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Patients with asplenia have an increased lifelong risk of severe infections especially post splenectomy sepsis with hospital mortality rates of 30–50%. Adherence to existing guidelines for preventive measures is low. Objective of the study is the evaluation of a novel intervention to increase health psychological outcomes in patients with asplenia resulting in better adherence to preventive measures. The intervention was evaluated by conducting a prospective, two-armed historical control group design via propensity score analysis. Focus are health-psychological outcomes: self-efficacy, intention, risk perception, behaviour planning, self-management, health literacy, patient involvement and disease-knowledge. Patients in the intervention group (N = 110) showed a higher increase in almost all outcomes compared to a historical control group (N = 115). The strongest increase was observed in "asplenia-specific self-management" (average treatment effect: ATE 1.14 [95% CI 0.91–1.36] p <.001) and "asplenia-specific health-literacy" (ATE 1.42 [95% CI 1.18–1.65] p <.001). Significant intervention effects were also found in behaviour planning, perceived involvement and disease-knowledge. The patient-focused intervention is effective in improving health-psychological outcomes in patients with asplenia. The implementation of the intervention can make an important contribution to care and lead to an improvement of health-psychological outcomes that may result in a higher adherence to prevention measures. [ABSTRACT FROM AUTHOR]

Background There are limited data on the merits of an early invasive strategy in diabetics with non‐ST‐elevation acute coronary syndrome, with unclear influence of this strategy on survival. The aim of this study was to evaluate the in‐hospital survival of diabetics with non‐ST‐elevation acute coronary syndrome treated with an early invasive strategy compared with an initial conservative strategy. Methods and Results The National Inpatient Sample database, years 2012–2013, was queried for diabetics with a primary diagnosis of non‐ST‐elevation acute coronary syndrome defined as either non‐ST‐elevation myocardial infarction or unstable angina (unstable angina). An early invasive strategy was defined as coronary angiography±revascularization within 48 hours of admission. Propensity scores were used to assemble a cohort managed with either an early invasive or initial conservative strategy balanced on >50 baseline characteristics and hospital presentations. Incidence of in‐hospital mortality was compared in both groups. In a cohort of 363 500 diabetics with non‐ST‐elevation acute coronary syndrome, 164 740 (45.3%) were treated with an early invasive strategy. Propensity scoring matched 21 681 diabetics in both arms. Incidence of in‐hospital mortality was lower with an early invasive strategy in both the unadjusted (2.0% vs 4.8%; odds ratio [OR], 0.41; 95% CI, 0.39–0.42; P

Purpose: In patients following severe trauma sometimes the physiological condition or soft tissue status may not allow definitive fixation of a femoral fracture. In these patients, an external fixator can be placed to temporarily stabilise the fracture, after which definitive fixation can be performed in a second procedure. The aim of this study was to compare the postoperative wound infection and union rates of patients treated with direct intramedullary nailing (IMN) and patients treated with the ‘two-stage treatment’.Methods: All patients with high-energy femoral fractures treated with IMN between 2000 and 2016 in a single Level 1 trauma centre were eligible. Electronic charts were reviewed for patient and surgical characteristics; furthermore, the development of complications was noted. A propensity score analysis was performed to assess the attributed risk of the external fixator on the development of postoperative wound infections.Results: A total of 149 patients were included in this study; 93 underwent direct IMN and 56 underwent the two-stage treatment. Patients who underwent two-stage treatment were more severely injured, reflected by lower EMV and higher ISS on admission. Patients in the two-stage treatment group had a significant higher risk of postoperative wound infections (OR: 4.698, 95% CI: 1.203–18.339) but not a higher risk on deep postoperative wound infections (OR 2.345, 95% CI: 0.439–12.540). Union rate did not differ between the two groups (94% vs 94% NS).Conclusions: The two-stage treatment is a safe treatment option in patients with a high-energy femoral fracture in terms of postoperative wound infections. Union rates are also comparable between the two treatment groups. [ABSTRACT FROM AUTHOR]

Background/Aims: Higher level of serum uric acid (SUA) predicts early entry to dialysis in chronic kidney disease (CKD) patients. However, a short-term effect of SUA remains to be elucidated using a novel surrogate endpoint. Methods: Japanese CKD stage 3 to 4 patients were retrospectively examined (n= 701). The follow-up level of SUA was estimated as timeaveraged uric acid (TA-UA). A propensity score for 6.0, 6.5 or 7.0 mg/dL of TA-UA was respectively calculated using baseline 23 covariates. The time-to-event analysis was performed for 30% decline in estimated GFR over 2 years. Results: Incidence rates over 2 years were 90 of 440 in men and 36 of 261 in women (p = 0.03). Despite the negative result of baseline SUA, stratified Cox regression on the quintiles of the estimated propensity score showed that higher TA-UA of the three thresholds were all significant (crude HR 2.10 to 2.44) even after adjusting for the confounders. Kaplan-Meier analysis after propensity score matching likewise showed worse survival in the patients with the higher TA-UA (HR 3.11 to 4.26). Conclusion: Higher SUA increases likelihood of reaching a surrogate endpoint over 2 years. Early intervention for SUA less than 6.0 mg/dL is recommended for slowing CKD progression. [ABSTRACT FROM AUTHOR]

