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1.
Eur Radiol ; 26(2): 576-84, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25991490

RESUMEN

OBJECTIVES: Investigate the effect of a novel Bayesian penalised likelihood (BPL) reconstruction algorithm on analysis of pulmonary nodules examined with 18F-FDG PET/CT, and to determine its effect on small, sub-10-mm nodules. METHODS: 18F-FDG PET/CTs performed for nodule evaluation in 104 patients (121 nodules) were retrospectively reconstructed using the new algorithm, and compared to time-of-flight ordered subset expectation maximisation (OSEM) reconstruction. Nodule and background parameters were analysed semi-quantitatively and visually. RESULTS: BPL compared to OSEM resulted in statistically significant increases in nodule SUVmax (mean 5.3 to 8.1, p < 0.00001), signal-to-background (mean 3.6 to 5.3, p < 0.00001) and signal-to-noise (mean 24 to 41, p < 0.00001). Mean percentage increase in SUVmax (%ΔSUVmax) was significantly higher in nodules ≤10 mm (n = 31, mean 73%) compared to >10 mm (n = 90, mean 42 %) (p = 0.025). Increase in signal-to-noise was higher in nodules ≤10 mm (224%, mean 12 to 27) compared to >10 mm (165%, mean 28 to 46). When applying optimum SUVmax thresholds for detecting malignancy, the sensitivity and accuracy increased using BPL, with the greatest improvements in nodules ≤10 mm. CONCLUSION: BPL results in a significant increase in signal-to-background and signal-to-noise compared to OSEM. When semi-quantitative analyses to diagnose malignancy are applied, higher SUVmax thresholds may be warranted owing to the SUVmax increase compared to OSEM. KEY POINTS: • Novel Bayesian penalised likelihood PET reconstruction was applied for lung nodule evaluation. • This was compared to current standard of care OSEM reconstruction. • The novel reconstruction generated significant increases in lung nodule signal-to-background and signal-to-noise. • These increases were highest in small, sub-10-mm pulmonary nodules. • Higher SUV max thresholds may be warranted when using semi-quantitative analyses to diagnose malignancy.


Asunto(s)
Procesamiento de Imagen Asistido por Computador/métodos , Neoplasias Pulmonares/diagnóstico por imagen , Tomografía de Emisión de Positrones/métodos , Nódulo Pulmonar Solitario/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Teorema de Bayes , Femenino , Fluorodesoxiglucosa F18 , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Imagen Multimodal , Radiofármacos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Adulto Joven
2.
Eur Radiol ; 26(11): 4098-4106, 2016 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26914696

RESUMEN

PURPOSE: To investigate whether using a Bayesian penalised likelihood reconstruction (BPL) improves signal-to-background (SBR), signal-to-noise (SNR) and SUVmax when evaluating mediastinal nodal disease in non-small cell lung cancer (NSCLC) compared to ordered subset expectation maximum (OSEM) reconstruction. MATERIALS AND METHODS: 18F-FDG PET/CT scans for NSCLC staging in 47 patients (112 nodal stations with histopathological confirmation) were reconstructed using BPL and compared to OSEM. Node and multiple background SUV parameters were analysed semi-quantitatively and visually. RESULTS: Comparing BPL to OSEM, there were significant increases in SUVmax (mean 3.2-4.0, p<0.0001), SBR (mean 2.2-2.6, p<0.0001) and SNR (mean 27.7-40.9, p<0.0001). Mean background SNR on OSEM was 10.4 (range 7.6-14.0), increasing to 12.4 (range 8.2-16.7, p<0.0001). Changes in background SUVs were minimal (largest mean difference 0.17 for liver SUVmean, p<0.001). There was no significant difference between either algorithm on receiver operating characteristic analysis (p=0.26), although on visual analysis, there was an increase in sensitivity and small decrease in specificity and accuracy on BPL. CONCLUSION: BPL increases SBR, SNR and SUVmax of mediastinal nodes in NSCLC compared to OSEM, but did not improve the accuracy for determining nodal involvement. KEY POINTS: • Penalised likelihood PET reconstruction was applied for assessing mediastinal nodes in NSCLC. • The new reconstruction generated significant increases in signal-to-background, signal-to-noise and SUVmax. • This led to an improvement in visual sensitivity using the new algorithm. • Higher SUV max thresholds may be appropriate for semi-quantitative analyses with penalised likelihood.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Neoplasias Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Radiofármacos , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Carcinoma de Pulmón de Células no Pequeñas/patología , Métodos Epidemiológicos , Femenino , Humanos , Neoplasias Pulmonares/patología , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/patología , Metástasis Linfática , Masculino , Persona de Mediana Edad , Imagen Multimodal , Estadificación de Neoplasias
3.
Int Urogynecol J ; 25(4): 517-23, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24108392

