Healthcare and economic burden of anticholinergic use in adults with overactive bladder: a systematic literature review

Aim: To determine the economic burden associated with anticholinergic medication use in adults with overactive bladder (OAB) in the USA. Methods: A systematic literature review was conducted to identify articles assessing healthcare resource utilization (HCRU) and costs associated with anticholinergic use in adults with OAB. Results: From the 34 articles identified, increased anticholinergic burden, switching anticholinergic treatments and potentially inappropriate anticholinergic use were associated with increased HCRU and/or costs. However, studies comparing patients with OAB receiving anticholinergics to individuals with untreated OAB or without OAB reported a mix of increases and decreases in HCRU and costs. Conclusion: Additional controlled studies assessing the economic impact of anticholinergics in OAB are needed and may enable optimization of economic and potentially patient outcomes.

Methodological guidelines: Cow milk mid-infrared spectra to predict GreenFeed enteric methane emissions

Various methodological protocols were tested on milk samples from cows fed diets affecting both methanogenesis and milk synthesis to identify the best approach for the prediction of GreenFeed system (GF) measured methane (CH₄) emissions by milk mid-infrared (MIR) spectroscopy. The models developed were also tested on a data set from cows fed chemical inhibitors of CH₄ emission [3-nitrooxypropanol (3NOP)] that just marginally affect milk composition. A total of 129 primiparous and multiparous Holstein cows fed diets with different methanogenic potential were considered. Individual milk yield (MY) and dry matter intake were recorded daily, whereas fat- and protein-corrected milk (FPCM) was recorded twice a week. The MIR spectra from 2 consecutive milkings were collected twice a week. Twenty CH₄ spot measurements with GF were taken as the basic measurement unit (BMU) of CH₄. The equations were built using partial least squares regression by splitting the database into calibration and validation data sets (excluding 3NOP samples). Models were developed for milk MIR spectra by milking and on day spectra obtained by averaging spectra from 2 consecutive milkings. Models based on day spectra were calibrated by using CH₄ reference data for a measurement duration of 1, 2, 3, or 4 BMU. Models built from the average of the day spectra collected during the corresponding CH₄ measurement periods were developed. Corrections of spectra by days in milk (DIM) and the inclusion of parity, MY, and FPCM as explanatory variables were tested as tools to improve model performance. Models built on day milk MIR spectra gave slightly better performances that those developed using spectra from a single milking. Long duration of CH₄ measurement by GF performed better than short duration: the coefficient of determination of validation (R²V) for CH₄ emissions expressed in grams per day were 0.60 vs. 0.52 for 4 and 1 BMU, respectively. When CH₄ emissions were expressed as grams per kilogram of dry of matter intake, grams per kilogram of MY, or grams per kilogram of FPCM, performance with a long duration also improved. Coupling GF reference data with the average of milk MIR spectra collected throughout the corresponding CH₄ measurement period gave better predictions than using day spectra (R²V = 0.70 vs. 0.60 for CH₄ as g/d on 4 BMU). Correcting the day spectra by DIM improved R²V compared with the equivalent DIM-uncorrected models (R²V = 0.67 vs. 0.60 for CH₄ as g/d on 4 BMU). Adding other phenotypic information as explanatory variables did not further improve the performance of models built on single day DIM-corrected spectra, whereas including MY (or FPCM) improved the performance of models built on the average of spectra (uncorrected by DIM) recorded during the CH₄ measurement period (R²V = 0.73 vs. 0.70 for CH₄ as g/d on 4 BMU). When validating the models on the 3NOP data set, predictions were poor without (R²V = 0.13 for CH₄ as g/d on 1 BMU) or with (R²V = 0.31 for CH₄ as g/d on 1 BMU) integration of 3NOP data in the models. Thus, specific models would be required for CH₄ prediction when cows receive chemical inhibitors of CH₄ emissions not affecting milk composition.

807 The Association between Blood Transfusion and Outcome in Hip Fracture Patients

Aim

Hip Fractures are endemic in older adults across Europe, with potential increases in incidence expected as the population ages. Management of blood loss and anaemia is a mainstay of care for these patients, but there is still significant debate regarding balance between benefit and risk of liberal versus restrictive transfusion policies. Understanding the association between providing blood products and adverse healthcare outcomes in hip fracture patients is a key component in the transfusion decision-making process.

