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Kagansky D, Or K, Elkan M, Koren S, Koren R. The effect of over- and undertreatment of hypothyroidism on hospitalization outcomes of patients with decompensated heart failure. J Investig Med 2023; 71:646-654. [PMID: 36975306 DOI: 10.1177/10815589231162542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
The effect of over- and undertreatment of hypothyroidism on hospitalization outcomes of patients with acute decompensated heart failure (HF) has not been evaluated yet. We conducted retrospective cohort analyses of outcomes among 231 consecutive patients with treated hypothyroidism who were admitted to internal medicine departments of Shamir Medical Center with HF (2011-2019). Patients were divided into three groups according to their thyroid-stimulating hormone (TSH) levels: well treated (TSH: 0.4-4 mIU/L), overtreated (TSH: <0.4 mIU/L), and undertreated (TSH: >4 mIU/L). The main outcomes were mortality and recurrent hospitalization within 3 months. Among 231 patients, 106 were euthyroid, 14 were overtreated, and 111 undertreated. Patients' mean age was 79.8 ± 9.4 years. In-hospital mortality occurred in 4.7% in euthyroid patients, 14.3% in the overtreated group, and 10.7% in the undertreated group (p = 0.183). Differences in 30-day (p = 0.287) and 90-day (p = 0.2) mortality or recurrent hospitalization (p = 0.438) were not significantly different as well. However, in patients who were markedly undertreated and overtreated (TSH: >10 mIU/L or below 0.4 mIU/L) compared with 0.4-10 mIU/L, a significant increase in 90-day mortality was observed (33.3% vs 15.1% p = 0.016). Treatment status was independently associated with 90-day mortality after controlling for confounders with an adjusted odds ratio of 3.55 (95% confidence interval: 1.39-9.06). Although mild under- or overtreatment of hypothyroidism does not have a significant detrimental effect on hospitalization outcomes of patients with acute decompensated HF, markedly under- and overtreatment are independently associated with rehospitalizations and 90-day mortality. Larger cohorts are needed to establish the relationship between treatment targets and hospitalization outcomes of patients at risk for HF hospitalization.
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Affiliation(s)
- Dana Kagansky
- Department of Internal Medicine A, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Karen Or
- Department of Internal Medicine D, Endocrine Institute Shamir Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Endocrine Institute Shamir Medical Center, Zerifin, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Matan Elkan
- Department of Internal Medicine A, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Shlomit Koren
- Endocrine Institute Shamir Medical Center, Zerifin, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Internal Medicine A, Shamir Medical Center, Zerifin, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ronit Koren
- Department of Internal Medicine A, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
- Endocrine Institute Shamir Medical Center, Zerifin, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Osório F, Barros AS, Peleteiro B, Amendoeira I, Fougo JL. Quality Indicators Compliance and Survival Outcomes in Breast Cancer according to Age in a Certified Center. Cancers (Basel) 2023; 15. [PMID: 36900236 DOI: 10.3390/cancers15051446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
Age as a breast cancer (BC) prognostic factor remains debatable. Several studies have investigated clinicopathological features at different ages, but few make an age group direct comparison. The European Society of Breast Cancer Specialists quality indicators (EUSOMA-QIs) allow a standardized quality assurance of BC diagnosis, treatment, and follow-up. Our objective was to compare clinicopathological features, compliance to EUSOMA-QIs and BC outcomes in three age groups (≤45 years, 46-69 years, and ≥70 years). Data from 1580 patients with staged 0-IV BC from 2015 to 2019 were analyzed. The minimum standard and desirable target on 19 mandatory and 7 recommended QIs were studied. The 5-year relapse rate, overall survival (OS), and BC-specific survival (BCSS) were also evaluated. No meaningful differences in TNM staging and molecular subtyping classification between age groups were found. On the contrary, disparities in QIs compliance were observed: 73.1% in ≤45 years and 46-69 years women vs. 54% in older patients. No differences in loco-regional or distant progression were observed between age groups. Nevertheless, lower OS was found in older patients due to concurrent non-oncological causes. After survival curves adjustment, we underscored evidence of undertreatment impacting BCSS in ≥70 years women. Despite a unique exception-more invasive G3 tumors in younger patients-no age-specific differences in BC biology impacting outcome were found. Although increased noncompliance in older women, no outcome correlation was observed with QIs noncompliance in any age group. Clinicopathological features and differences in multimodal treatment (not the chronological age) are predictors of lower BCSS.
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van Dijk D, Groen AH, van Dijk BAC, van Veen TL, Sluiter WJ, Links TP, Plukker JTHM. The outcome of treatment in differentiated thyroid cancer according to recommendations in current Dutch and American guidelines. Clin Endocrinol (Oxf) 2023; 98:123-130. [PMID: 35781313 PMCID: PMC10087791 DOI: 10.1111/cen.14795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/06/2022] [Accepted: 06/26/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Assessment of treatment outcome in current de-escalation for differentiated thyroid cancer (DTC) according to the 2015 Dutch thyroid cancer guidelines (NL-15) and American Thyroid Association guidelines (ATA-15). DESIGN Retrospectively, the recommendations of the NL-15 and ATA-15 guidelines were evaluated to estimate potentially adequate, under- and overtreatment of DTC in patients treated in the University Medical Center Groningen between 2007 and 2017. PATIENTS A total of 240 patients with a cT1-T3aN0-1aM0 DTC fulfilled the inclusion criteria. MEASUREMENTS After actual treatment was given, patients were again categorized according to both guidelines into low, intermediate, or high-risk based on tumour status. Next, they were categorized into a congruent low-risk (n = 60), congruent high-risk (n = 73), or incongruent risk group (n = 107). Follow-up data were used to estimate the proportion of potentially adequate, under-, and overtreatment according to both guidelines. RESULTS Comparing treatment recommended by NL-15 and ATA-15 showed significantly more over- and adequate treatment when following NL-15 recommendations, and more undertreatment following ATA-15 (all: p < .001). Subanalysis of the congruent low-risk group showed overtreatment in 64% when following NL-15 guidelines (p < .001). No treatment differences were found in the congruent high-risk group. Undertreatment was most often seen in the incongruent risk group when following ATA-15 (p < .001). CONCLUSIONS Low-risk patients were treated too aggressively when following NL-15 recommendations, where the less aggressive ATA-15 approach seemed more adequate. Treatment of intermediate risk DTC patients varies greatly, with a relative higher rate of undertreatment according to the recommendations of the ATA-15, advocating further refining of the risk classification in this patient group.
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Affiliation(s)
- Deborah van Dijk
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andries H Groen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Boukje A C van Dijk
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tim L van Veen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wim J Sluiter
- Department of Internal Medicine, Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thera P Links
- Department of Internal Medicine, Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - John T H M Plukker
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Rajput VK, Dowie J, Kaltoft MK. Individualising Life Expectancy Is Necessary for Optimal Prescribing. Stud Health Technol Inform 2022; 298:112-116. [PMID: 36073467 DOI: 10.3233/shti220918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
One possible cause of overprescribing (or insufficient deprescribing) is the failure to explicitly address the individual's life expectancy (LE). For example, if a LE estimate shows the person has six months to live, this should influence the prescribing of a medication that offers benefits only over a much longer LE. Predicting exactly the number of years a person will live is impossible, but probabilistic forecasting is possible and arguably essential, both for the selection of the optimal intervention and for meeting the 'reasonable patient' standard of information about the harms and benefits of alternative options. One side-effect of the COVID-19 pandemic has been to bring mortality into greater prominence, hopefully facilitating its discussion in the clinic as part of the 'new normal'. This paper outlines the case for introducing LE into prescribing decisions as a way of making more individualised decisions and potentially reducing overprescribing. It concentrates on how the clinical task of arriving at individualised estimates of LE might be tackled, especially in the case of the growing number of older patients with heterogeneous sociodemographic characteristics who are experiencing multiple long term conditions of varying severity and are frequently subject to 'polypharmacy'.
