Christine M Lohse

Mayo Clinic - Rochester, Рочестер, Minnesota, United States

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Publications (365)1690.66 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: : Although experts recognize that including patient functional and social variables would improve models predicting risk of using costly health services, these self-reported variables are not widely used. Explore differences in predisposing characteristics, enabling resources, patient-perceived need for care and professionally evaluated need for care variables between patients receiving primary care within a Health Care Home who did and did not use hospital, emergency department, or skilled nursing facility services in a 3-month period of time. Primary care. Guided by the Behavioral Model of Health Service Use, a secondary analysis was conducted on data from a study that included 57 community-dwelling older adults receiving primary care in a Health Care Home. Because of the exploratory nature of the study, group differences in the use of costly care services were compared at the 0.10 level of statistical significance. Seventeen patients (29.8%) experienced costly care services. The greatest number of differences in variables between groups was in the category of patient-perceived need for care (functional impairments, dependencies, difficulties). Targeting case management services using evidence-based decision support tools such as prediction models enhances the opportunity to maximize outcomes and minimize waste of resources. Patient-perceived and clinician-evaluated need for care may need to be combined to fully describe the contextual needs that drive the use of health services. Difficulty with Activities with Daily Living and Instrumental Activities of Daily Living should be considered in future studies as candidate predictor variables for need for case management services in primary care settings.
    Professional case management 12/2015; 20(1):3-11. DOI:10.1097/NCM.0000000000000060
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    ABSTRACT: Background: The pemphigus group is characterized by the presence of circulating immunoglobulins against desmosomes. IgG/IgA pemphigus is defined by the presence of IgG and IgA cell surface deposits upon direct immunofluorescence (DIF) and/or circulating IgG and IgA autoantibodies upon indirect immunofluorescence. Previous reports of patients with IgG/IgA pemphigus are sparse. Whether IgG/IgA pemphigus is best classified as a subtype of IgG (classic) pemphigus or IgA pemphigus, or as a distinct entity, has yet to be determined. Objectives: We compared the features of patients with IgG/IgA pemphigus to those of IgG pemphigus and IgA pemphigus. Methods: Retrospective clinicopathologic study of patients with IgG, IgG/IgA, and IgA pemphigus evaluated at our clinic (1993-2013). Results: We included 26, 13, and seven patients with IgG, IgG/IgA, and IgA pemphigus, respectively. Patients with IgG/IgA pemphigus did not differ significantly from patients with IgG pemphigus in terms of clinical and microscopic features, DIF findings, anti-desmoglein antibody values, and treatments required. However, patients with IgG/IgA pemphigus were significantly different from patients with IgA pemphigus regarding intertriginous distribution (P = 0.038) and pustular lesions (P < 0.001), acantholysis (P = 0.043), and presence of intercellular C3 deposits on DIF (P < 0.001). Conclusion: Comparative clinicopathologic data imply that IgG/IgA pemphigus may best be regarded as a variant of IgG pemphigus and distinct from IgA pemphigus.
    International journal of dermatology 11/2015; DOI:10.1111/ijd.13025 · 1.31 Impact Factor
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    ABSTRACT: Background: Staphylococcus aureus bacteremia is a life threatening condition that may lead to metastatic infection, including prosthetic joint infection. Methods: To assess clinical factors associated with hematogenous prosthetic joint infection, we retrospectively reviewed all patients with a joint arthroplasty in place at the time of a first episode of S. aureus bacteremia over a five year period at our institution. Patients with post-surgical prosthetic joint infection without hematogenous prosthetic joint infection were excluded. Results: There were 85 patients (143 arthroplasties) with either no prosthetic joint infection (n = 50; 58.8%) or hematogenous prosthetic joint infection in at least one arthroplasty (n = 35; 41.2%). The odds of hematogenous prosthetic joint infection was significantly increased among patients with community-acquired S. aureus bacteremia (OR 18.07; 95% CI 2.64-infinity; p = 0.001) as compared with nosocomial S. aureus bacteremia, in which there were no patients with hematogenous prosthetic joint infection. After adjusting for S. aureus bacteremia classification, the presence of > 3 joint arthroplasties in place was associated with a nearly 9-fold increased odds of hematogenous prosthetic joint infection as compared to those with 1-2 joint arthroplasties in place (OR 8.55; 95% CI 1.44-95.71; p = 0.012). All but one joint with prosthetic joint infection demonstrated at least one clinical feature suggestive of infection. There were 4 additional S. aureus prosthetic joint infection diagnosed during a median of 3.4 years of follow-up post hospitalization for S. aureus bacteremia. Conclusion: Prosthetic joint infection is frequent in patients with existing arthroplasties and concomitant S. aureus bacteremia, particularly with community-acquired S. aureus bacteremia and multiple prostheses. In contrast, occult S. aureus prosthetic joint infection without clinical features suggestive of prosthetic joint infection at the time of S. aureus bacteremia is rare.
