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Patient Outcome

Nathan J Turnbull, Keith R Berend, Vincent Y Ng, Joanne B Adams, David A Crawford, Adolph V Lombardi
INTRODUCTION: The gender-specific total knee arthroplasty (TKA) debate focuses on differences in distal femoral mediolateral to anteroposterior aspect ratio between males and females. However, randomized studies have been unable to demonstrate significant differences in outcomes utilizing gender-specific implants. No studies have examined the effect of intermediate femoral component sizes on outcome. We compared outcomes before and after intermediate sizing availability. MATERIALS AND METHODS: We identified 331 patients (413 knees) who underwent primary TKA between 2003 and 2004 with a single complete knee system...
October 26, 2016: Surgical Technology International
Sandra Aissou, Victoire Cartier, Antoine Hamy, Fleur Plumereau, Christophe Aube, Emilie Lermite
BACKGROUND: Liver resection is the curative treatment for patients with colorectal liver metastases (CRLMs), with five-year survival rates of 30-50%. Radiofrequency ablation (RFA) is a local and useful alternative for patients with non-resectable CRLMs to obtain complete tumor clearance. The aim of this study was to analyze survival rates with this local treatment. MATERIALS AND METHODS: All patients who underwent RFA and resection or RFA alone for unresectable CRLMs between 2001 and 2012 were included in a retrospective study...
October 26, 2016: Surgical Technology International
Zacharias G Laoutidis, Georgia E Lekka, Kanellos T Kioulos
OBJECTIVE: The aim of the present study was to review the existing literature on clinical trials with glutamatergic agents in adults with obsessive-compulsive disorder (OCD) and to perform a meta-analysis to estimate the overall effect size. DATA SOURCES: We searched in MEDLINE, Embase, and the Cochrane Library for eligible studies, using the following search terms: (glutamate OR glutaminergic OR glutamatergic OR NMDA OR AMPA OR kainate) AND (obsessive-compulsive disorder OR obsessive OR compulsive OR OCD)...
October 25, 2016: Journal of Clinical Psychiatry
Amy M Kilbourne, Michelle M Barbaresso, Zongshan Lai, Kristina M Nord, Margretta Bramlet, David E Goodrich, Edward P Post, Daniel Almirall, Mark S Bauer
OBJECTIVE: Persons with chronic mental disorders are disproportionately burdened with physical health conditions. We determined whether Life Goals Collaborative Care compared to usual care improves physical health in patients with mental disorders within 12 months. METHODS: This single-blind randomized controlled effectiveness study of a collaborative care model was conducted at a midwestern Veterans Affairs urban outpatient mental health clinic. Patients (N = 293 out of 474 eligible approached) with an ICD-9-CM diagnosis of schizophrenia, bipolar disorder, or major depressive disorder and at least 1 cardiovascular disease risk factor provided informed consent and were randomized (February 24, 2010, to April 29, 2015) to Life Goals (n = 146) or usual care (n = 147)...
October 25, 2016: Journal of Clinical Psychiatry
Marco Pozzi, Simone Pisano, Silvana Bertella, Annalisa Capuano, Renata Rizzo, Stefania Antoniazzi, Fabiana Auricchio, Carla Carnovale, Dario Cattaneo, Carmen Ferrajolo, Marta Gentili, Giuseppe Guastella, Elisa Mani, Concetta Rafaniello, Maria Pia Riccio, Maria Grazia Scuderi, Serena Sperandeo, Liberata Sportiello, Laura Villa, Sonia Radice, Emilio Clementi, Francesco Rossi, Antonio Pascotto, Renato Bernardini, Massimo Molteni, Carmela Bravaccio
OBJECTIVE: The practical effectiveness of second-generation antipsychotics in children and adolescents is an understudied issue. It is a crucial area of study, though, because such patients are often treated for long-lasting disorders. METHODS: We carried out a 24-month (March 2012-March 2014) observational study on an unselected population of pediatric outpatients treated with risperidone, aripiprazole, olanzapine, or quetiapine aiming to (1) describe drug use, (2) compare post hoc the discontinuation rates due to specific causes and dose adjustments by Kaplan-Meier analyses between drugs, and (3) analyze predictors influencing these outcomes by Cox multivariate models...
