Vaginal practices among women at risk for HIV acquisition in Soweto, South Africa.

Background: Vaginal practices (VP) may adversely affect normal vaginal flora and mucosal integrity, and increase acquisition risk of HIV and other genital tract infections.

Objective: The aim of this study was to describe self-reported VP, changes in the reported number of VP over time and factors associated with VP in a cohort of young Sowetan women enrolled in the HVTN 915 observational study.

Method: We longitudinally assessed self-reported VP in 50 young women at risk of HIV acquisition aged 18-25 years in a prospective study over 3 months in Soweto, South Africa.

Mobile Phone Questionnaires for Sexual Risk Data Collection Among Young Women in Soweto, South Africa.

Recall and social desirability bias undermine self-report of paper-and-pencil questionnaires. Mobile phone questionnaires may overcome these challenges. We assessed and compared sexual risk behavior reporting via in-clinic paper-and-pencil and mobile phone questionnaires.

Long term survival with stereotactic ablative radiotherapy (SABR) versus thoracoscopic sublobar lung resection in elderly people: national population based study with propensity matched comparative analysis.

Objectives:  To compare cancer specific survival after thoracoscopic sublobar lung resection and stereotactic ablative radiotherapy (SABR) for tumors ≤2 cm in size and thoracoscopic resection (sublobar resection or lobectomy) and SABR for tumors ≤5 cm in size.

Design:  National population based retrospective cohort study with propensity matched comparative analysis.

Setting:  Surveillance, Epidemiology, and End Results (SEER) registry linked with Medicare database in the United States.

Comparison of Open, Laparoscopic, and Robotic Colectomies Using a Large National Database: Outcomes and Trends Related to Surgery Center Volume.

Background: Previous studies have shown that high-volume centers and laparoscopic techniques improve outcomes of colectomy. These evidence-based measures have been slow to be accepted, and current trends are unknown. In addition, the current rates and outcomes of robotic surgery are unknown.

Centralization of pancreatoduodenectomy a decade later: Impact of the volume-outcome relationship.

Background: The hospital volume-outcome relationship for complex procedures has led to the suggestion that care should be centralized. This study was performed to investigate whether centralization is occurring for pancreatoduodenectomy (PD) and to examine its effect on short-term postoperative outcomes.

Methods: We queried the New York State Statewide Planning and Research Cooperative System database (n = 6,185, 2002-2011) and the California and Florida State Inpatient Databases (n = 6,766 and 4,810, respectively, 2002-2011) for PD.

Association of Breast Conservation Surgery for Cancer With 90-Day Reoperation Rates in New York State.

Importance: For early-stage breast cancer, breast conservation surgery (BCS) is a conservative option for women and involves removing the tumor with a margin of surrounding breast tissue. If margins are not tumor free, patients undergo additional surgery to avoid local recurrence.

Objectives: To investigate the use of BCS in New York State and to determine rates of reoperation, procedure choice, and the effect of surgeon experience on the odds of a reoperation 90 days after BCS.

Clipping and Coiling of Unruptured Intracranial Aneurysms Among Medicare Beneficiaries, 2000 to 2010.

Background And Purpose: Endovascular coiling therapy is increasingly popular for obliteration of unruptured intracranial aneurysms, but older patients face higher procedural risks and shorter periods during which an untreated aneurysm may rupture causing subarachnoid hemorrhage (SAH). We assessed trends in clipping and coiling of unruptured intracranial aneurysms, outcomes after clipping and coiling of unruptured intracranial aneurysms, and in SAH among Medicare beneficiaries.

Methods: Using 2000 to 2010 Medicare Provider Analysis and Review data, we identified 2 cohorts of patients admitted electively for clipping or coiling of an unruptured aneurysm: (1) utilization cohort (2000-2010): patients ≥65 years enrolled ≥1 month in a given year and (2) outcomes cohort (2001-2010): patients ≥66 years of age enrolled in Medicare for ≥1 year.

The Effect of Center Volume on In-Hospital Mortality After Aortic and Mitral Valve Surgical Procedures: A Population-Based Study.

Background: We aimed to determine the relationship between hospital volume and use of dual aortic and mitral valve surgical procedures.

Methods: Patients who underwent both aortic and mitral valve repair or replacement during the same hospital stay were identified from the Nationwide Inpatient Sample (NIS). We compared patients' characteristics and in-hospital outcomes by the average annual center volume for multiple-heart valve surgical procedures, grouped into tertiles of patients with low (1 to 8), medium (9 to 18), and high (19+) volume categories using χ(2) tests and adjusted hierarchical logistic regression models.

National trends in utilization and in-hospital outcomes of mechanical versus bioprosthetic aortic valve replacements.

Objective: Substantial controversy surrounds the choice between a mechanical versus bioprosthetic prosthesis for aortic valve replacement (AVR), based on age. This study aims to investigate national trends and in-hospital outcomes of the 2 prosthesis choices.

