Three-phase 18F-fluorocholine PET/CT in the evaluation of prostate cancer recurrence.

AIM: Contribution of 3-phase 18F-fluorocholine PET/CT in suspected prostate cancer recurrence at early rise of PSA. PATIENTS, METHODS: Retrospective analysis was performed in 47 patients after initial treatment with radiotherapy (n=30) or surgery (n=17). Following CT, 10 minutes list-mode PET acquisition was done over the prostate bed after injection of 300 MBq of 18F-fluorocholine. Three timeframes of 3 minutes each were reconstructed for analysis. All patients underwent subsequent whole body PET/CT. Delayed pelvic PET/CT was obtained in 36 patients. PET/CT was interpreted visually by two observers and SUVmax determined for suspicious lesions. Biopsies were obtained from 13 patients. RESULTS: Biopsies confirmed the presence of cancer in 11 of 13 patients with positive PET for a total of 15 local recurrences in which average SUVmax increased during 14 minutes post injection and marginally decreased in delayed scanning. Conversely inguinal lymph nodes with mild to moderate metabolic activity on PET showed a clearly different pattern with decreasing SUVmax on dynamic images. Three-phase PET/CT contributed to the diagnostic assessment of 10 of 47 patients with biological evidence of recurrence of cancer. It notably allowed the discrimination of confounding blood pool or urinary activity from suspicious hyperactivities. PET/CT was positive in all patients with PSA>or=2 ng/ml (n=34) and in 4/13 patients presenting PSA values<2 ng/ml. CONCLUSION: 18F-fluorocholine 3-phase PET/CT showed a progressively increasing SUVmax in biopsy confirmed cancer lesions up to 14 minutes post injection while decreasing in inguinal lymph nodes interpreted as benign. Furthermore, it was very useful in differentiating local recurrences from confounding blood pool and urinary activity.

New obesity body mass index threshold for self-reported data.

BACKGROUND: Since subjects included in population studies tend to underreport their weight and overestimate their height, obesity prevalence based on these data is often inaccurate. A reduced obesity threshold for self-reported height and weight was proposed and evaluated for its accuracy. METHODS: Self-reported heights and weights were compared with measured heights and weights in a Swiss city adult population representative sample. Participants were asked their height and weight and were invited to undergo a health examination, during which these data were measured. An optimal body mass index (BMI) value was assessed using receiver operating characteristic (ROC) curve analysis and its ability to correctly estimate obesity prevalence was tested on an external French population sample. RESULTS: The Swiss population sample consisted of 13 162 subjects (mean age 51.4). The comparison between self-reported and measured data showed that obesity prevalence calculated from declarations was underestimated: among obese subjects (according to measured BMI), 33.6% of men and 27.5% of women were considered to be non-obese according to their self-report. Considering measures as a reference, a lower BMI cut-off of 29.2 kg/m(2) was identified for both genders for the definition of obesity based on self-report. Respective misclassification was reduced to 17.9% in men and 16.9% in women. The validation procedure on a French population sample (n = 1858) yielded similar results. CONCLUSIONS: The reduced threshold based on self-report allowed a better estimation of obesity prevalence. Its use should be limited to population studies only.

Longitudinal analyses of renal lesions due to acute pyelonephritis in children and their impact on renal growth.

