treatment. [source] Loss of STARD10 expression identifies a group of poor prognosis breast cancers independent of HER2/Neu and triple negative statusINTERNATIONAL JOURNAL OF CANCER, Issue 6 2010Niamh C. Murphy Abstract The phospholipid transfer protein STARD10 cooperates with c-erbB signaling and is overexpressed in Neu/ErbB2 breast cancers. We investigated if STARD10 expression provides additional prognostic information to HER2/neu status in primary breast cancer. A published gene expression dataset was used to determine relationships between STARD10 and HER2 mRNA levels and patient outcome. The central findings were independently validated by immunohistochemistry in a retrospective cohort of 222 patients with breast cancer with a median follow-up of 64 months. Kaplan,Meier and Cox proportional hazards analyses were used for univariate and multivariate analyses. Patients with low STARD10 or high HER2 tumor mRNA levels formed discrete groups each associated with a poor disease-specific survival (p = 0.0001 and p = 0.0058, respectively). In the immunohistochemical study low/absent STARD10 expression i.e. ,10% positive cells was observed in 24 of 222 (11%) tumors. In a univariate model, low/absent STARD10 expression was significantly associated with decreased patient survival (p = 0.0008). In multivariate analyses incorporating tumor size, tumor grade, lymph node status, ER, PR and HER2 status, low STARD10 expression was an independent predictor of death from breast cancer (HR: 2.56 (95% CI: 1.27,5.18), p = 0.0086). Furthermore, low/absent STARD10 expression, HER2 amplification and triple negative status were independent prognostic variables. Loss of STARD10 expression may provide an additional marker of poor outcome in breast cancer identifying a subgroup of patients with a particularly adverse prognosis, which is independent of HER2 amplification and the triple negative phenotype. [source] Clinical Utility of Office-Based Cognitive Predictors of Fitness to Drive in Persons with Dementia: A Systematic ReviewJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2006Frank J. Molnar MDCM OBJECTIVES: To perform a systematic review of evidence available regarding in-office cognitive tests that differentiate safe from unsafe drivers with dementia. DESIGN: A comprehensive literature search of multiple databases including Medline, CINAHL, PsychInfo, AARP Ageline, and Sociofile from 1984 to 2005 was performed. This was supplemented by a search of Current Contents and a review of the bibliographies of all relevant articles. SETTING: English prospective cohort, retrospective cohort, and case-control studies that used accepted diagnostic criteria for dementia or Alzheimer's disease and that employed one of the primary outcomes of crash, simulator assessment, or on-road assessment were included. PARTICIPANTS: Two reviewers. MEASUREMENTS: The reviewers independently assessed study design, main outcome of interest, cognitive tests, and population details and assigned a Newcastle-Ottawa quality assessment rating. RESULTS: Sixteen articles met the inclusion criteria. Tests recommended by guidelines (e.g., the American Medical Association (AMA) and Canadian Medical Association guidelines) for the assessment of fitness to drive did not demonstrate robustly positive findings (e.g., Mini-Mental State Examination, Trails B) or were not evaluated in any of the included studies (e.g., Clock Drawing). Fifteen studies did not report any cutoff scores. CONCLUSION: Without validated cutoff scores, it is impossible to employ tests in a standardized fashion in front-line clinical settings. This study identified a research gap that will prevent the development of evidence-based guidelines. Recommendations to address this gap are that driving researchers routinely perform cutoff score analyses and that stakeholder organizations (e.g., AMA, American Geriatrics Society) sponsor consensus fora to review driving research methodologies. [source] Limited Response to Cardiac Resynchronization Therapy in Patients with Concomitant Right Ventricular DysfunctionJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2010M.P.H., PAUL B. TABEREAUX M.D. Limited Response to CRT in Patients with RVD.,Introduction: Patients with left ventricular dysfunction (LVD) and LV dyssynchrony may respond to cardiac resynchronization therapy (CRT). However, right ventricular dysfunction (RVD) is a predictor of decreased survival in patients with LVD, and its influence on clinical response to CRT is unknown. The purpose of this study was to examine the effect of RVD on the clinical response to CRT. Methods and Results: A retrospective cohort of consecutive patients who underwent implantation of a CRT implantable cardioverter-defibrillator (ICD) were included and deemed to have RVD based on a RV ejection fraction <0.40. A lack of response to CRT was defined as: death, heart transplantation, implantation of an LV assist device, absent improvement in NYHA functional class at 6 months or hospice care. Among 130 patients included (mean age 58 ± 11 years, 68.5% male, 87.7% Caucasian, 51.5% nonischemic cardiomyopathy), 77 (59.2%) had no response to CRT as defined above. Of the nonresponders, 43 (56%) had RVD and 34 (44%) did not have RVD (P = 0.02). After adjustment for age, race, gender, cardiomyopathy type, atrial fibrillation, serum sodium, and severe mitral regurgitation, RVD (adjusted OR = 0.34, 95%CI 0.14,0.82), female gender (adjusted OR = 0.36, 95%CI 0.14,0.95), and serum creatinine (adjusted OR = 0.25, 95%CI 0.09,0.71) were independently associated with decreased odds of response to CRT. There was a significant difference in survival of patients with and without RVD after CRT (log rank P = 0.01). Conclusion: RVD represents a strong predictor of lack of clinical response to CRT in patients with CHF due to LVD and should be considered when prescribing CRT. (J Cardiovasc Electrophysiol, Vol. 21, pp. 431,435, April 2010) [source] Significance of Periodontal Risk Assessment in the recurrence of periodontitis and tooth lossJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2 2010G. Matuliene Matuliene G, Studer R, Lang NP, Schmidlin K, Pjetursson BE, Salvi GE, Brägger U, Zwahlen M. Significance of Periodontal Risk Assessment on the recurrence of periodontitis and tooth loss. J Clin Periodontol 2010; 37: 191,199. doi: 10.1111/j.1600-051X.2009.01508.x. Abstract Aim: To investigate the association of the Periodontal Risk Assessment (PRA) model categories with periodontitis recurrence and tooth loss during supportive periodontal therapy (SPT) and to explore the role of patient compliance. Material and Methods: In a retrospective cohort, PRA was performed for 160 patients after active periodontal therapy (APT) and after 9.5 ± 4.5 years of SPT. The recurrence of periodontitis and tooth loss were analysed according to the patient's risk profile (low, moderate or high) after APT and compliance with SPT. The association of risk factors with tooth loss and recurrence of periodontitis was investigated using logistic regression analysis. Results: In 18.2% of patients with a low-risk profile, in 42.2% of patients with a moderate-risk profile and in 49.2% of patients with a high-risk profile after APT, periodontitis recurred. During SPT, 1.61 ± 2.8 teeth/patient were lost. High-risk profile patients lost significantly more teeth (2.59 ± 3.9) than patients with moderate- (1.02 ± 1.8) or low-risk profiles (1.18 ± 1.9) (Kruskal,Wallis test, p=0.0229). Patients with erratic compliance lost significantly (Kruskal,Wallis test, p=0.0067) more teeth (3.11 ± 4.5) than patients compliant with SPT (1.07 ± 1.6). Conclusions: In multivariate logistic regression analysis, a high-risk patient profile according to the PRA model at the end of APT was associated with recurrence of periodontitis. Another significant factor for recurrence of periodontitis was an SPT duration of more than 10 years. [source] Primary biliary cirrhosis in Singapore: Evaluation of demography, prognostic factors and natural course in a multi-ethnic populationJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 4 2008Reuben-Km Wong Abstract Background and Aim:, Primary biliary cirrhosis (PBC) is infrequent in Asians. Among Asian patients with PBC, information on natural course is scarce. The aim of this study was to study the clinical course and prognosticators among Asians with PBC. Methods:, During 1990,2005, patients diagnosed with PBC at the National University Hospital, Singapore, constituted the retrospective cohort. Their demographic characteristics were evaluated. To evaluate the prognostic factors and natural course, two outcome measures were assessed: hepatic decompensation and death or liver transplant. Multivariate analysis was undertaken to identify factors associated with hepatic decompensation and terminal event (death or liver transplantation). Results:, Thirty-four PBC patients aged 56.8 ± 1.8 years (mean ± SEM) of whom 32 (94%) were women were included. Thirty-two (94%) of them were of Chinese origin. At presentation, 18 (53%) were symptomatic in the form of jaundice (n = 9, 26.5%), pruritus (n = 6, 17.6%) and fatigue (n = 5, 14.7%). During 4.80 ± 0.7 (range 0.02,15.03) years follow up, 6/16 (37.5%) asymptomatic patients developed symptoms. After 5 years, 17.6% (n = 6) and 8.8% (n = 3) had hepatic decompensation and terminal event, respectively. Sicca syndrome was present in 26% (n = 9) of patients. Multivariate analysis revealed that serum bilirubin level at presentation was the sole determinant of decompensation. Rate of change of laboratory indices did not predict either event. Conclusion:, In Singapore, Chinese women constitute most of the PBC patients. Elevated serum bilirubin level at presentation was the sole predictive marker associated with dismal outcome. [source] Diagnostic and treatment delays in recurrent clostridium difficile,associated diseaseJOURNAL OF HOSPITAL MEDICINE, Issue 2 2008Danielle Scheurer MD Abstract BACKGROUND: Because Clostridium difficile,associated disease (CDAD) is primarily an inpatient issue, hospitalists are at