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Benefit of Uracil-Tegafur Used as a Postoperative Adjuvant Chemotherapy for Stage IIA Colon Cancer. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010010. [PMID: 36676634 PMCID: PMC9864689 DOI: 10.3390/medicina59010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Postoperative adjuvant therapy with uracil and tegafur (UFT) is often used for stage II colon cancer in Japan, but a limited number of studies have investigated the effects of UFT in these patients. Materials and Methods: We conducted a population-based cohort study in patients with resected stage II colon cancer comparing the outcomes after postoperative adjuvant chemotherapy with UFT with an observation-only group. The data were collected from the Taiwan National Health Insurance Research Database from 2000 to 2015. The outcomes of the study were disease-free survival (DFS) and overall survival (OS). The hazard ratios (HRs) were calculated using multivariate Cox proportional hazard regression models. Results: No differences in the DFS and OS were detected between the UFT (1137 patients) and observation (2779 patients) cohorts (DFS: adjusted HR 0.702; 95% confidence interval (CI) 0.489-1.024; p = 0.074) (OS: adjusted HR 0.894; 95% CI 0.542-1.186; p = 0.477). In the subgroup analyses of the different substages, UFT prolonged DFS in patients with stage IIA colon cancer (adjusted HR 0.652; 95% CI 0.352-0.951; p = 0.001) compared with DFS in the observation cohort, but no differences in the OS were detected (adjusted HR 0.734; 95% CI 0.475-1.093; p = 0.503). Conclusions: Our results show that DFS improved significantly in patients with stage IIA colon cancer receiving UFT as a postoperative adjuvant chemotherapy compared with DFS in the observation group.
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King BL, Meyer ML, Chari SV, Hurka-Richardson K, Bohrmann T, Chang PP, Rodgers JE, Busby-Whitehead J, Casey MF. Accuracy of the electronic health record's problem list in describing multimorbidity in patients with heart failure in the emergency department. PLoS One 2022; 17:e0279033. [PMID: 36512600 PMCID: PMC9747000 DOI: 10.1371/journal.pone.0279033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
Patients with heart failure (HF) often suffer from multimorbidity. Rapid assessment of multimorbidity is important for minimizing the risk of harmful drug-disease and drug-drug interactions. We assessed the accuracy of using the electronic health record (EHR) problem list to identify comorbid conditions among patients with chronic HF in the emergency department (ED). A retrospective chart review study was performed on a random sample of 200 patients age ≥65 years with a diagnosis of HF presenting to an academic ED in 2019. We assessed participant chronic conditions using: (1) structured chart review (gold standard) and (2) an EHR-based algorithm using the problem list. Chronic conditions were classified into 37 disease domains using the Agency for Healthcare Research Quality's Elixhauser Comorbidity Software. For each disease domain, we report the sensitivity, specificity, positive predictive value, and negative predictive of using an EHR-based algorithm. We calculated the intra-class correlation coefficient (ICC) to assess overall agreement on Elixhauser domain count between chart review and problem list. Patients with HF had a mean of 5.4 chronic conditions (SD 2.1) in the chart review and a mean of 4.1 chronic conditions (SD 2.1) in the EHR-based problem list. The five most prevalent domains were uncomplicated hypertension (90%), obesity (42%), chronic pulmonary disease (38%), deficiency anemias (33%), and diabetes with chronic complications (30.5%). The positive predictive value and negative predictive value of using the EHR-based problem list was greater than 90% for 24/37 and 32/37 disease domains, respectively. The EHR-based problem list correctly identified 3.7 domains per patient and misclassified 2.0 domains per patient. Overall, the ICC in comparing Elixhauser domain count was 0.77 (95% CI: 0.71-0.82). The EHR-based problem list captures multimorbidity with moderate-to-good accuracy in patient with HF in the ED.
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Affiliation(s)
- Brandon L. King
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Michelle L. Meyer
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Srihari V. Chari
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Karen Hurka-Richardson
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Thomas Bohrmann
- Analytical Partners Consulting LLC, Raleigh, North Carolina, United States of America
| | - Patricia P. Chang
- Division of Cardiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Jo Ellen Rodgers
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina, United States of America
| | - Jan Busby-Whitehead
- Division of Geriatric Medicine and Center of Aging and Health, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Martin F. Casey
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
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Multidimensional analysis of adult patients’ care trajectories before a first diagnosis of schizophrenia. SCHIZOPHRENIA 2022; 8:52. [PMID: 35854023 PMCID: PMC9261102 DOI: 10.1038/s41537-022-00256-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 04/21/2022] [Indexed: 11/09/2022]
Abstract
For patients at high-risk for developing schizophrenia, a delayed diagnosis could be affected, among many reasons, by their patterns of healthcare use. This study aims to describe and generate a typology of patients’ care trajectories (CTs) in the 2 years preceding a first diagnosis of schizophrenia, over a medico-administrative database of 3712 adults with a first diagnosis between April 2014 and March 2015 in Quebec, Canada. This study applied a multidimensional approach of State Sequence Analysis, considering together sequences of patients’ diagnoses, care settings and care providers. Five types of distinct CTs have emerged from this data-driven analysis: The type 1, shared by 77.6% of patients, predominantly younger men, shows that this group sought little healthcare, among which 17.5% had no healthcare contact for mental disorders. These individuals might benefit from improved promotion and prevention of mental healthcare at the community level. The types 2, 3 and 4, with higher occurrence of mental disorder diagnoses, represent together 19.5% of the study cohort, mostly middle-aged and women. These CTs, although displaying roughly similar profiles of mental disorders, revealed very dissimilar sequences and levels of care providers encounters, primary and specialized care use, and hospitalizations. Surprisingly, patients of these CTs had few consultations with general practitioners. An increased attentiveness for middle-aged patients and women with high healthcare use for mental disorders could help to reduce delayed diagnosis of schizophrenia. This calls for further consideration of healthcare services for severe mental illness beyond those offered to young adults.
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Associations between existing and newly diagnosed chronic health conditions and change in subjective life expectancy: Results from a panel study. SSM Popul Health 2022; 20:101271. [PMID: 36325487 PMCID: PMC9619028 DOI: 10.1016/j.ssmph.2022.101271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022] Open
Abstract
Background Subjective life expectancy (SLE) is a vital predictor of mortality, health and retirement. Nevertheless, we have sparse knowledge about what drives changes in SLE. Having a chronic health condition (CHC) is probably associated with a change SLE. However, how CHCs are associated with changes in SLE may depend on whether the CHC was newly diagnosed and the type of CHC. Aim We hypothesize that newly diagnosed CHCs will be strongly negatively associated with changes in SLE than existing CHCs. As CHCs vary in their presentation and prognosis, we differentiate associations between five CHCs - arthritis, cardiovascular diseases, sleep disorders, psychological disorders and life-threatening conditions - and changes in SLE. Method Data from two waves of a Dutch pension panel survey, collected 3 years apart in 2015 and 2018, were used. The analytical sample included 4824 older workers between the ages of 60-65 years at wave 1. Data were analysed longitudinally using a conditional change ordered logistic regression model. Results In general, newly diagnosed CHCs were strongly negatively associated with changes in SLE, relative to having no CHCs. Existing CHCs were also negatively associated with changes in SLE, but to a weaker strength. Interestingly, associations between CHCs and the change in SLE differed based on the CHC in question. Conclusion Newly diagnosed life-threatening conditions, psychological disorders and cardiovascular diseases are strongly negatively associated with changes in SLE. These results provide insight into the differences in how older workers with CHCs experience late career work and how these experiences influence their SLE.
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Chiu YM, Dufour I, Courteau J, Vanasse A, Chouinard MC, Dubois MF, Dubuc N, Elazhary N, Hudon C. Profiles of frequent emergency department users with chronic conditions: a latent class analysis. BMJ Open 2022; 12:e055297. [PMID: 36175089 PMCID: PMC9528600 DOI: 10.1136/bmjopen-2021-055297] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Frequent emergency department users represent a small proportion of users while cumulating many visits. Previously identified factors of frequent use include high physical comorbidity, mental health disorders, poor socioeconomic status and substance abuse. However, frequent users do not necessarily exhibit all these characteristics and they constitute a heterogeneous population. This study aims to establish profiles of frequent emergency department users in an adult population with chronic conditions. DESIGN This is a retrospective cohort study using administrative databases. SETTING All adults who visited the emergency department between 2012 and 2013 (index date) in the province of Quebec (Canada), diagnosed with at least one chronic condition, and without dementia were included. Patients living in remote areas and who died in the year following their index date were excluded. We used latent class analysis, a probability-based model to establish profiles of frequent emergency department users. Frequent use was defined as having five visits or more during 1 year. Patient characteristics included sociodemographic characteristics, physical and mental comorbidities and prior healthcare utilisation. RESULTS Out of 4 51 775 patients who visited emergency departments at least once in 2012-2013, 13 676 (3.03%) were frequent users. Four groups were identified: (1) 'low morbidity' (n=5501, 40.2%), (2) 'high physical comorbidity' (n=3202, 23.4%), (3) 'injury or chronic non-cancer pain' (n=2313, 19.5%) and (4) 'mental health or alcohol/substance abuse' (n=2660, 16.9%). CONCLUSIONS The four profiles have distinct medical and socioeconomic characteristics. These profiles provide useful information for developing tailored interventions that would address the specific needs of each type of frequent emergency department users.
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Affiliation(s)
- Yohann Moanahere Chiu
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Isabelle Dufour
- École des sciences infirmières, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Josiane Courteau
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Alain Vanasse
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Maud-Christine Chouinard
- Département des sciences de la santé, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada
| | - Marie-France Dubois
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Nicole Dubuc
- École des sciences infirmières, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de Recherche sur le Vieillissement, Sherbrooke, Quebec, Canada
| | - Nicolas Elazhary
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Catherine Hudon
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
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Dufour I, Vedel I, Quesnel-Vallée A. Identification of Major Cognitive Disorders in Self-Reported versus Administrative Health Data: A Cohort Study in Quebec. J Alzheimers Dis 2022; 89:1091-1101. [PMID: 35964188 DOI: 10.3233/jad-220327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The first imperative in producing the relevant and needed knowledge about major neurocognitive disorder (MNCD) is to identify people presenting with the condition adequately. To document potential disparities between administrative health databases and population-based surveys could help identify specific challenges in this population and methodological shortfalls. OBJECTIVE To describe and compare the characteristics of community-dwelling older adults according to four groups: 1) No MNCD; 2) Self-reported MNCD only; 3) MNCD in administrative health data only; 4) MNCD in both self-reported and administrative health data. METHODS This retrospective cohort study used the Care Trajectories-Enriched Data (TorSaDE) cohort, a linkage between five waves of the Canadian Community Health Survey (CCHS) and health administrative health data. We included older adults living in the community who participated in at least one cycle of the CCHS. We reported on positive and negative MNCD in self-reported versus administrative health data. We then compared groups' characteristics using chi-square tests and ANOVA. RESULTS The study cohort was composed of 25,125 older adults, of which 784 (3.12%) had MNCD. About 70% of people with an MNCD identified in administrative health data did not report it in the CCHS. The four groups present specific challenges related to the importance of perception, timely diagnosis, and the caregivers' roles in reporting health information. CONCLUSION To a certain degree, both data sources fail to consider subgroups experiencing issues related to MNCD; studies like ours provide insight to understand their characteristics and needs better.
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Affiliation(s)
- Isabelle Dufour
- Department of Epidemiology, Biostatistics, andOccupational Health, Faculty of Medicine, McGill University, Montreal, Canada
| | - Isabelle Vedel
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Faculty of Medicine, McGill University, Montréal, Canada
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Guo Ie H, Tang CH, Sheu ML, Liu HY, Lu N, Tsai TY, Chen BL, Huang KC. Evaluation of risk adjustment performance of diagnosis-based and medication-based comorbidity indices in patients with chronic obstructive pulmonary disease. PLoS One 2022; 17:e0270468. [PMID: 35802678 PMCID: PMC9269939 DOI: 10.1371/journal.pone.0270468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/12/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives
This study assessed risk adjustment performance of six comorbidity indices in two categories of comorbidity measures: diagnosis-based comorbidity indices and medication-based ones in patients with chronic obstructive pulmonary disease (COPD).
Methods
This was a population–based retrospective cohort study. Data used in this study were sourced from the Taiwan National Health Insurance Research Database. The study population comprised all patients who were hospitalized due to COPD for the first time in the target year of 2012. Each qualified patient was individually followed for one year starting from the index date to assess two outcomes of interest, medical expenditures within one year after discharge and in-hospital mortality of patients. To assess how well the added comorbidity measures would improve the fitted model, we calculated the log-likelihood ratio statistic G2. Subsequently, we compared risk adjustment performance of the comorbidity indices by using the Harrell c-statistic measure derived from multiple logistic regression models.
Results
Analytical results demonstrated that that comorbidity measures were significant predictors of medical expenditures and mortality of COPD patients. Specifically, in the category of diagnosis-based comorbidity indices the Elixhauser index was superior to other indices, while the RxRisk-V index was a stronger predictor in the framework of medication-based codes, for gauging both medical expenditures and in-hospital mortality by utilizing information from the index hospitalization only as well as the index and prior hospitalizations.
Conclusions
In conclusion, this work has ascertained that comorbidity indices are significant predictors of medical expenditures and mortality of COPD patients. Based on the study findings, we propose that when designing the payment schemes for patients with chronic diseases, the health authority should make adjustments in accordance with the burden of health care caused by comorbid conditions.
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Affiliation(s)
- Huei Guo Ie
- Teaching Resource Center, Office of Academic Affairs, Taipei Medical University, Taipei City, Taiwan
| | - Chao-Hsiun Tang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei City, Taiwan
| | - Mei-Ling Sheu
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei City, Taiwan
| | - Hung-Yi Liu
- Health and Clinical Research Data Center, Taipei Medical University, Taipei City, Taiwan
| | - Ning Lu
- Department of Health Administration, College of Health and Human Services, Governors State University, University Park, Illinois, United States of America
| | - Tuan-Ya Tsai
- Department of Pharmacy, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Bi-Li Chen
- Department of Pharmacy, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Kuo-Cherh Huang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei City, Taiwan
- * E-mail:
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Maltais A, Simard M, Vedel I, Sirois C. Changes in Polypharmacy and Psychotropic Medication Use After Diagnosis of Major Neurocognitive Disorders: A Population-based Study in Québec, Canada. Alzheimer Dis Assoc Disord 2022; 36:222-229. [PMID: 35661072 DOI: 10.1097/wad.0000000000000513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/30/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Older adults with major neurocognitive disorder (MNCD) are often exposed to polypharmacy. We aimed to assess the prescribing and discontinuation patterns of medications following diagnosis of MNCD among community-dwelling older adults. METHODS Using the Quebec Integrated Chronic Disease Surveillance System, we conducted a population-based cohort study comparing 1-year prediagnosis and postdiagnosis use of medications between a group of individuals older than 65 years newly diagnosed with MNCD in 2016-2017 and a control group without MNCD. The difference-in-difference method was used to estimate the prediagnosis and postdiagnosis variation in the number of medications prescribed and in the proportion of psychotropic and anticholinergic medication users. RESULTS In the MNCD group, the mean number of medications used (excluding Alzheimer disease treatments) increased by 1.25 in the year after the diagnosis. The respective increase was 0.45 in the control group, yielding an adjusted difference-in-differences of 0.81 (95% confidence interval: 0.74; 0.87) between groups. The adjusted difference-in-differences in the proportions of antipsychotic, antidepressant, and anticholinergic medication users was 13.2% (12.5; 13.9), 7.1% (6.5; 7.7), and 3.8% (3.1; 4.6), respectively. CONCLUSIONS The medication burden among older adults tends to increase in the year following a diagnosis of MNCD. The use of antipsychotics and antidepressants may explain a part of the observed increase.
