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Lim J, Panagiotoglou D. The effect of Montreal's supervised consumption sites on injection-related infections among people who inject drugs: An interrupted time series. PLoS One 2024; 19:e0308482. [PMID: 39190638 PMCID: PMC11349102 DOI: 10.1371/journal.pone.0308482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/23/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Between June and November 2017, four supervised consumption sites (SCS) began operating in Montreal, Quebec. Earlier studies on SCS focused on examining their effects on blood-borne viral infections and overdose mortality. Our objective was to examine the effect of Montreal's SCS on the incidence, health service use and outcomes of injection-related infections (IRI) in people who inject drugs. METHODS We used Quebec's provincial administrative health data to identify people who inject drugs in Montreal and calculated the incidence of IRI in this population between December 2014 and December 2019. We conducted a retrospective, population-based interrupted time series to estimate the effect of Montreal's four SCS on the monthly incidence rates of IRI-related hospitalizations, emergency department (ED) visits, physician visits, and mortality. We also examined the effects of SCS on average length of IRI-related hospitalizations and incidence of hospitalizations involving surgery. RESULTS The average age of Montreal's people who inject drugs was 41.84 years, and 66.41% were male. After the implementation of SCS, there was a positive level change in the incidence of hospitalizations (0.97; 95% confidence interval [CI]: 0.26, 1.68) for IRI. There was also a significant post-intervention decline in hospitalization trends (-0.05; 95% CI: -0.08, -0.02), with modest trend changes in ED visits (-0.02; 95% CI: -0.05, 0.02). However, post-intervention changes in level (0.72; 95% CI: -3.85, 5.29) and trend (0.06; 95% CI: -0.23, 0.34) for physician visits remained limited. SCS had no effect on the average length of hospitalizations, but there was a decreasing post-intervention trend in hospitalizations involving surgery (-0.03; 95% CI: -0.06, 0.00). CONCLUSION Following the opening of the SCS, there was a moderate decline in the rate of hospitalizations to treat IRI, but the impact of the sites on the rate of physician visits remained limited. These findings suggest that SCS may mitigate the incidence of more serious and complicated IRI over time.
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Affiliation(s)
- Jihoon Lim
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Dimitra Panagiotoglou
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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van Leeuwen FD, Lugtig P, Feskens R. The performance of interrupted time series designs with a limited number of time points: Learning losses due to school closures during the COVID-19 pandemic. PLoS One 2024; 19:e0301301. [PMID: 39110741 PMCID: PMC11305537 DOI: 10.1371/journal.pone.0301301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 06/04/2024] [Indexed: 08/10/2024] Open
Abstract
Interrupted time series (ITS) designs are increasingly used for estimating the effect of shocks in natural experiments. Currently, ITS designs are often used in scenarios with many time points and simple data structures. This research investigates the performance of ITS designs when the number of time points is limited and with complex data structures. Using a Monte Carlo simulation study, we empirically derive the performance-in terms of power, bias and precision- of the ITS design. Scenarios are considered with multiple interventions, a low number of time points and different effect sizes based on a motivating example of the learning loss due to COVID school closures. The results of the simulation study show the power of the step change depends mostly on the sample size, while the power of the slope change depends on the number of time points. In the basic scenario, with both a step and a slope change and an effect size of 30% of the pre-intervention slope, the required sample size for detecting a step change is 1,100 with a minimum of twelve time points. For detecting a slope change the required sample size decreases to 500 with eight time points. To decide if there is enough power researchers should inspect their data, hypothesize about effect sizes and consider an appropriate model before applying an ITS design to their research. This paper contributes to the field of methodology in two ways. Firstly, the motivation example showcases the difficulty of employing ITS designs in cases which do not adhere to a single intervention. Secondly, models are proposed for more difficult ITS designs and their performance is tested.
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Affiliation(s)
- Florian D. van Leeuwen
- Department of Methods and Statistics, Faculty of Social Science, Utrecht University, Utrecht, The Netherlands
| | - Peter Lugtig
- Department of Methods and Statistics, Faculty of Social Science, Utrecht University, Utrecht, The Netherlands
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Gardezi AI, Yuan Z, Aziz F, Parajuli S, Mandelbrot D, Chan MR, Astor BC. Effect of End-Stage Renal Disease Prospective Payment System on Utilization of Peritoneal Dialysis in Patients with Kidney Allograft Failure. Am J Nephrol 2024:1-10. [PMID: 38754385 DOI: 10.1159/000539062] [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: 02/01/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION The Center for Medicare and Medicaid Services introduced an End-Stage Renal Disease Prospective Payment System (PPS) in 2011 to increase the utilization of home dialysis modalities, including peritoneal dialysis (PD). Several studies have shown a significant increase in PD utilization after PPS implementation. However, its impact on patients with kidney allograft failure remains unknown. METHODS We conducted an interrupted time series analysis using data from the US Renal Data System (USRDS) that include all adult kidney transplant recipients with allograft failure who started dialysis between 2005 and 2019. We compared the PD utilization in the pre-PPS period (2005-2010) to the fully implemented post-PPS period (2014-2019) for early (within 90 days) and late (91-365 days) PD experience. RESULTS A total of 27,507 adult recipients with allograft failure started dialysis during the study period. There was no difference in early PD utilization between the pre-PPS and the post-PPS period in either immediate change (0.3% increase; 95% CI: -1.95%, 2.54%; p = 0.79) or rate of change over time (0.28% increase per year; 95% CI: -0.16%, 0.72%; p = 0.18). Subgroup analyses revealed a trend toward higher PD utilization post-PPS in for-profit and large-volume dialysis units. There was a significant increase in PD utilization in the post-PPS period in units with low PD experience in the pre-PPS period. Similar findings were seen for the late PD experience. CONCLUSION PPS did not significantly increase the overall utilization of PD in patients initiating dialysis after allograft failure.
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Affiliation(s)
- Ali I Gardezi
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Zhongyu Yuan
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Fahad Aziz
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sandesh Parajuli
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Didier Mandelbrot
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Micah R Chan
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Brad C Astor
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Zhang Y, Ren Y, Huang Y, Yao M, Jia Y, Wang Y, Mei F, Zou K, Tan J, Sun X. Design and statistical analysis reporting among interrupted time series studies in drug utilization research: a cross-sectional survey. BMC Med Res Methodol 2024; 24:62. [PMID: 38461257 PMCID: PMC10924989 DOI: 10.1186/s12874-024-02184-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/20/2024] [Indexed: 03/11/2024] Open
Abstract
INTRODUCTION Interrupted time series (ITS) design is a commonly used method for evaluating large-scale interventions in clinical practice or public health. However, improperly using this method can lead to biased results. OBJECTIVE To investigate design and statistical analysis characteristics of drug utilization studies using ITS design, and give recommendations for improvements. METHODS A literature search was conducted based on PubMed from January 2021 to December 2021. We included original articles that used ITS design to investigate drug utilization without restriction on study population or outcome types. A structured, pilot-tested questionnaire was developed to extract information regarding study characteristics and details about design and statistical analysis. RESULTS We included 153 eligible studies. Among those, 28.1% (43/153) clearly explained the rationale for using the ITS design and 13.7% (21/153) clarified the rationale of using the specified ITS model structure. One hundred and forty-nine studies used aggregated data to do ITS analysis, and 20.8% (31/149) clarified the rationale for the number of time points. The consideration of autocorrelation, non-stationary and seasonality was often lacking among those studies, and only 14 studies mentioned all of three methodological issues. Missing data was mentioned in 31 studies. Only 39.22% (60/153) reported the regression models, while 15 studies gave the incorrect interpretation of level change due to time parameterization. Time-varying participant characteristics were considered in 24 studies. In 97 studies containing hierarchical data, 23 studies clarified the heterogeneity among clusters and used statistical methods to address this issue. CONCLUSION The quality of design and statistical analyses in ITS studies for drug utilization remains unsatisfactory. Three emerging methodological issues warranted particular attention, including incorrect interpretation of level change due to time parameterization, time-varying participant characteristics and hierarchical data analysis. We offered specific recommendations about the design, analysis and reporting of the ITS study.
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Affiliation(s)
- Yuanjin Zhang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
- Hainan Healthcare Security Administration Key Laboratory for Real World Data Research, Chengdu, China
| | - Yan Ren
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
- Hainan Healthcare Security Administration Key Laboratory for Real World Data Research, Chengdu, China
| | - Yunxiang Huang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
- Hainan Healthcare Security Administration Key Laboratory for Real World Data Research, Chengdu, China
| | - Minghong Yao
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
- Hainan Healthcare Security Administration Key Laboratory for Real World Data Research, Chengdu, China
| | - Yulong Jia
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
- Hainan Healthcare Security Administration Key Laboratory for Real World Data Research, Chengdu, China
| | - Yuning Wang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
- Hainan Healthcare Security Administration Key Laboratory for Real World Data Research, Chengdu, China
| | - Fan Mei
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
- Hainan Healthcare Security Administration Key Laboratory for Real World Data Research, Chengdu, China
| | - Kang Zou
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
- Hainan Healthcare Security Administration Key Laboratory for Real World Data Research, Chengdu, China
| | - Jing Tan
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China.
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China.
- Hainan Healthcare Security Administration Key Laboratory for Real World Data Research, Chengdu, China.
| | - Xin Sun
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China.
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China.
- Hainan Healthcare Security Administration Key Laboratory for Real World Data Research, Chengdu, China.
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Saha AK, Segal S. A Quality Improvement Initiative to Reduce Adverse Effects of Transitions of Anesthesia Care on Postoperative Outcomes: A Retrospective Cohort Study. Anesthesiology 2024; 140:387-398. [PMID: 37976442 DOI: 10.1097/aln.0000000000004839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND An intraoperative transfer of care from one anesthesia provider to another, or handover, may result in information loss and contribute to adverse patient outcomes. In 2019 the authors undertook a quality improvement effort to increase the use of a structured intraoperative handover tool incorporated in the electronic medical record. The authors hypothesized that intraoperative handovers of anesthesia care would be associated with adverse patient outcomes, and that increased use of a structured tool would attenuate this effect. METHODS This study included adult patients undergoing noncardiac surgery of at least 1 h duration performed during the period 2016 to 2021. Cases with a handover were identified if either there was a change of attending anesthesiologist or change of nurse anesthetist or resident for more than 35 min. The primary outcome was the occurrence of a composite of postoperative mortality and major postoperative morbidity. The effect of the intervention was analyzed by examining the quarterly change in odds ratio for the primary outcome for cases with and without a handover. RESULTS A total of 121,077 cases, 40.4% of which had a handover, were included. After weighting, the composite outcome was statistically associated with handovers (3,517 of 48,986 [7.2%] in handover cases vs. 4,470 of 72,091 [6.2%] in nonhandover cases; odds ratio, 1.08; 95% CI, 1.04 to 1.12). Time series analysis showed a marked increase in usage of the structured tool after the initial intervention. The odds ratio for the composite outcome showed a significant decrease over time after the initial intervention (t = -3.97; P < 0.001), with the slope of the odds ratio versus time curve decreasing from 0.002 (95% CI, 0.001 to 0.004; P = 0.018) to -0.011 (95% CI, -0.01 to -0.018; P < 0.001). CONCLUSIONS Intraoperative handovers are significantly associated with adverse outcomes even after controlling for multiple confounding variables. Use of a structured handover tool during anesthesia care may attenuate the adverse effect. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Amit K Saha
- Department of Anesthesiology, and Perioperative Outcomes and Informatics Collaborative, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Scott Segal
- Department of Anesthesiology, and Perioperative Outcomes and Informatics Collaborative, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Assad Z, Valtuille Z, Rybak A, Kaguelidou F, Lazzati A, Varon E, Pham LL, Lenglart L, Faye A, Caseris M, Cohen R, Levy C, Vabret A, Gravey F, Angoulvant F, Koehl B, Ouldali N. Unique Changes in the Incidence of Acute Chest Syndrome in Children With Sickle Cell Disease Unravel the Role of Respiratory Pathogens: A Time Series Analysis. Chest 2024; 165:150-160. [PMID: 37544426 DOI: 10.1016/j.chest.2023.07.4219] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Acute chest syndrome (ACS) is a life-threatening complication of sickle cell disease (SCD). Although respiratory pathogens are frequently detected in children with ACS, their respective role in triggering the disease is still unclear. We hypothesized that the incidence of ACS followed the unprecedented population-level changes in respiratory pathogen dynamics after COVID-19-related nonpharmaceutical interventions (NPIs). RESEARCH QUESTION What is the respective role of respiratory pathogens in ACS epidemiology? STUDY DESIGN AND METHODS This study was an interrupted time series analysis of patient records from a national hospital-based surveillance system. All children aged < 18 years with SCD hospitalized for ACS in France between January 2015 and May 2022 were included. The monthly incidence of ACS per 1,000 children with SCD over time was analyzed by using a quasi-Poisson regression model. The circulation of 12 respiratory pathogens in the general pediatric population over the same period was included in the model to assess the fraction of ACS potentially attributable to each respiratory pathogen. RESULTS Among the 55,941 hospitalizations of children with SCD, 2,306 episodes of ACS were included (median [interquartile range] age, 9 [5-13] years). A significant decrease was observed in ACS incidence after NPI implementation in March 2020 (-29.5%; 95% CI, -46.8 to -12.2; P = .001) and a significant increase after lifting of the NPIs in April 2021 (24.4%; 95% CI, 7.2 to 41.6; P = .007). Using population-level incidence of several respiratory pathogens, Streptococcus pneumoniae accounted for 30.9% (95% CI, 4.9 to 56.9; P = .02) of ACS incidence over the study period and influenza 6.8% (95% CI, 2.3 to 11.3; P = .004); other respiratory pathogens had only a minor role. INTERPRETATION NPIs were associated with significant changes in ACS incidence concomitantly with major changes in the circulation of several respiratory pathogens in the general population. This unique epidemiologic situation allowed determination of the contribution of these respiratory pathogens, in particular S pneumoniae and influenza, to the burden of childhood ACS, highlighting the potential benefit of vaccine prevention in this vulnerable population.
