Outcomes in stage I non-small cell lung cancer following the introduction of stereotactic body radiotherapy in Alberta - A population-based study.

PURPOSE: To review outcomes of patients with stage I non-small cell lung cancer (NSCLC) following the introduction of stereotactic body radiation therapy (SBRT). METHODS: SBRT cases were linked to the cancer registry database along with clinical, treatment and health service parameters for n=2146 cases of stage I NSCLC diagnosed between 2005 and 2011. The pre-diagnosis Aggregated Clinical Risk Grouping score (ACRG3) was used as a proxy for pre-treatment patient comorbidity. A Cox regression model and the concordance statistic (C-statistic) were used to examine variables predicted for overall survival (OS). RESULTS: The SBRT utilization rate increased annually with superior OS to conventional RT (median survival [MS] of 39.4 VS. 23.5months, P<0.001) despite higher ACRG3 scores. Surgical patients were younger, had lower ACRG3, achieving MS of 69.6months. Regression analysis indicated both Surgery (hazard ratio [HR]=0.23, 95% CI: 0.18-0.28) and SBRT (HR=0.33, 95% CI: 0.21-0.51) remained most strongly associated with OS. ACRG3 (HR=0.79, P<0.001) and age (HR=0.83, P=0.03) were independently associated with OS. The OS model was associated with the C-statistic at 0.86, 95% CI: 0.81-0.90. CONCLUSION: In stage I NSCLC patients treated with surgery have the best survival. SBRT demonstrates improved OS compared to conventional RT. C-statistic result demonstrates discrimination of treatment selection factors on OS.

Gender-specific aspects of cardiovascular disease.

When William Heberden gave his classic description of angina pectoris in 1768, he inadvertently described a gender-specific difference in heart disease when he noted the predominance of men with this condition. It is only in the last few decades that the medical profession has recognized that women are equally afflicted with atherosclerotic cardiovascular disease, albeit with some differences in presentation, risk factors and outcomes. This article will detail the ways in which men and women differ when it comes to the number one killer in the developed, and increasingly the developing, world.

Anatomically safe and minimally invasive transcrestal technique for procurement of autogenous cancellous bone graft from the mid-iliac crest.

BACKGROUND: Open iliac bone harvesting techniques can result in significant complications and residual morbidity. In reconstructive procedures where a small volume of autogenous cancellous bone graft is required, a minimally invasive technique for bone harvesting applied at the mid-iliac crest has been deemed satisfactory. We sought to assess the application of a well-established surgical technique to procure adequate volume of autogenous cancellous iliac bone graft with minimal trauma to adjacent structures. METHODS: We retrospectively reviewed the cases of patients who underwent a minimally invasive transcrestal mid-iliac bone graft procurement technique between May 2003 and December 2007. The technique was performed using a 3.5-mm Steinmann pin as a trocar and a 4.5-mm AO drill sleeve as a trephine. We administered a questionnaire, either in the clinic or by mail, to assess a number of parameters, including postoperative pain, dysthesia, parasthesia, status of the donor site wound and patient satisfaction. RESULTS: Of the 37 consecutive patients who underwent the procedure, data from 26 patients were available for assessment. Donor site pain resolved within a few days of the surgery, and none of the patients experienced symptoms of chronic pain. At the final review, none of the patients reported any unpleasant signs and symptoms related to the residual scar. CONCLUSION: We recommend that the described minimally invasive trephine method be used when a small cancellous bone graft is needed. We found that patient morbidity was significantly lower with the trephine harvest technique than with open bone harvesting methods at the anterior iliac crest.

Validity of administrative data claim-based methods for identifying individuals with diabetes at a population level.

OBJECTIVES: This study assessed the validity of a widely-accepted administrative data surveillance methodology for identifying individuals with diabetes relative to three laboratory data reference standard definitions for diabetes. METHODS: We used a combination of linked regional data (hospital discharge abstracts and physician data) and laboratory data to test the validity of administrative data surveillance definitions for diabetes relative to a laboratory data reference standard. The administrative discharge data methodology includes two definitions for diabetes: a strict administrative data definition of one hospitalization code or two physician claims indicating diabetes; and a more liberal definition of one hospitalization code or a single physician claim. The laboratory data, meanwhile, produced three reference standard definitions based on glucose levels +/- HbA1c levels. RESULTS: Sensitivities ranged from 68.4% to 86.9% for the administrative data definitions tested relative to the three laboratory data reference standards. Sensitivities were higher for the more liberal administrative data definition. Positive predictive values (PPV), meanwhile, ranged from 53.0% to 88.3%, with the liberal administrative data definition producing lower PPVs. CONCLUSIONS: These findings demonstrate the trade-offs of sensitivity and PPV for selecting diabetes surveillance definitions. Centralized laboratory data may be of value to future surveillance initiatives that use combined data sources to optimize case detection.