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Demers SP, Cournoyer A, Dagher O, Noly PE, Ducharme A, Ly H, Albert M, Serri K, Cavayas YA, Ben Ali W, Lamarche Y. Impact of clinical variables on outcomes in refractory cardiac arrest patients undergoing extracorporeal cardiopulmonary resuscitation. Front Cardiovasc Med 2024; 10:1315548. [PMID: 38250030 PMCID: PMC10799334 DOI: 10.3389/fcvm.2023.1315548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024] Open
Abstract
Background In the past two decades, extracorporeal resuscitation (ECPR) has been increasingly used in the management of refractory cardiac arrest (CA) patients. Decision algorithms have been used to guide the care such patients, but the effectiveness of such decision-making tools is not well described. The aim of this study was to compare the rate of survival with a good neurologic outcome of patients treated with ECPR meeting all criteria of a clinical decision-making tool for the initiation of ECPR to those for whom ECPR was implemented outside of the algorithm. Methods All patients who underwent E-CPR between January 2014 and December 2021 at the Montreal Heart Institute were included in this retrospective analysis. We dichotomized the cohort according to adherence or non-adherence with the ECPR decision-making tool, which included the following criteria: age ≤65 years, initial shockable rhythm, no-flow time <5 min, serum lactate <13 mmol/L. Patients were included in the "IN" group when they met all criteria of the decision-making tool and in the "OUT" group when at least one criterion was not met. Main outcomes and measures The primary outcome was survival with intact neurological status at 30 days, defined by a Cerebral Performance Category (CPC) Scale 1 and 2. Results A total of 41 patients (IN group, n = 11; OUT group, n = 30) were included. A total of 4 (36%) patients met the primary outcome in the IN group and 7 (23%) in the OUT group [odds ratio (OR): 1.88 (95% CI, 0.42-8.34); P = 0.45]. However, survival with a favorable outcome decreased steadily with 2 or more deviations from the decision-making tool [2 deviations: 1 (11%); 3 deviations: 0 (0%)]. Conclusion and relevance Most patients supported with ECPR fell outside of the criteria encompassed in a clinical decision-making tool, which highlights the challenge of optimal selection of ECPR candidates. Survival rate with a good neurologic outcome did not differ between the IN and OUT groups. However, survival with favorable outcome decreased steadily after one deviation from the decision-making tool. More studies are needed to help select proper candidates with refractory CA patients for ECPR.
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Affiliation(s)
- Simon-Pierre Demers
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Cardiology, Montreal Heart Institute, Montreal, QC, Canada
| | - Alexis Cournoyer
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Emergency Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Olina Dagher
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Surgery, Montreal Heart Institute, Montreal, QC, Canada
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Pierre-Emmanuel Noly
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Surgery, Montreal Heart Institute, Montreal, QC, Canada
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
| | - Anique Ducharme
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Cardiology, Montreal Heart Institute, Montreal, QC, Canada
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
| | - Hung Ly
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Cardiology, Montreal Heart Institute, Montreal, QC, Canada
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
| | - Martin Albert
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Surgery, Montreal Heart Institute, Montreal, QC, Canada
- Department of Medicine, Critical Care, Hôpital du Sacré-Cœur de Montréal and CIUSSS NIM Research Center, Montreal, QC, Canada
| | - Karim Serri
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Surgery, Montreal Heart Institute, Montreal, QC, Canada
- Department of Medicine, Critical Care, Hôpital du Sacré-Cœur de Montréal and CIUSSS NIM Research Center, Montreal, QC, Canada
| | - Yiorgos Alexandros Cavayas
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Surgery, Montreal Heart Institute, Montreal, QC, Canada
- Department of Medicine, Critical Care, Hôpital du Sacré-Cœur de Montréal and CIUSSS NIM Research Center, Montreal, QC, Canada
| | - Walid Ben Ali
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
| | - Yoan Lamarche
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
- Department of Medicine, Critical Care, Hôpital du Sacré-Cœur de Montréal and CIUSSS NIM Research Center, Montreal, QC, Canada
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Chafjiri FMA, Reece L, Voke L, Landschaft A, Clark J, Kimia AA, Loddenkemper T. Natural language processing for identification of refractory status epilepticus in children. Epilepsia 2023; 64:3227-3237. [PMID: 37804085 DOI: 10.1111/epi.17789] [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: 04/19/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE Pediatric status epilepticus is one of the most frequent pediatric emergencies, with high mortality and morbidity. Utilizing electronic health records (EHRs) permits analysis of care approaches and disease outcomes at a lower cost than prospective research. However, reviewing EHR manually is time intensive. We aimed to compare refractory status epilepticus (rSE) cases identified by human EHR review with a natural language processing (NLP)-assisted rSE screen followed by a manual review. METHODS We used the NLP screening tool Document Review Tool (DrT) to generate regular expressions, trained a bag-of-words NLP classifier on EHRs from 2017 to 2019, and then tested our algorithm on data from February to December 2012. We compared results from manual review to NLP-assisted search followed by manual review. RESULTS Our algorithm identified 1528 notes in the test set. After removing notes pertaining to the same event by DrT, the user reviewed a total number of 400 notes to find patients with rSE. Within these 400 notes, we identified 31 rSE cases, including 12 new cases not found in manual review, and 19 of the 20 previously identified cases. The NLP-assisted model found 31 of 32 cases, with a sensitivity of 96.88% (95% CI = 82%-99.84%), whereas manual review identified 20 of 32 cases, with a sensitivity of 62.5% (95% CI = 43.75%-78.34%). SIGNIFICANCE DrT provided a highly sensitive model compared to human review and an increase in patient identification through EHRs. The use of DrT is a suitable application of NLP for identifying patients with a history of recent rSE, which ultimately contributes to the implementation of monitoring techniques and treatments in near real time.
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Affiliation(s)
- Fatemeh Mohammad Alizadeh Chafjiri
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Latania Reece
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Nexamp, Boston, Massachusetts, USA
| | - Lillian Voke
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Justice Clark
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amir A Kimia
- Department of Medicine, Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Connecticut Children's Hospital, Hartford, Connecticut, USA
| | - Tobias Loddenkemper
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Chughtai M, Scollan JP, Emara AK, Jin Y, Evans PJ, Shapiro DB, Styron JF. Validation of a Smartphone-Based Institutional Electronic Data Capture System for Thumb Carpometacarpal Joint Arthroplasty. Hand (N Y) 2023; 18:1135-1141. [PMID: 35321574 PMCID: PMC10798209 DOI: 10.1177/15589447221082163] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Orthopaedic Minimal Data Set (OrthoMiDaS) Episode of care (OME) is a prospectively collected database enabling capture of patient and surgeon-reported data in a more efficient, comprehensive, and dependable manner than electronic medical record (EMR) review. We aimed to assess and validate the OME as a data capture tool for carpometacarpal (CMC) arthroplasty compared to traditional EMR-based review. Specifically, we aimed to: (1) compare the completeness of the OME versus EMR data; and (2) evaluate the extent of agreement between the OME and EMR data-based datasets for carpometacarpal (CMC) arthroplasty. METHODS The first 100 thumb CMC arthroplasties after OME inception (Febuary, 2015) were included. Blinded EMR-based review of the same cases was performedfor 48 perioperative variables and compared to their OME-sourced counterparts. Outcomes included completion rates and agreement measures in OME versus EMR-based control datasets. RESULTS The OME demonstrated superior completion rates compared to EMR-based retrospective review. There was high agreement between both datasets where 75.6% (34/45) had an agreement proportion of >0.90% and 82.2% (37/45) had an agreement proportion of >0.80. Over 40% of the variables had almost perfect to substantial agreement (κ > 0.60). Among the 6 variables demonstrating poor agreement, the surgeon-inputted OME values were more accurate than the EMR-based review control. CONCLUSIONS This study validates the use of the OME for CMC arthroplasty by illustrating that it is reliably able to match or supersede traditional chart review for data collection; thereby offering a high-quality tool for future CMC arthroplasty studies.