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Affiliation(s)
- Vije Kumar Rajput
- Stonydelph Health Centre, Tamworth, UK
- London School of Hygiene and Tropical Medicine
| | - Jack Dowie
- London School of Hygiene and Tropical Medicine
- University of Southern Denmark
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Cigiloglu A, Efendioglu EM, Ozturk ZA. A retrospective study of diabetes treatment in older adults: what should we AIM for? Postgrad Med 2022; 134:693-697. [PMID: 35697060 DOI: 10.1080/00325481.2022.2090175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Management of diabetes in elderly individuals requires a complex approach, considering the negative consequences. Glycemic overtreatment and undertreatment are relatively common conditions among this population. This study aimed to determine the potential overtreatment and undertreatment frequencies in older adults and the factors associated with these conditions. METHODS This retrospective study included 405 diabetic older adults aged >65 years. Sociodemographic characteristics, additional comorbidities, medications, HbA1c and fasting glucose levels of the patients have been recorded. RESULTS The median age of the patients was 71 years. The frequency of potential overtreatment and undertreatment has been found to be 20.2% and 17.8%, respectively. Insulin and sulfonylureas were found to be associated with increased risk of potential overtreatment (p = 0.000, OR = 14.91 and p = 0.000, OR = 8.48, respectively) and reduced risk of potential undertreatment (p = 0.001, OR = 0.16 and p = 0.000, OR = 0.05, respectively), while DPP-4 inhibitors were found to be associated with reduced risk of potential undertreatment (p = 0.000, OR = 0.12). CONCLUSION Our study has shown that potential glycemic overtreatment and undertreatment are common problems in diabetic older adults. It was found that agents with a high risk of hypoglycemia, such as insulin and sulfonylureas, were more closely associated with potential overtreatment. In the management of diabetes in the elderly, it should be aimed to choose treatment agents that lead to less negative consequences and to follow up the patients more closely.
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Affiliation(s)
- Ahmet Cigiloglu
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Gaziantep University, Sahinbey, Turkey
| | - Eyyup Murat Efendioglu
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Gaziantep University, Sahinbey, Turkey
| | - Zeynel Abidin Ozturk
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Gaziantep University, Sahinbey, Turkey
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Chow EJ, Chen Y, Armstrong GT, Baldwin LM, Cai CR, Gibson TM, Hudson MM, McDonald A, Nathan PC, Olgin JE, Syrjala KL, Tonorezos ES, Oeffinger KC, Yasui Y. Underdiagnosis and Undertreatment of Modifiable Cardiovascular Risk Factors Among Survivors of Childhood Cancer. J Am Heart Assoc 2022; 11:e024735. [PMID: 35674343 PMCID: PMC9238650 DOI: 10.1161/jaha.121.024735] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Determine the prevalence and predictors associated with underdiagnosis and undertreatment of modifiable cardiovascular disease (CVD) risk factors (hypertension, dyslipidemia, glucose intolerance/diabetes) among adult survivors of childhood cancer at high risk of premature CVD. Methods and Results This was a cross‐sectional study of adult‐aged survivors of childhood cancer treated with anthracyclines or chest radiotherapy, recruited across 9 US metropolitan regions. Survivors completed questionnaires and in‐home clinical assessments. The comparator group was a matched sample from the National Health and Nutrition Examination Survey. Multivariable logistic regression estimated the risk (odds ratios) of CVD risk factor underdiagnosis and undertreatment among survivors compared with the National Health and Nutrition Examination Survey. Survivors (n=571; median age, 37.7 years and 28.5 years from cancer diagnosis) were more likely to have a preexisting CVD risk factor than the National Health and Nutrition Examination Survey (n=345; P<0.05 for all factors). While rates of CVD risk factor underdiagnosis were similar (27.1% survivors versus 26.1% National Health and Nutrition Examination Survey; P=0.73), survivors were more likely undertreated (21.0% versus 13.9%, P=0.007; odds ratio, 1.8, 95% CI, 1.2–2.7). Among survivors, the most underdiagnosed and undertreated risk factors were hypertension (18.9%) and dyslipidemia (16.3%), respectively. Men and survivors who were overweight/obese were more likely to be underdiagnosed and undertreated. Those with multiple adverse lifestyle factors were also more likely undertreated (odds ratio, 2.2, 95% CI, 1.1–4.5). Greater health‐related self‐efficacy was associated with reduced undertreatment (odds ratio, 0.5; 95% CI, 0.3–0.8). Conclusions Greater awareness of among primary care providers and cardiologists, combined with improving self‐efficacy among survivors, may mitigate the risk of underdiagnosed and undertreated CVD risk factors among adult‐aged survivors of childhood cancer. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03104543.
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Affiliation(s)
- Eric J Chow
- Public Health Sciences and Clinical Research Divisions Fred Hutchinson Cancer Research Center Seattle WA.,Department of Pediatrics Seattle Children's HospitalUniversity of Washington Seattle WA
| | - Yan Chen
- University of Alberta Edmonton Alberta Canada
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital Memphis TN
| | | | - Casey R Cai
- School of Medicine University of Texas Southwestern Dallas TX
| | - Todd M Gibson
- Division of Cancer Epidemiology and Genetics National Cancer Institute Rockville MD
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital Memphis TN.,Department of Oncology St. Jude Children's Research Hospital Memphis TN
| | - Aaron McDonald
- Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital Memphis TN
| | - Paul C Nathan
- Department of Pediatrics The Hospital for Sick Children University of Toronto Ontario Canada
| | - Jeffrey E Olgin
- Division of Cardiology Department of Medicine University of California San Francisco CA
| | - Karen L Syrjala
- Public Health Sciences and Clinical Research Divisions Fred Hutchinson Cancer Research Center Seattle WA
| | - Emily S Tonorezos
- Division of Cancer Control and Population Science National Cancer Institute Rockville MD
| | | | - Yutaka Yasui
- University of Alberta Edmonton Alberta Canada.,Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital Memphis TN
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Koza E, Diaz J, Chaudhary D, Shahjouei S, Li J, Abedi V, Zand R. Lack of Sex Disparity in Oral Anticoagulation in Atrial Fibrillation Patients Presenting with Ischemic Stroke in a Rural Population. J Clin Med 2021; 10:4670. [PMID: 34682796 DOI: 10.3390/jcm10204670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022] Open
Abstract
Various studies on oral anticoagulants (OAC) use among atrial fibrillation (AF) patients have shown high rates of undertreatment and the presence of sex disparity. This study used the 'Geisinger Neuroscience Ischemic Stroke' (GNSIS) database to examine sex differences in OAC treatment among ischemic stroke patients with the pre-event diagnosis of AF in rural Pennsylvania between 2004 and 2019. We examined sex disparities in OAC undertreatment and associated risks based on age group and ischemic stroke year. A total of 1062 patients were included in the study and 1015 patients (96%) had CHA2DS2-VASc score ≥ 2, of which 549 (54.1%) were women. Undertreatment rates were not statistically significant between men and women in the overall cohort (50.0% vs. 54.5%, p = 0.18), and male sex was not found to be a significant factor in undertreatment (OR 0.82, 95% CI 0.62-1.09, p = 0.17). The result persisted even when patients were divided into four age groups and two groups based on the study time period. The undertreatment rates in both sex groups remained consistent following the introduction of novel oral anticoagulants. In conclusion, there was no evidence of sex disparity with respect to OAC treatment, even after stratifying the cohort by age and ischemic stroke year.
