Propensity Score-matched Control Research Articles

Increased risk of cancer in patients with retinal vein occlusion: a 12-year nationwide cohort study

AimsTo investigate the association between incident retinal vein occlusion (RVO) and the subsequent development of cancer.MethodsIn this nationwide population-based retrospective study using 2002–2013 National Health Insurance Service database which covers...

Convalescent plasma treatment of severe COVID-19: a propensity score-matched control study.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a new human disease with few effective treatments1. Convalescent plasma, donated by persons who have recovered from COVID-19, is the acellular component of blood that contains antibodies, including those that specifically recognize SARS-CoV-2. These antibodies, when transfused into patients infected with SARS-CoV-2, are thought to exert an antiviral effect, suppressing virus replication before patients have mounted their own humoral immune responses2,3. Virus-specific antibodies from recovered persons are often the first available therapy for an emerging infectious disease, a stopgap treatment while new antivirals and vaccines are being developed1,2. This retrospective, propensity score-matched case-control study assessed the effectiveness of convalescent plasma therapy in 39 patients with severe or life-threatening COVID-19 at The Mount Sinai Hospital in New York City. Oxygen requirements on day 14 after transfusion worsened in 17.9% of plasma recipients versus 28.2% of propensity score-matched controls who were hospitalized with COVID-19 (adjusted odds ratio (OR), 0.86; 95% confidence interval (CI), 0.75-0.98; chi-square test P value = 0.025). Survival also improved in plasma recipients (adjusted hazard ratio (HR), 0.34; 95% CI, 0.13-0.89; chi-square test P = 0.027). Convalescent plasma is potentially effective against COVID-19, but adequately powered, randomized controlled trials are needed.

Does the NHS Diabetes Prevention Programme prevent diabetes? A population-based matched cohort study

Abstract Background To reduce the incidence of type 2 diabetes (T2DM) in England, the National Health Service piloted the Diabetes Prevention Programme (DPP). The DPP aims to prevent T2DM by providing high-risk adults with access to 13 face-to-face sessions over nine months that focus on diet and weight management. The DPP has been shown to improve intermediate outcomes for T2DM prevention (weight loss and glycated haemoglobin (HbA1c) reduction). However, there is a lack of evidence examining incident T2DM as the outcome. Methods We conducted a retrospective observational cohort study using linked electronic health records from primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care for June 2016 to January 2019. We compared rates of new T2DM diagnoses among eligible adults who were referred to the DPP with rates for propensity score-matched (ratio of 1:4) controls who were eligible for the DPP but were not invited. DPP eligibility was defined as having HbA1c levels of 42-47 mmol/mol or fasting plasma glucose (FPG) levels of 5.5-6.9 mmol/L. Adults with pre-existing T2DM were excluded. Time to the first record of T2DM was modelled using Cox regression with age, alcohol intake, body mass index, ethnicity, sex, HbA1c, index of multiple deprivation and smoking status included as covariates. Results We identified 2205 individuals who participated in the DPP and 8820 matched controls with a similar breakdown in age, sex, HbA1c and FPG. During the 2.5-year study period, 4.13% of DPP individuals developed T2DM vs 6.42% of controls. Our results indicate that DPP referrals were associated with a 59% reduction T2DM incidence rates [adjusted hazard ratio=0.41;95%CI=0.38-0.44]. Conclusions This is the first study to investigate the impact of the DPP on T2DM, relative to usual care. Our results provide support for the effectiveness of DPP in preventing T2DM onset and are compatible with findings for similar interventions in other settings. Key messages The evidence suggests that providing consistent face-to-face sessions which concentrate on diet and weight management can reduce short-term T2DM incidences in high-risk adults. With a 59% reduction in T2DM rates in DPP referees relative to eligible adults who were not referred, the DPP is effective in reducing short-term T2DM incidences in high-risk adults.

Management and In-hospital Mortality of 2203 Patients With a Traumatic Intimal Tear of the Thoracic Aorta.