Background: The topic of trastuzumab therapy without chemotherapy in early breast cancer (EBC) has been repeatedly discussed at international consensus meetings, but is compromised by the lack of solid evidence from clinical studies.Methods: An observational study database of patients with EBC receiving trastuzumab-containing (neo)adjuvant therapy was screened to identify those patients who did not receive cytostatic agents.Results: Of 3935 patients, 232 (6%) were identified who received no chemotherapy, being characterized by older age, worse performance status, and/or less aggressive histology. Relapse-free survival in this cohort was 84% (95% confidence interval [CI] 78-89%) at 3 years and 80% (95% CI 74-87%) at 5 years. However, these rates were significantly worse than those in the group of patients who received chemotherapy (hazard ratio 1.49; 95% CI 1.06-2.09; P = 0.022). A similar pattern was observed for overall survival, with marginally non-significant inferiority in the group receiving no chemotherapy (hazard ratio 1.56; 95% CI 1.00-2.44; P = 0.052). Survival rates in patients receiving no chemotherapy were 93% (95% CI 88-97%) and 87% (95% CI 81-93%) at 3 and 5 years, respectively. These findings were confirmed by a propensity score analysis accounting for selection bias.Conclusions: Trastuzumab plus chemotherapy should remain the preferred option in all patients with HER2-positive EBC with an indication for adjuvant treatment. However, a limited proportion of patients will need an alternative treatment approach, either because of contraindications or the patient's preference. In these selected patients, trastuzumab monotherapy, eventually combined with endocrine agents, might be a reasonable option offering favorable long-term outcomes by addressing the high-risk profile associated with HER2-positive disease. [ABSTRACT FROM AUTHOR]

Acute appendicitis (AA) is among the most common causes of acute lower abdominal pain leading patients to the emergency department. Significant debate remains on whether AA should be operated or not. A propensity score-matched analysis was performed in seven Italian Hospitals, with the aim to assess safety and feasibility both nonoperative management with antibiotics (AT) and surgical therapy with appendectomy (ST) for patients with AA. Data regarding all patients discharged from the participating centers with a diagnosis of appendicitis from January 1st, 2014 to December 31st, 2014 were collected retrospectively. Follow-up data were collected from January 1st, 2015 to December 31st, 2016. The complication-free treatment success of AT (53.7%) was significantly inferior to that of ST (86.4%) ( P < 0.0001). Patients initially treated with antibiotics reported an index admission AT failure rate of 20.9% and a recurrence rate at 1-year follow-up of 20.3%. No statistically significant difference was found when comparing AT and ST groups for the outcome of interest post-operative complications (13.5 vs 13.6%, P = 0.834). Patients treated with AT were discharged home earlier than patients in the ST group (3.38 ± 1.89 vs 4.84 ± 2.69 days, P < 0.0001). Due to the low rates of complications occurred in the ST group and the high efficacy of the surgical therapy, laparoscopic appendectomy still represents the most effective treatment for patients with AA. AT is associated with shorter hospital stay and faster return to normal activity, and may prevent from appendectomies around 80% of patients who leave the hospital with clinical recovery. [ABSTRACT FROM AUTHOR]

In this study, we examine comparative rates of recidivism for Colorado inmates released from a private reentry center and public facilities. Using a sample of 6,102 inmates released from 2008 to 2012, we measure overall recidivism and recidivism for a new crime. Applying a quasi-experimental methodology, we find that overall rates of recidivism are comparable. Prior to matching, 46.8% of the treatment and 61.3% of the comparison group recidivated, and the difference is statistically significant. However, after matching on relevant covariates, the difference was reduced to nonsignificance. In contrast, those released from the private facility are more likely to return to prison for a new offense. Approximately 14% of those in the private facility committed a new crime compared with 9% prematching and 8% postmatching. Despite these modest differences in the rate of recidivism, the overall time to return to prison is comparable between the groups. [ABSTRACT FROM AUTHOR]

Objective/Aim The aim of this study was to identify a new index to predict early allograft dysfunction following living donor liver transplantation. Methods The study enrolled 260 adult living donor liver transplantation recipients. Postoperative laboratory variables were assessed for their association with the prevalence of early allograft dysfunction using the inverse probability of treatment weighting and propensity-score matching (n = 93 pairs) analysis. Results Forty-seven recipients (18.1%) developed early allograft dysfunction. In multivariable analysis, the alanine aminotransferase and gamma-glutamyl transpeptidase levels on postoperative day 1 were independent predictors of early allograft dysfunction. The alanine aminotransferase to gamma-glutamyl transpeptidase ratio (AGR) was developed. All cases were divided into two groups (Group 1 [AGR ≥ 8.47, n = 103] and Group 2 [AGR < 8.47, n = 157]). AGR ≥ 8.47 (OR 10.345, 95%CI 4.502–23.772, p < 0.001), hepatorenal syndrome (OR 3.016, 95%CI 1.119–8.125, p = 0.029), and graft to recipient weight ratio <0.8% (OR 2.155, 95%CI 1.004–4.624, p = 0.049) were independent risk factors for early allograft dysfunction. The prevalence of early allograft dysfunction was higher in group 1 (after adjusting for inverse probability of treatment weighting [n = 39; 37.9% vs n = 8; 5.1%] and propensity-score matching [n = 33; 35.5% vs n = 2; 2.2%]) than that in group 2 ( p < 0.001). Conclusions The postoperative AGR is a practical index for predicting early allograft dysfunction after living donor liver transplantation. [ABSTRACT FROM AUTHOR]

Objective Oral bisphosphonates (BPs) are widely used in the treatment of osteoporosis. When tooth extraction is performed, the recommendation is to discontinue oral BP therapy in patients if they have risk factors such as diabetes, treatment with steroids, malignancy, rheumatoid arthritis and renal failure, or have received these agents for a long period. However, there is little evidence to support this recommendation. The aim of this multicenter retrospective study was to assess the preventive effect of discontinuing oral BPs on development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Methods A total of 341 patients receiving oral BPs underwent extraction of 850 teeth from 402 jaws. Various factors were evaluated, including age, gender, diabetes, steroid use, malignancy, rheumatoid arthritis, renal failure, type of oral BP administered, duration of treatment, number of teeth extracted, reason for extraction, site (upper or lower jaw), wound status (open or complete closure), and whether BP therapy was discontinued. The relationship between these factors and development of BRONJ was analyzed by Fisher’s Exact test and one-way analysis of variance. Further, propensity score matching analysis was performed to reduce selection biases associated with retrospective data between discontinuing and continuing groups. Results BRONJ developed in 7 (2.1%) of 341 patients. Univariate analysis showed that BRONJ developed significantly more often in patients receiving second-generation agents. Discontinuation of BPs was not associated with a reduced risk of BRONJ. After propensity score matching, no factors including discontinuing BPs were correlated with development of BRONJ. Conclusion The results of this study do not support discontinuation of oral BPs before tooth extraction to prevent BRONJ. [ABSTRACT FROM AUTHOR]

