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  1. Article ; Online: How Does Outcomes Research Help Advance Our Knowledge of Patient Outcomes in Hepatopancreaticobiliary Surgery?

    Alvino, Donna Marie L / Chang, David C / Fong, Zhi Ven

    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

    2016  Volume 20, Issue 4, Page(s) 871–877

    Abstract: Randomized controlled trials have historically been regarded as the gold standard of modern clinical research tools, allowing us to elucidate the efficacy of novel therapeutics in an unparalleled manner. However, when attempting to generalize trial ... ...

    Abstract Randomized controlled trials have historically been regarded as the gold standard of modern clinical research tools, allowing us to elucidate the efficacy of novel therapeutics in an unparalleled manner. However, when attempting to generalize trial results to broader populations, it becomes apparent that the unexplained outcome variability exists among treatment recipients, suggesting that randomized controlled trials harbor inherent limitations. Herein, we explore the benefits of health services (outcomes) research utilization in addressing variation in patient outcomes following surgical intervention in the non-randomized setting, with a specific focus on hepatopancreaticobiliary surgery outcomes. To achieve this, we have constructed a framework that outlines the complex interactions existing between therapeutic, patient, and provider factors that subsequently lead to variation in outcomes. By exploring examples in the current literature, we have highlighted the areas where the knowledge is currently lacking and can be further strengthened through the application of outcomes research. Furthermore, we have attempted to demonstrate the utility of alternative study designs in the investigation of novel clinical questions currently unanswered in the field of hepatopancreaticobiliary surgery.
    MeSH term(s) Biliary Tract Surgical Procedures ; Humans ; Knowledge ; Liver/surgery ; Outcome Assessment, Health Care ; Pancreas/surgery ; Randomized Controlled Trials as Topic ; Research Design
    Language English
    Publishing date 2016-02-09
    Publishing country United States
    Document type Editorial
    ZDB-ID 2012365-6
    ISSN 1873-4626 ; 1934-3213 ; 1091-255X
    ISSN (online) 1873-4626 ; 1934-3213
    ISSN 1091-255X
    DOI 10.1007/s11605-015-3072-0
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  2. Article ; Online: How Far Are Patients Willing to Travel for Gastrectomy?

    Alvino, Donna Marie L / Chang, David C / Adler, Joel T / Noorbakhsh, Abraham / Jin, Ginger / Mullen, John T

    Annals of surgery

    2017  Volume 265, Issue 6, Page(s) 1172–1177

    Abstract: Objective: To determine travel patterns for patients undergoing gastrectomy for cancer and to identify factors associated with patient decision.: Background: Support for regionalization of complex surgery grows; however, little is known about the ... ...

    Abstract Objective: To determine travel patterns for patients undergoing gastrectomy for cancer and to identify factors associated with patient decision.
    Background: Support for regionalization of complex surgery grows; however, little is known about the willingness of patients to travel for care. Furthermore, utilization of outcomes data in patients' hospital selection processes is not well understood.
    Methods: Analysis of the California Office of Statewide Health Planning and Development database from 1996 to 2009. Outcome measures included total distance traveled and rate of bypassing the nearest gastrectomy-performing hospitals. Multivariate analyses to identify predictors of bypassing local hospitals were performed.
    Results: Total study population was 10,022. Majority (67.1%) of patients underwent gastrectomy at the nearest providing hospitals. Distance traveled to destination hospitals in California averaged 17.04 miles. Bypassing patients traveled approximately 16 miles beyond the nearest hospitals to receive care, selecting lower volume destination hospitals in 27.9% of cases. Annual gastrectomy volumes for nearest and for destination hospitals averaged 4.4 and 6.8 cases, respectively, and inhospital mortality rates were 5.9% and 4.8%, respectively. A few patients (19.2%) sought care at teaching hospitals. Rural county residence significantly reduced the likelihood of bypass (P < 0.001). High volume (>7 cases) and teaching status of destination hospitals (both P < 0.001) were predictive of hospital bypass, though no significant association between mortality rate and bypass was identified.
    Conclusions: The majority of gastric cancer patients underwent gastrectomy at providing hospitals nearest to home, reflecting little regionalization of gastrectomy in California. Patients' hospital selection appears not to be driven by outcomes data.
    MeSH term(s) California/epidemiology ; Decision Making ; Gastrectomy ; Health Services Accessibility/statistics & numerical data ; Hospitals/standards ; Hospitals/statistics & numerical data ; Humans ; Multivariate Analysis ; Outcome and Process Assessment (Health Care) ; Stomach Neoplasms/surgery ; Travel
    Language English
    Publishing date 2017-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000001826
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  3. Article ; Online: Long-Term Outcomes Following Percutaneous Cholecystostomy Tube Placement for Treatment of Acute Calculous Cholecystitis.

