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Byskosh A, Shi M, Helenowski I, Holl JL, Hsia RY, Liepert AE, Mackersie RC, Stey AM. Is state trauma funding associated with mortality among injured hospitalized patients? Am J Surg 2024; 229:133-139. [PMID: 38155075 PMCID: PMC10998441 DOI: 10.1016/j.amjsurg.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/08/2023] [Accepted: 12/10/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND We sought to quantify the association between state trauma funding and (1) in-hospital mortality and (2) transfers of injured patients. METHODS We conducted an observational cross-sectional study of states with publicly available trauma funding data. We analyzed in-hospital mortality using linked data from the Nationwide Inpatient Sample (NIS), American Hospital Association (AHA) Annual Survey, and these State Department of Public Health trauma funding data. RESULTS A total of 594,797 injured adult patients were admitted to acute care hospitals in 17 states. Patients in states with >$1.00 per capita state trauma funding had 0.82 (95 % CI: 0.78-0.85, p < 0.001) decreased adjusted odds of in-hospital mortality compared to patients in states with less than $1.00 per capita state trauma funding. CONCLUSIONS Increased state trauma funding is associated with decreased adjusted in-hospital mortality.
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Affiliation(s)
- Alexandria Byskosh
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Meilynn Shi
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Irene Helenowski
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Jane L Holl
- Department of Neurology, Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, IL, USA.
| | - Renee Y Hsia
- Department of Emergency Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA.
| | - Amy E Liepert
- Department of Surgery, School of Medicine, Marquette University, Columbia, MO, USA.
| | - Robert C Mackersie
- Department of Surgery, School of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Anne M Stey
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Byskosh A, Olsen K. Retained arterial catheter following patient self-discontinuation-a case report. J Surg Case Rep 2024; 2024:rjad727. [PMID: 38239372 PMCID: PMC10795922 DOI: 10.1093/jscr/rjad727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/19/2023] [Indexed: 01/22/2024] Open
Abstract
A patient self-discontinues arterial line resulting in retention of arterial catheter. The retained catheter was identified on bedside ultrasound and the patient required radial artery exploration and removal of catheter under general anesthesia. We describe potential contributing factors and solutions to catheter design and placement as well as next steps once a retained catheter has been identified.
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Affiliation(s)
- Alexandria Byskosh
- St. Elizabeth’s Medical Center, Department of Surgery, Chobanian and Boston University’s Avedisian School of Medicine, Boston, MA 02135, United States
| | - Kevin Olsen
- Department of Anesthesiology, Moffitt Cancer Center, Tampa, FL 33612, United States
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Matthay ZA, Hellmann ZJ, Robinson B, Abel MK, Chipman A, Kozar RA, Byskosh A, Callcut RA, Kornblith LZ. Impact of Transfusion Ratios on Mortality after Ultramassive Transfusion Across Nontrauma Surgical Specialties: An Eastern Association for the Surgery of Trauma Multicenter Study. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stocker B, Byskosh A, Weiss H, Devin CL, Weingarten N, Masteller M, Johnston A, Posluszny J. A Multifaceted Extubation Protocol to Reduce Reintubation Rates in the Surgical ICU. Jt Comm J Qual Patient Saf 2021; 48:81-91. [PMID: 34756824 DOI: 10.1016/j.jcjq.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Reintubation is associated with significant morbidity and mortality. The reintubation rate in surgical ICUs (SICUs) is ∼10% nationally but was 17.0% in our SICU. The objective of this study was to determine if the reintubation rate could be reduced with a protocol for extubation assessment and post-extubation care consisting of standardized extubation criteria and targeted interventions for patients at high risk for reintubation. METHODS Standardized extubation criteria for all SICU patients were identified via literature review and best-practice guidelines. High reintubation risk criteria were identified (age ≥ 65 years, chronic cardiopulmonary disease, ≥ 4 days intubated, emergency intubation, and fluid balance ≥ 5 liters) through a literature review and 13-month retrospective review of reintubations in our institution's SICU. Patients meeting at least one criterion putting them at higher risk for reintubation received interventions including post-extubation high-flow nasal cannula for 24 hours and algorithm-guided respiratory therapy. RESULTS During the 12-month period following protocol implementation, 36 of 402 extubations resulted in reintubations (9.0% vs. 17.0% preintervention, p < 0.001). Among all extubations, 305 (75.9%) were identified as high risk. Among reintubated patients, 34 (94.4%) met high-risk criteria. The mortality rate for reintubated patients was 40.0%, compared to 3.3% in those not reintubated (p < 0.001). The high-risk screening tool had a negative predictive value of 98%. CONCLUSION A multifaceted and pragmatic extubation and post-extubation care protocol significantly reduced one SICU's reintubation rate. This protocol can be easily implemented in any SICU to improve patient outcomes following extubation.
