Do cancer-specific variables improve risk-adjusted hospital quality comparisons?

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 585-585 ◽  
Author(s):  
Ryan P. Merkow ◽  
Thomas E. Kmiecik ◽  
David J Bentrem ◽  
Mark E Cohen ◽  
Bruce L Hall ◽  
...  
Keyword(s):  
Neoadjuvant Therapy ◽  
Colorectal Resection ◽  
Predictive Ability ◽  
Hospital Quality ◽  
Short Term ◽  
Combined Model ◽  
Related Factors ◽  
Fit Statistics ◽  
C Statistic ◽  
Improved Model

585 Background: For patients undergoing surgery for cancer, it has been suggested that risk-adjustment with cancer-specific variables is needed when evaluating short-term outcomes. Our objectives were to assess the influence of cancer-related variables on postoperative complications and hospital quality comparisons. Methods: Patients from ACS NSQIP and NCDB who underwent colorectal resection for cancer were linked (2006-2008) to create a dataset containing robust information on comorbidities, complications, and oncologic variables. Three hierarchical models were developed predicting the NSQIP outcome 30-day mortality or any serious morbidity using variables from (1) NSQIP only, (2) NCDB only, and (3) a combined model using NSQIP and NCDB. Models were compared with fit statistics and hospital outlier agreement. Results: From 146 NSQIP hospitals, 11401 patients underwent a colorectal resection for cancer, of which, 1954 (17%) experienced a mortality or serious morbidity event. The first five variables selected in the NCDB-only model were Charlson comorbidity score, neoadjuvant therapy use, T stage, primary payer, and M stage (c-statistic, 0.64; AIC, 9886). The first five variables selected in the NSQIP-only model were ASA class, preop sepsis, albumin, surgical procedure, and COPD (c-statistic, 0.66; AIC, 9787). In the combined model, neoadjuvant therapy use was the only cancer-specific variable selected in the top five. The remaining variables were ASA class, preop sepsis, albumin, and wound class (c-statistic, 0.67; AIC, 9455). At the hospital-level, the NCDB-only model identified three high outliers (worse than expected) and one low outlier (better than expected). Both the NSQIP-only and combined models identified the same four high and two low outlying hospitals (kappa: 1.0), which agreed marginally with the NCDB-only model (kappa: 0.59). Conclusions: Addition of cancer-specific variables to NSQIP models slightly improved model fit; however, hospital outcome comparisons were identical. For patients with colorectal cancer undergoing resection, cancer-related factors have limited predictive ability for short-term outcomes and did not influence hospital quality comparisons.

An Improved Model for Short-Term Traffic Forecasting Considering Weather Impacts

CICTP 2017 ◽  
2018 ◽  
Author(s):  
Xinchao Chen ◽  
Si Qin ◽  
Jian Zhang ◽  
Huachun Tan ◽  
Yunxia Xu ◽  
...  
Keyword(s):  
Short Term ◽  
Traffic Forecasting ◽  
Improved Model ◽  
Weather Impacts

Predictive value of short-term migration in determining long-term stable fixation in cemented and cementless total knee arthroplasties

2019 ◽  
Vol 101-B (7_Supple_C) ◽  
pp. 55-60 ◽  
Author(s):  
E. K. Laende ◽  
C. G. Richardson ◽  
M. J. Dunbar
Keyword(s):  
Predictive Value ◽  
Predictive Ability ◽  
Porous Metal ◽  
Short Term ◽  
Long Term Follow Up ◽  
Total Knee ◽  
Total Point ◽  
Cementless Components

Aims Early implant migration measured with radiostereometric analysis (RSA) has been proposed as a useful predictor of long-term fixation of tibial components in total knee arthroplasty. Evaluation of actual long-term fixation is of interest for cemented components, as well as for cementless fixation, which may offer long-term advantages once osseointegration has occurred. The objective of this study was to compare the long-term migration with one- and two-year migration to evaluate the predictive ability of short-term migration data and to compare migration and inducible displacement between cemented and cementless (porous metal monoblock) components at least ten years postoperatively. Patients and Methods Patients who had participated in RSA migration studies with two-year follow-up were recruited to return for a long-term follow-up, at least ten years from surgery. Two cemented tibial designs from two manufacturers and one porous metal monoblock cementless tibial design were studied. At the long-term follow-up, patients had supine RSA examinations to determine migration and loaded examinations (single leg stance) to determine inducible displacement. In total, 79 patients (54 female) returned, with mean time since surgery of 12 years (10 to 14). There were 58 cemented and 21 cementless tibial components. Results Migration at one year and two years was significantly correlated with long-term migration (p < 0.001). Median migration at the long-term follow-up was 0.6 mm (maximum total point motion; interquartile range (IQR) 0.4 to 0.9) for the cemented group and 0.6 mm (IQR 0.3 to 1.1) for the cementless group with no difference between groups (p = 0.99). Inducible displacement was significantly lower for the cementless components (p < 0.001). Conclusion Long-term migration was strongly correlated with two-year migration. Although long-term migration was not different for cemented or cementless tibial components, inducible displacement at the long-term visit was significantly lower for these cementless components, suggesting superior fixation. These findings support the predictive value of short-term migration in determining long-term fixation. Cite this article: Bone Joint J 2019;101-B(7 Supple C):55–60