October 25, 2016: Journal of Clinical Psychiatry
Chittaranjan Andrade
Patients with schizophrenia have increased prevalence rates for many cardiometabolic risk factors; the prevalence and severity of these risks increase after the institution of antipsychotic medication. Nearly 2 dozen different pharmacologic interventions have been trialed to prevent or attenuate antipsychotic-related cardiometabolic changes. Metformin (usually 1,000-1,500 mg/d) has emerged as the best-studied intervention; in short- and intermediate-duration randomized controlled trials, it has been shown to bring about improvements in weight and other anthropometric indices, in fasting sugar and other glycemic control indices, and in total cholesterol and other lipid metabolism indices...
September 2016: Journal of Clinical Psychiatry
David Misdrahi, Arnaud Tessier, Joel Swendsen, Fabrice Berna, Lore Brunel, Delphine Capdevielle, Isabelle Chereau, Jean-Marie Danion, Marie De Pradier, Jean-Michel Dorey, Caroline Dubertret, Julien Dubreucq, Catherine Faget, Franck Gabayet, Romain Rey, Raphaelle Richieri, Christine Passerieux, Aurélie Schandrin, Franck Schurhoff, Anne Marie Tronche, Mathieu Urbach, Pierre Michel Llorca, Guillaume Fond
OBJECTIVE: Medication nonadherence is one of the most important, and potentially modifiable, prognostic factors in the outcome of patients with schizophrenia. The aim of this article is to propose a new classification of adherence profiles according to the Medication Adherence Rating Scale (MARS) in a large community-dwelling sample of French patients with schizophrenia to provide a new tool to help clinicians in daily practice. METHODS: 319 community-dwelling patients from a national network of 10 Schizophrenia Expert Centers were interviewed between January 2009 and January 2014...
September 2016: Journal of Clinical Psychiatry
Richard J Cassidy, Yuan Liu, Kirtesh Patel, Jim Zhong, Conor E Steuer, David A Kooby, Maria C Russell, Theresa W Gillespie, Jerome C Landry
BACKGROUND: Stage II and III rectal cancers have been effectively treated with neoadjuvant chemoradiotherapy (NCRT) followed by definitive resection. Advancements in surgical technique and systemic therapy have prompted investigation of neoadjuvant multiagent chemotherapy (NMAC) regimens with the elimination of radiation (RT). The objective of the current study was to investigate factors that predict for the use of NCRT versus NMAC and compare outcomes using the National Cancer Data Base (NCDB) for select stage II and III rectal cancers...
October 25, 2016: Cancer
Robert Westermann, Chris A Anthony, Kyle R Duchman, Yubo Gao, Andrew J Pugely, Carolyn M Hettrich, Ned Amendola, Brian R Wolf
Infection following anterior cruciate ligament reconstruction (ACLR) is rare. Previous authors have concluded that diabetes, tobacco use, and previous knee surgery may influence infection rates following ACLR. The purpose of this study was to identify a cohort of patients undergoing ACLR and define (1) the incidence of infection after ACLR from a large multicenter database and (2) the risk factors for infection after ACLR. We identified patients undergoing elective ACLRs in the American College of Surgeons National Surgical Quality Improvement Program database between 2007 and 2013...
October 25, 2016: Journal of Knee Surgery
Sarah B Bateni, Frederick J Meyers, Richard J Bold, Robert J Canter
BACKGROUND: The impact of surgery on end of life care for patients with disseminated malignancy (DMa) is incompletely characterized. The purpose of this study was to evaluate postoperative outcomes impacting quality of care among DMa patients, specifically prolonged length of hospital stay, readmission, and disposition. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for years 2011-2012. DMa patients were matched to non-DMa patients with comparable clinical characteristics and operation types...