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Affiliation(s)
- Zein Assad
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris Cité University, Paris, France.
| | - Zaba Valtuille
- Centre d'Investigation Clinique, INSERM CIC1426, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; EA7323 Perinatal and Pediatric Pharmacology and Therapeutic Assessment, Paris Cité University, Paris, France
| | - Alexis Rybak
- INSERM UMR 1123, ECEVE, Paris Cité University, Paris, France; Urgences Pédiatriques, Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France; Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), St Maur-des-Fossés, France
| | - Florentia Kaguelidou
- Centre d'Investigation Clinique, INSERM CIC1426, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; EA7323 Perinatal and Pediatric Pharmacology and Therapeutic Assessment, Paris Cité University, Paris, France
| | - Andrea Lazzati
- Department of General Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, Centre de Recherche Clinique et Biologique, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Luu-Ly Pham
- INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris Cité University, Paris, France; Department of General Pediatrics, Jean Verdier University Hospital, Assistance Publique-Hôpitaux de Paris, Bondy, France
| | - Léa Lenglart
- INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris Cité University, Paris, France; Service d'Accueil des Urgences Pédiatriques, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Albert Faye
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR 1123, ECEVE, Paris Cité University, Paris, France
| | - Marion Caseris
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), St Maur-des-Fossés, France; Centre Hospitalier Intercommunal, Research Centre, Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), St Maur-des-Fossés, France; Centre Hospitalier Intercommunal, Research Centre, Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Astrid Vabret
- Department of Virology, Caen University Hospital, Caen, France; Univ Caen Normandie, Univ Rouen Normandie, INSERM UMR 1311, DYNAMICURE, Caen, France
| | - François Gravey
- Univ Caen Normandie, Univ Rouen Normandie, INSERM UMR 1311, DYNAMICURE, Caen, France
| | - François Angoulvant
- Paris Sorbonne University, Centre de Recherche des Cordeliers, INSERM UMRS 1138, Paris, France
| | - Bérengère Koehl
- Department of Child Hematology, Reference Center for Sickle-Cell Disease, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR S1134, Integrated Biology of Red Blood Cells, Paris Cité University, Paris, France
| | - Naïm Ouldali
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris Cité University, Paris, France; INSERM UMR 1123, ECEVE, Paris Cité University, Paris, France
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Lafay C, Assad Z, Ouldali N, Quoc EB, Clement A, Durand C, Fares S, Faye A, Eveillard LA, Kaguelidou F, Titah C, Valtuille Z, Vinit C, Meinzer U, Dumaine C. Increased Incidence of Pediatric Uveitis Associated with the COVID-19 Pandemic Occurring Before COVID-19 Vaccine Implementation: A Time-Series Analysis. J Pediatr 2023; 263:113682. [PMID: 37611738 DOI: 10.1016/j.jpeds.2023.113682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To examine whether the COVID-19 pandemic was associated with an increased incidence of uveitis in children. STUDY DESIGN We performed a time-series analysis of patient records from a national, hospital-based, French surveillance system. All children hospitalized for uveitis in France between January 2012 and March 2022 were included. The incidence of newly diagnosed uveitis per 100 000 children per trimester in France was analyzed by a quasi-Poisson regression. A cohort of children diagnosed with uveitis at Robert-Debré Hospital was used to compare the characteristics of uveitis after and before the onset of the pandemic. RESULTS During the study period, 2492 children were hospitalized for uveitis in France. The COVID-19 pandemic, which started in March 2020, was associated with a significant increase in the occurrence of uveitis (estimated cumulative change, 44.9%; 95% CI 11.4-78.4; P < .001). The increase in the incidence of pediatric uveitis started in October 2020, while the national immunization program targeting children aged less than 18 years began in June 2021. This increase involved all forms of uveitis, regardless of location, and clincial characteristics were similar to those diagnosed before the pandemic. CONCLUSIONS Our study evidenced a significant increase in the incidence of pediatric uveitis following the COVID-19 pandemic. This increase occurred 6 months before the implementation of the national COVID-19 vaccination program for children, suggesting that the resurgence of this rare disease is independent of COVID-19 vaccination.
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Affiliation(s)
- Céline Lafay
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Zein Assad
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Naïm Ouldali
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Bui Quoc
- Department of Ophthalmology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ana Clement
- Department of Ophthalmology, Adolph Rothschild Hospital, Paris, France
| | - Capucine Durand
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Selim Fares
- Department of Ophthalmology, Adolph Rothschild Hospital, Paris, France
| | - Albert Faye
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurye-Anne Eveillard
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, INSERM, Centre de Recherche sur l'inflammation UMR 1149, Paris, France
| | - Florentia Kaguelidou
- Center of Clinical Investigations, INSERM CIC1426, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cherif Titah
- Department of Ophthalmology, Adolph Rothschild Hospital, Paris, France
| | - Zaba Valtuille
- Center of Clinical Investigations, INSERM CIC1426, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Vinit
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ulrich Meinzer
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, INSERM, Centre de Recherche sur l'inflammation UMR 1149, Paris, France; Biology and Genetics of Bacterial Cell Wall Unit, Department of Microbiology, Institut Pasteur, Université de Paris, Paris, France.
| | - Cécile Dumaine
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, INSERM, Centre de Recherche sur l'inflammation UMR 1149, Paris, France
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Mathiesen L, Skovlund E. [Interrupted time series analyses]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2023; 143:23-0559. [PMID: 37830967 DOI: 10.4045/tidsskr.23.0559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
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Ma CF, Luo H, Leung SF, Wong GHY, Lam RPK, Bastiampillai T, Chen EYH, Chan SKW. Impact of community mental health services on the adult psychiatric admission through the emergency unit: a 20-year population-based study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 39:100814. [PMID: 37927999 PMCID: PMC10625018 DOI: 10.1016/j.lanwpc.2023.100814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/17/2023] [Accepted: 05/22/2023] [Indexed: 11/07/2023]
Abstract
Background There is a lack of real-life population-based study examining the effect of community mental health services on psychiatric emergency admission. In Hong Kong, Integrated Community Center for Mental Wellness (ICCMW) and telecare service were introduced in 2009 and 2012, respectively. We examined the real-life impact of these services on psychiatric emergency admissions over 20 years. Methods Number of psychiatric emergency admissions between 2001 and 2020 was retrieved from the Hong Kong Clinical Data Analysis & Reporting System. We used an interrupted time series analysis to examine monthly psychiatric admission trend before and after service implementation, considering socioeconomic and environmental covariates. Findings A total of 108,492 psychiatric emergency admissions (47.8% males; 64.9% aged 18-44 years) were identified from the study period, of which 56,858, 12,506, 12,295, 11,791, and 15,051 were that for schizophrenia-spectrum disorders, bipolar affective disorders, unipolar mood disorders, neuroses, and substance use disorders. ICCMW introduction has an immediate effect on psychiatric emergency admission (adjusted estimate per 100,000: -10.576; 95% CI, -16.635 to -4.518, p < 0.001), particularly among adults aged 18-44 years (-8.543; 95% CI, -13.209 to -3.877, p < 0.001), females (-5.843; 95% CI, -9.647 to -2.039, p = 0.003), and with neuroses (-3.373; 95% CI, -5.187 to -1.560, p < 0.001), without a significant long-term effect. Unemployment, seasonality, and infectious disease outbreak were significant covariates. Interpretation ICCMW reduced psychiatric emergency admission, but no further reduction following full implementation. Community mental health services should be dynamically tailored for different populations and socioeconomic variations over time. Funding None.
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Affiliation(s)
- Chak Fai Ma
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Hao Luo
- Department of Social Work and Social Administration, Faculty of Social Science, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Gloria Hoi Yan Wong
- Department of Social Work and Social Administration, Faculty of Social Science, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Rex Pui Kin Lam
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Tarun Bastiampillai
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Hoogervorst LA, Stijnen P, Albini M, Janda N, Stewardson AJ, Patel K, Nelissen RGHH, Marang-van de Mheen P. Clinical outcomes of non-COVID-19 orthopaedic patients admitted during the COVID-19 pandemic: a multi-centre interrupted time series analysis across hospitals in six different countries. BMJ Open 2023; 13:e073276. [PMID: 37666551 PMCID: PMC10481718 DOI: 10.1136/bmjopen-2023-073276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVES To assess across seven hospitals from six different countries the extent to which the COVID-19 pandemic affected the volumes of orthopaedic hospital admissions and patient outcomes for non-COVID-19 patients admitted for orthopaedic care. DESIGN A multi-centre interrupted time series (ITS) analysis. SETTING Seven hospitals from six countries who collaborated within the Global Health Data@Work collaborative. PARTICIPANTS Non-COVID-19 patients admitted for orthopaedic care during the pre-pandemic (January/2018-February/2020) and COVID-19 pandemic (March/2020-June/2021) period. Admissions were categorised as: (1) acute admissions (lower limb fractures/neck of femur fractures/pathological fractures/joint dislocations/upper limb fractures); (2) subacute admissions (bone cancer); (3) elective admissions (osteoarthritis). OUTCOME MEASURES Monthly observed versus expected ratios (O/E) were calculated for in-hospital mortality, long (upper-decile) length-of-stay and hospital readmissions, with expected rates calculated based on case-mix. An ITS design was used to estimate the change in level and/or trend of the monthly O/E ratio by comparing the COVID-19 pandemic with the pre-pandemic period. RESULTS 69 221 (pre-pandemic) and 22 940 (COVID-19 pandemic) non-COVID-19 orthopaedic patient admissions were included. Admission volumes were reduced during the COVID-19 pandemic for all admission categories (range: 33%-45%), with more complex patients treated as shown by higher percentages of patients admitted with ≥1 comorbidity (53.8% versus 49.8%, p<0.001). The COVID-19 pandemic was not associated with significant changes in patient outcomes for most diagnostic groups. Only for patients diagnosed with pathological fractures (pre-pandemic n=1671 and pandemic n=749), the COVID-19 pandemic was significantly associated with an immediate mortality reduction (level change of -77.7%, 95% CI -127.9% to -25.7%) and for lower limb fracture patients (pre-pandemic n=9898 and pandemic n=3307) with a significantly reduced trend in readmissions (trend change of -6.3% per month, 95% CI -11.0% to -1.6%). CONCLUSIONS Acute, subacute, as well as elective orthopaedic hospital admissions volumes were reduced in all global participating hospitals during the COVID-19 pandemic, while overall patient outcomes for most admitted non-COVID-19 patients remained the same despite the strain caused by the surge of COVID-19 patients.
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Affiliation(s)
- Lotje Anna Hoogervorst
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Biomedical Data Sciences & Medical Decision Making, Leiden University Medical Centre, Leiden, Netherlands
| | - Pieter Stijnen
- Department of Management Information and Reporting, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Marco Albini
- Department of Quality Monitoring, Humanitas Group, Rozzano, Italy
| | | | - Andrew J Stewardson
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia
| | - Kiran Patel
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Perla Marang-van de Mheen
- Department of Biomedical Data Sciences & Medical Decision Making, Leiden University Medical Centre, Leiden, Netherlands
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Antoniou T, McCormack D, Fell DB, Kwong JC, Gomes T. Impact of national recommendations for routine pertussis vaccination during pregnancy on infant pertussis in Ontario, Canada: a population-based time-series study. BMC Pregnancy Childbirth 2023; 23:627. [PMID: 37653488 PMCID: PMC10469528 DOI: 10.1186/s12884-023-05938-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 08/20/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND In February 2018, Canada's National Advisory Committee on Immunization (NACI) recommended antenatal tetanus-diphtheria-acellular pertussis (Tdap) immunization in every pregnancy regardless of previous Tdap immunization history. We examined the impact of the NACI recommendation on rates of infant pertussis in Ontario, Canada. METHODS We conducted a population-based time-series study of all live births in Ontario between August 1, 2011 and February 28, 2020. We used interventional autoregressive integrated moving average models to examine the impact of the NACI recommendation on monthly rates of pertussis among infants ≤ 3 months of age. RESULTS We observed 675 incident cases of pertussis among 1,368,024 infants 3 months of age or less between August 2011 and February 2020. The average monthly percent change in infant pertussis during the period up to and including publication of the NACI guidance and the period following publication were 0.0% (95% CI: -0.4-0.3%) and - 0.8% (95% CI -2.3% to -0.1%), respectively. Following interventional ARIMA modelling, publication of the NACI guidance was not associated with a statistically significant decrease in the monthly pertussis incidence trend (-0.67 cases per 100,000 infants; p = 0.73). CONCLUSION Publication of national recommendations for antenatal Tdap immunization in every pregnancy did not significantly reduce infant pertussis rates. This may reflect the persistently low rate of antenatal vaccination following publication of the recommendations. Expanding the scope of practice of allied health care providers to include antenatal Tdap immunization and patient education regarding antenatal pertussis immunization should be considered to further optimize uptake of vaccination.
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Affiliation(s)
- Tony Antoniou
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
- ICES, Toronto, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada.
| | | | - Deshayne B Fell
- ICES, Toronto, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Jeffrey C Kwong
- ICES, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
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Martínez P, Joseph J, Nazif-Munoz JI. The absence of data on driving under the influence of alcohol in road traffic studies: a scoping review of non-randomized studies with vote counting based on the direction of effects of alcohol policies. Subst Abuse Treat Prev Policy 2023; 18:46. [PMID: 37507756 PMCID: PMC10375679 DOI: 10.1186/s13011-023-00553-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Data on driving under the influence of alcohol (DUIA) are not always available, accurate, or reliable, making it difficult to study the effects of alcohol policies on road traffic outcomes. The objectives of our study were twofold: 1) to describe how road traffic outcomes of alcohol policies are assessed when DUIA data are missing, and 2) to explore the effects of alcohol policies when DUIA data are missing. METHODS We conducted a scoping review of non-randomized studies that assessed the road traffic outcomes of alcohol policies when DUIA data are missing. Until November 2021, we searched studies published between 2000 and 2021, in English or French, via MEDLINE, APA PsycInfo, CINAHL, and SocINDEX. We assessed the risk of bias in the included studies with the Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group. The selection process, data extraction, and the risk of bias assessment were conducted independently and in duplicate. We used vote counting based on the direction of the effects of alcohol policies as a synthesis method. The protocol for this review was published in PROSPERO under record number CRD42021266744. RESULTS Twenty-four eligible studies were included. Regarding objective 1, most studies used uncontrolled interrupted time series designs to assess road traffic fatalities resulting from night-time crashes. The reasons for missing DUIA data were generally not reported. Regarding objective 2, we found evidence for an association between alcohol policies and decreased road traffic fatalities. Subgroup analyses found no evidence for an association between methodological modifiers and positive effect directions for road traffic fatalities. CONCLUSION Caution is needed when interpreting road traffic outcomes associated with alcohol policies when DUIA data are missing. Greater efforts should be made to improve the reporting of outcomes assessments. Future studies must address several methodological issues (e.g., more granular data, well-defined intervention and implementation, and controlled designs). Our results should be compared to those from others reviews where DUIA data were available to confirm or recalibrate the associations found in studies where DUIA data were missing.
