1
|
Liu Z, Sun X, Guo ZN, Sun Y, Yang Y, Yan X. Effects of a Planned Web-Based Educational Intervention Based on the Health Belief Model for Patients With Ischemic Stroke in Promoting Secondary Prevention During the COVID-19 Lockdown in China: Quasi-Experimental Study. JMIR Mhealth Uhealth 2024; 12:e44463. [PMID: 38659156 DOI: 10.2196/44463] [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] [Received: 11/20/2022] [Revised: 01/29/2024] [Accepted: 02/26/2024] [Indexed: 04/26/2024] Open
Abstract
Background Some common modified vascular risk factors remain poorly controlled among stroke survivors, and educational programs may help improve these conditions. Objective This study aimed to evaluate the effect of a planned web-based educational intervention based on the health belief model (HBM) in promoting secondary prevention among patients with ischemic stroke. Methods An evaluation-blinded quasi-experimental trial with a historical control group was conducted. Patients admitted from March to June 2020 were assigned to the historical control group, and patients admitted from July to October 2020 were assigned to the intervention group. The control group received routine health management. The intervention group received 6 additional sessions based on the HBM via Tencent Meeting, an audio and video conferencing application, within 3 months after discharge. Sessions were held every 2 weeks, with each session lasting approximately 40 minutes. These sessions were conducted in small groups, with about 8 to 10 people in each group. The primary outcomes were changes in blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), hemoglobin A1c (HbA1c), and the proportion of patients achieving the treatment target. The secondary outcomes were medication adherence, assessed with the Morisky Medicine Adherence Scale (MMAS), and disability, assessed with the modified Rankin scale. Results In total, 315 patients experiencing their first-ever stroke were analyzed. More patients in the intervention group had controlled BP (41.9% vs 28.4%; adjusted odds ratio [aOR] 1.93; P=.01), LDL-C (83.1% vs 67.7%; aOR 2.66; P=.001), and HbA1c (91.9% vs 83.9%; aOR: 3.37; P=.04) levels as well as a significant postintervention decrease in the systolic BP (adjusted β -3.94; P=.02), LDL-C (adjusted β -0.21; P=.008), and HbA1c (adjusted β -0.27; P<.001), compared with control groups. Significant between-group differences were observed in medication adherence (79.4% vs 63.2%; aOR 2.31; P=.002) but not in favorable functional outcomes. Conclusions A web-based education program based on the HBM may be more effective than current methods used to educate patients having strokes on optimal vascular risk factors and medication adherence.
Collapse
Affiliation(s)
- Zhuo Liu
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xin Sun
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Zhen-Ni Guo
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
- Neuroscience Research Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Ye Sun
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yi Yang
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xiuli Yan
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| |
Collapse
|
2
|
Yoo SGK, Chung GS, Bahendeka SK, Sibai AM, Damasceno A, Farzadfar F, Rohloff P, Houehanou C, Norov B, Karki KB, Azangou-Khyavy M, Marcus ME, Aryal KK, Brant LCC, Theilmann M, Cífková R, Lunet N, Gurung MS, Mwangi JK, Martins J, Haghshenas R, Sturua L, Vollmer S, Bärnighausen T, Atun R, Sussman JB, Singh K, Saeedi Moghaddam S, Guwatudde D, Geldsetzer P, Manne-Goehler J, Huffman MD, Davies JI, Flood D. Aspirin for Secondary Prevention of Cardiovascular Disease in 51 Low-, Middle-, and High-Income Countries. JAMA 2023; 330:715-724. [PMID: 37606674 PMCID: PMC10445202 DOI: 10.1001/jama.2023.12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/26/2023] [Indexed: 08/23/2023]
Abstract
Importance Aspirin is an effective and low-cost option for reducing atherosclerotic cardiovascular disease (CVD) events and improving mortality rates among individuals with established CVD. To guide efforts to mitigate the global CVD burden, there is a need to understand current levels of aspirin use for secondary prevention of CVD. Objective To report and evaluate aspirin use for secondary prevention of CVD across low-, middle-, and high-income countries. Design, Setting, and Participants Cross-sectional analysis using pooled, individual participant data from nationally representative health surveys conducted between 2013 and 2020 in 51 low-, middle-, and high-income countries. Included surveys contained data on self-reported history of CVD and aspirin use. The sample of participants included nonpregnant adults aged 40 to 69 years. Exposures Countries' per capita income levels and world region; individuals' socioeconomic demographics. Main Outcomes and Measures Self-reported use of aspirin for secondary prevention of CVD. Results The overall pooled sample included 124 505 individuals. The median age was 52 (IQR, 45-59) years, and 50.5% (95% CI, 49.9%-51.1%) were women. A total of 10 589 individuals had a self-reported history of CVD (8.1% [95% CI, 7.6%-8.6%]). Among individuals with a history of CVD, aspirin use for secondary prevention in the overall pooled sample was 40.3% (95% CI, 37.6%-43.0%). By income group, estimates were 16.6% (95% CI, 12.4%-21.9%) in low-income countries, 24.5% (95% CI, 20.8%-28.6%) in lower-middle-income countries, 51.1% (95% CI, 48.2%-54.0%) in upper-middle-income countries, and 65.0% (95% CI, 59.1%-70.4%) in high-income countries. Conclusion and Relevance Worldwide, aspirin is underused in secondary prevention, particularly in low-income countries. National health policies and health systems must develop, implement, and evaluate strategies to promote aspirin therapy.