Our goal was to describe contemporary management and inhospital mortality associated with blunt thoracic aortic intimal tears (IT) within the American College of Surgeons Trauma Quality Improvement Program. The evidence basis for nonoperative expectant management of traumatic iT of the thoracic aorta remains weak. All adult patients with a thoracic aortic IT following blunt trauma were captured from Level I and II North American Centers enrolled in Trauma Quality Improvement Program from 2010 to 2017. For each patient, we extracted demographics, injury characteristics, the timing and approach of thoracic aortic repair and in-hospital mortality. Mortality attributable to IT was calculated by comparing IT patients to a propensity-score matched control cohort of severely injured blunt trauma patients without aortic injury. There were 2203 IT patients across 315 facilities. Injury most often resulted from motor vehicle collision (75%). A total of 758 patients (34%) underwent operative management, with 93% (N = 708) of repairs performed via an endovascular approach. Median time to surgery was 11 hours (IQR 4- 40). The frequency of operative management was higher in patients without traumatic brain injury (TBI) (35%, N = 674) compared to those with TBI (29%, N = 84) (P = 0.024). Compared to severely injured blunt trauma patients without aortic injury, ITwas not associated with additional in-hospital mortality (10.7% for IT vs 11.7% for no IT, absolute risk difference: -1.0%, 95% CI: -2.9% to 0.8%). The majority of blunt thoracic IT are managed nonoperatively and IT does not confer additional in-hospital mortality risk. Future studies should focus on the risk of injury progression.

Postoperative negative pressure wound therapy is associated with decreased surgical site infections in all lower extremity amputations

IntroductionWe hypothesize that Negative Pressure Wound Therapy (NPWT) is associated with a lower incidence of surgical site infection (SSI) in lower extremity amputations (LEAs), a potentially devastating complication. MethodsNSQIP database from 2011 to 2018 was queried to identify all-level LEAs. Cases using NPWT were identified. One-to-one nearest-neighbor propensity score matching was performed using a binary logistic regression on NPWT status controlling for patient comorbidities. ResultsNPWT was used in 133 of 5237 total LEAs (2.54%). Compared to propensity score-matched controls, they had significantly fewer SSIs (1.50% vs. 8.27%). ConclusionsNPWT was associated with lower incidence of SSI.

Oral Bisphosphonate use Reduces Cardiovascular Events in a Cohort of Danish Patients Referred for Bone Mineral Density.

The cardiovascular (CV) safety of oral bisphosphonates (oBPs) is uncertain. Determine the risk of CV events in oBP users referred for bone mineral density (BMD) testing compared with matched controls. Cohort study. Danish national prescription registry enriched with local hospital data from Odense. Individuals aged ≥45 years referred for BMD testing. oBP. Hospitalization for any CV event. Secondary study outcomes were specific CV events. Negative (inguinal hernia surgery and ingrown toenail) and positive (fragility fracture) control outcomes assessed systemic bias. Cox proportional hazards models were fitted to estimate hazard ratio (HR) and 95% confidence intervals. There were 2565 oBP users (82.6% women) and 4568 (82.3% women) propensity score-matched controls. Alendronate accounted for 96% of oBP prescription. A total of 406 (15.8%) CV events occurred in oBP users (rate = 73.48 [66.67-80.98]); rate = events divided by person-time; and 837 (18.3%) events in controls (rate = 104.73 [97.87-112.07]) with an adjusted HR of 0.68 (95% CI 0.60-0.77). Additional adjustment for BMD did not attenuate estimates (HR 0.67; 95% CI 0.58-0.78]. Similar results were seen for secondary outcomes where risk reductions were seen regarding atrial fibrillation, stroke, heart failure, and aneurysms. Positive and negative control outcome analyses identified minimal residual confounding. Oral BP users experienced a 33% reduced risk of CV events. This observational real-world study adds to a growing body of evidence for cardioprotection by oBP that warrants testing in a randomized setting.

Acute Kidney Injury and Outcomes in Children Undergoing Noncardiac Surgery: A Propensity-Matched Analysis.