    The American journal of medicine 10/2015; DOI:10.1016/j.amjmed.2015.09.006 · 5.00 Impact Factor
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    ABSTRACT: Background: We aimed to evaluate factors associated with prolonged emergency department (ED) length of stay (LOS) among psychiatric patients and to develop a multivariable predictive model to guide future interventions to reduce ED LOS. Methods: Electronic health records of ED patients receiving a psychiatric consultation and providing research authorization were reviewed from September 14, 2010, through September 13, 2013, at an academic hospital with approximately 73000 visits annually. Prolonged LOS was defined as ≥8 hours. Results: We identified 9247 visits among 6335 patients; median LOS was 4.1 hours, with 1424 visits (15%) with prolonged LOS. In the multivariable model, characteristics associated with an increased risk of a prolonged LOS included patient age 12 to 17 years (odds ratio [OR], 2.43; P<.001) or ≥65 years (OR, 1.46; P=.007); male gender (OR, 1.24; P=.002); Medicare insurance coverage (OR, 1.34; P=.008); use of restraints (OR, 2.25; P=.006); diagnoses of cognitive disorder (OR, 4.62; P<.001) or personality disorder (OR, 3.45; P<.001); transfer to an unaffiliated psychiatric hospital (OR, 22.82; P<.001); ED arrival from 11 pm through 6:59 am (OR, 1.53; P<.001) or on a Sunday (OR, 1.76; P<.001); or ED evaluation in February (OR, 1.59; P=.006), April (OR, 1.66; P=.002), and May (OR, 1.54; P=.007). Conclusions: Many psychiatric patients had a prolonged ED LOS. Understanding the multiple, patient-specific, ED operational, and seasonal factors that predict an increased LOS will help guide allocation of resources to improve overall ED processes and patient care.
    The American journal of emergency medicine 10/2015; DOI:10.1016/j.ajem.2015.09.044 · 1.27 Impact Factor
  • J. Walston · S.D. Bellew · M.F. Bellolio · D. Cabrera · C.M. Lohse ·

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    ABSTRACT: To evaluate the association between severe skeletal muscle deficiency or sarcopenia and disease progression, cancer-specific (CSM), and all-cause mortality (ACM) among patients with localized renal cell carcinoma (RCC) treated with radical nephrectomy (RN). Baseline lumbar skeletal muscle index (SMI) of 387 patients treated with RN for nonmetastatic RCC between 2000 and 2010 was measured on preoperative computed tomography. Sarcopenia was classified according to sex-specific consensus definitions: Male: SMI <55 cm(2)/m(2), Female: SMI <39 cm(2)/m(2). Progression free (PFS), Cancer-specific (CSS) and overall survival (OS) were estimated with the Kaplan Meier method. Associations with progression, CSM, and ACM were summarized with hazard ratios (HRs). In total, 180/387 (47%) patients were sarcopenic. Sarcopenic patients were older, more likely to be male (77% vs. 56%, p<0.001), have a smoking history (67% vs. 55%, p=0.02), and have nuclear grade ≥3 (67% vs. 60%, p=0.05), but were otherwise similar to nonsarcopenic patients. Median postoperative follow-up was 7.2 years. Sarcopenic patients had inferior 5-year CSS (79% vs. 85%, p=0.05) compared to non-sarcopenic patients as well as significantly worse 5-year OS (65% vs. 74%, p= 0.005). As a continuous variable, increasing SMI was linearly associated with a decreased risk of CSM and ACM. Moreover, on multivariable analysis, sarcopenia was associated with increased CSM (HR 1.70, p=0.047) and ACM (HR 1.48, p=0.039). Sarcopenia is independently associated with CSM and ACM following RN for RCC. These findings underscore the importance of assessing SMI for risk stratification, patient counseling, and treatment planning. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
    The Journal of urology 08/2015; DOI:10.1016/j.juro.2015.08.072 · 4.47 Impact Factor
  • Sara J Aberle · Christine M Lohse · Matthew D Sztajnkrycer ·
