BACKGROUND There are limited data comparing the clinical presentations, comorbidities, and outcomes of patients with infections due to seasonal influenza with patients with infections due to pandemic (H1N1) 2009 influenza. OBJECTIVE To compare the epidemiological characteristics and outcomes of pandemic (H1N1) 2009 influenza with those of seasonal influenza. METHODS A cross-sectional study was conducted among patients who received diagnoses during emergency department and inpatient encounters at 2 affiliated academic medical centers in Philadelphia, Pennsylvania. Cases of seasonal influenza during the period November 1, 2005, through June 1, 2008, and cases of pandemic influenza during the period from May 1, 2009, through August 7, 2009, were identified retrospectively. RESULTS Forty-nine cases of pandemic influenza and 503 cases of seasonal influenza were identified. Patients with pandemic H1N1 were younger (median age, 29 years) than patients with seasonal influenza (median age, 59 years) (P < .001). More patients with pandemic H1N1 (35 [71%] of 49) were African American, compared with patients with seasonal influenza (267 [53%] of 503; P =.02). Several symptoms were more common among patients with pandemic influenza infections than among patients with seasonal influenza infections: cough (98% vs 83%; P =.007), myalgias (71% vs 46%; P =.001), and pleuritic chest pain (45% vs 15%; P < .001). Pregnancy was the only comorbidity that occurred significantly more often in the pandemic influenza group than in the seasonal influenza group (16% vs 1%; P < .001). There were no significant differences in frequencies of deaths of hospitalized patients, intensive care unit admission, or length of hospitalization between groups. CONCLUSION Other than pregnancy, there were few clinically important differences between infections due to seasonal influenza and those due to pandemic influenza. The greater rate of lower respiratory tract symptoms in pandemic cases might serve to differentiate pandemic influenza from seasonal influenza.
There is currently no consensus regarding preferred clinical outcome measures following image-guided tumor ablation or clear definitions of oncologic end points. This consensus document proposes standardized definitions for a broad range of oncologic outcome measures with recommendations on how to uniformly document, analyze, and report outcomes. The initiative was coordinated by the Society of Interventional Oncology in collaboration with the Definition for the Assessment of Time-to-Event End Points in Cancer Trials, or DATECAN, group. According to predefined criteria, based on experience with clinical trials, an international panel of 62 experts convened. Recommendations were developed using the validated three-step modified Delphi consensus method. Consensus was reached on when to assess outcomes per patient, per session, or per tumor; on starting and ending time and survival time definitions; and on time-to-event end points. Although no consensus was reached on the preferred classification system to report complications, quality of life, and health economics issues, the panel did agree on using the most recent version of a validated patient-reported outcome questionnaire. This article provides a framework of key opinion leader recommendations with the intent to facilitate a clear interpretation of results and standardize worldwide communication. Widespread adoption will improve reproducibility, allow for accurate comparisons, and avoid misinterpretations in the field of interventional oncology research.
Preceding VA with a diagnostic study improves positive localization of the site of lower gastrointestinal hemorrhage compared with VA alone. Increasing the use of CTA for pre-angiography imaging may reduce overall imaging studies while appearing to increase positive yield at VA. Computed tomographic angiography can be used as part of a lower intestinal hemorrhage management algorithm and does not appear to worsen renal function despite the additional contrast load.
Recent data show that overall survival after endoscopic mucosal resection (EMR) is similar to esophagectomy, however, limited data exists regarding the comparative efficacy of definitive radiotherapy (RT) for the treatment of T1N0 esophageal cancer. We sought to investigate the patterns of practice for the treatment of T1N0 esophageal cancer in the United States as well as to evaluate the comparative efficacy of esophagectomy vs EMR vs RT. Materials/Methods: Patients with clinical T1N0 esophageal carcinoma who underwent esophagectomy, EMR or RT (45 e 70 Gy) were identified from the National Cancer Database (NCDB) from 2004 to 2013. Univariate (UVA) and multivariable (MVA) effects of treatment type on survival were assessed using Cox proportional hazards regression. Overall survival (OS) was compared using Kaplan-Meier analysis and the log-rank test. Variables with p<0.001 were included in the MVA for OS. Results: 6,262 met criteria for inclusion in this study: 2,995 (48%) underwent esophagectomy, 2,130 (34%) underwent EMR and 1,137 (18%) underwent RT. Only 3 patients underwent esophageal brachytherapy. Median age was 68 years, and patients undergoing RT were older (72 y) compared to those undergoing esophagectomy (65 y) or EMR (70 y) (p<0.0001). In the esophagectomy, EMR and RT groups, 70%, 75% and 72% of patients had a Charlson score of 0, respectively. Median follow-up was 34 months. Median RT dose was 50.4 Gy and 78% underwent concurrent chemotherapy. 30 day mortality was 3.1% for esophagectomy and 0.6% for EMR. In recent years, EMR was more frequently utilized, rising from 23% to 43% whereas esophagectomy and RT were less frequently utilized in the same time period (p<0.0001). RT was more frequently utilized at non-academic centers than academic centers, 30.3% vs 9.3%, p<0.0001. Of the patients who underwent esophagectomy, 614 (21%) were upstaged. On MVA, patients with Charlson/Deyo score 1 (HR 1.2, pZ0.0003), older age (HR 1.03, p<0.001), Medicaid or no insurance (HR 1.5, pZ0.003), treatment at non-academic centers (HR 1.1, pZ0.009) and squamous histology (HR 1.3, p<0.001) were predictors of worse OS. There was no difference in OS between patients undergoing esophagectomy or EMR (pZ0.4) and this finding persisted when analysis was limited to T1a patients (pZ0.69). Patients requiring post-operative chemotherapy had a worse OS (HR 1.3, p<0.001). Patients who received definitive RT had a worse OS compared to patients who underwent esophagectomy or EMR (HR 1.8, p<0.001). Conclusion: EMR is increasingly utilized compared to esophagectomy and definitive RT for early esophageal cancer, whereas the utilization of esophageal brachytherapy was rare. Adoption of EMR in lieu of esophagectomy has not compromised survival. Patients undergoing esophagectomy and EMR had a superior OS compared to those who underwent definitive RT. Patients undergoing definitive RT appear to have unfavorable features likely affecting OS.
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