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  • 1
    Online Resource
    Online Resource
    Empirical Treatment Effectiveness Models for Binary Outcomes
    SAGE Publications ; 2016
    In:  Medical Decision Making Vol. 36, No. 1 ( 2016-01), p. 101-114
    Details
    In: Medical Decision Making, SAGE Publications, Vol. 36, No. 1 ( 2016-01), p. 101-114
    Abstract: Randomized trials provide strong evidence regarding efficacy of interventions but are limited in their capacity to address potential heterogeneity in effectiveness within broad clinical populations. For example, a treatment that on average is superior may be distinctly worse in certain patients. We propose a technique for using large electronic health registries to develop and validate decision models that measure—for distinct combinations of covariate values—the difference in predicted outcomes among 2 alternative treatments. We demonstrate the methodology in a prototype analysis of in-hospital mortality under alternative revascularization treatments. First, we developed prediction models for a binary outcome of interest for each treatment. Decision criteria were then defined based on the treatment-specific model predictions. Patients were then classified as receiving concordant or discordant care (in relation to the model recommendation), and the association between discordance and outcomes was evaluated. We then present alternative decision criteria and validation methodologies, as well as sensitivity analyses that investigate 1) the imbalance between treatments on observed covariates and 2) the aggregate impact of unobserved covariates. Our methodology supplements population-average clinical trial results by modeling heterogeneity in outcomes according to specific covariate values. It thus allows for assessment of current practice, from which cogent hypotheses for improved care can be derived. Newly emerging large population registries will allow for accurate predictions of outcome risk under competing treatments, as complex functions of predictor variables. Whether or not the models might be used to inform decision making depends on the extent to which important predictors are available. Further work is needed to understand the strengths and limitations of this approach, particularly in relation to those based on randomized trials.
    Type of Medium: Online Resource
    ISSN: 0272-989X , 1552-681X
    URL: Article
    DOI: 10.1177/0272989X15578835
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2040405-0
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  • 2
    Online Resource
    Online Resource
    Deceased Donor Hyperglycemia and Liver Graft Dysfunction
    SAGE Publications ; 2014
    In:  Progress in Transplantation Vol. 24, No. 1 ( 2014-03), p. 106-112
    Details
    In: Progress in Transplantation, SAGE Publications, Vol. 24, No. 1 ( 2014-03), p. 106-112
    Abstract: Hyperglycemia is common in deceased donors, and provokes numerous adverse events in hepatocytic mitochondria. Objective To determine whether hyperglycemia in deceased donors is associated with graft dysfunction after orthotopic liver transplant. Methods Charts on 572 liver transplants performed at the Cleveland Clinic between January 2005 and October 2010 were reviewed. The primary measure was time-weighted averages of donors' glucose measurements. Liver graft dysfunction was defined as (1) primary nonfunction as indicated by death or retransplant or (2) liver graft dysfunction as indicated by an aspartate amino transferase level greater than 2000 U/L or prothrombin time greater than 16 seconds during the first postoperative week. The relationship of interest was estimated by using a multivariable logistic regression. Results The incidence of graft dysfunction was 25%. No significant relationship was found between the range of donor glucose measurements and liver graft dysfunction after donor characteristics were adjusted for ( P = .14, Wald test, adjusted odds ratio [95% CI] for liver graft dysfunction corresponding to a relative doubling in time-weighted average for donor glucose of 1.43 [0.89–2.30] ). The results thus do not suggest that strict glucose control in donors is likely to improve graft quality.
