Search

Background: Patients with bladder cancer may experience mental health distress. Mental health-care service (MHS) use can quantify the magnitude of the problem.Methods: The Ontario Cancer Registry was used to identify all patients with bladder cancer treated with curative-intent cystectomy or radiotherapy in Ontario, Canada (2004-2013). Population-level databases were used to identify MHS use (visits to general practitioner, psychiatrist, emergency department, or hospitalization). Generalized estimating equations were used to compare rates of MHS use. Baseline, peritreatment, and posttreatment MHS use were defined as visits from 2 years to 3 months before, 3 months before to 3 months after, and from 3 months after to 2 years after start of treatment, respectively.Results: From 2004 to 2013, 4296 patients underwent cystectomy (n = 3332) or curative-intent radiotherapy (n = 964). Compared with baseline, the rate of MHS use was higher in the peritreatment (adjusted rate ratio [aRR] = 1.64, 95% confidence interval [CI] = 1.48 to 1.82) and posttreatment periods (aRR = 1.45, 95% CI =1.30 to 1.63). By 2 years posttreatment, 24.6% (95% CI = 23.4% to 25.9%) of all patients had MHS use. Patients with baseline MHS use had substantially higher MHS use in the peritreatment (aRR = 5.77, 95% CI = 4.86 to 6.86) and posttreatment periods (aRR = 4.58, 95% CI = 3.78 to 5.55). Female patients had higher use MHS use overall, but males had a higher incremental increase in the posttreatment period compared with baseline (2-sided Pinteraction = .02). Male patients had a statistically significant increase in MHS use following surgery or radiotherapy, whereas female patients only had an increase following surgery.Conclusions: MHS use is common among patients undergoing treatment for bladder cancer, particularly in the peritreatment period. Screening for mental health concerns in this population is warranted. [ABSTRACT FROM AUTHOR]

Background: Phosphatase and tensin homolog (PTEN) loss has long been associated with adverse findings in early prostate cancer. Studies to date have yet to employ quantitative methods (qPTEN) for measuring of prognostically relevant amounts of PTEN loss in postsurgical settings and demonstrate its clinical application.Methods: PTEN protein levels were measured by immunohistochemistry in radical prostatectomy samples from training (n = 410) and validation (n = 272) cohorts. PTEN loss was quantified per cancer cell and per tissue microarray core. Thresholds for identifying clinically relevant PTEN loss were determined using log-rank statistics in the training cohort. Univariate (Kaplan-Meier) and multivariate (Cox proportional hazards) analyses on various subpopulations were performed to assess biochemical recurrence-free survival (BRFS) and were independently validated. All statistical tests were two-sided.Results: PTEN loss in more than 65% cancer cells was most clinically relevant and had statistically significant association with reduced BRFS in training (hazard ratio [HR] = 2.48, 95% confidence interval [CI] = 1.59 to 3.87; P < .001) and validation cohorts (HR = 4.22, 95% CI = 2.01 to 8.83; P < .001). The qPTEN scoring method identified patients who recurred within 5.4 years after surgery (P < .001). In men with favorable risk of biochemical recurrence (Cancer of the Prostate Risk Assessment - Postsurgical scores <5 and no adverse pathological features), qPTEN identified a subset of patients with shorter BRFS (HR = 5.52, 95% CI = 2.36 to 12.90; P < .001) who may be considered for intensified monitoring and/or adjuvant therapy.Conclusions: Compared with previous qualitative approaches, qPTEN improves risk stratification of postradical prostatectomy patients and may be considered as a complementary tool to guide disease management after surgery. [ABSTRACT FROM AUTHOR]