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Affiliation(s)
- Annie Maltais
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University
- Quebec Center of Excellence on Aging, Research Center of the CHU of Quebec
| | - Marc Simard
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University
- Quebec Center of Excellence on Aging, Research Center of the CHU of Quebec
- Quebec National Institute of Public Health, Québec
| | - Isabelle Vedel
- Quebec National Institute of Public Health, Québec
- Lady Davis Institute of the Jewish General Hospital
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Caroline Sirois
- Faculty of Pharmacy, Laval University
- Quebec Center of Excellence on Aging, Research Center of the CHU of Quebec
- Quebec National Institute of Public Health, Québec
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Khelifi N, Blais C, Jean S, Hamel D, Clavel MA, Pibarot P, Mac-Way F. Temporal trends of aortic stenosis and comorbid chronic kidney disease in the province of Quebec, Canada. Open Heart 2022; 9:openhrt-2021-001923. [PMID: 35710290 PMCID: PMC9204438 DOI: 10.1136/openhrt-2021-001923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/04/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate temporal trends of chronic kidney disease (CKD) among patients with incident aortic stenosis (AS) and to compare these trends with that of a matched control population. METHODS Using the Quebec Integrated Chronic Disease Surveillance System, we performed a population-based nested case-control study including 108 780 patients newly hospitalised with AS and 543 900 age-matched, sex-matched and fiscal year-matched patients without AS from 2000 to 2016 in Quebec (Canada). Three subgroups were considered. Dialysis subgroup had at least two outpatient billing codes of dialysis. The predialysis subgroup had at least one hospital or two billing diagnostic codes of CKD. The remaining individuals were included in the non-CKD subgroup. We estimated overall and sex-specific standardised annual proportions of CKD subgroups through direct standardisation using the 2016-2017 age structure of the incident AS cohort. The trends overtime were estimated through fitting robust Poisson regression models. Age-specific distribution of AS and control population were assessed for each subgroup. RESULTS From 2000 to 2016, age-standardised proportions of patients with AS with dialysis and predialysis increased by 41% (99% CI 12.0% to 78.1%) and by 45% (99% CI 39.1% to 51.6%), respectively. Inversely, age-standardised proportions of dialysis and pre-dialysis among non-AS patients decreased by 63% (99% CI 55.8% to 68.7%) and by 32% (99% CI 29.9% to 34.6%), respectively, during the same study period. In patients with and without AS, age-standardised annual proportions of males in predialysis were significantly higher than females in most of the study period. Patients with AS on dialysis and predialysis were younger than their respective controls (dialysis: 29.6% vs 45.1% had ≥80 years, predialysis: 60.8% vs 72.7% had ≥80 years). CONCLUSIONS Over time, the proportion of patients with CKD increased significantly and remained consistently higher in incident AS individuals compared with controls. Our results highlight the need to investigate whether interventions targeting CKD risk factors may influence AS incidence in the future.
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Affiliation(s)
- Nada Khelifi
- Division of Nephrology, Endocrinology and Nephrology Axis, CHU de Quebec Research Center, Quebec, Quebec, Canada.,Faculty and Department of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Claudia Blais
- Institut National de Santé Publique du Québec, Quebec, Quebec, Canada.,Faculty of Pharmacy, Université Laval, Quebec, Quebec, Canada
| | - Sonia Jean
- Faculty and Department of Medicine, Université Laval, Quebec, Quebec, Canada.,Institut National de Santé Publique du Québec, Quebec, Quebec, Canada
| | - Denis Hamel
- Institut National de Santé Publique du Québec, Quebec, Quebec, Canada
| | - Marie-Annick Clavel
- Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec, Quebec, Canada
| | - Philippe Pibarot
- Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec, Quebec, Canada
| | - Fabrice Mac-Way
- Division of Nephrology, Endocrinology and Nephrology Axis, CHU de Quebec Research Center, Quebec, Quebec, Canada .,Faculty and Department of Medicine, Université Laval, Quebec, Quebec, Canada
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Flannery L, Etiwy M, Camacho A, Liu R, Patel N, Tavil-Shatelyan A, Tanguturi VK, Dal-Bianco JP, Yucel E, Sakhuja R, Jassar AS, Langer NB, Inglessis I, Passeri JJ, Hung J, Elmariah S. Patient- and Process-Related Contributors to the Underuse of Aortic Valve Replacement and Subsequent Mortality in Ambulatory Patients With Severe Aortic Stenosis. J Am Heart Assoc 2022; 11:e025065. [PMID: 35621198 PMCID: PMC9238693 DOI: 10.1161/jaha.121.025065] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Many patients with severe aortic stenosis (AS) and an indication for aortic valve replacement (AVR) do not undergo treatment. The reasons for this have not been well studied in the transcatheter AVR era. We sought to determine how patient‐ and process‐specific factors affected AVR use in patients with severe AS. Methods and Results We identified ambulatory patients from 2016 to 2018 demonstrating severe AS, defined by aortic valve area ≤1.0 cm2. Propensity scoring analysis with inverse probability of treatment weighting was used to evaluate associations between predictors and the odds of undergoing AVR at 365 days and subsequent mortality at 730 days. Of 324 patients with an indication for AVR (79.3±9.7 years, 57.4% men), 140 patients (43.2%) did not undergo AVR. The odds of AVR were reduced in patients aged >90 years (odds ratio [OR], 0.24 [95% CI, 0.08–0.69]; P=0.01), greater comorbid conditions (OR, 0.88 per 1‐point increase in Combined Comorbidity Index [95% CI, 0.79–0.97]; P=0.01), low‐flow, low‐gradient AS with preserved left ventricular ejection fraction (OR, 0.11 [95% CI, 0.06–0.21]), and low‐gradient AS with reduced left ventricular ejection fraction (OR, 0.18 [95% CI, 0.08–0.40]) and were increased if the transthoracic echocardiogram ordering provider was a cardiologist (OR, 2.46 [95% CI, 1.38–4.38]). Patients who underwent AVR gained an average of 85.8 days of life (95% CI, 40.9–130.6) at 730 days. Conclusions The proportion of ambulatory patients with severe AS and an indication for AVR who do not receive AVR remains significant. Efforts are needed to maximize the recognition of severe AS, especially low‐gradient subtypes, and to encourage patient referral to multidisciplinary heart valve teams.
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Affiliation(s)
- Laura Flannery
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Muhammad Etiwy
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Alexander Camacho
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Ran Liu
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Nilay Patel
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Arpi Tavil-Shatelyan
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Varsha K Tanguturi
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Jacob P Dal-Bianco
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Evin Yucel
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Rahul Sakhuja
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Arminder S Jassar
- Division of Cardiac Surgery Department of Surgery Massachusetts General HospitalHarvard Medical School Boston MA
| | - Nathaniel B Langer
- Division of Cardiac Surgery Department of Surgery Massachusetts General HospitalHarvard Medical School Boston MA
| | - Ignacio Inglessis
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Jonathan J Passeri
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Judy Hung
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Sammy Elmariah
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
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Gabet M, Gentil L, Lesage A, Fleury MJ. Investigating characteristics of patients with mental disorders to predict out-patient physician follow-up within 30 days of emergency department discharge. BJPsych Open 2022; 8:e95. [PMID: 35579032 PMCID: PMC9169501 DOI: 10.1192/bjo.2022.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prompt follow-up at emergency department discharge is a key indicator of healthcare quality and patient recovery. To improve services, better knowledge of predictors for out-patient physician follow-up within 30 days after discharge is needed. AIMS We investigated clinical and sociodemographic characteristics and service use to predict patients with mental disorders with or without physician follow-up after emergency department use. METHOD This study used data extracted from clinical administrative databases for 9514 patients who attended an emergency department in Quebec (Canada) in 2014-2015 (index visit) for mental health reasons. Patient clinical and sociodemographic characteristics from 2012-2013 to 2014-2015, and service use 12 months before the index visit, were investigated as predictors for patients with or without prompt follow-up, using hierarchical logistic regression. RESULTS Two-thirds of patients did not receive prompt physician follow-up. Patients with level 1-2 illness acuity at emergency department triage (needing immediate or urgent care); those with adjustment or bipolar disorders, but without alcohol-related disorders (clinical characteristics); and patients with higher continuity of physician care, more psychosocial interventions in community healthcare centres and prior hospital admission (service use characteristics) were more likely to receive prompt out-patient follow-up. CONCLUSIONS Access to medical care was poor, considering the high needs of this population. The role of the emergency department as a gateway for accessing out-patient care may be strengthened by strategies like screening, brief intervention including motivational treatments, brief case management offered by emergency department staff, timely referral to services and better post-discharge planning. Collaborative care for patients attending emergency departments should also be improved.
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Affiliation(s)
- Morgane Gabet
- Department of Health Administration, School of Public Health, Université de Montréal, Canada; and Douglas Hospital Research Center, Canada
| | - Lia Gentil
- Douglas Hospital Research Center, Canada; and Department of Psychiatry, McGill University, Canada
| | - Alain Lesage
- Department of Psychiatry, Université de Montréal, Canada; and Centre de recherche Fernand-Séguin, Institut universitaire en santé mentale de Montréal, Canada
| | - Marie-Josée Fleury
- Department of Health Administration, School of Public Health, Université de Montréal, Canada; Douglas Hospital Research Center, Canada; and Department of Psychiatry, McGill University, Canada
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Lorenzo CJ, Conte JI, Villasmil RJ, Abdelal QK, Pierce D, Wiese‐Rometsch W, Garcia‐Fernandez JA. Heart failure ejection fraction class conversions: impact of biomarkers, co‐morbidities, and pharmacotherapy. ESC Heart Fail 2022; 9:2538-2547. [PMID: 35570322 PMCID: PMC9288751 DOI: 10.1002/ehf2.13965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 12/24/2022] Open
Abstract
Aims Temporal conversions among ejection fraction (EF) classes can occur across the heart failure (HF) spectrum reflecting amended structural and functional outcomes unaccounted for by current taxonomy. This retrospective study aims to investigate the differences in serum laboratory values, guideline‐directed medical therapy (GDMT), and co‐morbidity burden across EF conversion groups. Methods and results Heart failure patients at least 18‐year‐old who obtained at least two echocardiograms between January 2018 and January 2020 were identified using ICD‐10 codes. Analysis of variance, chi‐square tests, and analysis of means for proportions were used as appropriate to identify associations with class conversion groups. A total of 874 patients who underwent 1748 echocardiograms on unique visits were categorized according to initial EF as HF with preserved EF (HFpEF) (n = 531, 61%), HF with mildly reduced or midrange EF (HFmrEF) (n = 132, 15%), or HF with reduced EF (HFrEF) (n = 211, 24%). In accordance with follow‐up EF, class conversions were categorized into HF with improved EF (HFiEF) (n = 143, 16%), HF with worsened EF (HFwEF) (n = 171, 20%), or HF with stable EF (HFsEF) (n = 560, 64%). The average age was 75 ± 13 years old; 54% were male, 85% were Caucasian, 11% were African American, and 4% other. The mean time between EF assessments was 208.6 ± 170.2 days. Serum sodium levels were greater in HFwEF (139 ± 3 mmol/L) when compared with HFsEF (138 ± 4 mmol/L) (P = 0.05). Pro‐BNP levels were higher in HFiEF (12 150 ± 19 554 pg/mL) versus HFsEF (6671 ± 10 525 pg/mL) (P = 0.007). Angiotensin receptor‐neprilysin inhibitors (ARNI) were more frequently ordered on index visit in HFiEF (P = 0.03), but no other significant differences in GDMT were identified. Despite similar Elixhauser Co‐morbidity Measure (ECM) scores, ECM categorical analysis revealed that HFwEF was more likely to have an established diagnosis of depression (P = 0.03) and a spectrum of psychiatric illnesses (P = 0.03) on preliminary visit. HFsEF was less likely to have an established diagnosis of blood loss anaemia (P = 0.04). Metastatic cancer was more likely to have been diagnosed in HFiEF and less likely in HFsEF (P = 0.002). Conclusions Despite similar ECM scores, EF class conversion groups demonstrated salient differences in average serum sodium and pro‐BNP levels. Inpatient ARNI orders, psychiatric, hematologic, and oncologic co‐morbidity patterns were also significantly different. Findings demonstrate blood‐based biomarker patterns and targetable co‐morbid conditions which may play a role in future EF class conversion. Dedicated studies evaluating measurements related to GDMT dose‐titration, quality of life, and functionality are the next steps in this field of HF.
