Revision total joint arthroplasty: the epidemiology of 63,140 cases in New York State.
80 and over; 80 and Over; Aged; arthroplasty; Arthroplasty; Databases; Factual; Humans; incidence; Joint Diseases – Epidemiology; Joint Diseases – Surgery; Joint Diseases/*epidemiology/surgery; Joint Prosthesis – Adverse Effects; Joint Prosthesis/adverse effects; Middle Age; Middle Aged; New York; New York/epidemiology; Prosthesis Failure; Reoperation – Statistics and Numerical Data; Reoperation – Trends; Reoperation/statistics & numerical data/trends; Replacement – Adverse Effects; Replacement – Statistics and Numerical Data; Replacement – Trends; Replacement/adverse effects/*statistics & numerical data/trends; Resource Databases; revision; revision burden; SPARCS
Recent evidence suggests a substantial rise in the number of revision total joint arthroplasty (TJA) procedures performed. The New York State SPARCS inpatient database was utilized to identify revision total shoulder, knee, and hip arthroplasty procedures between 1993 and 2010. Yearly incidence and related epidemiology were analyzed. A total of 1,806 revision TSA, 26,080 revision TKA, and 35,254 revision THA cases were identified. The population-based incidence of these procedures increased 288%, 246%, and 44% respectively (P\textless0.001). Revision burden for hip arthroplasty decreased from 16.1% in 2001 to 11.5% in 2010 (P\textless0.001). The rates of revision TSAs and TKAs increased at a substantially faster rate than that of revision THAs. Revision burden for hip arthroplasty steadily has decreased since 2001.
Bansal Ankit; Khatib Omar N; Zuckerman Joseph D
The Journal of arthroplasty
2014
2014-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.arth.2013.04.006" target="_blank" rel="noreferrer noopener">10.1016/j.arth.2013.04.006</a>
A gradient boosting algorithm for survival analysis via direct optimization of concordance index.
*Survival Analysis; Algorithms; Artificial Intelligence; Breast Neoplasms/*epidemiology/*mortality; Clinical; Databases; Decision Support Systems; Factual; Female; Humans; Internet; Models; Prognosis; Proportional Hazards Models; Software; Theoretical
Survival analysis focuses on modeling and predicting the time to an event of interest. Many statistical models have been proposed for survival analysis. They often impose strong assumptions on hazard functions, which describe how the risk of an event changes over time depending on covariates associated with each individual. In particular, the prevalent proportional hazards model assumes that covariates are multiplicatively related to the hazard. Here we propose a nonparametric model for survival analysis that does not explicitly assume particular forms of hazard functions. Our nonparametric model utilizes an ensemble of regression trees to determine how the hazard function varies according to the associated covariates. The ensemble model is trained using a gradient boosting method to optimize a smoothed approximation of the concordance index, which is one of the most widely used metrics in survival model performance evaluation. We implemented our model in a software package called GBMCI (gradient boosting machine for concordance index) and benchmarked the performance of our model against other popular survival models with a large-scale breast cancer prognosis dataset. Our experiment shows that GBMCI consistently outperforms other methods based on a number of covariate settings. GBMCI is implemented in R and is freely available online.
Chen Yifei; Jia Zhenyu; Mercola Dan; Xie Xiaohui
Computational and mathematical methods in medicine
2013
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1155/2013/873595" target="_blank" rel="noreferrer noopener">10.1155/2013/873595</a>
Hematologic counts as predictors of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.