Methods: All patients aged >18 years in the National Inpatient Sample who received an AVR between 1998 and 2011 were considered.

A population-based analysis of robotic-assisted mitral valve repair.

Background: Robotic-assisted mitral valve repair is becoming more frequently performed in cardiac surgery. However, little is known about its utilization and safety at a national level.

Methods: Patients undergoing mitral valve repair in the United States from 2008 to 2012 were identified in the National Inpatient Sample.

International comparative evaluation of knee replacement with fixed or mobile-bearing posterior-stabilized prostheses.

Background: Posterior-stabilized total knee prostheses were introduced to address instability secondary to loss of posterior cruciate ligament function, and they have either fixed or mobile bearings. Mobile bearings were developed to improve the function and longevity of total knee prostheses. In this study, the International Consortium of Orthopaedic Registries used a distributed health data network to study a large cohort of posterior-stabilized prostheses to determine if the outcome of a posterior-stabilized total knee prosthesis differs depending on whether it has a fixed or mobile-bearing design.

Multinational comprehensive evaluation of the fixation method used in hip replacement: interaction with age in context.

Background: Fixation in total hip replacements remains a controversial topic, despite the high level of its success. Data obtained from major orthopaedic registries indicate that there are large differences among preferred fixation and survival results.

Methods: Using a distributed registry data network, primary total hip arthroplasties performed for osteoarthritis from 2001 to 2010 were identified from six national and regional total joint arthroplasty registries.

A distributed health data network analysis of survival outcomes: the International Consortium of Orthopaedic Registries perspective.

The International Consortium for Orthopaedic Registries is a multinational initiative established by the United States Food and Drug Administration to develop a health data network aimed at providing a robust infrastructure to facilitate evidence-based decision-making on performance of medical devices. Through the International Consortium for Orthopaedic Registries, individual data holders have complete control of their data and can choose to participate in studies of their choice. In this article, we present an overview of the data extraction process and the analytic strategy employed to answer several device performance-related questions in total hip arthroplasty and total knee arthroplasty.

National study of utilization of male incontinence procedures.

Aims: We explored re-interventions and short and long term adverse events associated with procedures for male incontinence among Medicare beneficiaries.

Methods: All inpatient and outpatient claims for a simple random sample of Medicare beneficiaries for 2000-2011 were queried to identify patients of interest. All male patients with an International Classification of Diseases, 9th Edition (ICD-9) diagnosis code for stress incontinence or mixed incontinence were included.

Long term survival with thoracoscopic versus open lobectomy: propensity matched comparative analysis using SEER-Medicare database.

Objective: To compare long term survival after minimally invasive lobectomy and thoracotomy lobectomy.

Design: Propensity matched analysis.

Setting: Surveillance, Epidemiology and End Results (SEER)-Medicare database.

Safety of robotic prostatectomy over time: a national study of in-hospital injury.

Objective: To assess national trends of iatrogenic complications and associated burden of care among patients undergoing open and minimally invasive prostatectomy using a population-based cohort.

Methods: Using the nationally representative cohort, we identified patients who were diagnosed with prostate cancer, and underwent prostatectomy during 2001 and 2011. We determined the risk of iatrogenic complication and length of stay (LOS) over time among open and minimally invasive surgery (MIS) patients.

Comparative effectiveness of robotic-assisted vs thoracoscopic lobectomy.

Background: Robotic-assisted lobectomy is being offered increasingly to patients. However, little is known about its safety, complication profile, or effectiveness.

Methods: Patients undergoing lobectomy in in the United States from 2008 to 2011 were identified in the Nationwide Inpatient Sample.

A curriculum in measurement-based care: screening and monitoring of depression in a psychiatric resident clinic.

Objective: The goal of this curriculum was to train residents in measurement-based care (MBC).

Method: Third-year psychiatry residents were educated in MBC through didactic seminars and a quality-improvement (QI) initiative with the goal of implementing the Patient Health Questionnaire Depression Scale (PHQ-9) to screen and monitor patients for symptoms of depression.

Results: Residents suggested strategies for integrating the PHQ-9 into the clinic.

The feasibility of standardized patient assessments as a best practice in an academic training program.

The use of standardized patient assessments (SPAs) in psychiatry is an emerging best practice. This column describes a survey of resident and faculty supervisors at a large academic department examining current practices, attitudes, and perceived barriers to incorporating SPAs into clinical practice. Although the study found that SPAs were not routinely used in clinical practice or supervision, residents and faculty were fairly optimistic about their potential value.

Training psychiatry residents in quality improvement: an integrated, year-long curriculum.

OBJECTIVE The authors describe a curriculum for psychiatry residents in Quality Improvement (QI) methodology. METHODS All PGY3 residents (N=12) participated in a QI curriculum that included a year-long group project. Knowledge and attitudes were assessed before and after the curriculum, using a modified Quality Improvement Knowledge Assessment Tool (QIKAT) and a QI Self-Assessment survey.