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Affiliation(s)
- Christian J. Lorenzo
- Department of Medicine, Sarasota Memorial Health Care System Florida State University College of Medicine Sarasota FL USA
| | - Jorge I. Conte
- Department of Medicine, Sarasota Memorial Health Care System Florida State University College of Medicine Sarasota FL USA
| | - Ricardo J. Villasmil
- Department of Medicine, Sarasota Memorial Health Care System Florida State University College of Medicine Sarasota FL USA
| | - Qassem K. Abdelal
- Department of Medicine, Sarasota Memorial Health Care System Florida State University College of Medicine Sarasota FL USA
| | - Derek Pierce
- Department of Medicine, Sarasota Memorial Health Care System Florida State University College of Medicine Sarasota FL USA
| | - Wilhelmine Wiese‐Rometsch
- Department of Medicine, Sarasota Memorial Health Care System Florida State University College of Medicine Sarasota FL USA
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Brodeur S, Vanasse A, Courteau J, Stip E, Lesage A, Fleury MJ, Courteau M, Roy MA. Comparative effectiveness and safety of antipsychotic drugs in patients with schizophrenia initiating or reinitiating treatment: A Real-World Observational Study. Acta Psychiatr Scand 2022; 145:456-468. [PMID: 35158404 DOI: 10.1111/acps.13413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/10/2022] [Accepted: 02/05/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To compare the effectiveness and safety of various second-generation antipsychotics (SGAs), newer oral and long-acting injectable (LAI) SGAs, and first-generation antipsychotics (FGAs) treatments in patients with schizophrenia or schizoaffective disorder (SCZ). METHODS This retrospective cohort study included medical administrative information for patients with a diagnosis of SCZ living in Quebec (Canada), initiating or reinitiating at least one antipsychotic (AP) drug (with a clearance baseline period of 12 months without any APs). Effectiveness was defined by a reduced risk of hospitalization for mental disorder and discontinuation, and safety by a reduced risk of all-cause death and hospitalization for non-mental disorder, 2 years after AP initiation or reinitiation. Cox proportional hazard models were used to estimate the events associated with different antipsychotics compared with oral olanzapine. RESULTS The study cohort included 19,615 patients initiating or reinitiating an antipsychotic drug between January 2006 and December 2015. Results showed better effectiveness of clozapine (adjusted HR 0.36, 95% CI 0.30-0.42, p < 0.0001) and LAI SGAs (adjusted HR 0.56, 95% CI 0.51-0.61, p < 0.0001) compared with oral olanzapine when adding discontinuation to hospitalizations for mental disorder as a composite measure of effectiveness, as opposed to oral FGAs (adjusted HR 1.36, 95% CI 1.27-1.46, p < 0.0001) and LAI FGAs (adjusted HR 1.22, 95% CI 1.12-1.32, p < 0.0001). Most APs were as safe as oral olanzapine. CONCLUSION The effectiveness of LAI SGAs and clozapine appears to justify their use and are as safe as a recognized treatment (oral olanzapine) in Quebec (Canada).
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Affiliation(s)
- Sébastien Brodeur
- Département de Psychiatrie et Neurosciences, Université Laval, Québec City, Québec, Canada
| | - Alain Vanasse
- Groupe de Recherche PRIMUS, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada.,Département de Médecine de Famille et de Médecine d'urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Josiane Courteau
- Groupe de Recherche PRIMUS, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada
| | - Emmanuel Stip
- Département de Psychiatrie et d'Addictologie, Université de Montréal, Montréal, Québec, Canada.,Department of Psychiatry and Behavioral Science, College of Medicine and Health Science, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Alain Lesage
- Département de Psychiatrie et d'Addictologie, Université de Montréal, Montréal, Québec, Canada.,Research Centre, Institut Universitaire en Santé Mentale de Montréal, Montréal, Québec, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, McGill University, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Mireille Courteau
- Groupe de Recherche PRIMUS, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada
| | - Marc-André Roy
- Département de Psychiatrie et Neurosciences, Université Laval, Québec City, Québec, Canada.,Centre de Recherche CERVO, Québec City, Québec, Canada
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Brodeur S, Vanasse A, Courteau J, Courteau M, Stip E, Fleury MJ, Lesage A, Demers MF, Roy MA. Antipsychotic utilization trajectories three years after initiating or reinitiating treatment of schizophrenia: A state sequence analysis approach. Acta Psychiatr Scand 2022; 145:469-480. [PMID: 35152415 DOI: 10.1111/acps.13411] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This study aims to describe the utilization patterns of antipsychotic (AP) medication in patients with schizophrenia (SCZ), three years after initiating or reinitiating a given AP. METHODS Based on medico-administrative information on patients living in Quebec (Canada), this retrospective cohort study included 6444 patients with a previous diagnosis of SCZ initiating or reinitiating AP medication between January 1, 2012, and December 31, 2014, with continuous coverage by public drug insurance. For each day of follow-up (1092 days), patient was either exposed to one of the chosen categories of APs, or to none. This patient's sequence of AP exposure overtime has been referred to as the "antipsychotic utilization trajectory". These trajectories were analyzed using a State Sequence Analysis, an innovative approach which provides useful visual information on the continuation and discontinuation patterns of use over time. RESULTS Clozapine and long-acting injectable second-generation APs had the best continuation and discontinuation patterns over 3 years among all other groups, including less switching of APs, while oral first-generation APs had the poorest patterns. These findings were comparable among incident and non-incident cohorts. Oral second-generation antipsychotics, excluding clozapine, had a poorer continuation and discontinuation pattern than long-acting injectable antipsychotics. CONCLUSION State Sequence Analysis provides a clear representation of treatment adherence in comparison with dichotomous indicators of adherence or discontinuation. Consequently, this innovative method has shed light on the impact of the AP chosen to initiate or reinitiate treatment in SCZ, which has been identified as a key factor for long-term treatment continuation and discontinuation.
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Affiliation(s)
- Sébastien Brodeur
- Département de Psychiatrie et Neurosciences, Université Laval, Québec, QC, Canada
| | - Alain Vanasse
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada.,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Josiane Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada
| | - Mireille Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada
| | - Emmanuel Stip
- Département de Psychiatrie et d'Addictologie, Université de Montréal, Montréal, QC, Canada.,Department of Psychiatry and Behavioral Science, College of Medicine and Health Science, United Arab Emirates University, Al Ain, UAE
| | - Marie-Josée Fleury
- Institut universitaire en santé mentale, Université McGill, Montréal, QC, Canada.,Département de Psychiatrie, Université McGill, Montréal, QC, Canada
| | - Alain Lesage
- Département de Psychiatrie et d'Addictologie, Université de Montréal, Montréal, QC, Canada.,Centre de Recherche, Institut universitaire en santé mentale de Montréal (IUSMM), Montréal, QC, Canada
| | - Marie-France Demers
- Centre de Recherche CERVO, Québec, QC, Canada.,Faculté de pharmacie, Université Laval, Québec, QC, Canada
| | - Marc-André Roy
- Département de Psychiatrie et Neurosciences, Université Laval, Québec, QC, Canada.,Centre de Recherche CERVO, Québec, QC, Canada
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US Nationwide Insight Into All-cause 30-day Readmissions following Inpatient Endoscopic Retrograde Cholangiopancreatography. J Clin Gastroenterol 2022; 57:515-523. [PMID: 35537131 DOI: 10.1097/mcg.0000000000001709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/16/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS Endoscopic retrograde cholangiopancreatography (ERCP) is associated with a high risk for morbidity, mortality, and hospital readmission. Data regarding those risks in the United States is scarce. We assessed post-ERCP 30-day readmission rates, their etiologies, and impact on the health care system using national data. METHODS Using the National Readmission Database 2016, we identified patients who underwent inpatient ERCP from January 2016 to December 2016 using ICD-10-CM procedure codes. The primary endpoint was all-cause 30-day readmission rate. Etiologies of readmission were identified by tallying primary diagnosis. Multivariable logistic regression with complex survey design was used to identify independent risk factors associated with readmission. RESULTS A total of 130,145 patients underwent ERCP, 16,278 (12.5%) were readmitted within 30 days, with an associated cost of 268 million dollars. Nearly 40% of readmissions occurred within 7 days, and 47.9% were related to gastrointestinal etiologies. Male gender, increased comorbidities, cirrhosis, Medicare insurance, and pancreatitis or pancreatitis-related indications for ERCP were readmission risk factors. Performance of cholecystectomy on index hospitalization decreased odds of readmission by 50% (adjusted odds ratio: 0.48, 95% confidence interval: 0.45-0.52,P<0.0001). While academic and nonacademic centers had similar readmission rates, high ERCP volume centers had higher rates compared with low-volume centers (adjusted odds ratio:1.10,P=0.008). CONCLUSION All-cause 30-day readmission rates after inpatient ERCPs are high, mostly occur shortly postdischarge, and impose a heavy health care system burden. Large, multicenter prospective studies assessing the impact of center procedure volume on complications and readmission rates are needed.
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Factors Associated with Increased Inpatient Charges Following Aneurysmal Subarachnoid Hemorrhage with Vasospasm: a Nationwide Analysis. Clin Neurol Neurosurg 2022; 218:107259. [DOI: 10.1016/j.clineuro.2022.107259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/21/2022]
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Frieden P, Blais C, Hamel D, Gamache P, Pibarot P, Clavel MA. Evolution of the burden of aortic stenosis by sex in the province of Quebec between 2006 and 2018. Heart 2022; 108:1644-1650. [DOI: 10.1136/heartjnl-2021-319848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 02/10/2022] [Indexed: 11/04/2022] Open
Abstract
ObjectivesTo evaluate the evolution of the burden of aortic stenosis (AS) by sex in the province of Quebec from 2006–2007 to 2018–2019 and compare the percentage of mortality between people who underwent aortic valve intervention and those who did not.MethodsPersons aged ≥20 years were identified from the Quebec Integrated Chronic Disease Surveillance System using International Classification of Diseases and intervention codes in the hospital files.ResultsIn 2018, the crude prevalence and incidence of AS were 0.89% (99% CI 0.89 to 0.90) (n=59 025) and 1.39 per 1000 (1.35 to 1.43) (n=9105), respectively. Age-standardised prevalence and incidence of AS diagnosis increased between 2006 and 2018 from 0.67% (0.66 to 0.68) to 0.75% (0.74 to 0.76) and from 0.91 per 1000 (0.88 to 0.95) to 1.20 per 1000 (1.17 to 1.23), respectively. Among incident AS, the age-standardised percentage of valve interventions increased from 11.7% (10.9 to 12.6) to 14.5% (13.9 to 15.3). This increase was only observed in men. The 30-day mortality was stable among patients with incident AS treated conservatively, from 6.9% (6.5 to 7.4) to 7.3% (6.9 to 7.6), and decreased from 7.6% (6.1 to 9.3) to 3.8% (3.1 to 4.7) among operated patients with incident AS. This decrease was only observed in women. However, from 2010, the age-adjusted mortality among prevalent AS tended to be higher in women.ConclusionsIn the province of Quebec, age-standardised prevalence and incidence of AS diagnosis increased between 2006 and 2018. Among incident AS, there was an increase in valve intervention in men and a decrease in 30-day mortality in women who underwent valve intervention. Overall and age-standardised mortality remained higher in women.
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Sirois C, Boiteau V, Chiu Y, Gilca R, Simard M. Exploring the associations between polypharmacy and COVID-19-related hospitalisations and deaths: a population-based cohort study among older adults in Quebec, Canada. BMJ Open 2022; 12:e060295. [PMID: 35256449 PMCID: PMC8905411 DOI: 10.1136/bmjopen-2021-060295] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To study the association between polypharmacy and the risk of hospitalisation and death in cases of COVID-19 in the population over the age of 65. DESIGN Population-based cohort study. SETTING Quebec Integrated Chronic Disease Surveillance System, composed of five medico-administrative databases, in the province of Quebec, Canada. PARTICIPANTS 32 476 COVID-19 cases aged over 65 whose diagnosis was made between 23 February 2020 and 15 March 2021, and who were covered by the public drug insurance plan (thus excluding those living in long-term care). We counted the number of different medications they claimed between 1 April 2019 and 31 March 2020. OUTCOME MEASURES Robust Poisson regression was used to calculate relative risk of hospitalisation and death associated with the use of multiple medications, adjusting for age, sex, chronic conditions, material and social deprivation and living environment. RESULTS Of the 32 476 COVID-19 cases included, 10 350 (32%) were hospitalised and 4146 (13%) died. Compared with 0-4 medications, polypharmacy exposure was associated with increased hospitalisations, with relative risks ranging from 1.11 (95% CI 1.04 to 1.19) for those using 5-9 medications to 1.62 (95% CI 1.51 to 1.75) for those using 20+. Similarly, the risk of death increased with the number of medications, from 1.13 (95% CI 0.99 to 1.30) for those using (5-9 medications to 1.97 (95% CI 1.70 to 2.27) (20+). Increased risk was mainly observed in younger groups. CONCLUSIONS Polypharmacy was significantly associated with the risk of hospitalisations and deaths related to COVID-19 in this cohort of older adults. Polypharmacy may represent a marker of vulnerability, especially for younger groups of older adults.
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Affiliation(s)
- Caroline Sirois
- Faculty of Pharmacy, Université Laval, Quebec, Quebec, Canada
- Institut national de santé publique du Québec, Quebec, Quebec, Canada
| | - Véronique Boiteau
- Institut national de santé publique du Québec, Quebec, Quebec, Canada
| | - Yohann Chiu
- Faculty of Pharmacy, Université Laval, Quebec, Quebec, Canada
- Institut national de santé publique du Québec, Quebec, Quebec, Canada
| | - Rodica Gilca
- Institut national de santé publique du Québec, Quebec, Quebec, Canada
- Centre de recherche du CHU de Quebec-Universite Laval, Quebec, Quebec, Canada
| | - Marc Simard
- Institut national de santé publique du Québec, Quebec, Quebec, Canada
- Département de médecine sociale et préventive, Université Laval, Quebec, Quebec, Canada
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d'Etienne JP, Alanis N, Chou E, Garrett JS, Kirby JJ, Bryant DP, Shaikh S, Schrader CD, Wang H. Validation of a simplified comorbidity evaluation predicting clinical outcomes among patients with coronavirus disease 2019 – A multicenter retrospective observation study. Am J Emerg Med 2022; 56:57-62. [PMID: 35366439 PMCID: PMC8907112 DOI: 10.1016/j.ajem.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/24/2022] [Accepted: 03/05/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives We compared and validated the performance accuracy of simplified comorbidity evaluation compared to the Charlson Comorbidity Index (CCI) predicting COVID-19 severity. In addition, we also determined whether risk prediction of COVID-19 severity changed during different COVID-19 pandemic outbreaks. Methods We enrolled all patients whose SARS-CoV-2 PCR tests were performed at six different hospital Emergency Departments in 2020. Patients were divided into three groups based on the various COVID-19 outbreaks in the US (first wave: March–May 2020, second wave: June–September 2020, and third wave: October–December 2020). A simplified comorbidity evaluation was used as an independent risk factor to predict clinical outcomes using multivariate logistic regressions. Results A total of 22,248 patients were included, for which 7023 (32%) patients tested COVID-19 positive. Higher percentages of COVID-19 patients with more than three chronic conditions had worse clinical outcomes (i.e., hospital and intensive care unit admissions, receiving invasive mechanical ventilations, and in-hospital mortality) during all three COVID-19 outbreak waves. Conclusions This simplified comorbidity evaluation was validated to be associated with COVID clinical outcomes. Such evaluation did not perform worse when compared with CCI to predict in-hospital mortality.