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Affiliation(s)
- Pablo Martínez
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 150, Place Charles-Le Moyne, Longueuil, Québec, J4K A08, Canada.
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), 150, Place Charles-Le Moyne, Longueuil, Québec, J4K A08, Canada.
- Institut universitaire sur les dépendances, 950 Rue de Louvain Est, Montréal, Québec, H2M 2E8, Canada.
| | - Junon Joseph
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 150, Place Charles-Le Moyne, Longueuil, Québec, J4K A08, Canada
| | - José Ignacio Nazif-Munoz
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 150, Place Charles-Le Moyne, Longueuil, Québec, J4K A08, Canada
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), 150, Place Charles-Le Moyne, Longueuil, Québec, J4K A08, Canada
- Institut universitaire sur les dépendances, 950 Rue de Louvain Est, Montréal, Québec, H2M 2E8, Canada
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Akhtar S, Al-Hashel JY, Alroughani R. Impact of the first Gulf war on multiple sclerosis risk in Kuwait: a quasi-experimental study. BMC Neurol 2023; 23:259. [PMID: 37407920 DOI: 10.1186/s12883-023-03295-3] [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: 12/14/2022] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE It has been reasoned that stressful life events tend to alter immune function thereby increasing the susceptibility to autoimmune diseases including multiple sclerosis (MS). Using the database of Kuwait National MS Registry, this quasi-experimental study assessed the impact of the first Gulf War (Iraqi invasion of Kuwait in 1990) on MS risk in Kuwait. METHODS MS incidence data from 1980 to 2019 were obtained from the Kuwait National MS Registry. Annual age-standardized incidence rates (ASIRs) (per 105 person-years) were computed using the World Standard Population as a reference. Interrupted time series analysis with the option of autoregressive order (1) was used to evaluate the impact of the first Gulf War on MS risk by treating 1990 as an intervention year. RESULTS Estimated baseline annual ASIR (per 105 person-years) was 0.38 (95% CI: -1.02, 1.78; p = 0.587). MS ASIRs (per 105 person-years) tended to increase significantly every year prior to 1990 by 0.45 (ASIR per 105 person-years = 0.45; 95% CI: 0.15, 0.76; p = 0.005). During the first year of the first Gulf War, there seemed to be a non-significant increase (step change) in ASIRs (per 105 person-years) of MS (ASIR per 105 person-years = 0.85; 95% CI: - 5.16, 6.86; p = 0.775) followed by a non-significant increase in the annual trend in MS ASIRs per 105 person-years (relative to the preintervention trend i.e., the difference between the pre-first Gulf War versus the post-first Gulf War trends) by 0.65 (ASIR per 105 person-years = 0.65; 95% CI: - 0.22, 1.52; p = 0.138). However, a postestimation measure of the post-first Gulf War trend was statistically significant (ASIR per 105 person-years = 1.10; 95% CI: 0.40, 1.80; p = 0.003), which implies that the post-first Gulf War trend in the annual ASIRs (per 105 person-years) inclined to be the same as was the pre-first Gulf War (i.e., counterfactual of the pre-first Gulf War trend in annual ASIRs (per 105 person-years) as if no first Gulf War took place).The Durbin-Watson test statistic (d = 1.89) showed almost non-significant autocorrelations across the time series observations on ASIRs (per 105 person-years). CONCLUSIONS This study suggests that the first Gulf War was not significantly associated with the increasing trend in MS risk at population level in Kuwait neither with any short-term change nor with secular trend. Future studies may consider confirming the role of conflict-related stress or other stressful life events in potential exacerbation of MS risk along with unraveling biologically plausible mechanistic pathways.
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Affiliation(s)
- Saeed Akhtar
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, Safat, 13110, Kuwait.
| | - Jasem Y Al-Hashel
- Department of Medicine, College of Medicine, Kuwait University, PO Box 24923, Safat, 13110, Kuwait
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Arabian Gulf Street, Sharq, 13041, Kuwait
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Hoong JM, Gibbons B, Loh B, Tan C, Chen C. Impact of the value driven outcomes program among cataract surgery patients in Singapore: an interrupted time series analysis. BMC Health Serv Res 2023; 23:486. [PMID: 37189106 DOI: 10.1186/s12913-023-09427-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Healthcare cost is increasing rapidly in Singapore. Moving towards a value-based healthcare framework enables a sustainable health system. The National University Hospital (NUH) implemented the Value Driven Outcome (VDO) Program for cataract surgery due to its high volume and cost variability. We aimed to evaluate the association between VDO program implementation and costs and quality outcomes for cataract surgery in NUH. METHODS We conducted an interrupted time-series analysis for cataract surgery episodes between January 2015 and December 2018. Using segmented linear regression models, we estimate the changes in levels and trends of cost and quality outcomes post-program implementation. We adjusted for autoregression and various confounders. RESULTS Following VDO program implementation, the total cost of cataract surgery had a significantly decreased by $327.23 (95% CI: -$421.04 to -$233.43; p < 0.01) and the trend significantly decreased by $13.75 per month (95% CI: -$23.19 to -$4.30 per month; p < 0.01). There was a small improvement in the combined quality outcome score (0.028, 95% CI: 0.016 to 0.040; p < 0.01), but the trend remained unchanged. CONCLUSION The VDO program was associated with a reduction in cost without compromising on quality outcomes. The program provides a structured methodology to measure performances, and through these data, initiatives were implemented to improve value. There are benefits to providing a data reporting system to physicians to understand actual care costs and quality outcomes achieved by individual patients with defined clinical conditions.
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Affiliation(s)
- Jian Ming Hoong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #09-01T, Singapore, 117549, Singapore.
- Ng Teng Fong General Hospital, National University Health System, Singapore, 609606, Singapore.
| | - Brent Gibbons
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #09-01T, Singapore, 117549, Singapore
| | - Benedict Loh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #09-01T, Singapore, 117549, Singapore
| | - Clement Tan
- National University Hospital, National University Health System, Singapore, 119074, Singapore
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #09-01T, Singapore, 117549, Singapore
- Schaeffer Center, University of Southern California, Los Angeles, CA, 90089, USA
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Konishi T, Fujiogi M, Sato M, Michihata N, Matsui H, Nishioka K, Tanabe M, Seto Y, Yasunaga H. Impact of the National Action Plan for Antimicrobial Resistance on Antibiotic Use for Mastitis Using a Japanese Nationwide Database. Breast Care (Basel) 2023; 18:122-129. [PMID: 37261132 PMCID: PMC10228258 DOI: 10.1159/000529381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/24/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Mastitis is the inflammation of the mammary gland that mainly occurs during the lactation period and requires antibiotic treatment with little evidence for its efficacy. We investigated the effect of the National Action Plan for antimicrobial resistance aiming for appropriate antimicrobial stewardship on broad-spectrum antibiotics administration for mastitis despite the lack of a disease-specific antimicrobial agents manual. METHODS Using a large nationwide database, an interrupted time-series analysis was performed using data from 34,340 female patients who received antibiotics for mastitis between April 2012 and March 2020. This study compared the trend of outcomes before and after the publication date of the National Action Plan (April 2016). The outcomes were the proportion of broad-spectrum and first-choice narrow-spectrum antibiotic administration and surgical drainage within 30 days after the administration. RESULTS Broad-spectrum antibiotics were administered in 70% of the cases before and 67% of the cases after the National Action Plan publication date. The trend of broad-spectrum antibiotics administration significantly changed at the publication (-2.6% [95% confidence interval, -3.9% to -1.3%], p < 0.001) and the administration decreased after the publication (1.9% annual decrease, Ptrend < 0.001). The trend of first-choice antibiotics administration also changed at the publication (1.3% [0.1-2.4%], p = 0.028) and the administration increased after the publication (1.3% annual increase, Ptrend < 0.001). The occurrence of surgical drainage was stable during the study period. CONCLUSION Despite the lack of a disease-specific antimicrobial manual, the publication of the National Action Plan improved antimicrobial stewardship for mastitis without any impact on a surgical treatment course.
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Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Science, Technology, and Innovation Governance Education and Research Program, Graduate School of Public Policy, The University of Tokyo, Tokyo, Japan
| | - Michimasa Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Misuzu Sato
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kotoe Nishioka
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Del Giorgio F, Habti M, Merckx J, Kaufman JS, Gravel J, Piché N, Osmanlliu E, Drouin O. Investigating changes in incidence and severity of pediatric appendicitis during the COVID-19 pandemic in Canada: an interrupted time series analysis. World J Pediatr 2023; 19:288-292. [PMID: 36574211 PMCID: PMC9792923 DOI: 10.1007/s12519-022-00656-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/16/2022] [Indexed: 12/28/2022]
Affiliation(s)
| | - Merieme Habti
- Department of Medicine, Université de Montréal, Montreal, Canada
| | - Joanna Merckx
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Jay S Kaufman
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
| | - Nelson Piché
- Department of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
| | - Esli Osmanlliu
- Division of Pediatric Emergency Surgery, Montreal Children's Hospital, Montreal, Canada
| | - Olivier Drouin
- Department of Social and Preventative Medicine, Université de Montréal, Montreal, Canada.
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada.
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Marszalek M, Hawking MKD, Gutierrez A, Dostal I, Ahmed Z, Firman N, Robson J, Bedford H, Billington A, Moss N, Dezateux C. Implementation of a quality improvement programme using the Active Patient Link call and recall system to improve timeliness and equity of childhood vaccinations: protocol for a mixed-methods evaluation. BMJ Open 2023; 13:e064364. [PMID: 36669843 PMCID: PMC9872487 DOI: 10.1136/bmjopen-2022-064364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 01/11/2023] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Call and recall systems provide actionable intelligence to improve equity and timeliness of childhood vaccinations, which have been disrupted during the COVID-19 pandemic. We will evaluate the effectiveness, fidelity and sustainability of a data-enabled quality improvement programme delivered in primary care using an Active Patient Link Immunisation (APL-Imms) call and recall system to improve timeliness and equity of uptake in a multiethnic disadvantaged urban population. We will use qualitative methods to evaluate programme delivery, focusing on uptake and use, implementation barriers and service improvements for clinical and non-clinical primary care staff, its fidelity and sustainability. METHODS AND ANALYSIS This is a mixed-methods observational study in 284 general practices in north east London (NEL). The target population will be preschool-aged children eligible to receive diphtheria, tetanus and pertussis (DTaP) or measles, mumps and rubella (MMR) vaccinations and registered with an NEL general practice. The intervention comprises an in-practice call and recall tool, facilitation and training, and financial incentives. The quantitative evaluation will include interrupted time Series analyses and Slope Index of Inequality. The primary outcomes will be the proportion of children receiving at least one dose of a DTaP-containing or MMR vaccination defined, respectively, as administered between age 6 weeks and 6 months or between 12 and 18 months of age. The qualitative evaluation will involve a 'Think Aloud' method and semistructured interviews of stakeholders to assess impact, fidelity and sustainability of the APL-Imms tool, and fidelity of the implementation by facilitators. ETHICS AND DISSEMINATION The research team has been granted permission from data controllers in participating practices to use deidentified data for audit purposes. As findings will be specific to the local context, research ethics approval is not required. Results will be disseminated in a peer-reviewed journal and to stakeholders, including parents, health providers and commissioners.
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Affiliation(s)
- Milena Marszalek
- Wolfson Institute of Population Health, Yvonne Carter Building, Queen Mary University, London, UK
| | - Meredith K D Hawking
- Wolfson Institute of Population Health, Yvonne Carter Building, Queen Mary University, London, UK
| | - Ana Gutierrez
- Wolfson Institute of Population Health, Yvonne Carter Building, Queen Mary University, London, UK
| | - Isabel Dostal
- Wolfson Institute of Population Health, Yvonne Carter Building, Queen Mary University, London, UK
| | - Zaheer Ahmed
- Wolfson Institute of Population Health, Yvonne Carter Building, Queen Mary University, London, UK
| | - Nicola Firman
- Wolfson Institute of Population Health, Yvonne Carter Building, Queen Mary University, London, UK
| | - John Robson
- Wolfson Institute of Population Health, Yvonne Carter Building, Queen Mary University, London, UK
| | - Helen Bedford
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Anna Billington
- Wolfson Institute of Population Health, Yvonne Carter Building, Queen Mary University, London, UK
| | - Ngawai Moss
- Wolfson Institute of Population Health, Yvonne Carter Building, Queen Mary University, London, UK
| | - Carol Dezateux
- Wolfson Institute of Population Health, Yvonne Carter Building, Queen Mary University, London, UK
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18
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Norman G, Mason T, Dumville JC, Bower P, Wilson P, Cullum N. Approaches to enabling rapid evaluation of innovations in health and social care: a scoping review of evidence from high-income countries. BMJ Open 2022; 12:e064345. [PMID: 36600433 PMCID: PMC10580278 DOI: 10.1136/bmjopen-2022-064345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic increased the demand for rapid evaluation of innovation in health and social care. Assessment of rapid methodologies is lacking although challenges in ensuring rigour and effective use of resources are known. We mapped reports of rapid evaluations of health and social care innovations, categorised different approaches to rapid evaluation, explored comparative benefits of rapid evaluation, and identified knowledge gaps. DESIGN Scoping review. DATA SOURCES MEDLINE, EMBASE and Health Management Information Consortium (HMIC) databases were searched through 13 September 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included publications reporting primary research or methods for rapid evaluation of interventions or services in health and social care in high-income countries. DATA EXTRACTION AND SYNTHESIS Two reviewers developed and piloted a data extraction form. One reviewer extracted data, a second reviewer checked 10% of the studies; disagreements and uncertainty were resolved through consensus. We used narrative synthesis to map different approaches to conducting rapid evaluation. RESULTS We identified 16 759 records and included 162 which met inclusion criteria.We identified four main approaches for rapid evaluation: (1) Using methodology designed specifically for rapid evaluation; (2) Increasing rapidity by doing less or using less time-intensive methodology; (3) Using alternative technologies and/or data to increase speed of existing evaluation method; (4) Adapting part of non-rapid evaluation.The COVID-19 pandemic resulted in an increase in publications and some limited changes in identified methods. We found little research comparing rapid and non-rapid evaluation. CONCLUSIONS We found a lack of clarity about what 'rapid evaluation' means but identified some useful preliminary categories. There is a need for clarity and consistency about what constitutes rapid evaluation; consistent terminology in reporting evaluations as rapid; development of specific methodologies for making evaluation more rapid; and assessment of advantages and disadvantages of rapid methodology in terms of rigour, cost and impact.