Collapse
Affiliation(s)
- Sang Gune K. Yoo
- Cardiovascular Division, Department of Internal Medicine, Washington University in St Louis, St Louis, Missouri
| | - Grace S. Chung
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Silver K. Bahendeka
- Department of Internal Medicine, MKPGMS Uganda Martyrs University, Kampala, Uganda
- St Francis Hospital, Nsambya, Kampala, Uganda
| | - Abla M. Sibai
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Nucleo de Investigaçao, Departamento de Medicina, Hospital Central do Maputo, Maputo, Mozambique
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Peter Rohloff
- Center for Indigenous Health Research, Wuqu’ Kawoq, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Corine Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Bolormaa Norov
- Nutrition Department, National Center for Public Health, Ulaanbaatar, Mongolia
| | - Khem B. Karki
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Mohammadreza Azangou-Khyavy
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maja E. Marcus
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Krishna K. Aryal
- Bergen Centre for Ethics and Priority Setting in Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Public Health Promotion and Development Organization, Kathmandu, Nepal
| | - Luisa C. C. Brant
- Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Michaela Theilmann
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Renata Cífková
- Center for Cardiovascular Prevention, First Faculty of Medicine, and Thomayer University Hospital, Charles University in Prague, Prague, Czechia
- Department of Medicine II, First Faculty of Medicine, Charles University in Prague, Prague, Czechia
| | - Nuno Lunet
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Mongal S. Gurung
- Health Research and Epidemiology Unit, Ministry of Health, Thimphu, Bhutan
| | - Joseph Kibachio Mwangi
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
- Faculty of Medicine, The Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Joao Martins
- Faculty of Medicine and Health Sciences, National University of East Timor, Dili, Timor-Leste
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Lela Sturua
- Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
- Public Health Department, Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | - Sebastian Vollmer
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts
- Africa Health Research Institute, Somkhele and Durban, South Africa
| | - Rifat Atun
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Jeremy B. Sussman
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Kavita Singh
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Centre for Chronic Disease Control, New Delhi, India
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Stanford University, Stanford, California
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark D. Huffman
- Department of Medicine and Global Health Center, Washington University in St Louis, St Louis, Missouri
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Justine I. Davies
- Institute for Applied Health Research, University of Birmingham, Birmingham, England
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - David Flood
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Center for Indigenous Health Research, Wuqu’ Kawoq, Tecpán, Guatemala
- INCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| |
Collapse
|
3
|
Yu Z, Shen M, Shang W, Wu J, Xuan L. Timing of Acupuncture Treatment in Peripheral Facial Paralysis: A Systematic Review and Meta-Analysis. Comput Math Methods Med 2021; 2021:4221955. [PMID: 34956397 PMCID: PMC8694981 DOI: 10.1155/2021/4221955] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Investigate the optimum time of acupuncture treatment in peripheral facial paralysis in order to provide evidence for clinical treatment. METHODS CNKI, Wanfang, PubMed, Cochrane Library, and EMBASE databases were systematically searched from the inception dates to February 20, 2020. Studies limited to participants with acute peripheral facial paralysis treated with acupuncture and patients without information of the stage were excluded. The primary outcomes were effective rate and cure rate (based on facial nerve function scores). This meta-analysis is registered with PROSPERO, number CRD42020169870. RESULTS 15 randomized controlled trials that enrolled 2847 participants met the selection criteria. There was no significant differences in the effective rate (RR, 1.22; 95% CI, 0.70-2.11) when comparing acupuncture to prednisone therapy in acute facial paralysis. Acupuncture treatment in the acute stage increased both the effective rate (RR, 1.03; 95% CI, 1.00-1.07) and the cure rate (RR, 1.34; 95% CI, 1.14-1.58) compared to that in the nonacute stage. CONCLUSIONS In this meta-analysis, acupuncture showed a better effect in the acute stage than the nonacute stage for participants with peripheral facial paralysis. There was no statistical difference in the effective rate no matter the choice of acupuncture or prednisone therapies in the acute stage. These findings encourage early acupuncture treatment in peripheral facial paralysis.
Collapse
Affiliation(s)
- Zelin Yu
- The First Clinical Medicine College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Mengxia Shen
- The First Clinical Medicine College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Wenfang Shang
- The First Clinical Medicine College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Jiangxia Wu
- The First Clinical Medicine College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Lihua Xuan
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, China
| |
Collapse
|
4
|
Sala E, Carosi G, Del Sindaco G, Mungari R, Cremaschi A, Serban AL, Ronchi CL, Ferrante E, Arosio M, Mantovani G. Long-term remission of acromegaly after somatostatin analogues withdrawal: a single-centre experience. J Endocrinol Invest 2021; 44:2593-2599. [PMID: 34018167 PMCID: PMC8572221 DOI: 10.1007/s40618-021-01562-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/28/2020] [Accepted: 03/25/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE A long-lasting remission of acromegaly after somatostatin analogues (SAs) withdrawal has been described in some series. Our aim was to update the disease evolution after SAs withdrawal in a cohort of acromegalic patients. METHODS We retrospectively evaluated 21 acromegalic patients previously included in a multicentre study (Ronchi et al. 2008), updating data at the last follow-up. We added further 8 patients selected for SAs withdrawal between 2008-2018. Pituitary irradiation represented an exclusion criterion. The withdrawal was suggested after at least 9 months of clinical and hormonal disease control. Clinical and biochemical data prior and after SAs withdrawal were analysed. RESULTS In the whole cohort (29 patients) mean age was 50 ± 14.9 years and 72.4% were females. In 69% pituitary surgery was previously performed. Overall, the median time of treatment before SAs withdrawal was 53 months (IQR = 24-84). At the last follow up in 2019, 23/29 patients (79.3%) had a disease relapse after a median time of 6 months (interquartile range or IQR = 3-12) from the drug suspension, while 6/29 (20.7%) were still on remission after 120 months (IQR = 66-150). IGF-1 levels were significantly lower before withdrawal in patients with persistent remission compared to relapsing ones (IGF-1 SDS: -1.5 ± 0.6 vs -0.11 ± 1, p = 0.01). We did not observe any other difference between patients with and without relapse, including SAs formulation, dosage and treatment duration. CONCLUSION A successful withdrawal of SAs is possible in a subset of well-controlled acromegalic patients and it challenges the concept that medical therapy is a lifelong requirement.
Collapse
Affiliation(s)
- E. Sala
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - G. Carosi
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - G. Del Sindaco
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - R. Mungari
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - A. Cremaschi
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - A. L. Serban
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - C. L. Ronchi
- Institute of Metabolism and System Research, University of Birmingham, Birmingham, UK
| | - E. Ferrante
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - M. Arosio
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G. Mantovani
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| |
Collapse
|
5
|
Abstract
BACKGROUND Actinic keratoses (AKs) are a common premalignant cutaneous neoplasm and can progress to squamous cell carcinoma. A variety of treatment options are available for field therapy of diffuse AKs. OBJECTIVE This review systematically analyzes the use of chemical peels for treatment of AKs. MATERIALS AND METHODS A systematic review of PubMed was performed searching from 1946 to March 2020 to identify the literature on chemical peels for AKs. RESULTS Of the 151 articles identified, 5 met inclusion criteria for review. Four of the reviewed articles demonstrated the efficacy of chemical peels in reducing AK count and minimal adverse effects. In some studies, chemical peels exhibited potential to prevent additional AK formation and development of keratinocyte carcinomas. CONCLUSION Chemical peels are an efficacious and affordable treatment option for field treatment of AKs. With improved patient tolerance and adherence, chemical peels are an attractive option for field therapy of AKs for both dermatologists and patients.