Despite the high mortality rate, there is no therapy to improve survival in heart failure with preserved ejection fraction (HFpEF). Large randomized controlled trials (RCTs) did not show clear mortality benefit of renin-angiotensin system (RAS) inhibitors (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) in HFpEF. However, because of the strict enrollment criteria, the patients who participated in these trials might represent a selected group of patients that is poorly representative of patients treated in routine clinical practice. In contrast, clinical characteristics of real-world patients are similar to those of patients enrolled in observational cohort studies (OCSs). Although many OCSs have examined the prognostic effect of RAS inhibitors in HFpEF, the results are inconsistent due to limited power with small sample sizes and/or inadequate adjustment for known prognostic factors. We aimed to conduct a meta-analysis of OCSs with and those without propensity score (PS) analysis and RCTs on the effect of RAS inhibitors on mortality in HFpEF patients. The search of electronic databases identified 4 OCSs with PS analysis (10,164 patients), 8 OCSs without PS analysis (16,393 patients), and 3 RCTs (8001 patients). Use of RAS inhibitors was associated with reduced mortality in the pooled analysis of OCSs with PS analysis (RR [95% CI] = 0.90 [0.81-1.00]) and in that of OCSs without PS analysis (0.81 [0.68-0.96]) but not in that of RCTs (0.99 [0.87-1.12]). In conclusion, the present meta-analysis suggests the potential mortality benefit of RAS inhibitors in HFpEF, emphasizing the importance of conducting new well-designed RCTs. [ABSTRACT FROM AUTHOR]

Background: This study used a propensity score analysis to assess the roles of core-needle biopsy (CNB) and fine-needle aspiration (FNA) in the evaluation of thyroid incidentalomas detected on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). Methods: The study population was obtained from a historical cohort who underwent 18F-FDG PET/CT between October 2008 and September 2015. Patients were included who underwent ultrasound-guided CNB or FNA for incidental focal uptake of 18F-FDG in the thyroid gland on PET/CT. The primary study outcomes included the inconclusive result rates in the CNB and FNA groups. The secondary outcome measures included the non-diagnostic result rate and the diagnostic performance for neoplasms. Multivariate analysis, propensity score matching, and inverse probability weighting were conducted. Results: A total of 1360 nodules from 1338 patients were included in this study: 859 nodules from 850 patients underwent FNA, and 501 nodules from 488 patients underwent CNB. Compared to FNA, CNB demonstrated a significantly lower inconclusive result rate in the pooled cohort (23.8% vs. 35.4%; p < 0.001), propensity score-matched cohorts (22.9% vs. 36.6%; p < 0.001), and with inverse probability weighting (22.4% vs. 35.2%; p < 0.001). Non-diagnostic result rates were also significantly lower in CNB than in FNA. The diagnostic performance of the two groups in the pooled and matched cohorts was similar, with no significant differences found. Conclusions: The significantly lower inconclusive result rates in CNB than in FNA were consistent within the propensity score-matched cohorts. Therefore, CNB appears to be a promising diagnostic tool for patients with thyroid incidentalomas detected on 18F-FDG PET/CT. [ABSTRACT FROM AUTHOR]

Background: The growing interest in principal effectiveness as a means of improving teaching and student learning has led to a focus on the quality of principal preparation programs (PPPs) with calls for the adoption of PPP accountability systems similar to those of teacher preparation programs. Objective: The purpose of the present study is to examine the impact of the National Institute for School Leadership's Executive Development Program (NISL-EDP) on student achievement in a large school district in the Midwestern United States. Method: The sample included elementary and middle school students whose principals participated in the NISL-EDP compared with students in schools with non-EDP trained principals. Using propensity score matching, findings are reported from the analysis of standardized student achievement scores on the state test, the Wisconsin Knowledge and Concepts Examination. Results: Overall, in terms of state reading and mathematics achievement tests, the control students scored higher in Spring 2014 relative to their NISL counterparts. Conclusions: With respect to researchers and policymakers, the approach used to evaluating PPP effectiveness and principal effectiveness is informative and could be used as part of larger accountability systems. Student test scores do not, however, fully capture principal effectiveness and alone should not be used in making high-stakes decisions pertaining to programs or individuals. [ABSTRACT FROM AUTHOR]

Background. Steroid-avoidance protocols have gained popularity in pediatric kidney transplant recipients at low immunologic risk. The long-term safety of steroid avoidance in children with immunologic risk factors remains unknown. Methods. Pediatric kidney transplant recipients from 2004 to 2014 in the Organ Procurement and Transplantation Network database who received tacrolimus and mycophenolate immunosuppression were investigated. Propensity score matching was used to compare graft survival in 1624 children who received steroid avoidance with 1624 children who received steroidbased immunosuppression. The effect of steroid avoidance on graft failure among immunologic risk strata was estimated using Cox proportional hazards regression in this propensity scorematched cohort. Results. It was observed that 5-year graft survival was mildly improved in children receiving steroid avoidance (84.8% versus 81.2%, P=0.03). This improvement in graft survival occurred in the first 2 years following transplant, when the hazard ratio (HR) for allograft failure in children receiving steroid avoidance was 0.62 [95% confidence interval (CI) 0.45-0.86]. In contrast, steroid avoidance was not associated with improved allograft survival during Years 2-10 following transplant (HR=0.93; 95% CI 0.75-1.15). During this time period, HRs (95% CIs) for allograft failure within immunologic risk strata were not significantly different from the null value of 1: repeat kidney transplants, 1.84 (0.84-4.05); African-Americans, 1.02 (0.67-1.56); sensitized recipients, 1.24 (0.63-2.43); recipients of deceased donor kidneys, 1.02 (0.79-1.32); recipients of completely human leukocyte antigen-mismatched kidneys, 0.80 (0.47- 1.37); and recipients with pretransplant glomerular disease, 0.94 (0.71-1.23). Conclusions. In pediatric kidney transplant recipients receiving tacrolimus- and mycophenolate-based immunosuppression, steroid avoidance can be safely practiced in children with immunologic risk factors. [ABSTRACT FROM AUTHOR]

