Impact of Agent Orange Exposure on Non-muscle Invasive Bladder Cancer Outcomes.

Objective: To explore the effect of Agent Orange (AO) exposure on bladder cancer (BCa) outcomes in patients receiving Bacillus Calmette-Guérin (BCG) for non-muscle invasive BCa (NMIBC).

Methods: We retrospectively examined the association between AO exposure in patients with NMIBC in national veterans affairs databases who were being treated with BCG. Patients were diagnosed with NMIBC from 2000 to 2010 with follow-up through 2018.

Beta-Adrenergic Antagonists and Cancer Specific Survival in Patients With Advanced Prostate Cancer: A Veterans Administration Cohort Study.

Objective: To interrogate the National Veterans Health Administration (VA) database to determine if beta-blocker use at time of initiation of androgen therapy deprivation (ADT) would result in improved oncological outcomes in advanced prostate cancer (PCa).

Methods: All men diagnosed with high risk PCa (PSA >20) from 2000-2008 who were on ADT ≥ 6 months were identified. Patients receiving ADT concurrently with primary radiation therapy were excluded.

Amiodarone Use Prior to Cardiac Transplant Impacts Early Post-Transplant Survival.

Purpose: It remains unclear if use of amiodarone pre-cardiac transplantation impacts early post-transplant survival.

Methods: We selected all patients undergoing heart transplant from 2004 to 2006 with available information using the United Network for Organ Sharing database (n = 4057). Multivariable Cox models compared the risk of death within 30 days post-transplant in patients who were taking amiodarone at the time of transplant listing (n = 1227) to those who were not (n = 2830).

Outcomes of Community and Healthcare-onset Clostridium difficile Infections.

Background: Community-onset Clostridium difficile infections (CDI) are increasingly common, but there is little data on outcomes. The purpose of this study is to describe the epidemiology and outcomes of CDI in the Veterans Health Administration (VHA) system and compare these variables between hospital-onset (HCF) and community-onset (CO) cases.

Methods: We conducted a retrospective cohort study that included all patients with a positive test for C.

The impact of statins in combination with androgen deprivation therapyin patients with advanced prostate cancer: A large observational study.

Background: Statins are thought to possess antineoplastic properties related to their effect on cell proliferation and steroidogenesis. Progression to castrate resistant prostate cancer (CaP) includes de-regulation of androgen synthesis suggesting a role for statins in this setting. Our goal was to assess the role of statin use on oncologic outcomes in patients with advanced CaP being treated with androgen deprivation therapy (ADT).

The Impact of Agent Orange Exposure on Prostate Cancer Outcomes.

Purpose: In this study we explored the effect of Agent Orange exposure on prostate cancer survival in VA (Veterans Affairs) patients receiving androgen deprivation therapy for advanced prostate cancer.

Materials And Methods: We retrospectively examined the association between Agent Orange exposure in men with prostate cancer in national VA databases who were being treated with androgen deprivation therapy. Patients were diagnosed with prostate cancer from 2000 to 2008 with followup through May 2016.

Metformin Use is Associated with Improved Survival for Patients with Advanced Prostate Cancer on Androgen Deprivation Therapy.

Purpose: Metformin is commonly prescribed for patients with type 2 diabetes mellitus. We hypothesized that metformin plus androgen deprivation therapy may be beneficial in combination. Our objective was to assess this combination in a retrospective cohort of patients with advanced prostate cancer.

Adjuvant chemotherapy for stage II colon cancer with poor prognostic features.

Purpose: Adjuvant chemotherapy is typically considered for patients with stage II colon cancer characterized by poor prognostic features, including obstruction, perforation, emergent admission, T4 stage, resection of fewer than 12 lymph nodes, and poor histology. Despite frequent use, the survival advantage conferred on patients with stage II disease by chemotherapy is yet unproven. We sought to determine the overall survival benefit of chemotherapy among patients with stage II colon cancer having poor prognostic features.

Readmission after colectomy for cancer predicts one-year mortality.

Objectives: Early hospital readmission is a common and costly problem in the Medicare population. In 2009, the Centers for Medicaid and Medicare Services began mandating hospital reporting of disease-specific readmission rates. We sought to determine the rate and predictors of readmission after colectomy for cancer, as well as the association between readmission and mortality.

