These results suggest that consideration needs to be given regarding the integration of breast MRI into the pretreatment evaluation of women seeking breast conservation therapy.
Evidence from more than 27,000 women participating in randomized controlled trials suggests that improvement in symptoms with anticholinergic management of overactive bladder is modest and rarely fully resolves symptoms.
The association between GRE scores and academic success in graduate programs is currently of national interest. GRE scores are often assumed to be predictive of student success in graduate school. However, we found no such association in admission data from Vanderbilt’s Initiative for Maximizing Student Diversity (IMSD), which recruited historically underrepresented students for graduate study in the biomedical sciences at Vanderbilt University spanning a wide range of GRE scores. This study avoids the typical biases of most GRE investigations of performance where only high-achievers on the GRE were admitted. GRE scores, while collected at admission, were not used or consulted for admission decisions and comprise the full range of percentiles, from 1% to 91%. We report on the 29 students recruited to the Vanderbilt IMSD from 2007-2011 who have completed the program at this date. While the data set is not large, the predictive trends between GRE and long-term graduate outcomes (publications, first author publications, time to degree, predoctoral fellowship awards, and faculty evaluations) are remarkably null and there is sufficient precision to rule out even mild relationships between GRE and these outcomes. Career outcomes are encouraging; many students are in postdocs, and the rest are in stage-appropriate career environments for such a cohort, including tenure track faculty, biotech and entrepreneurship careers.
for 54 subjects but achieved treatment of only 29 and was stopped early because of slow enrollment and unbalanced withdrawal after randomization (5 of the 17 in the LPTI group declined to proceed in the study after having been randomized). As a result, this study is significantly underpowered. Nonetheless, the findings are significant because women in both groups improved, albeit in different ways. Women receiving LPTI reported improved pain scores in fewer treatment sessions and sooner (an average of 4 weeks) than did women receiving PT. However, the improvement in pain scores with PT was overall similar, and notably women having PT had greater improvements in sexual function as measured by the FSFI, primarily because of greater improvements in sexual pain. These findings will be very useful in the design of a more definitive trial for treatment of this poorly understood condition. Ideally, a doubleblind randomized trial of LPTI versus PT could be designed using a sham intervention for PT and a sham saline LPTI injection as controls. Such a design would potentially also limit postrandomization withdrawals. We badly need these data in urogynecology practice, where numerous patients experience chronic PFM, many iatrogenically after prior surgical interventions, particularly those with permanent materials.-ACW) ABSTRACTBehavior and lifestyle modifications are considered first-line therapy for overactive bladder (OAB). When these approaches are inadequate, the mainstay of second-line therapy is pharmacologic. The largest class of medications used for drug treatment is anticholinergic. Emerging evidence in a systematic review published in 2011 suggested that anticholinergic and other drugs used for OAB are often ineffective for long-term symptom management, with most patients discontinuing therapy within 6 months. Despite questionable data supporting use of anticholinergics for OAB, wider use of these agents was spurred by the 2013 US Food and Drug Administration approval of oxybutynin (Oxytrol) as an over-the-counter treatment for this condition as well as extensive direct-to-consumer advertising. The issue of effectiveness of drug therapy is of major concern to millions of women with OAB and to their health care providers.The aims of this systematic review and meta-analysis were first to examine available evidence from randomized clinical trials on outcomes of pharmacologic management of OAB in women and second to summarize comparative data from the active drug and placebo arms of randomized trials on the effectiveness of drugs for reducing urinary incontinence episodes and reducing voiding episodes. A search of 4 databases was conducted by multiple reviewers for original research published in English up to March 2014 on community-dwelling women with nonneurogenic OAB undergoing therapy with medications available in the United States. The database search included MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and ClinicalTrials.gov. All studies were composed of at least 75% female subjec...
