Appendectomy at Gynecologic Surgery: Feasibility and Outcomes in a High Risk Gynecologic Population—Revealing a High Rate of Incidental Appendiceal Cancer

2017 ◽  
Vol 33 (4) ◽  
pp. 145-148
Author(s):  
Michelle F. Benoit ◽  
Callan L. Kosnik ◽  
Emma A. Kent
Keyword(s):  
High Risk ◽  
High Rate ◽  
Gynecologic Surgery ◽  
Appendiceal Cancer

scholarly journals Spatio-temporal epidemiology of the tuberculosis incidence rate in Iran 2008 to 2018

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Behzad Kiani ◽  
Amene Raouf Rahmati ◽  
Robert Bergquist ◽  
Soheil Hashtarkhani ◽  
Neda Firouraghi ◽  
...  
Keyword(s):  
High Risk ◽  
Incidence Rate ◽  
Policy Development ◽  
Temporal Pattern ◽  
Temporal Analysis ◽  
High Rate ◽  
Spatial Scan Statistic ◽  
Cross Sectional ◽  
Risk Areas ◽  
Spatio Temporal

Abstract Background Effective reduction of tuberculosis (TB) requires information on the distribution of TB incidence rate across time and location. This study aims to identify the spatio-temporal pattern of TB incidence rate in Iran between 2008 and 2018. Methods This cross-sectional study was conducted on aggregated TB data (50,500 patients) at the provincial level provided by the Ministry of Health in Iran between 2008 and 2018. The Anselin Local Moran’s I and Getis-Ord Gi* were performed to identify the spatial variations of the disease. Furthermore, spatial scan statistic was employed for purely temporal and spatio-temporal analyses. In all instances, the null hypothesis of no clusters was rejected at p ≤ 0.05. Results The overall incidence rate of TB decreased from 13.46 per 100,000 (95% CI: 13.19–13.73) in 2008 to 10.88 per 100,000 (95% CI: 10.65–11.11) in 2018. The highest incidence rate of TB was observed in southeast and northeast of Iran for the whole study period. Additionally, spatial cluster analysis discovered Khuzestan Province, in the West of the country, having significantly higher rates than neighbouring provinces in terms of both total TB and smear-positive pulmonary TB (SPPTB). Purely temporal analysis showed that high-rate and low-rate clusters were predominantly distributed in the time periods 2010–2014 and 2017–2018. Spatio-temporal results showed that the statistically significant clusters were mainly distributed from centre to the east during the study period. Some high-trend TB and SPPTB statistically significant clusters were found. Conclusion The results provided an overview of the latest TB spatio-temporal status In Iran and identified decreasing trends of TB in the 2008–2018 period. Despite the decreasing incidence rate, there is still need for screening, and targeting of preventive interventions, especially in high-risk areas. Knowledge of the spatio-temporal pattern of TB can be useful for policy development as the information regarding the high-risk areas would contribute to the selection of areas needed to be targeted for the expansion of health facilities.

CCTG CO.28 primary endpoint analysis: Neoadjuvant chemotherapy, excision and observation for early rectal cancer, the NEO trial.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 3508-3508
Author(s):  
Hagen Fritz Kennecke ◽  
Carl J Brown ◽  
Jonathan M. Loree ◽  
Husein Moloo ◽  
Derek J. Jonker ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
High Risk ◽  
Tumor Progression ◽  
Primary Endpoint ◽  
Organ Preservation ◽  
Rectal Adenocarcinoma ◽  
The United States ◽  
High Rate ◽  
Pelvic Mri ◽  
Preservation Rate