Method

This retrospective cohort study uses national audit data from the Scottish Hip Fracture Audit (SHFA) and the Scottish National Blood Transfusion Service (SNBTS) to examine the association between blood transfusion and important hip fracture process of care measures and healthcare outcomes.

Results

A total of 28 461 patient records were included for assessment across 19 acute hospitals. Blood transfusion during admission was associated with a small but statistically significant decrease in survival at both 30 and 60 days. Those receiving blood transfusion during admission were less likely to be mobilised by the end of the 1st post-operative day, less likely to have a length of stay below the average and had far lower probability of discharge.

Conclusion

This study found that blood transfusion is associated with poor healthcare outcomes following hip fracture, even when adjusted for potential confounding factors. This likely reflects the potential harm of perioperative anaemia rather than any direct impact from transfusion. Further work to reduce perioperative blood loss is therefore key to improving important hip fracture outcomes.

Biophysical parameters and time to isolation of pulmonary veins with a novel cryoballoon: results of POLAR ICE study

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Boston Scientific

Introduction

Low nadir temperatures and long thaw times with cryoballoon ablation are associated with successful pulmonary vein isolation (PVI). Recently, a system that maintains uniform pressure and size has been introduced to improve catheter stability during cryoballoon ablation. The present results examine the relationship between cryoballoon time to isolation (TTI) and other biophysical parameters; time to -40ºC (TT-40), nadir temperature, time to thaw (TT0), and first pass isolation success in patients with paroxysmal AF (PAF).

Methods

POLAR ICE, a prospective, non-randomized, multicenter (international) registry (NCT04250714), enrolled 400 patients across 19 centers, between Aug 2020 and May 2021. This study included any patients indicated for treatment of PAF with the POLARx cryoablation system. Cryodosing regimen was left to the operator and not specified by study protocol. Procedural characteristics, such as time to isolation (TTI), cryoablations per pulmonary vein, nadir temperature, and occlusion grade were recorded. PVI was confirmed via entrance block. Biophysical parameters for ablations longer than 120s were evaluated.

Results

Data on 389 PVI procedures (n=2303 ablations) were collected. Of those ablations, 1914 (83%) had a duration of at least 120s and were included in this analysis. Isolation was attempted using the CB alone. TTI was reported in 1335 ablations with the majority (64%) occurring within 60s. Biophysical parameters and single shot success rates were examined based on TTI. Ablations with TTI<60s had significantly faster TT-40 (30.6±7.4s), lower nadir temperatures (-58.3±5.8ºC), longer thaw times (21.1±6.7s), and a greater proportion of grade 4 occlusions (88%) than longer TTIs or ablation with no TTI reported (Table 1). In TTIs<60s single shot success was 95%, significantly greater than TT≥60s, or No TTI. Procedure-related complications included: phrenic nerve palsy (0.5%), tamponade (0.5%), AV block (0.3%), stroke (0.3%), and transient ischemic attack (0.3%).

Conclusions

These data suggest a correlation between cryoballoon biophysical parameters and single shot success. Good occlusion likely drives faster freeze and lower nadir temperatures, resulting in longer thaw times with this novel cryoballoon. Future research should examine the relationship between these parameters to drive optimization of cryoablation techniques and provide guidance toward improved workflow.

[Take-home messages from the COPD 2021 biennial of the French Society of Respiratory Diseases. Understanding to so as to better innovate]

INTRODUCTION

The first COPD biennial organized by the French Society of Respiratory Diseases (SPLF) took place on 17 December 2021.

STATE OF THE ART

The objective of the biennial was to discuss current knowledge regarding COPD pathophysiology, current treatments, research development, and future therapeutic approaches.

PERSPECTIVES

The different lecturers laid emphasis on the complexity of pathophysiologic mechanisms including bronchial, bronchiolar and parenchymal alterations, and also dwelt on the role of microbiota composition in COPD pathenogenesis. They pointed out that addition to inhaled treatments, ventilatory support and endoscopic approaches have been increasingly optimized. The development of new therapeutic pathways such as biotherapy and cell therapy (stem cells…) call for further exploration.

CONCLUSIONS

The dynamism of COPD research was repeatedly underlined, and needs to be further reinforced, the objective being to "understand so as to better innovate" so as to develop effective new strategies for treatment and management of COPD.