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    ABSTRACT: Law enforcement tactical incidents involve high-risk operations that exceed the capabilities of regular, uniformed police. Despite the existence of tactical teams for 50 years, little is known about the frequency or nature of emergency medical services (EMS) response to tactical events in the United States. The purpose of this study was to perform a descriptive analysis of tactical events reported to a national EMS database. Descriptive analysis of the 2012 National Emergency Medical Services Information System (NEMSIS) Public Release research data set, containing EMS emergency response data from 41 states. A total of 17,479,328 EMS events were reported, of which 3,953 events were coded as "Activation-Tactical or SWAT Specialty Service/Response Team." The most common level of prehospital care present on scene was basic life support (55.2%). The majority (72.3%) of tactical incident activations involved a single patient; mass casualty incidents occurred in 0.5% of events. The most common EMS response locations were homes (48.4%), streets or highways (37.0%), and public buildings (6.3%). The mean age of treated patients was 44.1 years ± 22.0 years; 3.5% of tactical incident activation patients were aged 8 years or less. Injuries were coded as firearm assault in 14.8% and as chemical exposure in 8.9% of events. Cardiac arrest occurred in 5.1% of patients, with the majority (92.2%) occurring prior to EMS arrival. The primary symptoms reported by EMS personnel were pain (37.4%), change in responsiveness (13.1%), and bleeding (8.1%). Advanced airway procedures occurred in 30 patients. No patients were documented as receiving tourniquets or needle thoracostomy. Approximately 11 EMS responses in support of law enforcement tactical operations occur daily in the United States. The majority occur in homes and involve a single patient. Advanced airway procedures are required in a minority of patients. Cardiac arrest is rare and occurs prior to EMS response in the majority of cases. Better understanding of the nature and location of EMS responses to tactical incidents is required to develop consistent EMS policies in support of law enforcement tactical operations. 2015.
    Journal of special operations medicine : a peer reviewed journal for SOF medical professionals 07/2015; 15(2):117-122.
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    ABSTRACT: The Ki-67 index is essential in the pathological reports for pancreatic neuroendocrine tumors. There are three methods to determine the Ki-67 index including eyeball estimation, manual counting, or automated digital imaging analysis. The goal of this study was to compare the three quantification methods with the clinical outcome to determine the best method for clinical practice. Ki-67 immunostaining was performed on 97 resected pancreatic neuroendocrine tumors. The three methods of quantification were employed: (1) an average of eyeball estimation by three pathologists; (2) manual counting of at least 500 tumor cells; and (3) digital imaging analysis quantitation by selecting 8-10 hot spot regions. All tumors were graded according to the 2010 WHO grading system. The three quantification methods for the Ki-67 index had almost perfect agreement. The concordance between manual counting and digital imaging analysis and between manual counting and average eyeball estimation were 0.97 and 0.88, respectively. The concordance among the three pathologists' eyeball estimation was 0.86. All three methods correlated with patients' survival using the 2010 WHO grading system. Eyeball estimation scores were significantly less than those of the other two methods and tended to downgrade more tumors to grade 1, but they had higher predictive ability for survival and recurrence. The WHO system using the mitotic rate could also separate patients with different survival and even downgraded more tumors to grade 1. The results suggest the necessity of a consensus among pathologists for the method to determine the Ki-67 index and proper cutoff of the Ki-67 index for better clinical correlation.
