RESUMO
OBJECTIVES: The ISPOR Oncology Special Interest Group formed a working group at the end of 2010 to develop standards for conducting oncology health services research using secondary data. The first mission of the group was to develop a checklist focused on issues specific to selection of a sample of oncology patients using a secondary data source. METHODS: A systematic review of the published literature from 2006 to 2010 was conducted to characterize the use of secondary data sources in oncology and inform the leadership of the working group prior to the construction of the checklist. A draft checklist was subsequently presented to the ISPOR membership in 2011 with subsequent feedback from the larger Oncology Special Interest Group also incorporated into the final checklist. RESULTS: The checklist includes six elements: identification of the cancer to be studied, selection of an appropriate data source, evaluation of the applicability of published algorithms, development of custom algorithms (if needed), validation of the custom algorithm, and reporting and discussions of the ascertainment criteria. The checklist was intended to be applicable to various types of secondary data sources, including cancer registries, claims databases, electronic medical records, and others. CONCLUSIONS: This checklist makes two important contributions to oncology health services research. First, it can assist decision makers and reviewers in evaluating the quality of studies using secondary data. Second, it highlights methodological issues to be considered when researchers are constructing a study cohort from a secondary data source.
Assuntos
Lista de Checagem , Pesquisa sobre Serviços de Saúde/organização & administração , Oncologia/organização & administração , Avaliação de Resultados em Cuidados de Saúde/métodos , Algoritmos , Estudos de Coortes , Humanos , Neoplasias/terapiaRESUMO
PURPOSE: Preliminary results of the European Randomized Study of Screening for Prostate Cancer showed a decrease in prostate cancer specific mortality associated with prostate specific antigen screening. We evaluated the cost-effectiveness of prostate specific antigen screening using data from the European Randomized Study of Screening for Prostate Cancer protocol when extrapolated to the United States. MATERIALS AND METHODS: We used previously reported Surveillance, Epidemiology and End Results-Medicare data and a nationwide sample of employer provided estimates of costs of care for patients with prostate cancer. The European data were used in accordance with the study protocol to determine the costs and cost-effectiveness of prostate specific antigen screening. RESULTS: The lifetime cost of screening with prostate specific antigen, evaluating abnormal prostate specific antigen and treating identified prostate cancer to prevent 1 death from prostate cancer was $5,227,306 based on the European findings and extrapolated to the United States. If screening achieved a similar decrease in overall mortality as the decrease in prostate cancer specific mortality in the European study, such intervention would cost $262,758 per life-year saved. Prostate specific antigen screening reported in the European study would become cost effective when the lifelong treatment costs were below $1,868 per life-year, or when the number needed to treat was lowered to 21 or fewer men. CONCLUSIONS: The lifelong costs of screening protocols are determined by the cost of treatment with an insignificant contribution from screening costs. We established a model that predicts the minimal requirements that would make screening a cost-effective measure for population based implementation.
Assuntos
Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/economia , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Europa (Continente) , Humanos , Masculino , Programas de Rastreamento/economia , Pessoa de Meia-Idade , Neoplasias da Próstata/sangue , Ensaios Clínicos Controlados Aleatórios como Assunto , Estados UnidosRESUMO
Tuberculosis of the genitourinary tract presents with atypical manifestations. Only 20% to 30% of patients with genitourinary tuberculosis have a history of pulmonary infection. Tuberculosis often affects the lower genitourinary system rather than the kidney. Tuberculosis of the lower genitourinary tract most commonly affects the epididymis and the testis, followed by bladder, ureter, prostate, and penis. Use of bacillus Calmette-Guérin therapy for bladder cancer can cause symptomatic tubercular infections of the lower genitourinary tract. Tuberculosis of the lower genitourinary tract can present with irritative voiding symptoms, hematuria, epididymo-orchitis, prostatitis, and fistulas. Tuberculosis of the seminal vesicles, vas, fallopian tubes, and the uterus can cause infertility. Urinalysis may demonstrate sterile pyuria, hematuria, or albuminuria. Identification of acid-fast bacilli in culture or tissue or by polymerase chain reaction studies is diagnostic. Medical treatment may not result in resolution of symptoms. Surgical intervention and reconstruction of the urinary tract are frequently indicated.