the forefront of the timely diagnosis and treatment of patients with this disease. DESIGN: The study was a retrospective cohort of all inpatients with CDAD at Brigham and Women's Hospital from 1997 to 2004 in order to determine the time to diagnosis and treatment in initial and recurrent episodes of disease. RESULTS: The mean time to sampling, between 2.09 and 2.24 days, was not significantly different between initial and recurrent CDAD hospital episodes. The mean time to treatment (from symptoms and sampling) was shorter in recurrent episodes but was still 2.5 days. CONCLUSIONS: Patients with recurrent disease were more likely to be treated earlier but not diagnosed earlier than those with initial disease. Because both groups had significant diagnostic and treatment delays, this is an area in which hospitalists can have a major impact on patient care. Journal of Hospital Medicine 2008;3:156,159. © 2008 Society of Hospital Medicine. [source] Predictors of persistence with 5-aminosalicylic acid therapy for ulcerative colitisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2009S. V. KANE Summary Background, Individuals with ulcerative colitis (UC) are at risk for poor persistence with therapy. Aim, To identify factors predicting persistence with 5-aminosalicylic acid (5-ASA) therapy after 3 and 12 months in subjects with UC. Methods, In this retrospective cohort study, persistence with 5-ASA therapy was determined from prescription refill data from a commercial health insurance claims database. The analysis included subjects with UC who filled a prescription for any oral 5-ASA between October 2002 and September 2004. Persistence was defined as prescription refill at 3 and/or 12 months. Multivariate logistic regression modelling identified variables independently associated with persistence at 3 and 12 months. Results, In all, 3574 subjects were identified. Fifty-seven per cent (2044) were persistent at 3 months. Glucocorticoid use before the index prescription predicted improved persistence at 3 months. Psychiatric diagnosis, mail order of the index prescription, female gender and co-pay predicted decreased persistence. At 12 months, 1124 (55%) remained persistent. Rectal 5-ASA use, older age and switching to a different 5-ASA predicted improved persistence at 12 months. Hospitalization for a gastrointestinal condition, mail order of the 3-month prescription and number of co-morbid illnesses predicted lower persistence. Conclusion, Persistence with 5-ASA treatment in UC is complex and multifactorial, and differs by time period. [source] Clinical course of hepatitis B virus infection during pregnancyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2009G. NGUYEN Summary Background, For women with hepatitis B virus (HBV) infection, little is known about the natural progression of the disease during pregnancy or its impact on pregnancy outcomes. Objectives, To investigate the natural progression of HBV infection during pregnancy or its impact on pregnancy outcomes. Methods, In this retrospective cohort study, we reviewed medical records of all patients who were pregnant and presented with HBsAg-positivity between 2000 and 2008 at a community gastroenterology practice and a university hepatology clinic. Maternal characteristics were analysed according to maternal and perinatal outcomes. Results, A total of 29 cases with at least 2 measurements of either HBV DNA or alanine aminotransferase (ALT) levels were included. Older age was the only predictor of a trend towards higher risk of an adverse clinical outcome [OR = 1.21 (0.97,1.51), P = 0.089], defined as either a negative foetal outcome (premature delivery, spontaneous abortion), or a negative maternal outcomes (gestational diabetes mellitus, pre-eclampsia, hepatic flare, liver failure). This trend for age remained even after adjusting for baseline ALT. Baseline serum HBV DNA, ALT, hepatitis B e antigen status, gravida and parity were not significant predictors for adverse clinical outcomes. Four patients developed liver failure. Conclusions, Maternal and neonatal outcomes are highly variable in this clinic-based patient cohort. Severe complications due to HBV infection can occur during pregnancy in previously asymptomatic patients. It is unclear how generalizable the results observed in this cohort would be to the general population; therefore, further studies are needed to identify reliable predictors for significant adverse outcomes and until more data are available, pregnant patients with HBV infection should be monitored with periodic serum HBV DNA and ALT levels. [source] Clinical Stage, Therapy, and Prognosis in Canine Anal Sac Gland CarcinomaJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 2 2007Gerry A. Polton MA, MRCVS, MSc (Clin Onc), VetMB Background:Reports of canine anal sac gland carcinoma (ASGC) describe varied clinical presentations and management and differing responses to therapy. A unifying approach to clinical stage determination and management of this disease has yet to be presented. Hypothesis:An