Better Oncological Outcomes After Prostate-specific Membrane Antigen Positron Emission Tomography-guided Salvage Radiotherapy Following Prostatectomy.

Background And Objective: Up to 50% of patients with prostate cancer experience prostate-specific antigen (PSA) relapse following primary radical prostatectomy (RP). Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is increasingly being used for staging after RP owing to its high detection rate. Our aim was to compare outcomes for patients who received salvage radiotherapy (sRT) with versus without PSMA PET guidance.

Impact of Pseudomonas aeruginosa carriage on intensive care unit-acquired pneumonia: a European multicentre prospective cohort study.

Objectives: Pseudomonas aeruginosa (PA) is a common causative pathogen of pneumonia acquired in the intensive care unit (ICU). The aim of this study was to determine the incidence of PA ICU pneumonia (PAIP) and to quantify its independent association with PA colonization at different body sites.

Methods: Adult patients on mechanical ventilation at ICU admission were prospectively enrolled across 30 European ICUs.

Tracing In-Hospital COVID-19 Outcomes: A Multistate Model Exploration (TRACE).

This study aims to develop and apply multistate models to estimate, forecast, and manage hospital length of stay during the COVID-19 epidemic without using any external packages. Data from Bellvitge University Hospital in Barcelona, Spain, were analyzed, involving 2285 hospitalized COVID-19 patients with moderate to severe conditions. The implemented multistate model includes transition probabilities and risk rates calculated from transitions between defined states, such as admission, ICU transfer, discharge, and death.

Assessing the impact of Delta and Omicron in German intensive care units: a retrospective, nationwide multistate analysis.

Background: The spread of several severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) variants of concern (VOCs) has repeatedly led to increasing numbers of coronavirus disease 2019 (COVID-19) patients in German intensive care units (ICUs), resulting in capacity shortages and even transfers of COVID-19 intensive care patients between federal states in late 2021. In this respect, there is scarce evidence on the impact of predominant VOCs in German ICUs at the population level.

Methods: A retrospective cohort study was conducted from July 01, 2021, to May 31, 2022, using daily nationwide inpatient billing data from German hospitals on COVID-19 intensive care patients and SARS-CoV-2 sequence data from Germany.

Association of Bacterial Load and Colonization Sites With the Risk of Postoperative Infection.

Background: The independent effects of extranasal-only carriage, carriage at multiple bodily sites, or the bacterial load of colonizing (SA) on the risk of developing SA surgical site infections and postoperative bloodstream infections (SA SSI/BSIs) are unclear. We aimed to quantify these effects in this large prospective cohort study.

Methods: Surgical patients aged 18 years or older were screened for SA carriage in the nose, throat, or perineum within 30 days before surgery.

Assessing marginal effects of non-pharmaceutical interventions on the transmission of SARS-CoV-2 across Africa: a hybrid modeling study.

Since 2019, a new strain of coronavirus has challenged global health systems. Due its fragile healthcare systems, Africa was predicted to be the most affected continent. However, past experiences of African countries with epidemics and other factors, including actions taken by governments, have contributed to reducing the spread of SARS-CoV-2.

Lessons learned: avoiding bias via multi-state analysis of patients' trajectories in real-time.

Objectives: Many studies have attempted to determine the disease severity and patterns of COVID-19. However, at the beginning of the pandemic, the complex patients' trajectories were only descriptively reported, and many analyses were worryingly prone to time-dependent-, selection-, and competing risk biases. Multi-state models avoid these biases by jointly analysing multiple clinical outcomes while taking into account their time dependency, including current cases, and modelling competing events.

Protection from prior natural infection vs. vaccination against SARS-CoV-2-a statistical note to avoid biased interpretation.

Introduction: The fight against SARS-CoV-2 has been a major task worldwide since it was first identified in December 2019. An imperative preventive measure is the availability of efficacious vaccines while there is also a significant interest in the protective effect of a previous SARS-CoV-2 infection on a subsequent infection (natural protection rate).

Methods: In order to compare protection rates after infection and vaccination, researchers consider different effect measures such as 1 minus hazard ratio, 1 minus odds ratio, or 1 minus risk ratio.

Stacked probability plots of the extended illness-death model using constant transition hazards - an easy to use shiny app.

Background: Extended illness-death models (a specific class of multistate models) are a useful tool to analyse situations like hospital-acquired infections, ventilation-associated pneumonia, and transfers between hospitals. The main components of these models are hazard rates and transition probabilities. Calculation of different measures and their interpretation can be challenging due to their complexity.

Methodological biases in observational hospital studies of COVID-19 treatment effectiveness: pitfalls and potential.

Introduction: This study aims to discuss and assess the impact of three prevalent methodological biases: competing risks, immortal-time bias, and confounding bias in real-world observational studies evaluating treatment effectiveness. We use a demonstrative observational data example of COVID-19 patients to assess the impact of these biases and propose potential solutions.

Methods: We describe competing risks, immortal-time bias, and time-fixed confounding bias by evaluating treatment effectiveness in hospitalized patients with COVID-19.

The Impact of Head Position on Neurological and Histopathological Outcome Following Controlled Automated Reperfusion of the Whole Body (CARL) in a Pig Model.

