Lymph node evaluation as a colon cancer quality measure: A national hospital report card

Cancer Programs, American College of Surgeons, Chicago, IL 60611, USA.
CancerSpectrum Knowledge Environment (Impact Factor: 15.16). 09/2008; 100(18):1310-7. DOI: 10.1093/jnci/djn293
Source: PubMed

ABSTRACT Examination of 12 or more regional lymph nodes for colon cancer is associated with improved staging and survival, and the National Quality Forum recently endorsed lymph node examination for colon cancer as a quality surveillance measure. However, information regarding the extent of hospital compliance with the 12-node measure in the United States is lacking.
From the National Cancer Data Base, 1296 hospitals that performed 156 789 colectomies in 1996-1997 and 2004-2005 were identified, and rates of hospital-level compliance (defined as examination of >or=12 nodes in >or=75% of patients) in these two time periods were compared. Multivariable models were developed to determine if hospital type, volume, or differences in case mix were associated with 12-node measure compliance. All statistical tests were two-sided.
In 1996-1997, 15% of hospitals were compliant with the 12-node measure; in 2004-2005 the percentage of compliant hospitals had increased to 38%. From 1996-1997 to 2004-2005, 12-node measure compliance increased at 980 hospitals, remained unchanged at 6 hospitals, and decreased at 310 hospitals. In 2004-2005, National Cancer Institute-designated Comprehensive Cancer Centers were more frequently compliant with the 12-node measure than other academic hospitals, Veterans' Administration hospitals, or community hospitals (78.1% versus 52.4%, 53.1%, and 33.7%, respectively, all P < .001), even after adjustment for differences in characteristics of the colon cancer patients at these hospitals.
This study provides a national report card of nearly 1300 hospitals showing that more than 60% of institutions failed to achieve a compliance benchmark for the 12-node measure. Considerable improvement is needed in colon cancer nodal evaluation in the United States.

Download full-text


Available from: Mark S Talamonti, Aug 04, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Limitations in controlling chaos in continuous dynamical systems by delayed feedback are proved. The results are as follows: (1) If the linear variational equation about a hyperbolic unstable periodic orbit (UPO) has an odd number of real characteristic multipliers which are greater than unity, the UPO can never be stabilized with any value of feedback gain. (2) If all the characteristic exponents of the variational equation are different from each other and at least one of them is real and positive, then the UPO can never be stabilized with any feedback gain matrix of the form of diag(k, ..., k). These theorems are proved on the basis of Floquet theory. The result of the first theorem is also explained intuitively using bifurcation theory
    Control of Oscillations and Chaos, 1997. Proceedings., 1997 1st International Conference; 09/1997
  • [Show abstract] [Hide abstract]
    ABSTRACT: Oxidation can damage all biological macromolecules, and the survival of a cell therefore depends on its ability to control the level of oxidants. Microbes possess an astonishing variety of antioxidant defences, ranging from small, oxidant-scavenging molecules to self-regulating, homeostatic gene networks. Most often these antioxidant defences are activated by exposure to specific classes of oxidants. Interestingly, the isolation of pleiotropic mutations that impair or exacerbate the expression of subsets of oxidant-responsive genes led to the identification of global regulators. In a few, well-characterized cases, these regulators can transduce oxidative damage into gene regulation. Recently, the application of genomic tools to study the antioxidant responses of E. coli has both confirmed previous observations and provided evidence for a wealth of putative new anti-oxidant functions. Here, we review the remarkable diversity of antioxidant defence mechanisms, with emphasis on signal transduction by global regulator proteins and the corresponding genetic networks that protect the microbial cell against oxidative stress.
    Advances in Microbial Physiology 02/2002; 46:319-41. DOI:10.1016/S0065-2911(02)46007-9 · 5.80 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper presents a new hardware architecture that calculates SAD for variable block-size motion estimation (VBSME). The proposed architecture with a 16×1-PE array, a 4-stage adder tree and two flexible register arrays supports 16×16, 16×8, 8×8, 8×4, 4×8, and 4×4 block's SAD calculation. The architecture can be used in the encoder that supports the enhanced motion estimation with variable block size in the MPEG-4 AVC (advanced video coding) and the emerging H.264 standard. Our design was described in Verilog-HDL and implemented in a Altera FPGA APEX20K with a clock frequency of 120MHz allowing the processing of 29296 16×16 per search area.
    ASIC, 2003. Proceedings. 5th International Conference on; 11/2003
Show more