Prognosis in HIV-infected patients with non-small cell lung cancer.

BACKGROUND: We conducted a population-based study to evaluate whether non-small cell lung cancer (NSCLC) prognosis was worse in HIV-infected compared with HIV-uninfected patients. METHODS: Using the Surveillance, Epidemiology and End Results (SEER) registry linked to Medicare claims, we identified 267 HIV-infected patients and 1428 similar controls with no evidence of HIV diagnosed with NSCLC between 1996 and 2007. We used conditional probability function (CPF) analyses to compare survival by HIV status accounting for an increased risk of non-lung cancer death (competing risks) in HIV-infected patients. We used multivariable CPF regression to evaluate lung cancer prognosis by HIV status adjusted for confounders. RESULTS: Stage at presentation and use of stage-appropriate lung cancer treatment did not differ by HIV status. Median survival was 6 months (95% confidence interval (CI): 5-8 months) among HIV-infected NSCLC patients compared with 20 months (95% CI: 17-23 months) in patients without evidence of HIV. Multivariable CPF regression showed that HIV was associated with a greater risk of lung cancer-specific death after controlling for confounders and competing risks. CONCLUSION: NSCLC patients with HIV have a poorer prognosis than patients without evidence of HIV. NSCLC may exhibit more aggressive behaviour in the setting of HIV.

Sources of uncertainty in economic analysis of the Water Framework Directive.

The Water Framework Directive (WFD) imposes a new approach to water resource management in the EU states. Uncertainty surrounding its implementation, however, could badly affect the achievement of the objectives set by the Directive. Although not directly linked to a set of techniques to deal with it, the WFD and accompanying guidance documents mention uncertainty as a relevant factor in implementing the WFD and especially in the context of economic analysis of water uses. In this paper we review several sources of uncertainty surrounding economic analysis focusing on uncertainty related to socioeconomic descriptors of river basins and water uses and uncertainty surrounding the selection of measures (WFD article 11). While a number of sources of uncertainty in socioeconomic descriptors of river basins and water uses are discussed, we argue that the transformation of this information into hydrological spatial units may turn out to be a real challenge for uncertainty assessment. For the choice of the most appropriate measures, we distinguish between uncertainty being 'internalised' in decisions (by using stochastic decision methods) and uncertainty stemming from the application of these methods.

[Doctor reports of a neurological clinic in the view of permanent resident neurologists and nerve doctors]. / Arztbriefe neurologischer Kliniken in der Sicht niedergelassener Neurologen und Nervenärzte.

Eight discharge reports involving five diagnoses (anterior territory ischemic stroke, epilepsy, Parkinson's syndrome, multiple sclerosis, polyneuropathy) from five neurological departments were peer-reviewed by five neurologists working in out-patient (private) practice. The review considered the diagnosis, case history, clinical status, laboratory investigation, differential diagnosis and treatment. Criticism mainly involved the quality of the clinical assessment, lack of clinical status at discharge, narrow or incomplete differential diagnosis and the quality of the neurophysiological investigations for epilepsy and polyneuropathy. Improvement potential was seen for the speed of reporting, better comprehensibility, omission of irrelevant information, greater participation of experienced neurologists in report writing, and standardization.

[Nuclear magnetic resonance tomographic appearance of disseminated encephalomyelitis in relation to clinical diagnosis]. / Kernspintomographisches Erscheinungsbild der Encephalomyelitis disseminata in Abhängigkeit von der klinischen Diagnosestellung.

The MRI findings in 149 patients with a clinical diagnosis of disseminated encephalomyelitis (D.E.) were related to the diagnostic criteria of McAlpine (definite, probable, possible). The most common pattern in all three groups was a mixed peri- and para-ventricular distribution of foci. The findings in 'possible' D.E., compared with 'definite' D.E., showed fewer confluent lesions, but were characterised by peri- and para-ventricular as well as solitary foci. The results of the present study permit better classification and evaluation of the MRI findings if the clinical diagnosis of D.E. is only suspected (probable or possible).