Legitimate Treatment Research Articles

Mothers' attitude to the use of a combined oral contraceptive pill by their daughters for menstrual disorders or contraception.

Mothers' attitude may affect use of combined oral contraceptive pills by their daughters. We explored Chinese mothers' knowledge of and attitudes towards the use of combined oral contraceptive pills by their daughters for menstrual disorders or contraception, and evaluate the factors affecting their attitude. This survey was conducted from October 2012 to March 2013, and recruited Chinese women who attended a gynaecology clinic or accompanied their daughter to a gynaecology clinic, and who had one or more daughters aged 10 to 18 years. They completed a 41-item questionnaire to assess their knowledge of and attitude towards use of the combined oral contraceptive pills by their daughters. The demographic data of the mothers and their personal experience in using the pills were also collected. A total of 300 women with a mean age of 45.2 (standard deviation, 5.0) years completed the questionnaire. Only 58.3% of women reported that they had knowledge about the combined oral contraceptive pills; among them, a majority (63.3%) reported that their source of knowledge came from medical professionals. Of a total possible score of 22, their mean knowledge score for risk, side-effects, benefits, and contra-indications to use of combined oral contraceptive pills was only 5.0 (standard deviation, 4.7). If the medical recommendation to use an oral contraceptive was to manage their daughter's dysmenorrhoea, menorrhagia, acne, or contraception needs, 32.0%, 39.3%, 21.0% and 29.7%, respectively would accept this advice. Women who were an ever-user of combined oral contraceptive pills or who were more knowledgeable about combined oral contraceptives had a higher acceptance rate. Chinese women had a low acceptance level of using combined oral contraceptive pills as a legitimate treatment for their daughters. This was associated with lack of knowledge or a high degree of uncertainty about their risks and benefits. It is important that health caregivers provide up-to-date information about combined oral contraceptive pills to women and their daughters.

A mini-invasive procedure for treating arthrofibrosis of the knee

ObjectiveThe aim of this study was to introduce the results of a novel mini-invasive operative technique comprising mini-incision release, “pie-crusting” lengthening of the quadriceps extensor, and arthroscopic lysis in severe arthrofibrotic knees. MethodsFrom 2010 to 2014, 17 patients (12 males and 5 females with a mean age of 44 years (range, 19–62 years)) with severely arthrofibrotic knees were treated with this operative technique. The mean follow-up duration was 23 months. The knee range of motion (ROM) was assessed with a goniometer. The functional outcomes were evaluated according to the Hospital for Special Surgery (HSS) score and Judet's criteria. ResultsThe ROM significantly improved from 29.7° (range, 7°–56°) preoperatively to 127° (range, 120°–136°) at the final follow-up in all patients (p < 0.001). According to Judet's criteria, all patients achieved excellent results (ROM>100°). The HSS score was improved from 70 points (range, 60–85 points) preoperatively to 91 points (range, 84–98 points) (p < 0.001) at the final follow-up. No extension lag, skin necrosis, quadriceps weakness, wound dehiscence or quadriceps tendon rupture occurred. ConclusionsMini-invasive quadricepsplasty-associated arthroscopic lysis and manipulation of the knee in flexion is simple and easy and should be considered as a legitimate treatment for arthrofibrosis of the knee.

Evidence-Based Curricular Content Improves Student Knowledge and Changes Attitudes towards Transgender Medicine

Previous studies have demonstrated that the addition of transgender medicine content to a medical school curriculum increased students' comfort and willingness to treat transgender patients. We aimed to demonstrate that (1) evidence-based curricular content would improve knowledge of and change attitudes towards transgender medicine, and (2) students would consider cross-sex hormone therapy a legitimate treatment option for transgender patients. Curricular content with a focus on the biologic evidence for the durability of gender identity was added to the first-year medical program at Boston University School of Medicine. Immediately before and after exposure to the content, students were presented with an assessment of their knowledge of the etiology of gender identity. Immediately following exposure to the content, a significant number of students changed their answer regarding the etiology of gender identity so that the number of correct responses increased from 63% (n = 56) to 93% (n = 121) (P<.001). For transgender treatment, the number of correct responses increased from 20% (n = 56) before exposure to the content to 50% (n = 121) following exposure (P<.001). The addition of transgender medicine content to a medical school curriculum with a focus on the biologic evidence for a durable gender identity is an effective means of educating students about the etiology of gender identity and the appropriateness of cross-sex hormone therapy as a treatment for transgender patients.