Collapse
Affiliation(s)
- Angela J Jiang
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - Seaver L Soon
- Department of Dermatology, The Skin Clinic MD, San Diego, California
| | - Peter Rullan
- Department of Dermatology, Dermatology Institute, Chula Vista, California
- Department of Dermatology, University of California San Diego, San Diego, California
| | - Harold J Brody
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Gary D Monheit
- Department of Dermatology, Total Skin and Beauty Dermatology Center, Birmingham, AL
| | - Kachiu C Lee
- Department of Dermatology, Main Line Center for Laser Surgery, Ardmore, Pennsylvania
| |
Collapse
|
6
|
Stabile E, Franzese M, Chianese S, Alfani A, Gerardi D, Colaiori I, Annunziata M, Nappi P, Scalise M, Di Serafino L, Puzone B, Avvedimento M, Leone A, Ilardi F, Piccolo R, Franzone A, Cirillo P, Morisco C, Trimarco B, Esposito G. Predictors of adherence to composite therapy after acute coronary syndromes. J Cardiovasc Med (Hagerstown) 2021; 22:645-651. [PMID: 33966020 DOI: 10.2459/jcm.0000000000001201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Adherence to medical therapy following acute coronary syndrome (ACS) affects a patient's prognosis. In this cohort study, we sought to assess the factors that could affect a patient's adherence to therapy after ACS. METHODS We prospectively collected information from patients (N = 964) hospitalized at the coronary care unit of the Federico II University Hospital, from 1 January 2015 to 30 June 2017, for ACS. Adherence to three classes of drugs including statins, antiplatelets [dual or single antiplatelet agent (SAPT)] and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARB) and their composites were assessed at 1 month, 1 and 2 years after discharge. RESULTS At 30 days adherence to prescribed therapy was 94.4% for dual antiplatelet therapy (DAPT), 78.2% for statins, 92.7% for ACE-I/ARB and 70.7% for multitherapy. At 1 year, it was 91.1% for DAPT, 81.2% for ACE-I/ARB, 84.9% for statins and 71.4% for multitherapy. At 2 years, it was 97.1% for SAPT, 78.1% for ACE-I/ARB, 91.8% for statins, 72.8% for multitherapy. Multivariable logistic analysis demonstrated that at each time point, a telephone follow-up assessment predicts nonadherence to multitherapy and that a percutaneous coronary intervention at the index hospitalization is an independent predictor of adherence to composite therapy at 1 month and 1 year. CONCLUSION Up to 2 years after ACS, three out of four patients are adherent to multitherapy prescription; percutaneous coronary intervention during the index hospitalization improves a patient's adherence, whereas telephone follow-up is associated with reduced adherence to multitherapy.Campania Salute Network Registry (Clinical Trials.gov Identifier: NCT02211365).
Collapse
Affiliation(s)
- Eugenio Stabile
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Napoli 'Federico II', Napoli, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Kuber A, Reuter A, Geldsetzer P, Chimbindi N, Moshabela M, Tanser F, Bärnighausen T, Vollmer S. The effect of eligibility for antiretroviral therapy on body mass index and blood pressure in KwaZulu-Natal, South Africa. Sci Rep 2021; 11:14718. [PMID: 34282184 PMCID: PMC8289961 DOI: 10.1038/s41598-021-94057-z] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/05/2021] [Indexed: 11/09/2022] Open
Abstract
We use a regression discontinuity design to estimate the causal effect of antiretroviral therapy (ART) eligibility according to national treatment guidelines of South Africa on two risk factors for cardiovascular disease, body mass index (BMI) and blood pressure. We combine survey data collected in 2010 in KwaZulu-Natal, South Africa, with clinical data on ART. We find that early ART eligibility significantly reduces systolic and diastolic blood pressure. We do not find any significant effects on BMI. The effect on blood pressure can be detected up to three years after becoming eligible for ART.
Collapse
Affiliation(s)
- Aditi Kuber
- Department of Economics, University of Goettingen, Göttingen, Germany
| | - Anna Reuter
- Department of Economics, University of Goettingen, Göttingen, Germany.
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | | | - Mosa Moshabela
- Africa Health Research Institute, Durban, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Frank Tanser
- Africa Health Research Institute, Durban, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Till Bärnighausen
- Africa Health Research Institute, Durban, South Africa
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Sebastian Vollmer
- Department of Economics, University of Goettingen, Göttingen, Germany
| |
Collapse
|
8
|
Wu PA, Yuan GY, Zhou RM, Ho WWS, Lu ZQ, Cai JF, Yang SY, Tsang RKY, Chan JYW. Extracranial/Intracranial Vascular Bypass in the Treatment of Head and Neck Cancer - Related Carotid Blowout Syndrome. Laryngoscope 2021; 131:1548-1556. [PMID: 33571390 DOI: 10.1002/lary.29427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/20/2020] [Revised: 01/01/2021] [Accepted: 01/12/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE/HYPOTHESIS To investigate the endovascular intervention or extracranial/intracranial (EC/IC) vascular bypass in the management of patients with head and neck cancer-related carotid blowout syndrome (CBS). STUDY DESIGN Retrospective case series. METHODS Retrospective analysis of clinical data of patients with head and neck cancer-related CBS treated by endovascular intervention and/or EC/IC vascular bypass, analysis of its bleeding control, neurological complications, and survival results. RESULTS Thrity-seven patients were included. Twenty-five were associated with external carotid artery (ECA); twelve were associated with internal or common carotid artery (ICA/CCA). All patients with ECA hemorrhage were treated with endovascular embolization. Of the 12 patients with ICA/CCA hemorrhage, 9 underwent EC/IC bypass, 1 underwent endovascular embolization, and 3 underwent endovascular stenting. For patients with ECA-related CBS, the median survival was 6 months, and the 90-day, 1-year, and 2-year survival rates were 67.1%, 44.7%, and 33.6%, respectively; the estimated rebleeding risk at 1-month, 6-month, and 2-year was 7.1%, 20.0%, and 31.6%, respectively. For patients with ICA/CCA-related CBS, the median survival was 22.5 months, and the 90-day, 1-year, and 2-year survival rates were 92.3%, 71.8%, and 41.0%, respectively; the estimated rebleeding risk at 1 month, 6 months, and 2 years is 7.7%,15.4%, and 15.4%, respectively. ICA/CCA-related CBS patients have significantly longer survival time and lower risk of rebleeding, which may be related to the more use of EC/IC vascular bypass as a definite treatment. CONCLUSIONS For patients with ICA/CCA-related CBS, if there is more stable hemodynamics, longer expected survival, EC/IC vascular bypass is preferred. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1548-1556, 2021.