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Tran AT, Berg TJ, Mdala I, Gjelsvik B, Cooper JG, Sandberg S, Claudi T, Jenum AK. Factors associated with potential over- and undertreatment of hyperglycaemia and annual measurement of HbA 1c in type 2 diabetes in norwegian general practice. Diabet Med 2021; 38:e14500. [PMID: 33354827 PMCID: PMC8359382 DOI: 10.1111/dme.14500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/11/2020] [Accepted: 12/14/2020] [Indexed: 12/16/2022]
Abstract
AIMS To identify individual and general practitioner (GP) characteristics associated with potential over- and undertreatment of hyperglycaemia in type 2 diabetes and with HbA1c not being measured. METHODS A cross-sectional study that included 10233 individuals with type 2 diabetes attending 282 GPs. Individuals with an HbA1c measurement during the last 15 months were categorized as potentially overtreated if they were prescribed a sulphonylurea and/or insulin when the HbA1c was less than 53 mmol/mol (7%) when aged over 75 years or less than 48 mmol/mol (6.5%) when aged between 65 and 75 years. Potential undertreatment was defined as age less than 60 years and HbA1c > 64 mmol/mol (8.0%) or HbA1c > 69 mmol/mol (8.5%) and treated with lifestyle modification and/or monotherapy. We used multilevel binary and multinominal logistic regression models to examine associations. RESULTS Overall, 4.1% were potentially overtreated, 7.8% were potentially undertreated and 11% did not have HbA1c measured. Characteristics associated with potential overtreatment were as follows: long diabetes duration, prescribed antihypertensive medication, cardiovascular disease and renal failure. Potential undertreatment was associated with male gender, non-western origin and low educational level. Characteristics associated with not having an HbA1c measurement performed were male gender, age < 50 years and cardiovascular diseases. GP specialist status and GPs' use of a Noklus diabetes application reduced the risk of not having an HbA1c measurement performed. CONCLUSION Potential overtreatment in elderly individuals with type 2 diabetes was relatively low. Nevertheless, appropriate de-intensification or intensification of treatment and regular HbA1c measurement in identified subgroups is warranted.
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Affiliation(s)
- Anh T. Tran
- Department of General PracticeInstitute of Health and SocietyUniversity of OsloOsloNorway
| | - Tore J. Berg
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloOsloNorway
- Department of Endocrinology, Morbid Obesity and Preventive MedicineOslo University HospitalOsloNorway
| | - Ibrahimu Mdala
- Department of General PracticeInstitute of Health and SocietyUniversity of OsloOsloNorway
| | - Bjørn Gjelsvik
- Department of General PracticeInstitute of Health and SocietyUniversity of OsloOsloNorway
| | - John G. Cooper
- Norwegian Quality Improvement of Laboratory ExaminationsHaraldsplass Deaconess HospitalBergenNorway
- Department of MedicineStavanger University HospitalStavangerNorway
| | - Sverre Sandberg
- Norwegian Quality Improvement of Laboratory ExaminationsHaraldsplass Deaconess HospitalBergenNorway
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
- Department of Clinical Biochemistry and PharmacologyHaukeland University HospitalBergenNorway
| | - Tor Claudi
- Department of MedicineNordland HospitalBodøNorway
| | - Anne K. Jenum
- Department of General PracticeInstitute of Health and SocietyUniversity of OsloOsloNorway
- General Practice Research Unit (AFE)Department of General PracticeInstitute of Health and Society, University of OsloOsloNorway
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Ingrasciotta Y, Isgrò V, Ientile V, Tari M, Trifirò G, Guarneri C. Are Patients with Psoriasis and Psoriatic Arthritis Undertreated? A Population-Based Study from Southern Italy. J Clin Med 2021; 10:3431. [PMID: 34362214 DOI: 10.3390/jcm10153431] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/18/2022] Open
Abstract
This study aimed to explore the pattern of use of different treatment lines in psoriasis (PsO) and psoriatic arthritis (PsA) patients from Southern Italy. A retrospective cohort study was performed during the years 2010–2018 using data from the Caserta Local Health Unit (LHU) claims database. All of the PsO or PsA patients were identified. The proportion of PsO/PsA patients untreated or treated with ≥1 drug classes (i.e., non-disease-modifying antirheumatic drugs (non-DMARDs), conventional synthetic DMARDs (csDMARDs), biological drugs (bDMARDs) or targeted synthetic small molecules (tsDMARDs)) was calculated in the years 2016–2018. Among the bDMARD users, the median times from the first registered PsO/PsA diagnosis/from the first csDMARD to the first bDMARD were calculated. Overall, 10,296 (1.1%) and 1724 (0.2%) PsO and PsA patients were identified. More than half of the PsO patients (N = 5301; 51.6%) and 15% of the PsA patients (N = 251) were not treated with any drug. A very low proportion of PsO patients (N = 121; 1.2%) received csDMARDs/bDMARDs dispensing. Instead, 538 (32.2%) PsA patients were treated with bDMARDs. The median times from the first diagnosis to the first bDMARD dispensing were 54.0 (Q1–Q3: 30.5–72.2) and 13.3 (Q1–Q3: 3.1–43.9) months in the PsO and PsA patients, respectively. The median time from the first csDMARD to the first bDMARD dispensing was shorter in the PsO [9.2 months (Q1–Q3: 5.5–30.0)] than in the PsA [14.5 months (Q1–Q3: 8.6–33.5)] patients. A potential undertreatment of PsO (much less for PsA) in an LHU from Southern Italy, with a particularly low use of more recently marketed drugs, such as biological ones, was shown.
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O'Hair DP, Gada H, Sotelo MR, Wagner L, Feind CM, Brigman L, Rogers C, Kohli NS. Enhanced Detection of Heart Valve Disease Using Integrated Artificial Intelligence at Scale. Ann Thorac Surg 2021; 113:1499-1504. [PMID: 34139187 DOI: 10.1016/j.athoracsur.2021.04.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/20/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Undertreatment of heart valve disease creates unnecessary patient risk. Poorly integrated healthcare data systems are unequipped to solve this problem. A software program utilizing a rules-based algorithm to search the electronic health record (EHR) for heart valve disease among patients treated by healthcare systems in the United States may provide a solution. METHODS A software interface allowed concurrent access to Picture Archiving Communication Systems (PACS), the electronic health record (EHR) and other sources. The software platform was created to programmatically run a rules engine to search structured and unstructured data for identification of moderate or severe heart valve disease using guideline reported values. Incidence and progression of disease as well as compliance with a care pathway were assessed. RESULTS 60,145 patients had 77,215 echocardiograms in two health institutions in the United States. Moderate or severe aortic stenosis (AS) was identified at a rate of 9.1% (5,474) of patients (6,910 echoes) in this population. The precision and accuracy of the algorithm for the detection of moderate or severe aortic stenosis was 92.9% and 98.6%, respectively. Thirty five percent (441/1,265) of patients with moderate stenosis and a subsequent echocardiogram progressed to severe (mean interval 358 days). In one sample, 70.3% of moderate AS patients lacked a 6-month echo or appointment. The platform enabled 100% accountability for all patients with severe aortic stenosis. CONCLUSIONS A rules-based software program enhances detection of heart valve disease and can be used to measures disease progression and care pathway compliance.