ordinal clinical staging scheme for canine ASGC can be devised on the basis of responses to therapy for a retrospective cohort of affected dogs. Animals:130 dogs with naturally occurring ASGC. Methods:A simplified clinical stage system and a management algorithm for canine ASGC were derived from retrospective evaluation of a cohort of 80 dogs; applicability of both was then prospectively evaluated in a cohort of 50 dogs. Results:Retrospective evaluation revealed 4 statistically significant negative prognostic indicators for survival: lack of therapy, presence of distant metastases, presence of lymph node metastases, and primary tumor size. Lymph node extirpation was a statistically significant positive prognostic indicator by bivariate analysis. In both retrospective and prospective analyses, the modified clinical stage scheme revealed a significant association with survival time. Conclusions and Clinical Importance: The clinical staging scheme permits differentiation between groups in terms of prognosis and, therefore, decisions on therapy. This will facilitate application of appropriate therapy and enhanced communication and collaboration in further investigations of ASGC. [source] Proton pump inhibitors increase significantly the risk of Clostridium difficile infection in a low-endemicity, non-outbreak hospital settingALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2009B. R. DALTON Summary Background, Proton pump inhibitors (PPI) have been linked to higher risk of Clostridium difficile infection (CDI). The relevance of this association in hospitals with low disease activity, where an outbreak strain is nondominant, has been assessed in relatively few studies. Aim, To assess the association of PPI and CDI in a setting of low disease activity. Methods, A retrospective cohort study was conducted at two hospitals. Patients admitted for ,7 days receiving antibiotics were included. Demographics, exposure to PPI, antibiotics and other drugs in relation to diagnosis of CDI were assessed by univariate and multivariate analyses. Results, Of 14 719 patients, 149 (1%) first episode CDI were documented; PPI co-exposure increased CDI [1.44 cases/100 patients vs. 0.74 cases/100 non-exposed (OR: 1.96, 95% CI: 1.42,2.72)]. By logistic regression, PPI days (adjusted OR: 1.01 per day, 95% CI: 1.00,1.02), histamine-2 blockers, antidepressants, antibiotic days, exposure to medications, age, admission service and length of admission were significant predictors. Conclusions, A statistically significant increase in CDI was observed in antibiotic recipients who received PPI, but the absolute risk increase is modest. In settings of with low rates of CDI, the benefit of PPI therapy outweighs the risk of developing CDI. These data support programmes to decrease inappropriate use of PPI in hospitalized patients. [source] Long-term survival of patients with unresectable hepatocellular carcinoma treated with transcatheter arterial chemoinfusionALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2007B. Y. HA Summary Background Transcatheter arterial chemoembolization (TACE) has become one of the most common treatments for unresectable hepatocellular carcinoma. Published studies of TACE report a 5,16% risk of serious complications. Compared with TACE, transcatheter arterial chemoinfusion (TACI) may have similar efficacy and fewer side effects. Aim To examine the clinical outcomes of TACI. Methods We performed a retrospective cohort study of 345 consecutive TACI cases in 165 patients performed at a single United States medical center between 1998 and 2002. Primary outcomes were tumour response and survival rates. Results Only seven patients were hospitalized for more than 24 h after the procedure, and only three patients had worsening of liver function within 30 days of TACI. Survival was significantly poorer for patients with tumour-node-metastasis (TNM) IV compared to those with TNM I,III and also for patients with Child's class B/C vs. A. Following adjustment for age, gender, ethnicity and aetiology of liver diseases, independent predictors of poor survival were Child's class B/C [Hazard Ratio (HR) = 1.69, P = 0.024] and TNM IV staging (HR = 1.63, P = 0.014). Conclusions TACI appears to be safe and effective for unresectable hepatocellular carcinoma with TNM stage I,III; randomized controlled trials are needed to compare TACI to TACE. [source] Effect of body mass index on the survival benefit of liver transplantation,LIVER TRANSPLANTATION, Issue 12 2007Shawn J. Pelletier Obese patients are at higher risk for morbidity and mortality after liver transplantation (LT) than nonobese recipients. However, there are no reports assessing the survival benefit of LT according to recipient body mass index (BMI). A retrospective cohort of liver transplant candidates who were initially wait-listed between September 2001 and December 2004 was identified in the Scientific Registry of Transplant Recipients database. Adjusted Cox regression models were fitted to assess the association between BMI and liver