*Blood Cell Count; *Inflammation; *Intracranial vasospasm; *Subarachnoid hemorrhage; *Transcranial Doppler sonography; Anemia/blood/diagnosis; Brain Ischemia/blood/complications/*diagnosis/epidemiology; Cerebrovascular Circulation/physiology; Critical Care; Databases; Doppler; Factual; Female; Humans; Leukocytosis/blood/diagnosis; Logistic Models; Male; Middle Aged; Models; Odds Ratio; Ohio/epidemiology; Sensitivity and Specificity; Subarachnoid Hemorrhage/*complications/diagnostic imaging; Theoretical; Transcranial; Ultrasonography
PURPOSE: Aneurysmal subarachnoid hemorrhage (SAH) is associated with high morbidity and mortality, but currently no single clinical method or ancillary test can reliably predict which subset of patients will develop delayed cerebral ischemia (DCI). The aim of this study was to find hematologic derangements and clinical factors present during the first 7 days after bleeding that could help identify patients at risk for development of DCI. MATERIALS AND METHODS: Databank analysis of patients with SAH admitted between 2010 and 2012 in a single center. Data from demographics, imaging, laboratory, and clinical factors were collected. Statistical testing was conducted to test for association to the outcome, and multivariate logistic regression was used to design a predictive model. RESULTS: Of 55 patients, 14 developed DCI (25%). Anemia and leukocytosis on the third day after bleeding were significantly correlated with the outcome (for anemia: P\textless.032; confidence interval, 1.12-15.16; odds ratio, 4.12; for leukocytosis: P\textless.046; confidence interval, 1.03-26.13; odds ratio, 5.18). Anemia and leukocytosis were still statistically significant after adjustment for age, sex, modified Fisher scale, and Hunt-Hess scale. CONCLUSION: The presence of leukocytosis and anemia during the third day after SAH was statistically correlated with the occurrence of DCI.
Da Silva Ivan Rocha Ferreira; Gomes Joao Antonio; Wachsman Ari; de Freitas Gabriel Rodriguez; Provencio Jose Javier
Journal of critical care
2017
2017-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jcrc.2016.09.011" target="_blank" rel="noreferrer noopener">10.1016/j.jcrc.2016.09.011</a>
Virtual screening to identify novel antagonists for the G protein-coupled NK3 receptor.
*Models; *Narcotic Antagonists; *Quantitative Structure-Activity Relationship; Animals; Binding; Calcium Signaling/drug effects; CHO Cells; Competitive; Cricetinae; Cricetulus; Databases; Factual; Humans; Ligands; Molecular; Neurokinin-3/*antagonists & inhibitors/chemistry; Opioid/chemistry; Quinolines/*chemistry/pharmacology; Radioligand Assay; Receptors
The NK(3) subtype of tachykinin receptor is a G protein-coupled receptor that is a potential therapeutic target for several neurological diseases, including schizophrenia. In this study, we have screened compound databases for novel NK(3) receptor antagonists using a virtual screening protocol of similarity analysis. The lead compound for this study was the potent NK(3) antagonist talnetant. Compounds of the quinoline type found in the virtual screen were additionally evaluated in a comparative molecular field analysis model to predict activity a priori to testing in vitro. Selected members of this latter set were tested for their ability to inhibit ligand binding to the NK(3) receptor as well as to inhibit senktide-induced calcium responses in cells expressing the human NK(3) receptor. Two novel compounds were identified that inhibited NK(3) receptor agonist binding, with potencies in the nM range and antagonized NK(3) receptor-mediated increases in intracellular calcium. These results demonstrate the utility of similarity analysis in identifying novel antagonist ligands for neuropeptide receptors.
Geldenhuys Werner J; Kuzenko Stephanie R; Simmons Mark A
Journal of medicinal chemistry
2010
2010-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1021/jm1010012" target="_blank" rel="noreferrer noopener">10.1021/jm1010012</a>
Thirty-Day Readmissions After Transcatheter Aortic Valve Replacement in the United States: Insights From the Nationwide Readmissions Database.