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Affiliation(s)
- Daniel P O'Hair
- Boulder Community Health, Boulder, CO; Mpirik, Milwaukee, WI.
| | | | | | | | | | | | | | - Navjot S Kohli
- Advocate Aurora Health, Milwaukee, WI; Mpirik, Milwaukee, WI
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Stasinopoulos J, Wood SJ, Bell JS, Manski-Nankervis JA, Hogan M, Sluggett JK. Potential Overtreatment and Undertreatment of Type 2 Diabetes Mellitus in Long-Term Care Facilities: A Systematic Review. J Am Med Dir Assoc 2021; 22:1889-1897.e5. [PMID: 34004183 DOI: 10.1016/j.jamda.2021.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the prevalence, outcomes, and factors associated with potential glycemic overtreatment and undertreatment of type 2 diabetes mellitus (T2DM) in long-term care facilities (LTCFs). DESIGN Systematic review. SETTING AND PARTICIPANTS Residents with T2DM and aged ≥60 years living in LTCFs. MEASURES Articles published between January 2000 and September 2020 were retrieved following a systematic search of MEDLINE, EMBASE, Cochrane Library, CINAHL plus, and gray literature. Inclusion criteria were the reporting of (1) potential overtreatment and undertreatment quantitatively defined (implicitly or explicitly) based on hemoglobin A1c (HbA1c) and/or blood glucose; (2) prevalence, outcomes, and associated factors of potential glycemic overtreatment and undertreatment; and (3) the study involved residents of LTCFs. RESULTS Fifteen studies were included. Prevalence of potential overtreatment (5%-86%, n = 15 studies) and undertreatment (1.4%-35%, n = 8 studies) varied widely among facilities and geographical locations, and according to definitions used. Prevalence of potential overtreatment was 16%-74% when defined as treatment with a glucose-lowering medication in a resident with ≥1 hypoglycemia risk factor or serious comorbidity, together with a HbA1c <7% (n = 10 studies). Potential undertreatment was commonly defined as residents on glucose-lowering medication having HbA1c >8.5% and the prevalence 1.4%-14.8% (n = 6 studies). No studies prospectively measured resident health outcomes from overtreatment and undertreatment. Potential overtreatment was positively associated with use of oral glucose-lowering medications, dementia diagnosis or dementia severity, and/or need for assistance with activities of daily living (n = 2 studies). Negative association was found between potential overtreatment and use of insulin/combined insulin and oral glucose-lowering medication. No studies reported factors associated with potential undertreatment. CONCLUSIONS AND IMPLICATIONS The prevalence of potential glycemic overtreatment and undertreatment varied widely among residents with T2DM depending on the definition(s) used in each study. Longitudinal studies examining associations between glycemic management and health outcomes, and the use of consensus definitions of overtreatment and undertreatment are required to establish findings about actual glycemic overtreatment and undertreatment in LTCFs.
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Affiliation(s)
- Jacquelina Stasinopoulos
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.
| | - Stephen J Wood
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jo-Anne Manski-Nankervis
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, VIC, Australia
| | | | - Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia; University of South Australia, UniSA Allied Health and Human Performance, Adelaide, SA, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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12
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Angerer S, Glätzle-Rützler D, Waibel C. Monitoring institutions in healthcare markets: Experimental evidence. Health Econ 2021; 30:951-971. [PMID: 33590574 DOI: 10.1002/hec.4232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 10/20/2020] [Accepted: 11/15/2020] [Indexed: 06/12/2023]
Abstract
This paper investigates the impact of monitoring institutions on market outcomes in health care. Healthcare markets are characterized by asymmetric information. Physicians have an information advantage over patients with respect to appropriate treatments, which they may exploit through over- or under-provision or by overcharging. We introduce two types of costly monitoring: endogenous and exogenous monitoring. When monitoring detects misbehavior, physicians have to pay a fine. Endogenous monitoring can be requested by patients, while exogenous monitoring is performed randomly by a third party. We present a toy model that enables us to derive hypotheses and test them in a laboratory experiment. Our results show that introducing endogenous monitoring reduces the level of undertreatment and overcharging. Even under high monitoring costs, the threat of patient monitoring is sufficient to discipline physicians. Exogenous monitoring also reduces undertreatment and overcharging when performed sufficiently frequently. Market efficiency increases when endogenous monitoring is introduced and when exogenous monitoring is implemented with sufficient frequency. Our results suggest that monitoring may be a feasible instrument to improve outcomes in healthcare markets.
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Affiliation(s)
- Silvia Angerer
- UMIT-University for Health Sciences, Medical Informatics and Technology, Institute for Management and Economics in Healthcare, Hall in Tirol, Austria
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13
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Wojszel ZB. Dementia Diagnoses and Treatment in Geriatric Ward Patients: A Cross-Sectional Study in Poland. Clin Interv Aging 2020; 15:2183-2194. [PMID: 33223824 PMCID: PMC7671484 DOI: 10.2147/cia.s281723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/17/2020] [Indexed: 02/01/2023] Open
Abstract
Purpose The study aimed to determine the prevalence of dementia, its types, and treatment in geriatric ward patients. Patients and Methods A cross-sectional study of 406 patients (77.8% women, median age 82, IQR (77-86) years) who underwent a comprehensive geriatric assessment in one of the Polish hospitals between September 2014 and April 2015 was conducted. Results Dementia was diagnosed in 132 (32.5%) patients (46% mixed dementia; 32% Alzheimer's disease; 10%vascular dementia; 5% dementia in Parkinson's disease; 4% frontotemporal; 3% atypical parkinsonism). A total of 95 (72%) dementia cases were not detected before, and in the above half of these patients, it was not mentioned in the referral document. Only 33.3% of dementia patients were on cognitive enhancers (donepezil, rivastigmine, or memantine); 36.4% received antipsychotics, 45.5% received anti-depressants, 25.8% received nootropics, and 16.7% received anxiolytics/hypnotics. Discussion The results confirmed the high incidence of underdiagnoses and undertreatment of dementia in patients admitted to the geriatric ward. It is partly due to the lack of systematic cognitive assessment in primary care settings, although other factors can play a role.
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Affiliation(s)
- Zyta Beata Wojszel
- Department of Geriatrics, Medical University of Bialystok, Bialystok, Poland.,Department of Geriatrics, Hospital of the Ministry of Interior in Bialystok, Bialystok, Poland
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14
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Schmid S, Suipyte J, Herrmann C, Mousavi M, Hitz F, Früh M. Does progress achieved in the treatment of patients with metastatic non-small-cell lung cancer reach the elderly population? A cohort study from a cancer centre from Eastern Switzerland. Eur J Cancer Care (Engl) 2020; 29:e13206. [PMID: 31965647 DOI: 10.1111/ecc.13206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 11/11/2019] [Accepted: 11/22/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Treatment options for non-small-cell lung cancer (NSCLC) have been evolving. The goal of our study was to evaluate whether novel therapeutics are used in the elderly population and improve outcomes to a similar extent as in young patients. METHODS We enrolled patients registered in the Cancer Registry of Eastern Switzerland and grouped them into four cohorts: Elderly patients aged ≥70 years diagnosed 2005-2007 and 2015-2016 (elderly cohorts 1,2) were compared to cohorts of patients < 70 years diagnosed during the same time periods (young cohorts 1,2). RESULTS 499 individuals were analysed. Median cancer-specific survival in the elderly cohorts 1 and 2 was 3.9 months and 6.3 months, respectively, and 8.0 and 12.7 months in the young cohorts 1 and 2. 12-month survival significantly improved over ten years only in younger patients (35.6% and 54.9%), however not in the elderly cohorts (20% vs. 35%). Proportion of patients receiving any line of systemic treatment remained lower in the elderly cohorts (53% vs. 78%). CONCLUSION Despite the increase in median cancer-specific survival in both cohorts, a significant and clinically meaningful improvement of 12-month cancer-specific survival was only seen in young patients. The adoption of novel treatment approaches is lagging behind in the elderly population.