3508 Background: CO.28 (NCT03259035) is a phase II study designed to determine if patients with cT1-T3a/bN0 rectal cancer can be treated with induction chemotherapy (FOLFOX/CAPOX) and organ-preserving surgery. Methods: Patients with MRI staged cT1-3a/bN0 tumors and no pathologic (p) high risk features received 6/4 cycles of FOLFOX/CAPOX, repeat sigmoidoscopy/pelvic MRI and subsequent Transanal Endoscopic Surgery (TES) in the absence of tumor progression. ypT0/T1N0 tumors were treated with observation while ypT2+ or ypN+ stage were recommended Total Mesorectal Excision (TME). The primary endpoint was protocol specified Organ Preservation Rate (psOPR = ypT0/T1N0, no p high risk features) and actual Organ Preservation Rate (aOPR = ypT0/T1N0 stage plus higher yp stage patients who declined TME surgery). The study would be considered negative with an psOPR of 50% or lower (H0) and as promising if it is 65% or higher (H1). Results: Between 08/2017 to 05/2020, 58 eligible patients were accrued in Canada and the United States, median age was 67 years, 71% male. All had well-moderately differentiated, non-mucinous rectal adenocarcinoma and median tumor height was 6 cm (range 0-18). Median follow-up was 15.4 months. Chemotherapy with FOLFOX (32) or CAPOX (26) was administered, 90% completed all planned cycles. A total of 56/58 (97%) proceeded to TES, while one patient was ineligible due to tumor progression (1.7%) and one declined. In the intention to treat analysis, the psOPR was 57% (95% CI 43-70%) while the aOPR was 79% (95% CI 67% to 89%) due to 13/23 declining recommended TME surgery. Of 10 patients who proceeded to recommended TME, a complete R0 TME was performed in 9/10, and no p residual carcinoma was found in 7/10. Crude loco-regional (LR) and distant recurrence rates were 3.5% (95% CI 0.4 to 12%) and 0%, respectively. A recurrence occurred in 1/13 patients who initially declined TME surgery. Conclusions: In select patients with early stage rectal cancer, three months of induction CAPOX/FOLFOX followed by TES resulted in a high OPR without the use of pelvic irradiation. The observed high rate of pathologic downstaging may point to high chemo-responsiveness in early rectal adenocarcinoma with no p high risk features. Further trials to evaluate this approach are justified and updated results will be presented. Clinical trial information: NCT03259035. [Table: see text]

Abstract 1942: Drug-Eluting Stents for Cerebrovascular Disease: Feasibility, Safety and Intermediate-term Outcomes

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Nirav J Mehta ◽  
Srihari S Naidu
Keyword(s):  
High Risk ◽  
Cerebrovascular Disease ◽  
Cerebral Circulation ◽  
Bare Metal Stents ◽  
High Rate ◽  
Bleeding Complications ◽  
Minor Stroke ◽  
Metal Stents ◽  
Major Stroke

Background: Cerebral atherosclerosis poses risk of ischemic stroke by embolic or flow-related mechanism. Patients with cerebral vascular disease who are deemed high risk due to critical stenosis or medication failure may have annual risk of recurrent ischemic event in excess of 40%. Major concern with currently used bare metal stents (BMS) is very high rate of restenosis, reportedly > 30%. We analyzed current literature to assess feasibility, safety and short- and intermediate-term outcomes after DES implantation in cerebral circulation. Methods: We performed a systematic literature search for reports that evaluated DES in cerebrovascular disease. Data were extracted to analyze baseline characteristics, vessel selection, technical success, and peri-procedure and intermediate-term outcome. Results: Three studies totaling 88 patients, 94 vessels, and 88 stent placements met the inclusion criteria. Mean age of the patients was 61.5 ± 13.1 years. The success rate for DES delivery was 94% (88/94 vessels). 54 stents were paclitaxel-eluting and 34 were sirolimus-eluting. Peri-procedure complication rate was low with 2 disabling strokes (modified Rankin scale > 2), 1 minor stroke and 2 asymptomatic non-flow limiting dissections. No death or bleeding complications occurred. Stent thrombosis occurred in two cases despite double antiplatelet therapy, accounting for the disabling strokes. At intermediate follow-up (6.5 ± 3.15 months), 4 (5%) cases of restenosis of > 50% vessel diameter were detected, one of which was symptomatic. Major stroke-free survival by Kaplan-Meier analysis was 96% at 9 months. Conclusion: Elective DES delivery in cerebral circulation is technically feasible with low rate of procedural and intermediate-term major stroke or death in high-risk patients. Prospective studies with long term follow-up are required to assess efficacy of DES compared to BMS.

scholarly journals 1100. Facility Factors Are a Stronger Driver of Peri-Operative Vancomycin Use Than Patient Risk Factors