Acute kidney injury (AKI) has been well documented in adults after noncardiac surgery and demonstrated to be associated with adverse outcomes. We report the prevalence of AKI after pediatric noncardiac surgery, the perioperative factors associated with postoperative AKI, and the association of AKI with postoperative outcomes in children undergoing noncardiac surgery. Patients ≤18 years of age who underwent noncardiac surgery with serum creatinine during the 12 months preceding surgery and no history of end-stage renal disease were included in this retrospective observational study at a single tertiary academic hospital. Patients were evaluated during the first 7 days after surgery for development of any stage of AKI, according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patients were classified into stages of KDIGO AKI for the purposes of describing prevalence. For further analyses, patients were grouped into those who developed any stage of AKI postoperatively and those who did not. Additionally, the time point at which each patient was first diagnosed with stage I AKI or greater was also assessed. Pre-, intra-, and postoperative factors were compared between the 2 groups. A multivariable Cox proportional hazards regression model was created to examine the time to first diagnosis of AKI using all nonredundant covariates. Analysis of the association of AKI with postoperative outcomes, mortality and 30-day readmission, was undertaken utilizing propensity score-matched controls and a multivariable Cox proportional hazards regression model. A total of 25,203 cases between 2013 and 2018 occurred; 8924 met inclusion criteria. Among this cohort, the observed prevalence of postoperative AKI was 3.2% (288 cases; confidence interval [CI], 2.9-3.6). The multivariable Cox model showed American Society of Anesthesiologists (ASA) status to be associated with the development of postoperative AKI. Several other factors, including intraoperative hypotension, were significantly associated with postoperative AKI in univariable models but found not to be significantly associated after adjustment. The multivariable Cox analyses with propensity-matched controls showed an estimated hazard ratio of 3.28 for mortality (CI, 1.71-6.32, P < .001) and 1.55 for 30-day readmission (CI, 1.08-2.23, P = .018) in children who developed AKI versus those who did not. In children undergoing noncardiac surgery, postoperative AKI occurred in 3.2% of patients. Several factors, including intraoperative hypotension, were significantly associated with postoperative AKI in univariable models. After adjustment, only ASA status was found to be significantly associated with AKI in children after noncardiac surgery. Postoperative AKI was found to be associated with significantly higher rates of mortality and 30-day readmission in multivariable, time-varying models with propensity-matched controls.

Association of Roux-en-Y Gastric Bypass With Postoperative Health Care Use and Expenditures in Canada

Results of previous studies are mixed regarding the economic implications of a Roux-en-Y gastric bypass (RYGB). To assess the 5-year incremental health care use and expenditures after RYGB. This population-based cohort study conducted in Ontario, Canada, used a difference-in-differences approach to compare health care use and expenditures between patients who underwent a publicly funded RYGB from March 1, 2010, to March 31, 2013, and propensity score-matched control individuals who did not undergo a surgical bariatric procedure. The study period allowed for a minimum 60 months of follow-up because, at that time, the most recent date for which administrative data on health care and expenditures were available was March 31, 2018. Data sources included the Ontario Bariatric Registry linked to several Ontario health administrative databases and the Electronic Medical Record Administrative Data Linked Database. Health care use and expenditures data for 5 years before and 5 years after the index date (procedure date for RYGB group; random date for controls) were analyzed. Data analyses were performed March 12, 2019, to March 10, 2020. RYGB procedure. The primary outcome was total health care expenditures. The final propensity score-matched cohorts comprised 1587 individuals in the RYGB group (mean [SD] age, 47 [10.2] years) and 1587 controls (mean [SD] age, 47 [12.2] years); each group had 1228 women (77.4%) and a mean body mass index (calculated as weight in kilograms divided by height in meters squared) of 46. Mean total health care expenditures (2017 Canadian dollars) per patient in the RYGB group increased from CAD $15 594 (95% CI, CAD $14 743 to CAD $16 614) (US $12 008 [95% CI, US $11 353 to US $12 794]) in the 5 years before the procedure to CAD $30 389 (95% CI, CAD $28 789 to CAD $32 232) (US $23 401 [95% CI, US $22 169 to US $24 821]) over the 5 years after the procedure, a difference of CAD $14 795 (95% CI, CAD $13 172 to CAD $16 480) (US $11 393 [95% CI, US $10 143 to US $12 691]). For the control group, mean total health care expenditures per individual increased from CAD $16 109 (95% CI, CAD $14 727 to CAD $17 591) (US $12 405 [95% CI, US $11 341 to US $13 546]) 5 years before the index date to CAD $20 073 (95% CI, CAD $18 147 to CAD $22 169) (US $15 457 [95% CI, US $13 974 to US $17 071]) 5 years after the date, a difference of CAD $3964 (95% CI, CAD $2250 to CAD $5875) (US $3053 [95% CI, US $1733 to US $4524]). Overall, the difference-in-differences estimate of the net cost of RYGB was CAD $10 831 (95% CI, CAD $8252 to CAD $13 283) (US $8341 [95% CI, $6355 to $10 229]) over the 5-year period. This amount excluded the mean (SD) cost associated with the index date: CAD $6501 (CAD $1087) (US $5006 [US $837]) for the RYGB cohort and CAD $9 (CAD $72) (US $7 [US $55]) for the controls. The cost differential was primarily associated with increased hospitalizations in the first months immediately after RYGB. Expenditures leveled off in year 3 after the index date; differences in total expenditures between the RYGB and control cohorts were not statistically significantly different in years 4 and 5. Health care expenditures in the 3 years after publicly funded RYGB were higher in patients who underwent the procedure than in control individuals, but the costs were similar thereafter. This finding suggests the need to decrease hospital and emergency department readmissions after surgical bariatric procedures because such use is associated with increased spending.