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Affiliation(s)
- James P d'Etienne
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, United States of America.
| | - Naomi Alanis
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, United States of America.
| | - Eric Chou
- Department of Emergency Medicine, Baylor University Medical Center, 3305 Worth St, Dallas, TX 75246, United States of America.
| | - John S Garrett
- Department of Emergency Medicine, Baylor University Medical Center, 3305 Worth St, Dallas, TX 75246, United States of America.
| | - Jessica J Kirby
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, United States of America.
| | - David P Bryant
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, United States of America.
| | - Sajid Shaikh
- Department of Information Technology, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, United States of America.
| | - Chet D Schrader
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, United States of America.
| | - Hao Wang
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, United States of America.
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McKay R, Letarte L, Lebel A, Quesnel-Vallée A. Exploring social inequalities in healthcare trajectories following diagnosis of diabetes: a state sequence analysis of linked survey and administrative data. BMC Health Serv Res 2022; 22:131. [PMID: 35101054 PMCID: PMC8805244 DOI: 10.1186/s12913-021-07450-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Social inequalities in complications associated with diabetes mellitus persist. As a primary care sensitive condition (PCSC), this association could be related to differential access to primary care. Our objectives are to establish a typology of care trajectories following a new diagnosis, and to explore social determinants of trajectories. Methods We used the TorSaDe (The Care Trajectories-Enriched Data) cohort, which links Canadian Community Health Survey respondents to health administrative data. Care trajectories were mapped over a two-year period following a new diagnosis and analysed using state sequence and clustering methods. Associations between individual and geographic characteristics with trajectory types were assessed with multinomial logistic regression. Results Three trajectories were identified: Regular Family Physician (FP) Predominant, Specialist Physician Predominant, and Few Services. With Regular FP as the reference, males had higher odds of experiencing the Few Services trajectory, higher education was associated with higher odds of both the Few Services and the Specialist trajectories, and immigrants had higher odds of the Specialist trajectory. Diagnoses in a physician’s office, as opposed to in hospital, were associated with higher odds of the Regular FP trajectory. Conclusions The Regular FP trajectory most closely aligns with the management principles of the PCSC approach. We did not find strong evidence of social status privileging access to this trajectory. However, the association with location of diagnosis suggests that efforts to ensure patients diagnosed in hospital are well linked to a regular family physician for follow up may help to reduce unnecessary specialist use and meet PCSC goals. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07450-9.
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Affiliation(s)
- Rachel McKay
- McGill Observatory on Health and Social Services Reforms, Montreal, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Laurence Letarte
- Centre for Research on Planning and Development (CRAD), Laval University, Quebec, G1V 0A6, Canada.,Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Institute Research Center, Quebec, G1V 4G5, Canada
| | - Alexandre Lebel
- Centre for Research on Planning and Development (CRAD), Laval University, Quebec, G1V 0A6, Canada.,Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Institute Research Center, Quebec, G1V 4G5, Canada
| | - Amélie Quesnel-Vallée
- McGill Observatory on Health and Social Services Reforms, Montreal, Canada. .,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada. .,Department of Sociology, McGill University, Montreal, Canada.
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Brodeur S, Courteau J, Vanasse A, Courteau M, Stip E, Fleury MJ, Lesage A, Demers MF, Corbeil O, Béchard L, Roy MA. Association between previous and future antipsychotic adherence in patients initiating clozapine: real-world observational study. Br J Psychiatry 2022; 220:1-8. [PMID: 35082000 DOI: 10.1192/bjp.2022.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although recognised as the most effective antipsychotic for treatment-resistant schizophrenia, clozapine remains underused. One reason is the widespread concern about non-adherence to clozapine because of poor adherence before initiating clozapine. AIMS To determine if prior poor out-patient adherence to treatmentbefore initiating clozapine predisposes to poor out-patient adherence to clozapine or to any antipsychotics (including clozapine) after its initiation. METHOD This cohort study included 3228 patients with schizophrenia living in Quebec (Canada) initiating (with a 2-year clearance period) oral clozapine (index date) between 2009 and 2016. Using pharmacy data, out-patient adherence to treatment was measured by the medication possession ratio (MPR), over a 1-year period preceding and following the index date. Five groups of patients were formed based on their prior MPR level (independent variable). Two dependent variables were defined after clozapine initiation (good out-patient adherence to any antipsychotics and to clozapine only). Along with multiple logistic regressions, state sequence analysis was used as a visual representation of antipsychotic-use trajectories over time, before and after clozapine initiation. RESULTS Although prior poor adherence to antipsychotics was associated with poor adherence after clozapine initiation, the absolute risk of subsequent poor adherence remained low, regardless of previous adherence level. Most patients adhered to their treatment after initiating clozapine (>68% to clozapine and >84% to any antipsychotics). CONCLUSIONS Despite the fact that poor adherence prior to initiating clozapine is widely recognised by clinicians as a barrier for the prescription of clozapine, the current study supports the initiation of clozapine in all eligible patients.
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Affiliation(s)
- Sébastien Brodeur
- Département de Psychiatrie et Neurosciences, Université Laval, Canada
| | - Josiane Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Canada
| | - Alain Vanasse
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Canada and Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Canada
| | - Mireille Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Canada
| | - Emmanuel Stip
- Département de Psychiatrie et d'Addictologie, Université de Montréal, Canada and Department of Psychiatry and Behavioral Science, College of Medicine and Health Science, United Arab Emirates University, United Arab Emirates
| | - Marie-Josée Fleury
- Institut universitaire en santé mentale, Université McGill, Canada and Département de Psychiatrie, Université McGill, Canada
| | - Alain Lesage
- Département de Psychiatrie et d'Addictologie, Université de Montréal, Canada and Centre de Recherche, Institut universitaire en santé mentale de Montréal (IUSMM), Canada
| | - Marie-France Demers
- Centre de Recherche CERVO, Canada and Faculté de pharmacie, Université Laval, Canada
| | | | | | - Marc-André Roy
- Département de Psychiatrie et Neurosciences, Université Laval, Canada andCentre de Recherche CERVO, Canada
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Ray WA, Chung CP, Stein CM, Smalley W, Zimmerman E, Dupont WD, Hung AM, Daugherty JR, Dickson A, Murray KT. Association of Rivaroxaban vs Apixaban With Major Ischemic or Hemorrhagic Events in Patients With Atrial Fibrillation. JAMA 2021; 326:2395-2404. [PMID: 34932078 PMCID: PMC8693217 DOI: 10.1001/jama.2021.21222] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE The comparative effectiveness of rivaroxaban and apixaban, the most frequently prescribed oral anticoagulants for ischemic stroke prevention in patients with atrial fibrillation, is uncertain. OBJECTIVE To compare major ischemic and hemorrhagic outcomes in patients with atrial fibrillation treated with rivaroxaban or apixaban. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study using computerized enrollment and claims files for US Medicare beneficiaries 65 years or older. Between January 1, 2013, and November 30, 2018, a total of 581 451 patients with atrial fibrillation began rivaroxaban or apixaban treatment and were followed up for 4 years, through November 30, 2018. EXPOSURES Rivaroxaban (n = 227 572) and apixaban (n = 353 879), either standard or reduced dose. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of major ischemic (stroke/systemic embolism) and hemorrhagic (intracerebral hemorrhage/other intracranial bleeding/fatal extracranial bleeding) events. Secondary outcomes were nonfatal extracranial bleeding and total mortality (fatal ischemic/hemorrhagic event or other death during follow-up). Rates, hazard ratios (HRs), and rate differences (RDs) were adjusted for baseline differences in comorbidity with inverse probability of treatment weighting. RESULTS Study patients (mean age, 77.0 years; 291 966 [50.2%] women; 134 393 [23.1%] receiving reduced dose) had 474 605 person-years of follow-up (median [IQR] of 174 [62-397] days). The adjusted primary outcome rate for rivaroxaban was 16.1 per 1000 person-years vs 13.4 per 1000 person-years for apixaban (RD, 2.7 [95% CI, 1.9-3.5]; HR, 1.18 [95% CI, 1.12-1.24]). The rivaroxaban group had increased risk for both major ischemic events (8.6 vs 7.6 per 1000 person-years; RD, 1.1 [95% CI, 0.5-1.7]; HR, 1.12 [95% CI, 1.04-1.20]) and hemorrhagic events (7.5 vs 5.9 per 1000 person-years; RD, 1.6 [95% CI, 1.1-2.1]; HR, 1.26 [95% CI, 1.16-1.36]), including fatal extracranial bleeding (1.4 vs 1.0 per 1000 person-years; RD, 0.4 [95% CI, 0.2-0.7]; HR, 1.41 [95% CI, 1.18-1.70]). Patients receiving rivaroxaban had increased risk of nonfatal extracranial bleeding (39.7 vs 18.5 per 1000 person-years; RD, 21.1 [95% CI, 20.0-22.3]; HR, 2.07 [95% CI, 1.99-2.15]), fatal ischemic/hemorrhagic events (4.5 vs 3.3 per 1000 person-years; RD, 1.2 [95% CI, 0.8-1.6]; HR, 1.34 [95% CI, 1.21-1.48]), and total mortality (44.2 vs 41.0 per 1000 person-years; RD, 3.1 [95% CI, 1.8-4.5]; HR, 1.06 [95% CI, 1.02-1.09]). The risk of the primary outcome was increased for rivaroxaban in both those receiving the reduced dose (27.4 vs 21.0 per 1000 person-years; RD, 6.4 [95% CI, 4.1-8.7]; HR, 1.28 [95% CI, 1.16-1.40]) and the standard dose (13.2 vs 11.4 per 1000 person-years; RD, 1.8 [95% CI, 1.0-2.6]; HR, 1.13 [95% CI, 1.06-1.21]) groups. CONCLUSIONS AND RELEVANCE Among Medicare beneficiaries 65 years or older with atrial fibrillation, treatment with rivaroxaban compared with apixaban was associated with a significantly increased risk of major ischemic or hemorrhagic events.
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Affiliation(s)
- Wayne A. Ray
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Cecilia P. Chung
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - C. Michael Stein
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Walter Smalley
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Eli Zimmerman
- Department of Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - William D. Dupont
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Adriana M. Hung
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- Veterans Affairs Tennessee Valley Healthcare System, Nashville Campus
| | - James R. Daugherty
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Alyson Dickson
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Katherine T. Murray
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee
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73
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Beaudoin C, Jean S, Moore L, Gamache P, Bessette L, Ste-Marie LG, Brown JP. Prediction of Osteoporotic Fractures in Elderly Individuals: A Derivation and Internal Validation Study Using Healthcare Administrative Data. J Bone Miner Res 2021; 36:2329-2342. [PMID: 34490952 DOI: 10.1002/jbmr.4438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/11/2021] [Accepted: 09/04/2021] [Indexed: 12/27/2022]
Abstract
In Canada and other countries, osteoporosis is monitored as part of chronic disease population surveillance programs. Although fractures are the principal manifestation of osteoporosis, very few algorithms are available to identify individuals at high risk of osteoporotic fractures in current surveillance systems. The objective of this study was to derive and validate predictive models to accurately identify individuals at high risk of osteoporotic fracture using information available in healthcare administrative data. More than 270,000 men and women aged ≥66 years were randomly selected from the Quebec Integrated Chronic Disease Surveillance System. Selected individuals were followed between fiscal years 2006-2007 and 2015-2016. Models were constructed for prediction of hip/femur and major osteoporotic fractures for follow-up periods of 5 and 10 years. A total of 62 potential predictors measurable in healthcare administrative databases were identified. Predictor selection was performed using a manual backward algorithm. The predictive performance of the final models was assessed using measures of discrimination, calibration, and overall performance. Between 20 and 25 predictors were retained in the final prediction models (eg, age, sex, social deprivation index, most of the major and minor risk factors for osteoporosis, diabetes, Parkinson's disease, cognitive impairment, anemia, anxio-depressive disorders). Discrimination of the final models was higher for the prediction of hip/femur fracture than major osteoporotic fracture and higher for prediction for a 5-year than a 10-year period (hip/femur fracture for 5 years: c-index = 0.77; major osteoporotic fracture for 5 years: c-index = 0.71; hip/femur fracture for 10 years: c-index = 0.73; major osteoporotic fracture for 10 years: c-index = 0.68). The predicted probabilities globally agreed with the observed probabilities. In conclusion, the derived models had adequate predictive performance in internal validation. As a final step, these models should be validated in an external cohort and used to develop indicators for surveillance of osteoporosis. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Claudia Beaudoin
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada.,CHU de Québec - Université Laval Research Centre, Quebec, QC, Canada.,Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, QC, Canada
| | - Sonia Jean
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, QC, Canada.,Department of Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Lynne Moore
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada.,CHU de Québec - Université Laval Research Centre, Quebec, QC, Canada
| | - Philippe Gamache
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, QC, Canada
| | - Louis Bessette
- CHU de Québec - Université Laval Research Centre, Quebec, QC, Canada.,Department of Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | | | - Jacques P Brown
- CHU de Québec - Université Laval Research Centre, Quebec, QC, Canada.,Department of Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
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74
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Gosselin E, Simard M, Lunghi C, Sirois C. Trends in benzodiazepine and alternative hypnotic use in relation with multimorbidity among older adults in Quebec, Canada. Pharmacoepidemiol Drug Saf 2021; 31:322-333. [PMID: 34748234 DOI: 10.1002/pds.5383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 10/15/2021] [Accepted: 11/01/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Benzodiazepines and other hypnotic alternatives are associated with increased risks of adverse events. Heightened awareness of risks may have changed prescribing habits over the years. However, these trends are not fully described, especially in vulnerable people such as multimorbid older adults. OBJECTIVE We aimed to describe the annual prevalence of benzodiazepine and other hypnotic use in relation to multimorbidity among older adults in the province of Quebec, Canada, from 2000 to 2016. METHOD We conducted a population-based study using the Quebec Integrated Chronic Disease Surveillance System. We included all individuals aged ≥66 years covered by the public drug plan. For each year, we evaluated the sex- and age-standardized proportion of benzodiazepine and other hypnotic users, defined as individuals with at least one drug claim in the year. We stratified our results according to multimorbidity and used log-binomial regression to study trends. RESULTS The proportion of individuals using benzodiazepines decreased from 34.8% in 2000 to 24.8% in 2016 (p for trend <0.001). Multimorbid people (≥2 chronic diseases) remained the highest users over the years, with 43.3% and 30.6% of them being users in 2000 and 2016, respectively. Conversely, the proportion of users increased for other hypnotics, particularly for trazodone and quetiapine, rising from 5.4% to 8.4% (p < 0.001), and especially among multimorbid individuals (from 7.4% to 11.6%). CONCLUSION Older adults used benzodiazepines less frequently but quetiapine and trazodone more frequently in recent years. The use of these medications, particularly in multimorbid people at risk of adverse events, must be addressed.