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Affiliation(s)
- Sabine Schmid
- Department of Oncology/Haematology, Cantonal Hospital St. Gallen, St.Gallen, Switzerland
| | | | - Christian Herrmann
- Cancer Registry St. Gallen-Appenzell, Cancer League Eastern Switzerland, St. Gallen, Switzerland
| | - Mohsen Mousavi
- Cancer Registry St. Gallen-Appenzell, Cancer League Eastern Switzerland, St. Gallen, Switzerland
| | - Felicitas Hitz
- Department of Oncology/Haematology, Cantonal Hospital St. Gallen, St.Gallen, Switzerland.,University of Zürich, Zürich, Switzerland
| | - Martin Früh
- Department of Oncology/Haematology, Cantonal Hospital St. Gallen, St.Gallen, Switzerland.,University of Bern, St. Bern, Switzerland
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15
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de Man Y, Atsma F, Oosterveld-Vlug MG, Brom L, Onwuteaka-Philipsen BD, Westert GP, Groenewoud AS. The Intensity of Hospital Care Utilization by Dutch Patients With Lung or Colorectal Cancer in their Final Months of Life. Cancer Control 2019; 26:1073274819846574. [PMID: 31159571 PMCID: PMC6552371 DOI: 10.1177/1073274819846574] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Understanding the overuse and underuse of health-care services in the end-of-life (EoL) phase for patients with lung cancer (LC) and colorectal cancer (CRC) is important, but knowledge is limited. To help identify inappropriate care, we present the health-care utilization profiles for hospital care at the EoL of patients with LC (N = 25 553) and CRC (N = 14 911) in the Netherlands between 2013 and 2015. An administrative database containing all in-hospital health-care activities was analyzed to investigate the association between the number of days patients spent in the emergency department (ED) or intensive care unit (ICU) and their exposure to chemotherapy or radiotherapy. Fewer patients received hospital care as death neared, but their intensity of care increased. In the last month of life, the average numbers of hospital bed days, ICU days, and ER contacts were 9.0, 5.5, and 1.2 for patients with CRC, and 8.9, 6.2 and 1.2 for patients with LC in 2015. On the other hand, the occurrence of palliative consultations ranged from 1% to 4%. Patients receiving chemotherapy 6 months before death spent fewer days in ICU than those who did not receive this treatment (odds ratios: CRC = 0.6 [95% confidence interval: 0.4-0.8] and LC = 0.7 [0.5-0.9]), while those receiving chemotherapy 1 month before death had more ED visits (odds ratios: CRC = 17.2 [11.8-25.0] and LC = 15.8 [12.0-20.9]). Our results showed that patients who were still receiving hospital care when death was near had a high intensity of care, yet palliative consultations were low. Receiving chemotherapy or radiotherapy in the final month of life was significantly associated with more ED and ICU contacts in patients with LC.
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Affiliation(s)
- Yvonne de Man
- 1 Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, the Netherlands
| | - Femke Atsma
- 1 Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, the Netherlands
| | - Mariska G Oosterveld-Vlug
- 2 Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliatie Care, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Linda Brom
- 3 IKNL, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Bregje D Onwuteaka-Philipsen
- 2 Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliatie Care, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Gert P Westert
- 1 Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, the Netherlands
| | - A Stef Groenewoud
- 1 Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, the Netherlands
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Abstract
Heart failure (HF) has emerged as a global epidemic and it affects about 6 million adults in the US. HF medical treatment, as recommended in guidelines, significantly improves survival and quality of life; however, the mortality burden of HF remains high. For decades, treatment has been guided, mainly by symptoms, leading to undertreatment in a range of settings. Current evidence emphasises the unfavourable outcomes of HF even in early stages or in patients who achieve reverse remodeling and remission or recovery under optimised treatment. This should stimulate efforts towards a more objective, rigorous management, covering the entire spectrum of mild, moderate and severe HF.
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Affiliation(s)
| | | | - Javed Butler
- University of Mississippi Medical Center, Jackson MS, US
| | - Robert C Long
- University of Mississippi Medical Center, Jackson MS, US
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17
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van den Beuken-van Everdingen MHJ, van Kuijk SMJ, Janssen DJA, Joosten EAJ. Treatment of Pain in Cancer: Towards Personalised Medicine. Cancers (Basel) 2018; 10:E502. [PMID: 30544683 DOI: 10.3390/cancers10120502] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/03/2018] [Accepted: 12/07/2018] [Indexed: 01/23/2023] Open
Abstract
Despite increased attention to cancer pain, pain prevalence in patients with cancer has not improved over the last decade and one third of cancer patients on anticancer therapy and half of patients with advanced disease still suffer from moderate to severe pain. In this review, we explore the possible reasons for the ongoing high prevalence of cancer pain and discuss possible future directions for improvement in personalised pain management. Among possible reasons for the lack of improvement are: Barriers for patients to discuss pain with clinicians spontaneously; pain measurement instruments are not routinely used in daily practice; limited knowledge concerning the assessment of undertreatment; changes in patients’ characteristics, including the ageing of the population; lack of significant improvement in the treatment of neuropathic pain; limitations of pharmacological treatment and lack of evidence-based nonpharmacological treatment strategies. In order to improve cancer pain treatment, we recommend: (1) Physicians proactively ask about pain and measure pain using assessment instruments; (2) the development of an optimal tool measuring undertreatment; (3) educational interventions to improve health care workers’ skills in pain management; (4) the development of more effective and personalised pharmacological and nonpharmacological pain treatment.
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18
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Jonsson A, Norberg H, Bergdahl E, Lindmark K. Obstacles to mineralocorticoid receptor antagonists in a community-based heart failure population. Cardiovasc Ther 2018; 36:e12459. [PMID: 30019390 PMCID: PMC6175311 DOI: 10.1111/1755-5922.12459] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/20/2018] [Accepted: 07/13/2018] [Indexed: 12/11/2022] Open
Abstract
AIM Previous studies and national assessments indicate an undertreatment of mineralocorticoid receptor antagonists (MRA) in heart failure with reduced ejection fraction (HFrEF). This study aimed to investigate why MRA is not used to full extent. METHODS A complete community-based heart failure population was studied. Several variables were collected, and medical records were scrutinized to identify reasons for not prescribing MRA. RESULTS Of 2029 patients, 812 had EF ≤40%. Five hundred and fifty-three patients (68%) tried MRA at some point but 184 of these (33%) discontinued therapy. There were 259 patients that never tried MRA with 177 with a listed explanation or contraindication. Eighty-two patients, 10% of the total HFrEF population, had no clear contraindications. They were older and had less HF hospitalizations compared to patients on MRA (P < 0.05) and 32% did not have any follow-up at the cardiology clinic. Contraindications to MRA were renal dysfunction (93 patients), hypotension (28 patients), and hyperkalemia (25 patients). Only six patients had hyperkalemia without renal dysfunction. Of the patients with renal dysfunction, 66 (72%) had eGFR >30 mL/min. CONCLUSIONS The reasons why MRA are underutilized were mainly because of contraindications. However, the data suggest that physicians are overly cautious about moderately reduced kidney function. There seems to be a 10%-18% avoidable undertreatment with MRA, especially for elderly patients that are admitted to the hospital for other reasons than heart failure. This suggests that patients with heart failure would benefit from routine follow-up at a cardiology clinic.