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Tata N, Byskosh A, Helenowski I, Dunderdale J, Jovanovic B, Kulkarni S. The Effect of Obesity on Operating Room Utilization in Breast Surgery. J Surg Res 2020; 260:229-236. [PMID: 33360306 DOI: 10.1016/j.jss.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/19/2020] [Accepted: 10/16/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The current obesity epidemic is associated with increased health care costs associated with comorbidities such as diabetes and heart disease as well as postoperative complications. However, the effect of obesity on operating room (OR) utilization, especially in common breast procedures, has not been completely evaluated. Our study is the first to examine the effect of patient obesity on operative time (OPT) for common breast procedures. METHODS The American College of Surgeons National Surgical Quality Improvement Project databases for 2010-2018 were searched for this retrospective review. Patients undergoing common breast operations (lumpectomy, lumpectomy with sentinel lymph node biopsy (SLNB) (+/- injection), lumpectomy and axillary lymph node dissection (ALND), simple mastectomy, mastectomy with SLNB (+/- injection), and mastectomy with ALND) were filtered out by Current Procedural Terminology code and divided into three groups based on their body mass index (BMI) and weight. Using the two-sample t-test, OPT for the procedures was compared among the lowest and highest BMI and weight categories. We also used a linear regression t-test to demonstrate that for every unit increase in BMI, there was a corresponding increase in OPT for each procedure. RESULTS When the lowest and highest BMI and weight groups were compared, significant differences in OPT (P < 0.0001) were seen for each of the procedures. Numerous factors that could affect the complexity of surgery and thus OR time were identified. The correlation between BMI and weight and OPT remained significant after controlling for these variables. The differences between the highest and lowest BMI groups were most pronounced for higher complexity procedures, such as lumpectomy with ALND and mastectomy with ALND, with average operating times increasing by 18.2 min and 18.6 min, respectively, for patients with a higher BMI. CONCLUSIONS Patient BMI and weight significantly affect OPT for common breast procedures. Therefore, patient BMI should be taken into account to improve OR scheduling.
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Affiliation(s)
- Nalini Tata
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alexandria Byskosh
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Irene Helenowski
- Department of Prevention, Northwestern University, Chicago, Illinois
| | - Julie Dunderdale
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Borko Jovanovic
- Department of Prevention, Northwestern University, Chicago, Illinois
| | - Swati Kulkarni
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
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Stey AM, Byskosh A, Etkin C, Mackersie R, Stein DM, Bilimoria KY, Crandall ML. Describing the density of high-level trauma centers in the 15 largest US cities. Trauma Surg Acute Care Open 2020; 5:e000562. [PMID: 33083559 PMCID: PMC7549441 DOI: 10.1136/tsaco-2020-000562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/02/2020] [Accepted: 09/18/2020] [Indexed: 11/03/2022] Open
Abstract
Background There has been a proliferation of urban high-level trauma centers. The aim of this study was to describe the density of high-level adult trauma centers in the 15 largest cities in the USA and determine whether density was correlated with urban social determinants of health and violence rates. Methods The largest 15 US cities by population were identified. The American College of Surgeons' (ACS) and states' department of health websites were cross-referenced for designated high-level (levels 1 and 2) trauma centers in each city. Trauma centers and associated 20 min drive radius were mapped. High-level trauma centers per square mile and per population were calculated. The distance between high-level trauma centers was calculated. Publicly reported social determinants of health and violence data were tested for correlation with trauma center density. Results Among the 15 largest cities, 14 cities had multiple high-level adult trauma centers. There was a median of one high-level trauma center per every 150 square kilometers with a range of one center per every 39 square kilometers in Philadelphia to one center per596 square kilometers in San Antonio. There was a median of one high-level trauma center per 285 034 people with a range of one center per 175 058 people in Columbus to one center per 870 044 people in San Francisco. The median minimum distance between high-level trauma centers in the 14 cities with multiple centers was 8 kilometers and ranged from 1 kilometer in Houston to 43 kilometers in San Antonio. Social determinants of health, specifically poverty rate and unemployment rate, were highly correlated with violence rates. However, there was no correlation between trauma center density and social determinants of health or violence rates. Discussion High-level trauma centers density is not correlated with social determinants of health or violence rates. Level of evidence VI. Study type Economic/decision.