RESUMEN

INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence (SUI) is a common and growing problem among adult women and affects individuals and society through decreased quality of life (QoL), decreased work productivity, and increased health care costs. A new, nonsurgical treatment option has become available for women who have failed conservative therapy, but its cost effectiveness has not been evaluated. This study examined the cost effectiveness of transurethral radiofrequency microremodeling of the female bladder neck and proximal urethra compared with synthetic transobturator tape (TOT), retropubic transvaginal tape (TVT) sling, and Burch colposuspension surgeries for treating SUI. METHODS: A Markov model was used to compare the cost effectiveness of five strategies for treating SUI for patients who had previously failed conservative therapy. The strategies were designed to compare the value of starting with a less invasive treatment. The cost-effectiveness analysis was conducted from the health care system perspective. Efficacy and adverse event rates were obtained from the literature; reimbursement costs were based on Medicare fee schedule. The model cycle was 3 months, with a 3-year time horizon. Single-variable sensitivity analyses were conducted to assess stability of base-case results. RESULTS: Two of the five strategies employed the use of transurethral radiofrequency microremodeling and achieved 17-30 % lower mean costs relative to their comparative sling or Burch strategies. CONCLUSIONS: Superior safety and cost effectiveness are recognized when patients are offered a sequential approach to SUI management that employs transurethral radiofrequency microremodeling before invasive surgical procedures. This sequential approach is consistent with treatment strategies for other conditions and offers a solution for women with SUI who want to avoid the inherent risks and costs of invasive continence surgery.


Asunto(s)
Modelos Económicos , Terapia por Radiofrecuencia , Incontinencia Urinaria de Esfuerzo/radioterapia , Femenino , Humanos
4.
J Urol ; 189(1): 210-6, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23174264

RESUMEN

PURPOSE: Conservative therapy and antimuscarinic agents are first line therapies for overactive bladder. Patients refractory to treatment are candidates for neuromodulation therapy. We estimated the costs and cost-effectiveness of percutaneous tibial nerve stimulation and sacral nerve stimulation. MATERIALS AND METHODS: A Markov model was constructed to simulate the total costs and effectiveness of percutaneous tibial and sacral nerve stimulation during 2 years. Cost data used average Medicare national physician payments, and ambulatory payment classification and diagnosis related group payments for hospital based care and office visits. Clinical effectiveness, and the rates of patient adherence to treatment and adverse events were estimated by a review of the literature. RESULTS: The costs of initial therapy were $1,773 for 12 weekly percutaneous tibial nerve stimulation treatments and $1,857 for test sacral nerve stimulation. For ongoing therapy the cost of the sacral nerve stimulation surgical implant was $22,970. Cumulative discounted 2-year costs were $3,850 for percutaneous tibial nerve stimulation and $14,160 for sacral nerve stimulation, including those who discontinued therapy. Of the patients 48% and 49%, respectively, remained on therapy. The incremental cost-effectiveness ratio was $573,000 per additional patient on sacral nerve stimulation. When considering only patients who completed initial stimulation successfully, the costs were $4,867 and $24,342 for percutaneous tibial and sacral nerve stimulation with 71% and 90%, respectively, remaining on therapy for an incremental cost-effectiveness ratio of $99,872. CONCLUSIONS: Percutaneous tibial nerve stimulation and sacral nerve stimulation are safe, effective neuromodulation therapies for overactive bladder. In this economic model percutaneous tibial nerve stimulation had substantially lower cost. An additional 1% of patients would remain on therapy at 2 years if sacral nerve stimulation were used rather than percutaneous tibial nerve stimulation but the average cost per additional patient would be more than $500,000.