    Type of Medium: Online Resource
    ISSN: 1526-9248 , 2164-6708
    URL: Article
    DOI: 10.7182/pit2014737
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
    detail.hit.zdb_id: 2864264-8
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  • 3
    Online Resource
    Online Resource
    Comparative Outcomes of Cooled Versus Traditional Radiofrequency Ablation of the Lateral Branches for Sacroiliac Joint Pain
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  The Clinical Journal of Pain Vol. 29, No. 2 ( 2013-02), p. 132-137
    Details
    In: The Clinical Journal of Pain, Ovid Technologies (Wolters Kluwer Health), Vol. 29, No. 2 ( 2013-02), p. 132-137
    Type of Medium: Online Resource
    ISSN: 0749-8047
    URL: Article
    DOI: 10.1097/AJP.0b013e3182490a17
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1497640-7
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  • 4
    Online Resource
    Online Resource
    “A rising tide floats all boats”: The role of neighborhood collective efficacy in responding to child maltreatment
    Elsevier BV ; 2022
    In:  Child Abuse & Neglect Vol. 124 ( 2022-02), p. 105461-
    Details
    In: Child Abuse & Neglect, Elsevier BV, Vol. 124 ( 2022-02), p. 105461-
    Type of Medium: Online Resource
    ISSN: 0145-2134
    URL: Article
    DOI: 10.1016/j.chiabu.2021.105461
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2004382-X
    SSG: 5,2
    SSG: 5,3
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  • 5
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    Online Resource
    Relationship Between Glenoid Component Shift and Osteolysis After Anatomic Total Shoulder Arthroplasty : Three-Dimensional Computed Tomography Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Journal of Bone and Joint Surgery Vol. 103, No. 15 ( 2021-8-4), p. 1417-1430
    Details
    In: Journal of Bone and Joint Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 103, No. 15 ( 2021-8-4), p. 1417-1430
    Abstract: The purpose of this study was to evaluate glenoid component position and radiolucency following anatomic total shoulder arthroplasty (TSA) using sequential 3-dimensional computed tomography (3D CT) analysis. Methods: In a series of 152 patients (42 Walch A1, 16 A2, 7 B1, 49 B2, 29 B3, 3 C1, 3 C2, and 3 D glenoids) undergoing anatomic TSA with a polyethylene glenoid component, sequential 3D CT analysis was performed preoperatively (CT1), early postoperatively (CT2), and at a minimum 2-year follow-up (CT3). Glenoid component shift was defined as a change in component version or inclination of ≥3° from CT2 to CT3. Glenoid component central anchor peg osteolysis (CPO) was assessed at CT3. Factors associated with glenoid component shift and CPO were evaluated. Results: Glenoid component shift occurred from CT2 to CT3 in 78 (51%) of the 152 patients. CPO was seen at CT3 in 19 (13%) of the 152 patients, including 15 (19%) of the 78 with component shift. Walch B2 glenoids with a standard component and glenoids with higher preoperative retroversion were associated with a higher rate of shift, but not of CPO. B3 glenoids with an augmented component and glenoids with greater preoperative joint-line medialization were associated with CPO, but not with shift. More glenoid component joint-line medialization from CT2 to CT3 was associated with higher rates of shift and CPO. A greater absolute change in glenoid component inclination from CT2 to CT3 and a combined absolute glenoid component version and inclination change from CT2 to CT3 were associated with CPO. Neither glenoid component shift nor CPO was associated with worse clinical outcomes. Conclusions: Postoperative 3D CT analysis demonstrated that glenoid component shift commonly occurs following anatomic TSA, with increased inclination the most common direction. Most (81%) of the patients with glenoid component shift did not develop CPO. Longer follow-up is needed to determine the relationships of glenoid component shift and CPO with loosening over time. Level of Evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
    Type of Medium: Online Resource
    ISSN: 0021-9355 , 1535-1386
    URL: Article
    DOI: 10.2106/JBJS.20.00833
    RVK:
    XA 52200.A
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 6
    Online Resource
    Online Resource
    Blood Type O is not associated with increased blood loss in extensive spine surgery
    Elsevier BV ; 2014
    In:  Journal of Clinical Anesthesia Vol. 26, No. 6 ( 2014-09), p. 432-437
    Details
    In: Journal of Clinical Anesthesia, Elsevier BV, Vol. 26, No. 6 ( 2014-09), p. 432-437
    Type of Medium: Online Resource
    ISSN: 0952-8180
    URL: Article