Nitrogen isotopic discrimination as a biomarker of between-cow variation in the efficiency of nitrogen utilization for milk production: A meta-analysis

Estimating the efficiency of N utilization for milk production (MNE) of individual cows at a large scale is difficult, particularly because of the cost of measuring feed intake. Nitrogen isotopic discrimination (Δ¹⁵N) between the animal (milk, plasma, or tissues) and its diet has been proposed as a biomarker of the efficiency of N utilization in a range of production systems and ruminant species. The aim of this study was to assess the ability of Δ¹⁵N to predict the between-animal variability in MNE in dairy cows using an extensive database. For this, 20 independent experiments conducted as either changeover (n = 14) or continuous (n = 6) trials were available and comprised an initial data set of 1,300 observations. Between-animal variability was defined as the variation observed among cows sharing the same contemporary group (CG; individuals from the same experimental site, sampling period, and dietary treatment). Milk N efficiency was calculated as the ratio between mean milk N (grams of N in milk per day) and mean N intake (grams of N intake per day) obtained from each sampling period, which lasted 9.0 ± 9.9 d (mean ± SD). Samples of milk (n = 604) or plasma (n = 696) and feeds (74 dietary treatments) were analyzed for natural ¹⁵N abundance (δ¹⁵N), and then the N isotopic discrimination between the animal and the dietary treatment was calculated (Δ¹⁵n = δ¹⁵N_animal - δ¹⁵N_diet). Data were analyzed through mixed-effect regression models considering the experiment, sampling period, and dietary treatment as random effects. In addition, repeatability estimates were calculated for each experiment to test the hypothesis of improved predictions when MNE and Δ¹⁵N measurements errors were lower. The considerable protein mobilization in early lactation artificially increased both MNE and Δ¹⁵N, leading to a positive rather than negative relationship, and this limited the implementation of this biomarker in early lactating cows. When the experimental errors of Δ¹⁵N and MNE decreased in a particular experiment (i.e., higher repeatability values), we observed a greater ability of Δ¹⁵N to predict MNE at the individual level. The predominant negative and significant correlation between Δ¹⁵N and MNE in mid- and late lactation demonstrated that on average Δ¹⁵N reflects MNE variations both across dietary treatments and between animals. The root mean squared prediction error as a percentage of average observed value was 6.8%, indicating that the model only allowed differentiation between 2 cows in terms of MNE within a CG if they differed by at least 0.112 g/g of MNE (95% confidence level), and this could represent a limitation in predicting MNE at the individual level. However, the one-way ANOVA performed to test the ability of Δ¹⁵N to differentiate within-CG the top 25% from the lowest 25% individuals in terms of MNE was significant, indicating that it is possible to distinguish extreme animals in terms of MNE from their N isotopic signature, which could be useful to group animals for precision feeding.

An app with brief behavioural support to promote physical activity after a cancer diagnosis (APPROACH): study protocol for a pilot randomised controlled trial

Background

There are multiple health benefits from participating in physical activity after a cancer diagnosis, but many people living with and beyond cancer (LWBC) are not meeting physical activity guidelines. App-based interventions offer a promising platform for intervention delivery. This trial aims to pilot a theory-driven, app-based intervention that promotes brisk walking among people living with and beyond cancer. The primary aim is to investigate the feasibility and acceptability of study procedures before conducting a larger randomised controlled trial (RCT).

Methods

This is an individually randomised, two-armed pilot RCT. Patients with localised or metastatic breast, prostate, or colorectal cancer, who are aged 16 years or over, will be recruited from a single hospital site in South Yorkshire in the UK. The intervention includes an app designed to encourage brisk walking (Active 10) supplemented with habit-based behavioural support in the form of two brief telephone/video calls, an information leaflet, and walking planners. The primary outcomes will be feasibility and acceptability of the study procedures. Demographic and medical characteristics will be collected at baseline, through self-report and hospital records. Secondary outcomes for the pilot (assessed at 0 and 3 months) will be accelerometer measured and self-reported physical activity, body mass index (BMI) and waist circumference, and patient-reported outcomes of quality of life, fatigue, sleep, anxiety, depression, self-efficacy, and habit strength for walking. Qualitative interviews will explore experiences of participating or reasons for declining to participate. Parameters for the intended primary outcome measure (accelerometer measured average daily minutes of brisk walking (≥ 100 steps/min)) will inform a sample size calculation for the future RCT and a preliminary economic evaluation will be conducted.