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Mills C, Hazeltine K, Zucco A, Phan T, Baker E. Therapist perceptions of barriers to telehealth uptake in children's occupational therapy. Aust Occup Ther J 2023. [PMID: 37127838 DOI: 10.1111/1440-1630.12875] [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: 11/23/2022] [Revised: 04/09/2023] [Accepted: 04/13/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION The COVID-19 pandemic resulted in a rapid shift to telehealth implementation across paediatric occupational therapy services. Although telehealth can be an appealing option, access is conditional, and the delivery of a telehealth service differs from face-to-face. If telehealth is to be a viable and equitable option for families, insight is needed into why the service might be declined. The purpose of our study was to explore barriers to paediatric occupational therapy telehealth services from client and therapist perspectives in a Greater Sydney local health district. METHOD A mixed method approach was used, including (i) retrospective review of clinical records for 250 clients seeking occupational therapy who declined the service and (ii) a focus group with four therapists providing the service. Client demographic information was summarised using descriptive statistics. Open-text responses about reasons for declining telehealth were analysed using qualitative content analysis, whereas thematic analysis was used to explore focus group data. FINDINGS Key findings from the mixed methods analysis identified barriers and issues to consider when working to ensure equitable access to telehealth for children and families. These issues included child engagement, family complexity, the nature of assessments, interventions, and overarching service characteristics as well as the family's digital inclusion. Digital inclusion comprises affordable access to the internet, data, and devices and the capacity of a child and/or family to engage online. CONCLUSION Our findings suggest that telehealth is not a panacea when face-to-face services are not available. Multiple barriers confounded uptake of telehealth prompting a call to action to ensure equitable access to occupational therapy services for all children.
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Affiliation(s)
- Caroline Mills
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, New South Wales, Australia
| | - Kirralee Hazeltine
- South Western Sydney Local Health District (SWSLHD), Liverpool, New South Wales, Australia
| | - Annette Zucco
- South Western Sydney Local Health District (SWSLHD), Liverpool, New South Wales, Australia
| | - Tracy Phan
- South Western Sydney Local Health District (SWSLHD), Liverpool, New South Wales, Australia
| | - Elise Baker
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
- South Western Sydney Local Health District (SWSLHD), Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Transforming Early Education and Child Health (TeEACH), Western Sydney University, Penrith, New South Wales, Australia
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Choi S, Choi SJ, Shin JW, Yoon YA. Common Data Model-based Analysis of Selective Leukoreduction Protocol Compliance at Three Hospitals. Ann Lab Med 2023; 43:187-195. [PMID: 36281513 PMCID: PMC9618907 DOI: 10.3343/alm.2023.43.2.187] [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: 04/22/2022] [Revised: 07/14/2022] [Accepted: 09/19/2022] [Indexed: 12/27/2022] Open
Abstract
Background The selective leukoreduction protocol (SLP) is limited in that patients who require it can be overlooked. We estimated SLP compliance (SLPC) using the Observational Medical Outcomes Partnership common data model (CDM). Methods Patients were classified into eight groups: pre- and post-hematology disease (A and B), pre- and post-solid organ transplantation (C and D), solid cancer (E), immunodeficiency (F), anticancer therapy (G), and cardiovascular surgery (H). We examined the red blood cell (RBC) transfusion history from three hospital datasets comprising approximately three million patients over 20 years using CDM-based analysis. SLPC was calculated as the percentage of patients who received only leukoreduced RBCs in total patients transfused RBCs. Results In total, 166,641 patients from three hospitals were enrolled in this study. From 2001 to 2021, SLPC in all groups, except H, tended to increase, although there were differences among the hospitals. Based on the most recent values (2017-2021), the SLPC in groups A, B, D, and G was maintained at ≥75% until 1,095 days before or after diagnosis or treatment. Groups E, F, and H had < 50% SLPC one day after diagnosis and treatment. Conclusions CDM analysis supports the review of large datasets for SLPC evaluation. Although SLPC tended to improve in most patient groups, additional education and monitoring are needed for groups that continue to show low SLPC.
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Affiliation(s)
- Sooin Choi
- Department of Laboratory Medicine and Genetics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Soo Jeong Choi
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jeong Won Shin
- Department of Laboratory Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Young Ahn Yoon
- Department of Laboratory Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
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Sultanum N, Naeem F, Brudno M, Chevalier F. ChartWalk: Navigating large collections of text notes in electronic health records for clinical chart review. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2023; 29:1244-1254. [PMID: 36166535 DOI: 10.1109/tvcg.2022.3209444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Before seeing a patient for the first time, healthcare workers will typically conduct a comprehensive clinical chart review of the patient's electronic health record (EHR). Within the diverse documentation pieces included there, text notes are among the most important and thoroughly perused segments for this task; and yet they are among the least supported medium in terms of content navigation and overview. In this work, we delve deeper into the task of clinical chart review from a data visualization perspective and propose a hybrid graphics+text approach via ChartWalk, an interactive tool to support the review of text notes in EHRs. We report on our iterative design process grounded in input provided by a diverse range of healthcare professionals, with steps including: (a) initial requirements distilled from interviews and the literature, (b) an interim evaluation to validate design decisions, and (c) a task-based qualitative evaluation of our final design. We contribute lessons learned to better support the design of tools not only for clinical chart reviews but also other healthcare-related tasks around medical text analysis.
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King C, Nielsen S, Schmanski A, Abdul-Rahman O, Fishler KP. Evaluating a general pediatric/adult genetic counseling clinic in a Midwest medical center. J Genet Couns 2022; 31:1282-1289. [PMID: 35781721 PMCID: PMC10084315 DOI: 10.1002/jgc4.1603] [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: 10/18/2021] [Revised: 05/17/2022] [Accepted: 05/30/2022] [Indexed: 12/14/2022]
Abstract
In 2018, the Munroe-Meyer Institute for Genetics & Rehabilitation (MMI) at the University of Nebraska Medical Center (UNMC) in Omaha, NE created a genetic counseling clinic (GCC) to increase access to genetics services and decrease the time spent between a referral and being seen in a general genetics outpatient clinic. In the GCC, genetic counselors led patient encounters and geneticists served as advisors, rather than primary providers. We conducted a chart review of 109 patients seen in the GCC from November 1, 2018, to March 16, 2020, and obtained information regarding patient demographics, indications, and clinical recommendations as a result of the visit. Most patients seen in this clinic were female (65.1%) and aged 19 years of age or older (54.1%). The primary indications for patients in this clinic included review genetic test results (42.2%), coordination of genetic testing for a known familial variant (30.2%), and concerns for personal or family history suspicious of a genetic condition without dysmorphic features (24.8%). The average patient wait time between referral date and appointment date in the GCC was 49.8 days. The two most common clinical recommendations made by genetic counselors in the GCC were genetic testing (56.1%) and/or follow-up with specialist (26.5%). These specialists primarily included endocrinology (n = 5), neurology (n = 4), cardiology (n = 4), ophthalmology (n = 3), and audiology (n = 3). We found that the GCC model may be appropriate for patients with (1) genetic test results requiring interpretation, (2) a known familial variant or (3) genetic testing recommended by a specialist physician. Descriptions of the indications and recommendations for patients seen in this GCC provide a framework for potential implementation of a GCC in other regions across the nation.