    Alvino, Donna Marie L / Fong, Zhi Ven / McCarthy, Colin J / Velmahos, George / Lillemoe, Keith D / Mueller, Peter R / Fagenholz, Peter J

    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

    2017  Volume 21, Issue 5, Page(s) 761–769

    Abstract: Introduction: Percutaneous cholecystostomy tube (PCT) placement is considered a safe alternative to cholecystectomy for the treatment of acute calculous cholecystitis (ACC), but data regarding long-term outcomes following PCT are limited.: Methods: ... ...

    Abstract Introduction: Percutaneous cholecystostomy tube (PCT) placement is considered a safe alternative to cholecystectomy for the treatment of acute calculous cholecystitis (ACC), but data regarding long-term outcomes following PCT are limited.
    Methods: We retrospectively reviewed our institutional experience of patients undergoing PCT for ACC between 1997 and 2015. Recurrent biliary events were defined as cholecystitis, cholangitis, or gallstone pancreatitis.
    Results: PCT was placed for 288 patients with ACC. Mean age and age-adjusted Charlson comorbidity index were 72 ± 15 years and 5.3 ± 2.4, respectively. Following PCT placement, 91% of patients successfully resolved their episode of ACC. PCT dysfunction occurred in 132 patients (46%), with 80 patients (28%) requiring re-intervention, while 7% developed procedure-related complications. Interval cholecystectomy reduced the risk of recurrent biliary events to 7% from 21% (p = 0.002). Cholecystectomy was completed laparoscopically in 45% of patients receiving an interval operation vs. 22% of those undergoing urgent surgery for PCT failure or recurrent biliary event (p = 0.03).
    Conclusions: PCT placement is a highly successful treatment for acute calculous cholecystitis and is associated with low complication rate, but high rate of tube dysfunction requiring frequent re-intervention. Interval cholecystectomy is associated with a decreased likelihood of recurrent biliary events and increased likelihood of successful laparoscopic completion.
    MeSH term(s) Aged ; Aged, 80 and over ; Cholecystectomy ; Cholecystitis, Acute/etiology ; Cholecystitis, Acute/surgery ; Cholecystostomy/instrumentation ; Cholecystostomy/methods ; Cholelithiasis/complications ; Cholelithiasis/surgery ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Recurrence ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome
    Language English
    Publishing date 2017-02-21
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2012365-6
    ISSN 1873-4626 ; 1934-3213 ; 1091-255X
    ISSN (online) 1873-4626 ; 1934-3213
    ISSN 1091-255X
    DOI 10.1007/s11605-017-3375-4
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  4. Article ; Online: Reappraisal of Staging Laparoscopy for Patients with Pancreatic Adenocarcinoma: A Contemporary Analysis of 1001 Patients.

    Fong, Zhi Ven / Alvino, Donna Marie L / Fernández-Del Castillo, Carlos / Mehtsun, Winta T / Pergolini, Ilaria / Warshaw, Andrew L / Chang, David C / Lillemoe, Keith D / Ferrone, Cristina R

    Annals of surgical oncology

    2017  Volume 24, Issue 11, Page(s) 3203–3211

    Abstract: Background: Recent advances in imaging and the increasing use of neoadjuvant therapy puts the contemporary utility of staging laparoscopy for patients with pancreatic adenocarcinoma (PDAC) into question. This study aimed to develop a prognostic score to ...