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Affiliation(s)
- Emmanuelle Gosselin
- Laval University, Quebec City, Quebec, Canada.,Institut national de santé publique du Québec, Quebec City, Quebec, Canada.,Centre d'excellence sur le vieillissement de Québec, Quebec City, Quebec, Canada
| | - Marc Simard
- Laval University, Quebec City, Quebec, Canada.,Institut national de santé publique du Québec, Quebec City, Quebec, Canada
| | | | - Caroline Sirois
- Laval University, Quebec City, Quebec, Canada.,Institut national de santé publique du Québec, Quebec City, Quebec, Canada.,Centre d'excellence sur le vieillissement de Québec, Quebec City, Quebec, Canada
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75
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Gristina GR, Piccinni M. COVID-19 pandemic in ICU. Limited resources for many patients: approaches and criteria for triaging. Minerva Anestesiol 2021; 87:1367-1379. [PMID: 34633169 DOI: 10.23736/s0375-9393.21.15736-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The COVID-19 pandemic has shattered the illusion that healthcare resource shortages that require rationing are problems restricted to low- and middle-income countries. During the pandemic surges, many high-income countries have been confronted with unprecedented demands for healthcare systems that dramatically exceeded available resources. Hospitals capacities were overwhelmed, and physicians working in intensive care units (ICUs) were often forced to deny admissions to patients in desperate need of intensive care. To support these difficult decisions, many scientific societies and governmental bodies have developed guidelines on the triage of patients in need of mechanical ventilation and other life-support treatments. The ethical approaches underlying these guidelines were grounded on egalitarian or utilitarian principles. Thus far, however, consensus on the approaches used, and, above all, on the solutions adopted have been limited, giving rise to a clash of opinions that has further complicated health professionals' ability to respond optimally to their patients' needs. As the COVID-19 crisis moves toward a phase of what some have called "pandemic normalcy," the need to debate the merits and demerits of the individual decisions made in the allocation of ICU resources seems less pressing. Instead, the aims of the authors are: 1) to critically review the approaches and criteria used for triaging patients to be admitted in ICU; 2) to clarify how macro- and micro-allocation choices, in their interdependance, can condition decision-making processes regarding the care of individual patients; 3) to reflect on the need for decision-makers and professionals working in ICUs to maintain a proper degree of "honesty" towards citizens and patients regarding the causes of the resource shortages and the decision-making processes, which, in different ways routinely and in crisis times, involve the need to make "tragic choices" at both levels.
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Affiliation(s)
- Giuseppe R Gristina
- Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care (SIAARTI), Rome, Italy -
| | - Mariassunta Piccinni
- Department of Political and Legal Sciences, and International Studies, University of Padua, Padua, Italy
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76
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Simard M, Rahme E, Calfat AC, Sirois C. Multimorbidity measures from health administrative data using ICD system codes: A systematic review. Pharmacoepidemiol Drug Saf 2021; 31:1-12. [PMID: 34623723 DOI: 10.1002/pds.5368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/08/2021] [Accepted: 10/04/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aimed to identify and characterize adult population-based multimorbidity measures using health administrative data and the International Classification of Diseases (ICD) codes for disease identification. METHODS We performed a narrative systematic review of studies using or describing development or validation of multimorbidity measures. We compared the number of diseases included in the measures, the process of data extraction (case definition) and the validation process. We assessed the methodological robustness using eight criteria, five based on general criteria for indicators (AIRE instrument) and three multimorbidity-specific criteria. RESULTS Twenty-two multimorbidity measures were identified. The number of diseases they included ranged from 5 to 84 (median = 20), with 19 measures including both physical and mental conditions. Diseases were identified using ICD codes extracted from inpatient and outpatient data (18/22) and sometimes including drug claims (10/22). The validation process relied mainly on the capacity of the measures to predict health outcome (5/22), or on the validation of each individual disease against a gold standard (8/22). Six multimorbidity measures met at least six of the eight robustness criteria assessed. CONCLUSION There is significant heterogeneity among the measures used to assess multimorbidity in administrative databases, and about a third are of low to moderate quality. A more consensual approach to the number of diseases or groups of diseases included in multimorbidity measures may improve comparison between regions, and potentially provide better control for multimorbidity-related confounding in studies.
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Affiliation(s)
- Marc Simard
- Quebec National Institute of Public Health, Quebec City, Québec, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Elham Rahme
- Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, Québec, Canada
| | - Alexandre Campeau Calfat
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Caroline Sirois
- Quebec National Institute of Public Health, Quebec City, Québec, Canada.,Faculty of Pharmacy, Laval University, Quebec City, Québec, Canada.,Centre of Excellence on Aging of Quebec, VITAM Research Centre on Sustainable Health, Quebec City, Québec, Canada
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77
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Salerno S, Sun Y, Morris EL, He X, Li Y, Pan Z, Han P, Kang J, Sjoding MW, Li Y. Comprehensive evaluation of COVID-19 patient short- and long-term outcomes: Disparities in healthcare utilization and post-hospitalization outcomes. PLoS One 2021; 16:e0258278. [PMID: 34614008 PMCID: PMC8494298 DOI: 10.1371/journal.pone.0258278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/22/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Understanding risk factors for short- and long-term COVID-19 outcomes have implications for current guidelines and practice. We study whether early identified risk factors for COVID-19 persist one year later and through varying disease progression trajectories. METHODS This was a retrospective study of 6,731 COVID-19 patients presenting to Michigan Medicine between March 10, 2020 and March 10, 2021. We describe disease progression trajectories from diagnosis to potential hospital admission, discharge, readmission, or death. Outcomes pertained to all patients: rate of medical encounters, hospitalization-free survival, and overall survival, and hospitalized patients: discharge versus in-hospital death and readmission. Risk factors included patient age, sex, race, body mass index, and 29 comorbidity conditions. RESULTS Younger, non-Black patients utilized healthcare resources at higher rates, while older, male, and Black patients had higher rates of hospitalization and mortality. Diabetes with complications, coagulopathy, fluid and electrolyte disorders, and blood loss anemia were risk factors for these outcomes. Diabetes with complications, coagulopathy, fluid and electrolyte disorders, and blood loss were associated with lower discharge and higher inpatient mortality rates. CONCLUSIONS This study found differences in healthcare utilization and adverse COVID-19 outcomes, as well as differing risk factors for short- and long-term outcomes throughout disease progression. These findings may inform providers in emergency departments or critical care settings of treatment priorities, empower healthcare stakeholders with effective disease management strategies, and aid health policy makers in optimizing allocations of medical resources.
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Affiliation(s)
- Stephen Salerno
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Yuming Sun
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Emily L. Morris
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Xinwei He
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Yajing Li
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Ziyang Pan
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Peisong Han
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Jian Kang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Michael W. Sjoding
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Yi Li
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
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Chien CC, Chen PH, Chung CH, Sun CA, Chien WC, Chien KH. Association between Statins and Retinal Vascular Occlusion: A Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189864. [PMID: 34574786 PMCID: PMC8471930 DOI: 10.3390/ijerph18189864] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
Retinal vascular occlusion (RVO), including retinal arterial occlusion and retinal vein occlusion, is a common retinal vascular disease that causes visual disturbance. The exact pathogenesis of RVO remains unclear. In all types of RVO patients, hyperlipidemia is more than twofold more common than in controls. Statins have been used to control blood cholesterol levels and have been found to reduce the risk of cardiovascular morbidity and mortality. Moreover, the immunomodulatory functions of statins may play a role in treating inflammatory diseases. This study aimed to evaluate whether patients taking statins have a lower risk of developing RVO compared to patients not taking statins. Adult patients with statins usage on the index date identified from the Taiwan National Health Insurance Research Database (NHIRD) between 2000 and 2013 were included. A threefold matched group was selected using age, sex, and year of index date for comparison. During the mean follow-up period of 12.87 ± 1.88 years, the cumulative incidence of RVO was significantly lower in the statin-user group (29.96 per 105 person-years [PYs]) than in the non-statin-user group (39.35 per 105 PYs). The results showed a lower cumulative incidence rate of RVO in patients prescribed statins than in those not prescribed statins (log-rank test, p = 0.020). The adjusting hazard ratio (HR) was significantly greater for RVO in the statin-user group (adjusted HR, 0.704; 95% CI, 0.591-0.873). Statin users had a decreased risk for all types of RVO development, including central retinal artery occlusion, arterial branch occlusion, central retinal vein occlusion, and branch retinal vein occlusion. In conclusion, patients undergoing statin treatment have a lower risk of developing RVO compared to patients not taking statins.
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Affiliation(s)
- Chien-Cheng Chien
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City 114202, Taiwan;
| | - Po-Huang Chen
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 114202, Taiwan;
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei City 114201, Taiwan;
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City 114202, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei City 114201, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City 242062, Taiwan;
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City 242062, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei City 114201, Taiwan;
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City 114202, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei City 114201, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei City 114201, Taiwan
- Correspondence: (W.-C.C.); (K.-H.C.); Tel.: +886-2-8792-3311 (ext. 19189) (W.-C.C.); +886-2-8792-3311 (ext. 13464) (K.-H.C.); Fax: +886-2-8792-7235 (W.-C.C.); +886-2-8792-7164 (K.-H.C.)
| | - Ke-Hung Chien
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City 114202, Taiwan;
- Correspondence: (W.-C.C.); (K.-H.C.); Tel.: +886-2-8792-3311 (ext. 19189) (W.-C.C.); +886-2-8792-3311 (ext. 13464) (K.-H.C.); Fax: +886-2-8792-7235 (W.-C.C.); +886-2-8792-7164 (K.-H.C.)
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Chaudhry YP, MacMahon A, Rao SS, Sterling RS, Oni JK, Khanuja HS. Incidence, mortality, and complications of acute myocardial infarction with and without percutaneous coronary intervention in hip fracture patients. Injury 2021; 52:2344-2349. [PMID: 33663802 DOI: 10.1016/j.injury.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Acute myocardial infarction (AMI) is a common cause of death following hip fracture surgery. This study aimed to determine the incidence and timing of perioperative AMI treated with percutaneous coronary intervention (PCI) in hip fracture patients, and to compare in-hospital mortality and complications between hip fracture patients who did not have an AMI, those who sustained a perioperative AMI and did not undergo PCI, and those who sustained an AMI and underwent PCI. METHODS The National Inpatient Sample (NIS) was queried from 2010 through the third quarter of 2015 to identify all patients undergoing hip fracture surgery. Patients were stratified into three cohorts: perioperative AMI but no PCI (no PCI cohort), perioperative AMI with PCI (PCI cohort), and no perioperative AMI or PCI (no AMI cohort). Patient demographics, comorbidities, in-hospital mortality, and complications were compared between cohorts. Multivariable logistic regression adjusting for age, sex, procedure, and Elixhauser score was used to assess the relative odds of in-hospital mortality for each cohort. RESULTS A total of 1,535,917 hip fracture cases were identified, with 1.9% in the no PCI cohort, 0.01% in the PCI cohort, and 98.0% in the no AMI cohort. In-hospital mortality was lower in the PCI cohort than in the no PCI cohort (8.8% vs. 14%), and was greater for both than in the no AMI cohort (1.6%, p < 0.001 for all). Both the no PCI cohort (OR, 6.1; 95% CI, 5.6-6.6) and PCI cohort (OR, 4.1; 95% CI, 2.8-6.0) had increased adjusted odds of in-hospital mortality compared to the no AMI cohort. The PCI cohort had a higher rate of bleeding complications than both other cohorts, and the no PCI cohort had a higher rate of transfusion than both other cohorts. CONCLUSIONS Perioperative AMI both with and without PCI independently increases the risk of mortality in hip fracture patients, with the highest risk of mortality in those with AMI without PCI. Providers should understand the increased morbidity and mortality associated with AMI in hip fracture patients, as well as the risks and benefits of perioperative PCI, in order to better counsel and manage these patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yash P Chaudhry
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N.Caroline St., Baltimore, MD 21287, USA
| | - Aoife MacMahon
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N.Caroline St., Baltimore, MD 21287, USA
| | - Sandesh S Rao
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N.Caroline St., Baltimore, MD 21287, USA
| | - Robert S Sterling
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N.Caroline St., Baltimore, MD 21287, USA
| | - Julius K Oni
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N.Caroline St., Baltimore, MD 21287, USA
| | - Harpal S Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N.Caroline St., Baltimore, MD 21287, USA.
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Sirois C, Khoury R, Durand A, Deziel PL, Bukhtiyarova O, Chiu Y, Talbot D, Bureau A, Després P, Gagné C, Laviolette F, Savard AM, Corbeil J, Badard T, Jean S, Simard M. Exploring polypharmacy with artificial intelligence: data analysis protocol. BMC Med Inform Decis Mak 2021; 21:219. [PMID: 34284765 PMCID: PMC8290537 DOI: 10.1186/s12911-021-01583-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Polypharmacy is common among older adults and it represents a public health concern, due to the negative health impacts potentially associated with the use of several medications. However, the large number of medication combinations and sequences of use makes it complicated for traditional statistical methods to predict which therapy is genuinely associated with health outcomes. The project aims to use artificial intelligence (AI) to determine the quality of polypharmacy among older adults with chronic diseases in the province of Québec, Canada. METHODS We will use data from the Quebec Integrated Chronic Disease Surveillance System (QICDSS). QICDSS contains information about prescribed medications in older adults in Quebec collected over 20 years. It also includes diagnostic codes and procedures, and sociodemographic data linked through a unique identification number for each individual. Our research will be structured around three interconnected research axes: AI, Health, and Law&Ethics. The AI research axis will develop algorithms for finding frequent patterns of medication use that correlate with health events, considering data locality and temporality (explainable AI or XAI). The Health research axis will translate these patterns into polypharmacy indicators relevant to public health surveillance and clinicians. The Law&Ethics axis will assess the social acceptability of the algorithms developed using AI tools and the indicators developed by the Heath axis and will ensure that the developed indicators neither discriminate against any population group nor increase the disparities already present in the use of medications. DISCUSSION The multi-disciplinary research team consists of specialists in AI, health data, statistics, pharmacy, public health, law, and ethics, which will allow investigation of polypharmacy from different points of view and will contribute to a deeper understanding of the clinical, social, and ethical issues surrounding polypharmacy and its surveillance, as well as the use of AI for health record data. The project results will be disseminated to the scientific community, healthcare professionals, and public health decision-makers in peer-reviewed publications, scientific meetings, and reports. The diffusion of the results will ensure the confidentiality of individual data.