Lower-extremity Arterial Thrombosis Associated with COVID-19 Is Characterized by Greater Thrombus Burden and Increased Rate of Amputation and Death.

BackgroundDuring the peak of COVID-19 pandemic, we have noted an increase in positive lower extremity CT angiogram (CTA) exams in patients presenting with leg ischemia. The goal of this study was to determine whether lower extremity arterial thrombosis was associated with COVID-19 and whether it was characterized by greater severity in these patients.MethodsIn this IRB approved retrospective propensity score–matched study, 16 SARS-CoV-2 positive patients who underwent CTA of the lower extremities and 32 SARS-CoV-2 negative patients observed from January to April in 2018-2020 were compared using three scoring system: two systems including all vessels with weighting given in one system to more proximal vessel and in the other to more distal vessels, and a third system where only the common iliac through popliteal arteries were considered. Correlation with presenting symptoms and outcomes was computed. Fisher exact tests were used to compare COVID-19 positive to negative patients regarding presence of clots and presenting symptoms. A Mantel-Haenszel test was used to associate outcome of death/amputation with COVID-19 adjusted by the history of peripheral vascular disease (PVD).ResultsSixteen patients with confirmed COVID-19 (70 +/- 14 years, 7 women) underwent CTA and 32 propensity-score matched control patients (71 +/- 15 years, 16 women) were included. All COVID-19 patients (100%, 95%CI: 79-100%) had at least one thrombus while only 69% (95%CI: 50-84%) of controls had thrombi (p=0.02). 94% (95%CI: 70-99.8%) of COVID-19 patients had proximal thrombi compared to 47% (95%CI: 29-65%) of controls (p<0.001). Mean thrombus score using any of the three scoring systems yielded greater scores in the COVID-19 patients (p<0.001). Adjusted for history of PVD, death or limb amputation was more common in COVID-19 patients (OR 25, 95%CI 4.3-147, p<0.001). COVID-19 patients presenting with symptoms of leg ischemia only were more likely to avoid amputation or death than patients presenting also with pulmonary or systemic symptoms (p=0.001).ConclusionCOVID-19 is associated with lower extremity arterial thrombosis characterized by greater clot burden and a more dire prognosis.

Risk of Total Knee and Hip Arthroplasty in Patients With Rheumatoid Arthritis: A 12-Year Retrospective Cohort Study of 65,898 Patients