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Affiliation(s)
- Charlie King
- Nebraska Hematology-Oncology P.C., Lincoln, Nebraska, USA
| | - Shelly Nielsen
- University of Nebraska Medical Center, Munroe-Meyer Institute for Genetics & Rehabilitation, Omaha, Nebraska, USA
| | - Andrew Schmanski
- University of Nebraska Medical Center, Munroe-Meyer Institute for Genetics & Rehabilitation, Omaha, Nebraska, USA
| | - Omar Abdul-Rahman
- University of Nebraska Medical Center, Munroe-Meyer Institute for Genetics & Rehabilitation, Omaha, Nebraska, USA
| | - Kristen P Fishler
- University of Nebraska Medical Center, Munroe-Meyer Institute for Genetics & Rehabilitation, Omaha, Nebraska, USA
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de Sanctis V, Soliman AT, Daar S, Tzoulis P, Fiscina B, Kattamis C. Retrospective observational studies: Lights and shadows for medical writers. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022319. [PMID: 36300226 PMCID: PMC9686178 DOI: 10.23750/abm.v93i5.13179] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/01/2022] [Indexed: 01/26/2023]
Abstract
A retrospective study (by definition non-interventional) is a purely observational review and/or reassessment of database records with the aim of analyzing previous events of interest. The ethical and scientific standards for conducting biomedical research with humans have been established in international guidelines. Nevertheless, the reporting of ethical considerations in human research is not yet agreed upon globally, although some progress has been made in recent years. If a study has been granted exemption from ethics approval, this should be indicated in the manuscript (including the reasons for the exemption) and, if formal review by an ethics committee is not available, a statement should be included indicating that the research was conducted according to the principles of the Declaration of Helsinki. Editors play an important role in adherence to these ethical requirements for all submitted and published research papers in their journals. This short review paper focuses on the main lights and shadows of ethical aspects for conducting retrospective observational studies in humans and implications for medical writers.
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Affiliation(s)
- Vincenzo de Sanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
| | - Ashraf T Soliman
- Pediatrics and Endocrinology Department of Pediatrics, Hamad Medical Center, Doha, Qatar and Department of Pediatrics, University of Alexandria, Alexandria, Egypt
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman and Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
| | - Ploutarchos Tzoulis
- Consultant Endocrinologist and Diabetologist, Whittington Hospital- UCL Medical School, London, UK
| | | | - Christos Kattamis
- First Department of Paediatrics, National Kapodistrian University of Athens, Athens, Greece
| | - with the participation of the International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescence Medicine (ICET-A)
- International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescence Medicine (ICET-A):Atanas Banchev (Sofia, Bulgaria), Denka Stoyanova (Sofia, Bulgaria), Michael Angastiniotis (Nicosia, Cyprus), Soteroula Christou (Nicosia, Cyprus), Heba Elsedfy (Cairo,Egypt), Mohamed El Kholy (Cairo, Egypt), Doaa Khater (Alexandria, Egypt), Antonis Kattamis (Athens, Greece), Polyxeni Delaporta (Athens, Greece), Haleh Bozorgi (Shiraz, Islamic Republic of Iran), Mehran Karimi (Shiraz, Islamic Republic of Iran), Saveria Campisi (Siracusa, Italy), Salvatore Di Maio (Naples, Italy), Carmelo Fortugno (Catanzaro Italy), Maria Concetta Galati (Catanzaro, Italy), Giuseppe Raiola (Catanzaro, Italy), Soad K Al Jaouni (Jeddah, Kingdom of Saudi Arabia), Yasser Wali (Muscat, Oman), Mohamed A Yassin (Doha, Qatar), Joan Lluis Vives Corrons (Barcelona, Catalonia, Spain), Dulani Kottahachchi (Ragama, Sri Lanka), Duran Canatan (Antalya, Turkey)
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Ishaku SG, Umeh G, Adzu B, Onimisi A, Dauda M, Iyal HA, Iliyasu N, Sunday DJ, Daikwo J, Yates SM, Ibrahim II, Samaila LH, Abdullahi B, Parom SK, Maiwashi KY, Zakari F, Nuhu KS. Adverse event following vaccine surveillance in Kaduna State, Northwestern Nigeria (January 2018 -June 2019): analysis of health facility´s records. Pan Afr Med J 2021; 40:268. [PMID: 35251462 PMCID: PMC8856967 DOI: 10.11604/pamj.2021.40.268.26961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/01/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Adverse Events Following Immunization (AEFI) are one of the main reasons for inadequate immunization coverage in Kaduna State, and AEFI underreporting serves as a barrier to achieving goals of global pharmaco-vigilance for vaccine. The purpose of this study is to estimate the completeness of variables in the AEFI line-listing forms, calculate AEFI reporting rates by Local Government Areas & vaccine type and profile the reported cases according to their reactions. METHODS we conducted a descriptive, cross-sectional, retrospective study of primary surveillance records. We calculated AEFI reporting rates in the State and Local Government areas and AEFI Vaccine reaction rates to the various antigens. We used Binary logistic regression to determine the association between gender and vaccine reactions. RESULTS seven thousand eight hundred and twenty-four (7,824) AEFI cases were reported. The completeness of variables on the filled AEFI line-list varied from 21% to 100%. The State had a high AEFI reporting rate of 9.09 per 10,000 administered doses. Fever (<38oC) was the main AEFI reaction. Severe AEFI cases accounted for only 0.89% of the total reported cases. Pentavalent vaccine was the suspect antigen responsible for the highest number of AEFI cases, with a vaccine reaction rate of 44.77 per 10,000 doses. The Zaria Local Government area had the highest AEFI reporting rate, while the Sanga Local Government area had the lowest AEFI reporting rate in the State. The difference between genders in the number of reported AEFI cases was not statistically significant (p>0.05). There were 35% higher odds of occurrence of bleeding among males than among females (aOR: 1.354; P-value: p=.012; 95% CI: 1.070-1.715; Nagelkerke-R2-: 0.003). The other reactions were not significantly related to gender. CONCLUSION our study shows a higher occurrence of severe AEFI in subjects undergoing pentavalent vaccine. Thiscaused the highest incidence of AEFI. There was no significant association between gender and AEFI reactions.
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Affiliation(s)
- Sambo Godwin Ishaku
- World Health Organization (WHO), Kaduna State Office, Kaduna, Nigeria,,Corresponding author: Sambo Godwin Ishaku, World Health Organization (WHO), Kaduna State Office, Kaduna, Nigeria.
| | - Gregory Umeh
- World Health Organization (WHO), Kaduna State Office, Kaduna, Nigeria
| | - Bulus Adzu
- Department of Pharmacology and Toxicology, National Institute for Pharmaceutical Research and Development, Abuja, Nigeria
| | | | - Madubu Dauda
- World Health Organization (WHO), Kaduna State Office, Kaduna, Nigeria
| | - Hadiza Aliyu Iyal
- World Health Organization (WHO), Kaduna State Office, Kaduna, Nigeria
| | - Neyu Iliyasu
- Kaduna State Primary Healthcare Board, Kaduna, Nigeria
| | | | | | | | | | | | - Basirat Abdullahi
- World Health Organization (WHO), Kaduna State Office, Kaduna, Nigeria
| | | | | | | | - Kase Sarah Nuhu
- Department of Medical Laboratory Science, Kaduna State University, Kaduna, Nigeria
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Bauzon J, Murphy C, Wahi-Gururaj S. Using macros in microsoft excel to facilitate cleaning of research data. J Community Hosp Intern Med Perspect 2021; 11:653-657. [PMID: 34567457 PMCID: PMC8462890 DOI: 10.1080/20009666.2021.1954282] [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] [Indexed: 12/04/2022] Open
Abstract
Background: Retrospective chart review studies may be delayed by inability to export clean clinical data from an electronic medical record (EMR) or data repository. Macros are pre-programmed procedures that can be used in Microsoft Excel to help streamline the process of cleaning clinical datasets. Objectives: To demonstrate how macros may be useful for researchers at community hospitals and smaller academic health centers that lack informatics support. Methods: Using an intrinsic function of our institution’s EMR, vital signs and lab results from 20 individual hospitalizations were exported to a spreadsheet. Two macros were developed to sort through these datasets and output them into a specified format. The speed of macro-assisted data cleaning was compared to manual transcription. Results: Time spent on data cleaning was significantly reduced when using macro-assisted sorting compared to the manual approach for both vital signs (46.5 seconds versus 12.3 minutes per record, a 94% reduction; P < 0.001) and labs (13.7 seconds versus 2.6 minutes per record, a 91% reduction; P < 0.001). Conclusions:Macros offer a flexible and efficient tool for cleaning large sets of clinical data, particularly when an institution lacks informatics support or EMR functionality to export clinical data in an analysis-ready format.