*aortic stenosis; *costs and cost analysis; *length of stay; *Patient Readmission/economics; *readmission; *rehospitalization; *transcatheter aortic valve implantation; *transcatheter aortic valve replacement; 80 and over; Aged; Aortic Valve Stenosis/diagnosis/economics/*surgery; Comorbidity; Databases; Factual; Female; Hospital Costs; Humans; Length of Stay; Male; Patient Discharge; Postoperative Complications/etiology; Risk Factors; Skilled Nursing Facilities; Time Factors; Transcatheter Aortic Valve Replacement/*adverse effects/economics; Treatment Outcome; United States
BACKGROUND: Readmissions after cardiac procedures are common and contribute to increased healthcare utilization and costs. Data on 30-day readmissions after transcatheter aortic valve replacement (TAVR) are limited. METHODS AND RESULTS: Patients undergoing TAVR (International Classification of Diseases-Ninth Revision-CM codes 35.05 and 35.06) between January and November 2013 who survived the index hospitalization were identified in the Nationwide Readmissions Database. Incidence, predictors, causes, and costs of 30-day readmissions were analyzed. Of 12 221 TAVR patients, 2188 (17.9%) were readmitted within 30 days. Length of stay \textgreater5 days during index hospitalization (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.24-1.73), acute kidney injury (HR, 1.23; 95% CI, 1.05-1.44), \textgreater4 Elixhauser comorbidities (HR, 1.22; 95% CI, 1.03-1.46), transapical TAVR (HR, 1.21; 95% CI, 1.05-1.39), chronic kidney disease (HR, 1.20; 95% CI, 1.04-1.39), chronic lung disease (HR, 1.16; 95% CI, 1.01-1.34), and discharge to skilled nursing facility (HR, 1.16; 95% CI, 1.01-1.34) were independent predictors of 30-day readmission. Readmissions were because of noncardiac causes in 61.8% of cases and because of cardiac causes in 38.2% of cases. Respiratory (14.7%), infections (12.8%), bleeding (7.6%), and peripheral vascular disease (4.3%) were the most common noncardiac causes, whereas heart failure (22.5%) and arrhythmias (6.6%) were the most common cardiac causes of readmission. Median length of stay and cost of readmissions were 4 days (interquartile range, 2-7 days) and $8302 (interquartile range, $5229-16 021), respectively. CONCLUSIONS: Thirty-day readmissions after TAVR are frequent and are related to baseline comorbidities, TAVR access site, and post-procedure complications. Awareness of these predictors can help identify and target high-risk patients for interventions to reduce readmissions and costs.
Kolte Dhaval; Khera Sahil; Sardar M Rizwan; Gheewala Neil; Gupta Tanush; Chatterjee Saurav; Goldsweig Andrew; Aronow Wilbert S; Fonarow Gregg C; Bhatt Deepak L; Greenbaum Adam B; Gordon Paul C; Sharaf Barry; Abbott J Dawn
Circulation. Cardiovascular interventions
2017
2017-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1161/CIRCINTERVENTIONS.116.004472" target="_blank" rel="noreferrer noopener">10.1161/CIRCINTERVENTIONS.116.004472</a>
Non-health Care Facility Medication Errors Associated with Hormones and Hormone Antagonists in the United States.
80 and over; Adolescent; Adult; Age Distribution; Aged; Child; Databases; Drug-Related Side Effects and Adverse Reactions/diagnosis/*epidemiology/mortality/therapy; Factual; Female; Hormone antagonists; Hormone Antagonists/*adverse effects; Hormones; Hormones/*adverse effects; Humans; Infant; Male; Medication Errors/*statistics & numerical data; Middle Aged; Newborn; Oral hypoglycemic medications; Poison control center; Poison Control Centers; Preschool; Retrospective Studies; Risk Factors; Sex Distribution; Time Factors; Unintentional therapeutic error; United States/epidemiology; Young Adult
INTRODUCTION: Hormones and hormone antagonists are frequently associated with medication errors and may result in important adverse outcomes. The purpose of this study is to investigate non-health care facility (non-HCF) medication errors associated with hormones and hormone antagonists in the United States (US). METHODS: A retrospective analysis of National Poison Data System data was conducted to identify characteristics and trends of unintentional non-HCF therapeutic errors involving hormones and hormone antagonists among individuals of all ages from 2000 to 2012. RESULTS: From 2000 to 2012, US poison control centers received 169,695 calls regarding unintentional non-HCF therapeutic errors associated with hormone therapies, averaging 13,053 medication error calls annually. The rate of reported errors increased significantly by 162.6% (p \textless 0.001), from 2.24 per 100,000 US residents in 2000 to 5.89 per 100,000 in 2012. Two thirds of the errors (65.2%) occurred among females. The medications most commonly associated with errors were thyroid preparations (23.2%), corticosteroids (21.9%), and insulin (20.0%). All nine deaths and 93.2% of major effects were attributed to hypoglycemic agents. Sulfonylureas alone accounted 43.9% of major effects. The number and rate of therapeutic errors increased significantly for all medication categories except estrogen and thiazolidinediones. Most errors were managed at the site of exposure (82.9%) and did not result in serious medical outcomes (95.6%). CONCLUSIONS: This study provides an overview of non-HCF medication errors associated with hormones and hormone antagonists in the US. While most errors did not result in adverse outcomes, their increasing frequency places a greater burden on the health care system.