BackgroundRheumatoid arthritis (RA) is an inflammatory disease that causes the destruction of soft tissues and cartilage around joints. Owing to the widespread use of potent disease-modifying antirheumatic drugs, the need for total knee and hip arthroplasties (TKA and THA) has been reduced in patients with RA. However, the current association between RA and either THA or TKA has not been demonstrated in large-scale epidemiological studies. MethodsWe conducted a large-scale retrospective cohort study of patients diagnosed with RA during a 12-year period (2000-2012) in Taiwan. We recruited 32,949 patients with RA and 32,949 individually propensity score-matched non-RA controls. ResultsAfter adjusting for confounding factors, we found that the risk of THA or TKA was 4.02 times higher in patients with RA than in those without RA (95% confidence interval [CI], 3.77-4.52). The risk of THA or TKA was highest in patients with RA younger than 40 years (adjusted hazard ratio, 43.18; 95% CI, 16.01-116.47). Compared with non-RA patients, patients with RA were 4.82 times more likely to undergo THA (95% CI, 3.84-6.04), 3.85 times more likely to undergo TKA (95% CI, 3.48-4.25), and 19.06 times more likely to undergo both THA and TKA (95% CI, 8.90-40.80). ConclusionThese findings document a 4.02-fold greater long-term risk of undergoing THA or TKA in RA patients relative to non-RA patients in Taiwan.

Effect of Pressure-controlled intermittent Coronary Sinus Occlusion (PiCSO) on infarct size in anterior STEMI: PiCSO in ACS study

BackgroundThe aim of this clinical research was to investigate the effects of Pressure-controlled intermittent Coronary Sinus Occlusion (PiCSO) on infarct size at 5 days after primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI). Methods and resultsThis comparative study was carried out in four UK hospitals. Forty-five patients with anterior STEMI presenting within 12 h of symptom onset received pPCI plus PiCSO (initiated after reperfusion; n = 45) and were compared with a propensity score-matched control cohort from INFUSE-AMI (n = 80). Infarct size (% of LV mass, median [interquartile range]) measured by cardiac magnetic resonance (CMR) at day 5 was significantly lower in the PiCSO group (14.3% [95% CI 9.2–19.4%] vs. 21.2% [95% CI 18.0–24.4%]; p = 0.023). There were no major adverse cardiac events (MACE) related to the PiCSO intervention. ConclusionsPiCSO, as an adjunct to pPCI, was associated with a lower infarct size at 5 days after anterior STEMI in a propensity score-matched population.

Roflumilast in Severely Ill Patients with Chronic Obstructive Pulmonary Disease with Frequent Exacerbations: Risk of Pneumonia Hospitalization and Severe Exacerbations.

Roflumilast is given as an add-on to inhalation medication in patients with chronic obstructive pulmonary disease (COPD) and chronic bronchitis. Animal experiments have documented deleterious effects of roflumilast in bacterial infections, but trials have not reported the risk of bacterial infections in patients. The objective of this study is to determine, among outpatients with severe COPD in a two-year follow-up period, the risk of hospitalization-requiring pneumonia, severe acute exacerbation in COPD (AECOPD-hosp), and death. Patients with COPD using roflumilast (roflumilast users) were compared to a propensity score-matched COPD control group not using roflumilast (non-roflumilast users). Roflumilast users had an increased 2-year risk of hospitalization-requiring pneumonia (HR 1.5, 95% CI 1.3 to 1.8, p-value < 0.0001) compared to controls, and of AECOPD-Hosp (hazard ratio(HR) 1.6, 95%, confidence interval (CI) 1.5 to 1.8, p-value < 0.0001) and. When adding an active comparator (theophylline) as a matching variable, the signal was largely unchanged. In conclusion, roflumilast was associated with an increased number of hospitalizations for pneumonia and for AECOPD. Since trials have not reported risks of bacterial complications and data regarding severe exacerbations in roflumilast users are sparse and diverging, these data are concerning. Trials focused on the risk of pneumonia, AECOPD, and other bacterial infections in roflumilast users are needed urgently.

PND124 INFLUENCE OF COMORBIDITIES ON HEALTHCARE EXPENDITURES AND PERCEIVED PHYSICAL AND MENTAL HEALTH STATUS AMONG ADULTS WITH MULTIPLE SCLEROSIS: A PROPENSITY SCORE MATCHED US NATIONAL-LEVEL STUDY