Collapse
Affiliation(s)
- Ping-An Wu
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P.R. China
| | - Guo-Yan Yuan
- Department of Surgery, Division of Neurosurgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P.R. China
| | - Ru-Ming Zhou
- Department of Interventional Radiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P.R. China
| | - Wilson Wai-Shing Ho
- Department of Surgery, Division of Neurosurgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P.R. China
| | - Zhao-Qun Lu
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P.R. China
| | - Ji-Fu Cai
- Department of Neurology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P.R. China
| | - Si-Yi Yang
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P.R. China
| | - Raymond King-Yin Tsang
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P.R. China
| | - Jimmy Yu-Wai Chan
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P.R. China
| |
Collapse
|
9
|
Pan X, Xu L, Zhou C, Zhang Z, Sun H. Meta-analysis of patent foramen ovale closure versus medical therapy for prevention of recurrent ischemic neurological events: Impact of medication type. Medicine (Baltimore) 2021; 100:e26473. [PMID: 34160457 PMCID: PMC8238362 DOI: 10.1097/md.0000000000026473] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 06/08/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The optimal treatment strategy for patent foramen ovale (PFO) patients with cryptic stroke remains controversial. We performed this meta-analysis to evaluate the effect of PFO closure versus different types of medical therapy. METHODS We searched PubMed, Embase, and Cochrane databases. The primary efficacy endpoints were the composite outcome of recurrent stroke and/or transient ischemic attack (TIA). Secondary efficacy endpoints included separate stroke and TIA. Safety endpoints included new-onset atrial fibrillation (AF)/atrial flutter and bleeding. RESULTS Compared with antiplatelet therapy, PFO closure significantly reduced the risk of composite outcome (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.27-0.51), stroke (OR 0.22, 95% CI 0.13-0.36], and TIA (OR 0.57, 95% CI 0.34-0.98); Compared with the mixed medical therapy group (consist of antiplatelet therapy, anticoagulant therapy, or both), PFO closure still showed some benefits, but the effect was not as significant as that of antiplatelet therapy (composite outcome: OR 0.53, 95% CI 0.41-0.69; stroke: OR 0.48, 95% CI 0.34-0.68; TIA: OR 0.69, 95% CI 0.50-0.96); Compared with anticoagulant therapy, PFO closure showed no benefit (composite outcome: OR 0.77, 95% CI 0.46-1.28; stroke: OR 0.59, 95% CI 0.28-1.25; TIA: OR 1.01, 95% CI 0.50-2.04). In terms of safe endpoints, compared with antiplatelet therapy and anticoagulant therapy, PFO closure increased the risk of AF/atrial flutter (OR 9.56, 95% CI 2.85-32.06; OR 18.96, 95% CI 1.11-323.8, respectively) and reduced the risk of bleeding (OR 0.50, 95% CI 0.24-1.05; OR 0.13, 95% CI 0.04-0.46, respectively); compared with mixed medical therapy, PFO closure increased the risk of AF/atrial flutter (OR 4.40,95% CI 2.24-8.67), but there was no difference in bleeding (OR 0.97, 95% CI 0.56-1.68). CONCLUSIONS With the addition of anticoagulants, the benefit of PFO closure decreased gradually. Patient groups that adopt individualized medical therapy strategies may benefit more.
Collapse
Affiliation(s)
- Xuemei Pan
- Department of Ultrasound, The Third People's Hospital of Yichang City
| | - Liang Xu
- Department of Ultrasound, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang, Hubei Province, China
| | - Chang Zhou
- Department of Ultrasound, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang, Hubei Province, China
| | - Zhi Zhang
- Department of Ultrasound, The Third People's Hospital of Yichang City
| | - Heng Sun
- Department of Ultrasound, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang, Hubei Province, China
| |
Collapse
|
10
|
Abstract
IMPORTANCE The net benefit of aspirin for prevention of cardiovascular disease (CVD), particularly primary prevention, remains debated in people with and without diabetes. Recent studies suggest that the benefits of preventive aspirin may be outweighed by the potential for harm in older adults; therefore, it is important to monitor current aspirin use in order to minimize risk for future harm in the oldest segment of the population. OBJECTIVE To determine the prevalence of preventive aspirin use in older US adults with and without diabetes for both primary and secondary prevention by age, sex, and CVD risk category. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis used nationally representative data from the National Health and Nutrition Examination Survey from 2011 to 2018. A total of 7103 individuals 60 years or older with and without diabetes completed a questionnaire on preventive aspirin use. Statistical analyses were performed from July 1, 2019, to April 1, 2021. MAIN OUTCOMES AND MEASURES Preventive aspirin use was defined as participants' self-reported use of low-dose aspirin therapy based on their physician's advice or their own decision. RESULTS A total of 7103 individuals (mean [SD] age, 69.6 [0.1] years; 45.2% men; 75.8% White participants) were evaluated. Overall, 61.7% of older US adults with diabetes vs 42.2% without diabetes used aspirin. Among people with diabetes, in multivariable logistic models adjusting for race, sex, education, CVD risk category, and body mass index, the likelihood of aspirin use in older vs younger age categories (reference: 60-69 years) did not differ. Among people without diabetes, aspirin use was significantly greater in older age categories vs the reference (model 3, 70-79 years, odds ratio [OR], 1.50; 95% CI, 1.23-1.83; model 3, ≥80 years, OR, 1.59; 95% CI, 1.24-2.04). An estimated 9.9 million US adults 70 years or older with or without diabetes reported taking aspirin for primary prevention. The likelihood of aspirin use for primary prevention in those at high vs low risk for CVD did not differ among older adults with diabetes (model 3, OR, 1.69; 95% CI, 0.65-4.39) but was significantly higher in those without diabetes (model 3, OR, 2.46; 95% CI, 1.63-3.71). Women vs men with diabetes were less likely to be using aspirin for primary prevention (model 3, OR, 0.63; 95% CI, 0.48-0.83). CONCLUSIONS AND RELEVANCE This cross-sectional study found that preventive aspirin use was higher among older adults with diabetes than in those without diabetes. Results suggest that 9.9 million older US adults who previously took aspirin for primary prevention would not be recommended for its continued use, particularly among those with diabetes.