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Affiliation(s)
- Justin Bauzon
- School of Medicine, University of Nevada Las Vegas (UNLV), Las Vegas, Nevada, USA
| | - Caleb Murphy
- Department of Medicine, UNLV School of Medicine, Las Vegas, Nevada, USA
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Song MJ, Kim S, Boo D, Park C, Yoo S, Yoon HI, Cho YJ. Comparison of proton pump inhibitors and histamine 2 receptor antagonists for stress ulcer prophylaxis in the intensive care unit. Sci Rep 2021; 11:18467. [PMID: 34531488 PMCID: PMC8446063 DOI: 10.1038/s41598-021-98069-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 09/03/2021] [Indexed: 12/24/2022] Open
Abstract
Proton pump inhibitors (PPIs), followed by histamine 2 receptor antagonists (H2RAs), are the most commonly used drugs to prevent gastrointestinal bleeding in critically ill patients through stress ulcer prophylaxis. The relative efficacy and drug-related adverse events of PPIs and H2RAs remain unclear. In this retrospective, observational, comparative cohort study, PPIs and H2RAs for stress ulcer prophylaxis in critically ill patients were compared using a common data model. After propensity matching, 935 patients from each treatment group (PPI or H2RA) were selected. The PPI group had a significantly higher 90-day mortality than the H2RA group (relative risk: 1.28; P = 0.01). However, no significant inter-group differences in the risk of clinically important gastrointestinal bleeding were observed. Moreover, there were no significant differences between the groups concerning the risk of pneumonia or Clostridioides difficile infection, which are known potential adverse events related to these drugs. Subgroup analysis of patients with high disease severity were consistent with those of the total propensity score-matched population. These findings do not support the current recommendations, which prefer PPIs for gastrointestinal bleeding prophylaxis in the intensive care unit.
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Affiliation(s)
- Myung Jin Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Seok Kim
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dachung Boo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Changhyun Park
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sooyoung Yoo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ho Il Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
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12
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Chimbatata CS, Chisale MR, Kayira AB, Sinyiza FW, Mbakaya BC, Kaseka PU, Kamudumuli P, Wu TSJ. Paediatric sickle cell disease at a tertiary hospital in Malawi: a retrospective cross-sectional study. BMJ Paediatr Open 2021; 5:e001097. [PMID: 34568588 PMCID: PMC8438882 DOI: 10.1136/bmjpo-2021-001097] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) remains a major cause of childhood mortality and morbidity in Malawi. However, literature to comprehensively describe the disease in the paediatric population is lacking. METHODS A retrospective review of clinical files of children with SCD was conducted. Descriptive statistics were performed to summarise the data. χ2 or Fisher's exact test was used to look for significant associations between predictor variables and outcome variables (case fatality and length of hospital stay). Predictor variables that were significantly associated with outcome variables (p≤0.05) in a χ2 or Fisher's exact test were carried forward for analysis in a binary logistic regression. A multivariable binary logistic regression was used to identify covariates that independently predicted length of hospital stay. RESULTS There were 16 333 paediatric hospitalisations during the study period. Of these, 512 were patients with SCD representing 3.1% (95% CI: 2.9%- 3.4%). Sixty-eight of the 512 children (13.3%; 95% CI: 10.5% - 16.5%) were newly diagnosed cases. Of these, only 13.2% (95% CI: 6.2% - 23.6%) were diagnosed in infancy. Anaemia (94.1%), sepsis (79.5%) and painful crisis (54.3%) were the most recorded clinical features. The mean values of haematological parameters were as follows: haemoglobin (g/dL) 6.4 (SD=1.9), platelets (×109/L) 358.8 (SD=200.9) while median value for white cell count (×109/L) was 23.5 (IQR: 18.0-31.2). Case fatality was 1.4% (95% CI: 0.6% - 2.8%)and 15.2% (95% CI: 12.2% -18.6%) of the children had a prolonged hospital stay (>5 days). Patients with painful crisis were 1.7 (95% CI: 1.02 - 2.86) times more likely to have prolonged hospital stay than those without the complication. CONCLUSION Anaemia, sepsis and painful crisis were the most common clinical features paediatric patients with SCD presented with. Patients with painful crisis were more likely to have prolonged hospital stay. Delayed diagnosis of SCD is a problem that needs immediate attention in this setting. Although somewhat encouraging, the relatively low in-hospital mortality among SCD children may under-report the true mortality from the disease considering community deaths and deaths occurring before SCD diagnosis is made.
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Affiliation(s)
| | - Master Ro Chisale
- Biological Sciences, Mzuzu University Faculty of Health Sciences, Mzuzu, Northern Region, Malawi.,Laboratory, Mzuzu Central Hospital, Mzuzu, Northern Region, Malawi
| | | | | | | | | | - Pocha Kamudumuli
- University of Maryland Global Initiatives Corporation Baltimore, Lilongwe, Central Region, Malawi
| | - Tsung-Shu Joseph Wu
- Luke International, Mzuzu, Northern Region, Malawi.,Ping Tung Christian Hospital, Pingtung, Taiwan
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13
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Singh-Franco D, Mastropietro DR, Metzner M, Dressler MD, Fares A, Johnson M, De La Rosa D, Wolowich WR. Impact of pharmacy-supported interventions on proportion of patients receiving non-indicated acid suppressive therapy upon discharge: A systematic review and meta-analysis. PLoS One 2020; 15:e0243134. [PMID: 33270710 PMCID: PMC7714117 DOI: 10.1371/journal.pone.0243134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 11/16/2020] [Indexed: 12/13/2022] Open
Abstract
Objective Conduct a systematic review and meta-analysis to estimate the impact of pharmacy-supported interventions on the proportion of patients discharged from the hospital on inappropriate acid suppressive therapy (AST). Methods To identify studies, the following databases were systematically searched on October 14th, 2018 and repeated on September 12th, 2019: Ovid MEDLINE(R) and In-Process & Other Non-Indexed Citations and Daily, Embase.com, CINAHL, Web of Science, Cochrane CENTRAL (EBSCO), and ClinicalTrials.gov. Eligible studies consisted of adults, intervention and historical/usual care groups, description of active pharmacy-supported intervention, and proportion of patients discharged on inappropriate AST. Qualitative assessments and quantitative analyses were performed. Modified funnel plot analysis assessed heterogeneity. Preferred reporting items of systematic reviews and meta-analyses (PRISMA) methodology was used to evaluate studies in this review. Results Seventeen publications resulting in 16 studies were included in the review. Using random effects model, meta-analysis showed a significant reduction in the odds of being discharged on inappropriate AST from the hospital in the pharmacist-supported intervention arm versus comparator (Odds Ratio 0.33 [95%CI 0.20 to 0.53]), with significant heterogeneity (I2 = 86%). Eleven studies favored pharmacy-supported interventions, four were inconclusive and one favored usual care. Using modified funnel plot analysis, our final evaluation was distilled to 11 studies and revealed a similar outcome (OR 0.36 [95%CI 0.27 to 0.48]), but with less heterogeneity (I2 = 36%). Conclusion This systematic review and meta-analysis showed that pharmacy-supported interventions were associated with a significantly reduced probability of patients discharged on inappropriate AST. However, heterogeneity was high and may affect interpretation of results. Using funnel plot optimization method, three positive and two negative studies were objectively removed from analyses, resulting in a similar effect size, but with less heterogeneity. To improve study quality, future researchers should consider utilizing a pre-post, multi-arm, prospective design with sampling randomization, training of data extractors (preferably two extractors), re-evaluating a small dataset to check for agreement and providing a comprehensive methodology in subsequent publications.