transplant survival benefit (posttransplantation vs. waiting list mortality). During the study period, 25,647 patients were placed on the waiting list. Of these, 4,488 (17%) underwent LT by December 31, 2004. At wait-listing and transplantation, similar proportions were morbidly obese (BMI , 40; 3.8% vs. 3.4%, respectively) and underweight (BMI < 20; 4.5% vs. 4.0%, respectively). Underweight patients experienced a significantly higher covariate-adjusted risk of death on the waiting list (hazard ratio [HR] = 1.61; P < 0.0001) compared to normal weight candidates (BMI 20 to <25), but underweight recipients had a similar risk of posttransplantation death (HR = 1.28; P = 0.15) compared to recipients of normal weight. In conclusion, compared to patients on the waiting list with a similar BMI, all subgroups of liver transplant recipients demonstrated a significant (P < 0.0001) survival benefit, including morbidly obese and underweight recipients. Our results suggest that high or low recipient BMI should not be a contraindication for LT. Liver Transpl, 2007. © 2007 AASLD. [source] Biases affecting the proportional reporting ratio (PRR) in spontaneous reports pharmacovigilance databases: the example of sertindolePHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2003Nicholas Moore Abstract Background Automated measures of reporting disproportionality in databases of spontaneous reports of adverse drug reactions are an emerging tool to identify drug-related alerts. Sertindole, a new atypical neuroleptic known to prolong the QT interval, was suspended in November 1998 because the proportion of reports of fatal reactions suggesting arrhythmia among all reports with sertindole was almost ten times higher than that for other atypical neuroleptics in the UK. This excess risk was not predicted in preclinical data and had not been found in premarketing trials. Method Reporting patterns over time were analysed. Prescription Event Monitoring (PEM) studies and a large retrospective cohort allowed for the comparison of actual death rates with atypical neuroleptics, and to assess which proportion of the deaths that occurred were reported. Results There were indications of possible skewing of reporting related to notoriety, surveillance and market size effects. Death rates in PEM studies were essentially similar between sertindole and other neuroleptics. Cardiac deaths had been two to three times more often reported than other causes of death. Conclusion Proportional reporting ratios indicate differential reporting of possible reactions, not necessarily differential occurrence. There was no indication of an actual increase of risk of all causes or cardiac deaths during sertindole treatment, but only an increased risk of its being reported. The suspension of sertindole was rescinded by Committee on Proprietary Medicinal Products (CPMP) in October 2001. Copyright © 2003 John Wiley & Sons, Ltd. [source] Occupational injuries among aides and nurses in acute care,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 12 2009R.L. Rodríguez-Acosta PhD Abstract Background Occupational injuries are common among nursing personnel. Most epidemiologic research on nursing aides comes from long-term care settings. Reports from acute care settings often combine data on nurses and aides even though their job requirements and personal characteristics are quite different. Our objective was to assess risk of work-related injuries in an acute care setting while contrasting injuries of aides and nurses. Methods A retrospective cohort of aides (n,=,1,689) and nurses (n,=,5,082) working in acute care at a large healthcare system between 1997 and 2004 were identified via personnel records. Workers' compensation filings were used to ascertain occupational injuries. Poisson regression was used to estimate rate ratios (RR) and 95% confidence intervals (95% CI). Results Aides had higher overall injury rates than nurses for no-lost work time (RR,=,1.2, 95% CI: 1.1,1.3) and lost work time (RR,=,2.8, 95% CI: 2.1,3.8) injuries. The risk of an injury due to lifting was greater among aides compared to nurses for both non-lost work time and lost work time injuries. Injury rates among aides were particularly high in rehabilitation and orthopedics units. Most of the injuries requiring time away from work for both groups were related to the process of delivering direct patient care. Conclusions Our findings illustrate the importance of evaluating work-related injuries separately for aides and nurses, given differences in injury risk profiles and injury outcomes. It is particularly important that occupational safety needs of aides be addressed as this occupation experiences significant job growth. Am. J. Ind. Med. 52:953,964, 2009. © 2009 Wiley-Liss, Inc. [source] Use of the harmonic scalpel in thyroidectomyANZ JOURNAL OF SURGERY, Issue 6 2009David J. Parker Abstract Thyroidectomy is a surgical procedure that requires meticulous dissection, safe anatomical exposure and effective haemostasis. Use of the harmonic scalpel in thyroidectomy