Asunto(s)
Plexo Lumbosacro , Nervio Tibial , Estimulación Eléctrica Transcutánea del Nervio/economía , Vejiga Urinaria Hiperactiva/economía , Vejiga Urinaria Hiperactiva/terapia , Costos y Análisis de Costo , Humanos , Cadenas de Markov
5.
Cancer Treat Res Commun ; 31: 100538, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35220069

RESUMEN

BACKGROUND: Management of early-stage non-small cell lung cancer (ES-NSCLC) has evolved over the last few years especially in terms of work-up and the use of systemic therapy. This consensus statement was developed to present updated guidelines for the management of this disease. METHODS: Multidisciplinary team (MDT) of lung cancer experts convened to discuss a set of pertinent questions with importance relevance to the management of ES-NSCLC. ES-NSCLC includes stages I, II and resected stage III. The experts included consultants in chest imaging, thoracic surgery, radiation oncology, and medical oncology. Questions were discussed in virtual meetings and then a written manuscript with supporting evidence was drafted, reviewed, and approved by the team members. RESULTS: The Consensus Statement included 9 questions addressing work-up and management of ES-NSCLC. Background information and literature review were presented for each question followed by specific recommendations to address the questions by oncology providers. The Statement was endorsed by various oncology societies in the Gulf region. CONCLUSION: The Consensus Statement serves as a guide for thoracic MDT members in the management of ES-NSCLC. Adaptation of these to the local setting is dictated usually by available resources and expertise, however, all efforts should be excreted to provide the optimal care to all patients whenever possible.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Carcinoma Pulmonar de Células Pequeñas , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Consenso , Humanos , Neoplasias Pulmonares/cirugía , Oncología Médica
6.
Lung Cancer ; 158: 60-73, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34119934

RESUMEN

The Middle East and Africa (MEA) region, a large geographical area, lies at the confluence of Asian, Caucasian and African races and comprises of a population with several distinct ethnicities. The course of management of non-small cell lung cancer (NSCLC) differs as per patients' performance status as well as stage of disease, requiring personalized therapy decisions. Although management of NSCLC has received a significant impetus in the form of molecularly targeted therapies and immune therapies in last few years, surgery remains gold standard for patients with early-stage disease. In case of unresectable disease, radiotherapy and chemotherapy are the primary management modalities. With newer therapies being approved for treatment of early stage disease, use of multi-disciplinary team (MDT) for comprehensive management of NSCLC is of prime importance. A group of experts with interest in thoracic oncology, deliberated and arrived at a consensus statement for the community oncologists treating patients with NSCLC in the MEA region. The deliberation was based on the review of the published evidence including literature and global and local guidelines, subject expertise of the participating panellists and experience in real-life management of patients with NSCLC. We present the proposed regional adaptations of international guidelines and recommends the MDT approach for management of NSCLC in MEA.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Oncólogos , África/epidemiología , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Carcinoma de Pulmón de Células no Pequeñas/epidemiología , Carcinoma de Pulmón de Células no Pequeñas/terapia , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/terapia , Medio Oriente/epidemiología
7.
J Oral Maxillofac Surg ; 68(12): 2947-54, 2010 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-20678842

RESUMEN

PURPOSE: This study attempts to provide insight on how the treatment preference for a mandible fracture and treatment received and its consequences are related to the patient's risk tolerance, as measured by the Standard Gamble (SG). PATIENTS AND METHODS: Data from a prospective cohort study of 203 subjects receiving treatment at the former King/Drew Medical Center in Los Angeles, CA, for either a mandible fracture (n = 98) or third molar removal (n = 105) were examined. Subjects were interviewed at 4 time points: on admission to the medical center and at 3 monthly follow-up visits. Risk tolerance for hypothetical treatment scenarios is measured by use of the SG, a health-value utility measure assessing the tradeoff between good outcomes and serious complications associated with treatment. Separate regression analyses with subsets of predictors (sociodemographic, psychosocial health, and clinical characteristics) were conducted and then synthesized by use of the significant predictors in separate analyses. RESULTS: For fracture subjects, there was a noticeable rise in the SG reports from admission to the 1-month follow-up. Their greater risk tolerance was associated with being older, receiving surgery, having a lower post-traumatic stress disorder score, and having a swollen jaw or face. For third molar subjects, SG did not change substantively over the course of the study. Predictors of greater risk tolerance for third molar subjects included the jaw or face being swollen and having to use less pain medication. CONCLUSIONS: Findings from this study show a preference for less invasive treatment, with the majority of both groups preferring wiring, and support the theory that treatment choices differ between subjects with different health states. Factors associated with risk tolerance include the patient's age, treatment received, psychosocial health state, experience with previous treatment, and value for oral health quality of life.