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Affiliation(s)
- Devada Singh-Franco
- Department of Pharmacy Practice, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, Florida, United States of America
- * E-mail:
| | - David R. Mastropietro
- Department of Pharmaceutical Sciences, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Miriam Metzner
- Department of Pharmacy Practice, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, Florida, United States of America
| | - Michael D. Dressler
- Department of Pharmaceutical Sciences, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Amneh Fares
- Department of Pharmacy Practice, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, Florida, United States of America
| | - Melinda Johnson
- Martin and Gail Press Health Professions Division Library, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Daisy De La Rosa
- Martin and Gail Press Health Professions Division Library, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - William R. Wolowich
- Department of Pharmacy Practice, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, Florida, United States of America
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14
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Davidovich E, Grender J, Zini A. Factors Associated with Dental Plaque, Gingivitis, and Caries in a Pediatric Population: A Records-Based Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228595. [PMID: 33228082 PMCID: PMC7699320 DOI: 10.3390/ijerph17228595] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 12/14/2022]
Abstract
This retrospective, cross-sectional study evaluated dental records of 1000 healthy children to determine factors associated with plaque, gingivitis, and caries. A logistic model for plaque and gingivitis (mild versus moderate/severe) and caries (yes/no) was carried out separately for each variable using the following potential factors: Age, Gender, Brush Type, Starting Age of Brushing, Brushing Frequency, and Bite Type. Data from 998 children (median age: 4 years, 10 months (range: 2.5-7 years)) were analyzed. Sixty-four percent were manual toothbrush users; 36% were oscillating-rotating electric toothbrush users. For plaque and gingivitis, but not caries, Brush Type was more impactful than Brushing Frequency. Age influenced the severity of plaque and gingivitis, with increases in the odds of having moderate/severe plaque or gingivitis associated with increasing age. The probability of caries increased until approximately age 5 and then decreased until age 7. Oscillating-rotating brush users were more likely to present with less plaque, gingivitis, and caries, with 6.0, 5.1, and 1.4 times greater odds of having mild (versus moderate/severe) plaque, less severe gingivitis, and being caries-free, respectively, than manual brush users. Similarly, brushing twice daily and starting brushing at an earlier age were associated with better oral health outcomes. Children with anterior bite abnormalities had increased odds of developing moderate/severe plaque and gingivitis than children with normal anterior bites. Gender was not a statistically significant factor associated with plaque, gingivitis, or caries. Children's oral health is influenced by toothbrush type, starting age of brushing, compliance with twice-daily brushing, and bite abnormalities.
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Affiliation(s)
- Esti Davidovich
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Hebrew University & Hadassah, Jerusalem 91120, Israel;
| | - Julie Grender
- Statistics and Data Management, The Procter & Gamble Company, Mason, OH 45040, USA;
| | - Avi Zini
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Hebrew University & Hadassah, Jerusalem 91120, Israel;
- Correspondence: ; Tel.: +972-26-758569
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15
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Mintz HP, Dosanjh A, Parsons HM, Hughes A, Jakeman A, Pope AM, Bryan RT, James ND, Patel P. Development and validation of a follow-up methodology for a randomised controlled trial, utilising routine clinical data as an alternative to traditional designs: a pilot study to assess the feasibility of use for the BladderPath trial. Pilot Feasibility Stud 2020; 6:165. [PMID: 33292682 PMCID: PMC7599120 DOI: 10.1186/s40814-020-00713-y] [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: 08/13/2019] [Accepted: 10/20/2020] [Indexed: 01/19/2023] Open
Abstract
Background Bladder cancer outcomes have not changed significantly in 30 years; the BladderPath trial (Image Directed Redesign of Bladder Cancer Treatment Pathway, ISRCTN35296862) proposes to evaluate a modified pathway for diagnosis and treatment ensuring appropriate pathways are undertaken earlier to improve outcomes. We are piloting a novel data collection technique based on routine National Health Service (NHS) data, with no traditional patient-Health Care Professional contact after recruitment, where trial data are traditionally collected on case report forms. Data will be collected from routine administrative sources and validated via data queries to sites. We report here the feasibility and pre-trial methodological development and validation of the schema proposed for BladderPath. Methods Locally treated patient cohorts were utilised for routine data validation (hospital interactions data (HID) and administrative radiotherapy department data (RTD)). Single site events of interest were algorithmically extracted from the 2008–2018 HID and validated against reference datasets to determine detection sensitivity. Survival analysis was performed using RTD and HID data. Hazard ratios and survival statistics were calculated estimating treatment effects and further validating and assessing the scope of routine data. Results Overall, 829/1042 (sensitivity 0.80) events of interest were identified in the HID, with varying levels of sensitivity; identifying, 202/206 (sensitivity 0.98; PPV 0.96) surgical events but only 391/568 (sensitivity 0.69; PPV 0.95) radiotherapy regimens. An overall temporal quality improvement trend was present: detecting 41/117 events (35%) in 2011 to 104/109 (95%) in 2017 (all event types). Using the RTD, 5-year survival rates were 43% (95% CI 25–59%) in the chemoradiotherapy group and 30% (95% CI 23–36%) in the radiotherapy group; using the HID, the 5-year radical cystectomy survival rate was 57% (95% CI 50–63%). Conclusions Routine data are a feasible method for trial data collection. As long as events of interest are pre-validated, very high sensitivities for trial conduct can be achieved and further improved with targeted data queries. Outcomes can also be produced comparable to clinical trial and national dataset results. Given the real-time, obligatory nature of the HID, which forms the Hospital Episode Statistics (HES) data, alongside other datasets, we believe routine data extraction and validation is a robust way of rapidly collecting datasets for trials. Supplementary Information Supplementary information accompanies this paper at 10.1186/s40814-020-00713-y.