Assuntos
Tuberculose Urogenital , Feminino , Humanos , Masculino , Tuberculose dos Genitais Femininos/diagnóstico , Tuberculose dos Genitais Femininos/terapia , Tuberculose dos Genitais Masculinos/diagnóstico , Tuberculose dos Genitais Masculinos/terapia , Tuberculose Urogenital/diagnóstico , Tuberculose Urogenital/terapia , Doenças Uretrais/diagnóstico , Doenças Uretrais/microbiologia , Doenças Uretrais/terapia , Doenças da Bexiga Urinária/diagnóstico , Doenças da Bexiga Urinária/microbiologia , Doenças da Bexiga Urinária/terapiaAssuntos
Carcinoma de Células Renais , Neoplasias Renais , Idoso , Humanos , Medicare , Estados UnidosRESUMO
OBJECTIVE: Familial occurrence of testicular torsion has been infrequently reported. To date, no systematic analysis has been published. We systematically analyzed the literature to elucidate the epidemiology, presentation, management, and whether the observed prevalence of testicular torsion in families is consistent with absence of inheritance and is randomly distributed. PATIENTS AND METHODS: We searched electronic databases using keywords "testicular torsion", "spermatic cord torsion", "familial torsion" and "sibling torsion". Reports with genetically related first degree relatives were included in the analysis. Levene's nonparametric test was used to compare the variance of the age of presentation within families to that between different families to differentiate between familial predisposition and chance events. RESULTS: Up to 10% of patients with testicular torsion have an affected first degree relative. We were able to reject the null hypothesis that the observed prevalence of testicular torsion is due to chance (p < 0.001). Family history is missed in at least 27% of affected families. There is a high incidence of bilateral testicular torsion in families (37%) and probands (17%) and a high concordance rate for bilaterality among monozygous twins. CONCLUSIONS: Current evidence from clinical and animal studies suggests the presence of a genetically determined component in familiar testicular torsion. Increased awareness may lead to earlier clinical presentation and higher testicular salvage rates.
Assuntos
Torção do Cordão Espermático/genética , Doenças em Gêmeos/genética , Humanos , Masculino , Torção do Cordão Espermático/epidemiologia , Torção do Cordão Espermático/terapia , Gêmeos MonozigóticosRESUMO
We report the first and largest family with testicular torsion in three consecutive generations affecting four first-degree relatives. The incidence of familial testicular torsion is under reported in the literature. We recommend eliciting family history in evaluation of acute scrotum, as a useful adjunct for clinical decision making. In families with a strong predisposition to testicular torsion, management should include family counseling about the significant risk of occurrence of this condition.
Assuntos
Orquiectomia , Orquidopexia , Torção do Cordão Espermático/genética , Torção do Cordão Espermático/cirurgia , Humanos , Lactente , Masculino , Torção do Cordão Espermático/diagnóstico por imagem , Torção do Cordão Espermático/patologia , Testículo/diagnóstico por imagem , Testículo/patologia , UltrassonografiaRESUMO
The debate about the usefulness of population-based prostate cancer screening has been ongoing for decades. The most current evidence shows limited benefit of population screening, and significant psychological, physical and financial costs. Efforts to improve screening with better markers and more selective treatment may make population-based screening more effective.
Assuntos
Programas de Rastreamento , Neoplasias da Próstata/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Efeitos Psicossociais da Doença , Exame Retal Digital , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Qualidade de Vida , Fatores de RiscoRESUMO
Epidemiologic changes that include immune-compromised patients and drug-resistant fungi have caused an increase in nosocomial infections by Candida albicans and non-albicans Candida species. Other fungi, aspergilla and Cryptococcus (environmental contaminants), are opportunistic invaders of the immune-compromised (transplant, HIV) patients. The environmental fungi Coccidioides immitis (dry arid areas), Histoplasma capsulatum (Avian-infested areas), and Blastomyces dermatitidis (aquatic areas) can cause infections in immune-competent and immune-deficient patients. Each fungus can cause changes in the prostate that mimic bacterial infection, benign prostatic hypertrophy, or neoplasm. Diagnosis can be established by urine cultures or needle biopsy of the prostate. Prostate surgery for carcinoma or benign enlargement may detect latent fungal infection. Different fungal species can have divergent clinical manifestations and require different treatment. In some cases, asymptomatic localized fungal prostatitis can be cured by removal of the infected gland. Symptomatic and disseminated infection may require prostatectomy and systemic antifungal therapy.