PURPOSE: Acute pyelonephritis is a common condition in children, and can lead to renal scarring. The aim of this study was to analyze the progression of renal scarring with time and its impact on renal growth. MATERIALS AND METHODS: A total of 50 children who had renal scarring on dimercapto-succinic acid scan 6 months after acute pyelonephritis underwent a repeat scan 3 years later. Lesion changes were evaluated by 3 blinded observers, and were classified as no change, partial resolution or complete disappearance. Renal size at time of acute pyelonephritis and after 3 years was obtained by ultrasound, and renal growth was assessed comparing z-score for age between the 2 measures. Robust linear regression was used to identify determinants of renal growth. RESULTS: At 6 months after acute pyelonephritis 88 scars were observed in 100 renal units. No change was observed in 27%, partial resolution in 63% and complete disappearance in 9% of lesions. Overall, 72% of lesions improved. Increased number of scars was associated with high grade vesicoureteral reflux (p = 0.02). Multivariate analysis showed that the number of scars was the most important parameter leading to decreased renal growth (CI -1.05 to -0.35, p <0.001), and with 3 or more scars this finding was highly significant on univariate analysis (-1.59, CI -2.10 to -1.09, p <0.0001). CONCLUSIONS: Even 6 months after acute pyelonephritis 72% of dimercapto-succinic acid defects improved, demonstrating that some of the lesions may be not definitive. The number of scars was significantly associated with loss of renal growth at 3 years.

Food intake in 1707 hospitalised patients: a prospective comprehensive hospital survey.

BACKGROUND & AIMS: This study aimed to assess the ability of the hospital meal service to meet patients' nutritional needs. METHODS: All hospitalised patients who received 3 meals/day without artificial nutritional support were included. The nutritional values of food served, consumed and wasted during a 24 h period were compared to patients' needs estimated as energy: 110% Harris-Benedict formula; protein: 1.2 or 1.0 g/kg bodyweight/day for patients < or = or > 65 years old, respectively. A structured interview recorded patients' evaluation of the meal quality, their reasons for non-consumption of food and the relationship between food intake and disease. RESULTS: Out of 1707 patients included, 1416 were fully assessable (59% women; 68+/-21 years; body mass index: 24.3+/-5.1 kg/m(2)). Daily meals provided 2007+/-479 kcal and 78+/-21 g of protein and exceeded patients' needs by 41% and 15%, respectively. However, 975 patients did not eat enough. Plate waste was 471+/-372 kcal and 21+/-17 g of protein/day/patient. Moreover, the food intake of 572 (59%) of these underfed patients was not predominantly affected by disease. Logistic regression analyses identified as other risk factors: elevated BMI, male gender, modified diet prescription, length of stay <8 or > or = 90 days and inadequate supper. CONCLUSION: Despite sufficient food provision, most of the hospitalised patients did not cover their estimated needs. Since insufficient food intake was often attributed to causes other than disease, there should be potential to improve the hospital meal service.

Relationship between hospital length of stay and quality of care in patients with congestive heart failure.

OBJECTIVE: To determine the relationship between hospital length of stay (LOS) and quality of care in patients admitted for congestive heart failure (CHF). METHODS: This observational study was conducted in the medical wards of the Geneva University Hospitals, Geneva, Switzerland. A random sample of 371 patients was drawn from the 1084 patients discharged alive with a principal diagnosis of CHF between January 1997 and December 1998. Explicit criteria grouped into three scores were used to assess the quality of processes of care: admission work-up (admission score); evaluation and treatment during the stay (treatment score); and readiness for discharge (discharge score). The association between LOS and quality of care was analysed using linear regression with adjustment for clinical characteristics. RESULTS: The mean proportion of criteria met were 80% for the admission score, 66% for the treatment score, and 76% for the discharge score. Mean (SD) LOS was 13.2 (8.8) days. The admission score was not associated with LOS, but the treatment score increased by 0.5% (95% CI 0.3 to 0.7; p < 0.001) with each additional day in hospital and the discharge score increased by 2.5% (95% CI 1.6 to 3.3; p < 0.001) per day from admission to day 10 but remained unchanged thereafter. Adjustment for potential confounders did not substantially modify these relationships. CONCLUSIONS: In patients with CHF there is a significant association between LOS and the quality of the treatment provided, as well as with readiness for discharge. Appropriate reorganisation of processes of care should accompany attempts at reducing LOS to avoid detrimental effects on quality of care.

Unplanned readmissions of patients with congestive heart failure: do they reflect in-hospital quality of care or patient characteristics?