Magal Pranav; Spiller Henry A; Casavant Marcel J; Chounthirath Thitphalak; Hodges Nichole L; Smith Gary A
Journal of medical toxicology : official journal of the American College of Medical Toxicology
2017
2017-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/s13181-017-0630-8" target="_blank" rel="noreferrer noopener">10.1007/s13181-017-0630-8</a>
The impact of Chiari malformation on daily activities: A report from the national Conquer Chiari Patient Registry database.
*Activities of Daily Living; *Disabled Persons; *Quality of Life; Adult; Arnold-Chiari malformation; Arnold-Chiari Malformation/classification/*complications; Automobile Driving; Daily living; Databases; Factual; Female; Food Handling; Housekeeping; Humans; Male; Middle Aged; Physical activities; Quality of life; Recreational activities; Registries; Severity of Illness Index; United States; Walking
BACKGROUND: Chiari malformation (CM) is characterized by herniation of the cerebellar tonsils into the cervical spine. While ample literature on CM exists for clinical and procedural aspects of the disease, few studies have measured the impact CM has on daily activities. OBJECTIVE: The objective of this study was to measure the impact that CM has on daily living activities. METHODS: Data was analyzed from 798 CM patients gathered by the national Conquer Chiari Patient Registry database. RESULTS: Results indicate CM is associated with negative impact on daily living and physical activities for patients, even those exhibiting mild symptoms. Participants with severe symptoms experience the greatest deficit with regards to daily living such as difficulty walking, driving, housecleaning and food preparation. CONCLUSIONS: As 96.1% of CM patients report impact in one or more areas of daily living, CM is classified as a disability according to 42 U.S. CODE section sign 12101 (Americans with Disabilities Act). The degree of self-reported CM symptom severity is strongly related to the frequency and extent of limitations in both physical and daily activities.
Meeker James; Amerine Jenna; Kropp Denise; Chyatte Michelle; Fischbein Rebecca
Disability and health journal
2015
2015-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.dhjo.2015.01.003" target="_blank" rel="noreferrer noopener">10.1016/j.dhjo.2015.01.003</a>
Incidence and epidemiology of cervical radiculopathy in the United States military: 2000 to 2009.
*Military Personnel/statistics & numerical data; Adult; Age Factors; Cohort Studies; Databases; Factual; Female; Humans; Incidence; Male; Prospective Studies; Radiculopathy/diagnosis/*epidemiology; Risk Factors; Sex Factors; United States/epidemiology; Young Adult
STUDY DESIGN: Epidemiological review of a prospectively collected military database. OBJECTIVE: This investigation sought to determine the incidence of cervical radiculopathy and risk factors for its development within the population of the United States military from 2000 to 2009. SUMMARY OF BACKGROUND DATA: Currently, the epidemiology of cervical radiculopathy remains poorly understood and risk factors for its development have not been reliably defined. METHODS: The military's Defense Medical Epidemiological Database was used to identify all servicemembers diagnosed with cervical radiculopathy (International Classification of Diseases code 723.4) between 2000 and 2009. Demographic data was obtained for all identified individuals including age group, sex, race, military rank, and branch of service. Like data was recorded for all servicemembers within the Armed Forces during the time period under study. The incidence of cervical radiculopathy was calculated and unadjusted incidence rate ratios were determined. Risk factors were analyzed by performing multivariate Poisson regression analysis, controlling for all other factors within the model. RESULTS: Between 2000 and 2009, about 24,742 individuals were diagnosed with cervical radiculopathy among a population-at-risk of 13,813,333, for an incidence of 1.79 per 1000 person-years. Statistically significant differences (P\textless0.001) in adjusted incidence rate ratios were identified for each successive age group with mutually exclusive 95% confidence intervals. Those age 40 years and above were found to have the greatest risk of cervical radiculopathy. Female sex (P\textless0.001), White race (P\textless0.001), senior positions within the rank structure (P\textless0.001), and service in the Army (P\textless0.001) or Air Force (P=0.01) were also identified as significant risk factors for cervical radiculopathy. CONCLUSIONS: This study is the first to attempt to define the incidence of cervical radiculopathy and characterize risk factors for its development within an American population. Findings presented here indicate that age is most likely the greatest risk factor for cervical radiculopathy, with female sex, White race, senior military positions, and Army or Air Force service also influencing risk to varying degrees.