Objectives Diabetic patients who undergo lower limb arterial bypass surgery are considered to have a worse clinical outcome compared to non-diabetics. The aim of the study was to test this hypothesis after applying propensity score matching analysis. Patients and methods A total of 113 consecutive lower limb bypass procedures (55 diabetic and 58 non-diabetic) were evaluated regarding their clinical outcome. Endpoints of the study included amputation-free survival, limb salvage, patency and patients' survival up to 36 months post-procedure. After propensity score matching analysis, two new groups, diabetic and non-diabetic, of 31 limbs in each one were created, both equivalent regarding all baseline characteristics. Results Between the propensity score matching groups, the amputation-free survival was 68.8% in the non-diabetic and 37.7% in the diabetic group at 36 months ( p = 0.004). Similarly, the survival was 88.6% and 57.6%, respectively, in the two groups at the same time point ( p = 0.01). On the contrary, no difference was found in patency (58.3% vs. 56%) and in limb salvage rate (74.1% vs. 60.8%). Conclusions Lower limbs arterial bypass surgery has similar results regarding patency and limb salvage rate in diabetic and non-diabetic patients. On the contrary, mortality is worse in diabetic patients, this affecting negatively their amputation-free survival. [ABSTRACT FROM AUTHOR]

The PARTNER group recently published a comparison between the latest generation SAPIEN 3 transcatheter aortic valve implantation (TAVI) system (Edwards Lifesciences, Irvine, CA, USA) and surgical aortic valve replacement (SAVR) in intermediate-risk patients, apparently demonstrating superiority of the TAVI and suggesting that TAVI might be the preferred treatment method in this risk class of patients. Nonetheless, assessment of the non-randomized methodology used in this comparison reveals challenges that should be addressed in order to elucidate the validity of the results. The study by Thourani and colleagues showed several major methodological concerns: suboptimal methods in propensity score analysis with evident misspecification of the propensity scores (PS; no adjustment for the most significantly different covariates: left ventricular ejection fraction, moderate-severe mitral regurgitation and associated procedures); use of PS quintiles rather than matching; inference on not-adjusted Kaplan-Meier curves, although the authors correctly claimed for the need of balancing score adjusting for confounding factors in order to have unbiased estimates of the treatment effect; evidence of poor fit; lack of data on valve-related death. These methodological flaws invalidate direct comparison between treatments and cannot support authors' conclusions that TAVI with SAPIEN 3 in intermediate-risk patients is superior to surgery and might be the preferred treatment alternative to surgery. [ABSTRACT FROM AUTHOR]

Uric acid (UA) remains a possible risk factor of chronic kidney disease (CKD) but its potential role should be elucidated given a fact that multidisciplinary treatments assure a sole strategy to inhibit the progression to end-stage renal disease (ESRD). In clinical setting, most observational studies showed that elevation of serum uric acid (SUA) independently predicts the incidence and the development of CKD. The meta-analysis showed that SUA-lowering therapy with allopurinol may retard the progression of CKD but did not reach conclusive results due to small-sized studies. Larger scale, randomized placebo-controlled trials to assess SUA-lowering therapy are needed. Our recent analysis by propensity score methods has shown that the threshold of SUA should be less than 6.5 mg/dL to abrogate ESRD. In animal models an increase in SUA by the administration of oxonic acid, uricase inhibitor, or nephrectomy can induce glomerular hypertension, arteriolosclerosis including afferent arteriolopathy and tubulointerstitial fibrosis. The ever-growing discoveries of urate transporters prompt us to learn UA metabolism in the kidney and intestine. One example is that the intestinal ABCG2 may play a compensatory role at face of decreased renal clearance of UA in nephrectomized rats, the trigger of which is not a uremic toxin but SUA itself. This review will summarize the recent knowledge on the relationship between SUA and the kidney and try to draw a conclusion when and how to treat asymptomatic hyperuricemia accompanied by CKD. Finally we will address a future perspective on UA study including a Mendelian randomization approach. [ABSTRACT FROM AUTHOR]

Background Whether the waiting time for radical radiotherapy (WRT) detrimentally impacts nasopharyngeal carcinoma (NPC) prognosis is unclear. We estimated the influence of WRT on overall survival (OS) and disease-specific survival (DSS) of NPC. Patients and methods Patients were identified from prospectively maintained database. WRT was calculated from histological diagnosis to initiation of radiotherapy (RT). Survival analysis was estimated using Weibull parametric model and propensity score analysis (PSA). Recursive partitioning analysis (RPA) identified optimal WRT threshold via conditional inference trees to estimate the greatest survival differences based on randomly selected training and validation sets, and this process was repeated 1000 times to ensure threshold robustness. Sensitivity analysis estimated effects of potential unmeasured confounders. Results A total of 9896 patients were included. In multivariate analysis, WRT of 31–60°d, of 61–90°d and of greater than 90°d independently increased mortality risk compared to less than 30°d. Upon RPA, ranges of 30–35°d with the peak of 30°d were confirmed with 89% of simulations validating optimal thresholds. In threshold-based groups, adjusted hazard ratios (HRs) for WRT of greater than 30°d by both Weibull model and PSA were significantly higher than for WRT of less than 30°d [OS: HR = 1.13, 95% confidence interval (CI) 1.04–1.23, P = 0.003; DSS: HR = 1.15, 95% CI 1.05–1.26, P = 0.002]. Sensitivity analysis revealed robustness of results. Conclusions WRT independently affects survival. Increasing WRT beyond 30°d was most consistently detrimental to survival. WRT of NPC should be as short as reasonably achievable (ASARA). [ABSTRACT FROM AUTHOR]