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S391-S391
Author(s):  
Westyn Branch-Elliman ◽  
William O’Brien ◽  
Judith Strymish ◽  
Kamal Itani ◽  
Kalpana Gupta
Keyword(s):  
High Risk ◽  
Total Joint Replacement ◽  
High Risk Patient ◽  
High Rate ◽  
Common Reason ◽  
Surgical Prophylaxis ◽  
Medical Centers ◽  
Facility Level ◽  
Manual Review ◽  
Colorectal Procedures

Abstract Background Prior reports suggest that the use of vancomycin for surgical prophylaxis is common and increasing. However, rates of administration and reasons for choosing vancomycin are unknown. Thus, we sought to quantify the frequency of vancomycin as a surgical prophylaxis agent and to determine drivers of use. Methods All Veteran patients undergoing major cardiac, orthopedic total joint, vascular, or colorectal procedures and entered into the VA External Peer Review Program (EPRP) database during the period from October 1, 2008 to September 30, 2013 were included. EPRP includes a manual review of surgical cases to measure type of prophylaxis, and, in the case of vancomycin, clinician-documented reasons for vancomycin use (β-lactam allergy, patient at high risk of methicillin-resistant Staphylococcus aureus (MRSA), facility high rate of MRSA). Descriptive statistics were used to evaluate findings. Results Among 79, 058 surgical procedures at 109 different medical centers, 20,349 (25.7%) received vancomycin either alone or in combination with another agent for prophylaxis. Rates of vancomycin use were the highest for cardiac surgeries (10,455/21,396, 48.9%), followed by orthopedic total joint replacement surgeries (8,044/38,675, 20.8%), vascular surgeries (1,504/8,177, 18.4%) and colorectal surgeries (346/10,810, 3.2%). The most common reason for vancomycin use was a perceived high facility rate of MRSA (7,367, 36.2%) followed by β-lactam allergy (4,855, 23.9%) and high-risk patient (1,420/20,349, 7.0%). There was no reason documented in 5,194 (25.5%). The most common reason for vancomycin use differed by surgical type. Among cardiac and orthopedic cases, high facility rate was the most commonly reported reason, but β-lactam allergy was the most common driver among vascular and colorectal procedures. Conclusion Facility factors are a major driver of peri-operative vancomycin use, more so than β-lactam allergy or patient-level factors, particularly in cardiac and orthopedic surgery. These data suggest that facility-level interventions, such as implementation of specific guidelines, may be helpful for limiting vancomycin use in this population. Disclosures All authors: No reported disclosures.

Screening for prostate cancer

2017 ◽  
Author(s):  
Fritz H. Schröder
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Early Detection ◽  
Secondary Prevention ◽  
Current Knowledge ◽  
Age Groups ◽  
Population Based ◽  
High Rate ◽  
High Quality ◽  
Prostate Cancer Mortality

Screening for a disease must be clearly defined and differentiated from early detection. ‘Screening’ refers to the application of tests to the whole population or to defined segments such as males within certain defined high risk age groups. If applied in such a fashion ‘screening’ for prostate cancer may also be described epidemiologically as ‘secondary prevention’. While high-quality randomized studies show that screening reduces prostate cancer mortality by 21–44%, there is wide agreement that the introduction of population-based screening is at present premature because harms, mainly the high rate of overdiagnosis seen currently outweighs the benefits. This chapter attempts to put current knowledge into perspective with a set of recognized prerequirements for the application of screening, established by Wilson and Jungner in 1968.

High Rate of Actionable Variants Identifed by Multigene Testing for Pancreas Cancer Patients in a High Risk Clinic

2018 ◽  
Vol 113 (Supplement) ◽  
pp. S14-S15
Author(s):  
Gina Wideroff ◽  
Daniel A. Sussman ◽  
Peter J. Hosein ◽  
Rachel Silva-Smith ◽  
Talia Donenberg
Keyword(s):  
High Risk ◽  
Cancer Patients ◽  
Pancreas Cancer ◽  
High Rate ◽  
Actionable Variants ◽  
High Risk Clinic