Asunto(s)
Fracturas Mandibulares/psicología , Procedimientos Quirúrgicos Orales/psicología , Prioridad del Paciente/psicología , Asunción de Riesgos , Extracción Dental/psicología , Adaptación Psicológica , Adolescente , Adulto , Estudios de Cohortes , Toma de Decisiones , Femenino , Estudios de Seguimiento , Fijación de Fractura/métodos , Fijación de Fractura/psicología , Humanos , Masculino , Fracturas Mandibulares/cirugía , Persona de Mediana Edad , Tercer Molar/cirugía , Procedimientos Quirúrgicos Orales/métodos , Estudios Prospectivos , Adulto Joven
8.
J Public Health Dent ; 70(1): 13-8, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-19694938

RESUMEN

BACKGROUND: Patient treatment preferences do not necessarily remain stable over time. OBJECTIVE: This study focuses on predictors of patient treatment choice and on the extent to which patients are willing to take risks by choosing surgical versus nonsurgical treatment for mandibular fracture. METHODS: Surveys of African-American and Hispanic adults receiving treatment at King/Drew Medical Center for either a mandibular fracture (n = 98) or third-molar removal (n = 105) were used to investigate patterns of patient preference over the course of a 4-month study period using generalized estimating equations controlling for age, gender, income, and fracture versus third-molar patient. The study examined the effects of symptom rating and a"standard gamble" measure reflecting a patient's willingness to accept scarring or nerve damage. This analysis is based on 169 patients who participated in four waves of data collection. RESULTS: The most salient predictor of patient treatment was the standard gamble measure at 1-month follow-up. Subjects with higher risk tolerance were more likely to select surgery versus jaw wiring. A higher likelihood of choosing surgery was associated with higher income and greater symptom severity. Fracture patients were more likely to select surgery compared with third-molar patients. CONCLUSIONS: The significance of symptom severity 1-month post-surgery raises an important issue regarding the healing process. Moreover, the significance of standard gamble as a predictor of treatment choice for mandibular fracture should encourage other researchers to use this measure of willingness to accept risk when studying acute conditions such as jaw fracture.


Asunto(s)
Fracturas Mandibulares/terapia , Prioridad del Paciente/estadística & datos numéricos , Asunción de Riesgos , Adolescente , Adulto , Toma de Decisiones , Fijación de Fractura/psicología , Humanos , Técnicas de Fijación de Maxilares/psicología , Modelos Lineales , Fracturas Mandibulares/cirugía , Persona de Mediana Edad , Tercer Molar/cirugía , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Extracción Dental/psicología , Estados Unidos , Adulto Joven
9.
Case Rep Gastrointest Med ; 2020: 1519243, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32884847

RESUMEN

Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and therapeutic procedure with many studied complications. We are presenting a rare complication of ERCP in choledocholithiasis: gallstone dislodging into the airway upon retrieval. The patient is a 37-year-old female admitted with obstructive jaundice. She was evaluated, and her management plan included a referral for an ERCP to extract the impacted common bile duct stones. Upon retrieval of the gallstone, it fell out the basket and lodged into the airway which was confirmed on bronchoscopy and successfully retrieved. This report describes successful management of a rare but potentially dangerous complication of ERCP to remove impacted CBD stones. The possible complications of delayed removal or inability to remove gallstones from the airway have yet to be studied and reported but are likely to include recurrent chest infections, bronchiectasis, and empyema of the lung.

10.
J Oral Maxillofac Surg ; 67(2): 328-34, 2009 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-19138607

RESUMEN

PURPOSE: This study sought to identify sociodemographic, psychosocial, and clinical factors associated with increased postsurgery depressive symptoms among inner-city minority patients recovering from a mandibular fracture. PATIENTS AND METHODS: Surveys of African American and Hispanic adults receiving treatment at King/Drew Medical Center for a mandible fracture (n=98) are used to identify factors associated with increased postsurgery depressive symptoms. Using correlation coefficients and t tests, bivariate relationships between patient characteristics and depressive symptoms at first follow-up were examined. Multiple regression analysis was used, predicting depressive symptoms at 1 month postadmission by entering covariates that were found to be significant at the bivariate level. RESULTS: Consistent with the etiology of maxillofacial trauma, the majority of study participants were male (88%), unmarried (92%), unemployed (57%), and experienced some type of interpersonal violence resulting in their broken jaw (77%). Patient characteristics significantly associated with depressive symptoms at first follow-up included age (r=0.26, P= .011), symptoms of post-traumatic stress (r=0.31, P= .003), prior dental problems (r=0.24, P= .022), current pain (r=0.38, P<0.001), and oral health problems during healing (GOHAI) (r= 0.34, P= .001). Two of the 5 significant covariates (pain and GOHAI) remained significant at the multivariate level (adjusted R(2)=0.33). CONCLUSION: Findings from this study show that depressive symptoms increase immediately after oral surgery for jaw fracture. This increase is associated with pain and quality of life during recovery.