Background Many children in contact with child welfare agencies do not receive needed health services. These agencies have used participatory decision making (PDM) practices as a way to increase families' use of recommended services. However, we lack evidence of whether caregiver participation in PDM increases children's use of health services. This study uses a national sample of children involved with child welfare to compare their health service use between those children serve through a PDM practice and those who did not experience it. Methods Cross-sectional analyses using the 2009-2010 National Survey of Child and Adolescent Well-Being. Propensity score analysis accounted for observed selection bias. PDM practice was measured as whether the caregiver was included in decision-making during service planning meetings. Health service use was measured as child's receipt of any primary or mental health care services in the past year. Primary health care need was measured using standardized measures and caseworker report. The sample was comprised of children ages 2-17 with primary or mental health needs in contact with a child welfare agency. Results In the unmatched sample of 1,358 children, 14% were served through a PDM service practice, and 12% had a primary health care and 37% a mental health need. Families served through PDM were also reported by caseworkers as more cooperative during the child welfare investigation, and with fewer reports of domestic violence and agency re-referrals ( P < 0.05). Analyses using matched samples showed that for primary health care, 59% of PDM children received services compared with 40% for non-PDM children ( P = 0.004). Group differences were not significant for mental health services. Conclusions Lower-risk families were more likely to be served through PDM which was positively associated with child use of primary health services. Inclusion of caregivers in decision making may not be sufficient to overcome barriers to children's mental health service use. [ABSTRACT FROM AUTHOR]

Background: The impact of unilateral and bilateral nerve-sparing robot-assisted laparoscopic radical prostatectomy (NS-RARP) procedures on continence and the time to continence recovery have not been established., Material and Methods: We retrospectively reviewed a total of 2801 patients who underwent RARP in 9 institutions. Procedures were classified as NS or non-NS; NS procedures were further classified as unilateral or bilateral. The recovery of continence was analysed using propensity score matching method., Results: The pad-free rates at 12 months after surgery were higher in the NS group (95% confidence interval of odds ratio, 1.06-1.51). Pad-free rates at all time points within 12 months of surgery did not significantly differ between the unilateral and bilateral NS groups., Conclusions: NS-RARP resulted in better urinary continence outcomes than non-NS-RARP in the first 12 months after surgery. Urinary recovery rates did not significantly differ between unilateral and bilateral NS-RARP., (© 2023 John Wiley & Sons Ltd.)

Objective: The aim of this study was to compare the long term efficacy of lower limb bypass with that of endovascular treatment (EVT) in patients with chronic limb threatening ischaemia (CLTI)., Methods: This retrospective, multicentre study evaluated the outcomes of patients with CLTI who underwent first time infra-inguinal bypass or EVT. The primary outcome was to compare amputation free survival (AFS) rates between the two propensity score matched groups. The secondary outcome was to compare wound healing within the first six months. Major adverse events were compared according to the type of revascularisation., Results: Overall, 793 patients fulfilled the eligibility criteria, from whom 236 propensity score matched pairs were analysed. The mean follow up was 52 months. The 236 bypass procedures included 190 autogenous bypass grafts (80.5%), 151 (64.0%) of which were infrapopliteal. Among the 236 EVT procedures, the target lesion was the femoropopliteal segment in 81 patients (34.3%), the femoropopliteal and infrapopliteal segments in 101 patients (42.8%), and the infrapopliteal segment in 54 patients (22.9%). AFS was significantly better in the bypass group at five years (60.5 ± 3.6%) compared with the EVT group (35.3 ± 3.6%) (p < .001). Major amputation occurred in 61 patients (25.8%) in the bypass group and 85 patients (36.0%) in the EVT group (HR 0.66, 95% CI 0.47 - 0.92; p = .014). The probability of healing was significantly better in the bypass group at six months compared with the EVT group (p = .003). The median length of stay was shorter for the EVT group (4 days) than for the bypass group (8 days) (p = .001). Urgent re-intervention and re-admission rates were high and did not differ significantly between the groups., Conclusion: This study has shown that lower limb bypass surgery offered a significantly higher probability of AFS and wound healing compared with EVT in patients with CLTI., (Copyright © 2023 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Purpose: We have previously demonstrated that prolonged use of glaucoma medications was associated with a poor surgical outcome of ab interno trabeculotomy (µTLO). Given that almost all types of glaucoma eye drop either enhance the drainage through the uveoscleral pathway or reduce aqueous humor production, we hypothesized that prolonged use of these medications might cause disuse atrophy of the conventional pathway. In contrast, ripasudil increases the conventional outflow and eventually shows a favorable outcome of µTLO. This study aimed to evaluate the effect of ripasudil use on µTLO outcomes., Method: The medical charts of 218 patients who underwent µTLO were analyzed retrospectively. We compared the 1-year outcome between ripasudil users versus nonusers by using propensity score matching. We set the covariates as age, sex, glaucoma types, preoperative intraocular pressure (IOP), the mean deviation values of visual field tests, the presence or absence of concomitant cataract surgery, trabecular meshwork incision range, the presence or absence of any glaucoma medication except ripasudil and duration of glaucoma medical therapy. Success was defined as a postoperative IOP between 5 and 21 mmHg, a ≥ 20% IOP reduction from baseline, and no additional glaucoma surgery at postoperative 1 year., Result: Fifty-seven patients each were allocated to the ripasudil users or nonusers. The 1-year success rates were 74% in ripasudil users and 51% in nonusers (p = 0.01). Kaplan‒Meier survival curves also showed that the ripasudil users had a higher survival distribution (p = 0.01)., Conclusion: The patients who took ripasudil showed a favorable 1-year outcome of µTLO., (© 2023. The Author(s).)