To evaluate the effect of comorbidities on healthcare expenditures and perceived physical and mental health status among adults with Multiple Sclerosis (MS) compared to propensity score-matched non-MS controls. A retrospective, cross-sectional, matched cohort study was conducted using the nationally representative Medical Expenditure Panel Survey (2005-2015) data. The base study sample consisted of adults (age ≥ 18 years) who were alive and had positive total healthcare expenditures during the calendar year. Adults with MS were propensity-matched (1:1) to non-MS controls based on age, gender, and race/ethnicity using a greedy matching algorithm (8:1-digit match). Healthcare expenditures consisted of total and subtypes (inpatient, outpatient, emergency room, prescription drugs, home health agency, dental care, and other expenditures) of healthcare expenditures. Health status consisted of perceived physical and mental health status. Comorbidities were identified using ICD-9-CM and Clinical Classification System codes. Ordinary Least Squares regression and multinomial logistic regression were used to analyze the healthcare expenditures and health status variables, respectively. The final study sample consisted of 541 adults in each MS and non-MS control groups after propensity score matching. Yearly average total expenditures (expressed in 2018 US$) were significantly (p<0.001) higher for adults with MS ($29,396) compared to propensity score-matched non-MS adults ($7,875). After adjusting for potential confounders, individuals with MS had greater total and sub-types of expenditures compared to non-MS controls, and several comorbidities (e.g., depression, hypertension) were significantly associated with increased healthcare expenditures. Individuals with MS were more likely to report good and poor/fair physical and good mental health status (reference group=excellent) compared to propensity score-matched non-MS controls, and several comorbidities (e.g., anxiety, depression, emphysema, hypertension) were significant independent predictors of lower health status. Findings from this study indicate substantial economic and health status burden among adults with MS at US national-level that are significantly influenced by comorbidities.

Blood pressure and the risk of major adverse cardiovascular events among firefighters

No long-term follow-up study has investigated the effect of blood pressure (BP) on cardiovascular disease mortality and morbidity in firefighters. To investigate the effects of BP on the risk of major adverse cardiovascular events (MACEs) using a national representative population-matched cohort. We enrolled all firefighters (N = 8242) and 28 678 referent controls aged more than 40 years who underwent baseline health examinations in 2002 and 2003. Records of hospitalization and mortality until 2015 were checked. To evaluate the causal effect of BP on MACE, subcohort analysis using a propensity score-matched (PSM) cohort with respect to job classification (firefighter vs. control) was performed. Hypertension significantly increased the risk of MACEs compared with normal BP in both firefighters and the age--sex matched cohort, but in participants with elevated BP, significantly increased risk of MACEs [hazards ratio 1.41, 95% confidence interval (CI) 1.06-1.88] was observed only among firefighters. In the PSM cohort, firefighters had a significantly higher risk of death or hospitalization from MACEs (hazard ratio 1.29, 95% CI 1.14-1.47), myocardial infarction (hazard ratio 1.24, 95% CI 1.07-1.43), and ischemic stroke (hazard ratio 1.43, 95% CI 1.12-1.82) than controls. Firefighters with elevated BP (hazard ratio 1.58, 95% CI 1.04-2.40), stage 1 (hazard ratio 1.24, 95% CI 1.00-1.52), and stage 2 (hazard ratio 1.39, 95% CI 1.13-1.71) hypertension had higher risk of MACEs than PSM controls. Firefighters showed significantly higher cardiovascular risk than referent controls when comparing those within the same BP category, suggesting that firefighters with elevated BP and hypertension may be at high risk of adverse prognosis.

Association of Systemic Hypertension With Primary Open-angle Glaucoma: A Population-based Case-Control Study

To examine the association between systemic hypertension (HTN) and primary open-angle glaucoma (POAG) using Taiwan's nationwide health insurance claims data. A case-control study. Data for this case-control study were retrieved from the Taiwan National Health Insurance Research Database for all 112,929 newly diagnosed patients with POAG from January 2010 through December 2015 (cases), and 449,840 propensity score-matched controls from Taiwan's National Health Insurance system. We performed multiple logistic regression analysis to estimate the odds (ORs) of prior HTN among cases vs controls. Of total 562,300 study patients, 296,975 (52.81%) had HTN prior to the index date, 63,528 (56.49%) among cases and 233,447 (51.90%) among controls (P < .001). POAG was significantly associated with prior HTN (OR 1.31, 95% CI 1.29-1.33) after adjusting for age, sex, monthly income, geographic location and residential urbanization level, hyperlipidemia, diabetes, coronary heart disease, migraine, hypotension, and obstructive sleep apnea syndrome. POAG is associated with pre-existing HTN, suggesting that internal medicine/family medicine physicians should refer patients with hypertension periodically for regular ophthalmological examinations and ophthalmologists should alert patients with glaucoma to have their blood pressure regularly monitored.