may assist in achieving these goals, particularly in respect to enabling efficient haemostatic coagulation and division of small vessels. This report demonstrates the results of utilizing the harmonic scalpel in a series of 88 prospective thyroidectomies in patients under the care of two surgeons over a 2-year period recording a number of parameters, including operative times and post-operative complications. These data were compared with a retrospective cohort of 57 patients who underwent thyroidectomies by the same two surgeons prior to the introduction of the harmonic scalpel. The results of this study show that the use of the harmonic scalpel decreased surgical operating time by 20 min (22.5%) for a hemithyroidectomy and 13.5 min (12%) for a total thyroidectomy. Harmonic scalpel use was not associated with an increased complication rate and has been demonstrated to be a very efficient and safe tool in assisting with the conduct of a thyroidectomy. [source] Advanced Airway Management Does Not Improve Outcome of Out-of-hospital Cardiac ArrestACADEMIC EMERGENCY MEDICINE, Issue 9 2010M. Arslan Hanif MD ACADEMIC EMERGENCY MEDICINE 2010; 17:926,931 © 2010 by the Society for Academic Emergency Medicine Abstract Background:, The goal of out-of-hospital endotracheal intubation (ETI) is to reduce mortality and morbidity for patients with airway and ventilatory compromise. Yet several studies, mostly involving trauma patients, have demonstrated similar or worse neurologic outcomes and survival-to-hospital discharge rates after out-of-hospital ETI. To date, there is no study comparing out-of-hospital ETI to bag-valve-mask (BVM) ventilation for the outcome of survival to hospital discharge among nontraumatic adult out-of-hospital cardiac arrest (OOHCA) patients. Objectives:, The objective was to compare survival to hospital discharge among adult OOHCA patients receiving ETI to those managed with BVM. Methods:, In this retrospective cohort study, the records of all OOHCA patients presenting to a municipal teaching hospital from November 1, 1994, through June 30, 2008, were reviewed. The type of field airway provided, age, sex, race, rhythm on paramedic arrival, presence of bystander cardiopulmonary resuscitation (CPR), whether the arrest was witnessed, site of arrest, return of spontaneous circulation (ROSC), survival to hospital admission, comorbid illnesses, and survival to hospital discharge were noted. A univariate odds ratio (OR) was first computed to describe the association between the type of airway and survival to hospital discharge. A multivariable logistic regression analysis was performed, adjusting for rhythm, bystander CPR, and whether the arrest was witnessed. Results:, A cohort of 1,294 arrests was evaluated. A total of 1,027 (79.4%) received ETI, while 131 (10.1%) had BVM, 131 (10.1%) had either a Combitube or an esophageal obturator airway, and five (0.4%) had incomplete prehospital records. Fifty-five of 1,294 (4.3%) survived to hospital discharge; there were no survivors in the Combitube/esophageal obturator airway cohort. Even after multivariable adjustment for age, sex, site of arrest, bystander CPR, witnessed arrest, and rhythm on paramedic arrival, the OR for survival to hospital discharge for BVM versus ETI was 4.5 (95% confidence interval [CI] = 2.3,8.9; p<0.0001). Conclusions:, In this cohort, when compared to BVM ventilation, advanced airway methods were associated with decreased survival to hospital discharge among adult nontraumatic OOHCA patients. [source] Variation in the incidence of and risk factors for the development of nephrolithiasis after radical or partial nephrectomyBJU INTERNATIONAL, Issue 8 2010Aditya Bagrodia Study Type , Prevalence (retrospective cohort) Level of Evidence 2b OBJECTIVE To examine incidence of and risk factors for the development of nephrolithiasis in patients treated with radical nephrectomy (RN) or partial nephrectomy (nephron-sparing surgery, NSS). PATIENTS AND METHODS The study comprised a single-centre review of 749 patients treated with RN or NSS from August 1987 to June 2006. Demographics, medical and stone history, metabolic variables and postoperative stone events were recorded. Data were analysed within subgroups based on treatment (RN vs NSS). Multivariate analysis was used to identify risk factors for postoperative stone formation. RESULTS In all, 499 patients had RN and 250 had NSS (mean age 57.9 years; mean follow-up 6.3 years). There were no significant differences in their demographic factors, but tumours were significantly larger in RN (P < 0.001). There was no significant difference in preoperative urinary pH < 6.0 or stone history. Significantly fewer patients after NSS than RN formed calculi (NSS 1.6% vs RN 8.4%, P < 0.001), developed hypobicarbonataemia (NSS 7.2% vs RN 12.8%, P= 0.020), and a urinary pH of <6.0 (NSS 11.2% vs RN 19.4%, P= 0.004). Multivariate analysis showed that RN (odds ratio 18.18), postoperative urinary pH < 6 (15.63), previous stone disease (13.7), age <60 years (7.33, all P < 