The Outcome for Patients With Pathologic Node-Positive Prostate Cancer Treated With Intensity Modulated Radiation Therapy and Androgen Deprivation Therapy: A Case-Matched Analysis of pN1 and pN0 Patients

Improved outcome is reported after surgery or external beam radiation therapy (EBRT) plus androgen deprivation therapy (ADT) for patients with lymph node (LN) positive (N1) prostate cancer (PC). Surgical series have shown that pathologic (p)N1 PC does not behave the same in all patients. The aim of this study was to perform a matched-case analysis to compare the outcome of pN1 and pN0 PC after high-dose EBRT plus ADT. Radiation therapy up to 80Gy was delivered to the prostate with a minimal dose of 45Gy to the pelvis for pN1 patients. After matching, Kaplan-Meier statistics were used to compare the 5-year biochemical and clinical relapse-free survival (bRFS and cRFS), prostate cancer-specific survival (PCSS), and overall survival (OS). Acute and late rectal and urinary toxicity was evaluated. Sixty-nine pN1 PC patients were matched 1:1 with pN0 PC patients. The median follow-up time was 60months. The 5-year bRFS and cRFS for pN1 versus pN0 PC patients were 65%±7% versus 79%±5% (P=.08) and 70%±6% versus 83%±5% (P=.04) respectively. No significant difference was found in bRFS or cRFS rates between low volume pN1 (≤2 positive LNs) and pN0 patients. The 5-year PCSS and OS were comparable between pN1 and pN0 PC patients: PCSS: 92%±4% versus 93%±3% (P=.66); OS: 82%±5% versus 80%±5% (P=.58). Severe toxicity was rare for both groups, although pN1 patients experienced significantly more acute grade 2 rectal toxicity. Primary EBRT plus 2 to 3years of ADT is a legitimate treatment option for pN1 PC patients, especially those with ≤2 positive LNs, and this with bRFS and cRFS rates comparable to those in pN0 PC patients. For pN1 PC patients with >2 positive LNs, bRFS and cRFS are worse than in pN0 patients, but even in this subgroup, long-term disease control is obtained.

A Dichotomy of Information-Seeking and Information-Trusting: Stem Cell Interventions and Children with Neurodevelopmental Disorders.

Parents and primary caregivers of children with Cerebral Palsy (CP) and Autism Spectrum Disorder (ASD) are faced with difficult treatment choices and management options for their children. The potential of stem cell technologies as an interventional strategy for CP and ASD has gained attention in the last decade. Information about these interventions varies in quality, resulting in a complex landscape for parent decision making for a child's care. Further complicating this landscape are clinics that advertise these interventions as a legitimate treatment for a fee. In this study, we surveyed individuals who considered taking their child with ASD or CP abroad for stem cell interventions on their use of different sources of stem cell related health information and their level of trust in these sources. Participants reported that while the Internet was their most frequent source of information, it was not well-trusted. Rather, information sources trusted most were researchers and the science journals in which they publish, other parents of children with CP and ASD, and healthcare providers. These findings highlight a dichotomy between information-seeking preferences and information-trusted sources. We discuss the challenges of health science communication and present innovative opportunities to increase communication with trusted and reliable sources as part of an integrated multi-pronged approach.

Thinking About Electroconvulsive Therapy: The Opinions of Parents of Adolescents with Schizophrenia Spectrum Disorders.