Effectiveness of a Domestic Abuse Program for Australian Indigenous Offenders.

The subject of this study is to assess the effectiveness of a culture-neutral domestic abuse program (DAP) developed for offenders with domestic and family violence histories, when used for Australian Indigenous offenders, serving community-based supervised orders. The study employed a retrospective quasi-experimental research design and intention-to-treat program definition for 953 DAP-treated men and propensity score-matched controls, from diverse cultural, religious, and racial backgrounds, 19% being Indigenous Australians. Outcomes measured were program completion, time to first reconviction, and reconviction rates. Indigenous men completed the program similar to non-Indigenous men (58% vs. 63%; NS), although significantly more dropped out (22% vs. 18%); 63% of Indigenous DAP-treated men, remained reconviction free versus 49% of Indigenous controls. Significant therapeutic benefits required program completion, 73% Indigenous and 74% of non-Indigenous men remained reconviction free. Indigenous DAP participants, relative to controls, took significantly longer to first reconviction. Survival was associated with prior criminal histories, but not with rural or remote domiciles. Reconviction rates were predicted by Level of Service Inventory-Revised actuarial risk scores and by DAP completion, but not by Indigenous status. Program effect size was d = .477, mean reconvictions for Indigenous DAP enrollees being 50% lower than controls. Generic domestic violence interventions utilising evidence-based theoretical principles can be effective for Indigenous offenders, despite an absence of specific Indigenous cultural, or healing content, and delivery by Indigenous facilitators or Elders.

Risk factors and oncological outcomes of urethral recurrence in male patients with muscle invasive bladder cancer after radical cystectomy combined with urinary diversion: a propensity score-matched case control study.

Radical cystectomy (RC) is the primary treatment strategy for muscle invasive bladder cancer (MIBC). However, it carries a high risk of urethral recurrence (UR) in male patients. The risk factors and oncological outcomes of UR remain unclear. We aimed to identify the risk factors and oncological outcomes of UR in male patients with MIBC after RC combined with urinary diversion. After propensity score matching, we evaluated 137 male patients with MIBC who underwent RC combined with urinary diversion at our center between January 1, 2007 and December 31, 2015. Patient demographics, comorbidity, and perioperative data were recorded. Univariate and multivariate Cox proportional hazards regression were used to estimate the hazard ratio and 95% confidence intervals. Cancer-specific survival (CSS) and overall survival (OS) were measured using the Kaplan-Meier curve with log-rank test. P < 0.05 was considered statistically significant. Of the 310 patients, 30 (9.7%) patients underwent UR. In the matched group, the independent risk factors of UR were history of TURB (HR = 3.069, P = 0.018), tumor stage (T3 vs. T2, HR = 3.997, P = 0.014; T4 vs. T2, HR = 2.962, P = 0.015), and tumor multifocality (HR = 2.854, P = 0.011). The CSS and OS of patients with UR were equivalent to the patients without UR (P = 0.295, P = 0.616). This propensity score-matched case-control study showed that UR is not rare in male patients with MIBC after RC combined with urinary diversion. We identified three independent risk factors of UR: history of TURB, tumor stage, and tumor mutifocality. The oncological outcomes were equivalent between patients with and without UR. These findings could help improve treatment strategies and follow-up schedules.

Is bone mineral density lower in the necrotic lesion in pre-collapse osteonecrosis of the femoral head?