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Affiliation(s)
- Gill Norman
- Division of Nursing, Midwifery & Social Work; School of Health Sciences; Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
| | - Thomas Mason
- Centre for Primary Care and Health Services Research; School of Health Sciences; Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Jo C Dumville
- Division of Nursing, Midwifery & Social Work; School of Health Sciences; Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
| | - Peter Bower
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
- Centre for Primary Care and Health Services Research; School of Health Sciences; Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Paul Wilson
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
- Centre for Primary Care and Health Services Research; School of Health Sciences; Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery & Social Work; School of Health Sciences; Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
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19
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Shragai T, Talley L, Summers A, Behringer H, Wrabel M, Stobaugh H, Leidman E. Outcomes after Acute Malnutrition Program Adaptations to COVID-19, Uganda, Ethiopia, and Somalia. Emerg Infect Dis 2022; 28:S288-S298. [PMID: 36502417 DOI: 10.3201/eid2813.212266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
At the onset of the COVID-19 pandemic, protocols for community-based management of acute malnutrition (CMAM) were implemented to support continuity of essential feeding services while mitigating COVID-19 transmission. To assess correlations between adaptation timing and CMAM program indicators, we evaluated routine program data in Uganda, Ethiopia, and Somalia for children 6-59 months of age. We specifically analyzed facility-level changes in total admissions, average length of stay (ALOS), total children screened for admission, and recovery rates before and after adaptations. We found no statistically significant changes in program indicators after adaptations. For Somalia, we also analyzed child-level changes in ALOS and in weight and mid-upper arm circumference at admission and discharge. ALOS significantly increased immediately after adaptations and then decreased to preadaptation levels. We found no meaningful changes in either weight or mid-upper arm circumference at admission or discharge. These findings indicate that adapted CMAM programs can remain effective.
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20
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Huang HN, Yang Z, Wang Y, Ou CQ, Guan Y. The use of generalized synthetic control method to evaluate air pollution control measures of G20 Hangzhou Summit. Front Public Health 2022; 10:1021177. [PMID: 36262223 PMCID: PMC9574187 DOI: 10.3389/fpubh.2022.1021177] [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: 08/17/2022] [Accepted: 09/16/2022] [Indexed: 01/28/2023] Open
Abstract
The traditional campaign-style enforcement in environmental governance has been debated whether its rebound effect is likely to eat away the short-term environmental benefits and subsequently bring about severer pollution. There are methodological challenges in assessing the effect of temporary environmental intervention. By applying the generalized synthetic control method (GSCM), we quantified and characterized the effectiveness of environmental regulations implemented for the G20 Hangzhou Summit held on 4-5 September, 2016. The summit was successful in reducing Air Quality Composite Index by 17.40% (95% CI: 9.53%, 24.60%), 13.30% (95% CI: 4.23%, 21.50%), and 10.09% (95% CI: 2.01%, 17.51%) in the core, strictly-regulated and regulated areas respectively, comparing with the index expected under a "No-G20" scenario during the preparatory period and the summit period (July-September 2016), and the reduction of the levels in specific pollutants (PM10, PM2.5, NO2, and CO) was also observed. Besides, the environmental benefits lasted for at least 3 months after the summit. This study demonstrates that the pollution control measures during the G20 Hangzhou Summit improved air quality immediately and continuously, and the GSCM provides a useful tool for evaluating the intervention effects of environmental regulations.
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Affiliation(s)
- Hao-Neng Huang
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Zhou Yang
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yukun Wang
- Guangdong University of Foreign Studies South China Business College, Guangzhou, China
| | - Chun-Quan Ou
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China,Chun-Quan Ou
| | - Ying Guan
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China,*Correspondence: Ying Guan
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21
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Ulvin OE, Skjærseth EÅ, Haugland H, Thorsen K, Nordseth T, Orre MF, Vesterhus L, Krüger AJ. The introduction of a regional Norwegian HEMS coordinator: an assessment of the effects on response times, geographical service areas and severity scores. BMC Health Serv Res 2022; 22:1020. [PMID: 35948977 PMCID: PMC9365225 DOI: 10.1186/s12913-022-08337-z] [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: 11/16/2021] [Accepted: 07/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background Due to unwanted delays and suboptimal resource control of helicopter emergency medical services (HEMS), regional HEMS coordinators have recently been introduced in Norway. This may represent an unnecessary link in the alarm chain, which could cause delays in HEMS dispatch. Systematic evaluations of this intervention are lacking. We wanted to conduct this study to assess possible changes in HEMS response times, mission distribution patterns and patient characteristics within our region following this intervention. Methods We retrospectively collected timeline parameters, patient characteristics and GPS positions from HEMS missions executed by three regional HEMS bases in Mid-Norway during 2017–2018 (preintervention) and 2019 (postintervention). The mean regional response time in HEMS missions was assessed by an interrupted time series analysis (ITS). The geographical mission distribution between regional HEMS resources was assessed by a before-after study with a convex hull-based method. Results There was no significant change in the level (-0.13 min/month, p = 0.88) or slope (-0.13 min/month, p = 0.30) of the mean regional response time trend line pre- and postintervention. For one HEMS base, the service area was increased, and the median mission distance was significantly longer. For the two other bases, the service areas were reduced. Both the mean NACA score (4.13 ± SD 0.027 vs 3.98 ± SD 0.04, p < 0.01) and the proportion of patients with severe illness or injury (NACA 4–7, 68.2% vs 61.5%, p < 0.001) were higher in the postintervention group. Conclusion The introduction of a regional HEMS coordinator in Mid-Norway did not cause prolonged response times in acute HEMS missions during the first year after implementation. Higher NACA scores in the patients treated postintervention suggest better selection of HEMS use.
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Affiliation(s)
- Ole Erik Ulvin
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway. .,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. .,Department of Emergency Medicine and Pre-Hospital Services, St. Olav`s University Hospital, Trondheim, Norway. .,Department of Anaesthesia and Intensive Care Medicine, St. Olav`s University Hospital, Trondheim, Norway.
| | - Eivinn Årdal Skjærseth
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav`s University Hospital, Trondheim, Norway
| | - Helge Haugland
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav`s University Hospital, Trondheim, Norway.,Department of Anaesthesia and Intensive Care Medicine, St. Olav`s University Hospital, Trondheim, Norway
| | - Kjetil Thorsen
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Trond Nordseth
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Anaesthesia and Intensive Care Medicine, St. Olav`s University Hospital, Trondheim, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Marie Falch Orre
- Department of Civil and Environmental Engineering, Master's Degree Programme of Engineering and ICT, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lars Vesterhus
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav`s University Hospital, Trondheim, Norway
| | - Andreas Jørstad Krüger
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Emergency Medicine and Pre-Hospital Services, St. Olav`s University Hospital, Trondheim, Norway
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22
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Fukaguchi K, Goto T, Yamamoto T, Yamagami H. Experimental Implementation of NSER Mobile App for Efficient Real-Time Sharing of Prehospital Patient Information With Emergency Departments: Interrupted Time-Series Analysis. JMIR Form Res 2022; 6:e37301. [PMID: 35793142 PMCID: PMC9301553 DOI: 10.2196/37301] [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: 02/15/2022] [Revised: 05/19/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background With the aging society, the number of emergency transportations has been growing. Although it is important that a patient be immediately transported to an appropriate hospital for proper management, accurate diagnosis in the prehospital setting is challenging. However, at present, patient information is mainly communicated by telephone, which has a potential risk of communication errors such as mishearing. Sharing correct and detailed prehospital information with emergency departments (EDs) should facilitate optimal patient care and resource use. Therefore, the implementation of an app that provides on-site, real-time information to emergency physicians could be useful for early preparation, intervention, and effective use of medical and human resources. Objective In this paper, we aimed to examine whether the implementation of a mobile app for emergency medical service (EMS) would improve patient outcomes and reduce transportation time as well as communication time by phone (ie, phone-communication time). Methods We performed an interrupted time-series analysis (ITSA) on the data from a tertiary care hospital in Japan from July 2021 to October 2021 (8 weeks before and 8 weeks after the implementation period). We included all patients transported by EMS. Using the mobile app, EMS can send information on patient demographics, vital signs, medications, and photos of the scene to the ED. The outcome measure was inpatient mortality and transportation time, as well as phone-communication time, which was the time for EMS to negotiate with ED staffs for transport requests. Results During the study period, 1966 emergency transportations were made (n=1033, 53% patients during the preimplementation period and n=933, 47% patients after the implementation period). The ITSA did not reveal a significant decrease in patient mortality and transportation time before and after the implementation. However, the ITSA revealed a significant decrease in mean phone-communication time between pre- and postimplementation periods (from 216 to 171 seconds; −45 seconds; 95% CI −71 to −18 seconds). From the pre- to postimplementation period, the mean transportation time from EMS request to ED arrival decreased by 0.29 minutes (from 36.1 minutes to 35.9 minutes; 95% CI −2.20 to 1.60 minutes), without change in time trends. We also introduced cases where the app allowed EMS to share accurate and detailed prehospital information with the emergency department, resulting in timely intervention and reducing the burden on the ED. Conclusions The implementation of a mobile app for EMS was associated with reduced phone-communication time by 45 seconds (22%) without increasing mortality or overall transportation time despite the implementation of new methods in the real clinical setting. In addition, real-time patient information sharing, such as the transfer of monitor images and photos of the accident site, could facilitate optimal patient care and resource use.
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Affiliation(s)
- Kiyomitsu Fukaguchi
- Department of Emergency Medicine, Shonan Kamakura General Hospital, Kamakura-shi, Kanagawa, Japan
| | | | - Tadatsugu Yamamoto
- Department of Emergency Medicine, Shonan Kamakura General Hospital, Kamakura-shi, Kanagawa, Japan
| | - Hiroshi Yamagami
- Department of Emergency Medicine, Shonan Kamakura General Hospital, Kamakura-shi, Kanagawa, Japan
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23
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Chimhuya S, Neal SR, Chimhini G, Gannon H, Cortina Borja M, Crehan C, Nkhoma D, Chiyaka T, Wilson E, Hull-Bailey T, Fitzgerald F, Chiume M, Heys M. Indirect impacts of the COVID-19 pandemic at two tertiary neonatal units in Zimbabwe and Malawi: an interrupted time series analysis. BMJ Open 2022; 12:e048955. [PMID: 35728901 PMCID: PMC9213761 DOI: 10.1136/bmjopen-2021-048955] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/31/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To examine indirect impacts of the COVID-19 pandemic on neonatal care in low-income and middle-income countries. DESIGN Interrupted time series analysis. SETTING Two tertiary neonatal units in Harare, Zimbabwe and Lilongwe, Malawi. PARTICIPANTS We included a total of 6800 neonates who were admitted to either neonatal unit from 1 June 2019 to 25 September 2020 (Zimbabwe: 3450; Malawi: 3350). We applied no specific exclusion criteria. INTERVENTIONS The first cases of COVID-19 in each country (Zimbabwe: 20 March 2020; Malawi: 3 April 2020). PRIMARY OUTCOME MEASURES Changes in the number of admissions, gestational age and birth weight, source of admission referrals, prevalence of neonatal encephalopathy, and overall mortality before and after the first cases of COVID-19. RESULTS Admission numbers in Zimbabwe did not initially change after the first case of COVID-19 but fell by 48% during a nurses' strike (relative risk (RR) 0.52, 95% CI 0.41 to 0.66, p<0.001). In Malawi, admissions dropped by 42% soon after the first case of COVID-19 (RR 0.58, 95% CI 0.48 to 0.70, p<0.001). In Malawi, gestational age and birth weight decreased slightly by around 1 week (beta -1.4, 95% CI -1.62 to -0.65, p<0.001) and 300 g (beta -299.9, 95% CI -412.3 to -187.5, p<0.001) and outside referrals dropped by 28% (RR 0.72, 95% CI 0.61 to 0.85, p<0.001). No changes in these outcomes were found in Zimbabwe and no significant changes in the prevalence of neonatal encephalopathy or mortality were found at either site (p>0.05). CONCLUSIONS The indirect impacts of COVID-19 are context-specific. While our study provides vital evidence to inform health providers and policy-makers, national data are required to ascertain the true impacts of the pandemic on newborn health.