Clustered and multivariate survival times, such as times to recurrent events, commonly arise in biomedical and health research, and marginal survival models are often used to model such data. When a large number of predictors are available, variable selection is always an important issue when modeling such data with a survival model. We consider a Cox's proportional hazards model for a marginal survival model. Under the sparsity assumption, we propose a penalized generalized estimating equation approach to select important variables and to estimate regression coefficients simultaneously in the marginal model. The proposed method explicitly models the correlation structure within clusters or correlated variables by using a prespecified working correlation matrix. The asymptotic properties of the estimators from the penalized generalized estimating equations are established and the number of candidate covariates is allowed to increase in the same order as the number of clusters does. We evaluate the performance of the proposed method through a simulation study and analyze two real datasets for the application. [ABSTRACT FROM AUTHOR]

Aim: To describe the association between patient- and hospital-level factors and coronary angiography among patients who suffer out-of-hospital cardiac arrest (OHCA).Methods: A population-based retrospective cohort study using data from 28 hospitals in Southern Ontario between March 1, 2010 and December 31, 2014. We included consecutive adult patients with atraumatic, OHCA, who achieved return of spontaneous circulation, and were alive at least six hours after hospital arrival. Multilevel logistic regression was used to measure the relationship between patient- and hospital-level covariates and receipt of coronary angiography.Results: Among 2578 consecutive patients, the mean age was 67(±15), 69% were male, 49% had a shockable initial cardiac arrest rhythm and 84% were comatose at hospital admission. Overall, 33% of the study population received coronary angiography. This varied markedly by hospital of first assessment (13%-70%). Factors associated with receiving coronary angiography included ST-segment elevation (OR = 21.30, CI95 16.17-28.04), a shockable initial cardiac rhythm (OR = 5.00, CI95 3.70-6.75), bystander AED use (OR = 2.51, CI95 1.49-4.23), EMS-witnessed arrest (OR = 2.49, CI95 1.62-3.81), initial admission to a PCI center (OR = 2.94, CI95 1.66-5.21), age (OR = 1.04, CI95 1.02-1.07 for age <55, OR = 0.91, CI95 0.88-0.94 for age ≥55), and pre-hospital ROSC (OR = 1.59, CI95 1.06-2.39).Conclusion: We identified patient- and hospital-level factors that explain some of the variability in the use of coronary angiography for OHCA. Future work should determine which post arrest patients will benefit most from urgent coronary angiography and evaluate knowledge translation strategies to ensure consistent delivery of best practices. [ABSTRACT FROM AUTHOR]

Machinery entanglements are a leading cause of hospitalized injury on Canadian farms. This study evaluates the role farm tasks play in the occurrence of machinery entanglement events. A retrospective case series of 41 entanglement injuries involving 35 farm-machinery types was assembled. Only a few limited tasks were implicated in the majority of entanglements. These tasks were as follows: (1) field adjustments of machinery; (2) product handling and conveyance; and (3) driveline attachments and servicing. Hazards inherent and common to these tasks affected the behavior of farmers, leading to entanglements. This study establishes a need to identify hazards and assess risks associated with different tasks involving the use of farm machinery under actual field situations. Systemic changes are required to improve existing machinery safety practices through engineering, work methods, and work practice modifications. In addition to design solutions, occupational health and safetystrategies should consider activities associated with hazardous situations to inform the content of injury prevention efforts. [ABSTRACT FROM AUTHOR]

