Impact of the Spinal Instability Neoplastic Score on Surgical Referral Patterns and Outcomes

Background The Spinal Instability Neoplastic Score (sins) was developed to identify patients with spinal metastases who may benefit from surgical consultation. We aimed to assess the distribution of sins in a population-based cohort of patients undergoing palliative spine radiotherapy (rt) and referral rates to spinal surgery pre-rt. Secondary outcomes included referral to a spine surgeon post-rt, overall survival, maintenance of ambulation, need for re-intervention, and presence of spinal adverse events.Methods We retrospectively reviewed ct simulation scans and charts of consecutive patients receiving palliative spine rt between 2012 and 2013. Data were analyzed using Student’s t-test, Chi-squared, Fisher’s exact, and Kaplan-Meier log-rank tests. Patients were stratified into low (<7) and high (≥7) sins groups.Results We included 195 patients with a follow-up of 6.1 months. The median sins was 7. The score was 0 to 6 (low, no referral recommended), 7 to 12 (intermediate, consider referral), and 13 to 18 (high, referral suggested) in 34%, 59%, and 7% of patients, respectively. Eleven patients had pre-rt referral to spine surgery, with a surgery performed in 0 of 1 patient with sins 0 to 6, 1 of 7 with sins 7 to 12, and 1 of 3 with sins 13 to 18. Seven patients were referred to a surgeon post-rt with salvage surgery performed in two of those patients. Primary and secondary outcomes did not differ between low and high sins groups.Conclusion Higher sins was associated with pre-rt referral to a spine surgeon, but most patients with high sins were not referred. Higher sins was not associated with shorter survival or worse outcome following rt.

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Comparison of Survival Rates of Stainless-Steel Crowns Placed with and without Pulpotomy: A Two-Year Retrospective Study

International Journal of Dentistry ◽

10.1155/2020/8883189 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Fatmah N. AlMotawah ◽

Sharat Chandra Pani ◽

Tala AlKharashi ◽

Saleh AlKhalaf ◽

Mohammed AlKhathlan ◽

...

Keyword(s):

Stainless Steel ◽

General Anesthesia ◽

Survival Rates ◽

Survival Outcome ◽

Survival Outcomes ◽

Proximal Caries ◽

Kaplan Meier ◽

Significant Difference ◽

Chi Squared

Aim. This study aimed to retrospectively compare the survival outcomes over two years between teeth with proximal dental caries that were restored with stainless-steel crowns to those that were pulpotomized and then restored with a stainless-steel crown in patients who were rehabilitated under general anesthesia. Participants and Methods. The records of 131 patients aged between two to six years who had stainless-steel crowns placed under general anesthesia and had two-year follow-up were screened. 340 teeth with moderate proximal caries on the radiograph (D2) were included in the study. Of these, 164 teeth were treated with a pulpotomy and stainless-steel crown, while 176 teeth were crowned without a pulpotomy. The type of each tooth was compared using the Chi-squared test and Kaplan–Meier survival analysis, and curves were plotted based on the two-year outcomes. Results. Treatment: the sample comprised 59 males (mean age 4.73 years, SD ± 1.4 years) and 72 females (mean age 5.2 years, SD ± 2.0 years). The Kaplan–Meier regression model showed no significant difference in survival outcomes between teeth that had been pulpotomized and those that had not ( p = 0.283). Conclusion. Within the limitations of the current study, we can conclude that performing a pulpotomy does not influence the survival outcome of mild/moderate proximal caries restored with stainless-steel crowns under general anesthesia.