Collapse
Affiliation(s)
- Elizabeth Y. Liu
- Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University, Baltimore, Maryland
| | - Mohammed E. Al-Sofiani
- Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University, Baltimore, Maryland
- Division of Endocrinology, King Saud University College of Medicine, Riyadh, Saudi Arabia
| | - Hsin-Chieh Yeh
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | | | - Joshua J. Joseph
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University, Columbus
| | - Rita R. Kalyani
- Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University, Baltimore, Maryland
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
11
|
Sun XC, Yuan WF, Ma WJ, Zhang WJ, Xu SG. Study on the preventive effect of intravenous esomeprazole in the management of nonvarices upper gastrointestinal bleeding. Medicine (Baltimore) 2021; 100:e25420. [PMID: 34011021 PMCID: PMC8137025 DOI: 10.1097/md.0000000000025420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/09/2021] [Indexed: 01/05/2023] Open
Abstract
This retrospective study investigated the preventive effect of intravenous esomeprazole (IVEO) in the prevention of nonvarices upper gastrointestinal bleeding (NUGIB).This study enrolled 130 patients with NUGIB and all of them underwent successful endoscopic hemostasis, of which 65 cases received routine management and IVEO (Group A) and the other 65 cases received routine management alone (Group B). The primary outcome (recurrent bleeding rate within 72-hour, 7-day, and 30-day), and secondary outcomes ((all-cause mortality, bleeding-related mortality, blood transfused, hospital stay (day), and incidence of adverse events)) were compared between 2 groups.Patients in the group A showed lower recurrent bleeding rate within 72-hour(P < .05), 7-day (P < .05), and 30-day (P < .05), than that of patients in the group B. However, no significant differences were identified in all-cause mortality(P = .26), bleeding-related mortality (P = .57), blood transfused (P = .33), and hospital stay (P = .74) between 2 groups. In addition, both groups had similar safety profile.This study found that routine management and IVEO was superior to the routine management alone for preventing the recurrent bleeding rate after successful endoscopic hemostasis in patients with NUGIB.
Collapse
|
12
|
Nekkab N, Lana R, Lacerda M, Obadia T, Siqueira A, Monteiro W, Villela D, Mueller I, White M. Estimated impact of tafenoquine for Plasmodium vivax control and elimination in Brazil: A modelling study. PLoS Med 2021; 18:e1003535. [PMID: 33891582 PMCID: PMC8064585 DOI: 10.1371/journal.pmed.1003535] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite recent intensification of control measures, Plasmodium vivax poses a major challenge for malaria elimination efforts. Liver-stage hypnozoite parasites that cause relapsing infections can be cleared with primaquine; however, poor treatment adherence undermines drug effectiveness. Tafenoquine, a new single-dose treatment, offers an alternative option for preventing relapses and reducing transmission. In 2018, over 237,000 cases of malaria were reported to the Brazilian health system, of which 91.5% were due to P. vivax. METHODS AND FINDINGS We evaluated the impact of introducing tafenoquine into case management practices on population-level transmission dynamics using a mathematical model of P. vivax transmission. The model was calibrated to reflect the transmission dynamics of P. vivax endemic settings in Brazil in 2018, informed by nationwide malaria case reporting data. Parameters for treatment pathways with chloroquine, primaquine, and tafenoquine with glucose-6-phosphate dehydrogenase deficiency (G6PDd) testing were informed by clinical trial data and the literature. We assumed 71.3% efficacy for primaquine and tafenoquine, a 66.7% adherence rate to the 7-day primaquine regimen, a mean 5.5% G6PDd prevalence, and 8.1% low metaboliser prevalence. The introduction of tafenoquine is predicted to improve effective hypnozoite clearance among P. vivax cases and reduce population-level transmission over time, with heterogeneous levels of impact across different transmission settings. According to the model, while achieving elimination in only few settings in Brazil, tafenoquine rollout in 2021 is estimated to improve the mean effective radical cure rate from 42% (95% uncertainty interval [UI] 41%-44%) to 62% (95% UI 54%-68%) among clinical cases, leading to a predicted 38% (95% UI 7%-99%) reduction in transmission and over 214,000 cumulative averted cases between 2021 and 2025. Higher impact is predicted in settings with low transmission, low pre-existing primaquine adherence, and a high proportion of cases in working-aged males. High-transmission settings with a high proportion of cases in children would benefit from a safe high-efficacy tafenoquine dose for children. Our methodological limitations include not accounting for the role of imported cases from outside the transmission setting, relying on reported clinical cases as a measurement of community-level transmission, and implementing treatment efficacy as a binary condition. CONCLUSIONS In our modelling study, we predicted that, provided there is concurrent rollout of G6PDd diagnostics, tafenoquine has the potential to reduce P. vivax transmission by improving effective radical cure through increased adherence and increased protection from new infections. While tafenoquine alone may not be sufficient for P. vivax elimination, its introduction will improve case management, prevent a substantial number of cases, and bring countries closer to achieving malaria elimination goals.
Collapse
Affiliation(s)
- Narimane Nekkab
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| | - Raquel Lana
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Marcus Lacerda
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
| | - Thomas Obadia
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| | - André Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Wuelton Monteiro
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Daniel Villela
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ivo Mueller
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
- Population Health & Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael White
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| |
Collapse
|
13
|
Depaire M, Larrue H, Rudler M, Nault JC, Bureau C. Futility criteria for preemptive TIPS in patients with cirrhosis and variceal bleeding are still missing in most severe patients! J Hepatol 2021; 74:997-999. [PMID: 33340574 DOI: 10.1016/j.jhep.2020.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Martin Depaire
- Service d'Hépatologie Hopital Rangueil et CHU Toulouse et Université Paul Sabatier, Toulouse3, France
| | - Hélène Larrue
- Service d'Hépatologie Hopital Rangueil et CHU Toulouse et Université Paul Sabatier, Toulouse3, France
| | - Marika Rudler
- Service d'Hépatologie Hôpital La Pitié Salpétrière APHP, Paris, France
| | - Jean Charles Nault
- Service d'hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France; Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Paris, France; Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université Paris, INSERM UMR 1138, Functional Genomics of Solid Tumors laboratory, F-75006, Paris, France
| | - Christophe Bureau
- Service d'Hépatologie Hopital Rangueil et CHU Toulouse et Université Paul Sabatier, Toulouse3, France.