2016: PloS One
Wei Gao, Vincent Crosby, Andrew Wilcock, Rachael Burman, Eli Silber, Nilay Hepgul, K Ray Chaudhuri, Irene J Higginson
BACKGROUND: There is no standard palliative care outcome measure for people with progressive long term neurological conditions (LTNC). This study aims to determine the psychometric properties of a new 8-item palliative care outcome scale of symptom burden (IPOS Neuro-S8) in this population. DATA AND METHODS: Data were merged from a Phase II palliative care intervention study in multiple sclerosis (MS) and a longitudinal observational study in idiopathic Parkinson's disease (IPD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP)...
2016: PloS One
Karen H Keddy, Arvinda Sooka, Anthony M Smith, Alfred Musekiwa, Nomsa P Tau, Keith P Klugman, Frederick J Angulo
BACKGROUND: Typhoid fever remains an important disease in Africa, associated with outbreaks and the emerging multidrug resistant Salmonella enterica serotype Typhi (Salmonella Typhi) haplotype, H58. This study describes the incidence of, and factors associated with mortality due to, typhoid fever in South Africa, where HIV prevalence is high. METHODS AND FINDINGS: Nationwide active laboratory-based surveillance for culture-confirmed typhoid fever was undertaken from 2003-2013...
2016: PloS One
Ramnath Subbaraman, Ruvandhi R Nathavitharana, Srinath Satyanarayana, Madhukar Pai, Beena E Thomas, Vineet K Chadha, Kiran Rade, Soumya Swaminathan, Kenneth H Mayer
BACKGROUND: India has 23% of the global burden of active tuberculosis (TB) patients and 27% of the world's "missing" patients, which includes those who may not have received effective TB care and could potentially spread TB to others. The "cascade of care" is a useful model for visualizing deficiencies in case detection and retention in care, in order to prioritize interventions. METHODS AND FINDINGS: The care cascade constructed in this paper focuses on the Revised National TB Control Programme (RNTCP), which treats about half of India's TB patients...
October 2016: PLoS Medicine
Chiung-Ying Huang, Szu-Ying Lee, Chung-Wei Yang, Szu-Chun Hung, Chih-Kang Chiang, Jenq-Wen Huang, Kuan-Yu Hung
BACKGROUND: Low lean body mass (LBM) is an indicator of malnutrition inflammation syndrome, which is common in hemodialysis (HD) patients. The creatinine index (CI) has been validated as a reliable method to estimate LBM and evaluate the protein-energy status of HD patients. However, the traditional creatinine index formula was complex. We sought to investigate the impact of CI derived from a new simple formula on Chinese HD patient outcomes. METHODS: In this retrospective cohort study, we enrolled 1269 patients who initiated HD between February 1981 and February 2012 and followed them until the end of February 2013...
2016: PloS One
Mario Santos, Dalane W Kitzman, Kunihiro Matsushita, Laura Loehr, Carla A Sueta, Amil M Shah
BACKGROUND: The relationship between dyspnea and incident heart failure (HF) and myocardial infarction (MI) among patients without previously diagnosed cardiopulmonary disease is unclear. We studied the prognostic relevance of self-reported dyspnea for cardiovascular outcomes and all-cause mortality in persons without previously diagnosed cardiopulmonary disease. METHODS AND RESULTS: We studied 10 881 community-dwelling participants (mean age 57±6, 56% women, 25% black) who were free of prevalent cardiopulmonary disease from Atherosclerosis Risk in Communities Study...
2016: PloS One
Louise Barbier, Manuela Cesaretti, Federica Dondero, François Cauchy, Linda Khoy-Ear, Takeshi Aoyagi, Emmanuel Weiss, Olivier Roux, Safi Dokmak, Claire Francoz, Catherine Paugam-Burtz, Ailton Sepulveda, Jacques Belghiti, François Durand, Olivier Soubrane
BACKGROUND: Older liver grafts have been considered in the past decade due to organ shortage. The aim was to compare outcomes after liver transplantation with either younger or older donors. METHODS: Patients transplanted in our center between 2004 and 2014 with younger donors (younger than 60 years; n = 253) were compared with older donors (older than 75 years; n = 157). Multiorgan transplantations, split grafts, or non-heart-beating donors were not included. RESULTS: Donors in the older group were mostly women deceased from stroke, and only 3 patients had experienced cardiac arrest...