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Affiliation(s)
- Anna Jonsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Helena Norberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Ellinor Bergdahl
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Krister Lindmark
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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19
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Djulbegovic B, Elqayam S, Dale W. Rational decision making in medicine: Implications for overuse and underuse. J Eval Clin Pract 2018; 24:655-665. [PMID: 29194876 PMCID: PMC6001794 DOI: 10.1111/jep.12851] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/19/2017] [Accepted: 10/24/2017] [Indexed: 12/21/2022]
Abstract
In spite of substantial spending and resource utilization, today's health care remains characterized by poor outcomes, largely due to overuse (overtesting/overtreatment) or underuse (undertesting/undertreatment) of health services. To a significant extent, this is a consequence of low-quality decision making that appears to violate various rationality criteria. Such suboptimal decision making is considered a leading cause of death and is responsible for more than 80% of health expenses. In this paper, we address the issue of overuse or underuse of health care interventions from the perspective of rational choice theory. We show that what is considered rational under one decision theory may not be considered rational under a different theory. We posit that the questions and concerns regarding both underuse and overuse have to be addressed within a specific theoretical framework. The applicable rationality criterion, and thus the "appropriateness" of health care delivery choices, depends on theory selection that is appropriate to specific clinical situations. We provide a number of illustrations showing how the choice of theoretical framework influences both our policy and individual decision making. We also highlight the practical implications of our analysis for the current efforts to measure the quality of care and link such measurements to the financing of health care services.
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Affiliation(s)
- Benjamin Djulbegovic
- Department of Supportive Care MedicineCity of HopeDuarteCaliforniaUSA
- Department of HematologyCity of Hope, DuarteCaliforniaUSA
| | - Shira Elqayam
- School of Applied Social Sciences, Division of PsychologyDe Montfort UniversityLeicesterUK
| | - William Dale
- Department of Supportive Care MedicineCity of HopeDuarteCaliforniaUSA
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20
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García CA, Santos Garcia JB, Rosario Berenguel Cook MD, Colimon F, Flores Cantisani JA, Guerrero C, Rocío Guillén Núnez MD, Hernández Castro JJ, Kraychete DC, Lara-Solares A, Lech O, Rico Pazos MA, Gallegos MS, Marcondes LP. Undertreatment of pain and low use of opioids in Latin America. Pain Manag 2018; 8:181-196. [PMID: 29774774 DOI: 10.2217/pmt-2017-0043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Pain is highly prevalent among the adult Latin American population. However, many patients with moderate to severe pain do not have access to effective pain management with opioids due to limited access to healthcare, overuse of nonopioid analgesics, regulatory barriers and lack of appropriate information about opioids. There is scarce training on use of opioids among physicians and other healthcare providers, which leads to misconceptions, mainly related to a fear of prescribing opioids. Although opioids are safe and effective drugs for the treatment of moderate to severe chronic pain, the use of opioids in Latin American nations is clearly below standards compared with developed countries.
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Affiliation(s)
| | | | | | - Frantz Colimon
- Centro Oncológico de Antioquia, Medellín, Antioquia, Colombia
| | | | - Carlos Guerrero
- Hospital Universitario Fundación Santa Fe, Bogotá. Universidad de los Andes, Colombia
| | | | | | - Durval Campos Kraychete
- Federal University of Bahia, Coordinator of the Pain Outpatient Clinic, Brazilian Society for the Study of Pain, Brazil
| | - Argelia Lara-Solares
- Department of Pain Medicine & Palliative Care, Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán', Mexico City, Mexico
| | - Osvandré Lech
- Orthopaedic Residency Program, UFFS-HSVP-IOT, Passo Fundo, Brazil
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21
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Ahmadizar F, Souverein P, de Boer A, Maitland‐van der Zee AH. Undertreatment of hypertension and hypercholesterolaemia in children and adolescents with type 1 diabetes: long-term follow-up on time trends in the occurrence of cardiovascular disease, risk factors and medications use. Br J Clin Pharmacol 2018; 84:776-785. [PMID: 29218780 PMCID: PMC5867118 DOI: 10.1111/bcp.13482] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 11/06/2017] [Accepted: 11/26/2017] [Indexed: 12/13/2022] Open
Abstract
AIMS The aims of the present study were, firstly, to evaluate long-term trends in the occurrence and treatment of cardiovascular disease (CVD) risk factors and the occurrence of CVD events in children with type 1 diabetes mellitus (T1DM) and, secondly, to assess the determinants of undertreatment of CVD risk factors. METHODS A retrospective cohort study was conducted in 3728 children (<19 years of age) with T1DM and up to 5 age- and gender-matched diabetes-free children (reference cohort) (n = 18 513) using data from the Clinical Practice Research Datalink (CPRD). RESULTS Compared with diabetes-free subjects, children with T1DM had significantly higher annual prevalence rates of CVD risk factors and cardiovascular (CV) medication use 20 years after the onset of diabetes (index date): hypertension: 35.2% vs. 11.4%, P < 0.001; hypercholesterolaemia: 66.7% vs. 7.14%, P < 0.001; and CV medication use: 37.0% vs. 3.6%, P < 0.001. The significant differences between prevalence rates in the two cohorts started from 1 year before the index date. Furthermore, 50% of the children in the T1DM cohort with hypertension and 53% with hypercholesterolaemia remained untreated with CV drugs for a period of 2-5 years during the 20-year follow-up. Age was the only determinant associated with undertreated hypertension in the T1DM cohort. CONCLUSIONS Children with T1DM had substantially higher prevalence rates of hypertension and hypercholesterolaemia from 1 year before up to 20 years after the onset of diabetes compared with nondiabetics. There is a substantial undertreatment of CVD risk factors with CV drugs. In children with T1DM, screening for CVD risk factors and adequate treatment are of the utmost importance to prevent CVD later in life.
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Affiliation(s)
- Fariba Ahmadizar
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Patrick Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Anke H. Maitland‐van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
- Department of Respiratory Medicine, Academic Medical CentreUniversity of AmsterdamAmsterdamThe Netherlands
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22
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Abstract
Neonatal tumors are rare with no standard treatment approaches to these diseases, and the patients experience poor outcomes. Our aim was to determine the distribution of cancers affecting neonates and compare survival between these cancers and older children. We analyzed SEER data (1973–2007) from patients who were younger than 2 years at diagnosis of malignancy. Special permission was granted to access the detailed (i.e., age in months) data of those patients. The Chi‐square Log‐rank test was used to compare survival between neonates (aged <1 month) and older children (>1 month to <2 years). We identified 615 neonatal cancers (454 solid tumors, 93 leukemia/lymphoma, and 68 CNS neoplasms). Neuroblastoma was the most common neonatal tumor followed by Germ cell tumors. The 5‐year overall survival (OS) for all neonates was 60.3% (95% CI, 56.2–64.4). Neonates with solid tumors had the highest 5‐year OS (71.2%; 95% CI, 66.9–75.5), followed by those with leukemia (39.1%; 95% CI, 28.3–49.9) or CNS tumors (15%; 95% CI, 5.4–24.6). Except for neuroblastoma, all neonatal tumors showed inferior outcomes compared to that in the older group. The proportion of neonates who died from causes other than cancer was significantly higher than that of the older children (37.9% vs. 16.4%; P < 0.0005). In general, the outcome of neonatal cancers has not improved over the last 34 years. The distribution of neonatal cancer is different than other pediatric age groups. Although the progress in neonatal and cancer care over the last 30 years, only death from noncancer causes showed improvement. Studying neonatal tumors as part of national studies is essential to understand their etiology, determine the best treatment approaches, and improve survival and quality of life for those patients.