    Endocrine Pathology 06/2015; 26(3). DOI:10.1007/s12022-015-9379-2 · 1.76 Impact Factor

  • European Urology 06/2015; 68(4). DOI:10.1016/j.eururo.2015.05.033 · 13.94 Impact Factor
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    ABSTRACT: Several studies have demonstrated small but statistically significant differences in quality-of-life (QOL) scores among vestibular schwannoma (VS) treatment modalities. However, does a several-point difference on a 100-point scale really matter? The minimal clinically important difference (MCID)-defined as the smallest difference in scores that patients perceive as important and that could lead to a change in management-was developed to answer this important question. While the MCID has been determined for QOL measures used in other diseases, it remains undefined in the VS literature. Distribution- and anchor-based techniques were utilized to define the MCID for the Penn Acoustic Neuroma Quality of Life (PANQOL) and 36-Item Short Form Health Survey (SF-36). Two academic referral centers. Patients with VS (N = 538). Cross-sectional postal survey. MCID for PANQOL domains and total score and SF-36 Physical and Mental Health Component Summary scores. The MCID (median, interquartile range) for the PANQOL total score was 11 points (10-12); the MCIDs for individual domains were as follows: hearing, 6 (5-8); balance, 16 (14-19); facial, 10 (no interquartile range); pain, 11 (10-13); energy, 13 (10-17); anxiety, 11 (5-22); and general, 15 (11-19). The MCID was 7 points (6-11) for the SF-36 Mental Health Component Summary score and 8 points (6-10) for the Physical Health Component Summary score. The MCIDs determined in the current study generally exceed differences reported in previous prospective studies, in which conclusions about QOL benefit (or harm) among VS treatment modalities were based on statistical significance alone. Moving forward, these MCIDs should be considered when interpreting results of VS QOL studies. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
    Otolaryngology Head and Neck Surgery 06/2015; 153(2). DOI:10.1177/0194599815585508 · 2.02 Impact Factor
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    ABSTRACT: Although cytoreductive nephrectomy (CN) has been associated with perioperative morbidity, data are lacking regarding the risk of prolonged length of stay (pLOS) and delay to receipt of systemic therapy (ST). To evaluate the association of clinicopathologic features with postoperative complications, pLOS, and time to receipt of ST. We evaluated 294 patients with M1 renal cell carcinoma treated between 1990 and 2009. CN. Logistic and Cox regressions were used to evaluate associations of clinicopathologic features with 30-d postoperative complications, pLOS (LOS ≥75th percentile), and time to receipt of ST. Fifteen (5%) patients experienced at least one Clavien grade ≥3 early complication. Among patients for whom postsurgical ST was recommended, 61% did not receive ST within 60 d, but the delay was surgery-related in only 11%. In multivariable models limited to preoperative features, liver metastases were associated with complications (odds ratio [OR] 3.73, p=0.004) and pLOS (OR 2.46, p=0.03), while a laparoscopic approach was associated with earlier administration of ST (hazard ratio [HR] 5.05, p<0.001). In multivariable models incorporating operative features, intraoperative transfusion was associated with complications (OR 1.14, p<0.001) and pLOS (OR 1.22, p<0.001), while pN1 disease was associated with pLOS (OR 2.12, p=0.049) and delay to ST (HR 0.38, p=0.004). Limitations include the retrospective design and surgical selection bias. Overall, 61% of CN patients did not receive timely ST, but only 5% of patients experienced Clavien grade ≥3 complications and the delay to ST was surgery-related in 11%. Liver metastases, intraoperative transfusion, and pN1 disease were independently associated with perioperative morbidity. We evaluated the morbidity of cytoreductive nephrectomy and identified predictors of unfavorable perioperative outcomes. Although 61% of patients did not receive timely systemic therapy, the rates of complications and surgery-related delay to systemic therapy were low. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.
