2020 The clinical implications of a positive prostate cancer screen in patients undergoing a cardiac transplant evaluation

OBJECTIVES/SPECIFIC AIMS: Screening the general population for prostate cancer with prostate specific antigen (PSA) continues to be controversial. Patients with advanced heart failure undergoing evaluation for suitability for cardiac transplantation are often requested to undergo prostate cancer screening, with guiding evidence generated from the general population. The objective of this study is to determine the clinical implications of a positive prostate cancer screen result in this patient population. METHODS/STUDY POPULATION: A retrospective cohort study was performed on all men that were referred to a tertiary care cardiac transplant center between January 2000 and December 2015. Patients were classified as having either a “positive screen” (PSA≥4 ng/mL) or a “negative screen” (PSA<4 ng/mL) at the point of evaluation. The primary outcome of time to listing for cardiac transplant (days) was calculated from the date of referral to the date of listing. A multivariable Cox proportional hazards model was developed to assess the association between a positive prostate cancer test result and listing for cardiac transplantation. RESULTS/ANTICIPATED RESULTS: Among the 704 patients included in this study, 66 men (9.4%) had a positive prostate cancer screen result. Men with a positive prostate cancer screen were approximately 4 year older (mean 58.5 vs. 54.1 years), more likely to have a diagnosis of Ischemic Cardiomyopathy (74% vs. 53%) and require continuous mechanical support (61% vs. 16%) at the point of transplant evaluation. The median time for listing for cardiac transplant was greater in patients with a positive PSA (119 vs. 48 days, p<0.05). After adjusting for age, renal function, clinical status at evaluation, history of COPD, and year of referral, patients with a positive prostate cancer screen had a reduced hazards ratio (HR) for progressing to cardiac transplant listing compared with those with a negative screen (HR 0.58, 95%CI: 0.38–0.91). DISCUSSION/SIGNIFICANCE OF IMPACT: Screening patients undergoing cardiac transplant evaluation for prostate cancer with PSA has a low diagnostic yield. An individual’s PSA value is influenced by their age and clinical status at the time of screening, with a positive screen being associated with a reduced likelihood for progressing to listing for cardiac transplant.

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Annual Prostate Cancer Screen Didn't Save Lives

Internal Medicine News ◽

10.1016/s1097-8690(12)70007-0 ◽

2012 ◽

Vol 45 (1) ◽

pp. 4

Author(s):

DIANA MAHONEY

Keyword(s):

Prostate Cancer ◽

Cancer Screen

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Annual Prostate Cancer Screen Wasn't Better

Family Practice News ◽

10.1016/s0300-7073(12)70084-1 ◽

2012 ◽

Vol 42 (2) ◽

pp. 9

Author(s):

DIANA MAHONEY

Keyword(s):

Prostate Cancer ◽

Cancer Screen

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The Use of an Absorbable Microporous Polysaccharide Hemosphere Haemostat (AristaAH®) in Ventricular Assist Device Implant and Cardiac Transplantation Procedures

European Cardiology Review ◽

10.15420/ecr.2012.8.2.125 ◽

2012 ◽

Vol 8 (2) ◽

pp. 125

Author(s):

Brian A Bruckner ◽

Matthias Loebe ◽

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Keyword(s):

Surgical Procedures ◽

Ventricular Assist Device ◽

Cardiac Transplantation ◽

Cardiac Surgical Procedures ◽

High Risk Group ◽

Cardiac Transplant ◽

Assist Device ◽

Ventricular Assist ◽

Refractory Heart Failure ◽

Haemostatic Agents

Topical haemostatic agents are useful adjuncts for the overall approach to haemostasis during mechanical support and cardiac transplant surgical procedures. Increasing numbers of cardiac surgical patients are presenting with pharmacologically induced impairment of the clotting cascade. Additionally, there continues to be an increase in the numbers of ventricular assist device implantations worldwide and these patients have haemostasis challenges both at the time of implantation and at subsequent transplantation. Patients undergoing assist device placement or cardiac transplantation usually have severe, refractory heart failure and varying degrees of multi-organ dysfunction, which make them susceptible to bleeding during the surgical procedure. Despite routine blood conservation measures and the use of intravenous agents, local surgical field haemostasis still remains a challenge. Topical agents are increasingly used in cardiac surgical procedures, especially in assist device or transplant cases. Herein, we report our institutional approach to topical haemostasis in a high-risk group of patients undergoing assist device or cardiac transplant. AristaAH®, a novel polysaccharide topical haemostat, provides effective and safe control of challenging bleeding situations.

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Impact of Positive Vancomycin-Resistant Enterococcus (VRE) Screen Result on Appropriateness of Definitive Antibiotic Therapy

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.829 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s263-s263

Author(s):

Jenna Reynolds ◽

Lynn Chan ◽

Raelene Trudeau ◽

Maria Teresa Seville

Keyword(s):