Asunto(s)
Depresión/etiología , Fijación Interna de Fracturas/psicología , Mandíbula/cirugía , Fracturas Mandibulares/cirugía , Complicaciones Posoperatorias/psicología , Trastornos por Estrés Postraumático/etiología , Adulto , Factores de Edad , Anciano , Depresión/diagnóstico , Femenino , Humanos , Masculino , Fracturas Mandibulares/psicología , Persona de Mediana Edad , Grupos Minoritarios , Salud Bucal , Dolor Postoperatorio/complicaciones , Áreas de Pobreza , Pronóstico , Análisis de Regresión , Factores de Riesgo , Factores Socioeconómicos , Trastornos por Estrés Postraumático/diagnóstico , Estrés Psicológico/complicaciones , Encuestas y Cuestionarios , Adulto Joven
11.
J Oral Maxillofac Surg ; 66(11): 2203-12, 2008 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-18940481

RESUMEN

PURPOSE: Owing to its putative advantages over conventional maxillomandibular fixation (MMF), open-reduction and rigid internal fixation (ORIF) is used frequently to treat mandible fractures, particularly in noncompliant patients. The resource-intensive nature of ORIF, the large variation in its use, and the lack of systematic studies substantiating ORIF attributed benefits compel a randomized controlled investigation comparing ORIF to MMF treatment. The objective of this study was to determine whether ORIF provides better clinical and functional outcomes than MMF in noncomplying type of patients with a similar range of mandible fracture severity. PATIENTS AND METHODS: From a total of 336 patients who sought treatment for mandible fractures, 142 patients with moderately severe mandible fractures were assigned randomly to receive MMF or ORIF and followed prospectively for 12 months. A variety of clinician and patient-reported measures were used to assess outcomes at the 1, 6, and 12 months follow-up visits. These measures included clinician-reported number of surgical complications, patient-reported number of complaints, as well as cumulative costs of treatment. Pain intensity was measured on a 10-point scale and the 12-item General Oral Health Assessment Index was used to assess the patients' oral health-related quality of life. Because the protocol allowed clinical judgment to overrule the randomly assigned treatment, outcomes were compared on an "intent-to-treat" basis as well as in terms of actual treatment received. RESULTS: The sociodemographic and clinical characteristics of the injury did not differ among the 2 groups. On an intent-to-treat basis, the difference in complication rates was not significant but favored MMF; 8.1% of patients developed complications with MMF versus 12.5% with ORIF. Differences in the rate of patient complaints were not significant on an intent-to-treat basis, but a significant between-group difference (P = .012) favoring MMF was noted on an as-treated basis at the 1 month recall, with 40% of ORIF patients reporting greater than 1 complaint versus 18.8% of MMF patients. No significant differences were detected between the 2 treatment groups at any time point with respect to oral health-related quality of life reflected by the General Oral Health Assessment Index scores. In-patient days and total costs did not differ significantly on an intent-to-treat basis, but on an as-treated basis, patients treated with MMF had fewer in-patient days on average (1.64 vs 5.50 for ORIF) and lower average costs of treatment ($7,206 vs $26,089 for ORIF). In the intent-to-treat analyses, patients receiving MMF treatment had significantly lower (P = .05) pain scores at the 12-month recall (mean = 0.58, SE = 0.30) compared with patients assigned to ORIF (mean = 1.78, SE = 0.52). CONCLUSION: Our study did not show a clear overall benefit of the resource-intensive ORIF over conventional MMF treatment in the management of moderately severe mandible fractures in at-risk patients; our data instead suggest some cost as well as oral health quality-of-life advantages for the use of MMF in this patient population.