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Affiliation(s)
| | - Samuel R Neal
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Gwen Chimhini
- Child and Adolescent Health Unit, University of Zimbabwe, Harare, Zimbabwe
| | - Hannah Gannon
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Mario Cortina Borja
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Caroline Crehan
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Deliwe Nkhoma
- Parent and Child Health Initiative, Lilongwe, Malawi
| | - Tarisai Chiyaka
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Emma Wilson
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Tim Hull-Bailey
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Felicity Fitzgerald
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Msandeni Chiume
- Department of Paediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Michelle Heys
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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24
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Klopotowska JE, Kuks PFM, Wierenga PC, Stuijt CCM, Arisz L, Dijkgraaf MGW, de Keizer N, Smorenburg SM, de Rooij SE. The effect of structured medication review followed by face-to-face feedback to prescribers on adverse drug events recognition and prevention in older inpatients - a multicenter interrupted time series study. BMC Geriatr 2022; 22:505. [PMID: 35715742 PMCID: PMC9206349 DOI: 10.1186/s12877-022-03118-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background The effectiveness of interventions to improve medication safety in older inpatients is unclear, given a paucity of properly designed intervention studies applying clinically relevant endpoints such as hospital-acquired preventable Adverse Drug Events (pADEs) and unrecognized Adverse Drug Events (uADEs). Therefore, we conducted a quality improvement study and used hospital-acquired pADEs and uADEs as main outcomes to assess the effect of an intervention aimed to improve medication safety in older inpatients. Method The study followed an interrupted time series design and consisted of three equally spaced sampling points during baseline and during intervention measurements. Each sampling point included between 80 to 90 patients. A total of 500 inpatients ≥65 years and admitted to internal medicine wards of three Dutch hospitals were included. An expert team retrospectively identified and assessed ADEs via a structured patient chart review. The findings from baseline measurement and meetings with the internal medicine and hospital pharmacy staff were used to design the intervention. The intervention consisted of a structured medication review by hospital pharmacists, followed by face-to-face feedback to prescribers, on average 3 days per week. Results The rate of hospital-acquired pADEs per 100 hospitalizations was reduced by 50.6% (difference 16.8, 95% confidence interval (CI): 9.0 to 24.6, P < 0.001), serious hospital-acquired pADEs by 62.7% (difference 12.8, 95% CI: 6.4 to 19.2, P < 0.001), and uADEs by 51.8% (difference 11.2, 95% CI: 4.4 to 18.0, P < 0.001). Additional analyses confirmed the robustness of the intervention effect, but residual bias cannot be excluded. Conclusions The intervention significantly decreased the overall and serious hospital-acquired pADE occurrence in older inpatients, and significantly improved overall ADE recognition by prescribers. Trial registration International Standard Randomized Controlled Trial Number Register, trial registration number: ISRCTN64974377, registration date (date assigned): 07/02/2011. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03118-z.
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Affiliation(s)
- Joanna E Klopotowska
- Amsterdam University Medical Centers location University of Amsterdam, Medical Informatics, Amsterdam, The Netherlands. .,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands.
| | - Paul F M Kuks
- Amsterdam University Medical Centers location University of Amsterdam, Pharmacy and Clinical Pharmacology, Amsterdam, The Netherlands
| | - Peter C Wierenga
- Gelderse Vallei Hospital, Hospital Pharmacy, Ede, The Netherlands
| | - Clementine C M Stuijt
- Center of Excellence on Parkinson's disease (Punt voor Parkinson), Groningen, The Netherlands
| | - Lambertus Arisz
- Amsterdam University Medical Centers location University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Amsterdam University Medical Centers location University of Amsterdam, Epidemiology and Data Science, Amsterdam, The Netherlands.,Amsterdam Public Health, Methodology, Amsterdam, the Netherlands
| | - Nicolette de Keizer
- Amsterdam University Medical Centers location University of Amsterdam, Medical Informatics, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Susanne M Smorenburg
- Amsterdam University Medical Centers location University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands
| | - Sophia E de Rooij
- Amstelland Hospital, Board of Directors, Amstelveen, The Netherlands
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25
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Tang X, Chen W, Tang SQ, Zhao PZ, Ling L, Wang C. The evaluation of preventive and control measures on congenital syphilis in Guangdong Province, China: a time series modeling study. Infection 2022; 50:1179-1190. [PMID: 35301682 PMCID: PMC9522686 DOI: 10.1007/s15010-022-01791-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/24/2022] [Indexed: 11/18/2022]
Abstract
Purpose To evaluate the effectiveness of preventive and control measures for congenital syphilis (CS) implemented since 2012 in Guangdong Province, China, and assess the epidemic trend in the near future. Methods The interrupted time series analysis was conducted to compare changes in slope and level of CS notification rate from 2005 to 2020 in Guangdong Province and its three regions with different economic developmental levels. The ARIMA model was established to predict the new CS case number of Guangdong Province in 2021. Results A total of 12,687 CS cases were reported from 2005 to 2020. The CS notification rate of the province had been increasing until 2012 (128.55 cases per 100,000 live births) and then been decreasing constantly, hitting the lowest point in 2020 (5.76 cases per 100,000 live births). The severe epidemic cluster shifted from the developed region to underdeveloped ones over time. The effectiveness of the measures was proved by the significant change in the slope of the notification rate which was found in both of the provinces (− 18.18, 95% CI − 25.63 to − 10.75) and two less-developed regions (− 10.49, 95% CI − 13.13 to − 7.86 and − 32.89, 95% CI − 41.67 to − 24.10, respectively). In the developed region where the notification rate had already been decreasing in the pre-implementation period, implementing these measures also aided in hastening the rate of descent. The CS case number in 2021 was predicted to be 48, indicating a low-level epidemic. Conclusions The preventive and control measures have assisted Guangdong Province to control CS effectively, of which the supportive ones ensured a successful implementation. For resource-limited countries where CS is still endemic, especially guaranteeing the support in financial subsidy, professional training, supervision and so on might trigger the effectiveness of other measures and eventually make significant and sustainable progress. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-022-01791-1.
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Affiliation(s)
- XiJia Tang
- School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Wen Chen
- School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Shang Qing Tang
- School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China.,Sun-Yat Sen University Cancer Center, Guangzhou, 510080, Guangdong, China
| | - Pei Zhen Zhao
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China.,Institute for Global Health and Sexually Transmitted Disease, Southern Medical University, Guangzhou, 510091, Guangdong, China
| | - Li Ling
- School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China.
| | - Cheng Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China. .,Institute for Global Health and Sexually Transmitted Disease, Southern Medical University, Guangzhou, 510091, Guangdong, China.
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26
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Alfandre D, Bipin Gandhi A, Onukwugha E. Adverse Discharge Outcomes Associated With the Medicare Hospital Readmissions Reduction Program Among Commercially Insured Adults. J Healthc Qual 2022; 44:1-10. [PMID: 33724963 DOI: 10.1097/jhq.0000000000000302] [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] [Indexed: 11/26/2022]
Abstract
ABSTRACT It is unknown if changes in the rate of discharges against medical advice (DAMA) are related to the implementation of the Medicare Hospital Readmissions Reduction Program (HRRP). We performed an interrupted time series analysis of monthly DAMA rates per 1,000 discharges of all enrolled individuals 18-64 years old with a hospitalization between January 1, 2006, and December 31, 2015, in a commercially insured population. We performed a segmented linear regression with two interruptions: (1) April 2010 to coincide with the passage of the HRRP and (2) October 2012 to coincide with the implementation of HRRP penalties. There were 1,087,812 discharges representing 668,823 individuals over 120 months. The downward trend in monthly DAMA rates was reversed significantly after April 2010 with a sustained 0.1 increase in the monthly rate that continued after the implementation of penalties in October 2012. Allowing for the two interruptions, there was a statistically significant positive trend (0.10; 0.06-0.13, p < .01) in April 2010. Relative to the first interruption, there was no statistically significant change in the slope in October 2012; the estimated slope was -0.04 (-0.08 to 0.002). Monthly DAMA rates increased in anticipation of and after HRRP implementation, suggesting a potential relationship between the HRRP and DAMA.
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27
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Multistep antimicrobial stewardship intervention on antibiotic prescriptions and treatment duration in children with pneumonia. PLoS One 2021; 16:e0257993. [PMID: 34705849 PMCID: PMC8550372 DOI: 10.1371/journal.pone.0257993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 09/16/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The Italian antimicrobial prescription rate is one of the highest in Europe, and antibiotic resistance has become a serious problem with high costs and severe consequences, including prolonged illnesses, the increased period of hospitalization and mortality. Inadequate antibiotic prescriptions have been frequently reported, especially for lower respiratory tract infections (LRTI); many patients receive antibiotics for viral pneumonia or bronchiolitis or broad-spectrum antibiotics for not complicated community-acquired pneumonia. For this reason, healthcare organizations need to implement strategies to raise physicians' awareness about this kind of drug and their overall effect on the population. The implementation of antibiotic stewardship programs and the use of Clinical Pathways (CPs) are excellent solutions because they have proven to be effective tools at diagnostic and therapeutic levels. AIMS This study evaluates the impact of CPs implementation in a Pediatric Emergency Department (PED), analyzing antibiotic prescriptions before and after the publication in 2015 and 2019. The CP developed in 2019 represents an update of the previous one with the introduction of serum procalcitonin. The study aims to evaluate the antibiotic prescriptions in patients with community-acquired pneumonia (CAP) before and after both CPs (2015 and 2019). METHODS The periods analyzed are seven semesters (one before CP-2015 called PRE period, five post CP-2015 called POST 1-5 and 1 post CP-2019 called POST6). The patients have been split into two groups: (i) children admitted to the Pediatric Acute Care Unit (INPATIENTS), and (ii) patients evaluated in the PED and sent back home (OUTPATIENTS). We have analyzed all descriptive diagnosis of CAP (the assessment of episodes with a descriptive diagnosis were conducted independently by two pediatricians) and CAP with ICD9 classification. All antibiotic prescriptions for pediatric patients with CAP were analyzed. RESULTS A drastic reduction of broad-spectrum antibiotics prescription for inpatients has been noticed; from 100.0% in the PRE-period to 66.7% in POST1, and up to 38.5% in POST6. Simultaneously, an increase in amoxicillin use from 33.3% in the PRE-period to 76.1% in POST1 (p-value 0.078 and 0.018) has been seen. The outpatients' group's broad-spectrum antibiotics prescriptions decreased from 54.6% PRE to 17.4% in POST6. Both for outpatients and inpatients, there was a decrease of macrolides. The inpatient group's antibiotic therapy duration decreased from 13.5 days (PRE-period) to 7.0 days in the POST6. Antibiotic therapy duration in the outpatient group decreased from 9.0 days (PRE) to 7.0 days (POST1), maintaining the same value in subsequent periods. Overlapping results were seen in the ICD9 group for both inpatients and outpatients. CONCLUSIONS This study shows that CPs are effective tools for an antibiotic stewardship program. Indeed, broad-spectrum antibiotics usage has dropped and amoxicillin prescriptions have increased after implementing the CAP CP-2015 and the 2019 update.
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The authors reply. Crit Care Med 2021; 49:e1059-e1060. [PMID: 34529630 DOI: 10.1097/ccm.0000000000005236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kaufman BG, Whitaker R, Mahendraratnam N, Hurewitz S, Yi J, Smith VA, McClellan M. State variation in effects of state social distancing policies on COVID-19 cases. BMC Public Health 2021; 21:1239. [PMID: 34182972 PMCID: PMC8237534 DOI: 10.1186/s12889-021-11236-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/08/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The novel coronavirus disease 2019 (COVID-19) sickened over 20 million residents in the United States (US) by January 2021. Our objective was to describe state variation in the effect of initial social distancing policies and non-essential business (NEB) closure on infection rates early in 2020. METHODS We used an interrupted time series study design to estimate the total effect of all state social distancing orders, including NEB closure, shelter-in-place, and stay-at-home orders, on cumulative COVID-19 cases for each state. Data included the daily number of COVID-19 cases and deaths for all 50 states and Washington, DC from the New York Times database (January 21 to May 7, 2020). We predicted cumulative daily cases and deaths using a generalized linear model with a negative binomial distribution and a log link for two models. RESULTS Social distancing was associated with a 15.4% daily reduction (Relative Risk = 0.846; Confidence Interval [CI] = 0.832, 0.859) in COVID-19 cases. After 3 weeks, social distancing prevented nearly 33 million cases nationwide, with about half (16.5 million) of those prevented cases among residents of the Mid-Atlantic census division (New York, New Jersey, Pennsylvania). Eleven states prevented more than 10,000 cases per 100,000 residents within 3 weeks. CONCLUSIONS The effect of social distancing on the infection rate of COVID-19 in the US varied substantially across states, and effects were largest in states with highest community spread.
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Affiliation(s)
- Brystana G Kaufman
- Margolis Center for Health Policy, Duke University, 230 Science Drive, Durham, NC, 27705, USA.
- Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.
| | - Rebecca Whitaker
- Margolis Center for Health Policy, Duke University, 230 Science Drive, Durham, NC, 27705, USA
| | - Nirosha Mahendraratnam
- Margolis Center for Health Policy, Duke University, 230 Science Drive, Durham, NC, 27705, USA
| | - Sophie Hurewitz
- Margolis Center for Health Policy, Duke University, 230 Science Drive, Durham, NC, 27705, USA
| | - Jeremy Yi
- Margolis Center for Health Policy, Duke University, 230 Science Drive, Durham, NC, 27705, USA
| | - Valerie A Smith
- Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA
- General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Mark McClellan
- Margolis Center for Health Policy, Duke University, 230 Science Drive, Durham, NC, 27705, USA
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Hoenink JC, Stuber JM, Lakerveld J, Waterlander W, Beulens JWJ, Mackenbach JD. The effect of on-shelf sugar labeling on beverage sales in the supermarket: a comparative interrupted time series analysis of a natural experiment. Int J Behav Nutr Phys Act 2021; 18:49. [PMID: 33823851 PMCID: PMC8025575 DOI: 10.1186/s12966-021-01114-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nutrition labels show potential in increasing healthy food and beverage purchases, but their effectiveness seems to depend on the type of label, the targeted food category and the setting, and evidence on their impact in real-world settings is limited. The aim of this study was to evaluate the effectiveness of an industry-designed on-shelf sugar label on the sales of beverages with no, low, medium and high sugar content implemented within a real-world supermarket. METHODS In week 17 of 2019, on-shelf sugar labels were implemented by a Dutch supermarket chain. Non-alcoholic beverages were classified using a traffic-light labeling system and included the beverage categories "green" for sugar free (< 1.25 g/250 ml), "blue" for low sugar (1.25-6.24 g/250 ml), "yellow" for medium sugar (6.25-13.5 g/250 ml) and "amber" for high sugar (> 13.5 g/250 ml). Store-level data on beverage sales and revenue from 41 randomly selected supermarkets for 13 weeks pre-implementation and 21 weeks post-implementation were used for analysis. In total, 30 stores implemented the on-shelf sugar labels by week 17, and the 11 stores that had not were used as comparisons. Outcome measures were differences in the number of beverages sold in the four label categories and the total revenue from beverage sales in implementation stores relative to comparison stores. Analyses were conducted using a multiple-group Interrupted Time Series Approach. Results of individual store data were combined using random effect meta-analyses. RESULTS At the end of the intervention period, the changes in sales of beverages with green (B 3.4, 95%CI -0.3; 7.0), blue (B 0.0, 95%CI -0.6; 0.7), yellow (B 1.3, 95%CI -0.9; 3.5), and amber (B 0.9, 95%CI -5.5; 7.3) labels were not significantly different between intervention and comparison stores. The changes in total revenues for beverages at the end of the intervention period were also not significantly different between intervention and comparison stores. CONCLUSION The implementation of an on-shelf sugar labeling system did not significantly decrease unhealthy beverage sales or significantly increase healthier beverage sales. Nutrition labeling initiatives combined with complementary strategies, such as pricing strategies or other healthy food nudging approaches, should be considered to promote healthier beverage purchases.