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Affiliation(s)
- Anne M Stey
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alexandria Byskosh
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Caryn Etkin
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert Mackersie
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Deborah M Stein
- R Adams Cowley Shock Trauma Center, San Francisco, California, USA
| | - Karl Y Bilimoria
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Marie L Crandall
- Department of Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
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Stocker B, Weiss H, Byskosh A, Weingarten N, Alan Masteller M, Johnston A, Anthony Posluszny J. Multifaceted and Pragmatic Extubation Protocol Reduces Reintubation Rate in the Surgical ICU. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Weingarten N, Byskosh A, Stocker B, Weiss H, Lee H, Masteller M, Johnston A, Quach G, Devin CL, Issa N, Posluszny J. Simulation-Based Course Improves Resident Comfort, Knowledge, and Ability to Manage Surgical Intensive Care Unit Patients. J Surg Res 2020; 256:355-363. [PMID: 32739618 DOI: 10.1016/j.jss.2020.05.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/04/2020] [Accepted: 05/24/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Simulation-based education can augment residents' skills and knowledge. We assessed the effectiveness of a simulation-based course for surgery interns designed to improve their comfort, knowledge, and ability to manage common surgical critical care (SCC) conditions. MATERIALS AND METHODS For 2 y, all first year residents (n = 31) in general surgery, urology, interventional radiology, and the integrated plastics, vascular, and cardiothoracic surgery training programs at our institution participated in a simulation-based course emphasizing evidence-based management of SCC conditions. Precourse and postcourse surveys and multiple-choice tests, as well as summative simulation tests, assessed interns' comfort, knowledge, and ability to manage SCC conditions. Changes in these measures were assessed with Wilcoxon matched-pairs signed rank tests. Factors associated with summative performance were determined by linear regression. RESULTS The course consisted of four simulation-based teaching sessions in year 1 and six in year 2. The course taught seven of the 18 core SCC conditions in the Surgical Council on Resident Education general surgery curriculum in year 1 and 10 in year 2. Interns' self-reported comfort, knowledge, and ability to manage each condition taught in the course increased (P < 0.02). Their knowledge of each condition, as assessed by written tests, also increased (P < 0.02). Their summative simulation test performance correlated with the number of course sessions attended (P < 0.03) and status as general surgery residents (P < 0.01). CONCLUSIONS A simulation-based SCC training course for surgery interns that emphasizes evidence-based management of SCC conditions improves interns' comfort, knowledge, and ability to manage these conditions.
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Affiliation(s)
- Noah Weingarten
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Alexandria Byskosh
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Benjamin Stocker
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Hannah Weiss
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Howard Lee
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael Masteller
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alex Johnston
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Giang Quach
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Courtney L Devin
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nabil Issa
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joseph Posluszny
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Rafferty MR, MacDonald J, Byskosh A, Sloan L, Toledo S, Marciniak C, Simuni T. Using Implementation Frameworks to Provide Proactive Physical Therapy for People With Parkinson Disease: Case Report. Phys Ther 2019; 99:1644-1655. [PMID: 31508801 PMCID: PMC7372734 DOI: 10.1093/ptj/pzz129] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 03/15/2019] [Accepted: 04/12/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND AND PURPOSE European clinical practice guidelines recommend physical therapy for people with Parkinson disease (PD) soon after diagnosis to provide education, physical activity advice, and individualized interventions when needed. However, therapy is frequently not used until after gait and balance problems occur. The purpose of this administrative case study is to present the application of a proactive physical therapy (PAPT) approach at 1 rehabilitation center using implementation frameworks to support the (1) implementation process, (2) determinants of implementation success, and (3) implementation evaluation. CASE DESCRIPTION The PAPT program targeted people with PD before the onset of significant mobility dysfunction. It was initiated in 1 outpatient neurological rehabilitation center. The program used shared decision-making to promote long-term maintenance of independent exercise. The Knowledge-to-Action Framework was used by champions to plan implementation processes. Implementation barriers were addressed using the Consolidated Framework for Implementation Research. The program was evaluated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework with mixed methods. OUTCOMES In the program's first year, 38 people were referred, 28 were evaluated, and 20 participated in the 6-month program evaluation. Following PAPT, the number of participants reporting regular participation in aerobic, strengthening, and flexibility exercise approximately doubled, while those engaging in balance activities increased from 1 to 8. They reported a median of 140 minutes of aerobic exercise per week. Implementation barriers included location, insurance coverage, and difficulty scheduling long-term follow-up visits. Participants reported physical and emotional benefits of the program. DISCUSSION Implementation frameworks assisted with the implementation and evaluation of a PAPT delivery model that helped people with PD to increase and maintain independent exercise participation.