    European Urology 06/2015; DOI:10.1016/j.eururo.2015.05.022 · 13.94 Impact Factor
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    ABSTRACT: Risk factors that predict which patients with anaphylaxis might require repeat doses of epinephrine are poorly understood. The objective of this study was to identify risk factors associated with the need for multiple doses of epinephrine during an anaphylactic reaction. Patients were included if they met diagnostic criteria for anaphylaxis on presentation to the emergency department (ED) at our academic medical center between April 2008 and February 2014. Data were collected on allergic history, presenting signs and symptoms, anaphylaxis management, and disposition. Univariable and multivariable analyses were performed to estimate associations between possible risk factors and the need for multiple doses. Of 582 ED patients with anaphylaxis, 45 (8%) required multiple doses of epinephrine. By multivariable analysis, factors associated with the need for repeat doses were a history of anaphylaxis (odds ratio [OR], 2.5 [95% CI, 1.3-4.7]; P = .005), the presence of flushing or diaphoresis (OR, 2.4 [95% CI, 1.3-4.5]; P = .007), and the presence of dyspnea (OR, 2.2 [95% CI, 1.0-5.0]; P = .046). Patients who received more than 1 dose were more likely to be admitted to the general medical floor (OR, 2.8 [95% CI, 1.1-7.2]; P = .03) or intensive care unit (OR, 7.6 [95% CI, 3.7-15.6]; P < .001). Patients with a history of anaphylaxis, flushing or diaphoresis, or dyspnea may require multiple doses of epinephrine to treat anaphylactic reactions. Patients who require more than 1 dose are more likely to be admitted to the hospital, thus increasing health care resource utilization. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
    05/2015; 3(4). DOI:10.1016/j.jaip.2015.04.009
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    ABSTRACT: Introduction Management of contaminated patients in the decontamination corridor requires the use of hazardous material (HazMat) personal protective equipment (PPE). Previous studies have demonstrated that HazMat PPE may increase the difficulty of airway management. This study compared the efficiency of video laryngoscopy (VL) with traditional direct laryngoscopy (DL) during endotracheal intubation (ETI) while wearing HazMat PPE. Post-graduate year (PGY) 1-3 Emergency Medicine residents were randomized to VL or DL while wearing encapsulating PPE. Video laryngoscopy was performed using the GlideScope Cobalt AVL video laryngoscope. The primary outcome measure was time to successful ETI in a high-fidelity simulation mannequin. Three time points were utilized in the analysis: Time 0 (blade at lips), Time 1 (blade removed from lips after endotracheal tube placement), and Time 2 (bag valve mask [BVM] attached to endotracheal tube). Secondary outcome measures were perceived ease of use and feasibility of VL and DL ETI modalities. Twenty-one of 23 (91.3%) eligible residents participated. Mean time to ETI was 10.0 seconds (SD=5.3 seconds) in the DL group and 7.8 seconds (SD=3.0 seconds) in the VL group (P=.081). Mean times from blade insertion until BVM attachment were 17.4 seconds (SD=6.0 seconds) and 15.6 seconds (SD=4.6 seconds), respectively (P=.30). There were no unsuccessful intubation attempts. Seventeen out of 20 participants (85.0%) perceived VL to be easier to use when performing ETI in PPE. Twelve out of 20 participants (60%) perceived DL to be more feasible in an actual HazMat scenario. The time to successful ETI was not significantly different between VL and DL. Video laryngoscopy had a greater perceived ease of use, but DL was perceived to be more feasible for use in actual HazMat situations. These findings suggest that both DL and VL are reasonable modalities for use in HazMat situations, and the choice of modality could be based on the clinical situation and provider experience. Aberle SJ , Sandefur BJ , Sunga KL , Campbell RL , Lohse CM , Alecastro Puls H , Laudon S , Sztajnkrycer MD . Intubation efficiency and perceived ease of use of video laryngoscopy vs direct laryngoscopy while wearing HazMat PPE: a preliminary high-fidelity mannequin study. Prehosp Disaster Med. 2015;30(3):1-5.
    Prehospital and disaster medicine: the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation 05/2015; 30(3):1-5. DOI:10.1017/S1049023X15004707
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    ABSTRACT: Bladder cancer has the sixth highest incidence in the United States. Treatment of metastatic bladder cancer is difficult, and mortality is certain. There are certain pathways in cancer growth and progression that are important in bladder cancer development. Recently, the estrogen pathway has been found to be a potential target for therapy. We identified 410 patients treated with radical cystectomy for urothelial cell carcinoma between 1990 and 1994. We obtained representative paraffin-embedded tissue blocks for 336 (82.0%) of these cases and evaluated the expression and intensity of estrogen receptor (ER)-α, ER-β, and progesterone receptor by immunohistochemistry. Among the 12 ER-α-positive cases, median tumor ER-α expression was 10% (range, 10%-50%). In contrast to ER-α, all cases were ER-β-positive. Median tumor ER-β expression was 90% (range, 20%-100%). Nearly all cases had ER-β expression of ≥ 90% (175 [55.9%] with 90% and 103 [32.9%] with 100%). However, the intensity of ER-β staining varied from focal to moderate to marked in 64 (20.5%), 167 (53.4%), and 82 (26.2%) cases, respectively. Progesterone receptor expression was noted to be negative in all cases. ER-β is highly expressed in bladder cancer. Prospective validation of these data might further elucidate the utility of ER-β as a marker for prognosis or possible target for therapy. Copyright © 2015 Elsevier Inc. All rights reserved.