To assess the experience with, knowledge of, and attitudes toward electroconvulsive therapy (ECT) among parents of adolescents with schizophrenia spectrum disorders (SSD) who have received ECT. A self-administered questionnaire was used to assess the experience with, knowledge of, and attitudes toward ECT in a sample of parents of adolescents diagnosed with SSD. Parents of adolescents treated with ECT before the age of 18 years (ECT group; n = 19) were compared with a randomly selected group of parents of adolescents treated only with antipsychotics (No ECT group; n = 20). Most parents in the ECT group claimed that they had received adequate information about the ECT procedure (94.7%), most of them thought it had been helpful for their children (73.7%) and none thought that it had made things worse. The large majority of parents in the ECT group (80%) thought that the illness had been worse than ECT or medication, and none thought that ECT was the worst. Parents in the ECT group generally had better knowledge of what ECT is and its indications. All the parents in the ECT group (100%) and almost all of those in the No ECT group (94.7%) would agree to the treatment for their children if recommended in the future by a doctor, there being no differences between the groups in this respect (p = 0.447). Most parents in the ECT group (88.9%) thought it was a legitimate treatment when used appropriately, an opinion that was held by a much smaller proportion of parents in the No ECT group (52.6%), although the remaining parents in that group were unsure about it (47.4%). Most parents of adolescents with SSD treated with ECT had positive views about the treatment. Parents of adolescents treated only with antipsychotics tended either to have positive views about ECT or claimed to have no knowledge about it, with negative views being uncommon.

On Pat Conroy: The Power to Withstand, the Power to Understand

REVIEW-ESSAY DANIEL CROSS TURNER Institute for Southern Studies, University of South Carolina On Pat Conroy: The Power to Withstand, the Power to Understand WHEN HE FIRST HEARD THERE WOULD BE A SCHOLARLY BOOK DEDICATED to Pat Conroy’s work, lifelong friend Bernie Schein quipped, “Understanding Pat Conroy.? What’s there to understand? I could write all there is to understand about him in two pages” (Pat Conroy, personal communication with the author, May 8, 2015). Funny, but, one fears, there’s some kernel of truth to that. Because Conroy put so much of himself into everything he did. His novels, his memoirs, his adaptations, hisinterviews,hisreadings,hisbook-signings,hisletters,hisphonecalls. Everything, already out there on the page, the screen, the stage, the signing table. How could a serious critic make it beyond Schein’s sarcastically proposed two-page limit? Luckily, Catherine Seltzer’s got Conroy’s number. Seltzer is also immersed in the multi-year project of penning Conroy’s official biography. These kinds of publications are likely to see increase and increased attention with the author’s recent passing; the establishing of the annual Pat Conroy Literary Festival in Beaufort, South Carolina, as well as the founding there of the Pat Conroy Literary Center under the directorship of Jonathan Haupt; and the recent donation of his papers to create the Pat Conroy Archive housed in Rare Books and Special Collections at the University of South Carolina Libraries. Seltzer begins by acknowledging that many of Conroy’s readers feel they understand him deeply already: an instant empathy seems to arise from his willingness to write and speak openly about the physical and emotional abuse that he had to withstand, and that he devoted much of his adulthood trying to understand. This immediate yet profound emotional connection in part explains why he remained such an astoundingly popular writer across five decades; so many of his readers, too, had withstood abusive households, violently dysfunctional families, and Pat Conroy helped lead them to a collective working through of their 116 Daniel Cross Turner traumas, to come to some form of understanding. Seltzer rightly gives proper due to the remarkable emotive chords Conroy’s books have struck with his avid readership—his writings model the power to withstand and the power to understand, psychically (per Seltzer, “Literature, in Conroy’s vision, is meant not simply to impress its reader but to transform him or her” [9])—yet fulfills her job, in perspicacious and engaging fashion, by bringing us to a deeper intellectual understanding of Conroy’s work, particularly as a writer who records a diversifying region that supersedes a disintegrating traditional South, which is “a dangerous facsimile of its admittedly mythic antecedent” (7). The Understanding Contemporary American Literature series from the University of South Carolina Press is designed to provide a clear, accessible scholarly overview of the work of a post-World War II US writer. Begun on the watch of Matthew J. Bruccoli, renowned textual scholar and literary executor for F. Scott Fitzgerald and James Dickey, there are many stalwart authors represented, and represented well (for instance, Michael Kreyling on Eudora Welty), but the series can be uneven, with some seemingly odd or lesser known choices. Under the shepherdship of current series editor Linda Wagner-Martin, there have been some fine recent titles—to offer but one timely example, Andy Crank’s excellent study of the late Sam Shepard. Seltzer’s account of Conroy’s career output certainly fits the bill for the series. She constructs an impeccably organized, insightful, and user-friendly (i.e., denuded of the latest-order scholarly shibboleths we academics tend to prize highly) panorama of Conroy’s prolific writing career as novelist and memoirist. Yet Seltzer’s installment in the series, I suspect, holds the power to do more. Unlike so many scholarly texts, even those ostensibly written for a wider audience with a not-so-terribly-esoteric topic, this one—dare I say it—might sell. There’s a hungry readership out there. And this book contains the first legitimate wholesale scholarly treatment of Conroy’s work. Each of the main chapters covers a single work, moving in chronological order. Seltzer adroitly covers the highlights, the...