0.001), body mass index ,30 kg/m2 (3.26, P= 0.033), male gender (2.67, P= 0.039), and hypobicarbonataemia (2.46, P= 0.034) were significantly associated with the development of postoperative calculi. CONCLUSIONS Patients undergoing RN have a significantly higher incidence of postoperative nephrolithiasis than a well-matched cohort undergoing NSS. In addition to RN, male sex, urinary pH < 6.0, hypobicarbonataemia, history of stone disease, obesity, and age <60 years were significantly associated with postoperative stone formation. [source] Carbonic anhydrase IX and pathological features as predictors of outcome in patients with metastatic clear-cell renal cell carcinoma receiving vascular endothelial growth factor-targeted therapyBJU INTERNATIONAL, Issue 6 2010Toni K. Choueiri Study Type , Prognosis (retrospective cohort) Level of Evidence 2b OBJECTIVE To investigate the utility of tumour carbonic anhydrase IX (CAIX) expression and histological features for predicting the outcome in patients with metastatic clear-cell renal cell carcinoma (mRCC) treated with vascular endothelial growth factor (VEGF)-targeted therapy. PATIENTS AND METHODS We identified 118 patients with mRCC initiating first-line VEGF-targeted therapy, including 94 with clinical and histological data, and available tissue. The primary endpoint was to detect an interaction between sorafenib vs sunitinib treatment and CAIX status on tumour shrinkage. Other treatment outcomes were also assessed. RESULTS There was heterogeneity in tumour responsiveness to sunitinib or sorafenib according to CAIX status; the mean shrinkage was ,17% vs ,25% for sunitinib-treated patients with high vs low tumour CAIX expression, compared to ,13% vs +9% for sorafenib-treated patients (P interaction, 0.05). A higher tumour clear-cell component was independently associated with greater tumour shrinkage (P= 0.02), response (P= 0.02) and treatment duration (P= 0.02). CONCLUSIONS Although CAIX expression had no prognostic value in patients with clear-cell mRCC treated with VEGF-targeted therapy, it might be a predictive biomarker for response to sorafenib treatment. Patients with a higher clear-cell component in their tumours are likely to have a superior clinical benefit from VEGF-targeted therapy. [source] A pretreatment nomogram predicting biochemical failure after salvage cryotherapy for locally recurrent prostate cancerBJU INTERNATIONAL, Issue 2 2010Philippe E. Spiess Study Type , Prognosis (retrospective cohort) Level of Evidence 2b OBJECTIVE To gather a pooled database from six tertiary-care referral centres using salvage cryotherapy (SC) for locally recurrent prostate cancer, and develop a pretreatment nomogram allowing a prediction of the probability of biochemical failure after SC, based on pretreatment clinical variables. PATIENTS AND METHODS We retrospectively analysed 797 men treated at six tertiary-care referral centres with SC for locally recurrent disease after primary radiotherapy with curative intent. The median duration of follow-up from the time of SC to the date of last contact was 3.4 years. The primary study endpoint was biochemical failure, defined as a serum prostate-specific antigen (PSA) level after SC of >0.5 ng/mL. RESULTS Overall, the rate of biochemical failure was 66% with a median of 3.4 years of follow-up. A logistic regression model was used to predict biochemical failure. Covariates included serum PSA level at diagnosis, initial clinical T stage, and initial biopsy Gleason score. On the basis of these results, a pretreatment nomogram was developed which can be used to help select patients best suited for SC. Our pretreatment nomogram was internally validated using 500 bootstrap samples, with the concordance index of the model being 0.70. CONCLUSION A pretreatment nomogram based on several diagnostic variables (serum PSA level at diagnosis, biopsy Gleason grade, and initial clinical T stage) was developed and might allow the selection of ideal candidates for SC. [source] Genetic and environmental effects on the continuity of ejaculatory dysfunctionBJU INTERNATIONAL, Issue 12 2010Patrick Jern Study Type , Symptom prevalence (retrospective cohort) Level of Evidence 2b OBJECTIVES To investigate temporal continuity in ejaculatory dysfunction by comparing self-reported experiences of premature ejaculation (PE) at first intercourse with self-reported PE and delayed ejaculation at present, and to clarify whether and to what extent genetic or environmental factors affect continuity in ejaculatory dysfunction, as previous studies indicate moderate heritability for PE at first intercourse. SUBJECTS AND METHODS The study comprised retrospective self-reported data on ejaculatory performance at first sexual intercourse and a concurrent self-report of the same at the time of data collection in a population-based sample of 2633 Finnish twins and their siblings aged 18,48 years (mean 26.63, sd 4.68). The continuity of ejaculatory function was assessed by correlation and multiple regression. Reasons for continuity were