scholarly journals Hemophagocytic Lymphohistiocytosis: Prevalence, Risk Factors, Outcome, and Outcome-related Factors in Adult Idiopathic Inflammatory Myopathies

2019 ◽  
Vol 47 (10) ◽  
pp. 1532-1540 ◽  
Author(s):  
Junyu Liang ◽  
Danyi Xu ◽  
Chuanyin Sun ◽  
Weiqian Chen ◽  
Heng Cao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Disease Activity ◽  
Case Control Study ◽  
Case Control ◽  
Short Term ◽  
Related Factors ◽  
Term Outcome ◽  
Factors Influencing ◽  
Short Term Outcome ◽  
Control Study

Objective.To clarify the prevalence, risk factors, outcome, and outcome-related factors of hemophagocytic lymphohistiocytosis (HLH) in patients with dermatomyositis (DM), polymyositis (PM), or clinically amyopathic dermatomyositis (CADM).Methods.Data of patients with DM, PM, or CADM who were admitted to the First Affiliated Hospital of Zhejiang University from February 2011 to February 2019 were retrospectively collected. Patients diagnosed with HLH constituted the case group. A 1:4 case-control study was performed to identify risk factors for HLH in patients with DM, PM, or CADM through comparison, univariate, and multivariate logistic regression analysis. Intragroup comparison was made among patients with HLH to identify factors influencing unfavorable short-term outcome.Results.HLH was a rare (4.2%) but fatal (77.8%) complication in patients with DM, PM, or CADM. The retrospective case-control study revealed that higher on-admission disease activity (p = 0.008), acute exacerbation of interstitial lung disease (AE-ILD, p = 0.002), and infection (p = 0.002) were risk factors for complication of HLH in patients with DM, PM, or CADM. The following intragroup comparison showed that higher on-admission disease activity (p = 0.035) and diagnosis of CADM (p = 0.039) might influence the short-term outcome of patients with HLH. However, no risk factor was identified after false discovery rate correction.Conclusion.In this study, secondary HLH was a fatal complication, with higher on-admission disease activity, AE-ILD, and infection working as risk factors. The underlying role of infection and autoimmune abnormality in HLH in connective tissue disease was subsequently noted. Clinical factors influencing the short-term outcome of patients with secondary HLH require further study.

scholarly journals Dermal Advanced REACH Tool (dART)—Development of a Dermal Exposure Model for Low-Volatile Liquids

2019 ◽  
Vol 63 (6) ◽  
pp. 624-636 ◽  
Author(s):  
Henk A Goede ◽  
Kevin McNally ◽  
Jean-Philippe Gorce ◽  
Hans Marquart ◽  
Nick D Warren ◽  
...  
Keyword(s):  
Mechanistic Model ◽  
Predictive Ability ◽  
Field Studies ◽  
Dermal Exposure ◽  
Exposure Model ◽  
Sufficient Evidence ◽  
Software Platform ◽  
Related Factors ◽  
Direct Emission ◽  
Volatile Liquids