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Affiliation(s)
- J C Hoenink
- Department of Epidemiology and Data Science, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands. .,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - J M Stuber
- Department of Epidemiology and Data Science, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - J Lakerveld
- Department of Epidemiology and Data Science, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - W Waterlander
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - J W J Beulens
- Department of Epidemiology and Data Science, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, Utrecht, the Netherlands
| | - J D Mackenbach
- Department of Epidemiology and Data Science, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
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Treatment Patterns and Outcomes in a Nationwide Cohort of Older and Younger Veterans with Waldenström Macroglobulinemia, 2006-2019. Cancers (Basel) 2021; 13:cancers13071708. [PMID: 33916545 PMCID: PMC8038459 DOI: 10.3390/cancers13071708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Waldenström macroglobulinemia is a rare cancer about which little is known. Evidence from real-world settings provides invaluable information to patients and clinicians, especially for older and/or frailer patients, a demographic often excluded from clinical trials. This study provides information about treatment patterns and outcomes from real-world cohorts of older (>70 years) and younger (≤70 years) patients. We report findings across early (2006–2012) and modern (2013–2019) eras, reflecting a transition during which the number of treatments available for Waldenström macroglobulinemia rapidly increased. We found marked improvements in treatment outcomes among older patients in the modern vs early era, with little or no improvement in outcomes among younger patients. Our findings emphasize the importance of real-world evidence in guiding patient-specific treatment decisions. Abstract Little is known about real-world treatment patterns and outcomes in Waldenström macroglobulinemia (WM) following the recent introduction of newer treatments, especially among older adults. We describe patterns of first-line (1 L) WM treatment in early (2006–2012) and modern (2013–2019) eras and report outcomes (overall response rate (ORR), overall survival (OS), progression-free survival (PFS), and adverse event (AE)-related discontinuation) in younger (≤70 years) and older (>70 years) populations. We followed 166 younger and 152 older WM patients who received 1 L treatment between January 2006 and April 2019 in the Veterans Health Administration. Median follow-up was 43.5 months (range: 0.6–147.2 months). Compared to the early era, older patients in the modern era achieved improved ORRs (early: 63.8%, modern: 72.3%) and 41% lower risk of death/progression (hazard ratio (HR) for PFS: 0.59, 95% CI (confidence interval): 0.36–0.95), with little change in AE-related discontinuation between eras (HR: 0.82, 95% CI: 0.4–1.7). In younger patients, the AE-related discontinuation risk increased almost fourfold (HR: 3.9, 95% CI: 1.1–14), whereas treatment effects did not change between eras (HR for OS: 1.4, 95% CI: 0.66–2.8; HR for PFS: 1.1, 95% CI: 0.67–1.7). Marked improvements in survival among older adults accompanied a profound shift in 1 L treatment patterns for WM.
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Accurate Spectral Estimation Technique Based on Decimated Linear Predictor for Leak Detection in Waterworks. SENSORS 2021; 21:s21062185. [PMID: 33804782 PMCID: PMC8004075 DOI: 10.3390/s21062185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 11/16/2022]
Abstract
Rural pipelines dedicated to water distribution, that is, waterworks, are essential for agriculture, notably plantations and greenhouse cultivation. Water is a primary resource for agriculture, and its optimized management is a key aspect. Saving water dispersion is not only an economic problem but also an environmental one. Spectral estimation of leakage is based on processing signals captured from sensors and/or transducers generally mounted on pipelines. There are different techniques capable of processing signals and displaying the actual position of leaks. Not all algorithms are suitable for all signals. That means, for pipelines located underground, for example, external vibrations affect the spectral response quality; then, depending on external vibrations/noises and flow velocity within pipeline, one should choose a suitable algorithm that fits better with the expected results in terms of leak position on the pipeline and expected time for localizing the leak. This paper presents findings related to the application of a decimated linear prediction (DLP) algorithm for agriculture and rural environments. In a certain manner, the application also detects the hydrodynamics of the water transportation. A general statement on the issue, DLP illustration, a real application and results are also included.
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Potnuru PP, Patel SD, Birnbach DJ, Epstein RH, Dudaryk R. Effects of State Law Limiting Postoperative Opioid Prescription in Patients After Cesarean Delivery. Anesth Analg 2021; 132:752-760. [PMID: 32639388 DOI: 10.1213/ane.0000000000004993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The impact of the Florida State law House Bill 21 (HB 21) restricting the duration of opioid prescriptions for acute pain in patients after cesarean delivery is unknown. Our objective was to assess the association of the passage of Florida State law HB 21 with trends in discharge opioid prescription practices following cesarean delivery, necessity for additional opioid prescriptions, and emergency department visits at a large tertiary care center. METHODS This was a retrospective cohort study conducted at a large, public hospital. The 2 cohorts represented the period before and after implementation of the law. Using a confounder-adjusted segmented regression analysis of an interrupted time series, we evaluated the association between HB 21 and trends in the proportions of patients receiving opioids on discharge, duration of opioid prescriptions, total opioid dose prescribed, and daily opioid dose prescribed. We also compared the need for additional opioid prescriptions within 30 days of discharge and the prevalence of emergency department visits within 7 days after discharge. RESULTS Eight months after implementation of HB 21, the mean duration of opioid prescriptions decreased by 2.9 days (95% confidence interval [CI], 5.2-0.5) and the mean total opioid dose decreased by 20.1 morphine milligram equivalents (MME; 95% CI, 4-36.3). However, there was no change in the proportion of patients receiving discharge opioids (95% CI of difference, -0.1 to 0.16) or in the mean daily opioid dose (mean difference, 5.3 MME; 95% CI, -13 to 2.4). After implementation of the law, there were no changes in the proportion of patients who required additional opioid prescriptions (2.1% vs 2.3%; 95% CI of difference, -1.2 to 1.5) or in the prevalence of emergency department visits (2.4% vs 2.2%; 95% CI of difference, -1.6 to 1.1). CONCLUSIONS Implementation of Florida Law HB 21 was associated with a lower total prescribed opioid dose and a shorter duration of therapy at the time of hospital discharge following cesarean delivery. These reductions were not associated with the need for additional opioid prescriptions or emergency department visits.
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Affiliation(s)
- Paul P Potnuru
- From the Department of Anesthesiology, University of Texas, McGovern Medical School, Houston, Texas
| | - Selina D Patel
- Department of Anesthesiology and Perioperative Medicine, University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - David J Birnbach
- Department of Anesthesiology and Perioperative Medicine, University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Richard H Epstein
- Department of Anesthesiology and Perioperative Medicine, University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Roman Dudaryk
- Department of Anesthesiology and Perioperative Medicine, University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
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Calderon-Anyosa RJC, Kaufman JS. Impact of COVID-19 lockdown policy on homicide, suicide, and motor vehicle deaths in Peru. Prev Med 2021; 143:106331. [PMID: 33232687 PMCID: PMC7680039 DOI: 10.1016/j.ypmed.2020.106331] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/01/2020] [Accepted: 11/15/2020] [Indexed: 12/20/2022]
Abstract
Although lockdown measures to stop COVID-19 have direct effects on disease transmission, their impact on violent and accidental deaths remains unknown. Our study aims to assess the early impact of COVID-19 lockdown on violent and accidental deaths in Peru. Based on data from the Peruvian National Death Information System, an interrupted time series analysis was performed to assess the immediate impact and change in the trend of COVID-19 lockdown on external causes of death including homicide, suicide, and traffic accidents. The analysis was stratified by sex and the time unit was every 15 days. All forms of deaths examined presented a sudden drop after the lockdown. The biggest drop was in deaths related to traffic accidents, with a reduction of 12.22 deaths per million men per month (95% CI: -14.45, -9.98) and 3.55 deaths per million women per month (95% CI:-4.81, -2.30). Homicide and suicide presented similar level drop in women, while the homicide reduction was 2.5 the size of the suicide reduction in men. The slope in homicide in men during the lock-down period increased by 6.66 deaths per million men per year (95% CI:3.18, 10.15). External deaths presented a sudden drop after the lockdown was implemented and an increase in homicide in men was observed. Falls in mobility have a natural impact on traffic accidents, however, the patterns for suicide and homicide are less intuitive and reveal important characteristics of these events, although we expect all of these changes to be transient.
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Affiliation(s)
- Renzo J C Calderon-Anyosa
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
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Calderon-Anyosa RJC, Kaufman JS. Impact of COVID-19 lockdown policy on homicide, suicide, and motor vehicle deaths in Peru. Prev Med 2021; 143:106331. [PMID: 33232687 DOI: 10.1101/2020.07.11.20150193] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/01/2020] [Accepted: 11/15/2020] [Indexed: 05/23/2023]
Abstract
Although lockdown measures to stop COVID-19 have direct effects on disease transmission, their impact on violent and accidental deaths remains unknown. Our study aims to assess the early impact of COVID-19 lockdown on violent and accidental deaths in Peru. Based on data from the Peruvian National Death Information System, an interrupted time series analysis was performed to assess the immediate impact and change in the trend of COVID-19 lockdown on external causes of death including homicide, suicide, and traffic accidents. The analysis was stratified by sex and the time unit was every 15 days. All forms of deaths examined presented a sudden drop after the lockdown. The biggest drop was in deaths related to traffic accidents, with a reduction of 12.22 deaths per million men per month (95% CI: -14.45, -9.98) and 3.55 deaths per million women per month (95% CI:-4.81, -2.30). Homicide and suicide presented similar level drop in women, while the homicide reduction was 2.5 the size of the suicide reduction in men. The slope in homicide in men during the lock-down period increased by 6.66 deaths per million men per year (95% CI:3.18, 10.15). External deaths presented a sudden drop after the lockdown was implemented and an increase in homicide in men was observed. Falls in mobility have a natural impact on traffic accidents, however, the patterns for suicide and homicide are less intuitive and reveal important characteristics of these events, although we expect all of these changes to be transient.
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Affiliation(s)
- Renzo J C Calderon-Anyosa
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
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Reductions in vancomycin and meropenem following the implementation of a febrile neutropenia management algorithm in hospitalized adults: An interrupted time series analysis. Infect Control Hosp Epidemiol 2021; 42:1090-1097. [PMID: 33487182 PMCID: PMC8459315 DOI: 10.1017/ice.2020.1368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective: To evaluate broad-spectrum intravenous antibiotic use before and after the implementation of a revised febrile neutropenia management algorithm in a population of adults with hematologic malignancies. Design: Quasi-experimental study. Setting and population: Patients admitted between 2014 and 2018 to the Adult Malignant Hematology service of an acute-care hospital in the United States. Methods: Aggregate data for adult malignant hematology service were obtained for population-level antibiotic use: days of therapy (DOT), C. difficile infections, bacterial bloodstream infections, intensive care unit (ICU) length of stay, and in-hospital mortality. All rates are reported per 1,000 patient days before the implementation of an febrile neutropenia management algorithm (July 2014–May 2016) and after the intervention (June 2016–December 2018). These data were compared using interrupted time series analysis. Results: In total, 2,014 patients comprised 6,788 encounters and 89,612 patient days during the study period. Broad-spectrum intravenous (IV) antibiotic use decreased by 5.7% with immediate reductions in meropenem and vancomycin use by 22 (P = .02) and 15 (P = .001) DOT per 1,000 patient days, respectively. Bacterial bloodstream infection rates significantly increased following algorithm implementation. No differences were observed in the use of other antibiotics or safety outcomes including C. difficile infection, ICU length of stay, and in-hospital mortality. Conclusions: Reductions in vancomycin and meropenem were observed following the implementation of a more stringent febrile neutropenia management algorithm, without evidence of adverse outcomes. Successful implementation occurred through a collaborative effort and continues to be a core reinforcement strategy at our institution. Future studies evaluating patient-level data may identify further stewardship opportunities in this population.
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Østerås N, Blaker IB, Hjortland T, Cottrell E, Quicke JG, Dziedzic KS, Blackburn S, Paulsen A. Improving osteoarthritis management in primary healthcare: results from a quasi-experimental study. BMC Musculoskelet Disord 2021; 22:79. [PMID: 33446167 PMCID: PMC7807869 DOI: 10.1186/s12891-021-03959-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/05/2021] [Indexed: 12/27/2022] Open
Abstract
Background To improve quality of care for patients with hip and knee osteoarthritis (OA), general practitioners (GPs) and physiotherapists (PTs) in a Norwegian municipality initiated an intervention. The intervention aimed to increase provision of core OA treatment (information, exercise, and weight control) prior to referral for surgery, rational use of imaging for assessing OA and improve communication between healthcare professionals. This study assessed the effectiveness of this intervention. Methods Forty-eight PTs and one hundred one GPs were invited to the intervention that included two interactive workshops outlining best practice and an accompanying template for PT discharge reports. Using interrupted time series research design, the study period was divided into three: pre-implementation, transition (implementation) and post-implementation. Comparing the change between pre- and post-implementation, the primary outcome was patient-reported quality of OA care measured with the OsteoArthritis Quality Indicator questionnaire. Secondary outcomes were number of PT discharge reports, information included in GP referral letters to orthopaedic surgeon, the proportion of GP referral letters indicating use of core treatment, and the use of imaging within OA assessment. Analyses involved linear mixed and logistic regression models. Results The PT workshop had 30 attendees, and 31 PTs and 33 GPs attended the multidisciplinary workshop. Two hundred eight and one hundred twenty-five patients completed the questionnaire during pre- and post-implementation, respectively. The adjusted model showed a small, statistically non-significant, increase in mean total score for quality of OA care (mean change = 4.96, 95% CI -0.18, 10.12, p:0.057), which was mainly related to items on OA core treatment. Patients had higher odds of reporting receipt of information on treatment alternatives (odds ratio (OR) 1.9, 95% CI 1.08, 3.24) and on self-management (OR 2.4, 95% CI 1.33, 4.32) in the post-implementation phase. There was a small, statistically non-significant, increase in the proportion of GP referral letters indicating prior use of core treatment modalities. There were negligible changes in the number of PT discharge reports, in the information included in the GP referral letters, and in the use of imaging for OA assessment. Conclusion This study suggests that a primary care intervention including two inter-active workshops can shift the quality of care towards best practice recommendations. Trial registration ClinicalTrials.gov: NCT02876120. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-03959-6.