EMDR With Sex Offenders: Using Offense Drivers to Guide Conceptualization and Treatment

Evidence shows that sexual offenders have higher levels of adverse childhood experiences (ACE) than either the general population or other criminal populations. Historically, it was considered standard practice for sex offender therapists to dissuade their clients from addressing childhood trauma or adversity for fear of excuse making for his offending. The pathways model, which highlights etiology, made room for trauma treatment for offender’s ACE as a legitimate treatment intervention. The adaptive information processing model inherent in eye movement desensitization and reprocessing (EMDR) trauma therapy is theorized to reorganize the maladaptively stored clustering of cognitions and emotions related to overwhelming or traumatic experiences such as childhood sexual abuse. We suggest EMDR therapy as a means of restructuring distorted implicit cognitions and personal vulnerability factors which are theorized to drive offending behavior. Through a comprehensive literature review, the authors considered 5 extant models in the sex offender literature and developed theoffense driversmodel. This model is designed to guide and inform EMDR therapy with sex offenders. A case example illustrates the implementation of this treatment process. A checklist ofoffense driversis provided to assist in case conceptualization and treatment.

Withdrawal Time of Phenylbutazone Administered to Healthy Horses

Equine medication regulation rules have been established to prevent a horse's performance being altered after the administration of prohibited substances or approved therapeutic medications used for legitimate treatment. Phenylbutazone (PBZ) is a nonsteroidal anti-inflammatory drug widely used in equine medicine and is one of the most frequently identified medications in the anti-doping controls. The aim of this study was to evaluate plasma elimination kinetic of PBZ in healthy horses after both intravenous and oral administration of two commercial products. Phenylbutazone was administered to horses intravenously or orally at a dose rate of 4.4 mg/kg once daily for five consecutive days. Blood (10 mL) samples were collected before the last dose (t0); and then after 1, 3, 6, 9, 12, and 24 hours; and every 12 hours for 10 days after treatment. Plasma levels of PBZ and its major metabolite oxyphenbutazone were measured by high performance liquid chromatography with ultraviolet detector (limit of detection [LOD] = 0.005 μg/mL). The detection time obtained in this study by both intravenous and oral PBZ administration by using a LOD of 0.005 μg/mL was 84 hours. Using the dose regimen reported here, a withdrawal time of 5 days could be a correct approach to be adopted for the use of PBZ in performance horses.

(Il)legitimate differential treatment

(Il)legitimate differential treatment

Between hope and evidence: how community advisors demarcate the boundary between legitimate and illegitimate stem cell treatments.

Stem cell science provides an exemplary study of the 'management of hope'. On the one hand, raising 'hopes' and expectations is a seen as a necessary aspect of securing investment in promising innovative research. On the other, such hyperbole risks raising hopes to a level that may lead people to undertake undue risks, which may ultimately undermine confidence in medical research. In this context, the 'management of hope' thus involves the negotiation of competing claims of truth about the value and safety of particular treatments and about the trustworthiness of providers. Using Gieryn's concept of boundary-work, this article examines the means by which this work of 'managing hope' is undertaken. Drawing on data collected as part of our study that investigated the perspectives of those who are consulted by patients and their carers about stem cell treatments, we explore how these community advisors – both scientists and clinicians with a stake in stem cell research and representatives from patient advocacy groups – demarcate the boundary between legitimate and illegitimate treatments. In particular, we examine how these actors rhetorically use 'evidence' to achieve this demarcation. We argue that analysing accounts of how advisors respond to patient enquiries about stem cell treatments offers a window for examining the workings of the politics of hope within contemporary bioscience and biomedicine. In conclusion, we emphasize the need to re-conceptualize the boundary between science and non-science so as to allow a better appreciation of the realities of health care in the age of medical travel.