| |
Collapse
|
14
|
Bai F, Chen J, Pandey D, Durazo-Arvizu R, Talavera GA, Allison MA, Perreira KM, Schneiderman N, Sutherland MW, Cai J, Daviglus ML, Testai FD. Stroke Risk Factor Status and Use of Stroke Prevention Medications Among Hispanic/Latino Adults in HCHS/SOL. Stroke 2021; 52:1339-1346. [PMID: 33657859 DOI: 10.1161/strokeaha.120.031216] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE We investigated the prevalence, awareness, and control of vascular risk factors (VRFs) and the use of antithrombotic and statin agents in HCHS (Hispanic Community Health Study)/SOL (Study of Latinos) participants with self-reported history of stroke or transient ischemic attack. METHODS Sociodemographic characteristics, medications, and prevalence of different VRFs were recorded. VRF diagnoses and goals were based on the recommendations of professional organizations. Factors associated with optimal VRF control and use of antithrombotic and statin agents were investigated using multivariate logistic regression. RESULTS The analysis included 404 participants (39% men). The prevalences of hypertension, dyslipidemia, and diabetes were 59%, 65%, and 39%, respectively. Among those who met the diagnostic criteria for these diagnoses, the frequencies of awareness were 90%, 75%, and 83%, respectively. In participants who were aware of their VRFs, the prevalences of controlled hypertension, dyslipidemia, and diabetes were 46%, 32%, and 54%. Approximately 46% of the participants were on antithrombotics, 39% on statins, and 26% on both. Only 38% of those with atrial fibrillation received anticoagulation. In multivariate analyses adjusted for baseline sociodemographic characteristics, older age was associated with uncontrolled hypertension and diabetes. Residing in the United States for ≥10 years and born in the United States were associated with uncontrolled diabetes, female sex with uncontrolled dyslipidemia, and lack of health insurance with decreased use of statins and hyperlipidemia. CONCLUSIONS Hispanic/Latino adults in the United States have high prevalence and awareness of VRFs but low adherence to secondary stroke prevention strategies. Older adults, women, and uninsured people are vulnerable groups that may benefit from targeted interventions. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02060344.
Collapse
Affiliation(s)
- Fang Bai
- Department of Neurology and Rehabilitation (F.B., D.P., F.D.T.), University of Illinois at Chicago
| | - Jingsong Chen
- Institute for Minority Health Research (J.C., R.D.-A., M.L.D.), University of Illinois at Chicago
| | - Dilip Pandey
- Department of Neurology and Rehabilitation (F.B., D.P., F.D.T.), University of Illinois at Chicago
| | - Ramon Durazo-Arvizu
- Institute for Minority Health Research (J.C., R.D.-A., M.L.D.), University of Illinois at Chicago
| | - Gregory A Talavera
- Graduate School of Public Health, San Diego State University, CA (G.A.T.)
| | - Matthew A Allison
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla (M.A.A.)
| | - Krista M Perreira
- Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill (K.M.P., J.C.)
| | - Neil Schneiderman
- Department of Psychology, Behavioral Medicine Research Center, University of Miami, FL (N.S.)
| | - Melanie W Sutherland
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia (M.W.S.)
| | - Jianwen Cai
- Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill (K.M.P., J.C.)
| | - Martha L Daviglus
- Institute for Minority Health Research (J.C., R.D.-A., M.L.D.), University of Illinois at Chicago
| | - Fernando D Testai
- Department of Neurology and Rehabilitation (F.B., D.P., F.D.T.), University of Illinois at Chicago
| |
Collapse
|
15
|
Abstract
BACKGROUND Diet plays a major role in the aetiology of cardiovascular disease (CVD) and as a modifiable risk factor is the focus of many prevention strategies. Recently vegan diets have gained popularity and there is a need to synthesise existing clinical trial evidence for their potential in CVD prevention. OBJECTIVES To determine the effectiveness of following a vegan dietary pattern for the primary and secondary prevention of CVD. SEARCH METHODS We searched the following electronic databases on 4 February 2020: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Web of Science Core Collection. We also searched ClinicalTrials.gov in January 2021. We applied no language restrictions. SELECTION CRITERIA We selected randomised controlled trials (RCTs) in healthy adults and adults at high risk of CVD (primary prevention) and those with established CVD (secondary prevention). A vegan dietary pattern excludes meat, fish, eggs, dairy and honey; the intervention could be dietary advice, provision of relevant foods, or both. The comparison group received either no intervention, minimal intervention, or another dietary intervention. Outcomes included clinical events and CVD risk factors. We included only studies with follow-up periods of 12 weeks or more, defined as the intervention period plus post-intervention follow-up. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, extracted data and assessed risks of bias. We used GRADE to assess the certainty of the evidence. We conducted three main comparisons: 1. Vegan dietary intervention versus no intervention or minimal intervention for primary prevention; 2. Vegan dietary intervention versus another dietary intervention for primary prevention; 3. Vegan dietary intervention versus another dietary intervention for secondary prevention. MAIN RESULTS Thirteen RCTs (38 papers, 7 trial registrations) and eight ongoing trials met our inclusion criteria. Most trials contributed to primary prevention: comparisons 1 (four trials, 466 participants randomised) and comparison 2 (eight trials, 409 participants randomised). We included only one secondary prevention trial for comparison 3 (63 participants randomised). None of the trials reported on clinical endpoints. Other primary outcomes included lipid levels and blood pressure. For comparison 1 there was moderate-certainty evidence from four trials with 449 participants that a vegan diet probably led to a small reduction in total cholesterol (mean difference (MD) -0.24 mmol/L, 95% confidence interval (CI) -0.36 to -0.12) and low-density lipoprotein (LDL) cholesterol (MD -0.22 mmol/L, 95% CI -0.32 to -0.11), a very small decrease in high-density lipoprotein (HDL) levels (MD -0.08 mmol/L, 95% CI -0.11 to -0.04) and a very small increase in triglyceride levels (MD 0.11 mmol/L, 95% CI 0.01 to 0.21). The very small changes in HDL and triglyceride levels are in the opposite direction to that expected. There was a lack of evidence for an effect with the vegan dietary intervention on systolic blood pressure (MD 0.94 mmHg, 95% CI -1.18 to 3.06; 3 trials, 374 participants) and diastolic blood pressure (MD -0.27 mmHg, 95% CI -1.67 to 1.12; 3 trials, 372 participants) (low-certainty evidence). For comparison 2 there was a lack of evidence for an effect of the vegan dietary intervention on total cholesterol levels (MD -0.04 mmol/L, 95% CI -0.28 to 0.20; 4 trials, 163 participants; low-certainty evidence). There was probably little or no effect of the vegan dietary intervention on LDL (MD -0.05 mmol/L, 95% CI -0.21 to 0.11; 4 trials, 244 participants) or HDL cholesterol levels (MD -0.01 mmol/L, 95% CI -0.08 to 0.05; 5 trials, 256 participants) or triglycerides (MD 0.21 mmol/L, 95% CI -0.07 to 0.49; 5 trials, 256 participants) compared to other dietary interventions (moderate-certainty evidence). We are very uncertain about any effect of the vegan dietary intervention on systolic blood pressure (MD 0.02 mmHg, 95% CI -3.59 to 3.62) or diastolic blood pressure (MD 0.63 mmHg, 95% CI -1.54 to 2.80; 5 trials, 247 participants (very low-certainty evidence)). Only one trial (63 participants) contributed to comparison 3, where there was a lack of evidence for an effect of the vegan dietary intervention on lipid levels or blood pressure compared to other dietary interventions (low- or very low-certainty evidence). Four trials reported on adverse events, which were absent or minor. AUTHORS' CONCLUSIONS Studies were generally small with few participants contributing to each comparison group. None of the included studies report on CVD clinical events. There is currently insufficient information to draw conclusions about the effects of vegan dietary interventions on CVD risk factors. The eight ongoing studies identified will add to the evidence base, with all eight reporting on primary prevention. There is a paucity of evidence for secondary prevention.