Schoenfeld Andrew J; George Alan A; Bader Julia O; Caram Pedro M Jr
Journal of spinal disorders & techniques
2012
2012-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/BSD.0b013e31820d77ea" target="_blank" rel="noreferrer noopener">10.1097/BSD.0b013e31820d77ea</a>
Epidemiology of cervical spine fractures in the US military.
Adult; Cervical Vertebrae/*injuries; Databases; Factual; Female; Humans; Incidence; Male; Military Personnel/statistics & numerical data; Spinal Cord Injuries/epidemiology/etiology; Spinal Fractures/complications/*epidemiology; United States/epidemiology; Young Adult
BACKGROUND CONTEXT: The epidemiology of cervical spine fractures and associated spinal cord injury (SCI) has not previously been estimated within the American population. PURPOSE: To determine the incidence of cervical spine fractures and associated SCI and identify potential risk factors for these injuries in a large multicultural military population. STUDY DESIGN: Query of a prospectively collected military database. PATIENT SAMPLE: The 13,813,333 military servicemembers serving in the US Armed Forces between 2000 and 2009. OUTCOME MEASURES: The Defense Medical Epidemiology Database (DMED) was queried to identify all servicemembers diagnosed with cervical spine fractures with and without SCI during the time period under investigation. Data were used to determine the incidence of cervical spine fractures and SCI as well as identify risk factors for their development. METHODS: The DMED was queried for the years 2000 to 2009 using the International Classification of Diseases, Ninth Revision, Clinical Modification code for cervical spine fractures with and without SCI (805.0, 805.1, 806.0, and 806.1). The database was also used to determine the total number of servicemembers within the military during the same period. The incidence of cervical spine fractures and fractures associated with SCI was determined, and unadjusted incidence rates were calculated for the demographic characteristics of sex, race, military rank, branch of service, and age. Adjusted incidence rate ratios were then determined using multivariate Poisson regression analysis to control for other factors in the model and identify significant risk factors for cervical spine fractures and cervical injuries associated with SCI. RESULTS: From 2000 to 2009, there were 4,048 cervical spine fractures in a population at risk of 13,813,333 servicemembers. The overall incidence of cervical spine fractures was 0.29 per 1,000 person-years, and the incidence of fracture associated SCI was 70 per 1,000,000. The cohorts at highest risk of cervical spine fracture were males, whites, Enlisted personnel, those serving in the Army, Navy, or Marine Corps, and servicemembers aged 20 to 29. Risk of fracture-associated SCI was significantly increased in males, Enlisted personnel, servicemembers in the Army, Navy, or Marines, and those aged 20 to 29. CONCLUSIONS: This study is the largest population-based investigation to be conducted within the United States regarding the incidence of SCI and the only study addressing incidence and risk factors for cervical spine fractures. Male sex, white race, Enlisted military rank, service in the Army, Navy, or Marine Corps, and ages 20 to 29 were found to significantly increase the risk for cervical fractures and/or fracture associated SCI. Our findings support previously published data but also represent best available evidence based on the size and diversity of the population under study. LEVEL OF EVIDENCE: Prognostic; Level II.
Schoenfeld Andrew J; Sielski Bernadette; Rivera Kenneth P; Bader Julia O; Harris Mitchel B
The spine journal : official journal of the North American Spine Society
2012
2012-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.spinee.2011.01.029" target="_blank" rel="noreferrer noopener">10.1016/j.spinee.2011.01.029</a>