Purpose: The National Lung Screening Trial (NLST) demonstrated that screening computed tomography (CT) reduces mortality caused by lung cancer and clinical societies and patient advocacy groups have recommended screening high risk individuals. Screening CT scan of the chest reduced lung cancer mortality in this trial but 96% of anomalies were false positives, 24% of lung surgeries resulted in a benign diagnosis. The overall mortality rate from procedures was 1.2% in the trail. The benign disease prevalence after surgical biopsy is not known at the state level and if these prevalences differ across the United States, then a nationwide screening regimen may have geographically varying success. The purpose of this study is to determine the benign disease point prevalence after surgical lung resection at the state level using a national dataset. Methods: We examined the point prevalence of benign disease after lung surgery in a retrospective cohort being evaluated for known or suspected lung cancer. The MEDPAR Hospital National Limited Data Set from 2009 was used to identify patients who had undergone lung surgery by ICD-9CM codes. Patients less than 19 years old or who had diseases not arising from a lung lesion were excluded. Malignancy and benign disease were determined by ICD-9CM codes. The benign diagnosis prevalence was estimated at the state level by dividing the total number of benign cases by the sum of the benign cases and malignant cases. Benign disease point prevalence was compared between states using Pearson chi-square test. Results: There were 25,362 patients who had a lung operation for known or suspected lung cancer. Among these, 2,312 (9.1%) had a benign diagnosis. Benign diagnosis was more frequent among women (9.8%) than men (8.5%) after surgery. Crude in hospital mortality rate for all patients was 2.3%. The mortality rate for patients with benign disease was 2.1%. Prevalence of benign disease varied significantly (chi-sq p<0.001) across states from a low of 1.3% in Vermont to a high of 25.0% in Hawaii. Median benign disease by state was 8.8% (IQR: 7.8 - 10.9). Conclusion: Benign disease prevalence after lung surgery varies widely by state and resulted in a mortality rate of 2.1 percent. Cause of observed differences is not known but may be due to practice variation or locally endemic lung diseases and should be investigated to determine the impact to a national lung cancer screening program. Citation Format: Stephen A. Deppen, Sharon Phillips, Melissa McPheeters, Melinda C. Aldrich, Jeffery Blume, David F. Penson, Yu Shyr, Eric L. Grogan. Benign disease prevalence after surgical lung resection varies geographically in the US Medicare population, implications for lung cancer screening. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3628. doi:10.1158/1538-7445.AM2013-3628
Lung cancer predictive models, such as the Mayo model (Swensen, 1997), that are used for screening and referral to surgery are based on only traditional variables and are outdated. Clinical information such as FEV1, FDG-PET and lesion growth increasingly are used in treatment decisions. This information needs to be incorporated into our clinical prediction models. We developed a lung cancer risk model utilizing the more extensive clinical information available at the point of a decision for surgery that predicts cancer better than existing models. We evaluated a lung cancer prediction model using multivariable logistic regression in a population being evaluated for lung surgery at a single academic institution in an IRB approved study. The model included non-linear relationships between continuous variables and lung cancer and used multiple imputation to handle missing data. Internal validation was conducted using the bootstrap method with 500 iterations. Area under the curve (AUC) and Brier score were calculated for the training model and internal bootstrap validation model. The characteristics of the new model were compared to the Mayo model. 492 individuals were recruited at who had been evaluated for surgery with known or suspected lung cancer. Lung cancer prevalence was 72%. Diagnosis was determined pathologically (92%) or by greater than 18 months of followup among those who didn't undergo surgery. Missing data occurred with FDG-PET scan (22%), growth on serial CT scans (13%), predicted FEV1 (10%) and pre-operative disease symptoms (7%). The remaining variables of interest had less than 5% missing data. Age (OR 1.05; 95%CI: 1.03-1.08), pack years (OR 1.03; 95%CI: 1.00-1.05), pre-operative lesion maximum diameter (OR 1.06; 95%CI: 1.04-1.08), lesion growth (OR 2.92 95%CI: 1.10-5.65), previous cancer (OR 1.86 95%CI: 1.05-3.32) and FDG-PET avidity (OR 4.56 95%CI: 2.17-9.57) predicted lung cancer (p<0.05). AUC for the initial model was 0.87 (95%CI: 0.84 - 0.91) and Brier score was 0.12. Bootstrap sampling estimated AUC of 0.85 and Brier score of 0.13 demonstrating internal validity of the model. The Mayo model was evaluated for those with complete data (93%) and had an AUC of 0.80 (95%CI: 0.75 - 0.85) which was significantly less (P<0.001) than that observed for the new model. The Mayo model generally underestimated risk and its Brier score was 0.17, showing poorer calibration than the new model. Our internally validated model performed better in distinguishing low risk from high risk patients than the Mayo model in a surgical population being evaluated for lung cancer. The Mayo model, with its more limited clinical information, underestimated risk. Future work will validate this model in an external dataset and prospectively evaluate the impact of the model on patient safety and resource utilization. Citation Format: Stephen A. Deppen, Melinda C. Aldrich, Ronald Walker, Catherine A. Necessary, Chiu-lan Chen, Huiyun Wu, Jeffery Blume, Pierre P. Massion, Theodore Speroff, Robert S. Dittus, Bill J. Putnam, Eric L. Grogan. A new model improves lung cancer prediction in the preoperative evaluation of patients with suspicious lung lesions. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3634. doi:10.1158/1538-7445.AM2013-3634
OBJECTIVES: Maximum urethral closure pressure (MUCP) and abdominal leak point pressure (ALPP) both measure urethral function but have only a weak correlation. The objective of this study was to evaluate whether other variables, such as age and Kegel strength, differentially impact MUCP and ALPP measurements. MATERIALS AND METHODS: This was a retrospective, cross-sectional study analyzing all women in the Vanderbilt University Medical Center Synthetic Derivative, a de-identified electronic medical record. Adult women who had undergone complex urodynamics with MUCP and ALPP measurements were identified by CPT codes 51797 and 51772. All women with urodynamic stress incontinence were included. Demographic information was obtained, as well as Kegel strength and POP-Q scores. Kegel scores were measured using the Oxford scale (0 to 5) and stratified into the following categories: absent to weak (0-1/5), medium (2-3/5), and strong (4-5/5). RESULTS: The initial search yielded 837 women, of whom 318 patients met inclusion criteria. Mean age was 59.1 AE 13.2 years with 282 (94%) white, 14 (5%) African American and 4 (2%) other. The median parity was 2, and mean BMI was 29.6 AE 6.6. POP-Q
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