separated into genetic and environmental sources using twin-model fitting. RESULTS Ejaculatory function, particularly PE, was stable over time. Genetic effects accounted for ,30% of the variance in PE both at first intercourse and when measured at data collection. Unshared environmental effects accounted for most of the variance (,70%). Genetic effects were almost identical between the sample occasions, but there was a substantial discrepancy between unshared environmental effects affecting PE at first intercourse and unshared environmental effects affecting PE later in life. Age effects were generally negligible. Data were self-reported and retrospective, and thus vulnerable to response bias. CONCLUSIONS Ejaculatory dysfunction seems to be temporally stable both in the short and long term. Genes that contribute to the variance in PE at first intercourse are similar to those that contribute to the variance in PE later in life, whereas there are, in this regard, substantial differences in the unshared environmental factors that are a cause of PE. [source] The prognostic role of comorbidity in salivary gland carcinomaCANCER, Issue 7 2008Chris H. J. Terhaard MD Abstract BACKGROUND. Patients with head and neck cancer are prone to develop significant comorbidity mainly because of the high incidence of tobacco and alcohol abuse, both of which are etiologic and prognostic factors. However, to the authors' knowledge little is known regarding the prognostic relevance of comorbidity in patients with salivary gland cancer. METHODS. A retrospective cohort of 666 patients with salivary gland cancer was identified within the Dutch Head and Neck Oncology Cooperative Group database. For multivariate analysis, a Cox proportional hazards model was used to study the effect of comorbidity on overall survival and disease-specific survival. RESULTS. According to the Adult Comorbidity Evaluation-27 (ACE-27) index, 394 patients (64%) had grade 0 comorbidity, 119 patients (19%) had grade 1 comorbidity, 71 patients (12%) had grade 2 comorbidity, and 29 patients (5%) had grade 3 comorbidity. In multivariate analysis for overall survival, the ACE-27 comorbidity grade was a strong independent prognostic variable. The hazards ratio (HR) of death, including all causes, was 1.5 (95% confidence interval [CI], 1.1-2.1) for patients with ACE-27 grade 1 comorbidity versus grade 0 comorbidity (P < .007). The HR was 1.7 (95% CI, 1.2-2.5) for grade 2 comorbidity (P = .003) and 2.7 (95% CI, 1.5-4.7) for grade 3 comorbidity versus grade 0 comorbidity (P = .001). In the current analysis, ACE-27 comorbidity grade was not an independent prognostic factor for disease-free survival. CONCLUSIONS. To the authors' knowledge, this is the first study concerning the prevalence and relevance of the prognostic comorbidity variable ACE-27 grade in patients with salivary gland cancer. Overall survival, but not disease-free survival, was correlated strongly with ACE-27 grade. Compared with other studies that investigated the effect of comorbidity on patients with head and neck cancer, patients with salivary gland cancer had less comorbidity. Their comorbid status appeared to be reasonably comparable to that of patients with other nonsmoking- and nonalcohol-related cancers. Cancer 2008. © 2008 American Cancer Society. [source] Optimal projection estimation for transcatheter aortic valve implantation based on contrast-aortography,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2010Validation of a Prototype Software Abstract We investigate the accuracy of a new software system (C-THV, Paieon) designed to calculate the optimal projection (OP) view for transcatheter aortic valve implantation (TAVI) based on two aortograms, and its agreement with the operator's choice. An optimal fluoroscopic working view projection with all three aortic cusps depicted in one line, is crucial during TAVI. In our institution selection of the OP is based on multislice computed tomography (MSCT). Seventy-three consecutive patients referred for TAVI were divided into two groups. For the first group (53 patients, retrospective cohort) we compared the OP views estimated by C-THV with the ones estimated by MSCT. For the second group (20 patients, prospective cohort), we compared the OP views estimated by C-THV with the operator's choice during TAVI. For the retrospective cohort, the mean absolute difference (mean ± SD) between C-THV and MSCT was 6.6 ± 4.9 degrees. In 77% of the cases the mean difference between C-THV and MSCT was <10 degrees. For the prospective cohort, the mean absolute difference (mean ± SD) between C-THV and the operator's choice was 5.5 ± 3.4 degrees. A mean difference of <10 degrees was found in 90% of the cases. In this study we found that the C-THV software estimated the OP view for TAVI with good accuracy. The level of agreement between C-THV and either the MSCT or the operator's choice was deemed satisfactory, with the vast majority of observed differences being <10 degrees. © 2010 Wiley-Liss, Inc. [source] | |||||||||||||||||||||||||