    Abstract Background: Recent advances in imaging and the increasing use of neoadjuvant therapy puts the contemporary utility of staging laparoscopy for patients with pancreatic adenocarcinoma (PDAC) into question. This study aimed to develop a prognostic score to optimize prevention of an unnecessary laparotomy and minimize the rate for unnecessary laparoscopy.
    Methods: Clinicopathologic data were evaluated for all patients undergoing surgical intervention for PDAC between 2001 and 2015, who were stratified into group 1 (2001-2008) and group 2 (2009-2014).
    Results: The study identified 1001 patients eligible for analysis, 331 (33%) of whom underwent a staging laparoscopy before exploration. An unnecessary laparotomy was prevented for 44.4% of the patients in period 1 and for 24% of the patients in period 2 (p < 0.001). Male gender [odds ratio (OR), 1.8; p < 0.05], preoperative resectability (borderline resectable OR 2.1; p < 0.019; locally advanced OR 7.6; p < 0.001), CA 19-9 levels higher than 394 U/L (OR 3.1; p < 0.001), no neoadjuvant chemotherapy (OR 2.7; p = 0.012), and pancreatic body or tail lesions (OR 1.8; p = 0.063) were predictive of occult metastatic disease. The developed scoring index demonstrated a c-statistic of 0.729. The observed-to-expected ratio for the index at every score level validated the index's model. A score cutoff at 4 was able to detect 76.1% of radiographically occult metastatic disease.
    Conclusion: The rate for unnecessary laparotomy among patients with PDAC has decreased in contemporary times, but unnecessary laparotomy still occurs for 1 in 4 patients. Using our scoring system, a cutoff of 4 allows 76% of radiographically occult metastases to be predicted, thereby selecting high-risk patients for laparoscopic biopsy and potentially avoiding a non-therapeutic laparotomy.
    MeSH term(s) Adenocarcinoma/secondary ; Adenocarcinoma/surgery ; Aged ; Female ; Follow-Up Studies ; Humans ; Laparoscopy/methods ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/surgery ; Pancreatic Neoplasms
    Language English
    Publishing date 2017-07-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-017-5973-5
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  5. Article ; Online: Lack of detectable HIV-1-specific CD8(+) T cell responses in Zambian HIV-1-exposed seronegative partners of HIV-1-positive individuals.

    Addo, Marylyn M / Altfeld, Marcus / Brainard, Diana M / Rathod, Almas / Piechocka-Trocha, Alicja / Fideli, Ulgen / Mulenga, Joseph / Shutes, Erin / Alvino, Donna Marie L / Hunter, Eric / Allen, Susan A / Walker, Bruce D

    The Journal of infectious diseases

    2010  Volume 203, Issue 2, Page(s) 258–262

    Abstract: Human immunodeficiency virus type 1 (HIV-1)-specific T cell responses were characterized in a blinded study involving infected individuals and their seronegative exposed uninfected (EU) partners from Lusaka, Zambia. HIV-1-specific T cell responses were ... ...

    Abstract Human immunodeficiency virus type 1 (HIV-1)-specific T cell responses were characterized in a blinded study involving infected individuals and their seronegative exposed uninfected (EU) partners from Lusaka, Zambia. HIV-1-specific T cell responses were detected ex vivo in all infected individuals and amplified, on average, 27-fold following in vitro expansion. In contrast, no HIV-1-specific T cell responses were detected in any of the EU partners ex vivo or following in vitro expansion. These data demonstrate that the detection of HIV-1-specific T cell immunity in EU individuals is not universal and that alternative mechanisms may account for protection in these individuals.
    MeSH term(s) CD8-Positive T-Lymphocytes/immunology ; Female ; HIV Infections/immunology ; HIV-1/immunology ; Humans ; Immunity, Innate ; Male ; Sexual Partners ; Zambia
    Language English
    Publishing date 2010-12-09
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 3019-3
    ISSN 1537-6613 ; 0022-1899
    ISSN (online) 1537-6613
    ISSN 0022-1899
    DOI 10.1093/infdis/jiq028
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  6. Article ; Online: The major genetic determinants of HIV-1 control affect HLA class I peptide presentation.