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Affiliation(s)
- Caroline Sirois
- Faculty of Pharmacy, Université Laval, Quebec, QC, Canada. .,Quebec National Institute of Public Health, Quebec, QC, Canada. .,Centre d'excellence sur le vieillissement de Québec, Hôpital St-Sacrement, Local L2-28, 1050, chemin Ste-Foy, Quebec, QC, G1S 4L8, Canada.
| | - Richard Khoury
- Faculty of Science and Engineering, Department of Computer Science and Software Engineering, Université Laval, Quebec, QC, Canada
| | - Audrey Durand
- Faculty of Science and Engineering, Department of Computer Science and Software Engineering, Université Laval, Quebec, QC, Canada
| | | | | | - Yohann Chiu
- Faculty of Pharmacy, Université Laval, Quebec, QC, Canada
| | - Denis Talbot
- Faculty of Medicine, Department of Social and Preventive Medicine, Université Laval, Quebec, QC, Canada
| | - Alexandre Bureau
- Faculty of Medicine, Department of Social and Preventive Medicine, Université Laval, Quebec, QC, Canada
| | - Philippe Després
- Faculty of Science and Engineering, Department of Physics, Physical Engineering and Optics, Université Laval, Quebec, QC, Canada
| | - Christian Gagné
- Faculty of Science and Engineering, Department of Electrical and Computer Engineering, Université Laval, Quebec, QC, Canada
| | - François Laviolette
- Faculty of Science and Engineering, Department of Electrical and Computer Engineering, Université Laval, Quebec, QC, Canada
| | | | - Jacques Corbeil
- Faculty of Medicine, Department of Molecular Medicine, Université Laval, Quebec, QC, Canada
| | - Thierry Badard
- Faculty of Forestry, Geography and Geomatics, Department of Geomatic Science, Université Laval, Quebec, QC, Canada
| | - Sonia Jean
- Quebec National Institute of Public Health, Quebec, QC, Canada
| | - Marc Simard
- Quebec National Institute of Public Health, Quebec, QC, Canada
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Ray WA, Chung CP, Murray KT, Malow BA, Daugherty JR, Stein CM. Mortality and concurrent use of opioids and hypnotics in older patients: A retrospective cohort study. PLoS Med 2021; 18:e1003709. [PMID: 34264928 PMCID: PMC8321368 DOI: 10.1371/journal.pmed.1003709] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/29/2021] [Accepted: 06/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Benzodiazepine hypnotics and the related nonbenzodiazepine hypnotics (z-drugs) are among the most frequently prescribed medications for older adults. Both can depress respiration, which could have fatal cardiorespiratory effects, particularly among patients with concurrent opioid use. Trazodone, frequently prescribed in low doses for insomnia, has minimal respiratory effects, and, consequently, may be a safer hypnotic for older patients. Thus, for patients beginning treatment with benzodiazepine hypnotics or z-drugs, we compared deaths during periods of current hypnotic use, without or with concurrent opioids, to those for comparable patients receiving trazodone in doses up to 100 mg. METHODS AND FINDINGS The retrospective cohort study in the United States included 400,924 Medicare beneficiaries 65 years of age or older without severe illness or evidence of substance use disorder initiating study hypnotic therapy from January 2014 through September 2015. Study endpoints were out-of-hospital (primary) and total mortality. Hazard ratios (HRs) were adjusted for demographic characteristics, psychiatric and neurologic disorders, cardiovascular and renal conditions, respiratory diseases, pain-related diagnoses and medications, measures of frailty, and medical care utilization in a time-dependent propensity score-stratified analysis. Patients without concurrent opioids had 32,388 person-years of current use, 260 (8.0/1,000 person-years) out-of-hospital and 418 (12.9/1,000) total deaths for benzodiazepines; 26,497 person-years,150 (5.7/1,000) out-of-hospital and 227 (8.6/1,000) total deaths for z-drugs; and 16,177 person-years,156 (9.6/1,000) out-of-hospital and 256 (15.8/1,000) total deaths for trazodone. Out-of-hospital and total mortality for benzodiazepines (respective HRs: 0.99 [95% confidence interval, 0.81 to 1.22, p = 0.954] and 0.95 [0.82 to 1.14, p = 0.513] and z-drugs (HRs: 0.96 [0.76 to 1.23], p = 0.767 and 0.87 [0.72 to 1.05], p = 0.153) did not differ significantly from that for trazodone. Patients with concurrent opioids had 4,278 person-years of current use, 90 (21.0/1,000) out-of-hospital and 127 (29.7/1,000) total deaths for benzodiazepines; 3,541 person-years, 40 (11.3/1,000) out-of-hospital and 64 (18.1/1,000) total deaths for z-drugs; and 2,347 person-years, 19 (8.1/1,000) out-of-hospital and 36 (15.3/1,000) total deaths for trazodone. Out-of-hospital and total mortality for benzodiazepines (HRs: 3.02 [1.83 to 4.97], p < 0.001 and 2.21 [1.52 to 3.20], p < 0.001) and z-drugs (HRs: 1.98 [1.14 to 3.44], p = 0.015 and 1.65 [1.09 to 2.49], p = 0.018) were significantly increased relative to trazodone; findings were similar with exclusion of overdose deaths or restriction to those with cardiovascular causes. Limitations included composition of the study cohort and potential confounding by unmeasured variables. CONCLUSIONS In US Medicare beneficiaries 65 years of age or older without concurrent opioids who initiated treatment with benzodiazepine hypnotics, z-drugs, or low-dose trazodone, study hypnotics were not associated with mortality. With concurrent opioids, benzodiazepines and z-drugs were associated with increased out-of-hospital and total mortality. These findings indicate that the dangers of benzodiazepine-opioid coadministration go beyond the documented association with overdose death and suggest that in combination with opioids, the z-drugs may be more hazardous than previously thought.
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Affiliation(s)
- Wayne A. Ray
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- * E-mail:
| | - Cecilia P. Chung
- Cecilia P. Chung, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Katherine T. Murray
- Departments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Beth A. Malow
- Department of Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - James R. Daugherty
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - C. Michael Stein
- Departments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
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Kirby JJ, Shaikh S, Bryant DP, Ho AF, d'Etienne JP, Schrader CD, Wang H. A Simplified Comorbidity Evaluation Predicting Clinical Outcomes Among Patients With Coronavirus Disease 2019. J Clin Med Res 2021; 13:237-244. [PMID: 34007362 PMCID: PMC8110217 DOI: 10.14740/jocmr4476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/26/2021] [Indexed: 01/08/2023] Open
Abstract
Background Patients with coronavirus disease 2019 (COVID-19) have shown a range of clinical outcomes. Previous studies have reported that patient comorbidities are predictive of worse clinical outcomes, especially when patients have multiple chronic diseases. We aim to: 1) derive a simplified comorbidity evaluation and determine its accuracy of predicting clinical outcomes (i.e., hospital admission, intensive care unit (ICU) admission, ventilation, and in-hospital mortality); and 2) determine its performance accuracy in comparison to well-established comorbidity indexes. Methods This was a single-center retrospective observational study. We enrolled all emergency department (ED) patients with COVID-19 from March 1, 2020, to December 31, 2020. A simplified comorbidity evaluation (COVID-related high-risk chronic condition (CCC)) was derived to predict different clinical outcomes using multivariate logistic regressions. In addition, chronic diseases included in the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI) were scored, and its accuracy of predicting COVID-19 clinical outcomes was also compared with the CCC. Results Data were retrieved from 90,549 ED patient visits during the study period, among which 3,864 patients were COVID-19 positive. Forty-seven point nine percent (1,851/3,864) were admitted to the hospital, 9.4% (364) patients were admitted to the ICU, 6.2% (238) received invasive mechanical ventilation, and 4.6% (177) patients died in the hospital. The CCC evaluation correlated well with the four studied clinical outcomes. The adjusted odds ratios of predicting in-hospital death from CCC was 2.84 (95% confidence interval (CI): 1.81 - 4.45, P < 0.001). C-statistics of CCC predicting in-hospital all-cause mortality was 0.73 (0.69 - 0.76), similar to those of the CCI's (0.72) and ECI's (0.71, P = 0.0513). Conclusions CCC can accurately predict clinical outcomes among patients with COVID-19. Its performance accuracies for such predictions are not inferior to those of the CCI or ECI's.
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Affiliation(s)
- Jessica J Kirby
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.,These authors contributed equally to this article
| | - Sajid Shaikh
- Department of Information Technology, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.,These authors contributed equally to this article
| | - David P Bryant
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Amy F Ho
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - James P d'Etienne
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Chet D Schrader
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Hao Wang
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
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Mehta HB, Wang L, Malagaris I, Duan Y, Rosman L, Alexander GC. More than two-dozen prescription drug-based risk scores are available for risk adjustment: A systematic review. J Clin Epidemiol 2021; 137:113-125. [PMID: 33838274 DOI: 10.1016/j.jclinepi.2021.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 02/10/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE While several prescription drug-based risk indices have been developed, their design, performance, and application has not previously been synthesized. STUDY DESIGN AND SETTING We searched Ovid MEDLINE, CINAHL and Embase from inception through March 3, 2020 and included studies that developed or updated a prescription drug-based risk index. Two reviewers independently performed screening and extracted information on data source, study population, cohort sizes, outcomes, study methodology and performance. Predictive performance was evaluated using C statistics for binary outcomes and R2 for continuous outcomes. The PROSPERO ID for this review is CRD42020165498. RESULTS Of 19,112 articles that were retrieved, 124 were full-text screened and 25 were included, each of which represented a de novo or updated drug-based index. The indices were customized to varied age groups and clinical populations and most commonly evaluated outcomes including mortality (36%), hospitalization (24%) and healthcare costs (24%). C statistics ranged from 0.62 to 0.92 for mortality and 0.59 to 0.72 for hospitalization, while adjusted R2 for healthcare costs ranged from 0.06 to 0.62. Seven of the 25 risk indices included used global drug classification algorithms. CONCLUSIONS More than two-dozen prescription drug-based risk indices have been developed and they differ significantly in design, performance and application.
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Affiliation(s)
- Hemalkumar B Mehta
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Lin Wang
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ioannis Malagaris
- Department of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Yanjun Duan
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lori Rosman
- Welch Medical Library, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - G Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Makar M, Makar G, Xia W, Greenberg P, Patel AV. Association of Clostridioides difficile with adverse clinical outcomes in patients with acute diverticulitis: A nationwide study. J Gastroenterol Hepatol 2021; 36:983-989. [PMID: 32870544 DOI: 10.1111/jgh.15240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 08/03/2020] [Accepted: 08/25/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Acute diverticulitis (AD) is a common gastrointestinal disease with a significant health care-associated burden. Patients hospitalized with AD have many risk factors for developing Clostridioides difficile infection (CDI). CDI is associated with poor outcomes in many diseases but has yet to be studied in AD. METHODS We utilized data from the National Inpatient Sample from January 2012 to October 2015 for patients hospitalized with AD and CDI compared with AD alone. Primary outcomes, which were mortality, length of stay, and hospitalization cost, were compared. Secondary outcomes were complications of diverticulitis and need for surgical interventions. Risk factors for mortality in AD and risk factors associated with CDI in AD patients were analyzed. RESULTS Among 767 850 hospitalizations for AD, 8755 also had CDI. A propensity score-matched cohort analysis demonstrated that CDI was associated with increased risk of inpatient mortality (odds ratio [OR] 2.78, 95% confidence interval [CI] 1.30, 5.95), prolonged duration of hospitalization by 4.27 days (P < 0.0001), total hospital cost by $33 271 (P < 0.0001), need for surgery (OR 1.45, 95% CI 1.22, 1.71), and complications of diverticulitis (OR 1.45, 95% CI 1.21, 1.74). Predictors of CDI among patients with AD included female gender (1.12 OR, 95% CI 1.01, 1.24), three or more comorbidities (1.81 OR, 95% CI 1.57, 2.09), and admissions to teaching hospitals (1.44 OR, 95% CI 1.22, 1.70). CONCLUSIONS Clostridioides difficile infection in AD is associated with increased mortality, length of stay, and hospital cost. Preventative measures should be made for at-risk patients with AD to decrease infection rate and poor outcomes.
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Affiliation(s)
- Michael Makar
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Gabriel Makar
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Weiyi Xia
- Biostatistics and Epidemiology Services Center, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Patricia Greenberg
- Biostatistics and Epidemiology Services Center, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Anish Vinit Patel
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Shen J, Crothers K, Kross EK, Petersen K, Melzer AC, Triplette M. Provision of Smoking Cessation Resources in the Context of In-Person Shared Decision-Making for Lung Cancer Screening. Chest 2021; 160:765-775. [PMID: 33745990 DOI: 10.1016/j.chest.2021.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Lung cancer screening (LCS) is effective at reducing mortality for high-risk smokers. Mortality benefits go beyond early cancer detection, because shared decision-making (SDM) may present a "teachable moment" to reinforce cessation and provide resources. RESEARCH QUESTION How well is smoking cessation performed during LCS SDM encounters, and what patient and provider characteristics are associated with smoking cessation assistance? STUDY DESIGN AND METHODS This is a retrospective cohort study of current smokers participating in initial LCS SDM through a multisite program in Seattle, Washington, between 2015-2018. The LCS tracking database and electronic health record were reviewed for demographics, comorbidity data, and clinical encounter information. The primary outcome was provision of a smoking cessation resource, defined as referral to cessation resources, recommendation for nicotine replacement, or prescription for cessation medication. Participant and provider factor associations with the outcome were evaluated using χ2 testing and multivariable logistic regression. RESULTS Most of the 423 study participants were men (70%), with a median age of 61 (IQR, 58-66) years and median of 50 (41-72) pack-years of smoking. Only 26% of encounters had documentation consistent with SDM. Thirty-nine percent of participants received at least one smoking cessation resource, and only 5% received both counseling referrals and medication. In a multivariable model, the provision of any smoking cessation resource was half as likely in participants with higher levels of comorbidity (Charlson Index >2; OR, 0.53; 95% CI, 0.31-0.81), and half as likely if the ordering provider was not the patient's PCP or their specialist (OR, 0.55; 95% CI, 0.32-0.96). INTERPRETATION Overall provision of smoking cessation resources was moderate during SDM encounters for LCS, and lower in patients with more comorbidities and when not performed by the patient's PCP or specialist. Interventions are needed to improve smoking cessation counseling and resource utilization at the time of LCS encounters.
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Affiliation(s)
| | - Kristina Crothers
- University of Washington, Seattle, WA; Veterans Affairs Puget Sound Medical Center, Seattle, WA
| | - Erin K Kross
- University of Washington, Seattle, WA; Cambia Palliative Care Center of Excellence at UW Medicine, Seattle, WA
| | | | - Anne C Melzer
- Division of Pulmonary, Allergy and Critical Care, University of Minnesota, Minneapolis, MN; Minneapolis Veterans Affairs Health Care System, Minneapolis, MN
| | - Matthew Triplette
- University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center and Department of Medicine, University of Washington, Seattle, WA.
