Penalized Spline-Involved Tree-based (PenSIT) Learning for estimating an optimal dynamic treatment regime using observational data.

Dynamic treatment regimes are a set of time-adaptive decision rules that can be used to personalize treatment across multiple stages of care. Grounded in causal inference methods, dynamic treatment regimes identify variables that differentiate the treatment effect and may be used to tailor treatments across individuals based on the patient's own characteristics - thereby representing an important step toward personalized medicine. In this manuscript we introduce Penalized Spline-Involved Tree-based Learning, which seeks to improve upon existing tree-based approaches to estimating an optimal dynamic treatment regime.

Trigger Finger Treatment: Identifying Predictors of Nonadherence and Cost.

Background: Evidence-based practices in medicine are linked with a higher quality of care and lower health care cost. For trigger finger, identifying patient factors associated with nonadherence to evidence-based practices will aid physicians in treatment decisions. The objectives were to (1) determine patient factors associated with treatment nonadherence, (2) examine the success rates of steroid injections, and (3) evaluate the economic consequences of nonadherence to treatment recommendations.

Assessment of Tree-Based Statistical Learning to Estimate Optimal Personalized Treatment Decision Rules for Traumatic Finger Amputations.

Importance: Optimal treatment for traumatic finger amputation is unknown to date.

Objective: To use statistical learning methods to estimate evidence-based treatment assignment rules to enhance long-term functional and patient-reported outcomes in patients after traumatic amputation of fingers distal to the metacarpophalangeal joint.

Design, Setting, And Participants: This decision analytical model used data from a retrospective cohort study of 338 consenting adult patients who underwent revision amputation or replantation at 19 centers in the United States and Asia from August 1, 2016, to April 12, 2018.

Assessment of Surgeon Variation in Adherence to Evidence-Based Recommendations for Treatment of Trigger Finger.

Importance: Stenosing tenosynovitis (trigger finger) affects approximately 2% of the population. Given the prevalence of trigger finger and rising health care costs, adherence to the cost-effective and evidence-based treatment algorithm will permit better outcomes and allocation of resources.

Objectives: To examine treatment patterns for trigger finger and to determine surgeon-level and patient-level factors that influence adherence to evidence-based treatment.

Patient satisfaction after treatment of distal radial fractures in older adults.

The Wrist and Radius Injury Surgical Trial (WRIST) collaboration is the largest clinical trial ever conducted in hand surgery. We applied data from this study to examine the relationship between functional outcomes and patient satisfaction after treatment of distal radial fractures. Patients aged 60 years and older with isolated distal radial fractures were enrolled at 24 health systems.

Local Control and Toxicity of Multilevel Spine Stereotactic Body Radiotherapy.

Background: Spine stereotactic body radiotherapy (sSBRT) is commonly limited to 1 or 2 vertebral levels given a paucity of efficacy and toxicity data when more than 2 levels are treated.

Objective: To prove our hypothesis that multilevel sSBRT could provide similar rates of local control (LC) (primary endpoint) and toxicity as single-level treatment using the same clinical target, planning target, and planning organ-at-risk volumes.

Methods: We analyzed consecutive cases of sSBRT treated from 2013 to 2017.

Radiation-Induced Skin Changes after Postmastectomy Radiation Therapy: A Pilot Study on Indicators for Timing of Delayed Breast Reconstruction.

Background:  Delayed autologous breast reconstruction is commonly recommended in patients requiring postmastectomy radiation. This study examines gross and histologic changes in the breast skin of patients who have undergone postmastectomy radiation to help determine when radiation-induced skin changes begin to stabilize.

Methods:  A prospective pilot study was conducted on eight patients with invasive breast cancer who required mastectomy and radiotherapy.

Effect of Aromatase Inhibitor Therapy on Sleep and Activity Patterns in Early-stage Breast Cancer.

Introduction: Adherence to aromatase inhibitor (AI) therapy is poor, often because of treatment-emergent side effects, including musculoskeletal symptoms, fatigue, and insomnia. In the present analysis, we examined the sleep patterns and daytime function both objectively using actigraphy and subjectively using validated questionnaires in women initiating AI therapy.

Patients And Methods: Postmenopausal women with stage 0-III hormone receptor-positive breast cancer who were initiating AI therapy were eligible.

Variable aromatase inhibitor plasma concentrations do not correlate with circulating estrogen concentrations in post-menopausal breast cancer patients.

Purpose: The aromatase inhibitors (AI) exemestane (EXE), letrozole (LET), and anastrozole suppress estrogen biosynthesis, and are effective treatments for estrogen receptor (ER)-positive breast cancer. Prior work suggests that anastrozole blood concentrations are associated with the magnitude of estrogen suppression. The objective of this study was to determine whether the magnitude of estrogen suppression, as determined by plasma estradiol (E2) concentrations, in EXE or LET treated patients is associated with plasma AI concentrations.