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Population-based cohort study examining the association between splenectomy and empyema in adults in Taiwan

BMJ Open ◽

10.1136/bmjopen-2016-015101 ◽

2017 ◽

Vol 7 (9) ◽

pp. e015101 ◽

Cited By ~ 12

Author(s):

Hsien-Feng Lin ◽

Kuan-Fu Liao ◽

Ching-Mei Chang ◽

Cheng-Li Lin ◽

Shih-Wei Lai

Keyword(s):

Cohort Study ◽

Incidence Rate ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Proportional Hazards Regression ◽

Kaplan Meier ◽

Confounding Variables ◽

Taiwan National Health Insurance

ObjectiveThis study aimed to investigate the association between splenectomy and empyema in Taiwan.MethodsA population-based cohort study was conducted using the hospitalisation dataset of the Taiwan National Health Insurance Program. A total of 13 193 subjects aged 20–84 years who were newly diagnosed with splenectomy from 2000 to 2010 were enrolled in the splenectomy group and 52 464 randomly selected subjects without splenectomy were enrolled in the non-splenectomy group. Both groups were matched by sex, age, comorbidities and the index year of undergoing splenectomy. The incidence of empyema at the end of 2011 was calculated. A multivariable Cox proportional hazards regression model was used to estimate the HR with 95% CI of empyema associated with splenectomy and other comorbidities.ResultsThe overall incidence rate of empyema was 2.56-fold higher in the splenectomy group than in the non-splenectomy group (8.85 vs 3.46 per 1000 person-years). The Kaplan-Meier analysis revealed a higher cumulative incidence of empyema in the splenectomy group than in the non-splenectomy group (6.99% vs 3.37% at the end of follow-up). After adjusting for confounding variables, the adjusted HR of empyema was 2.89 for the splenectomy group compared with that for the non-splenectomy group. Further analysis revealed that HR of empyema was 4.52 for subjects with splenectomy alone.ConclusionThe incidence rate ratio between the splenectomy and non-splenectomy groups reduced from 2.87 in the first 5 years of follow-up to 1.73 in the period following the 5 years. Future studies are required to confirm whether a longer follow-up period would further reduce this average ratio. For the splenectomy group, the overall HR of developing empyema was 2.89 after adjusting for age, sex and comorbidities, which was identified from previous literature. The risk of empyema following splenectomy remains high despite the absence of these comorbidities.

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Emergency Health Care Use among Sociodemographic Groups of Children Presenting to Emergency Departments for Self-Harm in Alberta

CJEM ◽

10.1017/cem.2015.1 ◽

2015 ◽

Vol 17 (5) ◽

pp. 497-506

Author(s):

Amanda S. Newton ◽

Conrad I. Tsang ◽

Rhonda J. Rosychuk

Keyword(s):

Health Care ◽

First Nations ◽

Emergency Departments ◽

Population Based ◽

Health Care Use ◽

Administrative Databases ◽

Sociodemographic Differences ◽

Kaplan Meier ◽

Self Harm

AbstractObjectiveTo examine sociodemographic variations among children <18 years in (1) rates of self-harm visits to emergency departments (EDs) and (2) physician follow-up after the self-harm visit in Alberta.MethodsA retrospective, population-based cohort (2002–2011) of ED visits for self-harm by individuals <18 years was conducted using administrative databases from Alberta, Canada. Individuals were grouped by First Nations status or type of health care premium subsidy (family receipt of government subsidy, human services program subsidy, no subsidy received). Visits from 104 EDs were summarized by crude and directly standardized visit rates (DSVRs) per 100,000 individuals. Kaplan-Meier estimates for median estimated time to physician follow-up were calculated with 95% confidence intervals (CIs).ResultsDuring the study period, visit rates decreased with the exception of children from families receiving government-sponsored program subsidy (DSVRs 163/100,000 to 250/100,000;p=0.032). First Nations children had disproportionately fewer follow-up visits compared to other children. The median time to follow-up for First Nations children was 39 days (95% CI: 32, 48) compared to 16 days for children from families receiving no subsidy (95% CI: 14, 19), who had the shortest follow-up time after an ED visit.ConclusionsSociodemographic differences were evident in ED visit rates as well as the number of and time to physician follow-up visit. The disparities experienced by First Nations children in the follow-up period highlight an opportunity for culturally-grounded risk and needs assessment in the ED to determine and facilitate timely and appropriate follow-up care.

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The Predictive Effect of Health Examination in the Incidence of Diabetes Mellitus in Chinese Adults: A Population-Based Cohort Study

Journal of Diabetes Research ◽

10.1155/2021/3552080 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Xiaomin Fu ◽

Yingmin Jia ◽

Jing Liu ◽

Qinghua Lei ◽

Lele Li ◽

...