Background: Whether combination therapy has higher hemostatic efficacy than epinephrine injection monotherapy in different Forrest classifications is not clear. This study aimed to compare hemostatic efficacy between epinephrine injection monotherapy (MT) and combination therapy (CT) based on different Forrest classifications., Methods: We retrospectively analyzed peptic ulcer bleeding (PUB) patients who underwent endoscopic epinephrine injections or epinephrine injections combined with a second therapy between March 2014 and June 2022 in our center, and the patients were divided into MT group or CT group. Subsequently, a propensity score matching analysis (PSM) was performed and rebleeding rates were calculated according to Forrest classifications via a stratified analysis., Results: Overall, 605 patients who met the inclusion criteria were included, and after PSM, 173 patients in each of the CT and MT groups were included. For PUB patients with nonbleeding visible vessels (FIIa), the rebleeding rates by Days 3, 7, 14, and 30 after PSM were 8.8%, 17.5%, 19.3%, and 19.3% in the MT group, respectively, and rates were 0%, 4.1%, 5.5%, and 5.5% in the CT group, respectively, with significant differences observed between the two groups by Days 3, 7, 14, and 30 (P = 0.015, P = 0.011, P = 0.014, and P = 0.014, respectively). However, for PUB patients with oozing bleeding (FIb), the rebleeding rates by Days 3, 7, 14, and 30 after PSM were 14.9%, 16.2%, 17.6%, and 17.6% in the MT group, respectively, and rates were 13.2%, 14.7%, 14.7%, and 16.2% in the CT group, respectively, with no significant differences observed between the two groups by Days 3, 7, 14, and 30 (P = 0.78, P = 0.804, P = 0.644 and P = 0.825)., Conclusion: Combined therapy has higher hemostatic efficacy than epinephrine injection monotherapy for PUB patients with visible blood vessel (FIIa) ulcers. However, epinephrine injection monotherapy is equally as effective as combined therapy for PUB patients with oozing blood (FIb) ulcers., (© 2023. The Author(s).)

A randomized controlled trial of blinatumomab for the treatment of patients with Philadelphia chromosome–positive B‐cell acute lymphoblastic leukemia is unlikely. In this issue of Cancer, Rambaldi et al perform a propensity score analysis to provide a comparison with historical standards of care. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the change of consumer behavior in electric power consumption after the application of dynamic pricing via real-time feedback. Afield experiment of dynamic pricing was carried out on Nushima Island, which is located in Hyogo Prefecture in central Japan. The panel data of hourly electric power consumption among 50 households (including 22 control households and 28 treated households) were collected from a baseline survey (14 days before the dynamic pricing experiment was conducted) and during the 14-day experimental period. Propensity score analysis with local linear matching was employed to analyze the average treatment effects of dynamic pricing on consumer behavior. The results report that dynamic pricing plays a crucial role in reducing consumers’ electric power consumption—by 9.6% compared to the pre-experimental period.

Objective: To assess the association between episiotomy and severe obstetric anal sphincter injury (OASIS) in nulliparous women at term according to the use of an instrument for delivery with control confounding by indication., Methods: This was an observational retrospective cohort study including 12 346 women from 2004 to 2020. All nulliparous women with a cephalic singleton pregnancy were included. The primary outcome was the occurrence of OASIS. Association between episiotomy and OASIS was assessed by multivariate logistic regression with adjustment for confounding factors and stratification on the use of an instrument at delivery. Propensity score matching was used to account for indication bias., Results: Among 12 346 women included, 7803 (63.2%) had an episiotomy and 4543 (36.8%) did not have an episiotomy; the rate of OASIS was similar in both groups (0.7%). After stratification on use of instrument, an association between episiotomy and OASIS was shown in the case of instrumental delivery (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.26-0.80) but not if the delivery was spontaneous (OR 0.76, 95% CI 0.29-1.98). The result was similar after matching on propensity score (in the case of operative vaginal delivery: OR 0.20, 95% CI 0.10-0.75)., Conclusion: Episiotomy seems to be a protective factor for OASIS in nulliparous woman at term only in the case of operative vaginal delivery., (© 2023 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is one of the most commonly found nosocomial infections in critically ill patients. However, the appropriate treatment period for a specific group of critically ill patients with CRAB infection is currently being debated. Therefore, our study aimed to evaluate the optimal courses of therapy for critically ill patients with CRAB infection by comparing the outcomes of colistin therapy of short duration (<14 days) versus long duration (≥ 14 days)., Methods: A retrospective cohort study was conducted at Nakornping Hospital on critically ill patients with CRAB infection who received either a short or long course of colistin treatment between 2015 and 2022. The primary outcome was the 30-day mortality rate while secondary outcomes were clinical response, microbiological response, and nephrotoxicity. Propensity score matching with a 1: 1 ratio was performed to reduce potential biases. Furthermore, a logistic regression model was used to estimate the odds ratio (OR)., Results: A total of 374 patients met the inclusion criteria. Two hundred and forty-eight patients were recruited after utilizing propensity scores to match patients at a 1: 1 ratio. The results from the propensity score matching analysis demonstrated that the long-course therapy group had a lower 30-day mortality rate compared to the short-course therapy group (adjusted OR (aOR) = 0.46, 95% CI: 0.26-0.83, p = 0.009). The clinical response and microbiological response rates were higher in patients who received the long course of colistin therapy compared to those receiving the short course (aOR = 3.24, 95% CI: 1.78-5.92, p = 0.001; aOR = 3.01, 95% CI: 1.63-5.57, p = 0.001). There was no significant different in the occurrence of nephrotoxicity (aOR = 1.28, 95% CI: 0.74-2.22, p = 0.368) between the two treatment groups., Conclusion: A long course of colistin therapy resulted in a lower 30-day mortality rate in critically ill patients, and better clinical and microbiological outcomes, but similar nephrotoxicity as compared to a short course of colistin therapy. Therefore, a specific subset of critically ill patients who had CRAB infection needed to be considered for a long course of therapy., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Preventing postpartum depression (PPD) is the most common self-reported motivation for human maternal placentophagy, yet very little systematic research has assessed mental health following placenta consumption. Our aim was to compare PPD screening scores of placenta consumers and non-consumers in a community birth setting, using propensity score matching to address anticipated extensive confounding., Methods: We used a medical records-based data set (n = 6038) containing pregnancy, birth, and postpartum information for US women who planned and completed community births. We first compared PPD screening scores as measured by the Edinburgh Postpartum Depression Scale (EPDS) of individuals who consumed their placenta to those who did not, with regard to demographics, pregnancy characteristics, and history of mental health challenges. Matching placentophagic (n = 1876) and non-placentophagic (n = 1876) groups were then created using propensity scores. The propensity score model included more than 90 variables describing medical and obstetric history, demographics, pregnancy characteristics, and intrapartum and postpartum complications, thus addressing confounding by all of these variables. We then used logistic regression to compare placentophagic to non-placentophagic groups based on commonly-cited EPDS cutoff values (≥ 11; ≥ 13) for likely PPD., Results: In the unmatched and unadjusted analysis, placentophagy was associated with an increased risk of PPD. In the matched sample, 9.9% of women who ate their placentas reported EPDS ≥ 11, compared to 8.4% of women who did not (5.5% and 4.8%, respectively, EPDS ≥ 13 or greater). After controlling for over 90 variables (including prior mental health challenges) in the matched and adjusted analysis, placentophagy was associated with an increased risk of PPD between 15 and 20%, depending on the published EPDS cutoff point used. Numerous sensitivity analyses did not alter this general finding., Conclusions: Placentophagic individuals in our study scored higher on an EPDS screening than carefully matched non-placentophagic controls. Why placentophagic women score higher on the EPDS remains unclear, but we suspect reverse causality plays an important role. Future research could assess psychosocial factors that may motivate some individuals to engage in placentophagy, and that may also indicate greater risk of PPD., (© 2023. The Author(s).)