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Affiliation(s)
- Harriet P Mintz
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW, UK
| | - Amandeep Dosanjh
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Helen M Parsons
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Ana Hughes
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Alicia Jakeman
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW, UK
| | - Ann M Pope
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Richard T Bryan
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | | | - Nicholas D James
- The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB, UK.,The Royal Marsden NHS foundation Trust, Fulham Road, Chelsea, London, SW3 6JJ, UK
| | - Prashant Patel
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW, UK. .,Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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16
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Iborra M, García-Morales N, Rubio S, Bertoletti F, Calvo M, Taxonera C, Boscá-Watts MM, Sierra M, Mancenido N, Beltrán B, Nantes Castillejo Ó, García-Planella E, Vera I, Alba C, Martí-Aguado D, Ballester MP, Cano-Sanz N, Pajares-Villarroya R, Cerrillo E, Cañada A, Nos P. Real-life experience with 4 years of golimumab persistence in ulcerative colitis patients. Sci Rep 2020; 10:17774. [PMID: 33082359 PMCID: PMC7576126 DOI: 10.1038/s41598-020-73577-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/17/2020] [Indexed: 02/08/2023] Open
Abstract
Golimumab has demonstrated its long-term efficacy and safety in ulcerative colitis in clinical trials, but no data of long-term persistence has been published from real world. To estimate long-term persistence of golimumab, as well as factors associated with longer persistence, in patients with ulcerative colitis in real life. Observational multicentre study including adult patients with ulcerative colitis treated with golimumab and with at least twelve months of follow-up. We included 190 patients, 105 (55.26%) naive to anti-TNF, with mean disease duration of 9.32 ± 8.09 years. Probability of persistence was 63%, 46%, 39% and 27% at 1, 2, 3 and 4 years, respectively. Persistence was lower in patients with primary failure to previous anti-TNF. Eighty-two (43.16%) patients needed dose intensification during follow-up, with a mean time until intensification of 8.03 ± 8.64 months. Dose intensification and lower disease duration predicted higher persistence with golimumab (p = 0.037 and p = 0.008, respectively). During a follow-up of 17.25 ± 15.83 months, 32 (16.5%) patients needed hospitalisation and 11 (6%) underwent colectomy. No unexpected adverse events were reported. Golimumab has demonstrated good persistence and safety profile for long treatment in ulcerative colitis patients.
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Affiliation(s)
- Marisa Iborra
- Department of Gastroenterology, Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
| | - Natalia García-Morales
- Department of Gastroenterology, Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Saoia Rubio
- Department of Digestive Diseases, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Federico Bertoletti
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Marta Calvo
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Carlos Taxonera
- Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Mónica Sierra
- Department of Gastroenterology, Complejo Asistencial Universitario de León, León, Spain
| | - Noemí Mancenido
- Department of Gastroenterology, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Belén Beltrán
- Department of Gastroenterology, Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | | | | | - Isabel Vera
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Cristina Alba
- Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain
| | - David Martí-Aguado
- Department of Gastroenterology, Hospital Clínico Universitario, Valencia, Spain
| | | | - Noelia Cano-Sanz
- Department of Gastroenterology, Complejo Asistencial Universitario de León, León, Spain
| | - Ramón Pajares-Villarroya
- Department of Gastroenterology, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Elena Cerrillo
- Department of Gastroenterology, Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Antonio Cañada
- Deparment of Biostatistics and Bioinformatics, Instituto de Investigación Sanitaria Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pilar Nos
- Department of Gastroenterology, Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
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17
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Argaw MD, Mavundla TR, Gidebo KD. Management of uncomplicated malaria in private health facilities in North-West Ethiopia: a clinical audit of current practices. BMC Health Serv Res 2019; 19:932. [PMID: 31801533 PMCID: PMC6894146 DOI: 10.1186/s12913-019-4722-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 11/07/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Malaria is one of the leading public health problems in sub-Saharan Africa that contributes to significant patient morbidity and mortality. The aim of the study was to investigate adherence to malaria diagnosis and treatment guidelines by private health sector providers and compare their performance against the public private partnership (PPP) status. METHODS A facility-based retrospective clinical audit was conducted between October 2016 and January 2017 in 11 medium clinics in the West Gojjam zone of the Amhara Region, North-west Ethiopia. Data was extracted from patient medical records using pretested data abstraction forms. Descriptive statistics were employed to present the findings and adherence of health workers against the national and international standards were classified as ideal, acceptable, minor error and major error for both malaria diagnosis and treatment. A chi-square (X2) test was used to test for a statistically significant relationship after the data had been categorized using public private partnership status at P < 0.05. RESULTS One thousand six hundred fifty clinical files were audited. All malaria suspected patients were investigated either with microscopy or rapid diagnostics test (RDT) for parasitological confirmation. The proportion of malaria treated cases was 23.7% (391/1650). Of which 16.6% (274/1650) were uncomplicated, 3.69% (61 /1650) were severe and complicated and the rest 3.39% (56/1650) were clinical diagnosed malaria cases. And the malaria parasite positivity rate was 20.30% (335/1650). All malaria suspected patients were not investigated with ideal malaria diagnosis recommendations; only 19.4% (320/1650) were investigated with acceptable malaria diagnosis (public private partnership (PPP) 19.4%; 176/907; and non-public private partnership (NPPP) 19.38%; 144/743, X2 (1) = 0.0With regards to treatments of malaria cases, the majority 82.9% of Plasmodium vivax cases were managed with ideal recommended treatment (X2 (1) = 0.35, P = 0.55); among Plasmodium falciparum, mixed (Plasmodium falciparum and Plasmodium vivax). CONCLUSION The clinical audit revealed that the majority of malaria patients had received minor error malaria diagnostic services. In addition, only one fifth of malaria patients had received ideal malaria treatment services. To understand the reasons for the low levels of malaria diagnosis and treatment adherence with national guidelines, a qualitative exploratory descriptive study is recommended.
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Affiliation(s)
- Mesele Damte Argaw
- USAID Transform: Primary Health Care, JSI Research & Training Institute, Inc., P.O. Box 1392, code 1110, Addis Ababa, Ethiopia.
- Department of Health Studies, University of South Africa, Pretoria, South Africa.
| | | | - Kassa Daka Gidebo
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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18
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Daddato AE, Dollar B, Lum HD, Burke RE, Boxer RS. Identifying Patient Readmissions: Are Our Data Sources Misleading? J Am Med Dir Assoc 2019; 20:1042-1044. [PMID: 31227472 DOI: 10.1016/j.jamda.2019.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 04/24/2019] [Accepted: 04/30/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The accuracy of data is vital to identifying hospitalization outcomes for clinical trials. Patient attrition and recall bias affects the validity of patient-reported outcomes, and the growing prevalence of Medicare Advantage (MA) could mean Fee-for-Service (FFS) claims are less reliable for ascertaining hospital utilization. Statewide health information exchanges (HIEs) may be a more complete data source but have not been frequently used for research. DESIGN Secondary analysis comparing identification of readmissions using 3 different acquisition approaches. SETTING Randomized controlled trial of heart failure (HF) disease management in 37 skilled nursing facilities (SNFs). PARTICIPANTS Patients with HF discharged from the hospital to SNF. MEASURES Readmissions up to 60 days post-SNF admission collected by patient self-report, recorded by nursing home (NH) staff during the SNF stay, or recorded in the state HIE. RESULTS Among 657 participants (mean age 79 ± 10 years, 49% with FFS), 295 unique readmissions within 60 days of SNF admission were identified. These readmissions occurred among 221 patients. Twenty percent of all readmissions were found using only patient self-report, 28% were only recorded by NH staff during the SNF stay, and 52% were identified only using the HIE. The readmission rate (first readmission only) based only on patient self-report and direct observation was 18% rather than 34% with the addition of the enhanced HIE method. CONCLUSIONS AND IMPLICATIONS More than one-quarter (34%) of HF patients were rehospitalized within 60 days post SNF admission. Use of a statewide HIE resulted in identifying an additional 153 admissions, 52% of all the readmissions seen in this study. Without use of an HIE, nearly half of readmissions would have been missed as a result of incomplete patient self-report or loss to follow-up. Thus, HIEs serve as an important resource for researchers to ensure accurate outcomes data.