Antibiotic Therapy ◽

Predictive Value ◽

Hematologic Malignancy ◽

Tertiary Care ◽

Alternative Therapy ◽

Care Hospital ◽

Positive Screen ◽

Screen Result ◽

Definitive Therapy ◽

Vancomycin Resistant

Background: Vancomycin-resistant Enterococcus (VRE) screening has been utilized to identify colonized patients to prevent transmission. However, little is known about the utility of screening to guide antibiotic therapy. We assessed the appropriateness of definitive therapy in patients with a VRE screen and evaluate the predictive value of screening for the development of a VRE infection. Methods: In this retrospective study, we evaluated VRE screening of patients aged 18 years admitted between June 1, 2015, and May 31, 2018, to a 280-bed, academic, tertiary-care hospital. Rectal swabs were tested using Cepheid Xpert. Screening was performed routinely on admission for hematologic malignancy and liver transplantation patients. Only the first screen result was included for patients who had multiple VRE screens. The patient was classified as having a VRE infection if any Enterococcus isolates were vancomycin resistant. The primary outcome was appropriateness of antibiotic therapy in patients who had a VRE screen. Appropriateness of VRE-directed therapy was defined as therapy with linezolid or daptomycin for patients who had a positive VRE culture and an identifiable source of infection, or who had no clinical improvement on alternative therapy, or who had a documented β-lactam allergy. If appropriateness was unclear, 2 infectious diseases specialists determined appropriateness. Results: In total, 1,374 patients who had a rectal VRE screen met inclusion criteria. Of these, 1,053 (88%) had a negative screen. We detected no difference in the appropriateness of VRE-directed therapy between patients with a positive screen and those with a negative screen (59.3% vs 61.0%; P = .8657). The VRE screen had a sensitivity of 60% (95% CI, 43%–74%), specificity of 90% (95% CI, 88%–92%), positive predictive value of 18% (95% CI, 12%–25%), and negative predictive value of 98% (95% CI, 97%–99%) for VRE infection. Conclusions: Although VRE screening may have utility to detect colonization in high-risk patients, a positive VRE screen is of limited value in determining the need for VRE-directed therapy. Patients with a negative VRE screen have a low likelihood of developing a VRE infection, and a negative screen could be used to identify patients who may not require empiric coverage for VRE. Further research is needed to determine optimal utilization of VRE screening for prediction and treatment of VRE infections.Funding: NoneDisclosures: None

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Definition and impact on oncologic outcomes of persistently elevated PSA after salvage lymph node dissection for node-only recurrent prostate cancer after radical prostatectomy: Clinical Implications for multi-modal therapy

European Urology ◽

10.1016/s0302-2838(21)01562-1 ◽

2021 ◽

Vol 79 ◽

pp. S1683-S1684

Author(s):

C.A. Bravi ◽

N. Fossati ◽

G. Gandaglia ◽

G. Motterle ◽

R.J. Karnes ◽

...

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

Radical Prostatectomy ◽

Lymph Node Dissection ◽

Oncologic Outcomes ◽

Clinical Implications ◽

Recurrent Prostate Cancer ◽

Node Dissection ◽

Salvage Lymph Node Dissection

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Attitudes of the general population to psychiatric and physical illness

Psychiatric Bulletin ◽

10.1192/pb.23.11.671 ◽

1999 ◽

Vol 23 (11) ◽

pp. 671-674 ◽

Cited By ~ 3

Author(s):

Stephen M. Lawrie

Keyword(s):

General Population ◽

Psychiatric Disorder ◽

Psychiatric Disorders ◽

Random Sample ◽

Response Bias ◽

Close Relationships ◽

Clinical Vignette ◽

Clinical Implications ◽

General Tendency ◽

Negative Attitudes

Aims and methodThe attitudes of members of the general population to people with psychiatric and physical illnesses were examined. We took a random sample of 280 members of the general population listed in the phone directory and sent them a brief clinical vignette about a neighbour with either schizophrenia, depression, diabetes or no illness.ResultsOnly 103 (41%) of the surveyed general population responded. Some unsolicited comments revealed negative attitudes from a small number of subjects. There were, however, no statistically significant differences in general attitudes to sufferers of psychiatric and physical illnesses suggestive of discrimination against the former. Indeed, respondents showed a general tendency to be more supportive of a neighbour with any illness than to those without. In a sub-analysis, however, those who knew someone with schizophrenia were significantly less likely to be sympathetic towards them.Clinical implicationsWe have not detected any general stigmatisation of those with psychiatric disorders, but our results may be attributable to response bias. Discrimination against those with psychiatric disorder may be limited to a relatively small sector of society or may only be manifest in relatively close relationships.

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Right-to-left shunt is common in chronic migraine

Cephalalgia ◽

10.1111/j.1468-2982.2009.02002.x ◽

2009 ◽

Vol 30 (5) ◽

pp. 535-542 ◽

Cited By ~ 11

Author(s):

SJ Nahas ◽

WB Young ◽

R Terry ◽

A Kim ◽

T Van Dell ◽

...

Keyword(s):

General Population ◽

Chronic Migraine ◽

Tertiary Care ◽

Episodic Migraine ◽

Diagnostic Interview ◽

Neurological Symptoms ◽

Valsalva Manoeuvre ◽

Clinical Implications ◽

Severity Of Disease ◽

Headache Clinic

Our aim was to determine the prevalence of right-to-left shunt (RtLS) in patients with chronic migraine (CM), and to correlate the presence and grade of RtLS with aura and neurological symptoms, and duration and severity of disease. The prevalence of RtLS in migraine without aura is similar to that of the general population (between 20 and 35%). In migraine with aura, the prevalence is much higher (approximately 50%). The prevalence in CM, with or without aura, is unknown. Consecutive patients between the ages of 18 and 60 years with CM attending a tertiary care specialty headache clinic over an 8-week period were eligible. There were 131 patients in the study. A structured diagnostic interview was performed. Bubble transcranial Doppler with Valsalva manoeuvre determined RtLS presence and grade. Sixty-six percent (86/131) of patients had RtLS, a statistically significantly greater rate than those reported in the general population and in migraine with or without aura ( P < 0.001). There was no difference in RtLS rate or grade between those with and those without aura. Specific headache features and the presence of neurological symptoms were similar between those with and those without RtLS. Compared with both the general population and the episodic migraine population (with and without aura), patients with CM, with or without aura, are more likely to have RtLS. The clinical implications of our findings need to be determined.

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