Keyword(s):

Diabetes Mellitus ◽

Cox Regression ◽

Population Based ◽

Health Examination ◽

The Public ◽

Kaplan Meier ◽

Potential Risk Factors ◽

The Relationship ◽

Predictive Effect

Background. The incidence of diabetes mellitus (DM) was increasing in recent years, and it is important to screen those nondiabetic populations through health examination to detect the potential risk factors for DM. We aimed to find the predictive effect of health examination on DM. Methods. We used the public database from Rich Healthcare Group of China to evaluate the potential predictive effect of health examination in the onset of DM. The colinear regression was used for estimating the relationship between the dynamics of the health examination index and the incident year of DM. The time-dependent ROC was used to calculate the best cutoff in predicting DM in the follow-up year. The Kaplan-Meier method and Cox regression were used to evaluate the HR of related health examination. Results. A total of 211,833 participant medical records were included in our study, with 4,172 participants diagnosing as DM in the following years (among 2-7 years). All the initial health examination was significantly different in participants’ final diagnosing as DM to those without DM. We found a negative correlation between the incidence of years of DM and the average initial FPG ( r = − 0.1862 , P < 0.001 ). Moreover, the initial FPG had a strong predictive effect in predicting the future incidence of DM ( AUC = 0.961 ), and the cutoff was 5.21 mmol/L. Participants with a higher initial FPG (>5.21 mmol/L) had a 2.73-fold chance to develop as DM in follow-up ( 95 % CI = 2.65 – 2.81 , P < 0.001 ). Conclusion. Initial FPG had a good predictive effect for detecting DM. The FPG should be controlled less than 5.21 mmol/L.

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879. Evaluation of the Incidence of Hypertension, Diabetes, and Hyperlipidemia in Patients on Antiretroviral Therapy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1074 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S531-S531

Author(s):

Niha Idrees ◽

Yu Jin Hwang ◽

Sabreen Arman ◽

Razan Hendi ◽

Sarah M Michienzi ◽

...

Keyword(s):

Weight Gain ◽

Primary Outcome ◽

Integrase Inhibitor ◽

Transcriptase Inhibitor ◽

Drug Classes ◽

Significant Difference ◽

Chi Squared ◽

Secondary Outcomes ◽

Metabolic Comorbidities

Abstract Background Although integrase inhibitor (INSTI)-based regimens have been associated with weight gain, there is limited data on whether INSTIs cause long-term metabolic consequences. This study evaluated the effect of INSTIs on the development of metabolic comorbidities compared to non-nucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor (PI)-based therapies in patients in the Illinois Department of Corrections. Methods This retrospective cohort study consisted of incarcerated adult patients living with HIV and receiving a guideline-recommended regimen between 7/12/10 and 12/31/19. Patients with a pre-existing diagnosis of diabetes, hypertension, or hyperlipidemia, or lack of medical follow-up data were excluded. The primary outcome was to compare the incidence of a metabolic comorbidity between regimens. Secondary outcomes compared the incidence of weight gain, diabetes, hypertension, and hyperlipidemia as separate outcomes between drug classes. Demographics and pertinent labs were collected. Data was analyzed with ANOVA, chi-squared, and paired t-tests. The primary outcome was adjusted for age, race, use of antipsychotic medications, and family history of metabolic comorbidities. Results A total of 206 patients were included in the analysis with mean follow-up time of 31.5 ± 19.4 months. Majority of patients were Black (69%) and male (91%). A total of 42 patients developed a metabolic comorbidity (Table 1). After adjustment for confounding factors, there was a significant difference in the development of comorbidities between the treatment groups (p=0.031) with INSTI use being more likely to develop a comorbidity than NNRTI (p=0.004). No difference was found between INSTI and PI use (p=0.518). Development of hypertension was significantly higher in the INSTI group than NNRTI group (p=0.014), while the development of diabetes and hyperlipidemia were not. Weight and BMI were significantly higher regardless of antiretroviral (Table 2). No differences were found in the primary outcome between agents within the same drug class or between 1st or 2nd generation INSTIs. Table 1. Results of Primary and Secondary Outcomes Table 2. Impact of HIV regimen on weight and BMI after 1 year Conclusion All antiretrovirals were linked to weight gain but INSTIs were associated with increased incidence of hypertension. Disclosures All Authors: No reported disclosures

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MANAGEMENT AND OUTCOME OF STAGE I SEMINOMA IN ONTARIO.