Collapse
Affiliation(s)
- Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Lena Al-Khudairy
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrea Takeda
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
| |
Collapse
|
16
|
Ferreira JA, Baptista RM, Monteiro SR, Gonçalves LM. Usefulness of universal beta-blocker therapy in patients after ST-elevation myocardial infarction. Medicine (Baltimore) 2021; 100:e23987. [PMID: 33545989 PMCID: PMC7837933 DOI: 10.1097/md.0000000000023987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/07/2020] [Accepted: 12/01/2020] [Indexed: 01/05/2023] Open
Abstract
The use of beta-blockers (BB) in the context of ST-segment elevation myocardial infarction (STEMI) was a universal practice in the pre-reperfusion era. Since then, evidence of their use for secondary prevention after STEMI is scarce. Our aim is to determine treatment results associated with BB therapy after a STEMI at 1-year follow-up in a contemporary nationwide cohort.A prospective analysis involving 49 national centers, including patients admitted with STEMI, enrolled between October 2010 and September 2019 was conducted. The primary outcome was defined as the composite of all-cause mortality or hospital re-admission for a cardiovascular (CV) cause in the first year after STEMI. The patients were distributed into 2 groups, depending on whether they received therapy with BB at hospital discharge or not (BB and NB group, respectively).A total of 3145 patients were included in the analysis, of which 2526 (80.3%) in the BB group. A total of 12.2% of patients reached the primary outcome. Regarding the univariate Cox regression analysis, the BB group presented lower mortality or re-admission for CV cause at 1-year follow-up [hazard ratio (HR) 0.69, confidence interval (CI) 95% 0.55-0.87, P = .001]. However, after adjustment for significant covariates, this association was lost (HR 0.73, CI 95% 0.51-1.04, P = .081). In patients with preserved (HR 0.73, CI 95% 0.51-1.04, P = .081) and mid-range (HR 1.01, CI 95% 0.64-1.61, P = .959) left ventricular ejection fraction (LVEF), the primary outcome was similar between the 2 groups, while in patients with reduced LVEF, the BB group presented a better prognosis, with fewer patients reaching the primary outcome (HR 0.431, CI 95% 0.262-0.703, P = .001).BB universal therapy after STEMI has not proved useful, but it seems to be beneficial in patients with reduced LVEF.
Collapse
Affiliation(s)
| | - Rui Miguel Baptista
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra
- iCBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | | | - Lino Manuel Gonçalves
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra
- iCBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| |
Collapse
|
17
|
Abu-Ghanem Y, Kleinmann N, Erlich T, Winkler HZ, Zilberman DE. The Impact of Dietary Modifications and Medical Management on 24-Hour Urinary Metabolic Profiles and the Status of Renal Stone Disease in Recurrent Stone Formers. Isr Med Assoc J 2021; 23:12-16. [PMID: 33443336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Dietary modifications and patient-tailored medical management are significant in controlling renal stone disease. Nevertheless, the literature regarding effectiveness is sparse. OBJECTIVES To explore the impact of dietary modifications and medical management on 24-hour urinary metabolic profiles (UMP) and renal stone status in recurrent kidney stone formers. METHODS We reviewed our prospective registry database of patients treated for nephrolithiasis. Data included age, sex, 24-hour UMP, and stone burden before treatment. Under individual treatment, patients were followed at 6-8 month intervals with repeat 24-hour UMP and radiographic images. Nephrolithiasis-related events (e.g., surgery, renal colic) were also recorded. We included patients with established long-term follow-up prior to the initiation of designated treatment, comparing individual nephrolithiasis status before and after treatment initiation. RESULTS Inclusion criteria were met by 44 patients. Median age at treatment start was 60.5 (50.2-70.2) years. Male:Female ratio was 3.9:1. Median follow-up was 10 (6-25) years and 5 (3-6) years before and after initiation of medical and dietary treatment, respectively. Metabolic abnormalities detected included: hypocitraturia (95.5%), low urine volume (56.8%), hypercalciuria (45.5%), hyperoxaluria (40.9%), and hyperuricosuria (13.6%). Repeat 24-hour UMP under appropriate diet and medical treatment revealed a progressive increase in citrate levels compared to baseline and significantly decreased calcium levels (P = 0.001 and 0.03, respectively). A significant decrease was observed in stone burden (P = 0.001) and overall nephrolithiasis-related events. CONCLUSIONS Dietary modifications and medical management significantly aid in correcting urinary metabolic abnormalities. Consequently, reduced nehprolithiasis-related events and better stone burden control is expected.