Discharge destination's effect on bounce-back risk in Black, White, and Hispanic acute ischemic stroke patients.

Objective: To determine whether racial and ethnic effects on bounce-back risk (ie, movement to settings of higher care intensity within 30 d of hospital discharge) in acute stroke patients vary depending on initial posthospital discharge destination.

Design: Retrospective analysis of administrative data.

Setting: Four hundred twenty-two hospitals, southern/eastern United States.

Analysis of guidelines for screening diabetes mellitus in an ambulatory population.

Objectives: To compare the case-finding ability of current national guidelines for screening diabetes mellitus and characterize factors that affect testing practices in an ambulatory population.

Patients And Methods: In this retrospective analysis, we reviewed a database of 46,991 nondiabetic patients aged 20 years and older who were seen at a large Midwestern academic physician practice from January 1, 2005, through December 31, 2007. Patients were included in the sample if they were currently being treated by the physician group according to Wisconsin Collaborative for Healthcare Quality criteria.

Long-term survival in older critically ill patients with acute ischemic stroke.

Objectives: To compare survival in older patients with acute ischemic stroke admitted to intensive care units (ICUs) with those not requiring ICU care and to assess the impact of mechanical ventilation (MV) and percutaneous gastrostomy tubes (PEG) on long-term mortality.

Design: Multicentered retrospective cohort study.

Setting: Administrative data from the Centers for Medicare and Medicaid Services covering 93 metropolitan counties primarily in the eastern half of the United States.

Predictors of malignancy and recommended follow-up in patients with negative endoscopic ultrasound-guided fine-needle aspiration of suspected pancreatic lesions.

Background: Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) can characterize and diagnose pancreatic lesions as malignant, but cannot definitively rule out the presence of malignancy. Outcome data regarding the length of follow-up in patients with negative or nondiagnostic EUS-FNA of pancreatic lesions are not well-established.

Objective: To determine the long-term outcome and provide follow-up guidance for patients with negative EUS-FNA diagnosis of suspected pancreatic lesions based on imaging predictors.

Insurance disruption due to spousal Medicare transitions: implications for access to care and health care utilization for women approaching age 65.

Objective: To assess whether a husband's Medicare transition leads to insurance disruptions for his wife that impact her perceived access to care, health care utilization, or health status.

Data Sources/study Setting: Respondents were married women under age 65 from the 2003-2005 round of the Wisconsin Longitudinal Study (N=655).

Study Design: Instrumental variable (IV) linear and IV-probit analyses provided unbiased estimates of the effect of an insurance disruption on study outcomes.

Predictors of hospice utilization among acute stroke patients who died within thirty days.

Background: Hospice is considered to be underutilized, particularly among patients with noncancer diagnoses such as stroke. The highest mortality among stroke patients occurs within the first 30 days; however, we know little about the hospice enrollment decision for this population during this critical time frame.

Objectives: To determine hospice enrollment rates and to describe sociodemographic and clinical predictors of hospice utilization among patients who die within 30 days of their stroke.

The price of bouncing back: one-year mortality and payments for acute stroke patients with 30-day bounce-backs.

Objectives: To examine 1-year mortality and healthcare payments of stroke patients experiencing zero, one and two or more bounce-backs within 30 days of discharge.

Design: Retrospective analysis of administrative data.

Setting: Four hundred twenty-two hospitals in the southern and eastern United States.

30-day survival and rehospitalization for stroke patients according to physician specialty.

Background And Purpose: Stroke patients appear to have improved outcomes when cared for by neurologists, but the mechanism by which improved outcome is achieved is unclear. This study compares 30-day cause-specific rehospitalization, 30-day mortality, and specific processes of care for patients treated by a neurologist only, a generalist only, a neurologist and a generalist (i.e.

Rehospitalization and survival for stroke patients in managed care and traditional Medicare plans.

Background: Stroke affects more than 500,000 older persons each year in the United States, but no studies have compared older stroke patients in Medicare health maintenance organizations (HMOs) and fee-for-service (FFS) after recent changes in FFS reimbursement.

Objectives: We sought to compare utilization and outcomes after stroke in Medicare HMO and FFS.

Design: We reviewed administrative data in 11 regions from Medicare and a large national health plan.