Clinical & Investigative Medicine ◽

10.25011/cim.v31i4.4786 ◽

2008 ◽

Vol 31 (4) ◽

pp. 2

Author(s):

Howard H An ◽

Paul Y Peng ◽

William J Mackillop

Keyword(s):

Testicular Cancer ◽

Patient Outcomes ◽

Management Strategies ◽

Patient Characteristics ◽

Population Based ◽

Stage I ◽

Adjuvant Radiation ◽

Chi Squared ◽

Stage I Seminoma ◽

Student’S T

Purpose: To describe the uptake and use of surveillance andirradiation in stage I seminoma post-orchiectomy in Ontario and to evaluate theimpact of these management strategies on patient outcomes. Background: Testicular cancer is the most common cancer in menbetween the ages of 20 and 44 (1). About half of testicular cancers areseminomas (2). Overall 85% of seminoma patients present with stage I disease with10-year survival over 99%. Adjuvant radiation therapy once constituted thestandard of care but surveillance as a post-orchiectomy management strategy isnow preferred in Ontario (3). Treatment with radiation results in importantlong-term toxicities (2). The actual management patterns and the effect ofthese patterns on seminoma patient outcomes is unknown. This will be the firstphase IV study to describe the management of stage I seminoma and to evaluateit’s effect on patient outcomes. Methods: This is a retrospective, population based cohort studyof seminoma patients in Ontario. Cases of seminoma are identified through theOntario Cancer Registry and linked with patient data from the CanadianInstitute of Health Information and Ontario radiotherapy data. An instrumentalvariable approach will be taken with time and location of treatment as theinstruments. Mantel-Haensel Chi-Squared tests, Student’s T-test, and Log ranktests will be used to find differences in patient characteristics, morbidity andsurvival. The Kaplan-Meier method will be used to model overall survival. Results and Conclusions:Pending data analysis. References: 1. Warde P, Srugeon J,Gospodarowicz M. Testicular Cancer. In: Gunderson L, Tepper J, eds. Clinicalradiation oncology. Philadelphia: Chruchill Livingstone; 2000: 844-862. 2. Nichols CR, Hung A, Corless CL, Foster RS, Roth BJ, Einhorn LH.Testis cancer. In: Kufe DW, Frei III E, Holland JF, Weichselbaum RR, PollockRE, Bast Jr RC, Hong WK, Hait WN, eds. Holland-Frei cancer medicine – 7^thEd.[e-book], Columbia: BC Decker; 2006 [cited 2008 Mar 17]: ch. 99. Availablefrom: Stat!Ref. 3. Chung P, Mayhew LA, Warde P, Winquist E, Lukka H et al. Management of stage I seminoma: Guidelinerecommendations. Cancer Care Ontario, Evidence-Based Series #3-18: Section1; Report date: 30 Jan 2008.

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Characterization of neuroblastic tumors as developmental cancers with survival determined by histology, age, and location.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.10046 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 10046-10046

Author(s):

Karen Elizabeth Effinger ◽

Lindsey Elizabeth Merrihew ◽

Paul Graham Fisher

Keyword(s):