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Affiliation(s)
- Ahmad S Alfaar
- Ophthalmology Department, Charité - Universitätsmedizin Berlin (Charité - Berlin Medical University), Berlin, Germany
| | - Waleed M Hassan
- Research Department, Children's Cancer Hospital Egypt, Cairo, 57357, Egypt
| | | | - Ibrahim Qaddoumi
- Departments of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,International Outreach Program, St. Jude Children's Research Hospital, Memphis, Tennessee
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Crowell KT, Julian KG, Katzman M, Berg AS, Tinsley A, Williams ED, Koltun WA, Messaris E. Compliance with Clostridium difficile treatment guidelines: effect on patient outcomes. Epidemiol Infect 2017; 145:2185-92. [PMID: 28578710 DOI: 10.1017/S0950268817000644] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Guidelines for the severity classification and treatment of Clostridium difficile infection (CDI) were published by Infectious Diseases Society of America (IDSA)/Society for Healthcare Epidemiology of America (SHEA) in 2010; however, compliance and efficacy of these guidelines has not been widely investigated. This present study assessed compliance with guidelines and its effect on CDI patient outcomes as compared with before these recommendations. A retrospective study included all adult inpatients with an initial episode of CDI treated in a single academic center from January 2009 to August 2014. Patients after guideline publication were compared with patients treated in 2009-2010. Demographic, clinical, and laboratory data were collected to stratify for disease severity. Outcome measures included compliance with guidelines, mortality, length of stay (LOS), and surgical intervention for CDI. A total of 1021 patients with CDI were included. Based upon the 2010 guidelines, 42 (28·8%) of 146 patients treated in 2009 would have been considered undertreated, and treatment progressively improved over time, as inadequate treatment decreased to 10·0% (15/148 patients) in 2014 (P = 0·0005). Overall, patient outcomes with guideline-adherent treatment decreased CDI attributable mortality twofold (P = 0·006) and CDI-related LOS by 1·9 days (P = 0·0009) when compared with undertreated patients. Compliance with IDSA/SHEA guidelines was associated with a decreased risk of mortality and LOS in hospitalized patients with CDI.
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Başaran Ö, Dogan V, Beton O, Tekinalp M, Aykan AC, Kalaycioğlu E, Bolat I, Taşar O, Şafak Ö, Kalcik M, Yaman M, İnci S, Altintaş B, Kalkan S, Kirma C, Biteker M. Suboptimal use of non-vitamin K antagonist oral anticoagulants: Results from the RAMSES study. Medicine (Baltimore) 2016; 95:e4672. [PMID: 27583892 PMCID: PMC5008576 DOI: 10.1097/md.0000000000004672] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 07/19/2016] [Accepted: 07/31/2016] [Indexed: 02/05/2023] Open
Abstract
This study aimed to investigate the potential misuse of novel oral anticoagulants (NOACs) and the physicians' adherence to current European guideline recommendations in real-world using a large dataset from Real-life Multicenter Survey Evaluating Stroke Prevention Strategies in Turkey (RAMSES Study).RAMSES study is a prospective, multicenter, nationwide registry (ClinicalTrials.gov identifier NCT02344901). In this subgroup analysis of RAMSES study, patients who were on NOACs were classified as appropriately treated (AT), undertreated (UT), and overtreated (OT) according to the European Society of Cardiology (ESC) guidelines. The independent predictors of UT and OT were determined by multivariate logistic regression.Of the 2086 eligible patients, 1247 (59.8%) received adequate treatment. However, off-label use was detected in 839 (40.2%) patients; 634 (30.4%) patients received UT and 205 (9.8%) received OT. Independent predictors of UT included >65 years of age, creatinine clearance ≥50 mL/min, urban living, existing dabigatran treatment, and HAS-BLED score of <3, whereas that of OT were creatinine clearance <50 mL/min, ongoing rivaroxaban treatment, and HAS-BLED score of ≥3.The suboptimal use of NOACs is common because of physicians' poor compliance to the guideline recommendations in patients with nonvalvular atrial fibrillation (NVAF). Older patients who were on dabigatran treatment with good renal functions and low risk of bleeding were at risk of UT, whereas patients who were on rivaroxaban treatment with renal impairment and high risk of bleeding were at risk of OT. Therefore, a greater emphasis should be given to prescribe the recommended dose for the specified patients.
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Affiliation(s)
- Özcan Başaran
- Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla
| | - Volkan Dogan
- Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla
| | - Osman Beton
- Department of Cardiology, Faculty of Medicine, Sivas Cumhuriyet University, Sivas
| | - Mehmet Tekinalp
- Department of Cardiology, Kahramanmaraş Necip Fazıl State Hospital, Kahramanmaraş
| | - Ahmet Cağri Aykan
- Department of Cardiology,Trabzon Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon
| | - Ezgi Kalaycioğlu
- Department of Cardiology,Trabzon Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon
| | - Ismail Bolat
- Department of Cardiology,Fethiye State Hospital, Fethiye
| | - Onur Taşar
- Department of Cardiology, Elazığ Education and Research Hospital, Elazığ
| | - Özgen Şafak
- Department of Cardiology, Burdur State Hospital, Burdur
| | - Macit Kalcik
- Department of Cardiology, İskilip Atıf Hoca State Hospital, Corum
| | - Mehmet Yaman
- Department of Cardiology, Samsun Education and Research Hospital, Samsun
| | - Sinan İnci
- Department of Cardiology, Aksaray State Hospital, Aksaray
| | - Bernas Altintaş
- Department of Cardiology, Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır
| | - Sedat Kalkan
- Department of Cardiology, Gönen State Hospital, Gönen
| | - Cevat Kirma
- Kartal Kosuyolu Heart Education and Research Hospital, Kartal, Istanbul, Turkey
| | - Murat Biteker
- Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla
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Spinozzi F, Murgia N, Baldacci S, Maio S, Pala AP, Casciari C, dell'Omo M, Viegi G. Characteristics and predictors of allergic rhinitis undertreatment in primary care. Int J Immunopathol Pharmacol 2015; 29:129-36. [PMID: 26680255 DOI: 10.1177/0394632015595779] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 06/17/2015] [Indexed: 01/11/2023] Open
Abstract
Although allergic rhinitis is considered a raising medical problem in many countries it is often undertreated. The reasons for this phenomenon are not completely clear.The aim of this study is to evaluate factors associated with allergic rhinitis under-/no treatment.A sample of 518 allergic rhinitis patients recruited by their primary care physicians, as a part of the ARGA study, were invited to fill in a specific questionnaire regarding rhinitis symptoms, treatment, and rhinitis-related work/social disability. Chi-square test and logistic regression were performed to assess risk factors for allergic rhinitis under-/no treatment.Over one out of four patients had no treatment despite the symptoms and 13.5% were inadequately treated. Participants with asthma (OR 0.47, 95% CI 0.30-0.75) and conjunctivitis (0.44, 95% CI 0.27-0.71) were at lower risk of allergic rhinitis under-/no treatment: in asthmatics this reduction was related mainly to the concomitant asthma treatment (OR 0.19, 95% CI 0.10-0.37).Asthmatics with under-/not treated rhinitis had the highest prevalence of rhinitis-related quality of life impairment.Under-/no treatment for allergic rhinitis is still rather frequent despite the relevance of this disease. The simultaneous presence of asthma and an anti-asthmatic therapy are able to influence positively the treatment. Targeted interventions toward a better characterization and a tight follow-up of rhinitis patient without asthma are needed.