Asunto(s)
Fijación Interna de Fracturas/economía , Técnicas de Fijación de Maxilares/economía , Fracturas Mandibulares/cirugía , Adolescente , Adulto , Análisis Costo-Beneficio , Femenino , Fijación Interna de Fracturas/efectos adversos , Humanos , Técnicas de Fijación de Maxilares/efectos adversos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Estudios Prospectivos , Calidad de Vida , Perfil de Impacto de Enfermedad , Resultado del Tratamiento
12.
Can J Aging ; 37(3): 245-260, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-29966539

RESUMEN

ABSTRACTHospitalized older adults are at high risk of falling. The HELPER system is a ceiling-mounted fall detection system that sends an alert to a smartphone when a fall is detected. This article describes the performance of the HELPER system, which was pilot tested in a geriatric mental health hospital. The system's accuracy in detecting falls was measured against the hospital records documenting falls. Following the pilot test, nurses were interviewed regarding their perceptions of this technology. In this study, the HELPER system missed one documented fall but detected four falls that were not documented. Although sensitivity (.80) of the system was high, numerous false alarms brought down positive predictive value (.01). Interviews with nurses provided valuable insights based on the operation of the technology in a real environment; these and other lessons learned will be particularly valuable to engineers developing this and other health and social care technologies.


Asunto(s)
Accidentes por Caídas/prevención & control , Personal de Enfermería en Hospital/psicología , Seguridad del Paciente , Anciano , Anciano de 80 o más Años , Demencia/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aplicaciones Móviles , Evaluación de Programas y Proyectos de Salud , Teléfono Inteligente , Grabación en Video/normas
13.
Lung Cancer ; 57(3): 389-94, 2007 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-17481775

RESUMEN

STUDY OBJECTIVES: Nutritional status has been reported as a predictor of complications following surgery for lung cancer. However, the impact of impaired nutrition in the long term has not been extensively studied. We have analysed our own experience after lobectomy for non-small cell lung cancer (NSCLC). PATIENTS: Six hundred and forty-two consecutive patients undergoing lobectomy for primary lung cancer in a single centre between October 1991 and April 2004 were included in the study. STUDY DESIGN: Impaired nutritional status was defined as any of low pre-operative albumin level (less than 30g/L), recent history of weight loss or low body mass index (BMI)--less than 18.5kg/m(2). There were 400 males and 242 females, median age 66 (range 32-89 years). Outcomes studied were hospital mortality and complications, and long term survival. RESULTS: A high proportion of patients (185 of 642, 28%) were classed as having poor nutritional status. There were 12 hospital deaths (1.9%). Nutritional depletion had no significant impact on hospital mortality (1.3% versus 2.7%), cardiac (14.4% versus 16.8%), or respiratory (17.5% versus 18.9%) complications. The overall median survival was 48+/-6 months (standard error). On Cox multivariate analysis, impaired nutritional status, tumour stage and need for en bloc chest wall excision were all independent predictors of survival. CONCLUSIONS: Nutritional status does not appear to significantly influence immediate outcomes following lobectomy for lung cancer. However, it is a predictor of survival in the long term independently of tumour extension and staging.


Asunto(s)
Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/cirugía , Estado Nutricional , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Reino Unido/epidemiología
15.
J Oral Maxillofac Surg ; 65(12): 2430-7, 2007 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-18022465

RESUMEN

PURPOSE: Patient preferences for treatment choices may depend on patient characteristics. Using standard gamble (SG) and willingness to pay (WTP), this study compares preferences for treatment of mandibular fracture among patients in a low-income urban area. PATIENTS AND METHODS: Surveys of African-American and Hispanic adults receiving treatment at King/Drew Medical Center for either mandibular fracture (n = 98) or third molar removal (n = 105) were used to investigate differences in patient characteristics across treatment groups (third molar vs fracture) and treatment preference (wiring vs surgery). RESULTS: The fracture patients were willing to pay more to restore function without scarring or nerve damage than were the third molar patients. Patients who chose surgery were willing to accept a greater risk of possible nerve damage or scarring than those who chose wiring. Among 15 potential predictors of SG and WTP studied in 4 subgroups defined by actual treatment and treatment preference, significant predictors varied, with associations for education and clinical experience for SG and associations with income and psychosocial predictors for WTP. CONCLUSIONS: SG and WTP capture different domains of health values in patients. There is considerable heterogeneity in relationships among patient characteristics and patient preferences across subgroups defined by actual treatment and treatment preferences.