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Mbuya-Bienge C, Simard M, Gaulin M, Candas B, Sirois C. Does socio-economic status influence the effect of multimorbidity on the frequent use of ambulatory care services in a universal healthcare system? A population-based cohort study. BMC Health Serv Res 2021; 21:202. [PMID: 33676497 PMCID: PMC7937264 DOI: 10.1186/s12913-021-06194-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 02/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frequent healthcare users place a significant burden on health systems. Factors such as multimorbidity and low socioeconomic status have been associated with high use of ambulatory care services (emergency rooms, general practitioners and specialist physicians). However, the combined effect of these two factors remains poorly understood. Our goal was to determine whether the risk of being a frequent user of ambulatory care is influenced by an interaction between multimorbidity and socioeconomic status, in an entire population covered by a universal health system. METHODS Using a linkage of administrative databases, we conducted a population-based cohort study of all adults in Quebec, Canada. Multimorbidity (defined as the number of different diseases) was assessed over a two-year period from April 1st 2012 to March 31st 2014 and socioeconomic status was estimated using a validated material deprivation index. Frequents users for a particular category of ambulatory services had a number of visits among the highest 5% in the total population during the 2014-15 fiscal year. We used ajusted logistic regressions to model the association between frequent use of health services and multimorbidity, depending on socioeconomic status. RESULTS Frequent users (5.1% of the population) were responsible for 25.2% of all ambulatory care visits. The lower the socioeconomic status, the higher the burden of chronic diseases, and the more frequent the visits to emergency departments and general practitioners. Socioeconomic status modified the association between multimorbidity and frequent visits to specialist physicians: those with low socioeconomic status visited specialist physicians less often. The difference in adjusted proportions of frequent use between the most deprived and the least deprived individuals varied from 0.1% for those without any chronic disease to 5.1% for those with four or more chronic diseases. No such differences in proportions were observed for frequent visits to an emergency room or frequent visits to a general practitioner. CONCLUSION Even in a universal healthcare system, the gap between socioeconomic groups widens as a function of multimorbidity with regard to visits to the specialist physicians. Further studies are needed to better understand the differential use of specialized care by the most deprived individuals.
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Affiliation(s)
- Cynthia Mbuya-Bienge
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada.
- Quebec National Institute of Public Health, Quebec, QC, Canada.
- Centre de Recherche Sur les Soins et les Services de Première Ligne de l'Université Laval, Québec, Canada.
| | - Marc Simard
- Quebec National Institute of Public Health, Quebec, QC, Canada
| | - Myles Gaulin
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
- Quebec National Institute of Public Health, Quebec, QC, Canada
| | - Bernard Candas
- National Institute of Excellence in Health and Social Services, Quebec, QC, Canada
| | - Caroline Sirois
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
- Quebec National Institute of Public Health, Quebec, QC, Canada
- Centre de Recherche Sur les Soins et les Services de Première Ligne de l'Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Centre de recherche du CHU de Québec, Quebec, QC, Canada
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Lien F, Wang HY, Lu JJ, Wen YH, Chiueh TS. Predicting 2-Day Mortality of Thrombocytopenic Patients Based on Clinical Laboratory Data Using Machine Learning. Med Care 2021; 59:245-250. [PMID: 33027237 PMCID: PMC7993911 DOI: 10.1097/mlr.0000000000001421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Clinical laboratories have traditionally used a single critical value for thrombocytopenic events. This system, however, could lead to inaccuracies and inefficiencies, causing alarm fatigue and compromised patient safety. OBJECTIVES This study shows how machine learning (ML) models can provide auxiliary information for more accurate identification of critical thrombocytopenic patients when compared with the traditional notification system. RESEARCH DESIGN A total of 50,505 patients' platelet count and other 26 additional laboratory datasets of each thrombocytopenic event were used to build prediction models. Conventional logistic regression and ML methods, including random forest (RF), artificial neural network, stochastic gradient descent (SGD), naive Bayes, support vector machine, and decision tree, were applied to build different models and evaluated. RESULTS Models using logistic regression [area under the curve (AUC)=0.842], RF (AUC=0.859), artificial neural network (AUC=0.867), or SGD (AUC=0.826) achieved the desired average AUC>0.80. The highest positive predictive value was obtained by the SGD model in the testing data (72.2%), whereas overall, the RF model showed higher sensitivity and total positive predictions in both the training and testing data and outperformed other models. The positive 2-day mortality predictive rate of RF methods is as high as 46.1%-significantly higher than using the traditional notification system at only 14.8% [χ2(1)=81.66, P<0.001]. CONCLUSIONS This study demonstrates a data-driven ML approach showing a significantly more accurate 2-day mortality prediction after a critical thrombocytopenic event, which can reinforce the accuracy of the traditional notification system.
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Affiliation(s)
- Frank Lien
- Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital
| | - Hsin-Yao Wang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital
- Department of Internal Medicine, Chang Gung University, TaoYuan, Taiwan
| | - Jang-Jih Lu
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital
| | - Ying-Hao Wen
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital
- Department of Internal Medicine, Chang Gung University, TaoYuan, Taiwan
| | - Tzong-Shi Chiueh
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital
- Department of Internal Medicine, Chang Gung University, TaoYuan, Taiwan
- New Taipei Municipal TuCheng Hospital, TuCheng, New Taipei
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88
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Huang WC, Chen YC, Wu CH, Ko Y. Cardiovascular outcomes and healthcare costs of liraglutide versus basal insulin for type 2 diabetes patients at high cardiovascular risk. Sci Rep 2021; 11:1430. [PMID: 33446845 PMCID: PMC7809152 DOI: 10.1038/s41598-020-80753-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/28/2020] [Indexed: 02/06/2023] Open
Abstract
We aimed to compare the (1) clinical outcomes including composite cardiovascular outcomes, cardiovascular death, and all-cause death, and (2) healthcare costs of using liraglutide and basal insulin as an initial treatment for patients with type 2 diabetes mellitus (T2DM) and high cardiovascular diseases (CVD) risk. This is a retrospective cohort study using Taiwan’s Health and Welfare Database. A total of 1057 patients treated with liraglutide were identified and matched with 4600 patients treated with basal insulin. The liraglutide group had a lower risk of a composite CVD outcome (hazard ratio (HR) 0.65; 95% confidence interval (CI) 0.50–0.85; p < 0.01), all-cause mortality (HR 0.40; 95% CI 0.28–0.59; p < 0.0001), and nonfatal stroke (HR 0.54; 95% CI 0.34–0.87; p = 0.01). Compared to the basal insulin group, the liraglutide group had lower median per-patient-per-month (PPPM) inpatient, emergency room (ER), and total medical costs, but higher median PPPM outpatient, total pharmacy, and total costs (all p < 0.0001). In conclusion, compared to basal insulin, liraglutide was found to be associated with reduced risk of a composite CVD outcome, nonfatal stroke, and all-cause mortality among high CVD risk patients with T2DM. In addition, liraglutide users had lower inpatient, ER, and total medical costs, but they had higher outpatient and total pharmacy costs.
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Affiliation(s)
- Wan-Chun Huang
- School of Pharmacy, College of Pharmacy, Taipei Medical University, No.250, Wuxing St., Taipei, 11031, Taiwan
| | - Yen-Chou Chen
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chung-Hsuen Wu
- School of Pharmacy, College of Pharmacy, Taipei Medical University, No.250, Wuxing St., Taipei, 11031, Taiwan
| | - Yu Ko
- School of Pharmacy, College of Pharmacy, Taipei Medical University, No.250, Wuxing St., Taipei, 11031, Taiwan. .,Research Center for Pharmacoeconomics, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
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89
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Ludvigsson JF, Appelros P, Askling J, Byberg L, Carrero JJ, Ekström AM, Ekström M, Smedby KE, Hagström H, James S, Järvholm B, Michaelsson K, Pedersen NL, Sundelin H, Sundquist K, Sundström J. Adaptation of the Charlson Comorbidity Index for Register-Based Research in Sweden. Clin Epidemiol 2021; 13:21-41. [PMID: 33469380 PMCID: PMC7812935 DOI: 10.2147/clep.s282475] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/02/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose Comorbidity indices are often used to measure comorbidities in register-based research. We aimed to adapt the Charlson comorbidity index (CCI) to a Swedish setting. Methods Four versions of the CCI were compared and evaluated by disease-specific experts. Results We created a cohesive coding system for CCI to 1) harmonize the content between different international classification of disease codes (ICD-7,8,9,10), 2) delete incorrect codes, 3) enhance the distinction between mild, moderate or severe disease (and between diabetes with and without end-organ damage), 4) minimize duplication of codes, and 5) briefly explain the meaning of individual codes in writing. Conclusion This work may provide an integrated and efficient coding algorithm for CCI to be used in medical register-based research in Sweden.
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Affiliation(s)
- Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Orebro University Hospital, Orebro, Sweden.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Peter Appelros
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro SE-701 82, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Rheumatology, Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Mia Ekström
- Global & Sexual Health Research Group (GloSH), Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Magnus Ekström
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Ekström Smedby
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Hannes Hagström
- Division of Hepatology, Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden.,Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Karolinska Huddinge, Institutet, Stockholm, Sweden
| | - Stefan James
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Bengt Järvholm
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Karl Michaelsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Helene Sundelin
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.,Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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90
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Gentil L, Grenier G, Meng X, Fleury MJ. Impact of Co-occurring Mental Disorders and Chronic Physical Illnesses on Frequency of Emergency Department Use and Hospitalization for Mental Health Reasons. Front Psychiatry 2021; 12:735005. [PMID: 34880788 PMCID: PMC8645581 DOI: 10.3389/fpsyt.2021.735005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Patients with mental disorders (MD) are at high risk for a wide range of chronic physical illnesses (CPI), often resulting in greater use of acute care services. This study estimated risk of emergency department (ED) use and hospitalization for mental health (MH) reasons among 678 patients with MD and CPI compared to 1,999 patients with MD only. Methods: Patients visiting one of six Quebec (Canada) ED for MH reasons and at onset of a MD in 2014-15 (index year) were included. Negative binomial models comparing the two groups estimated risk of ED use and hospitalization at 12-month follow-up to index ED visit, controlling for clinical, sociodemographic, and service use variables. Results: Patients with MD, more severe overall clinical conditions and those who received more intensive specialized MH care had higher risks of frequent ED use and hospitalization. Continuity of medical care protected against both ED use and hospitalization, while general practitioner (GP) consultations protected against hospitalization only. Patients aged 65+ had lower risk of ED use, whereas risk of hospitalization was higher for the 45-64- vs. 12-24-year age groups, and for men vs. women. Conclusion: Strategies including assertive community treatment, intensive case management, integrated co-occurring treatment, home treatment, and shared care may improve adequacy of care for patients with MD-CPI, as well as those with MD only whose clinical profiles were severe. Prevention and outreach strategies may also be promoted, especially among men and older age groups.
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Affiliation(s)
- Lia Gentil
- Douglas Mental Health University Institute Research Centre, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, Montréal, QC, Canada
| | - Xiangfei Meng
- Douglas Mental Health University Institute Research Centre, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute Research Centre, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada
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91
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Altonen BL, Arreglado TM, Leroux O, Murray-Ramcharan M, Engdahl R. Characteristics, comorbidities and survival analysis of young adults hospitalized with COVID-19 in New York City. PLoS One 2020; 15:e0243343. [PMID: 33315929 PMCID: PMC7735602 DOI: 10.1371/journal.pone.0243343] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/19/2020] [Indexed: 01/08/2023] Open
Abstract
This study reviewed 395 young adults, 18–35 year-old, admitted for COVID-19 to one of the eleven hospitals in New York City public health system. Demographics, comorbidities, clinical course, outcomes and characteristics linked to hospitalization were analyzed including temporal survival analysis. Fifty-seven percent of patients had a least one major comorbidity. Mortality without comorbidity was in 3.8% patients. Further investigation of admission features and medical history was conducted. Comorbidities associated with mortality were diabetes (n = 54 deceased/73 diagnosed,74% tested POS;98.2% with diabetic history deceased; Wilcoxon p (Wp) = .044), hypertension (14/44,32% POS, 25.5%; Wp = 0.030), renal (6/16, 37.5% POS,11%; Wp = 0.000), and cardiac (6/21, 28.6% POS,11%; Wp = 0.015). Kaplan survival plots were statistically significant for these four indicators. Data suggested glucose >215 or hemoglobin A1c >9.5 for young adults on admission was associated with increased mortality. Clinically documented respiratory distress on admission was statistically significant outcome related to mortality (X2 = 236.6842, df = 1, p < .0001). Overall, 28.9% required supportive oxygen beyond nasal cannula. Nasal cannula oxygen alone was required for 71.1%, who all lived. Non-invasive ventilation was required for 7.8%, and invasive mechanical ventilation 21.0% (in which 7.3% lived, 13.7% died). Temporal survival analysis demonstrated statistically significant response for Time to Death <10 days (X2 = 18.508, df = 1, p = .000); risk lessened considerably for 21 day cut off (X2 = 3.464, df = 1, p = .063), followed by 31 or more days of hospitalization (X2 = 2.212, df = 1, p = .137).