The ecology of prescription opioid abuse in the USA: geographic variation in patients' use of multiple prescribers ("doctor shopping").

This study estimates the prevalence in US counties of opioid patients who use large numbers of prescribers, the amounts of opioids they obtain, and the extent to which their prevalence is predicted by ecological attributes of counties, including general medical exposure to opioids. Finite mixture models were used to estimate the size of an outlier subpopulation of patients with suspiciously large numbers of prescribers (probable doctor shoppers), using a sample of 146 million opioid prescriptions dispensed during 2008. Ordinary least squares regression models of county-level shopper rates included independent variables measuring ecological attributes of counties, including rates of patients prescribed opioids, socioeconomic characteristics of the resident population, supply of physicians, and measures of healthcare service utilization. The prevalence of shoppers varied widely by county, with rates ranging between 0.6 and 2.5 per 1000 residents. Shopper prevalence was strongly correlated with opioid prescribing for the general population, accounting for 30% of observed county variation in shopper prevalence, after adjusting for physician supply, emergency department visits, in-patient hospital days, poverty rates, percent of county residents living in urban areas, and racial/ethnic composition of resident populations. Approximately 30% of shoppers obtained prescriptions in multiple states. The correlation between prevalence of doctor shoppers and opioid patients in a county could indicate either that easy access to legitimate medical treatment raises the risk of abuse or that drug abusers take advantage of greater opportunities in places where access is easy. Approaches to preventing excessive use of different prescribers are discussed.

Oxycodone/Naloxone: role in chronic pain management, opioid-induced constipation, and abuse deterrence.

The use of opioids in the treatment of chronic pain is widespread; the prevalence of specific opioids varies from country to country and depends on product availability, national formulary systems, and provider preferences. Patients often receive opioids for legitimate treatment of pain conditions, but on the opposite side of the spectrum, nonmedical use of opioids is a significant public health concern. Opioids are associated with several side effects, and constipation is the most commonly reported and persistent symptom. Unlike some adverse effects associated with opioid use, tolerance does not develop to constipation. Opioid-induced constipation (OIC) is the most prevalent patient complaint associated with opioid use and has been associated with declines in various quality of life measures. OIC can be extremely difficult for patients to tolerate and may prompt patients to decrease or discontinue opioid treatment. Current management strategies for OIC are often insufficient. A prolonged-release formulation of oxycodone/naloxone (OXN) has been investigated for the treatment of nonmalignant and cancer pain and mitigation of OIC, and evidence is largely favorable. Studies have demonstrated the capability of OXN to alleviate OIC while maintaining pain control comparable to oxycodone-only regimens. There is insufficient evidence for OXN efficacy for patients with mild OIC or patients maintained on high doses of opioids, and use in these populations is controversial. The reduction of costs associated with OIC may provide overall cost effectiveness with OXN. Additionally, the presence of naloxone may deter abuse/misuse by those seeking to misuse the formulation by modes of administration other than oral ingestion. Most studies to date have occurred in European countries, and phase 3 trials continue in the United States. This review will include current therapeutic options for pain and constipation, unique characteristics of OXN, evidence related to use of OXN and its place in therapy, discussion of opioid abuse/misuse, and various abuse-deterrent mechanisms, and areas of continuing research.Electronic supplementary materialThe online version of this article (doi:10.1007/s40122-014-0026-2) contains supplementary material, which is available to authorized users.

Preventing and managing aberrant drug-related behavior in primary care: Systematic review of outcomes evidence