Discussion

This pilot study will inform the design of a larger RCT to investigate the efficacy and cost-effectiveness of this intervention in people LWBC.

Trial registration

ISRCTN registry, ISRCTN18063498. Registered 16 April 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-022-01028-w.

Liraglutide, a glucagon-like peptide 1 receptor agonist, exerts analgesic, anti-inflammatory and anti-degradative actions in osteoarthritis

Osteoarthritis (OA) is a common disabling disease worldwide, with no effective and safe disease-modifying drugs (DMOAD) in the market. However, studies suggest that drugs, such as liraglutide, which possess strong potential in decreasing low-grade systemic inflammation may be effective in treating OA. Therefore, the aim of this study was to examine the anti-inflammatory, analgesic, and anti-degradative effects in OA using in vitro and in vivo experiments. The results showed that intra-articular injection of liraglutide alleviated pain-related behavior in in vivo sodium monoiodoacetate OA mouse model, which was probably driven by the GLP-1R-mediated anti-inflammatory activity of liraglutide. Moreover, liraglutide treatment significantly decreased IL-6, PGE₂ and nitric oxide secretion, and the expression of inflammatory genes in vitro in chondrocytes and macrophages in a dose-dependent manner. Additionally, liraglutide shifted polarized macrophage phenotype in vitro from the pro-inflammatory M1 phenotype to the M2 anti-inflammatory phenotype. Furthermore, liraglutide exerted anti-catabolic activity by significantly decreasing the activities of metalloproteinases and aggrecanases, a family of catabolic enzymes involved in cartilage breakdown in vitro. Overall, the findings of this study showed that liraglutide ameliorated OA-associated pain, possess anti-inflammatory and analgesic properties, and could constitute a novel therapeutic candidate for OA treatment.

Is the Development of Gestational Diabetes Associated With the ABO Blood Group/Rhesus Phenotype?

AIMS

There are few published data on the putative association between the ABO blood group/rhesus (Rh) factor and the risk of developing gestational diabetes mellitus (GDM). Our aim was to explore the link between each one factor and GDM development.

METHODS

All women having given birth at Lille University Medical Center (Lille, France) between August 1^st, 2017, and February 28^th, 2018, were tested for GDM, using the method recommended in the French national guidelines. The risk of GDM was assessed for each ABO blood group, each Rh phenotype and combinations thereof, using logistic regression models.

RESULTS

1194 women had at least one GDM risk factor. The percentage of GDM varied with the ABO group (p=0.013). Relative to group O women, group AB women were more likely to develop GDM (OR = 2.50, 95% CI [1.43 to 4.36], p=0.001). Compared with the Rh-positive O group, only the Rh-positive AB group had an elevated risk of developing GDM (OR = 3.02, 95% CI [1.69 to 5.39], p < 0.001).

CONCLUSIONS

Our results showed that Rh-positive group AB women have a greater risk of GDM. With a view to preventing GDM, at-risk individuals could be identified by considering the ABO blood group phenotype either as a single risk factor or in combination with other risk factors.

Targeting the GLP-1/GLP-1R axis to treat osteoarthritis: A new opportunity?

Osteoarthritis (OA) is a degenerative joint disease affecting millions of people worldwide. In OA, chondrocytes, synovial cells and other joint cells become activated when exposed to an abnormal environment, including mechanical stress, inflammatory cytokines or disorganization of matrix proteins. Several analogues of the hormones called incretins have been developed and are used notably for treating type 2 diabetes mellitus. Data has accumulated to suggest that incretinomimetics, which bind to the glucagon-like peptide-1 receptor (GLP-1R), have beneficial pleiotropic effects such as immunomodulation, anti-inflammation and neuronal protection. Thus, because of their anti-inflammatory properties, GLP-1-based therapies could benefit OA patients. This review focuses on the GLP-1R pathway, molecular mechanisms and phenotypes related to OA pathogenesis.

The translational potential of this article

The search for new therapeutic targets to treat people suffering from OA remains urgent as there is currently no disease-modifyingtherapy available for this disease. This review discusses how GLP-1 analogues could be potential DMOADs for treating OA thanks to their anti-inflammatory, immunoregulatory and differentiation properties.