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Affiliation(s)
- Andrea E Daddato
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO.
| | - Blythe Dollar
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Hillary D Lum
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO; Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO
| | - Robert E Burke
- Center for Health Equity Research and Promotion, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rebecca S Boxer
- Institute for Health Research, Kaiser Permanente, Aurora, CO
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19
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Hlongwa P, Levin J, Rispel LC. Epidemiology and clinical profile of individuals with cleft lip and palate utilising specialised academic treatment centres in South Africa. PLoS One 2019; 14:e0215931. [PMID: 31071123 PMCID: PMC6508722 DOI: 10.1371/journal.pone.0215931] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/10/2019] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE The study was conducted to determine the epidemiology and clinical profile of individuals with cleft lip and/or palate (CLP) utilizing specialized academic treatment centres in South Africa's public health sector. MATERIALS AND METHODS The Human Research Ethics Committee of the University of the Witwatersrand in Johannesburg provided ethical approval for the study. We conducted a retrospective record review of all cases of CLP treated at the specialised academic centres for the two-year period from 1 January 2013 until 31 December 2014. We used a structured, pre-tested record review form to obtain demographic, clinical and treatment information on each CLP case. We used Stata 13 to analyse the data and conducted statistical tests at 5% significance level. RESULTS We analysed 699 records of individuals with CLP. The estimated prevalence of CLP in the South African public health sector was 0.3 per 1000 live births, with provincial variation of 0.1/1000 to 1.2/1000. The distribution of clefts was: 35.3% cleft palate; 34.6% cleft lip and palate; 19.0% cleft lip and other cleft anomalies at 2%. Of the total number of CLP, 47.5% were male and 52.5% female, and this difference was statistically significant (p<0.001). The majority of clefts occurred on the left for males (35.5%) and palate for females (43.4%), with a male predominance of unilateral cleft lip and palate (53.3%). CONCLUSION The study findings should inform the implementation of South Africa's planned birth defect surveillance system and health service planning for individuals with CLP.
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Affiliation(s)
- Phumzile Hlongwa
- School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - Jonathan Levin
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - Laetitia C. Rispel
- Centre for Health Policy & DST/NRF SARChI Chair, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
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Endriyas M, Mekonnen E, Dana T, Daka K, Misganaw T, Ayele S, Shiferaw M, Tessema T, Getachew T. Burden of NCDs in SNNP region, Ethiopia: a retrospective study. BMC Health Serv Res 2018; 18:520. [PMID: 29973219 PMCID: PMC6031105 DOI: 10.1186/s12913-018-3298-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/14/2018] [Indexed: 12/19/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are medical conditions or diseases that are non-transmissible. As NCDs are becoming one of major public health problem, providing local description of diseases and injuries is key to health decision- making and planning processes. So, this study aimed to describe caseload of NCDs in Southern Nations Nationalities and People’s Region, Ethiopia. Methods A facility based retrospective study was conducted in February 2015 in SNNPR, Ethiopia. A total of 22,320 records of three years retrieved from 23 health facilities using systematic sampling. Data were entered in to Epi-Info 3.5.3 and descriptive analysis was carried out using SPSS version 20. Results From 22,320 records reviewed, 6633 (29.7%) clients visited health facilities due to Non-Communicable Diseases (NCDs). Majority (37.2%) of NCD cases were in productive age groups (20–35 year). Near to half (43%) of NCD cases were from rural and 45.8% were females. Digestive disorder (26.7%), cardiovascular diseases (18.8%) and Diabetes Mellitus (13.1%) were the most prevalent types of NCDs. Conclusion Health facilities are burdened with significant proportion of clients with NCDs. Young population accounts large share and NCDs are becoming public health problem of urban and rural area within a health care system that focus on communicable diseases. There is a need to strengthen the health system to work towards NCDs, and investigate risk factors associated with NCDs at individual level.
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Affiliation(s)
| | | | - Tadele Dana
- College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kassa Daka
- College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | | | | | | | | | - Tewodros Getachew
- College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Zaffanello M, Lippi G, Tenero L, Piazza M, Sacchetto L, Nosetti L, Gasperi E, Piacentini G. Childhood nasal obstruction and sleep-disordered breathing during clinical setting: Myth or reality? ACTA ACUST UNITED AC 2018. [DOI: 10.18621/eurj.410657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Zaffanello M, Piacentini G, Sacchetto L, Pietrobelli A, Gasperi E, Barillari M, Cardobi N, Nosetti L, Ramaroli D, Antoniazzi F. Sleep-Disordered Breathing in Children with Rare Skeletal Disorders: A Survey of Clinical Records. Med Princ Pract 2018; 27:451-458. [PMID: 29929197 PMCID: PMC6244108 DOI: 10.1159/000491391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 06/21/2018] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Craniofacial disharmony in skeletal diseases is strongly associated with sleep-disordered breathing. This study was aimed at studying the sleep respiratory patterns in young children with rare skeletal disorders. DESIGN This retrospective study included children with achondroplasia (ACH), osteogenesis imperfecta (OI) and Ellis van Creveld Syndrome. Our subjects underwent an in-laboratory overnight respiratory polygraph between January 2012 and April 2016. All medical records were reviewed and brain Magnetic Resonance Imaging was conducted on patients with ACH, nasopharynx, oropharynx and laryngopharynx spaces. PATIENTS Twenty-four children were enrolled, 13 with ACH, 2 with spondyloepiphyseal dysplasia, 1 with odontochondrodysplasia, 6 with OI and 2 with Ellis van Creveld Syndrome. RESULTS Children with ACH, who had adenotonsillectomy, showed fewer sleep respiratory involvement than untreated children. Among 13 patients with ACH, brain magnetic resonance imaging was available in 10 subjects and significant negative correlation was found between sleep respiratory patterns, nasopharynx and oropharynx space (p < 0.05). In 2 patients with spondyloepiphyseal dysplasia, mild-to-moderate sleep respiratory involvement was found. Both subjects had a history of adenotonsillectomy. Mild sleep respiratory involvement was also observed in 4 out of 6 patients with OI. One patient with Ellis van Creveld syndrome had mild sleep respiratory disturbance. CONCLUSIONS Sleep respiratory disturbances were detected in children with ACH, and with less severity also in OI and Ellis van Creveld syndrome. Adenotonsillectomy was successful in ACH in reducing symptoms. In light of our findings, multicenter studies are needed to obtain further information on these rare skeletal diseases.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
- *Marco Zaffanello, MD, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division University of Verona, Piazzale Stefani, 1, Woman & Child Hospital, Building 29, IT-37126 Verona (Italy), E-Mail
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Luca Sacchetto
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Emma Gasperi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Marco Barillari
- Department of Morphological and Biomedical Sciences, Institute of Radiology, University Hospital of Verona, Verona, Italy
| | - Nicolò Cardobi
- Department of Morphological and Biomedical Sciences, Institute of Radiology, University Hospital of Verona, Verona, Italy
| | - Luana Nosetti
- Department of Pediatrics, University of Insubria, Varese, Italy
| | - Diego Ramaroli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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Hu Z, Melton GB, Moeller ND, Arsoniadis EG, Wang Y, Kwaan MR, Jensen EH, Simon GJ. Accelerating Chart Review Using Automated Methods on Electronic Health Record Data for Postoperative Complications. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2017; 2016:1822-1831. [PMID: 28269941 PMCID: PMC5333220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Manual Chart Review (MCR) is an important but labor-intensive task for clinical research and quality improvement. In this study, aiming to accelerate the process of extracting postoperative outcomes from medical charts, we developed an automated postoperative complications detection application by using structured electronic health record (EHR) data. We applied several machine learning methods to the detection of commonly occurring complications, including three subtypes of surgical site infection, pneumonia, urinary tract infection, sepsis, and septic shock. Particularly, we applied one single-task and five multi-task learning methods and compared their detection performance. The models demonstrated high detection performance, which ensures the feasibility of accelerating MCR. Specifically, one of the multi-task learning methods, propensity weighted observations (PWO) demonstrated the highest detection performance, with single-task learning being a close second.