The augmented randomized controlled trial (RCT) with hybrid control arm includes a randomized treatment group (RT), a smaller randomized control group (RC), and a large synthetic control (SC) group from real-world data. This kind of trial is useful when there is logistics and ethics hurdle to conduct a fully powered RCT with equal allocation, or when it is necessary to increase the power of the RCT by incorporating real-world data. A difficulty in the analysis of augmented RCT is that the SC and RC may be systematically different in the distribution of observed and unmeasured confounding factors, causing bias when the two control groups are analyzed together as hybrid controls. We propose to use propensity score (PS) analysis to balance the observed confounders between SC and RC. The possible bias caused by unmeasured confounders can be estimated and tested by analyzing propensity score adjusted outcomes from SC and RC. We also propose a partial bias correction (PBC) procedure to reduce bias from unmeasured confounding. Extensive simulation studies show that the proposed PS + PBC procedures can improve the efficiency and statistical power by effectively incorporating the SC into the RCT data analysis, while still control the estimation bias and Type I error inflation that might arise from unmeasured confounding. We illustrate the proposed statistical procedures with data from an augmented RCT in oncology., (© 2023 John Wiley & Sons Ltd.)

Background Nearly half of patients with heart failure (HF) have preserved ejection fraction (EF) and the mortality of patients with HF with preserved EF (HFpEF) is high. However, there is no therapy to improve survival in HFpEF. Although observational cohort studies (OCSs) have examined the survival benefit of beta-blockers in HFpEF, the results are inconsistent due to limited power with small sample sizes and/or lack of adjustment for known confounders. Furthermore, recent randomized controlled trial (RCT)s failed to show the mortality benefit of beta-blockers in HFpEF. However, these RCTs were not adequately powered and thus the definite conclusion cannot be drawn. Methods and results We aimed to conduct a meta-analysis of the effect of beta-blockers on mortality in HFpEF. The search of electronic databases identified 5 OCSs with propensity score (PS) analysis (12,315 patients), 6 OCSs without PS analysis (15,275 patients), and 3 RCTs (1046 patients). Beta-blocker use was associated with improved survival in the pooled analysis of OCSs with PS analysis (RR [95% CI] = 0.79 [0.66–0.95]) and in that of OCSs without PS analysis (0.70 [0.52–0.94]). In the pooled analysis of RCTs, beta-blocker use was associated with non-significant reduced risk for mortality (RR [95% CI] = 0.80 [0.61–1.05]). Overall, use of beta-blockers reduced the risk of mortality by 21% (RR [95% CI] = 0.79 [0.71–0.88]). Conclusion Our meta-analysis suggests the potential mortality benefit of beta-blockers in HFpEF. Well-designed and powered RCTs should be planned to confirm our observed potential survival benefit of beta-blockers in HFpEF. [ABSTRACT FROM AUTHOR]

Compared to first marriages, remarriages have consistently demonstrated higher rates of divorce. Theories used to explain this phenomenon include the family process and selection perspectives. Researchers have attempted to address selection bias in this area but have not yet employed propensity score analysis to bolster causal inference. The purpose of this study is to assess the efficacy of covariate control methods for handling selection bias compared to propensity score methods and to examine whether a direct causal link between marriage order and relationship stability can be inferred after using propensity score greedy matching and propensity score weighting procedures. We analyze a sample of 1,679 first married and 410 remarried individuals drawn from the Relationship Evaluation Survey. Results provide support for the selection perspective and suggest that a direct causal link between marriage order and relationship stability should not be inferred. Implications, limitations, and future directions for research are discussed. [ABSTRACT FROM AUTHOR]

The objectives of this study are to: (1) define the concept of perceived post purchase (3P) luxury risk and (2) develop and validate a psychometrically sound 3P Luxury Risk Scale. A qualitative study and two field studies were conducted to develop and test the scale, and to examine the predictive validity of 3P luxury risk in a nomological network of word-of-mouth (WOM). The survey data is gathered from 333 actual customers of five golf clubs. Integrating structural equation modeling with propensity score analysis, the results of Study 1 reveal that 12 items adequately capture the dimensions of 3P luxury risk. After controlling for framing effects, the results of Study 2 indicate that all of the dimensions of 3P luxury risk negatively influence WOM. This article attempts to shed a new light on the realm of luxury risk studies incorporating normative and behavioral decision-making approaches. [ABSTRACT FROM AUTHOR]