Primary Tumor ◽

Poor Response ◽

Tumor Location ◽

Population Based ◽

Response To Therapy ◽

Kaplan Meier ◽

Chi Squared ◽

Neuroblastic Tumors ◽

Cox Proportional Hazard Regression ◽

Head Neck

10046 Background: Mortality associated with peripheral neuroblastic tumors (pNT), comprising neuroblastoma (NB) and ganglioneuroblastoma (GNB), varies with some tumors spontaneously regressing and others showing poor response to therapy, indicating different biologic mechanisms. We aimed to determine how epidemiologic constructs inform the underlying biology of pNT. Methods: Using the Surveillance Epidemiology and End Results (SEER 18) population-based registry, we identified 3,540 pNT (3,003 NB and 537 GNB) in patients from 1973-2009. Differences in histology (NB vs. GNB), gender, age (<18 months, 18 months-4 years, 5-14 years, or ≥15 years), race (white, black, or other), location of primary tumor (adrenal, abdominal, chest, head/neck, pelvic, or other), and stage (locoregional vs. metastatic) were evaluated with chi-squared tests using SAS 9.3. Kaplan Meier curves with log-rank tests as well as univariate and multivariate Cox proportional hazard regression methods were employed to determine the influence of these factors on survival. Results: NB occurred more frequently in infants (50%), arose in the adrenals (45%), and were metastatic at diagnosis (57%), while GNB more often affected children 18 months-4 years (48%, p <0.001), occurred in the chest (31%, p <0.001), and were locoregional (78%, p <0.001). The 5-year overall survival (OS) rate in NB was 59% compared to 80% in GNB (p <0.001). In NB, the 5-year OS rate was 81% in infants <18 months and 21-39% in the older groups (p <0.001); however, in GNB, the 5-year OS was 40% in subjects >15 years and 81-93% in the younger groups (p <0.001). In multivariate analysis of pNT, neuroblastoma, age >18 months, adrenal site of primary tumor, and metastatic disease were independent poor prognostic factors. Chest (HR 0.27 [0.21-0.35]), head/neck (HR 0.34 [0.20-0.52]), and pelvic (HR 0.35 [0.24-0.52]) tumors had the most improved survival compared to adrenal primaries. Conclusions: Although pNT are often evaluated together, NB and GNB represent two significantly distinct diseases. For each, survival is strongly determined by age, primary tumor location, and stage. These differences may stem from unique developmental mechanisms underlying tumorigenesis.

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Does the frequency of routine follow-up after curative treatment for head-and-neck cancer affect survival?

Current Oncology ◽

10.3747/co.26.4949 ◽

2019 ◽

Vol 26 (5) ◽

Author(s):

S. F. Hall ◽

T. Owen ◽

R. J. Griffiths ◽

K. Brennan

Keyword(s):

Health Care ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Population Based ◽

Kaplan Meier ◽

Multiple Variable ◽

Multiple Variable Regression ◽

Oncology Practice

Background: Routine follow-up is a cornerstone of oncology practice but evidence is lacking to support most aspects. Our Objective was to investigate the relationship between frequency of routine follow-up and survival.Methods: A population-based study using electronic health-care data based on 5310 patients from Ontario diagnosed with squamous cell head and neck cancer between 2007 and 2012. Treatments included surgery (24.6%), radiotherapy +/- chemotherapy (52.4%) and combined surgery and radiotherapy (23%). We determined the follow-up oncologist for each patient, calculated the average follow-up visits over 2.5 years for all the patients of each oncologist and compared by treatment the overall survival of the patients for the high, medium and low follow-up oncologist groups using Kaplan Meier and multiple variable regression analysis. Results: Many oncologists saw patients 40 to 80% more often than others. There was no relationship between appointment frequency and survival for patients for any treatment group.Conclusion: The practice of routine follow-up varies and is costly to both a health care system and to patients. Without evidence on the effectiveness of our current policies further research is required to investigate new or optimal practices.

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Changes in Spinal Instability After Combined Therapy of Conventional Radiotherapy and Bone Modifying Agents for Painful Vertebral Bone Metastases

10.21203/rs.3.rs-258203/v1 ◽

2021 ◽

Author(s):

Eiji Nakata ◽

Shinsuke Sugihara ◽

Yoshifumi Sugawara ◽

Ryuichi Nakahara ◽

Shouta Takihira ◽

...