The purpose of this study was to clarify whether bone mineral density (BMD) of the necrotic lesion in precollapse osteonecrosis of the femoral head (ONFH) is reduced according to Hounsfield unit (HU) values on computed tomography (CT). The superior one-third of the femoral head in the coronal section was set as the region of interest (ROI) for the measurement of HU values. First, HU values of 101 control participants were assessed to identify relevant confounding factors. Next, the relationship between HU values and BMD on dual-energy X-ray absorptiometry (DXA) was verified. Then the mean HU value of the ROI in patients with pre-collapse ONFH was compared with that in propensity score-matched control participants. Finally, the HU values of the lateral boundary in the patients with and without subsequent collapse were compared. Multivariable analysis showed that both age and BMI were significantly correlated with the HU value, which showed a strong correlation with the BMD of the femoral neck on DXA (r = 0.92). In 25 ONFH patients and 25 propensity-matched control participants, no significant difference was found in the HU value of the ROI (p = .54). The mean HU value of the lateral boundary in patients with subsequent collapse was found to be significantly higher than that in patients without subsequent collapse (p < .01). The assessment of HU values on CT was useful for the evaluation of BMD of the femoral head. The current assessment did not demonstrate reduced bone mineral density of the necrotic lesion in pre-collapse ONFH.

Association of cervical spondylosis with obstructive sleep apnea

ObjectiveThe study objective was to evaluate the association between cervical spondylosis (CS) and a subsequent diagnosis of obstructive sleep apnea (OSA) in light of the expected constricting impact of CS-associated cervical spine changes on the pharyngeal airway space, a key contributor to OSA. MethodsData were retrieved from the Taiwan National Health Insurance Research Dataset. A total of 98,234 patients who newly received a diagnosis of OSA were identified. We identified four propensity score-matched controls per OSA patient (n = 392,936). Chi-square tests were used to compare cases and controls on sociodemographic characteristics, and multivariable logistic regression modelling to examine the association of OSA with prior CS. ResultsOf the 98,234 sampled patients, 18,070 (18.4%) patients had a prior CS diagnosis, significantly different among cases compared to controls, being 18.4% and12.1%, respectively, p < 0.001. Logistic regression analysis showed an adjusted odds ratio (OR) of prior CS of 1.778 (95% confident interval (CI): 1.744–1.814) relative to controls. The adjusted odds of prior CS without myelopathy was 1.764 for cases relative to controls (95% CI: 1.727–1.801), and for prior CS with myelopathy (adjusted OR: 1.778, 95% CI: 1.721–1.837). Analysis stratified by age showed that in the 45–64- and >64-year age groups, the adjusted ORs of CS were 1.803 (95% CI: 1.758–1.850) and 1.634 (95% CI: 1.568–1.703), respectively, for cases relative to controls. ConclusionsOur results suggest that OSA is associated with prior CS. The results call for professionals to be alert to the possibility of subsequent development of OSA among patients with CS.

Early Detection of Pump Thrombosis in Patients With Left Ventricular Assist Device.

Pump thrombosis (PT) is a serious adverse event in patients receiving left ventricular assist devices (LVAD). The study aims to determine whether pump parameters and clinical data may enable early detection of PT. This retrospective study included 88 patients who received an LVAD between 2012 and 2015 among which those with intra-PT were identified. In a propensity score-matched control group observation, time periods were matched with time before thrombosis. International normalized ratio (INR) time in therapeutic range (TTR) and lactate dehydrogenase (LDH) were analyzed for 60 days preceding PT. Furthermore, pump data (power, flow, and speed) in HeartWare ventricular assist devices (HVAD) patients were analyzed 7 days before PT using a mixed-design analysis of variance to investigate temporal changes in pump data. Pump thrombosis occurred in 15 patients (13 males, age 58 ± 10 years, 7 HeartMate II and 8 HVAD). International normalized ratio therapeutic range (2.0-3.0) and acetylsalicylic acid daily doses (100-200 mg) were similar for both groups, but patients with PT had lower TTR (36% vs. 65%; p = 0.025). No significant difference in LVAD power between groups was seen at baseline (p = 0.31), and power did not change in the control group over time (p > 0.99). Lactate dehydrogenase increased already 1 week prior PT and power from 4.4 ± 0.8 W at baseline to 4.9 ± 0.8 W (p = 0.007) 2 days before readmission and to 6.5 ± 1.8 W (p = 0.015) at readmission. Pump thrombosis is associated with a lower percentage of INR TTR and elevated LDH before the event. A better monitoring of pump parameters would enable PT detection already up to 2 days in advance.