Violence prevention programs are commonplace in today’s schools, though reviews of the literature reveal mixed empirical findings on their effectiveness. Often, these programs include a variety of components such as social skills training, student mentoring, and activities designed to build a sense of school community that have not been tested for individual effectiveness. To fill this gap, we wanted to determine the relationships between specific violence prevention program components and aggression and violence outcomes. Using the U.S. Department of Education’s School Survey on Crime and Safety, we estimated the effects of components of violence prevention programs through analyses with proportional odds logistic regression and Poisson regression models. We found significant relationships between three violence prevention program components (individual attention, mentoring, tutoring, and/or coaching; recreational, enrichment, or leisure activities; and involving students in resolving student conduct problems) and aggression and violence outcomes. [ABSTRACT FROM PUBLISHER]

Students who participate in extracurricular activities in middle school exhibit higher levels of academic motivation and achievement, including graduation from high school. However, the mechanisms responsible for these beneficial effects are poorly understood. Guided by the bioecological models of development, this study tested the indirect effects of participation in grade 8 in school sports or performance arts and clubs on grade 9 academic achievement, academic competence beliefs, and school belonging, via adolescents' perceptions of their friends' prosocial norms. Participants were 495 (45 % female) ethnically diverse students (mean age at grade 8 = 13.9 years; SD = .58) who were recruited into a longitudinal study on the basis of below average literacy in grade 1. Using weighted propensity score analyses to control for potential confounders, results of longitudinal SEM found indirect effect of participation in sports, but not of participation in performance arts and clubs, on grade 9 outcomes noted above. Implications of findings for improving educational attainment of at-risk youth are discussed. [ABSTRACT FROM AUTHOR]

The financial difficulty of dementia caregivers and its effects on mental health has gained increasing attention from researchers. The present study examines the longitudinal relationship between financial difficulty and the depressive symptoms of dementia caregivers using matching methods to account for potential selection bias. Propensity score matching methods and mixed-effects models were used to determine the effects of financial difficulty on depressive symptoms among caregivers participating in the Resources for Enhancing Alzheimer's Caregiver Health (REACH) intervention program. Propensity score matching confirmed that caregivers experiencing financial difficulty were more likely to have depressive symptoms. The results suggest that dementia caregivers require support for their financial difficulty. Future research should fully examine the complex relationship between financial difficulty and the mental health of caregivers and how this issue can be addressed through assessment and intervention methods. [ABSTRACT FROM AUTHOR]

Purpose: Our intent was to compare survival following neoadjuvant chemotherapy followed by surgery versus chemoradiotherapy (CRT) among patients with potentially resectable esophageal squamous cell carcinoma. Methods: Information about 406 consecutive esophageal cancer patients with resectable disease who underwent surgery with neoadjuvant chemotherapy consisting of cisplatin plus 5-fluorouracil or who underwent definitive CRT was reviewed. The survival outcomes were analyzed using the Kaplan-Meier method and propensity score-adjusted Cox proportional hazards models. Relevant variables were included in the propensity score model. Results: Overall, 206 patients planned to undergo surgery (S group) and 200 patients planned to undergo CRT (CRT group). In the unadjusted situation, progression-free survival and overall survival did not differ statistically between the groups. After matching, both survival outcomes were better in the S group compared to the CRT group. Subanalysis showed both survival outcomes were better in the S group for patients with only stage III disease. However, survival outcomes for stages I, II, and IV were not significantly different between treatment groups. Conclusions: Among patients with resectable disease, survival outcomes in the S group were favored over those of the CRT group. These results indicate that different therapeutic strategies should be used for stage III esophageal cancer than for other stages. [ABSTRACT FROM AUTHOR]

We investigated the effect of participating in two domains of extracurricular activities (sports and performance arts/clubs) in Grades 7 and 8 on Grade 9 academic motivation and letter grades, above baseline performance. Participants were 483 students (55% male; 33% Euro-American, 25% African American, and 39% Latino). Propensity score weighting controlled for potential confounders in all analyses. Delayed (Grade 8 only) and continuous participation (Grades 7 and 8) in sports predicted competence beliefs and valuing education; delayed and continuous participation in performance arts/clubs predicted teacher-rated engagement and letter grades. Benefits of participation were similar across gender and ethnicity; however, Latino youth were least likely to participate in extracurricular activities. Implications for reducing ethnic and income disparities in educational attainment are discussed. [ABSTRACT FROM AUTHOR]

Objective: The study had two objectives (a) to adapt for Chinese children an intervention designed to strengthen the social information–processing (SIP) skills of children in the United States, and (b) to pilot test the adapted intervention in China. Methods: Adaptation of the Making Choices program involved reviewing Chinese literature on child development, translating and back-translating a treatment manual, modifying intervention content, and engaging experts to review program materials. Children (n = 91), ages 8–10, in five after-school child care centers in Tianjin, China, received the program. After propensity score adjustments, the skills of children who received the program were compared to the skills of children (n = 123) recruited from neighborhood primary schools. Results: The adapted program appears to have strengthened encoding skills. Patterns for other information-processing skills were promising but mixed. Conclusion: The program has the potential to strengthen the SIP skills of children in China. [ABSTRACT FROM AUTHOR]

Autologous hematopoietic stem cell transplantation (auto-HCT) is considered a standard therapy for transplant-eligible patients with multiple myeloma, while allogeneic HCT (allo-HCT) is controversial. We retrospectively analyzed 765 patients with myeloma who underwent tandem transplantation between 1998 and 2012 using Japanese registry data. We evaluated the clinical outcomes of tandem auto-HCT (n = 676) and auto/allo-HCT (n = 89). To adjust for a selection bias, we compared overall survival (OS) between the two groups by a propensity score analysis. The probability of OS at six years was 58.5% for the tandem auto-HCT group and 54.4% for the tandem auto/allo-HCT group (p = 0.47). In a matched-pair analysis based on the propensity score, the difference in survival between the two groups was not statistically significant, although the survival curve appeared to reach a plateau beyond five years in the auto/allo group. Further strategies to reduce treatment-related mortality and enhance a graft-versus-myeloma effect are necessary to improve OS. [ABSTRACT FROM AUTHOR]