Based on extracorporeal circulation, targeted reperfusion strategies have been developed to improve survival and neurologic recovery in refractory cardiac arrest: Controlled Automated Reperfusion of the whoLe Body (CARL). Furthermore, animal and human cadaver studies have shown beneficial effects on cerebral pressure due to head elevation during conventional cardiopulmonary resuscitation. Our aim was to evaluate the impact of head elevation on survival, neurologic recovery and histopathologic outcome in addition to CARL in an animal model.

Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization.

Importance: Staphylococcus aureus surgical site infections (SSIs) and bloodstream infections (BSIs) are important complications of surgical procedures for which prevention remains suboptimal. Contemporary data on the incidence of and etiologic factors for these infections are needed to support the development of improved preventive strategies.

Objectives: To assess the occurrence of postoperative S aureus SSIs and BSIs and quantify its association with patient-related and contextual factors.

Target trial emulation with multi-state model analysis to assess treatment effectiveness using clinical COVID-19 data.

Background: Real-world observational data are an important source of evidence on the treatment effectiveness for patients hospitalized with coronavirus disease 2019 (COVID-19). However, observational studies evaluating treatment effectiveness based on longitudinal data are often prone to methodological biases such as immortal time bias, confounding bias, and competing risks.

Methods: For exemplary target trial emulation, we used a cohort of patients hospitalized with COVID-19 (n = 501) in a single centre.

Activated phosphoinositide 3-kinase δ syndrome: Update from the ESID Registry and comparison with other autoimmune-lymphoproliferative inborn errors of immunity.

Background: Activated phosphoinositide-3-kinase δ syndrome (APDS) is an inborn error of immunity (IEI) with infection susceptibility and immune dysregulation, clinically overlapping with other conditions. Management depends on disease evolution, but predictors of severe disease are lacking.

Objectives: This study sought to report the extended spectrum of disease manifestations in APDS1 versus APDS2; compare these to CTLA4 deficiency, NFKB1 deficiency, and STAT3 gain-of-function (GOF) disease; and identify predictors of severity in APDS.

Concurrent analysis of hospital stay durations and mortality of emerging severe acute respiratory coronavirus virus 2 (SARS-CoV-2) variants using real-time electronic health record data at a large German university hospital.

Multistate methodology proves effective in analyzing hospitalized coronavirus disease 2019 (COVID-19) patients with emerging variants in real time. An analysis of 2,548 admissions in Freiburg, Germany, showed reduced severity over time in terms of shorter hospital stays and higher discharge rates when comparing more recent phases with earlier phases of the pandemic.

Lag-time effects of vaccination on SARS-CoV-2 dynamics in German hospitals and intensive-care units.

Background: The Efficacy and effectiveness of vaccination against SARS-CoV-2 have clearly been shown by randomized trials and observational studies. Despite these successes on the individual level, vaccination of the population is essential to relieving hospitals and intensive care units. In this context, understanding the effects of vaccination and its lag-time on the population-level dynamics becomes necessary to adapt the vaccination campaigns and prepare for future pandemics.

Target Trial Emulation Using Hospital-Based Observational Data: Demonstration and Application in COVID-19.

Methodological biases are common in observational studies evaluating treatment effectiveness. The objective of this study is to emulate a target trial in a competing risks setting using hospital-based observational data. We extend established methodology accounting for immortal time bias and time-fixed confounding biases to a setting where no survival information beyond hospital discharge is available: a condition common to coronavirus disease 2019 (COVID-19) research data.

Intensity and lag-time of non-pharmaceutical interventions on COVID-19 dynamics in German hospitals.

Introduction: Evaluating the potential effects of non-pharmaceutical interventions on COVID-19 dynamics is challenging and controversially discussed in the literature. The reasons are manifold, and some of them are as follows. First, interventions are strongly correlated, making a specific contribution difficult to disentangle; second, time trends (including SARS-CoV-2 variants, vaccination coverage and seasonality) influence the potential effects; third, interventions influence the different populations and dynamics with a time delay.

SAPS2, APACHE2, SOFA, and Core-10-TISS upon admission as risk indicators for ICU-acquired infections: a retrospective cohort study.

Purpose: Early identification of high-risk patients is an important component in improving infection prevention. The SAPS2, APACHE2, Core-10-TISS, and SOFA scores are already widely used to estimate mortality, morbidity and nursing workload, but this study evaluated their usefulness in assessing a patient's risk of ICU-acquired infection.

Methods: We conducted a retrospective cohort study by analyzing all patient admissions to seven ICUs at Charité Berlin, Germany in 2017 and 2018.

An empirical evaluation of the impact scenario of pooling bodies of evidence from randomized controlled trials and cohort studies in medical research.

Background: Randomized controlled trials (RCTs) and cohort studies are the most common study design types used to assess treatment effects of medical interventions. We aimed to hypothetically pool bodies of evidence (BoE) from RCTs with matched BoE from cohort studies included in the same systematic review.

Methods: BoE derived from systematic reviews of RCTs and cohort studies published in the 13 medical journals with the highest impact factor were considered.

Excess length of stay and readmission following hospital-acquired bacteraemia: a population-based cohort study applying a multi-state model approach.

Objectives: Population-based estimates of excess length of stay after hospital-acquired bacteraemia (HAB) are few and prone to time-dependent bias. We investigated the excess length of stay and readmission after HAB.

Methods: This population-based cohort study included the North Denmark Region adult population hospitalized for ≥48 hours, from 2006 to 2018.