Several strategies for preventing, identifying, and responding to aberrant opioid-related behaviors are recommended in pain management guidelines. This systematic review evaluated data supporting basic strategies for addressing aberrant opioid-related behaviors. Risk reduction strategies were identified via a review of available guidelines. Systematic literature searches of PubMed (May 1, 2007-January 18, 2013) identified articles with evidence relevant to nine basic strategies. Reference lists from relevant articles were reviewed for additional references of interest. Levels of evidence for articles identified were graded on a four-point scale (strongest evidence = level 1; weakest evidence = level 4) using Oxford Centre for Evidence-Based Medicine Levels of Evidence criteria. Weak to moderate evidence supports the value of thorough patient assessment, risk-screening tools, controlled-substance agreements, careful dose titration, opioid dose ceilings, compliance monitoring, and adherence to practice guidelines. Moderate to strong evidence suggests that prescribing tamper-resistant opioids may help prevent misuse but may also have the unintended consequence of prompting a migration of users to other marketed opioids, heroin, or other substances. Similarly, preliminary evidence suggests that although recent regulatory and legal efforts may reduce misuse, they also impose barriers to the legitimate treatment of pain. Despite an absence of consistent, strong supporting evidence, clinicians are advised to use each of the available risk-mitigation strategies in combination in an attempt to minimize the risk of abuse in opioid treatment patients. Physicians must critically evaluate their opioid prescribing and not only increase their efforts to prevent substance abuse but also not compromise pain management in patients who benefit from it.

Neurofeedback Requires Better Evidence of Efficacy Before It Should Be Considered a Legitimate Treatment for ADHD: What is the Evidence for this Claim?

The article reviews the evidence for the claim that neurofeedback lacks sufficient evidence of efficacy and, therefore, cannot be considered a legitimate treatment for ADHD.

Metacognition‐Oriented Social Skills Training for Individuals with Long‐Term Schizophrenia: Methodology and Clinical Illustration

There is much evidence indicating the presence of social deficits in schizophrenia and the detrimental effect of these deficits on global functioning in this population. As a result, social skills training (SST) has emerged as a legitimate psychosocial treatment, although effectiveness research has revealed small effect sizes and limited generalizability regarding the benefits of this treatment. In light of the strong evidence of metacognitive deficits in schizophrenia and the importance of metacognition to successful social functioning, we propose a novel therapeutic intervention wherein metacognitive remediation is integrated into SST: metacognition-oriented social skills training (MOSST). In the current paper, we present MOSST, an adapted SST programme wherein clients are also encouraged to have mindful contact with their own thoughts and to better consider and understand the mental states of others as well as the connection between mental states and behaviour. We present a case wherein an individual with schizophrenia successfully completed the MOSST programme. We outline directions for future research, starting with the logical next step of empirically testing the efficacy of MOSST. Currently social skills training is considered to be the elected psychosocial treatment for people affected by schizophrenia, although evidence indicates limited benefits. People with schizophrenia have metacognitive deficits, which interfere with proper social functioning. A metacognitive-oriented social skills training (MOSST) intervention has been developed by the authors.A treatment such as MOSST, which integrates social skills training and metacognitive training, promises to improve social skills through improving the metacognition.

The Argument for Medical Marijuana for the Treatment of Chronic Pain

This patient has legitimate pain and still deserves treatment despite being at high risk for substance abuse. Untreated pain will only create more drug hunger ⇓. Multimodal management would be best, including antidepressant and anticonvulsant medications, and physical modalities such as a transcutaneous electrical nerve stimulation unit ⇓. However, medicinal cannabis can be considered a legitimate next treatment step, much preferred to a prescription for opioids. Opioids and cannabinoids are both among the world's oldest drugs, with usage dating back thousands of years ⇓. Both medications work via specific receptors and are created …

Consenting Not to Be Informed

The aim of this study was to investigate the opinions of healthy students regarding the acceptability of placebo treatment if they were to experience depression. A survey was conducted among 344 students in five academic centers in Israel. After a thorough explanation of the placebo effect, its efficacy and limitations in the treatment of depression, the study participants completed a 32-item self-report questionnaire. Seventy percent (n = 243) of the participants answered that they would agree to treatment with a placebo as a first-line treatment if they were to experience depression in the future. Eighty-eight percent (n = 297) of the subjects did not think that a physician who administered placebos was deceitful. Once aware of the possible benefits and limitations of placebo treatment, most of our study population was willing to accept placebo as a legitimate treatment of depression. Additional studies on the possible use of placebo as an effective, safe, and acceptable form of therapy are warranted.