Abstract This article describes the development of a mechanistic model for underpinning the dermal Advanced REACH Tool (dART), an extension of the existing ART model and its software platform. It was developed for hand exposure to low volatile liquids (vapour pressure ≤ 10 Pa at 20°C) including solids-in-liquid products. The model is based on an existing conceptual dermal source-receptor model that has been integrated into the ART framework. A structured taxonomy of workplace activities referred to as activity classes are adopted from ART.  Three key processes involved in mass transport associated with dermal exposure are applied, i.e. deposition, direct emission and contact, and transfer. For deposition, the model adopts all the relevant modifying factors (MFs) applied in ART. In terms of direct emission and contact (e.g. splashes) and transfer (e.g. hand-surface contacts), the model defines independent principal MFs, i.e. substance-related factors, activity-related factors, localized- and dispersion control and exposed surface area of the hands. To address event-based exposures as much as possible, the model includes crucial events during an activity (e.g. hand immersions) and translates objective information on tools and equipment (manual or automated) to probable events (e.g. splashes) and worker behaviours (e.g. surface contacts). Based on an extensive review of peer-reviewed literature and unpublished field studies, multipliers were assigned to each determinant and provide an approximated (dimensionless) numerical value. In the absence of (sufficient) evidence, multipliers were assigned to determinants based on assumptions made during discussions by experts in the consortium. A worked example is presented to illustrate the calculation of hand exposure for a specific scenario. The dART model is not yet implemented in the ART software platform, and a robust validation of the model is necessary to determine its predictive ability. With advancing knowledge on dermal exposure and its determinants, this model will require periodic updates and refinements, in addition to further expansion of the applicability domain of the model.

scholarly journals MODELLING THE MELTING TEMPERATURE OF A LIPID‐BASED CRITICAL TEMPERATURE INDICATOR: A COMPARISION BETWEEN SIMPLEX-LATTICE AND SIMPLEX-CENTROID DESIGNS

2018 ◽  
Vol 35 (2) ◽  
Author(s):  
KARINE CRISTINE KAUFMANN ◽  
ODINEI HESS GONÇALVES ◽  
EVANDRO BONA ◽  
FERNANDA VITÓRIA LEIMANN
Keyword(s):  
Critical Temperature ◽  
Melting Point ◽  
Melting Temperature ◽  
Predictive Ability ◽  
Ternary Mixtures ◽  
Lipid Mixture ◽  
Color Changes ◽  
Lattice Design ◽  
Simplex Lattice ◽  
Improved Model

Critical temperature indicators (CTI) find applications in food industry in cases when defrost may not occur or a specific temperature may not be reached, , indicating changes through visual changes, such as melting, color changes, etc. Lipid mixtures are promising candidates to formulate CTI since the final melting point of the mixture may be manipulated by the proportion of each lipid. In this work a lipid mixture consisting of stearic acid, lard and peanut oil was used to develop a CTI mixture. Simplex-lattice and Simplex-centroid experimental designs were compared to modelling the melting temperature of the lipid mixture. Addition of axial points to the experimental design improved predictive ability of the models while the inclusion of inverse terms was necessary to improve models accuracy. Simplex-lattice design presented an improved ability to predict the melting point of binary mixtures, while the simplex-centroid design resulted in an improved model for predicting melting point of the ternary mixtures

scholarly journals Gleason Score and Lethal Prostate Cancer: Does 3 + 4 = 4 + 3?

2009 ◽  
Vol 27 (21) ◽  
pp. 3459-3464 ◽  
Author(s):  
Jennifer R. Stark ◽  
Sven Perner ◽  
Meir J. Stampfer ◽  
Jennifer A. Sinnott ◽  
Stephen Finn ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Predictive Ability ◽  
Fold Increase ◽  
Health Study ◽  
Prognostic Information ◽  
Gleason Grading ◽  
Gleason Pattern ◽  
C Statistic ◽  
Bony Metastases

Purpose Gleason grading is an important predictor of prostate cancer (PCa) outcomes. Studies using surrogate PCa end points suggest outcomes for Gleason score (GS) 7 cancers vary according to the predominance of pattern 4. These studies have influenced clinical practice, but it is unclear if rates of PCa mortality differ for 3 + 4 and 4 + 3 tumors. Using PCa mortality as the primary end point, we compared outcomes in Gleason 3 + 4 and 4 + 3 cancers, and the predictive ability of GS from a standardized review versus original scoring. Patients and Methods Three study pathologists conducted a blinded standardized review of 693 prostatectomy and 119 biopsy specimens to assign primary and secondary Gleason patterns. Tumor specimens were from PCa patients diagnosed between 1984 and 2004 from the Physicians' Health Study and Health Professionals Follow-Up Study. Lethal PCa (n = 53) was defined as development of bony metastases or PCa death. Hazard ratios (HR) were estimated according to original GS and standardized GS. We compared the discrimination of standardized and original grading with C-statistics from models of 10-year survival. Results For prostatectomy specimens, 4 + 3 cancers were associated with a three-fold increase in lethal PCa compared with 3 + 4 cancers (95% CI, 1.1 to 8.6). The discrimination of models of standardized scores from prostatectomy (C-statistic, 0.86) and biopsy (C-statistic, 0.85) were improved compared to models of original scores (prostatectomy C-statistic, 0.82; biopsy C-statistic, 0.72). Conclusion Ignoring the predominance of Gleason pattern 4 in GS 7 cancers may conceal important prognostic information. A standardized review of GS can improve prediction of PCa survival.

