Medicine
-
The purpose of this population-based study was to determine the change of glucose metabolism in patients undergoing pancreaticoduodenectomy (PD). We conducted a nationwide cohort study using data from Taiwan's National Health Insurance Research Database collected between 2000 and 2010. Our sample included 861 subjects with type 2 diabetes mellitus (DM) and 3914 subjects without DM. ⋯ In the 3914 subjects without diabetes, the only statistically significant comorbidity contributing to pancreatogenic diabetes was chronic pancreatitis (odds ratio, 1.446; 95% CI, 1.146-1.823; P = 0.002). Subjects with comorbid chronic pancreatitis and use of insulin had lower rates of resolution of DM after PD. In subjects without diabetes, chronic pancreatitis contributed significantly to the development of pancreatogenic DM.
-
Observational Study
Adjuvant therapy use among Appalachian breast cancer survivors.
There is a paucity of literature systemically examining the effects of access to cancer care resources on adjuvant endocrine therapy (AET) use behaviors, especially in underserved regions such as the Appalachian region in the United States, where gaps in healthcare access are well documented. The objectives of this study were to explore AET adherence and persistence in Appalachia, delineate the effects of access to care cancer on adherence/persistence, and evaluate the influences of adherence and persistence on overall survival. A retrospective cohort study from 2006 to 2008 was conducted among female breast cancer survivors living in the Appalachian counties of 4 states (PA, OH, KY, and NC). ⋯ Nonadherence to and nonpersistence with AET were associated with higher risks of all-cause mortality. Our findings of suboptimal AET adherence/persistence in Appalachia as well as positive associations between AET adherence/persistence and overall survival outcomes further underscore the importance of ensuring appropriate AET use in this population to reduce breast cancer mortality disparities. Our findings also suggest that intervention strategies focusing on individualized treatment and medication-related factors may improve adjuvant treatment use.
-
Observational Study
The Association of Hematological Malignancy and End-of-Life Expenditure in Cancer Decedents: A Population-Based Study in an Asian Country.
Within the overall National Health Insurance (NHI) budget in Taiwan, there has been a remarkable increase in expenditure for cancer patients. This study was designed to explore whether hematological malignancy is associated with higher end-of-life (EOL) medical expenditure in their last 6 months of life. We used data from the Taiwan NHI Research Database to do a retrospective cohort and population-based study. ⋯ The primary physician's specialty between acute leukemia, lymphoma, and nonhematological malignancy patients had statistically difference. The medical expenditure of cancer patients in acute leukemia and lymphoma was more than nonhematological malignancy. Treatment strategies for acute leukemia should be studied further in order to save the health care budget.
-
Monopolar electrocautery is a fast and elegant cutting option. However, as it creates surgical smoke containing polycyclic aromatic hydrocarbons (PAHs), it may be hazardous to the health of the surgical team. Although new technologies, such as feedback mode (FM) and Teflon-coated blades (TBs), reduce tissue damage, their impact on surgical smoke creation has not yet been elucidated. ⋯ Furthermore, different modes revealed higher temperature variations with the use of SETB (P = 0.004) and TB (P = 0.005) during cutting, but not SSB (P = 0.789). We found that the use of both TBs and FM was associated with reduced amounts of surgical smoke created during cutting. Thus, the surgical team may benefit from the adoption of such new technologies, which could contribute to the primary prevention of smoke-related diseases.
-
Recently, log odds of positive lymph nodes (LODDS) was proven a better prediction of outcomes than other methods in gastric cancer, pancreatic cancer, and colon cancer. However, the validity is not yet tested in oral cavity squamous cell carcinoma (OSCC). We conducted a retrospective study to compare the predictive ability of LODDS, traditional pN classification and lymph node ratio (rN) in OSCC patients. ⋯ The LODDS-based system had the highest prediction accuracy for 3-year DSS (Harrell's c-statistic, 0.803). In our series, LODDS shows great promise as a prognostic tool for OSCC. Compared with the AJCC pN classification and the rN classification, LODDS can stratify OSCC patients and help to identify high-risk patients missed by the other systems.