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Affiliation(s)
- Nina Østerås
- Division of Rheumatology and Research, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
| | | | | | - Elizabeth Cottrell
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, Keele University, Staffordshire, ST5 5BG, UK
| | - Jonathan G Quicke
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, Keele University, Staffordshire, ST5 5BG, UK
| | - Krysia S Dziedzic
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, Keele University, Staffordshire, ST5 5BG, UK
| | - Steven Blackburn
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, Keele University, Staffordshire, ST5 5BG, UK
| | - Aksel Paulsen
- Department of Orthopaedics, Division of Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Public Health, The Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Can continuous remote vital sign monitoring reduce the number of room visits to patients suspected of COVID-19: A quasi-experimental study. Int J Nurs Stud 2021; 115:103868. [PMID: 33465579 PMCID: PMC7778830 DOI: 10.1016/j.ijnurstu.2020.103868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/18/2020] [Accepted: 12/29/2020] [Indexed: 01/16/2023]
Abstract
Background Continuous remote monitoring of vital signs on the hospital ward gained popularity during the Severe Acute Respiratory Syndrome coronavirus 2 pandemic due to its ability to support early detection of respiratory failure, and the possibility to do so without physical contact between patient and clinician. The effect of continuous monitoring on patient room visits has not been established yet. Objectives To assess the impact of continuous monitoring on the number of patient room visits for patients suspected of Corona Virus Disease 2019 (COVID-19) and the use of personal protection equipment. Design and methods We performed a before-after study at a ward with private rooms for patients suspected of COVID-19 at a tertiary hospital in Nijmegen, The Netherlands. Non-participant observers observed hospital staff during day, evening and night shifts to record patient room visits and personal protection equipment usage. After eleven days, wearable continuous vital sign monitoring was introduced. An interrupted time series analysis was applied to evaluate the effect of continuous monitoring on the number of patient room visits, visits for obtaining vital signs (Modified Early Warning Score visits) and the amount of personal protection equipment used. Results During the 45 day study period, 86 shifts were observed. During each shift, approximately six rooms were included. A total of 2347 patient room visits were recorded. The slope coefficient for the number of patient room visits did not change after introducing continuous vital sign monitoring (B -0.003, 95% confidence interval -0.022/0.016). The slope coefficients of the number of Modified Early Warning Score visits and the amount of personal protection equipment used did not change either (B -0.002, 95% confidence interval -0.021/0.017 and B 0.046, 95% confidence interval -0.008/0.099). The number of Modified Early Warning Score visits did show a decline over the entire study period, however this decline was not influenced by the intervention. Evening and night shifts were associated with fewer patient room visits compared to day shifts. Conclusion Introduction of continuous vital sign monitoring at a general ward for patients with suspected COVID-19 did not reduce the number of patient room visits or the usage of personal protection equipment by hospital staff. The number of Modified Early Warning Score visits declined over time, but this was not related to the introduction of continuous monitoring. Detailed analysis of the influence of continuous monitoring on the workflow of hospital staff reveals key points to increase efficacy of this intervention.
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Batomen B, Moore L, Strumpf E, Yanchar NL, Thakore J, Nandi A. Trauma system accreditation and patient outcomes in British Columbia: an interrupted time series analysis. Int J Qual Health Care 2020; 32:677-684. [PMID: 33057668 DOI: 10.1093/intqhc/mzaa133] [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: 07/08/2020] [Revised: 09/11/2020] [Accepted: 10/06/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We aim to assess the impact of several accreditation cycles of trauma centers on patient outcomes, specifically in-hospital mortality, complications and hospital length of stay. DESIGN Interrupted time series. SETTING British Columbia, Canada. PARTICIPANTS Trauma patients admitted to all level I and level II trauma centers between January 2008 and March 2018. EXPOSURE Accreditation. MAIN OUTCOMES AND MEASURES We first computed quarterly estimates of the proportions of in-hospital mortality, complications and survival to discharge standardized for change in patient case-mix using prognostic scores and the Aalen-Johansen estimator of the cumulative incidence function. Piecewise regressions were then used to estimate the change in levels and trends for patient outcomes following accreditation. RESULTS For in-hospital mortality and major complications, the impact of accreditation seems to be associated with short- and long-term reductions after the first cycle and only short-term reductions for subsequent cycles. However, the 95% confidence intervals for these estimates were wide, and we lacked the precision to consistently conclude that accreditation is beneficial. CONCLUSIONS Applying a quasi-experimental design to time series accounting for changes in patient case-mix, our results suggest that accreditation might reduce in-hospital mortality and major complications. However, there was uncertainty around the estimates of accreditation. Further studies looking at clinical processes of care and other outcomes such as patient or health staff satisfaction are needed.
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Affiliation(s)
- Brice Batomen
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Meredith Charles House, 1130 Pine Avenue West, Room B9, Montreal, QC, H3A 1A3, Canada.,Institute for Health and Social Policy, and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Charles Meredith House, 1030 Pine Avenue W. office # 102, Montreal, Canada
| | - Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, 1401, 18e rue, local Z-215, Québec (Québec), G1J 1Z4, QC, Canada
| | - Erin Strumpf
- Department of Epidemiology, Biostatistics, and Occupational Health and Department of Economics, McGill University, Purvis Hall, 1020 Pine Ave W. Montreal, QC, H3A 1A2, Canada
| | - Natalie L Yanchar
- Clinical Professor in Surgery, University of Calgary, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
| | - Jaimini Thakore
- Provincial Lead, Data, Evaluation & Analytics, Trauma Services BC, Bristish Columbia, Canada
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Meredith Charles House, 1130 Pine Avenue West, Room B9, Montreal, QC, H3A 1A3, Canada.,Institute for Health and Social Policy, and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Charles Meredith House, 1030 Pine Avenue W. office # 102, Montreal, Canada
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Bonakdari H, Pelletier JP, Martel-Pelletier J. A continuous data driven translational model to evaluate effectiveness of population-level health interventions: case study, smoking ban in public places on hospital admissions for acute coronary events. J Transl Med 2020; 18:466. [PMID: 33298067 PMCID: PMC7724897 DOI: 10.1186/s12967-020-02628-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/20/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND An important task in developing accurate public health intervention evaluation methods based on historical interrupted time series (ITS) records is to determine the exact lag time between pre- and post-intervention. We propose a novel continuous transitional data-driven hybrid methodology using a non-linear approach based on a combination of stochastic and artificial intelligence methods that facilitate the evaluation of ITS data without knowledge of lag time. Understanding the influence of implemented intervention on outcome(s) is imperative for decision makers in order to manage health systems accurately and in a timely manner. METHODS To validate a developed hybrid model, we used, as an example, a published dataset based on a real health problem on the effects of the Italian smoking ban in public spaces on hospital admissions for acute coronary events. We employed a continuous methodology based on data preprocessing to identify linear and nonlinear components in which autoregressive moving average and generalized structure group method of data handling were combined to model stochastic and nonlinear components of ITS. We analyzed the rate of admission for acute coronary events from January 2002 to November 2006 using this new data-driven hybrid methodology that allowed for long-term outcome prediction. RESULTS Our results showed the Pearson correlation coefficient of the proposed combined transitional data-driven model exhibited an average of 17.74% enhancement from the single stochastic model and 2.05% from the nonlinear model. In addition, data demonstrated that the developed model improved the mean absolute percentage error and correlation coefficient values for which 2.77% and 0.89 were found compared to 4.02% and 0.76, respectively. Importantly, this model does not use any predefined lag time between pre- and post-intervention. CONCLUSIONS Most of the previous studies employed the linear regression and considered a lag time to interpret the impact of intervention on public health outcome. The proposed hybrid methodology improved ITS prediction from conventional methods and could be used as a reliable alternative in public health intervention evaluation.
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Affiliation(s)
- Hossein Bonakdari
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis Street, R11.412, Montreal, QC, H2X 0A9, Canada.,Department of Soil and Agri-Food Engineering, Laval University, 2425 rue de l'Agriculture, Québec, QC, G1V 0A6, Canada
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis Street, R11.412, Montreal, QC, H2X 0A9, Canada
| | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis Street, R11.412, Montreal, QC, H2X 0A9, Canada.
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Herkert C, Kraal JJ, Spee RF, Serier A, Graat-Verboom L, Kemps HMC. Quality Assessment of an Integrated Care Pathway Using Telemonitoring in Patients with Chronic Heart Failure and Chronic Obstructive Pulmonary Disease: Protocol for a Quasi-Experimental Study. JMIR Res Protoc 2020; 9:e20571. [PMID: 33211017 PMCID: PMC7714643 DOI: 10.2196/20571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 11/27/2022] Open
Abstract
Background Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) often coexist and are associated with a high morbidity and reduced quality of life (QoL). Although these diseases share similarities in symptoms and clinical course, and exacerbations of both diseases often overlap, care pathways for both conditions are usually not integrated. This results in frequent outpatient consultations and suboptimal treatment during exacerbations, leading to frequent hospital admissions. Therefore, we propose an integrated care pathway for both diseases, using telemonitoring to detect deterioration at an early stage and a single case manager for both diseases. Objective This study aims to investigate whether an integrated care pathway using telemonitoring in patients with combined CHF and COPD results in a higher general health-related QoL (HRQoL) as compared with the traditional care pathways. Secondary end points include disease-specific HRQoL, level of self-management, patient satisfaction, compliance to the program, and cost-effectiveness. Methods This is a monocenter, prospective study using a quasi-experimental interrupted time series design. Thirty patients with combined CHF and COPD are included. The study period of 2.5 years per patient is divided into a preintervention phase (6 months) and a postintervention phase (2 years) in which end points are assessed. The intervention consists of an on-demand treatment strategy based on monitoring symptoms related to CHF/COPD and vital parameters (weight, blood pressure, heart rate, oxygen saturation, temperature), which are uploaded on a digital platform. The monitoring frequency and the limit values of the measurements to detect abnormalities are determined individually. Monitoring is performed by a case manager, who has the opportunity for a daily multidisciplinary meeting with both the cardiologist and the pulmonologist. Routine appointments at the outpatient clinic are cancelled and replaced by telemonitoring-guided treatment. Results Following ethical approval of the study protocol, the first patient was included in May 2018. Inclusion is expected to be complete in May 2021. Conclusions This study is the first to evaluate the effects of a novel integrated care pathway using telemonitoring for patients with combined CHF and COPD. Unique to this study is the concept of remote on-demand disease management by a single case manager for both diseases, combined with multidisciplinary meetings. Moreover, modern telemonitoring technology is used instead of, rather than as an addition to, regular care. Trial Registration Netherlands Trial Register NL6741; https://www.trialregister.nl/trial/6741 International Registered Report Identifier (IRRID) DERR1-10.2196/20571
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Affiliation(s)
- Cyrille Herkert
- Flow, Center for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Máxima Medical Center, Eindhoven, Netherlands
| | - Jos Johannes Kraal
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Rudolph Ferdinand Spee
- Flow, Center for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Máxima Medical Center, Eindhoven, Netherlands
- Department of Cardiology, Máxima Medical Center, Eindhoven, Netherlands
| | - Anouk Serier
- Flow, Center for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Máxima Medical Center, Eindhoven, Netherlands
| | - Lidwien Graat-Verboom
- Flow, Center for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Máxima Medical Center, Eindhoven, Netherlands
- Department of Pulmonology, Máxima Medical Center, Eindhoven, Netherlands
| | - Hareld Marijn Clemens Kemps
- Flow, Center for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Máxima Medical Center, Eindhoven, Netherlands
- Department of Cardiology, Máxima Medical Center, Eindhoven, Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands
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Batomen B, Moore L, Strumpf E, Champion H, Nandi A. Impact of trauma centre accreditation on mortality and complications in a Canadian trauma system: an interrupted time series analysis. BMJ Qual Saf 2020; 30:853-866. [PMID: 33127834 DOI: 10.1136/bmjqs-2020-011271] [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: 04/02/2020] [Revised: 09/22/2020] [Accepted: 10/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Periodic external accreditation visits aiming to determine whether trauma centres are fulfilling the criteria for optimal care are part of most trauma systems. However, despite the growing trend towards accreditation of trauma centres, its impact on patient outcomes remains unclear. In addition, a recent systematic review found inconsistent results on the association between accreditation and patient outcomes, mostly due to the lack of robust controls. We aim to address these gaps by assessing the impact of trauma centre accreditation on patient outcomes, specifically in-hospital mortality and complications, using an interrupted time series (ITS) design. METHODS We included all major trauma admissions to five level I and four level II trauma centres in Quebec, Canada between 2008 and 2017. In order to perform ITS, we first obtained monthly and quarterly estimates of the proportions of in-hospital mortality and complications, respectively, for level I and level II centres. Prognostic scores were used to standardise these proportions to account for changes in patient case mix and segmented regressions with autocorrelated errors were used to estimate changes in levels and trends in both outcomes following accreditation. RESULTS There were 51 035 admissions, including 20 165 for major trauma during the study period. After accounting for changes in patient case mix and secular trend in studied outcomes, we globally did not observe an association between accreditation and patient outcomes. However, associations were heterogeneous across centres. For example, in a level II centre with worsening preaccreditation outcomes, accreditation led to -9.08 (95% CI -13.29 to -4.87) and -9.60 (95% CI -15.77 to -3.43) percentage point reductions in mortality and complications, respectively. CONCLUSION Accreditation seemed to be beneficial for centres that were experiencing a decrease in performance preceding accreditation.