Safety of Aspirin Use in Patients With Stroke and Small Unruptured Aneurysms

Neurology ◽  
2020 ◽  
Vol 96 (1) ◽  
pp. e19-e29
Author(s):  
Jian-Cong Weng ◽  
Jie Wang ◽  
Xin Du ◽  
Hao Li ◽  
Yu-Ming Jiao ◽  
...  
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Risk Group ◽  
Aneurysm Rupture ◽  
High Risk Group ◽  
High Rate ◽  
Uncontrolled Hypertension ◽  
Class Iii ◽  
Multicenter Cohort Study ◽  
Unruptured Intracranial Aneurysms

ObjectiveWe initiated a multicenter, prospective cohort study to test the hypothesis that aspirin is safe for patients with ischemic cerebrovascular disease (ICVD) harboring unruptured intracranial aneurysms (UIAs) <7 mm.MethodsThis prospective, multicenter cohort study consecutively enrolled 1,866 eligible patients with ICVD harboring UIAs <7 mm in diameter from 4 hospitals between January 2016 and August 2019. Baseline and follow-up patient information, including the use of aspirin, was recorded. The primary endpoint was aneurysm rupture.ResultsAfter a total of 4,411.4 person-years, 643 (37.2%) patients continuously received aspirin treatment. Of all included patients, rupture occurred in 12 (0.7%). The incidence rate for rupture (IRR) was 0.27 (95% confidence interval [CI] 0.15–0.48) per 100 person-years. The IRRs were 0.39 (95% CI 0.21–0.72) and 0.06 (95% CI 0.010–0.45) per 100 person-years for the nonaspirin and aspirin groups, respectively. In the multivariate analysis, uncontrolled hypertension and UIAs 5 to <7 mm were associated with a high rate of aneurysm rupture, whereas aspirin use was associated with a low rate of aneurysm rupture. Compared with other groups, the high-risk group (UIAs 5 to <7 mm with concurrent uncontrolled hypertension) without aspirin had higher IRRs.ConclusionAspirin is a safe treatment for patients with concurrent small UIAs and ICVD. Patients who are not taking aspirin in the high-risk group warrant intensive surveillance.ClinicalTrials.gov IdentifierNCT02846259.Classification of EvidenceThis study provides Class III evidence that for patients harboring UIAs <7 mm with ICVD, aspirin does not increase the risk of aneurysm rupture.

scholarly journals Suicide in bipolar disorder in a national English sample, 1996–2009: frequency, trends and characteristics

2013 ◽  
Vol 43 (12) ◽  
pp. 2593-2602 ◽  
Author(s):  
C. Clements ◽  
R. Morriss ◽  
S. Jones ◽  
S. Peters ◽  
C. Roberts ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
High Risk ◽  
Personality Disorder ◽  
Alcohol Dependence ◽  
National Sample ◽  
Depressive Illness ◽  
Primary Diagnosis ◽  
High Risk Group ◽  
Mood Stabilizers ◽  
High Rate

BackgroundBipolar disorder (BD) has been reported to be associated with high risk of suicide. We aimed to investigate the frequency and characteristics of suicide in people with BD in a national sample.MethodSuicide in BD in England from 1996 to 2009 was explored using descriptive statistics on data collected by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI). Suicide cases with a primary diagnosis of BD were compared to suicide cases with any other primary diagnosis.ResultsDuring the study period 1489 individuals with BD died by suicide, an average of 116 cases/year. Compared to other primary diagnosis suicides, those with BD were more likely to be female, more than 5 years post-diagnosis, current/recent in-patients, to have more than five in-patient admissions, and to have depressive symptoms. In BD suicides the most common co-morbid diagnoses were personality disorder and alcohol dependence. Approximately 40% were not prescribed mood stabilizers at the time of death. More than 60% of BD suicides were in contact with services the week prior to suicide but were assessed as low risk.ConclusionsGiven the high rate of suicide in BD and the low estimates of risk, it is important that health professionals can accurately identify patients most likely to experience poor outcomes. Factors such as alcohol dependence/misuse, personality disorder, depressive illness and current/recent in-patient admission could characterize a high-risk group. Future studies need to operationalize clinically useful indicators of suicide risk in BD.

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