Trajectories of prostate-specific antigen after treatment for prostate cancer.

Prostate-specific antigen (PSA) measurements after primary treatment reflect residual tumor burden among men with prostate cancer. Using a mixture model analysis, we identified distinct trajectories of post-treatment PSA measurements and evaluated their associations with prostate cancer mortality. The study sample included 623 US Veterans treated for prostate cancer with curative intent during 1991-1995; 225 men received surgery and 398 men received radiation therapy.

Using Radiological Data to Estimate Ischemic Stroke Severity.

Background: Risk-adjusted poststroke mortality has been proposed for use as a measure of stroke care quality. Although valid measures of stroke severity (e.g.

Velocity and doubling time of prostate-specific antigen: mathematics can matter.

Changes in prostate-specific antigen (PSA) values are often reported as velocity or doubling time. We compared the association of these two calculations-at the time of PSA failure after primary treatment for prostate cancer-with prostate cancer mortality. From a source population of 1313 US Veterans with prostate cancer, including 623 treated with curative intent, the study population included 242 men experiencing biochemical failure, 81 after surgery and 161 after radiation therapy.

Thrombocytopenia and in-hospital mortality risk among ischemic stroke patients.

Background: Thrombocytopenia has been associated with increased mortality in nonstroke conditions. Because its role in acute ischemic stroke is less well understood, we sought to determine whether thrombocytopenia at admission for acute ischemic stroke was associated with in-hospital mortality.

Methods: We used data from a retrospective cohort of stroke patients (1998-2003) at 5 U.

Anemia is associated with poor outcomes in patients with less severe ischemic stroke.

Anemia is a known predictor of in-hospital mortality among patients with such vascular conditions as acute myocardial infarction, congestive heart failure, and chronic kidney disease. The role of anemia in patients with acute ischemic stroke is less well understood. We sought to examine the association between anemia at hospital admission and the combined outcome of in-hospital mortality and discharge to hospice in patients with acute ischemic stroke.

Prevalence, predictors, and outcomes of poststroke falls in acute hospital setting.

Falls are a serious medical complication following stroke. The objectives of this study were to (1) confirm the prevalence of falls among patients with stroke during acute hospitalization, (2) identify factors associated with falls during the acute stay, and (3) examine whether in-hospital falls were associated with loss of function after stroke (new dependence at discharge). We completed a secondary analysis of data from a retrospective cohort study of patients with ischemic stroke who were hospitalized at one of four hospitals.

Impact of biochemical recurrence in prostate cancer among US veterans.

Background: Among men treated for prostate cancer, increasing prostate-specific antigen (PSA) is known as biochemical failure or biochemical recurrence (BCR). The impact of BCR on subsequent mortality is uncertain, however, especially given competing causes of death.

Methods: To describe patterns of BCR and subsequent mortality, we conducted an observational study in a community-based, "high-comorbidity" setting of 623 US veterans diagnosed as having prostate cancer from 1991 to 1995 and receiving radical prostatectomy or radiation therapy.

Processes of care associated with acute stroke outcomes.

Background: Many processes of care have been proposed as metrics to evaluate stroke care. We sought to identify processes of stroke care that are associated with improved patient outcomes after adjustment for both patient characteristics and other process measures.

Methods: This retrospective cohort study included patients 18 years or older with an ischemic stroke or transient ischemic attack (TIA) onset no more than 2 days before admission and a neurologic deficit on admission.

Derivation and validation of a clinical system for predicting pneumonia in acute stroke.

Aims: We derived and validated a clinical prediction rule that can be used to predict post-stroke pneumonia.

Methods: We conducted a retrospective cohort study of patients admitted to hospital with a stroke. The cohort was subdivided into a derivation group and a validation group.

Molecular markers and death from prostate cancer.

Background: Current methods to assess the prognosis of prostate cancer at the time of diagnosis are limited.

Objective: To determine whether molecular markers of cell cycle regulation (bcl-2 and p53) and angiogenesis (beta-3 integrin, vascular endothelial growth factor, and microvessel density) are associated with increased long-term risk for death among men with prostate cancer.

Design: Observational cohort study from 1991 to 2006.

Reporting of multivariable methods in the medical literature.

Background: Multivariable models are frequently used in the medical literature, but many clinicians have limited training in these analytic methods. Our objective was to assess the prevalence of multivariable methods in medical literature, quantify reporting of methodological criteria applicable to most methods, and determine if assumptions specific to logistic regression or proportional hazards analysis were evaluated.

Methods: We examined all original articles in Annals of Internal Medicine, British Medical Journal, Journal of the American Medical Association, Lancet, and New England Journal of Medicine, from January through June 2006.

Relationship of temporal lobe volumes to neuropsychological test performance in healthy children.