Background: Long-term prescription opioid use has been associated with adverse health outcomes, including opioid use disorder (OUD). We examined a population of opioid naïve individuals who initiated prescription opioids for non-cancer pain and investigated the associations between opioid prescription characteristics at initiation and time to treated OUD.Methods: We conducted a retrospective population-based cohort study in Ontario, Canada among opioid naïve individuals aged 15 years and older dispensed an opioid for non-cancer pain between 2013 and 2016. We used the Narcotic Monitoring System to abstract opioid dispensing data. A multivariable Cox regression model was used to examine the association between average daily dose and time to treated OUD.Results: We identified 1,607,659 opioid-naïve individuals who initiated a prescription opioid within the study period. The incidence of treated OUD within the study period was 86 cases per 100,000 person-years. Compared to an average daily dose of <20 morphine milligrams equivalent (MME), higher average daily doses at initiation were associated with greater hazard of treated OUD, 20-50 MME (HR 1.11, 95% CI: 1.02, 1.21), >50-90 MME (HR 1.29, 95% CI: 1.16, 1.44), >90-150 MME (HR 1.29, 95% CI: 1.06, 1.56), >150-200 MME (HR 2.49, 95% CI: 1.54, 4.03) and >200 MME (HR 4.15, 95% CI: 2.89, 5.97). Long-acting formulations and days' supply ≥11 days were also associated with greater hazard of treated OUD.Conclusion: Prescription opioid characteristics at initiation are associated with risk of treated OUD, identifying potentially important and modifiable risk factors among people initiating opioids for non-cancer pain. [ABSTRACT FROM AUTHOR]

Context: The end-of-life period is characterized by increased hospital utilization despite patients' preferences to receive care and die at home.Objectives: To evaluate the impact of interventions aimed at planning for a home death (Yellow Folder) and managing symptoms in the home (Symptom Response Kit) on place of death and hospital utilization among palliative home care patients.Methods: This was an ecologic and retrospective cohort study of palliative home care patients in southeastern Ontario from April 2009 to March 2014. Linked health administrative and clinical databases were used to identify palliative home care patients and their receipt of the interventions, hospitalizations, emergency department visits, and place of death. Bivariable and multivariable regressions were used to evaluate outcomes according to patients' receipt of intervention(s).Results: The proportion of patients who died in the community increased after implementation of the interventions, from 42.8% to 48.5% (P < 0.0001). Compared with patients who received neither intervention, patients who received the Yellow Folder or Symptom Response Kit had an increased likelihood of dying in the community, with the largest relative risk observed in patients who received both interventions (relative risk = 2.20, 95% confidence interval 2.05-2.36). Receipt of these interventions was only associated with reductions in hospitalization or emergency department visit rates in the six months before death.Conclusion: Patients who received the Yellow Folder or Symptom Response Kit were more likely remain at home at the end of life. This association was stronger when these interventions were used together. [ABSTRACT FROM AUTHOR]

Background: Uptake of perioperative chemotherapy for muscle-invasive bladder cancer (MIBC) has been historically poor. We describe contemporary use of neoadjuvant (NACT) and adjuvant chemotherapy (ACT) as well as medical oncology (MO) referral patterns in routine practice.Methods: Electronic treatment records were linked to the population-based Ontario Cancer Registry to identify all MIBC patients treated with cystectomy in Ontario 1994 to 2013. Physician billing records were used to identify consultation with MO. Practice patterns in the contemporary era (2009-2013) are compared with data from 1994 to 2008.Results: A total of 5,582 patients had cystectomy for MIBC. Use of NACT increased from 4% in 1994 to 2008 to 19% in 2009 to 2013 (P<0.001); rates continued to rise in the most recent era from 12% in 2009 to 27% in 2013 (P<0.001). ACT was delivered to 20% of patients in 2009 to 2013 (19% in 1994-2008, P = 0.875). Use of any chemotherapy (NACT or ACT) in 2009 to 2013 was 35% compared to 23% in 1994 to 2008 (P<0.001). Preoperative referral rates during 2009 to 2013 to MO were greater than 1994 to 2008 (32% vs. 11%, P<0.001); referral rates continued to increase in recent years from 21% in 2009 to 44% in 2013 (P<0.001). The proportion of referred patients ultimately treated with NACT increased substantially; from 32% in 1994 to 1998 to 54% in 2009 to 2013 (P<0.001).Conclusions: After many years of practice lagging behind evidence, use of NACT in the general population has increased substantially. Our results suggest that increased uptake has been driven by greater preoperative referral to MO as well as greater propensity of MOs to treat referred patients. [ABSTRACT FROM AUTHOR]