Keyword(s):

Combined Therapy ◽

Spinal Metastases ◽

Spinal Instability ◽

Vertebral Metastases ◽

Conventional Radiotherapy ◽

Potential Risk Factors ◽

The Difference ◽

Over Time ◽

Selection Of

Abstract Precise assessment of spinal instability is critical at the beginning and after radiotherapy for selection of the treatment and evaluating the effectiveness of radiotherapy. We investigated changes of spinal instability after radiotherapy and examined potential risk factors for the difference of the outcome of spinal instability for painful spinal metastases. We evaluated 81 patients who received radiotherapy for painful vertebral metastases in our institution between 2012 and 2016. The pain at the vertebrae was assessed. Radiological responses of irradiated vertebrae were assessed by computed tomography. Spinal instability was assessed by Spinal Instability Neoplastic Score (SINS). Follow-up assessments were done at the start of radiotherapy and at 1, 2, 3, 4, and 6 months after radiotherapy. At each of one to six months, pain disappeared in 62%, 84%, 93%, 98%, and 100% of patients. The median SINS were 8, 7, 6, 5, 5, and 4 at the beginning of radiotherapy and after 1, 2, 3, 4, and 6 months, respectively, which significantly decreased over time (P < 0.001). Multivariate analysis revealed that PLISE was the only risk factor for spinal instability at one month. In conclusion, spinal instability significantly improved over time after radiotherapy. Clinicians should take attention to PLISE in the radiotherapy of vertebral metastases.

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Impact of bevacizumab (bev) on overall survival (OS) in patients (pts) with metastatic colorectal cancer (MCRC): A population-based study

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.4114 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 4114-4114

Author(s):

D. J. Renouf ◽

H. J. Lim ◽

C. Speers ◽

D. Villa ◽

S. Gill ◽

...

Keyword(s):

Population Based ◽

Population Based Study ◽

Entire Cohort ◽

Kaplan Meier ◽

Cancer Agency ◽

Treatment Data ◽

Secondary Endpoints ◽

Improvement In Survival ◽

Cancer Network

4114 Background: As of 2003, irinotecan or oxaliplatin in combination with fluorouracil was standard treatment for MCRC in British Columbia (BC). The addition of bev to chemotherapy (CT) was approved in BC in 2006. We compared OS between referred pts diagnosed with MCRC in 2003/2004 (pre-bev era) and 2006 (bev era). Methods: All pts diagnosed with MCRC in 2003/04 and 2006, and referred to the BC Cancer Agency (BCCA) were included. The BCCA is a cancer network with centers throughout BC, ≈60% of MCRC pts in BC are referred to the BCCA. Systemic therapy (ST) is centrally funded and treatment data was obtained from the pharmacy database. The primary endpoint was OS of all pts within each cohort. Secondary endpoints were OS in pts treated with ST, and in those not treated. Kaplan Meier method was used for survival analysis. Subgroup analysis based on age was performed. Results: 1417 pts were included: 969 from 2003/04, and 448 from 2006. Median age at diagnosis of MCRC was 68y in 2003/04 and 69y in 2006. Median follow up time was 47.3 and 21.4 mos respectively. Between 2003/04 and 2006 the proportion of pts treated with ST for MCRC increased from 61.1% to 67.6% (p= 0.02). Proportion of pts who received irinotecan, oxaliplatin and fluorouracil did not change (24.7% to 23.7%, p=0.68). Proportion of pts who received bev increased (5.9% to 30.6%, p<0.001). Median OS significantly improved for the entire cohort (13.8 to 17.3 mos, p<0.001). Median OS for pts who received ST for MCRC improved (18.6 to 23.6 mos, p=0.001). Median OS for pts who did not receive ST did not change (6.1 to 5.9 mos, p=0.65). Of pts who received ST, the proportion who received bev increased in pts <70 (12.7% to 58%, p<0.001) and in pts ≥70 (3.6% to 22.7%, p<0.001). Median OS for pts <70 who received ST for MCRC improved (20.3 to 26.5 mos, p = 0.002). Median OS for pts ≥70 who received ST for MCRC improved (16.5 to 19.9 mos), but this was not significant (p=0.16). Conclusions: In this population based study, median OS for MCRC significantly increased between 2003/04 and 2006. The improvement in survival appears to be limited to pts treated with ST for metastatic disease. The main difference in ST has been the addition of bev. On a population basis, the addition of bev to CT is associated with a significant improvement in OS in MCRC. No significant financial relationships to disclose.

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