PURPOSE: To determine if early unplanned readmissions of patients hospitalized for heart failure are associated with suboptimal in-hospital care or with the clinical and demographic characteristics of the patient. SUBJECT AND METHODS: We performed a case-control study among patients discharged with a principal diagnosis of heart failure. Cases included all patients unexpectedly readmitted within 31 days of discharge; controls were randomly selected from among those not readmitted. Quality of care was measured using explicit criteria reflecting the admission work-up, evaluation and treatment, and readiness for discharge. RESULTS: Ninety-one cases and 351 controls were included. There was no significant association between early unplanned readmissions and the scores for quality of the admission work-up or evaluation and treatment during the stay. There was a significant association between readiness for discharge and subsequent early readmission: for each 10% decrease in the proportion of fulfilled criteria, the odds of readmission increased by 14% (95% confidence interval [CI] 1. 01 to 1.28, P = 0.04) for all-cause readmissions and by 19% (95% CI: 1.04 to 1.36, P = 0.01) for heart-failure-related readmissions. In a multiple logistic regression model, previous diagnosis of heart failure (odds ratio [OR] = 2.9, 95% CI: 1.7 to 4.8, P <0.001), age (OR = 3.3, 95% CI: 1.3 to 8.5, P = 0.01 for patients aged 65 to 79 years and OR = 4.1, 95% CI: 1.6 to 11, P = 0.004 for patients aged 80 years and older), and history of cardiac revascularization (OR = 2.1, 95% CI: 1.2 to 3.9, P = 0.01) showed a stronger association with early unplanned all-cause readmissions than the readiness-for-discharge score (OR = 1.16, 95% CI: 1.02 to 1.31, P = 0.02). Similar findings were seen for heart failure-related readmissions. CONCLUSIONS: Among patients with heart failure, early unplanned readmissions were not associated with suboptimal admission work-up or evaluation and treatment but were weakly associated with readiness for discharge. However, they were strongly associated with the patients' clinical and demographic characteristics.

Distinction between planned and unplanned readmissions following discharge from a Department of Internal Medicine.

Readmission rate is often used as an indicator for the quality of care. However, only unplanned readmissions may have a link with substandard quality of care. We compared two databases of the Geneva University Hospitals to determine which information is needed to distinguish planned from unplanned readmissions. All patients readmitted within 42 days after a first stay in the wards of the Department of Internal Medicine were identified. One of the databases contained encoded information needed to compute DRGs. The other database consisted of full-text discharge reports, addressed to the referring physician. Encoded reports allowed the classification of 64% of the readmissions, whereas full-text reports could classify 97% of the readmissions (p < 0.001). The concordance between encoded reports and full-text reports was fair (kappa = 0.40). We conclude that encoded reports alone are not sufficient to distinguish planned from unplanned readmissions and that the automation of detailed clinical databases seems promising.

Comparison between planned and unplanned readmissions to a department of internal medicine.

The objective of this study was to assess the respective frequency of planned and unplanned early readmissions after discharge from an internal medicine department, and to identify and compare risk factors for these two types of readmissions. Readmissions within 31 days of discharge were identified as planned or unplanned based on analysis of discharge summaries. Time-failure methods were used to describe the risk of readmissions over time and to assess relationships between patient and index stay characteristics and risk of readmission. Of 5828 patients discharged alive, 730 (12.5%) were readmitted within 31 days. There were slightly more planned than unplanned readmissions (393 vs. 337). The difference in time-to-event functions was significant (P=0.04). The risk of planned readmission was increased for men, younger patients, and for patients discharged with a diagnosis of coronary heart disease, cardiac arrhythmia, and neoplastic disease. Increased risk of unplanned readmission was associated with index length of stay longer than 3 days, an increased number of comorbidities, and with a diagnosis of neoplastic disease. Planned readmissions constitute more than half of early readmissions to our internal medicine department. Therefore, a crude readmission rate is unlikely to be a useful indicator of quality of care. Several patient characteristics influence the risk of unplanned readmission, suggesting that case-mix adjustments are necessary when readmission rates are compared between institutions or tracked over time.