Volumetric laser endomicroscopy features of dysplasia at the gastric cardia in Barrett’s oesophagus: results from an observational cohort study

ObjectiveVolumetric laser endomicroscopy (VLE) is an advanced imaging modality used in Barrett’s oesophagus (BE) to help identify dysplasia in the oesophagus. VLE criteria exist for oesophageal dysplasia but not for dysplasia in the gastric cardia. The aim of this study was to determine if there are in vivo VLE features that can predict gastric cardia dysplasia in BE.DesignThis was a single-centre observational cohort study from August 2016 to August 2018. Patients were included if they had BE, were undergoing a VLE exam as standard of care, and had a suspicious target laser marked at the gastric cardia. The following VLE features were correlated to histology to determine if an association existed between histology subtype and VLE feature: wide crypts, irregular surface, one large isolated gland, multiple glands, and complex glands.ResultsA total of 110 in vivo gastric cardia targets in 77 patients with BE were analysed. The following abnormalities were identified: 61 wide crypts, 34 isolated glands, 16 irregular surfaces, 15 multiple glands, and 11 complex glands. Complex glands were the only VLE feature that correlated to any histology subtype. They were present in 71% of targets with high-grade dysplasia (HGD), T1a cancer or T1b cancer and had a sensitivity, specificity, and accuracy of 71%, 99%, and 85%, respectively. Of the 10 patients with complex glands on VLE and HGD/cancer on histology, 4 had a normal-appearing mucosa (40%) on endoscopy.ConclusionIdentification of complex glands on VLE may aid in detection of HGD or early cancer in the gastric cardia in BE. This is particularly important, as dysplasia at the gastric cardia can be difficult to see endoscopically.

Download Full-text

Cost of care for prostate cancer patients: An observational cohort study comparing clinical trials to standard care.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.184 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 184-184

Author(s):

B. Jones ◽

R. Syme ◽

M. Eliasziw ◽

B. J. Eigl

Keyword(s):

Prostate Cancer ◽

Clinical Trials ◽

Cohort Study ◽

Cancer Patients ◽

Resource Utilization ◽

Standard Care ◽

Standard Of Care ◽

Observational Cohort Study ◽

Observational Cohort ◽

The Cost

184 Background: Monetary support of clinical trials is a fundamental necessity for improving treatment and prevention methods; however, current economic data pertaining to the per-patient costs of treating prostate cancer are limited. A concurrent lack of certainty regarding the cost requirements of standard care patients makes it difficult for healthcare professionals and policy makers to generate informed decisions regarding budgets and funding needs. Prostate cancer clinical trials are facing a national funding crisis due to the perception that patients enrolled in clinical trials consume more resources than patients receiving standard care. Methods: A retrospective observational cohort study was conducted to examine the costs incurred by prostate cancer patients at the Tom Baker Cancer Center over one year. Costs for 36 patients enrolled in one of nine cancer trials were compared with costs for 36 matched control subjects who received standard care. Resource utilization was tracked using medical charts and quantified by prices listed in the TBCC's 2009 Clinical Trials Budget template. Results: No evidence was found to support a difference in overall resource utilization between clinical trial patients and standard of care patients (Paired two-tailed t- test, N= 36, p =0.90). There was, however, variability in the types of resources used by each patient population, indicating that, while trial patients may take up significantly more clinic time (p =0.04), undergo more tests and procedures (p < 0.001) and require more diagnostic imaging (p = 0.01), standard care patients are more likely to receive costly interventions such as radiation therapy (p =0.06). Pharmaceutical costs have not yet been included in the analysis and could drastically alter the final results. Conclusions: This study revealed differences in the cost distribution of clinical trials patients versus standard of care patients, which could be used by administrators to improve budgeting and time allocation. The lack of difference in overall cost may be helpful to research advocates attempting to encourage centers to take on more trials. Further analysis is required before definitive conclusions can be drawn. No significant financial relationships to disclose.

Download Full-text

Treatment of Staphylococcal Device Infections: Synergistic Daptomycin With Ceftaroline Versus Rifampin-Adjunct Therapy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa072 ◽

2020 ◽

Vol 7 (3) ◽

Cited By ~ 1

Author(s):

Amy T Chang ◽

Reese A Cosimi ◽

Markian R Bochan

Keyword(s):

Cohort Study ◽

Combination Therapy ◽

Standard Of Care ◽

Observational Cohort Study ◽

Single Center ◽

Adjunct Therapy ◽

Observational Cohort ◽

Study Support ◽

Retrospective Observational Cohort Study

This is a single-center retrospective observational cohort study comparing daptomycin/ceftaroline combination therapy with rifampin-adjunct therapy for the treatment of staphylococcal device infections. The results of this study support use of the daptomycin/ceftaroline as an alternative or salvage option to standard of care.

Download Full-text