    Pereyra, Florencia / Jia, Xiaoming / McLaren, Paul J / Telenti, Amalio / de Bakker, Paul I W / Walker, Bruce D / Ripke, Stephan / Brumme, Chanson J / Pulit, Sara L / Carrington, Mary / Kadie, Carl M / Carlson, Jonathan M / Heckerman, David / Graham, Robert R / Plenge, Robert M / Deeks, Steven G / Gianniny, Lauren / Crawford, Gabriel / Sullivan, Jordan /
    Gonzalez, Elena / Davies, Leela / Camargo, Amy / Moore, Jamie M / Beattie, Nicole / Gupta, Supriya / Crenshaw, Andrew / Burtt, Noël P / Guiducci, Candace / Gupta, Namrata / Gao, Xiaojiang / Qi, Ying / Yuki, Yuko / Piechocka-Trocha, Alicja / Cutrell, Emily / Rosenberg, Rachel / Moss, Kristin L / Lemay, Paul / O'Leary, Jessica / Schaefer, Todd / Verma, Pranshu / Toth, Ildiko / Block, Brian / Baker, Brett / Rothchild, Alissa / Lian, Jeffrey / Proudfoot, Jacqueline / Alvino, Donna Marie L / Vine, Seanna / Addo, Marylyn M / Allen, Todd M / Altfeld, Marcus / Henn, Matthew R / Le Gall, Sylvie / Streeck, Hendrik / Haas, David W / Kuritzkes, Daniel R / Robbins, Gregory K / Shafer, Robert W / Gulick, Roy M / Shikuma, Cecilia M / Haubrich, Richard / Riddler, Sharon / Sax, Paul E / Daar, Eric S / Ribaudo, Heather J / Agan, Brian / Agarwal, Shanu / Ahern, Richard L / Allen, Brady L / Altidor, Sherly / Altschuler, Eric L / Ambardar, Sujata / Anastos, Kathryn / Anderson, Ben / Anderson, Val / Andrady, Ushan / Antoniskis, Diana / Bangsberg, David / Barbaro, Daniel / Barrie, William / Bartczak, J / Barton, Simon / Basden, Patricia / Basgoz, Nesli / Bazner, Suzane / Bellos, Nicholaos C / Benson, Anne M / Berger, Judith / Bernard, Nicole F / Bernard, Annette M / Birch, Christopher / Bodner, Stanley J / Bolan, Robert K / Boudreaux, Emilie T / Bradley, Meg / Braun, James F / Brndjar, Jon E / Brown, Stephen J / Brown, Katherine / Brown, Sheldon T / Burack, Jedidiah / Bush, Larry M / Cafaro, Virginia / Campbell, Omobolaji / Campbell, John / Carlson, Robert H / Carmichael, J Kevin / Casey, Kathleen K / Cavacuiti, Chris / Celestin, Gregory / Chambers, Steven T / Chez, Nancy / Chirch, Lisa M / Cimoch, Paul J / Cohen, Daniel / Cohn, Lillian E / Conway, Brian / Cooper, David A / Cornelson, Brian / Cox, David T / Cristofano, Michael V / Cuchural, George / Czartoski, Julie L / Dahman, Joseph M / Daly, Jennifer S / Davis, Benjamin T / Davis, Kristine / Davod, Sheila M / DeJesus, Edwin / Dietz, Craig A / Dunham, Eleanor / Dunn, Michael E / Ellerin, Todd B / Eron, Joseph J / Fangman, John J W / Farel, Claire E / Ferlazzo, Helen / Fidler, Sarah / Fleenor-Ford, Anita / Frankel, Renee / Freedberg, Kenneth A / French, Neel K / Fuchs, Jonathan D / Fuller, Jon D / Gaberman, Jonna / Gallant, Joel E / Gandhi, Rajesh T / Garcia, Efrain / Garmon, Donald / Gathe, Joseph C / Gaultier, Cyril R / Gebre, Wondwoosen / Gilman, Frank D / Gilson, Ian / Goepfert, Paul A / Gottlieb, Michael S / Goulston, Claudia / Groger, Richard K / Gurley, T Douglas / Haber, Stuart / Hardwicke, Robin / Hardy, W David / Harrigan, P Richard / Hawkins, Trevor N / Heath, Sonya / Hecht, Frederick M / Henry, W Keith / Hladek, Melissa / Hoffman, Robert P / Horton, James M / Hsu, Ricky K / Huhn, Gregory D / Hunt, Peter / Hupert, Mark J / Illeman, Mark L / Jaeger, Hans / Jellinger, Robert M / John, Mina / Johnson, Jennifer A / Johnson, Kristin L / Johnson, Heather / Johnson, Kay / Joly, Jennifer / Jordan, Wilbert C / Kauffman, Carol A / Khanlou, Homayoon / Killian, Robert K / Kim, Arthur Y / Kim, David D / Kinder, Clifford A / Kirchner, Jeffrey T / Kogelman, Laura / Kojic, Erna Milunka / Korthuis, P Todd / Kurisu, Wayne / Kwon, Douglas S / LaMar, Melissa / Lampiris, Harry / Lanzafame, Massimiliano / Lederman, Michael M / Lee, David M / Lee, Jean M L / Lee, Marah J / Lee, Edward T Y / Lemoine, Janice / Levy, Jay A / Llibre, Josep M / Liguori, Michael A / Little, Susan J / Liu, Anne Y / Lopez, Alvaro J / Loutfy, Mono R / Loy, Dawn / Mohammed, Debbie Y / Man, Alan / Mansour, Michael K / Marconi, Vincent C / Markowitz, Martin / Marques, Rui / Martin, Jeffrey N / Martin, Harold L / Mayer, Kenneth Hugh / McElrath, M Juliana / McGhee, Theresa A / McGovern, Barbara H / McGowan, Katherine / McIntyre, Dawn / Mcleod, Gavin X / Menezes, Prema / Mesa, Greg / Metroka, Craig E / Meyer-Olson, Dirk / Miller, Andy O / Montgomery, Kate / Mounzer, Karam C / Nagami, Ellen H / Nagin, Iris / Nahass, Ronald G / Nelson, Margret O / Nielsen, Craig / Norene, David L / O'Connor, David H / Ojikutu, Bisola O / Okulicz, Jason / Oladehin, Olakunle O / Oldfield, Edward C / Olender, Susan A / Ostrowski, Mario / Owen, William F / Pae, Eunice / Parsonnet, Jeffrey / Pavlatos, Andrew M / Perlmutter, Aaron M / Pierce, Michael N / Pincus, Jonathan M / Pisani, Leandro / Price, Lawrence Jay / Proia, Laurie / Prokesch, Richard C / Pujet, Heather Calderon / Ramgopal, Moti / Rathod, Almas / Rausch, Michael / Ravishankar, J / Rhame, Frank S / Richards, Constance Shamuyarira / Richman, Douglas D / Rodes, Berta / Rodriguez, Milagros / Rose, Richard C / Rosenberg, Eric S / Rosenthal, Daniel / Ross, Polly E / Rubin, David S / Rumbaugh, Elease / Saenz, Luis / Salvaggio, Michelle R / Sanchez, William C / Sanjana, Veeraf M / Santiago, Steven / Schmidt, Wolfgang / Schuitemaker, Hanneke / Sestak, Philip M / Shalit, Peter / Shay, William / Shirvani, Vivian N / Silebi, Vanessa I / Sizemore, James M / Skolnik, Paul R / Sokol-Anderson, Marcia / Sosman, James M / Stabile, Paul / Stapleton, Jack T / Starrett, Sheree / Stein, Francine / Stellbrink, Hans-Jurgen / Sterman, F Lisa / Stone, Valerie E / Stone, David R / Tambussi, Giuseppe / Taplitz, Randy A / Tedaldi, Ellen M / Theisen, William / Torres, Richard / Tosiello, Lorraine / Tremblay, Cecile / Tribble, Marc A / Trinh, Phuong D / Tsao, Alice / Ueda, Peggy / Vaccaro, Anthony / Valadas, Emilia / Vanig, Thanes J / Vecino, Isabel / Vega, Vilma M / Veikley, Wenoah / Wade, Barbara H / Walworth, Charles / Wanidworanun, Chingchai / Ward, Douglas J / Warner, Daniel A / Weber, Robert D / Webster, Duncan / Weis, Steve / Wheeler, David A / White, David J / Wilkins, Ed / Winston, Alan / Wlodaver, Clifford G / van't Wout, Angelique / Wright, David P / Yang, Otto O / Yurdin, David L / Zabukovic, Brandon W / Zachary, Kimon C / Zeeman, Beth / Zhao, Meng