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Affiliation(s)
- Brice Batomen
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Lynne Moore
- Social and Preventive Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Erin Strumpf
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Department of Economics, McGill University, Montreal, Quebec, Canada
| | - Howard Champion
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Arijit Nandi
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Institute for Health and Social Policy, Montreal, Quebec, Canada
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Schwarzfuchs D, Shashar S, Sagy I, Novack V, Zeldetz V. Does the physician in triage strategy improve door-to-balloon time for patients with STEMI? Emerg Med J 2020; 37:540-545. [DOI: 10.1136/emermed-2019-209241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 06/09/2020] [Accepted: 06/13/2020] [Indexed: 12/25/2022]
Abstract
BackgroundThe physician in triage (PIT) strategy was implemented in the emergency department (ED) of the Soroka University Medical Center (SUMC) to improve overcrowding and waiting time. Our objective in the current study was to assess the impact of the PIT strategy on door-to-balloon time for the treatment of acute ST-elevation myocardial infarction (STEMI).MethodsThe PIT programme began on January 2016, working weekdays between 8:00 and 23:00 hours. We included patients who visited the ED and were diagnosed with STEMI, from November 2014 to February 2018. The primary outcome was improvement in door-to-balloon (D2B) time <90 min between the preintervention and postintervention period. The analysis included a comparison between the two time periods using univariate tests, a time trend analysis illustrated by the locally weighted scatterplot smoothing curves and a regression analysis using generalised estimating equation models. To determine the impact of the PIT, as opposed to other changes in the department, we stratified the population arriving after January 2016 to patients arriving during PIT hours versus patients arriving on weekends and at nights (23:00–8:00 hours).ResultsIn all, 415 patients met all the inclusion criteria of which 237 (57.1%) visited on weekdays 8:00–23:00 hours. The per cent of patients with D2B <90 min was 13.9% higher for postintervention versus preintervention visits (p=0.006). D2B time was significantly shorter by 9 min for postintervention visits (p=0.001). In the postintervention period, patients arriving between 8:00 and 23:00 hours on weekdays were more likely to have D2B <90 min than those arriving nights and weekends; 90/146 (61.6%) vs 47.2% (51/108), respectively, p=0.02. ORs for D2B <90 min was 2.04 (95% CI 1.06 to 3.91) for weekday visits, and 1.90 (0.88 to 4.12) for weekend and night visits.ConclusionThe PIT model in SUMC is associated with D2B reduction for patients with STEMI. To achieve further reduction, both targeted interventions should be performed and PIT strategy should be applied for full time, including nights and weekends.
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Sia D, Dondbzanga BDG, Carabali M, Bonnet E, Enok Bonong PR, Ridde V. Effect of a free healthcare policy on health services utilisation for non-malarial febrile illness by children under five years in Burkina Faso: an interrupted time series analysis. Trop Med Int Health 2020; 25:1226-1234. [PMID: 32686252 DOI: 10.1111/tmi.13468] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the effect of a free healthcare policy for children under five years old implemented in Burkina Faso since April 2016, on the use of health care of non-malarial febrile illnesses (NMFI). METHODS To assess the immediate and long-term effect of the free healthcare policy in place, we conducted an interrupted time series analysis of routinely collected data on febrile illnesses from three urban primary health centres of Ouagadougou between 1 January 2015 and 31 December 2016. RESULTS Of the 39 046 febrile cases reported in the study period, 17 017 NMFI were included in the study. Compared to the period before the intervention, we observed an immediate, non-statistically significant increase of 7% in the number of NMFI (IRR = 1.07; 95% CI = 0.75, 1.51). Compared to the trend that would have been expected in absence of the intervention, the results showed a small but sustained increase of 6% in the trend of monthly number of NMFI during the intervention period (IRR = 1.06; 95%CI = 1.01, 1.12). CONCLUSION Our study highlighted an increase in the uptake of healthcare services, specifically for NMFI by children under five years of age, after the implementation of a free care policy. This analysis contributes to informing decision makers on the need to strengthen the capacities of healthcare centres and to anticipate the challenges of the sustainability of this policy.
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Affiliation(s)
- D Sia
- University of Québec in Outaouais, Saint-Jérôme, QC, Canada
| | | | - M Carabali
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - E Bonnet
- IRD (French Institute for Research on Sustainable Development), UMI Résiliences, Bondy, France
| | - P R Enok Bonong
- Department of Médecine Préventive, University of Montréal, Montreal, Canada
| | - V Ridde
- IRD (French Institute for Research on Sustainable Development), UMI Résiliences, Bondy, France
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Bonakdari H, Pelletier JP, Martel-Pelletier J. A reliable time-series method for predicting arthritic disease outcomes: New step from regression toward a nonlinear artificial intelligence method. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 189:105315. [PMID: 31972347 DOI: 10.1016/j.cmpb.2020.105315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/04/2020] [Indexed: 05/15/2023]
Abstract
BACKGROUND AND OBJECTIVE The interrupted time-series (ITS) concept is performed using linear regression to evaluate the impact of policy changes in public health at a specific time. Objectives of this study were to verify, with an artificial intelligence-based nonlinear approach, if the estimation of ITS data could be facilitated, in addition to providing a computationally explicit equation. METHODS Dataset were from a study of Hawley et al. (2018) in which they evaluated the impact of UK National Institute for Health and Care Excellence (NICE) approval of tumor necrosis factor inhibitor therapies on the incidence of total hip (THR) and knee (TKR) replacement in rheumatoid arthritis patients. We used the newly developed Generalized Structure Group Method of Data Handling (GS-GMDH) model, a nonlinear method, for the prediction of THR and TKR incidence in the abovementioned population. RESULTS In contrast to linear regression, the GS-GMDH yields for both THR and TKR prediction values that almost fitted with the measured ones. These models demonstrated a low mean absolute relative error (0.10 and 0.09 respectively) and high correlation coefficient values (0.98 and 0.78). The GS-GMDH model for THR demonstrated 6.4/1000 person years (PYs) at the mid-point of the linear regression line post-NICE, whereas at the same point linear regression is 4.12/1000 PYs, a difference of around 35%. Similarly for the TKR, the linear regression to the datasets post-NICE was 9.05/1000 PYs, which is lower by about 27% than the GS-GMDH values of 12.47/1000 PYs. Importantly, with the GS-GMDH models, there is no need to identify the change point and intervention lag time as they simulate ITS continually throughout modelling. CONCLUSIONS The results demonstrate that in the medical field, when looking at the estimation of the impact of a new drug using ITS, a nonlinear GS-GMDH method could be used as a better alternative to regression-based methods data processing. In addition to yielding more accurate predictions and requiring less time-consuming experimental measurements, this nonlinear method addresses, for the first time, one of the most challenging tasks in ITS modelling, i.e. avoiding the need to identify the change point and intervention lag time.
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Affiliation(s)
- Hossein Bonakdari
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 rue Saint-Denis, R11.412, H2X 0A9, Montreal, Quebec, Canada.
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 rue Saint-Denis, R11.412, H2X 0A9, Montreal, Quebec, Canada.
| | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 rue Saint-Denis, R11.412, H2X 0A9, Montreal, Quebec, Canada.
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Bonakdari H, Pelletier JP, Martel-Pelletier J. Viewpoint on Time Series and Interrupted Time Series Optimum Modeling for Predicting Arthritic Disease Outcomes. Curr Rheumatol Rep 2020; 22:27. [PMID: 32435959 DOI: 10.1007/s11926-020-00907-6] [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] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The propose of this viewpoint is to improve or facilitate the clinical decision-making in the management/treatment strategies of arthritis patients through knowing, understanding, and having access to an interactive process allowing assessment of the patient disease outcome in the future. RECENT FINDINGS In recent years, the time series (TS) concept has become the center of attention as a predictive model for making forecast of unseen data values. TS and one of its technologies, the interrupted TS (ITS) analysis (TS with one or more interventions), predict the next period(s) value(s) of a given patient based on their past and current information. Traditional TS/ITS methods involve segmented regression-based technologies (linear and nonlinear), while stochastic (linear modeling) and artificial intelligence approaches, including machine learning (complex nonlinear relationships between variables), are also used; however, each have limitations. We will briefly describe TS/ITS, provide examples of their application in arthritic diseases; describe their methods, challenges, and limitations; and propose a combined (stochastic and artificial intelligence) procedure in post-intervention that will optimize ITS modeling. This combined method will increase the accuracy of ITS modeling by profiting from the advantages of both stochastic and nonlinear models to capture all ITS deterministic and stochastic components. In addition, this combined method will allow ITS outcomes to be predicted as continuous variables without having to consider the time lag produced between the pre- and post-intervention periods, thus minimizing the prediction error not only for the given data but also for all possible future patterns in ITS. The use of reliable prediction methodologies for arthritis patients will permit treatment of not only the disease, but also the patient with the disease, ensuring the best outcome prediction for the patient.
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Affiliation(s)
- Hossein Bonakdari
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, R11.412, Montreal, QC, H2X 0A9, Canada.,Department of Soil and Agri-Food Engineering, Laval University, 2425 rue de l'Agriculture, Québec, QC, G1V 0A6, Canada
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, R11.412, Montreal, QC, H2X 0A9, Canada
| | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, R11.412, Montreal, QC, H2X 0A9, Canada.
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Heintjes EM, Bezemer ID, Prieto-Alhambra D, Smits E, Booth HP, Dedman D, He Y, Hoti F, Vehkala M, de Vogel S, Robinson NJ, Appenteng K, Penning-van Beest FJA. Evaluating the Effectiveness of an Additional Risk Minimization Measure to Reduce the Risk of Prescribing Mirabegron to Patients with Severe Uncontrolled Hypertension in Four European Countries. Clin Epidemiol 2020; 12:423-433. [PMID: 32431551 PMCID: PMC7200224 DOI: 10.2147/clep.s242065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/11/2020] [Indexed: 01/06/2023] Open
Abstract
Background Mirabegron, indicated for the treatment of overactive bladder, is contraindicated in patients with severe uncontrolled hypertension (systolic blood pressure ≥180 mm Hg and/or diastolic blood pressure ≥110 mm Hg). In September 2015, a Direct Healthcare Professional Communication (DHPC) letter was disseminated as an additional risk minimisation measure. Purpose To assess the effectiveness of the DHPC in reducing the proportions of patients with severe or non-severe uncontrolled hypertension at mirabegron initiation. Methods An observational multi-database cohort study was undertaken using routinely collected healthcare data (December 2012–December 2016) from the PHARMO Database Network (Netherlands), SIDIAP database (Spain), CPRD (United Kingdom, UK) and national healthcare registers and electronic medical records from Finland. DHPC effectiveness was evaluated using interrupted time series analyses comparing trends and changes in monthly proportions of severe or non-severe uncontrolled hypertensive mirabegron initiations relative to the timing of the DHPC dissemination. Results The study population comprised 52,078 patients. Prior to DHPC dissemination, across the four databases, 0.3–1.3% had severe uncontrolled hypertension. Estimated absolute changes (EAC) in proportions of severe uncontrolled hypertension post-DHPC indicated a tendency towards a lower proportion in the Netherlands (EAC −0.36%, p=0.053), unchanged proportions in Spain and the UK and a higher proportion in Finland (EAC +0.73%, p=0.016). For non-severe uncontrolled hypertension (13–16% pre-DHPC), post-DHPC proportions tended to be lower in the Netherlands (EAC −2.02%, p=0.038) and Spain (EAC −1.04%, p=0.071), and unchanged in the UK and Finland. Conclusion Severe uncontrolled hypertension prior to mirabegron initiation was uncommon in these four European countries even before DHPC dissemination. This suggests that other risk minimisation communications (prior to the DHPC dissemination) had worked adequately with respect to minimising mirabegron use among patients with severe uncontrolled hypertension. No strong and consistent evidence of further risk minimisation after the DHPC dissemination was observed in this study.
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Affiliation(s)
- Edith M Heintjes
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Irene D Bezemer
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Daniel Prieto-Alhambra
- Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Catalonia, Spain.,Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, England, UK
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Helen P Booth
- Clinical Practice Research Datalink (CPRD), London, UK
| | - Daniel Dedman
- Clinical Practice Research Datalink (CPRD), London, UK
| | - Ying He
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, England, UK
| | | | | | | | | | - Kwame Appenteng
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
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Dormuth CR, Fisher A, Carney G. A rapid monitoring plan following a shift in coverage from brand name to biosimilar drugs for rheumatoid arthritis in British Columbia. Pharmacoepidemiol Drug Saf 2020; 29:796-802. [PMID: 31914214 DOI: 10.1002/pds.4957] [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: 05/31/2019] [Revised: 10/18/2019] [Accepted: 12/16/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE To describe a rapid monitoring plan to assess the impacts of a shift in drug coverage for biosimilar drugs in British Columbia following the introduction of a new policy on 27 May 2019. The Biosimilars Initiative requires users of originator infliximab or etanercept to switch to biosimilar versions of those drugs to maintain coverage. We propose a signal-detection method to provide near-real-time information to policymakers on the impacts of the policy change. METHODS The exposure will be the Biosimilars Initiative, a policy affecting patients using originator infliximab (Remicade) and etanercept (Enbrel) for approved rheumatologic or dermatologic indications. Two policy cohorts and six historical control cohorts of patients using originator infliximab or etanercept will be assembled using linked and de-identified data from the British Columbia Ministry of Health. Patients will be identified during the 6-month period before the policy anniversary. Outcomes will include medication refills and switching, hospital admissions, emergency department visits, and physician visits. Summary outcome measures, such as cumulative incidence or average quantity as applicable, will be examined daily and reported monthly for 1 year. Outcomes in the policy cohorts will be compared with historical controls using likelihood ratios. RESULTS The results of this rapid monitoring plan will be based on analyses involving approximately 9000 patients: four infliximab cohorts of approximately 430 patients and four etanercept cohorts of approximately 1800 patients. CONCLUSIONS Rapid monitoring results will inform ongoing policy decisions related to the Biosimilars Initiative, in terms of impacts on both patient health and health services utilization.
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Affiliation(s)
- Colin R Dormuth
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anat Fisher
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Greg Carney
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
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Piquero AR, Riddell JR, Bishopp SA, Narvey C, Reid JA, Piquero NL. Reply to Gonzalez et al. AMERICAN JOURNAL OF CRIMINAL JUSTICE : AJCJ 2020; 45:1111-1118. [PMID: 33041616 PMCID: PMC7538534 DOI: 10.1007/s12103-020-09575-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/25/2020] [Indexed: 05/07/2023]
Affiliation(s)
- Alex R. Piquero
- University of Miami, Coral Gables, FL USA
- Monash University, Melbourne, Australia
| | | | | | | | - Joan A. Reid
- University of South Florida St. Petersburg, St. Petersburg, FL USA
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