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Affiliation(s)
- Zhen Hu
- Institute for Health Informatics
| | | | | | | | - Yan Wang
- Institute for Health Informatics
| | | | | | - Gyorgy J Simon
- Institute for Health Informatics; Department of Medicine, University of Minnesota, MN
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MULLIN S, ANAND E, SINHA S, SONG B, ZHAO J, ELKIN PL. Secondary Use of EHR: Interpreting Clinician Inter-Rater Reliability Through Qualitative Assessment. Stud Health Technol Inform 2017; 241:165-172. [PMID: 28809201 PMCID: PMC5698262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In a retrospective secondary-use EHR study identifying a cohort of Non-Valvular Atrial Fibrillation (NVAF) patients, chart abstraction was done by two sets of clinicians to create a gold standard for risk measures CHA2DS2-VASc and HAS-BLED. Inter-rater reliability between each set of clinicians for NVAF and the outcomes of interest were variable, ranging from extremely low agreement to high agreement. To assess the chart abstraction process, a focus group and a survey was conducted. Survey findings revealed patterns of difficulty in assessing certain items dealing with temporality and social data. The focus group raised issues on the quality and completeness of EHR data, including missing encounters, truncated notes, and low granularity. It also raised the issue of the usability of the data system, the Clinical Data Viewer, which did not mirror a live EHR and made it difficult to record outcomes. Finally, the focus group found it was difficult to infer certain outcomes, like severity, from the provided data. These factors produced differences in clinician rated outcomes.
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Kim CR, Tunçalp Ö, Ganatra B, Gülmezoglu AM. WHO Multi-Country Survey on Abortion-related Morbidity and Mortality in Health Facilities: study protocol. BMJ Glob Health 2016; 1:e000113. [PMID: 28588967 PMCID: PMC5321365 DOI: 10.1136/bmjgh-2016-000113] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/19/2016] [Accepted: 08/30/2016] [Indexed: 02/06/2023] Open
Abstract
Introduction According to the WHO, abortion accounts for about 8% (4.7–13.2) of maternal mortality worldwide. In 2010, the WHO Multi-Country Survey (MCS) on Maternal and Newborn Health collected data on over 300 000 women who were admitted in health facilities to receive pregnancy-related care. Abortion data were partially captured by centring on severe maternal outcomes (ie, near-miss or maternal deaths). Building on the experiences of the prior MCS as well as current WHO reproductive health projects, we are undertaking a multi-country survey to better capture the burden and severity of abortion-related complications and management among women presenting to the health facilities. Methods and analysis This is a large cross-sectional study with prospective data collection. It will be implemented in health facilities in 30 countries across the WHO regions of Africa, Americas, Eastern Mediterranean, Europe, South East Asia and Western Pacific. Countries and facilities will be identified through a multistage sampling methodology. Data collection will be at both the facility and individual levels, involving review of medical records and exit surveys with eligible women using audio computer-assisted self-interview. All women presenting to the health facilities with signs and symptoms of abortion complications will comprise the study population. Online data entry and management will be performed on a web-based data management system. Analysis will include prevalence of abortion-related complications and descriptive frequencies of procedural/non-procedural management and experience of care. Ethics and dissemination Ethical issues of the consent process are addressed. Dissemination plans will involve the participating facilities and communities to further strengthen abortion-related research capacity within the MCS on Abortion (MCS-A) countries. Furthermore, dissemination of results will be an iterative process at both the facility and national level to potentially propagate positive changes to abortion-related policies and practices.
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Affiliation(s)
- Caron R Kim
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Bela Ganatra
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Ahmet Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, WHO, Geneva, Switzerland
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Kattimani S, Menon V, Sarkar S, Arun AB, Venkatalakshmi P. Role of Demographic and Personality Factors in Mediating Vulnerability to Suicide Attempts under Intoxication with Alcohol: A Record-based Exploratory Study. Indian J Psychol Med 2016; 38:540-546. [PMID: 28031590 PMCID: PMC5178038 DOI: 10.4103/0253-7176.194919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Identifying those who are likely to make suicide attempts under alcohol intoxication has important implications for management and prevention of further suicidal behavior. AIMS To identify the frequency of suicide attempts made under the influence of alcohol and the percentage of impulsive suicide attempts among them. We also aimed to identify predictors of attempted suicide under intoxication with alcohol. SETTING AND DESIGN Record-based study carried out at a tertiary care hospital. MATERIALS AND METHODS The clinical charts of consecutive suicide attempters (n = 147) who presented to the crisis intervention clinic from July 2013 to June 2014 were reviewed, and relevant data were extracted. The participants were divided into three groups - nonusers of alcohol (n = 85), alcohol users who did not attempt under intoxication (n = 31) and alcohol users who attempted under intoxication (n = 31). These groups were compared on various sociodemographic and clinical variables. Logistic regression was done to identify predictors of suicide attempt under intoxication. STATISTICAL ANALYSIS USED Chi-square (χ2) test, one-way ANOVA (F) test and backward stepwise logistic regression. RESULTS About 21.08% of all suicide attempts occurred under alcohol intoxication. Such subjects were more likely to be older (F = 12.428, P < 0.001), male (χ2 = 87.367, P < 0.001), married (χ2 = 6.787, P = 0.034), employed (χ2 = 41.778, P < 0.001), and fewer years of formal schooling (F = 3.312, P = 0.039). Physical methods (hanging) were used more often in this group (χ2 = 19.510, P = 0.012). In regression analysis, only marital status and living condition emerged as predictors of attempt under intoxication (odds ratios 4.52 [confidence interval (CI) 1.34-15.24, P = 0.015] and 5.67 [CI 1.17-27.39, P = 0.031] respectively). CONCLUSION Certain demographic features may help us in identifying those who are more likely to make attempts under intoxication. The role of personality factors as potential mediators of such behavior needs further exploration.
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Affiliation(s)
- Shivanand Kattimani
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Siddharth Sarkar
- Department of Psychiatry, All Institute of Medical Sciences, New Delhi, India
| | - Anand Babu Arun
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Penchilaiya Venkatalakshmi
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Menon V, Sarkar S, Kattimani S, Mathan K. Do Personality Traits Such as Impulsivity and Hostility-Aggressiveness Predict Severity of Intent in Attempted Suicide? Findings From a Record Based Study in South India. Indian J Psychol Med 2015; 37:393-8. [PMID: 26702169 PMCID: PMC4676203 DOI: 10.4103/0253-7176.168563] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Little is known about the association of personality traits with intent in attempted suicide. AIMS Our objectives were to assess the levels of selected personality factors among suicide attempters and to examine their association with suicide intent. MATERIALS AND METHODS A chart review of 156 consecutive suicide attempters was carried out. All participants were administered the Beck Suicide Intent Scale, Barratt Impulsivity Scale-11, Buss-Perry Aggression Questionnaire, and Past Feelings and Acts of Violence Scale to assess suicide intent, trait impulsivity, hostility-aggression, and violence, respectively. Pearson's product moment correlation was the used as the test of association. Stepwise linear regression was used to identify predictors of suicide intent. RESULTS Suicide intent was significantly correlated with verbal aggression (Pearson r = 0.90, P = 0.030), hostility (Pearson r = 0.316, P < 0.001), and nonplanning impulsivity (r = -0.174, P = 0.049). High hostility and low motor impulsivity emerged as significant predictors of suicide intent. CONCLUSION Personality traits such as hostility and to an extent, impulsivity are accurate predictors of intentionality in attempted suicide. Clinicians should focus on these personality attributes during a routine evaluation of suicide attempters. They can also be considered as potential targets for suicide prevention programs.
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Affiliation(s)
- Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Siddharth Sarkar
- Department of Psychiatry, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Shivanand Kattimani
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Kaliaperumal Mathan
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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