    Science (New York, N.Y.)

    2010  Volume 330, Issue 6010, Page(s) 1551–1557

    Abstract: Infectious and inflammatory diseases have repeatedly shown strong genetic associations within the major histocompatibility complex (MHC); however, the basis for these associations remains elusive. To define host genetic effects on the outcome of a ... ...

    Abstract Infectious and inflammatory diseases have repeatedly shown strong genetic associations within the major histocompatibility complex (MHC); however, the basis for these associations remains elusive. To define host genetic effects on the outcome of a chronic viral infection, we performed genome-wide association analysis in a multiethnic cohort of HIV-1 controllers and progressors, and we analyzed the effects of individual amino acids within the classical human leukocyte antigen (HLA) proteins. We identified >300 genome-wide significant single-nucleotide polymorphisms (SNPs) within the MHC and none elsewhere. Specific amino acids in the HLA-B peptide binding groove, as well as an independent HLA-C effect, explain the SNP associations and reconcile both protective and risk HLA alleles. These results implicate the nature of the HLA-viral peptide interaction as the major factor modulating durable control of HIV infection.
    MeSH term(s) Black or African American/genetics ; Alleles ; Amino Acids/physiology ; Antigen Presentation ; CD8-Positive T-Lymphocytes/immunology ; Cohort Studies ; Disease Progression ; Genes, MHC Class I ; Genome-Wide Association Study ; HIV Antigens/immunology ; HIV Infections/ethnology ; HIV Infections/genetics ; HIV Infections/immunology ; HIV Infections/virology ; HIV Long-Term Survivors ; HIV-1/immunology ; HLA-A Antigens/chemistry ; HLA-A Antigens/genetics ; HLA-A Antigens/immunology ; HLA-A Antigens/metabolism ; HLA-B Antigens/chemistry ; HLA-B Antigens/genetics ; HLA-B Antigens/immunology ; HLA-B Antigens/metabolism ; HLA-C Antigens/chemistry ; HLA-C Antigens/genetics ; HLA-C Antigens/immunology ; HLA-C Antigens/metabolism ; Haplotypes ; Hispanic or Latino/genetics ; Humans ; Immunity, Innate ; Logistic Models ; Models, Molecular ; Polymorphism, Single Nucleotide ; Protein Conformation ; Viral Load ; White People/genetics
    Chemical Substances Amino Acids ; HIV Antigens ; HLA-A Antigens ; HLA-B Antigens ; HLA-C Antigens
    Language English
    Publishing date 2010-11-04
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, N.I.H., Intramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 128410-1
    ISSN 1095-9203 ; 0036-8075
    ISSN (online) 1095-9203
    ISSN 0036-8075
    DOI 10.1126/science.1195271
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