    Clinical Genitourinary Cancer 04/2015; 13(5). DOI:10.1016/j.clgc.2015.04.001 · 2.32 Impact Factor
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    The Journal of Urology 04/2015; 193(4):e879-e880. DOI:10.1016/j.juro.2015.02.2537 · 4.47 Impact Factor
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    The Journal of Urology 04/2015; 193(4):e531. DOI:10.1016/j.juro.2015.02.1556 · 4.47 Impact Factor
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    The Journal of Urology 04/2015; 193(4):e762. DOI:10.1016/j.juro.2015.02.2230 · 4.47 Impact Factor
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    ABSTRACT: Purpose: The appropriate duration of surveillance for renal cell carcinoma (RCC) after radical or partial nephrectomy remains unknown, and evidence to support current guidelines are lacking. Herein, we provide an approach to surveillance that balances the risk of recurrence versus the risk of non-RCC death. Patients and methods: We identified 2,511 patients who underwent surgery for M0 RCC between 1990 and 2008. Patients were stratified for analysis by pathologic stage (pT1Nx-0, pT2Nx-0, pT3/4Nx-0, and pTanyN1), relapse location (abdomen, chest, bone, and other), age (< 50, 50 to 59, 60 to 69, 70-79 and ≥ 80 years), and Charlson comorbidity index (CCI; ≤ 1 and ≥ 2). Risks of disease recurrence and non-RCC death were estimated by using parametric models for time-to-failure with Weibull distributions. Surveillance duration was estimated at the point when the risk of non-RCC death exceeded the risk of recurrence. Results: At a median follow-up of 9.0 years (interquartile range, 6.4 to 12.7 years), a total of 676 patients developed recurrence. By using a competing-risk model, vastly different surveillance durations were appreciated. Specifically, among patients with pT1Nx-0 disease and a CCI ≤ 1, risk of non-RCC death exceeded that of abdominal recurrence risk at 6 months in patients age 80 years and older but failed to do so for greater than 20 years in patients younger than age 50 years. For patients with pT1Nx-0 disease but a CCI ≥ 2, the risk of non-RCC death exceeded that of abdominal recurrence risk already at 30 days after surgery, regardless of patient age. Conclusion: We present an individualized approach to RCC surveillance that bases the duration of follow-up on the interplay between competing risk factors of recurrence and non-RCC death. This strategy may improve the balance between the derived benefit from surveillance and medical resource allocation.
    The Journal of Urology 04/2015; 193(4):e650-e651. DOI:10.1016/j.juro.2015.02.1793 · 4.47 Impact Factor
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    The Journal of Urology 04/2015; 193(4):e881. DOI:10.1016/j.juro.2015.02.2540 · 4.47 Impact Factor

Publication Stats

14k Citations
1,690.66 Total Impact Points


  • 1999-2015
    • Mayo Clinic - Rochester
      • • Department of Dermatology
      • • Department of Health Science Research
      • • Department of Laboratory Medicine & Pathology
      • • Department of Cardiovascular Diseases
      Рочестер, Minnesota, United States
  • 2005-2014
    • Mayo Foundation for Medical Education and Research
      • • Department of Pediatric and Adolescent Medicine
      • • Department of Urology
      Рочестер, Michigan, United States
  • 2013
    • Minneapolis Veterans Affairs Hospital
      Minneapolis, Minnesota, United States
    • Rochester College
      Rochester, New York, United States
  • 2012
    • University of Iowa
      Iowa City, Iowa, United States
  • 2008
    • University of Massachusetts Medical School
      • Department of Pathology
      Worcester, Massachusetts, United States
    • University of Minnesota Rochester
      Rochester, Minnesota, United States
  • 2007
    • Academy of Sciences of the Czech Republic
      • Institute of Organic Chemistry and Biochemistry
      Praha, Praha, Czech Republic
  • 2002
    • Northside Hospital
      Atlanta, Georgia, United States