Systematic review: managing aberrant drug behavior in primary care

Several strategies for preventing, identifying, and responding to aberrant opioid-related behaviors are recommended in pain management guidelines. This systematic review evaluated data in support of these strategies. Risk-reduction strategies were identified via a review of available guidelines. Systematic literature searches of PubMed were conducted (May 1, 2007 to May 21, 2012) to identify articles with evidence relevant to 9 basic strategies. Reference lists from relevant articles were reviewed for additional references of interest. Levels of evidence for articles identified were graded on a 4-point scale (strongest evidence=level 1; weakest evidence=level 4) using Oxford Centre for Evidence-based Medicine Levels of Evidence criteria. Weak to moderate evidence supported the value of thorough patient assessment, risk-screening tools, controlled-substance agreements, careful dose titration, opioid dose ceilings, compliance monitoring, and adherence to practice guidelines. Moderate to strong evidence suggests that tamper-resistant opioids may help prevent misuse but also that prescribing these formulations may have the unintended consequence of prompting a migration of users to other marketed opioids, heroin, or other substances. Similarly, there is preliminary evidence that recent regulatory and legal efforts may help reduce misuse but also impose barriers to the legitimate treatment of pain. Despite an absence of consistent, strong supporting evidence, clinicians are advised to use each of the available risk-mitigation strategies in combination as an attempt to minimize the risk of abuse in opioid treatment patients. Efforts to prevent abuse should not compromise pain management or promote other forms of substance abuse. Supported by Endo Pharmaceuticals Inc. (Chadds Ford, PA), who also funded editorial support provided by Complete Healthcare Communications, Inc. (Chadds Ford, PA).

1302 COMPARATIVE OUTCOMES OF SURGICAL AND NONSURGICAL MANAGEMENT OF RENAL MASSES IN PATIENTS >75 YEARS OF AGE

You have accessJournal of UrologyKidney Cancer: Localized (II)1 Apr 20131302 COMPARATIVE OUTCOMES OF SURGICAL AND NONSURGICAL MANAGEMENT OF RENAL MASSES IN PATIENTS >75 YEARS OF AGE Behfar Ehdaie, Nick Hauser, Aaron Bernie, and Paul Russo Behfar EhdaieBehfar Ehdaie New York, NY More articles by this author , Nick HauserNick Hauser New York, NY More articles by this author , Aaron BernieAaron Bernie New York, NY More articles by this author , and Paul RussoPaul Russo New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2656AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) represents an effective management strategy for incidental small renal masses; however the impact of nonsurgical management of larger renal masses is understudied. Specifically, patients >75 years of age with incidental renal masses are at increased risk to die of cardiovascular and other non-cancer comorbid medical conditions. We evaluated cancer-specific and other-cause mortality after either AS or nephrectomy, in patients >75 years of age. METHODS Following IRB approval, we prospectively reviewed an institutional database and identified 703 consecutive patients >75 years of age treated by partial or radical nephrectomy or managed with AS from 1983 to 2012 at Memorial Sloan Kettering Cancer Center. Cox proportional hazards regression was used to assess differences in cancer-specific survival and other-cause mortality between patients treated with nephrectomy and AS adjusting for age, tumor dimensions, and comorbidity. RESULTS Overall, 520 (74%) patients were treated by partial or radical nephrectomy and 183 (26%) patients were managed by AS. Median follow-up among patients alive treated by surgery and patients with AS were 38 months and 24 months, respectively. No patients treated with AS died of kidney cancer. After 5 years, 23 (4.4%) and 71 (13.7%) patients treated with surgery died of kidney cancer and other causes, respectively. In contrast, 12 (7.4%) of AS patients died of other causes at 5 years. After adjustment for factors associated with survival, including Charlson comorbidity score, and tumor size, treatment type was not associated with overall survival (p=0.079, 95% CI 0.28-1.07). CONCLUSIONS In patients >75 years of age, AS does not adversely impact cancer-specific and overall mortality. The increasing burden of comorbid conditions associated with aging represent a competing risk on overall mortality in patients >75 years of age with renal tumors. AS appears to be a legitimate and safe treatment option for small renal mass in patients > 75 years of age and comorbid medical conditions. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e531-e532 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Behfar Ehdaie New York, NY More articles by this author Nick Hauser New York, NY More articles by this author Aaron Bernie New York, NY More articles by this author Paul Russo New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...