No abstract

Variations existed in insurance status within the GBM population. Uninsured status and Medicaid insurance suggested shorter survival compared with non-Medicaid insurance among a population of patients with GBM. Cancer 2016;122:3157-65. © 2016 American Cancer Society.

Background Estimated glomerular filtration rate (eGFR) and albuminuria are central for diagnosis, staging, and risk evaluation in chronic kidney disease (CKD). Universal thresholds regardless of age, sex, and race are recommended, but relatively little is known about how these demographic factors alter the relationship of eGFR and albuminuria to cardiovascular outcomes. Study Design Observational cohort study. Setting & Participants 11,060 whites and blacks aged 52–75 years in the Atherosclerosis Risk in Communities (ARIC) Study with median follow-up of 11.2 years. Predictors eGFR by the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation (reference, 95 ml/min/1.73 m2) and urinary albumin-creatinine ratio (ACR) (reference, at 5 mg/g). Outcomes Cardiovascular events (coronary disease, stroke, and heart failure) and all-cause mortality. Measurements Adjusted HRs associated with eGFR and ACR in subgroups according to age, sex and race. Results Cardiovascular risk significantly increased at eGFR <70 ml/min/1.73 m2 in all subgroups according to age (< 65 vs. ≥65 years), sex, and race (P for interaction >0.2 for these subgroups; e.g., at eGFR 30 ml/min/1.73 m2, the adjusted HR was 2.19 [95% CI, 1.10–4.35] at age 52–64 years vs. 2.23 [95% CI, 1.33–3.72] at age 65–75 years). Results were similar for mortality. Log(ACR) was linearly associated with cardiovascular risk without threshold effects in all subgroups, with some quantitative interactions. HRs according to ACR tended to be lower in men vs. women (e.g., at ACR 40 mg/g, 1.18 [95% CI, 0.98–1.41] vs. 1.77 [95% CI, 1.45–2.15]) and in older vs. younger population (1.24 [95% CI, 1.04–1.49] vs. 1.73 [95% CI, 1.42–2.12]) (P for interaction <0.01 for sex and age). Less evident interactions were observed for mortality. Limitations Single measurement of eGFR with creatinine and ACR and relatively narrow age range. Conclusions The associations of eGFR and ACR with cardiovascular events were largely similar, with some quantitative interactions, among age, sex, and racial subgroups, generally supporting universal thresholds of GFR and ACR for CKD definition/staging.

Educational attainment was a robust independent predictor of 1-year DFR even when adjusting for other prognostic factors. A dose-response relationship was noted, with longer educational exposure associated with increased odds of DFR. This suggests that cognitive reserve could be a factor driving neural adaptation during recovery from TBI.

No abstract

Previous research has demonstrated that nonclinical factors are associated with differences in clinical care, with uninsured patients receiving decreased resource use. Studies on trauma populations have also shown unclear relationships between insurance status and hospital length of stay (LOS), a commonly used metric for evaluating quality of care. The objective of this study is to define the relationship between insurance status and LOS after trauma using the largest available national trauma dataset and controlling for significant confounders. Data from 2007 to 2010 National Trauma Data Bank were used to compare differences in LOS among three insurance groups: privately insured, publically insured, and uninsured trauma patients. Multivariable regression models adjusted for potential confounding due to baseline differences in injury severity and demographic and clinical factors. A total of 884,493 patients met the inclusion criteria. After adjusting for the influence of covariates, uninsured patients had significantly shorter hospital stays (0.3 days) relative to privately insured patients. Publicly insured patients had longer risk-adjusted LOS (0.9 days). Stratified differences in discharge disposition and injury severity significantly altered the relationship between insurance status and LOS. In conclusion, this study elucidates the association between insurance status and hospital LOS, demonstrating that a patient's ability to pay could alter LOS in acute trauma patients. Additional research is needed to examine causes and outcomes from these differences to increase efficiency in the health care system, decrease costs, and shrink disparities in health outcomes.

Purpose Neuropathic pain is an unavoidable treatment-related adverse event among patients with head and neck cancer who are undergoing radiotherapy. We aimed to test the efficacy and safety of pregabalin versus placebo in the treatment of radiotherapy-related neuropathic pain. Patients and Methods This randomized, double-blind, placebo-controlled trial was conducted in four centers in China. Eligible patients with a mean pain intensity score of 4 or more on an 11-point numeric rating scale were randomly assigned to receive either active treatment with a flexible dose of pregabalin or placebo for 16 weeks. The primary efficacy outcome was pain reduction measured on the numeric rating scale. Result There were 128 patients who received treatment as randomly assigned. Pain intensity reduction was 2.44 in the pregabalin arm and 1.58 in the placebo arm at week 16, yielding an adjusted mean difference of 0.87 (95% CI, 0.30 to 1.44; P = .003). In the pregabalin arm, 38 patients (59.4%) achieved at least 30% pain relief versus 21 (32.8%) in the placebo arm ( P = .006). Nineteen patients (29.7%) in the pregabalin group and five (7.8%) in the placebo group achieved 50% or greater pain relief ( P = .003). Total scores on the Profile of Mood States-Short Form, pain severity and functional interference of Brief Pain Inventory-Short Form, as well as the physiology and psychology domain of the WHO Quality of Life-BREF all were reduced significantly at week 16 in patients who received pregabalin compared with those who received placebo. There was no significant difference ( P = .29) in the incidence of experiencing at least one adverse event in the pregabalin arm (n = 35; 54.7%) versus the placebo arm (n = 29; 45.3%). Conclusion Patients treated with pregabalin with radiotherapy-related neuropathic pain had greater pain alleviation, better mood states, and higher quality of life compared with patients in the placebo group, with a good tolerability.

Purpose Patients with head-and-neck cancer (HNC) may experience xerostomia after radiation therapy (RT), which leads to compromised quality of life. The purpose of this study is to explore how the spatial pattern of radiation dose (radiomorphology) in the major salivary glands influences xerostomia in patients with HNC. Methods and materials A data-driven approach using spatially explicit dosimetric predictors, voxel dose (ie, actual radiation dose in voxels in parotid glands [PG] and submandibular glands [SMG]) was used to predict whether patients would develop xerostomia 3 months after RT. Using planned radiation dose data and other nondose covariates including baseline xerostomia grade of 427 patients with HNC in our database, the machine learning methods were used to investigate the influence of dose patterns across subvolumes in PG and SMG on xerostomia. Results Of the 3 supervised learning methods studied, ridge logistic regression yielded the best predictive performance. Ridge logistic regression was also preferred to evaluate the influence pattern of highly correlated dose on xerostomia, which showed a discriminative pattern of influence of doses in the PG and SMG on xerostomia. Moreover, the superior–anterior portion of the contralateral PG and medial portion of the ipsilateral PG were determined to be the most influential regions regarding dose effect on xerostomia. The area under the receiver operating characteristic curve from a 10-fold cross-validation was 0.70 ± 0.04. Conclusions Radiomorphology, combined with machine learning methods, is able to suggest patterns of dose in PG and SMG that are the most influential on xerostomia. The influence pattern identified by this data-driven approach and machine learning methods may help improve RT treatment planning and reduce xerostomia after treatment.