    DOI: 10.1016/j.jclinane.2014.01.019
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2014
    detail.hit.zdb_id: 1500489-2
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  • 7
    Online Resource
    Online Resource
    Motor and Somatosensory Evoked Potentials Are Well Maintained in Patients Given Dexmedetomidine during Spine Surgery
    Ovid Technologies (Wolters Kluwer Health) ; 2008
    In:  Anesthesiology Vol. 109, No. 3 ( 2008-09-01), p. 417-425
    Details
    In: Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 109, No. 3 ( 2008-09-01), p. 417-425
    Abstract: Many commonly used anesthetic agents produce a dose-dependent amplitude reduction and latency prolongation of evoked responses, which may impair diagnosis of intraoperative spinal cord injury. Dexmedetomidine is increasingly used as an adjunct for general anesthesia. Therefore, the authors tested the hypothesis that dexmedetomidine does not have a clinically important effect on somatosensory and transcranial motor evoked responses. Methods Thirty-seven patients were enrolled and underwent spinal surgery with instrumentation during desflurane and remifentanil anesthesia with dexmedetomidine as an anesthetic adjunct. Upper- and lower-extremity transcranial motor evoked potentials and somatosensory evoked potentials were recorded during four defined periods: baseline without dexmedetomidine; two periods with dexmedetomidine (0.3 and 0.6 ng/ml), in a randomly determined order; and a final period 1 h after drug discontinuation. The primary outcomes were amplitude and latency of P37/N20, and amplitude, area under the curve, and voltage threshold for transcranial motor evoked potential stimulation. Results Of the total, data from 30 patients were evaluated. Use of dexmedetomidine, as an anesthetic adjunct, did not have an effect on the latency or amplitude of sensory evoked potentials greater than was prespecified as clinically relevant, and though the authors were unable to claim equivalence on the amplitude of transcranial motor evoked responses due to variability, recordings were made throughout the study in all patients. Conclusion Use of dexmedetomidine as an anesthetic adjunct at target plasma concentrations up to 0.6 ng/ml does not change somatosensory or motor evoked potential responses during complex spine surgery by any clinically significant amount.
    Type of Medium: Online Resource
    ISSN: 0003-3022
    URL: Article
    DOI: 10.1097/ALN.0b013e318182a467
    RVK:
    XA 22600
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2008
    detail.hit.zdb_id: 2016092-6
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  • 8
    Online Resource
    Online Resource
    Effects of Dexmedetomidine and Propofol on Lower Esophageal Sphincter and Gastroesophageal Pressure Gradient in Healthy Volunteers
    Ovid Technologies (Wolters Kluwer Health) ; 2010
    In:  Anesthesiology Vol. 112, No. 1 ( 2010-01-01), p. 19-24
    Details
    In: Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 112, No. 1 ( 2010-01-01), p. 19-24
    Abstract: Many anesthetics reduce lower esophageal sphincter pressure (LESP). Reduced pressure and consequent reduction in the gastroesophageal pressure gradient (GEPG) thus promotes gastroesophageal reflux and may contribute to aspiration pneumonia and associated morbidity. Therefore, the authors compared LESP and GEPG during dexmedetomidine and propofol sedation. Methods Using a randomized, double-blind, crossover design, 11 healthy volunteers were sedated on 2 separate days. Baseline LESP and GEPG were recorded each day. Subsequently, on each day volunteers received three 40-min-long sedative infusions of increasing doses of 0.6, 1.2, and 2.4 ng/ml dexmedetomidine or 1, 2, and 4 microg/ml propofol. LESP and GEPG were recorded during inhalation and expiration at 20 and 40 min after starting each infusion phase, and these measurements were averaged. Results are presented as mean (95% confidence interval). Results Two subjects did not return for the dexmedetomidine study day, and the dexmedetomidine results were unusable in another; propofol results in these volunteers were nonetheless retained for analysis. There were no significant differences in LESP and GEPG as a function of drug. However, there was a small but significant 7.4 (-1.6 to -13.2) mmHg (approximately 25%) dose-dependent decrease in LESP over the range of targeted low to high blood levels of each drug. Conclusions Both dexmedetomidine and propofol have similar effects on LESP and GEPG. Although both of the drugs cause some decrease in LESP at high concentrations, it is unlikely that this effect would promote gastroesophageal reflux during sedation.