Asunto(s)
Fracturas Mandibulares/terapia , Tercer Molar/cirugía , Procedimientos Quirúrgicos Orales/psicología , Aceptación de la Atención de Salud/psicología , Extracción Dental/métodos , Adulto , Negro o Afroamericano/psicología , Factores de Edad , Hilos Ortopédicos , Conducta de Elección , Escolaridad , Empleo , Métodos Epidemiológicos , Femenino , Hispánicos o Latinos/psicología , Humanos , Los Angeles , Masculino , Fracturas Mandibulares/economía , Procedimientos Quirúrgicos Orales/efectos adversos , Procedimientos Quirúrgicos Orales/métodos , Factores Sexuales , Factores Socioeconómicos , Extracción Dental/economía , Extracción Dental/psicología , Población Urbana
16.
Ulus Travma Acil Cerrahi Derg ; 23(4): 348-350, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28762458

RESUMEN

This is the first report in the literature to describe removing war-related cardiothoracic shrapnel using video-assisted thoracoscopic surgery (VATS). War blast caused penetrating thoracic and extremity injuries in 30-year-old man. He was referred to our hospital after stabilization. Magnetic resonance imaging was required to evaluate brachial plexus injury. Large, penetrating shrapnel fragment in the right posterior chest wall, retained shrapnel in apex of the right lung, and another fragment in the pericardium were removed using VATS in staged approach. Postoperative period was uneventful. VATS is useful in managing complex, war-related cardiothoracic injuries.


Asunto(s)
Cuerpos Extraños/cirugía , Cirugía Torácica Asistida por Video , Heridas Penetrantes/cirugía , Adulto , Humanos , Pulmón/cirugía , Masculino , Pericardio/cirugía , Guerra
17.
Eur J Cardiothorac Surg ; 29(2): 244-7, 2006 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-16388954

RESUMEN

OBJECTIVE: There are limited and conflicting data available concerning the incidence of inadvertent splenectomy and its impact on the outcome in patients who have undergone oesophagectomy. The aim of this study is to identify the factors associated with a likelihood of inadvertent splenectomy and its influence on early and long-term outcome in patients having oesophagectomy for oesophageal carcinoma. METHODS: A consecutive series of 738 oesophagectomies performed between 1991 and 2004 was analysed. In our practice, the spleen was removed only if damaged intraoperatively. Routine chemo- and immunoprophylaxis would subsequently be used. Multivariate analysis with logistic and Cox models determined significant variables. RESULTS: Of the 738 oesophagectomies, 48 (6.5%) had splenectomy. Neoadjuvant chemotherapy was administered to a minority of patients; none subsequently had splenectomy. There were significant differences between types of operation (Ivor-Lewis 18 (9.0%), left thoracolaparotomy 14 (9.9%) and left thoracophrenotomy 15 (3.9%), p=0.01). Splenectomy was more common with advanced N stage disease (OR=0.44 [0.20-0.95]; p=0.04). Splenectomy resulted in more blood transfusions (median, 2 units vs 0 units; p=0.03) more anastomotic leaks (7 [14.6%] vs 42 [6.1%]; p=0.02) but not an increase in pulmonary complications (p=0.64) or in-hospital mortality (1 [4.6%] vs 37 [5.4%]; p=0.30). Splenectomy did not significantly affect median survival (551 [332-770] days vs 627 [554-700] days; p=0.63). CONCLUSION: Although inadvertent splenectomy increased the morbidity of oesophagectomy, it did not impair survival. Type of operation and advanced N stage are important risks for splenectomy. Though best avoided, most of the consequences of splenectomy can be managed. An unexpected relationship between splenectomy and anastomotic leaks needs further investigation.