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Affiliation(s)
- F Spinozzi
- Laboratory of Experimental Immunology and Allergy, Department of Medicine, University of Perugia, Piazzale Gambuli, 06100 Perugia, Italy
| | - N Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Piazzale Gambuli, 06100 Perugia, Italy
| | - S Baldacci
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Via Trieste 41, 56126 Pisa, Italy
| | - S Maio
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Via Trieste 41, 56126 Pisa, Italy
| | - A P Pala
- Technosciences Unit, CNR Institute of Clinical Physiology, Via Trieste 41, 56126 Pisa, Italy
| | - C Casciari
- Laboratory of Experimental Immunology and Allergy, Department of Medicine, University of Perugia, Piazzale Gambuli, 06100 Perugia, Italy
| | - M dell'Omo
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Piazzale Gambuli, 06100 Perugia, Italy
| | - G Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Via Trieste 41, 56126 Pisa, Italy CNR Institute of Biomedicine and Molecular Immunology "A. Monroy", Via Ugo La Malfa 153, 90146 Palermo, Italy
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Nagata T, Suzuki F, Teo AR. Generalized social anxiety disorder: A still-neglected anxiety disorder 3 decades since Liebowitz's review. Psychiatry Clin Neurosci 2015; 69:724-40. [PMID: 26121185 DOI: 10.1111/pcn.12327] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2015] [Indexed: 11/26/2022]
Abstract
In the 3 decades since Liebowitz's review of 'a neglected anxiety disorder,' controversy and challenges have remained in the study of social anxiety disorder (SAD). This review examines evidence around the classification and subtyping of SAD, focusing on generalized SAD. Substantial discrepancies and variation in definition, epidemiology, assessment, and treatment of generalized SAD exist as the international literature on it has grown. In East Asian cultures in particular, study of taijin kyofusho has been important to a broadened conceptualization of SAD into generalized SAD. Despite important progress with biological and other studies, many challenges in the understanding of generalized SAD will remain in the years to come.
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Affiliation(s)
| | - Futoshi Suzuki
- Department of Child and Adolescent Psychiatry, Nagoya University Hospital, Aichi, Japan
| | - Alan R Teo
- VA Portland Health Care System and Oregon Health & Science University, Oregon, USA
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Batstra L, Nieweg EH, Hadders-Algra M. Exploring five common assumptions on Attention Deficit Hyperactivity Disorder. Acta Paediatr 2014; 103:696-700. [PMID: 24661108 DOI: 10.1111/apa.12642] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 02/20/2014] [Accepted: 03/20/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED The number of children diagnosed with attention deficit hyperactivity disorder (ADHD) and treated with medication is steadily increasing. The aim of this paper was to critically discuss five debatable assumptions on ADHD that may explain these trends to some extent. These are that ADHD (i) causes deviant behaviour, (ii) is a disease, (iii) is chronic and (iv) is best treated by medication and (v) that classification should precede treatment. CONCLUSION We argue that ADHD is not a disease, not the cause of deviant behaviour and in most cases not chronic. Treatment for attention and hyperactivity problems could start with psychosocial interventions and without a diagnostic label. A stepped diagnosis approach may reduce overdiagnosis without risking undertreatment.
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Affiliation(s)
- Laura Batstra
- Department of Special Needs Education and Child Care; University of Groningen; Groningen the Netherlands
| | - Edo H. Nieweg
- Jonx Department of Child and Adolescent Mental Health; Lentis Psychiatric Institute; Groningen the Netherlands
| | - Mijna Hadders-Algra
- Department of Paediatrics - Developmental Neurology; University of Groningen; University Medical Center Groningen; Groningen the Netherlands
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Abstract
The British Menopause Society Council aims to aid health professionals in providing up to date and informed advice about post reproductive health. This guidance refers to the long-term, but often ignored condition of urogenital atrophy resulting from postmenopausal estrogen deficiency. Treatment should be based on up to date information and targeted to the needs of the individual woman. Non-estrogen- and estrogen-containing treatments are discussed.
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Affiliation(s)
- David Sturdee
- Department of Gynaecology, Solihull Hospital, Solihull, UK
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Lipworth L, Fazio S, Kabagambe EK, Munro HM, Nwazue VC, Tarone RE, McLaughlin JK, Blot WJ, Sampson UK. A prospective study of statin use and mortality among 67,385 blacks and whites in the Southeastern United States. Clin Epidemiol 2013; 6:15-25. [PMID: 24379700 PMCID: PMC3872085 DOI: 10.2147/clep.s53492] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose The primary objective of this study is to examine the race-specific associations between statin use and overall mortality, as well as cardiovascular and cancer mortality, among blacks and whites in the Southeastern United States (US). Little is known about these associations in blacks. Patients and methods The Southern Community Cohort Study is an ongoing, prospective cohort study, which enrolled from 2002 through 2009 nearly 86,000 participants aged 40–79 years. We used Cox regression models to estimate race-specific hazard ratios (HRs) and 95% confidence intervals (CI) for overall and cause-specific mortality associated with statin use based on self-reported hypercholesterolemia and treatment at cohort entry. Mean age at cohort entry was 51.4 years in blacks (n=48,825) and 53.5 years in whites (n=18,560). Sixty-one percent of participants were women. Whites were more likely to have self-reported hypercholesterolemia (40% versus 27%, P<0.001), and to report being treated with either statins (52% versus 47%, P<0.001) or combination lipid therapy (9% versus 4%, P<0.001) compared with blacks, regardless of sex. During follow-up (median: 5.6 years) 5,199 participants died. Compared with untreated hypercholesterolemic individuals, statin use was associated with reduced all-cause mortality (adjusted HR [aHR] 0.86; 95% CI 0.77–0.95) and cardiovascular disease mortality overall (aHR 0.75; 95% CI 0.64–0.89) and among whites (aHR 0.67; 95% CI 0.50–0.90), blacks (aHR, 0.80; 95% CI 0.65–0.98), men (aHR 0.70; 95% CI 0.55–0.90), and women (aHR 0.79; 95% CI 0.63–0.99) (P>0.05 for race and sex interaction). Statin use was not associated with cancer mortality overall or in subgroup analyses. Conclusion Regardless of race or sex, self-reported statin use was linked to reduced all-cause and cardiovascular disease mortality. However, factors contributing to the modestly lower statin use and markedly lower prevalence of self-reported hypercholesterolemia among blacks remain to be determined.
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Affiliation(s)
- Loren Lipworth
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sergio Fazio
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA ; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edmond K Kabagambe
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Victor C Nwazue
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - William J Blot
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA ; International Epidemiology Institute, Rockville, MD, USA
| | - Uchechukwu Ka Sampson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA ; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA ; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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Grønhøj Larsen C, Gyldenløve M, Linneberg A. Allergic rhinitis is often undiagnosed and untreated: results from a general population study of Danish adults. Clin Respir J 2013; 7:354-8. [PMID: 23362970 DOI: 10.1111/crj.12015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 12/06/2012] [Accepted: 12/16/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A few earlier studies have indicated that allergic rhinitis (AR) is underdiagnosed and undertreated. OBJECTIVE To assess awareness, diagnosis and treatment of AR in a general population of Danish adults. METHODS Between October 2007 and June 2008, a total of 1277 consecutive participants in a Danish general population study of 18- to 69-year olds were skin-prick-tested and asked about respiratory symptoms. AR was defined as a combination of self-reported rhinitis symptoms and skin-prick test reactivity against inhalant allergens. Participants reporting rhinitis symptoms completed an additional questionnaire on medication for rhinitis symptoms. RESULTS The prevalence of AR was 23.1%. A total of 43.6% (n = 122/280) of persons with AR had not received any treatment in the previous 12 months, and only 56.6% (n = 163/288) had been given a diagnosis of hay fever by a doctor. Both AR and lower airway symptoms indicating more severe AR were reported in 48.5% (n = 143/295). These persons were significantly more likely to having received treatment in previous 12 months and a diagnosis of hay fever. CONCLUSION Our results support that even in an affluent country like Denmark, AR is often undiagnosed and untreated. There appears to be a need for increased awareness of AR with regard to both diagnosis and treatment.
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Affiliation(s)
- Christian Grønhøj Larsen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital of Rigshospitalet, Copenhagen, Denmark
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