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Affiliation(s)
- Brian L. Altonen
- Division of Population Health and Research Administration, NYC Health + Hospitals, New York, New York, United States of America
| | - Tatiana M. Arreglado
- Division of Clinical Informatics, NYC Health + Hospitals, Harlem Hospital, New York, New York, United States of America
| | - Ofelia Leroux
- Department of Surgery, NYC Health + Hospitals, Harlem Hospital, New York, New York, United States of America
| | - Max Murray-Ramcharan
- Department of Surgery, NYC Health + Hospitals, Harlem Hospital, New York, New York, United States of America
| | - Ryan Engdahl
- Department of Surgery, NYC Health + Hospitals, Harlem and Woodhull Hospitals, New York, New York, United States of America
- * E-mail:
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92
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Cowling TE, Cromwell DA, Sharples LD, van der Meulen J. A novel approach selected small sets of diagnosis codes with high prediction performance in large healthcare datasets. J Clin Epidemiol 2020; 128:20-28. [DOI: 10.1016/j.jclinepi.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/15/2020] [Accepted: 08/05/2020] [Indexed: 12/23/2022]
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93
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Park HY, Lee Y, Lim CY, Kim M, Park J, Lee T. Effects of etomidate use in ICU patients on ventilator therapy: a study of 12,526 patients in an open database from a single center. Korean J Anesthesiol 2020; 74:300-307. [PMID: 33233029 PMCID: PMC8342844 DOI: 10.4097/kja.20509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background There is a debate regarding the safety of etomidate. We evaluated the effects of etomidate on mortality in a large cohort of critical care patients. Methods This retrospective matched-cohort study was performed using the Medical Information Mart for Intensive Care version 3 (MIMIC-III) database. Among 12,526 adult patients who were prescribed etomidate or propofol on the first day of mechanical ventilation, 625 patients administered etomidate were statistically matched with 6,250 patients administered propofol. The primary outcome measures were all-cause in-hospital mortality, 48-hour survival, cardiovascular morbidity, and infectious morbidity. Logistic regression analysis with stepwise selection of variables was performed to examine the dose–mortality relationship of etomidate. Results All-cause in-hospital mortality was 1.84 times higher in the etomidate cohort (OR: 1.84, 98.75% CI: 1.42, 2.37). Compared to the propofol cohort, the etomidate cohort showed 57% lower odds of 48-hour survival (0.43 [0.27, 0.73]), no difference in odds of cardiovascular morbidity (0.86 [0.66, 1.12]), and 1.77 times higher odds of infectious morbidity (1.77 [1.35, 2.31]). Additionally, the odds of mortality increased by 1.36 times per 0.1 mg/kg of etomidate (1.36 [95% CI: 1.23, 1.49]). Conclusions Etomidate is a poor choice as a hypnotic drug on the first day of mechanical ventilation, as it is associated with a dose-dependent increase in all-cause mortality, and does not improve survival for the first 48 h.
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Affiliation(s)
- Ha Yeon Park
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Younsuk Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.,D/M Statistics Institute, Dongguk University, Goyang, Korea
| | - Chi-Yeon Lim
- D/M Statistics Institute, Dongguk University, Goyang, Korea.,Department of Biostatistics, Dongguk University College of Medicine, Goyang, Korea
| | - Mina Kim
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jieun Park
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Teakseon Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
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94
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A New Care Model Reduces Polypharmacy and Potentially Inappropriate Medications in Long-Term Care. J Am Med Dir Assoc 2020; 22:141-147. [PMID: 33221164 DOI: 10.1016/j.jamda.2020.09.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Assess the impact of a new pharmaceutical care model on (1) polypharmacy and (2) potentially inappropriate medication (PIM) use in long-term care facilities (LTCFs). DESIGN Pragmatic quasi-experimental study with a control group. This multifaceted model enables pharmacists and nurses to increase their professional autonomy by enforcing laws designed to expand their scope of practice. It also involves a strategic reorganization of care, interdisciplinary training, and systematic medication reviews. SETTING AND PARTICIPANTS Two LTCFs exposed to the model (409 residents) were compared to 2 control LTCFs (282 residents) in Quebec, Canada. All individuals were aged 65 years or older and residing in included LTCFs. MEASURES Polypharmacy (≥10 medications) and PIM (2015 Beers criteria) were analyzed throughout 12 months between March 2017 and June 2018. Groups were compared before and after implementation using repeated measures mixed Poisson or logistic regression models, adjusting for potential confounding variables. RESULTS Over 12 months, for regular medications, polypharmacy decreased from 42% to 20% (exposed group) and from 50% to 41% (control group) [difference in differences (DID): 13%, P < .001]. Mean number of PIMs also decreased from 0.79 to 0.56 (exposed group) and from 1.08 to 0.90 (control group) (DID: 0.05, P = .002). CONCLUSIONS AND IMPLICATIONS Compared with usual care, this multifaceted model reduced the probability of receiving ≥10 medications and the mean number of PIMs. Greater professional autonomy, reorganization of care, training, and medication review can optimize pharmaceutical care. As the role of pharmacists is expanding in many countries, this model shows what could be achieved with increased professional autonomy of pharmacists and nurses in LTCFs.
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95
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Dufour I, Dubuc N, Chouinard MC, Chiu Y, Courteau J, Hudon C. Profiles of Frequent Geriatric Users of Emergency Departments: A Latent Class Analysis. J Am Geriatr Soc 2020; 69:753-761. [PMID: 33156527 DOI: 10.1111/jgs.16921] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/02/2020] [Accepted: 10/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES Frequent geriatric users of emergency departments (EDs) represent a complex and heterogeneous population. Identifying their specific subgroups would allow the development of interventions better customized to their needs and characteristics. Thus, this study aimed to develop profiles of frequent geriatric ED users using the individual characteristics of patients. DESIGN This was a retrospective cohort study. SETTING Databases from the Régie de l'assurance maladie du Québec (RAMQ) were utilized. PARTICIPANTSThis study included individuals aged 65 years or older living in the community in the Province of Quebec (Canada), who consulted in an ED at least four times in the year after an ED index date (an ED visit, chosen randomly, during an index period of January 1, 2012 to December 31, 2013) and who had received a diagnosis of ambulatory care-sensitive conditions (ACSCs) in the 2 years preceding the index date. MEASUREMENTS A latent class analysis was used to identify subgroups of frequent geriatric ED users according to their individual characteristics, including ACSC type, dementia, mental health disorders, cancer diagnosis, and comorbidity index. RESULTS The study cohort consisted of 21,393 frequent geriatric ED users. Four groups of frequent geriatric ED users were identified: people with low comorbidity (39.0%), comprising the individuals with the lowest number of physical and mental health conditions; people with cancer (32.7%); people with pulmonaryand cardiac diseases (18.1%); and people with dementia or mental health disorders (10.2%), composed of individuals with the highest proportion of common and severe mental health disease, as well as dementia. This group accounts for the highest use of overall healthcare services. CONCLUSION These profiles will be useful in developing customized interventions addressing the needs of each subgroup of frequent geriatric ED users. More research is needed to bridge the remaining gaps, especially regarding the healthiest frequent geriatric users of EDs.
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Affiliation(s)
- Isabelle Dufour
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Nicole Dubuc
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Yohann Chiu
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Josiane Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, Canada
| | - Catherine Hudon
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Canada
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96
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Shin JH, Kunisawa S, Imanaka Y. New outcome-specific comorbidity scores excelled in predicting in-hospital mortality and healthcare charges in administrative databases. J Clin Epidemiol 2020; 126:141-153. [DOI: 10.1016/j.jclinepi.2020.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 05/07/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
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97
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Pritchard E, Fawcett N, Quan TP, Crook D, Peto TE, Walker AS. Combining Charlson and Elixhauser scores with varying lookback predicated mortality better than using individual scores. J Clin Epidemiol 2020; 130:32-41. [PMID: 33002637 DOI: 10.1016/j.jclinepi.2020.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/02/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate variation in the presence of secondary diagnosis codes in Charlson and Elixhauser comorbidity scores and assess whether including a 1-year lookback period improved prognostic adjustment by these scores individually, and combined, for 30-day mortality. STUDY DESIGN AND SETTING We analyzed inpatient admissions from January 1, 2007 to May 18, 2018 in Oxfordshire, UK. Comorbidity scores were calculated using secondary diagnostic codes in the diagnostic-dominant episode, and primary and secondary codes from the year before. Associations between scores and 30-day mortality were investigated using Cox models with natural cubic splines for nonlinearity, assessing fit using Akaike Information Criteria. RESULTS The 1-year lookback improved model fit for Charlson and Elixhauser scores vs. using diagnostic-dominant methods. Including both, and allowing nonlinearity, improved model fit further. The diagnosis-dominant Charlson score and Elixhauser score using a 1-year lookback, and their interaction, provided the best comorbidity adjustment (reduction in AIC: 761 from best single score model). CONCLUSION The Charlson and Elixhauser score calculated using primary and secondary diagnostic codes from 1-year lookback with secondary diagnostic codes from the current episode improved individual predictive ability. Ideally, comorbidities should be adjusted for using both the Charlson (diagnostic-dominant) and Elixhauser (1-year lookback) scores, incorporating nonlinearity and interactions for optimal confounding control.
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Affiliation(s)
- Emma Pritchard
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Oxford, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Nicola Fawcett
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Oxford, UK; Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK
| | - T Phuong Quan
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Oxford, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK; National Institute for Health Research Biomedical Research Centre, Oxford, UK
| | - Derrick Crook
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Oxford, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK; Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK; National Institute for Health Research Biomedical Research Centre, Oxford, UK
| | - Tim Ea Peto
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Oxford, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK; Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK; National Institute for Health Research Biomedical Research Centre, Oxford, UK
| | - A Sarah Walker
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Oxford, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK; National Institute for Health Research Biomedical Research Centre, Oxford, UK
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98
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Park C, Bahethi R, Yang A, Gray M, Wong K, Courey M. Effect of Patient Demographics and Tracheostomy Timing and Technique on Patient Survival. Laryngoscope 2020; 131:1468-1473. [PMID: 32996189 DOI: 10.1002/lary.29000] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/06/2020] [Accepted: 07/19/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The ideal timing and technique of tracheostomy vary among patients and may impact outcomes. We aim to examine the association between tracheostomy timing, placement technique, and patient demographics on survival. STUDY DESIGN Retrospective cohort study. METHODS A retrospective review was performed for all patients who underwent tracheostomy in 2016 and 2017 at one urban academic tertiary-care hospital. Kaplan-Meier curves were created based on combinations of tracheostomy timing and technique (early percutaneous, early non-percutaneous, late percutaneous, and late non-percutaneous). Cox proportional hazard models were used to determine multivariable effects of timing, technique, and other demographic factors. Primary outcome measures were tracheostomy-related mortality and overall survival. Secondary outcomes were in-hospital, 30-day, and 90-day mortality. RESULTS Our study included 523 patients. There were six tracheostomy-related deaths, with hemorrhage and tracheoesophageal fistula being the most common causes. Tracheostomy timing and technique combinations were not associated with differences in all-cause mortality or survival following discharge. Cox proportional hazard models showed that Charlson Comorbidity Index (CCI) and unknown partner status were associated with a decrease in survival (P < .01 and P = .05, respectively). Additionally, patient age, gender, race, CCI, and body mass index were not independently associated with changes in survival. CONCLUSION Late and non-percutaneous tracheostomies were associated with more tracheostomy-related deaths, but timing and technique were not associated with differences in patient survival. Multiple regression analysis showed that increased patient comorbidities, measured via CCI, and unknown partner status were independently associated with decreased survival. Proceduralists should discuss timing, technique, and patient social factors together with the medical care team when constructing plans for postdischarge management. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1468-1473, 2021.
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Affiliation(s)
| | | | - Anthony Yang
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mingyang Gray
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kevin Wong
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mark Courey
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, USA
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The Charlson Comorbidity Index: can it predict the outcome in acute kidney injury? Int Urol Nephrol 2020; 52:1713-1718. [PMID: 32519240 DOI: 10.1007/s11255-020-02499-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Comorbidity has a significant impact on the health status and treatment outcome of a patient. The Charlson comorbidity index (CCI) is a frequently used scoring system, which evaluates the prognosis based on the patient's comorbid conditions. The aim of this study was to evaluate the usefulness of CCI in predicting the mortality and renal recovery in non-critically ill patients with severe AKI. METHODS A total of 530 adult patients who were referred from the emergency department and underwent intermittent urgent hemodialysis (uHD) were enrolled in the study. Personal history for comorbidities were recorded and then assessed using the CCI. RESULTS The mean CCI score was 3.3 ± 2.6. In our multivariate analysis, higher white blood cell count was associated with mortality (p = 0.023). The other parameters including CCI score were not found to be significantly associated with mortality excluding patients with sepsis. Moreover, the CCI was not significantly useful in the discrimination of patients with complete recovery from patients who remained dependent to dialysis. CONCLUSIONS We could not find significant association between CCI and short-term hospital mortality and renal outcome. Whereas, malnutrition, inflammation and general aging may have impact on short-term mortality among patients.
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Bagheri M, Fuchs PC, Lefering R, Grigutsch D, Busche MN, Niederstätter I, The German Burn Registry, Schiefer JL. Effect of comorbidities on clinical outcome of patients with burn injury - An analysis of the German Burn Registry. Burns 2020; 47:1053-1058. [PMID: 34092418 DOI: 10.1016/j.burns.2020.04.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Severe burn injuries are associated with high morbidity and mortality. Well-implemented scoring systems for patients with major burns exist in the literature. A major disadvantage of these scores is the partial non-consideration of patient-related comorbidities. Published data on this matter is limited to small study cohorts and/or single center studies. Further, the effect of comorbidities on clinical outcome of patients with severe burn injuries has not yet been examined nationwide in a large cohort in Germany. Hence, the aim of this study was to examine the influence of comorbidities on clinical outcome of these patients based on data from the national registry. METHODS Anonymized data from a total of 3455 patients with documented burns of 1% or more Total Burn Surface Area (TBSA) and over 16 years of age included in the German Burn Registry between 2017 and 2018 were analyzed retrospectively. Data included burn extent, body weight, age, burn depth, inhalation injury, comorbidities, mortality, number of operations and length of hospital stay (LOS). RESULTS In the logistic regression analysis age (OR 1.07 [1.06-1.09], p < 0.001), TBSA (OR 1.09 [1.08-1.11], p < 0.001), IHT (OR 2.15 [1.44-3.20], p < 0001), third degree burn (OR 2.08 [1.39-3.11], p < 0.001), Chronic Obstructive Pulmonary Disease (COPD) (OR 2.45 [1.38-4.35], p = 0.002) and renal insufficiency (OR 2.02 [1.13-3.59], p = 0.017) influenced mortality significantly. If a patient had more than one comorbidity, mortality was higher and in-hospital length of stay (LOS) longer. Renal insufficiency was significantly (p < 0.001) associated with the most prolonged LOS by 11.44 days. TBSA (p < 0.001), Abbreviated Burn Severity Index (ABSI) > 3 (p < 0.001) and IHT (p = 0.001) correlated with the amount of required surgeries and significantly predicted the need for intubation. Patients with arrhythmia significantly required more surgeries (p = 0.041), whereas patients with COPD required significantly less surgical interventions (p = 0.013). CONCLUSION Preexisting comorbidities have a significant impact on the clinical outcome of patients with severe burn injuries. Further investigation is warranted in order to supplement existing prognostic scores with new mortality-associated parameters.
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Affiliation(s)
- Mahsa Bagheri
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
| | - Paul Christian Fuchs
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
| | - Daniel Grigutsch
- Clinic of Anesthesiology at the University Hospital Bonn, Germany
| | - Marc Nicolai Busche
- Department of Plastic and Aesthetic Surgery, Burn Surgery, Leverkusen Hospital, Leverkusen, Germany; Hannover Medical School, Hannover, Germany
| | - Ines Niederstätter
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
| | | | - Jennifer Lynn Schiefer
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany.
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