November 2016: Transplantation
Firas Zahr Eldeen, Garrett R Roll, Carlos Derosas, Rajashankar Rao, Muhammad S Khan, Bridget K Gunson, James Hodson, Hynek Mergental, Ben-Hur Ferraz-Neto, John Isaac, Paolo Muiesan, Darius F Mirza, Asim Iqbal, M Thamara P R Perera
BACKGROUND: Whilst causes of hepatic artery thrombosis (HAT) after liver transplantation (LT) are multifactorial, early HAT (E-HAT) remains pertinent complication impacting on graft and patient survival. Currently there is no screening tool that would identify patients with increased risk of developing E-HAT. METHODS: We analyzed the native procoagulant state of LT recipients, identified through pretransplant thromboelastographic (TEG) data among other known risk factors, to identify risk factors for E-HAT...
November 2016: Transplantation
Marek Krawczyk, Michał Grąt, Rene Adam, Wojciech G Polak, Jurgen Klempnauer, Antonio Pinna, Fabrizio Di Benedetto, Franco Filipponi, Norbert Senninger, Aksel Foss, Sebastian Rufián-Peña, William Bennet, Johann Pratschke, Andreas Paul, Utz Settmacher, Giorgio Rossi, Mauro Salizzoni, Carlos Fernandez-Selles, Santiago T Martínez de Rituerto, Miguel A Gómez-Bravo, Jacques Pirenne, Olivier Detry, Pietro E Majno, Petr Nemec, Wolf O Bechstein, Michael Bartels, Silvio Nadalin, Francois R Pruvot, Darius F Mirza, Luigi Lupo, Michele Colledan, Giuseppe Tisone, Jan Ringers, Jorge Daniel, Ramón Charco Torra, Enrique Moreno González, Rafael Bañares Cañizares, Valentin Cuervas-Mons Martinez, Fernando San Juan Rodríguez, Sezai Yilmaz, Piotr Remiszewski
BACKGROUND: Liver transplantation is the most extreme form of surgical management of patients with hepatic trauma, with very limited literature data supporting its use. The aim of this study was to assess the results of liver transplantation for hepatic trauma. METHODS: This retrospective analysis based on European Liver Transplant Registry comprised data of 73 recipients of liver transplantation for hepatic trauma performed in 37 centers in the period between 1987 and 2013...
November 2016: Transplantation
Farees Ricky Tavangari, Michael Batech, J Craig Collins, Talar Tejirian
Though conventionally not considered standard of care, nonoperative management of patients with small bowel obstruction (SBO) without previous abdominal operations, so called "virgin abdomens," (VA) is presently being practiced. We aimed to determine outcomes of patients with VA undergoing operative and nonoperative management of SBO. A retrospective review of patients with SBO was performed; outcomes of patients with VA were analyzed. SBO with a VA was found in 103 patients over a 5-year period. With a mean follow-up of 4...
October 2016: American Surgeon
Maris S Jones, Hitoe Torisu-Itakura, Devin C Flaherty, Hans F Schoellhammer, Jihey Lee, Myung-Shim Sim, Mark B Faries
The impact on survival of a second primary melanoma (SPM) is unclear. We used our melanoma center's database to examine clinicopathologic risk factors and outcomes of stage 0 to IV cutaneous melanoma in patients with one versus two primaries. Among 12,325 patients with primary melanoma, 969 (7.86%) developed SPM. SPMs were significantly thinner than autologous primary melanomas (P = 0.01), and 451 SPM patients had better overall and melanoma-specific survival than 451 prognostically matched non-SPM patients (P < 0...
October 2016: American Surgeon
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