    Type of Medium: Online Resource
    ISSN: 0003-3022
    URL: Article
    DOI: 10.1097/01.anes.0000365963.97138.54
    RVK:
    XA 22600
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2010
    detail.hit.zdb_id: 2016092-6
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  • 9
    Online Resource
    Online Resource
    Nitrous oxide may not increase the risk of cancer recurrence after colorectal surgery: a follow-up of a randomized controlled trial
    Springer Science and Business Media LLC ; 2009
    In:  BMC Anesthesiology Vol. 9, No. 1 ( 2009-12)
    Details
    In: BMC Anesthesiology, Springer Science and Business Media LLC, Vol. 9, No. 1 ( 2009-12)
    Abstract: Even the best cancer surgery is usually associated with minimal residual disease. Whether these remaining malignant cells develop into clinical recurrence is at least partially determined by adequacy of host defense, especially natural killer cell function. Anesthetics impair immune defenses to varying degrees, but nitrous oxide appears to be especially problematic. We therefore tested the hypothesis that colorectal-cancer recurrence risk is augmented by nitrous oxide administration during colorectal surgery. Methods We conducted a 4- to 8-year follow-up of 204 patients with colorectal cancer who were randomly assigned to 65% nitrous oxide (n = 97) or nitrogen (n = 107), balanced with isoflurane and remifentanil. The primary outcome was the time to cancer recurrence. Our primary analysis was a multivariable Cox-proportional-hazards regression model that included relevant baseline variables. In addition to treatment group, the model considered patient age, tumor grade, dissemination, adjacent organ invasion, vessel invasion, and the number of nodes involved. The study had 80% power to detect a 56% or greater reduction in recurrence rates (i.e., hazard ratio of 0.44 or less) at the 0.05 significance level. Results After adjusting for significant baseline covariables, risk of recurrence did not differ significantly for nitrous oxide and nitrogen, with a hazard ratio estimate (95% CI) of 1.10 (0.66, 1.83), P = 0.72. No two-way interactions with the treatment were statistically significant. Conclusion Colorectal-cancer recurrence risks were not greatly different in patients who were randomly assigned to 65% nitrous oxide or nitrogen during surgery. Our results may not support avoiding nitrous oxide use to prevent recurrence of colorectal cancer. Implications Statement The risk of colorectal cancer recurrence was similar in patients who were randomly assigned to 65% nitrous oxide or nitrogen during colorectal surgery. Trial Registration Current Controlled Clinical Trials NCT00781352 http://www.clinicaltrials.gov
    Type of Medium: Online Resource
    ISSN: 1471-2253
    URL: Article
    DOI: 10.1186/1471-2253-9-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2009
    detail.hit.zdb_id: 2091252-3
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  • 10
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    Miscalibration of lung allocation models leads to inaccurate waitlist mortality predictions
    Elsevier BV ; 2023
    In:  American Journal of Transplantation Vol. 23, No. 1 ( 2023-01), p. 72-77
    Details
    In: American Journal of Transplantation, Elsevier BV, Vol. 23, No. 1 ( 2023-01), p. 72-77
    Type of Medium: Online Resource
    ISSN: 1600-6135
    URL: Article
    DOI: 10.1016/j.ajt.2022.11.012
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2045621-9
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