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Affiliation(s)
- Miriam R Rafferty
- Shirley Ryan AbilityLab Illinois; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 355 E Erie St, 19th Floor Strength and Endurance Lab, Chicago, IL 60611 (USA); and Department of Psychiatry and Behavioral Science, Feinberg School of Medicine, Northwestern University
| | - Jillian MacDonald
- Shirley Ryan AbilityLab. Dr MacDonald is a board-certified clinical specialist in neurologic physical therapy
| | | | | | - Santiago Toledo
- Shirley Ryan AbilityLab; and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University
| | - Christina Marciniak
- AbilityLab; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University; and Department of Neurology, Feinberg School of Medicine, Northwestern University
| | - Tanya Simuni
- Department of Neurology, Feinberg School of Medicine, Northwestern University
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Abstract
HYPOTHESIS The goal of the investigation was to determine if vector analysis of nystagmus in a patient with the Tullio phenomenon could determine the source of the nystagmus. BACKGROUND The Tullio phenomenon consists of the combination of vertigo and abnormal eye and/or head movements provoked by sound. Dehiscence of the superior semicircular canal can be found in certain patients with the Tullio phenomenon. METHODS The patient was tested with pure tones ranging from 250 to 3,000 Hz at 95dB HL. The time course of the three-dimensional vector of eye movement, including torsion and vertical and horizontal displacement angles was determined by individual stop-frame analysis of digitized video. RESULTS Torsion amplitude varied from 1 to 7 degrees; vertical amplitude varied from 1 to 5 degrees; and horizontal amplitude varied less than 1.5 degrees. The maximal response occurred on stimulation of the right ear with a 1,250-Hz 95-dB HL tone. This elicited a reliable counterclockwise torsional and down-beating fast phase nystagmus as seen from the examiner's point of view. Comparison of the nystagmus with known canal vectors identified the right superior semicircular canal as the source of stimulation. High-resolution computed tomography scan of the temporal bone showed a definite right superior canal dehiscence. CONCLUSION The origin of nystagmus from the Tullio phenomenon can be identified by calculating the three-dimensional vector of the observed nystagmus. We show that vector analysis of the observed eye movement can be used to infer the source of nystagmus in these patients. The development of real-time, three-dimensional vector analysis of nystagmus is desirable.
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Affiliation(s)
- V B Ostrowski
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Medical School, Chicago, Illinois, USA
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Abstract
Estrogen and progesterone receptor status in breast cancer can determine therapeutic options and may provide prognostic information. The purpose of this study is to compare the concordance of the primary breast cancer steroid hormone receptor status to that of the recurrent breast cancer and to determine whether the type of second lesion (local recurrence, second primary, or metastatic lesion) and adjuvant therapy received changed the receptor concordance. The records of eighty-three patients with estrogen receptor (ER) analysis available for primary (p) and recurrent (r) breast cancer for 1976-1990 were reviewed. In addition, 32 of these patients also had available progesterone receptor (PR) values for primary and recurrent breast cancers. Statistical evaluation was performed by chi-square, Student's t-test, and Wilcoxon signed-rank test. ER concordance (primary/recurrent, p/r) was identified in 59/83 (71%) patients; PR concordance was identified in 18/32 (56%) patients. Whether the second lesion was a local recurrence, second primary, or a metastatic lesion did not affect ER concordance or PR concordance. Adjuvant chemotherapy, hormonal therapy, or radiation therapy, either alone or in combination, did not affect ER or PR concordance. The disease-free survival (DFS) for patients with ER (p+)/(r-) (primary receptor positive/recurrent receptor negative) was significantly shorter than those with ER (p-)/(r+)(27.6 +/- 7.4 months versus 50.6 +/- 7.6 mo, P = 0.04). The DFS for PR (p+)/(r-) patients was 28.8 +/- 7.9 months compared to the DFS of 46.8 +/- 11.8 months for PR (p-)/(r+) patients (P = NS). A significantly shorter DFS for ER (p+)/(r-) patients compared to ER (p-)/(r+) patients and a trend towards a shorter DFS for PR (p+)/(r-) patients compared to PR (p-)/(r+) patients may reflect a loss of hormonal regulation or an increase in cancer aggressiveness.
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Affiliation(s)
- B D Li
- Department of Surgery, Northwestern University Medical School, Chicago, Illinois
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