Ecological validity of neuropsychological assessment includes the ability of tests to predict real-world functioning and/or covary with brain structures. Studies have examined the relationship between adaptive skills and test performance, with less focus on the association between regional brain volumes and neurobehavioral function in healthy children. The present study examined the relationship between temporal lobe gray matter volumes and performance on two neuropsychological tests hypothesized to measure temporal lobe functioning (visual perception-VP; peabody picture vocabulary test, third edition-PPVT-III) in 48 healthy children ages 5-18 years.

Molecular markers and mortality in prostate cancer.

Objective: To evaluate prognosis in prostate cancer by assessing the independent effect of selected molecular factors (e.g. markers of cell-cycle regulation), in addition to the effect of traditional clinical factors (e.

Dietary fish or seafood consumption is not related to cerebrovascular disease risk in twin veterans.

Background/aims: The results of studies about dietary fish consumption and stroke risk have been conflicting. We sought to examine the relationship between dietary fish and seafood consumption and the risk of stroke or transient ischemic attack (TIA).

Methods: We used data from the National Academy of Sciences-National Research Council Twin Registry, a prospective cohort of white male twins born in the US (1917-1927).

Brief report: parental report of sleep behaviors following moderate or severe pediatric traumatic brain injury.

Objective: Determine the effect of moderate and severe traumatic brain injuries (TBI) on the sleep of school-aged children.

Methods: A concurrent cohort-prospective design compared children aged 6-12 years who sustained moderate TBI (baseline n = 56), severe TBI (n = 53), or only orthopedic injuries (n = 80). Retrospective parental report of pre-injury sleep was collected about 3 weeks post-injury.

Prostate-specific antigen 'velocity' as a diagnostic test for prostate cancer.

Background: Prostate-specific antigen "velocity" (slope) is promoted as a diagnostic test for prostate cancer, but its clinical usefulness is uncertain. Accordingly, we evaluated the sensitivity of prostate-specific antigen (PSA) velocity among men who are diagnosed subsequently with prostate cancer.

Methods: Among 64,545 men receiving primary care at any of nine Veterans Affairs Medical Centers during 1989-1990, 1,313 men at least 50 years old had an incident diagnosis of prostate cancer during 1991-1995.

Prognostic implications of clinical practice guidelines among hemodialysis patients.

Although the National Kidney Foundation (NKF) has published clinical practice guidelines for the management of risk factors for cardiovascular disease, these guidelines have not been tested rigorously for their effectiveness. We conducted an observational study among patients with end-stage kidney disease to examine the prognostic impact of threshold levels recommended by the NKF for blood pressure, hemoglobin, calcium-phosphate product, parathyroid hormone, low-density lipoprotein, and glycosylated hemoglobin. The study population (N = 197) was assembled from a previously completed randomized trial examining arteriovenous graft thrombosis.

The effectiveness of screening for prostate cancer: a nested case-control study.

Background: Screening for prostate cancer is done commonly in clinical practice, using prostate-specific antigen (PSA) tests or digital rectal examination (DRE). Evidence is lacking, however, to confirm a survival benefit among screened patients. We evaluated the effectiveness of PSA, with or without DRE, in reducing mortality.

Altruism as a reason for participation in clinical trials was independently associated with adherence.

Background: To determine whether altruism as reason for participation in research is independently associated with adherence to a medical regimen in a clinical trial.

Methods: Participants were 475 participants in the Women's Estrogen for Stroke Trial. Before randomization to estrogen or placebo, all women were questioned about reason for participation and baseline features that may contribute to adherence.

Serum amylase, pancreatic stents, and pancreatitis after sphincter of Oddi manometry.

Background: Serum amylase levels 2 hours after ERCP predict postprocedure pancreatitis. The value of serum amylase measurements after sphincter of Oddi manometry (SOM) and the effect of pancreatic-duct stent placement on serum amylase are unknown.

Methods: Records were reviewed for 88 SOM patients who had serum amylase measured 2 hours after the procedure.

Diagnosis, evaluation, and treatment of childhood obesity in pediatric practice.

Objective: To determine rates of diagnosis and treatment, and types of treatment, among overweight children in clinical practice.

Design: Six hundred randomly selected records were reviewed.

Setting: Two community-based and 2 hospital-based clinics in New Haven.

Racial disparities in stroke risk factors: the impact of socioeconomic status.

Background And Purpose: In the US, blacks have a higher incidence of stroke and more severe strokes than whites. Our objective was to determine if differences in income, education, and insurance, as well as differences in the prevalence of stroke risk factors, accounted for the association between ethnicity and stroke.

Methods: We used data from the Third National Health and Nutrition Survey (NHANES III), a cross-sectional sample of the noninstitutionalized US population (1988-1994), and included blacks and whites aged 40 years or older with a self-reported stroke history.

Association between impaired insulin sensitivity and stroke.

Background: Prior research has indicated an association between insulin resistance and stroke; we sought to determine if this association persists after adjusting for stroke risk factors, including glycemic control.

Methods: We used data from the Third National Health and Nutrition Survey (1988-1994), including participants aged > or =40 years. We assessed insulin sensitivity using the homeostasis model assessment (HOMA): HOMA = (FPGSI x FPI)/22.