Surgery Related Factors Do Not Affect Short-Term Adjacent Segment Kinematics After Anterior Cervical Arthrodesis

Spine ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Stephen R. Chen ◽  
Clarissa M. LeVasseur ◽  
Samuel Pitcairn ◽  
Adam S. Kanter ◽  
David O. Okonkwo ◽  
...  
Keyword(s):  
Adjacent Segment ◽  
Short Term ◽  
Related Factors

Abstract P011: Predictive Ability of 35 Frailty Scores for Cardiovascular Events in the General Population

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Gloria A Aguayo ◽  
Anna Schritz ◽  
Anne-Françoise Donneau ◽  
Michel T Vaillant ◽  
Saverio Stranges ◽  
...  
Keyword(s):  
Proportional Hazards Model ◽  
Assessment Tool ◽  
Frailty Index ◽  
Predictive Ability ◽  
Continuous Variable ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Discriminative Ability ◽  
Basic Model ◽  
C Statistic

Introduction: Frailty is a state of vulnerability in elderly people linked to higher mortality risk. Cardiovascular disease (CVD) is highly prevalent in aged populations and associated with frailty. Thus, frailty state could predict higher risk of CVD. Many frailty scores (FS) have been developed, but none of them is considered the gold standard. We aimed to compare predictive and discriminative ability of an extensive list of FS with regard to incidence of CVD in a sample of the general elderly population in England. We assessed the hypothesis that some FS will have better predictive ability than others, depending on their characteristics. Methods: We performed a prospective analysis of the association between 35 FS in participants free of CVD at baseline wave 2 of the English Longitudinal Study of Ageing (2004-2005), and incident CVD assessed until February 2012. The sample consisted of 4,177 participants (43.0 % men). Hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated for each FS using Cox proportional hazards model, adjusted for demographic, lifestyle and comorbidity variables. FS were analyzed on a continuous scale and using original cutoffs. The added predictive ability of FS beyond a basic model consisting of sex and age was studied using Harrel’s C statistic (the higher the better). Results: The median follow-up was 5.8 years, the incidence rate of CVD events was 301.2 /10,000 person-years and CVD represented 28% of the total cause of death. The mean age was 70.5 (SD: ±7.8) years. In fully-adjusted models with demographics, lifestyles and comorbidity, HRs ranged from: 1.0 (0.7; 1.6) to 12.7 (5.5; 29.3). Using cutoffs, HRs ranged from 0.7 (0.2; 1.9) to 1.8 (1.3; 2.5). Adjusted for sex and age, delta Harrel’s C statistic ranged from -0.8 (-3.4; 1.8) to 3.0 (-0.4; 6.4). The best CVD predictive ability was found for the Frailty Index with 70 variables and the Comprehensive Geriatric Assessment screening FS for continuous and cutoff analyses respectively. In conclusion, there is high variability in the association between different published FS and incident CVD. FS have better predictive ability used as continuous variable. Although most of the analyzed FS have good predictive ability with regard to incident CVD, they do not significantly improve on the discriminative capacity of a basic model. Our results will help to guide clinicians, researchers and public health practitioners in choosing the most informative frailty assessment tool.

Doctors and Teachers

2021 ◽  
pp. 94-101
Author(s):  
Dominic Scott ◽  
R. Edward Freeman
Keyword(s):  
Informed Consent ◽  
Case Studies ◽  
Doctor Who ◽  
Short Term ◽  
Combined Model ◽  
Rational Persuasion ◽  
The Way

This chapter examines the way the models of the doctor and the teacher can be combined, where the leader as doctor makes their remedies more palatable to their followers by rational persuasion. The first part describes this combined model in Plato’s last work, the Laws, where the legislator is compared to a doctor who listens to his patients and then educates them about the nature and origin of their disease. Combining the two models anticipates our notion of ‘informed consent’: if the patient/follower is addressed rationally, they will be more inclined to take the remedy. The second part uses two case studies from previous chapters: Roy Vagelos, who appeared as an example of the corporate doctor, can also been seen as a teacher; and Indra Nooyi, who educated her stakeholders at Pepsi and can be seen as a corporate doctor, trying to ween the company off short-term thinking.

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