Asunto(s)
Adenocarcinoma/cirugía , Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía , Esplenectomía , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Anciano , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Esofagectomía/mortalidad , Femenino , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Penicilina V/uso terapéutico , Penicilinas/uso terapéutico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Esplenectomía/mortalidad , Tasa de Supervivencia , Resultado del Tratamiento
18.
Community Dent Oral Epidemiol ; 34(2): 93-102, 2006 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-16515673

RESUMEN

OBJECTIVES: This study analyzes results of 336 patients treated for mandible fractures at King/Drew Medical Center in South Central Los Angeles, California from August 1996 to December 2001. Subjects were enrolled in a prospective study to evaluate the association between patient's subjective evaluation and objective clinical evaluations on three surgical outcome measures following orofacial surgery. METHODS: Subjects were assessed at four time periods--hospital discharge, 10 days post-discharge, 1 month post-discharge and 6 months post-discharge. Three outcome measures were utilized to represent perceived health and oral health-related quality of life--General Oral Health Assessment Index (GOHAI); Mental Health Inventory (MHI-5); and a single-item self-reported health status measure. RESULTS: GOHAI scores at 1 month (mean=31.5, SD=9.5) were not substantially higher than at 10 days (mean=28.6, SD=8.8), but scores did improve substantially by 6 months (mean=42.6, SD=10.6). Mean mental health scores ranged from 17.7 at 10 days to 18.0 at 1 month and 18.6 at 6 months. Mean self-reported health status score were approximately 2.2 at all recalls, describing health as 'good.' A longitudinal growth curve analysis of GOHAI scores over four time periods indicated a significantly higher average intercept for the maxillomandibular fixation (MMF) treatment group (29.67) than in the rigid internal fixation (RIF) treatment group (25.38). Meanwhile, the increase in GOHAI scores over time was significantly greater in the RIF group than in the MMF group, resulting in scores being comparable between groups after 6 months. CONCLUSIONS: By implication, patients with MMF self-report fewer problems in the early days after placement of the intra-arch wire compared with patients with RIF.


Asunto(s)
Fracturas Mandibulares/terapia , Satisfacción del Paciente , Adolescente , Adulto , Actitud Frente a la Salud , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/psicología , Curación de Fractura/fisiología , Estado de Salud , Humanos , Técnicas de Fijación de Maxilares/psicología , Masculino , Fracturas Mandibulares/psicología , Salud Mental , Salud Bucal , Alta del Paciente , Estudios Prospectivos , Calidad de Vida , Resultado del Tratamiento
19.
J Public Health Dent ; 66(1): 37-43, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-16570749

RESUMEN

OBJECTIVES: While patients' preferences for medical care are widely studied, only a small number of studies have looked at the decision-making process for dental treatment of mandibular fracture. This study examines the decision-making process for treatment of mandibular fractures among minority groups. Study participants were asked to consider Maxillomandibular Fixation (MMF--a non-surgical approach of wiring the teeth for 4-8 weeks) or Rigid Internal Fixation (RIF--surgical placement of bone plate). METHODS: A qualitative study of patients receiving care at an inner-city hospital for either 3rd molar extraction under general anesthesia or a mandibular fracture were recruited to participate in an hour-long focus group to discuss their preferences. The 3rd molar group was selected as a comparison group exemplifying experience with oral surgery and recovery from general anesthesia. RESULTS: Seven decision-making factors affecting choice of treatment were discussed by both jaw fracture and 3rd molar groups, including: side effects, effectiveness of each treatment, trusting doctor's recommendation, what to expect from each procedure, use of pictures from previous case studies, surgery location of scar/incision, and size of scar. Rigid Internal Fixation (RIF) participants discussed a different set of concerns compared to Maxillomandibular Fixation (MMF) participants. CONCLUSIONS: Regardless of gender, the treatment of choice for both 3rd molar and jaw fracture participants was the non-surgical method of wiring of the teeth for 4-8 weeks. The Phase II part of this study will systematically examine patient preferences among a larger sample of 3rd molar and jaw fracture patients by incorporating the patient-reported concerns about treatment of jaw fracture found in this inductive, phenomenological study.


Asunto(s)
Toma de Decisiones , Fracturas Mandibulares/terapia , Grupos Minoritarios , Negro o Afroamericano/psicología , Periodo de Recuperación de la Anestesia , Actitud Frente a la Salud , Placas Óseas/efectos adversos , Cicatriz/patología , Relaciones Dentista-Paciente , Femenino , Grupos Focales , Fijación Interna de Fracturas/efectos adversos , Hispánicos o Latinos/psicología , Humanos , Técnicas de Fijación de Maxilares/efectos adversos , Masculino , Fracturas Mandibulares/etnología , Grupos Minoritarios/psicología , Tercer Molar/cirugía , Educación del Paciente como Asunto , Satisfacción del Paciente , Extracción Dental , Resultado del Tratamiento , Confianza , Población Urbana
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