Collapse
Affiliation(s)
- Yasmin Abu-Ghanem
- Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Kleinmann
- Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Erlich
- Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Harry Z Winkler
- Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
18
|
Sigglekow F, Horsburgh S, Parkin L. Statin adherence is lower in primary than secondary prevention: A national follow-up study of new users. PLoS One 2020; 15:e0242424. [PMID: 33211724 PMCID: PMC7676659 DOI: 10.1371/journal.pone.0242424] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 11/02/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Maintaining adherence to statins reduces the risk of an initial cardiovascular disease (CVD) event in high-risk individuals (primary prevention) and additional CVD events following the first event (secondary prevention). The effectiveness of statin therapy is limited by the level of adherence maintained by the patient. We undertook a nationwide study to compare adherence and discontinuation in primary and secondary prevention patients. METHODS Dispensing data from New Zealand community pharmacies were used to identify patients who received their first statin dispensing between 2006 and 2011. The Medication Possession Ratio (MPR) and proportion who discontinued statin medication was calculated for the year following first statin dispensing for patients with a minimum of two dispensings. Adherence was defined as an MPR ≥ 0.8. Previous CVD was identified using hospital discharge records. Multivariable logistic regression was used to control for demographic and statin characteristics. RESULTS Between 2006 and 2011 289,666 new statin users were identified with 238,855 (82.5%) receiving the statin for primary prevention compared to 50,811 (17.5%) who received it for secondary prevention. The secondary prevention group was 1.55 (95% CI 1.51-1.59) times as likely to be adherent and 0.67 (95% CI 0.65-0.69) times as likely to discontinue statin treatment than the primary prevention group. An early gap in statin coverage increased the odds of discontinuing statin treatment. CONCLUSION Adherence to statin medication is higher in secondary prevention than primary prevention. Within each group, a range of demographic and treatment factors further influences adherence.
Collapse
Affiliation(s)
- Finn Sigglekow
- Department of Preventive and Social Medicine, Otago Medical School—Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Simon Horsburgh
- Department of Preventive and Social Medicine, Otago Medical School—Dunedin Campus, University of Otago, Dunedin, New Zealand
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- * E-mail:
| | - Lianne Parkin
- Department of Preventive and Social Medicine, Otago Medical School—Dunedin Campus, University of Otago, Dunedin, New Zealand
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
| |
Collapse
|
19
|
Henao López V, Triviño Vargas Z. Adherence to Secondary Prevention and Influential Factors in Individuals with Coronary Angioplasty. Invest Educ Enferm 2020; 38:e05. [PMID: 33306895 PMCID: PMC7885540 DOI: 10.17533/udea.iee.v38n3e05] [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] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 10/05/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To explore the relation between adherence to secondary prevention and factors that influence on said adherence in people with acute coronary syndrome, who underwent percutaneous coronary angioplasty in a clinic in Medellín. METHODS Cross-sectional study on a random sample of 128 volunteer patients. A questionnaire was used for sociodemographic variables, the "Scale to measure therapeutic adherence for patients with chronic diseases, based on explicit behaviors" by Trujano, Vega, and Nava and the "Instrument to evaluate adherence by patients according to influential cardiovascular risk factors" validated by Consuelo Ortiz. RESULTS Socioeconomic factors influenced in very low manner on the adherence to secondary prevention; factors related with the therapy did so moderately and patient factors influenced in low manner. No relation was found between the health provider factor and said adherence. CONCLUSIONS Factors exist that influence in a lesser or higher measure on adherence to secondary prevention and which must be recognized in people with coronary angioplasty to design strategies to improve this aspect of self-care.
Collapse
Affiliation(s)
- Vanesa Henao López
- Nurse in the Adult Echocardiography service, Clínica Cardio VID, Colombia,
| | | |
Collapse
|
20
|
Anglemyer A, Moore TH, Parker L, Chambers T, Grady A, Chiu K, Parry M, Wilczynska M, Flemyng E, Bero L. Digital contact tracing technologies in epidemics: a rapid review. Cochrane Database Syst Rev 2020; 8:CD013699. [PMID: 33502000 PMCID: PMC8241885 DOI: 10.1002/14651858.cd013699] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Reducing the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a global priority. Contact tracing identifies people who were recently in contact with an infected individual, in order to isolate them and reduce further transmission. Digital technology could be implemented to augment and accelerate manual contact tracing. Digital tools for contact tracing may be grouped into three areas: 1) outbreak response; 2) proximity tracing; and 3) symptom tracking. We conducted a rapid review on the effectiveness of digital solutions to contact tracing during infectious disease outbreaks. OBJECTIVES To assess the benefits, harms, and acceptability of personal digital contact tracing solutions for identifying contacts of an identified positive case of an infectious disease. SEARCH METHODS An information specialist searched the literature from 1 January 2000 to 5 May 2020 in CENTRAL, MEDLINE, and Embase. Additionally, we screened the Cochrane COVID-19 Study Register. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster-RCTs, quasi-RCTs, cohort studies, cross-sectional studies and modelling studies, in general populations. We preferentially included studies of contact tracing during infectious disease outbreaks (including COVID-19, Ebola, tuberculosis, severe acute respiratory syndrome virus, and Middle East respiratory syndrome) as direct evidence, but considered comparative studies of contact tracing outside an outbreak as indirect evidence. The digital solutions varied but typically included software (or firmware) for users to install on their devices or to be uploaded to devices provided by governments or third parties. Control measures included traditional or manual contact tracing, self-reported diaries and surveys, interviews, other standard methods for determining close contacts, and other technologies compared to digital solutions (e.g. electronic medical records). DATA COLLECTION AND ANALYSIS Two review authors independently screened records and all potentially relevant full-text publications. One review author extracted data for 50% of the included studies, another extracted data for the remaining 50%; the second review author checked all the extracted data. One review author assessed quality of included studies and a second checked the assessments. Our outcomes were identification of secondary cases and close contacts, time to complete contact tracing, acceptability and accessibility issues, privacy and safety concerns, and any other ethical issue identified. Though modelling studies will predict estimates of the effects of different contact tracing solutions on outcomes of interest, cohort studies provide empirically measured estimates of the effects of different contact tracing solutions on outcomes of interest. We used GRADE-CERQual to describe certainty of evidence from qualitative data and GRADE for modelling and cohort studies. MAIN RESULTS We identified six cohort studies reporting quantitative data and six modelling studies reporting simulations of digital solutions for contact tracing. Two cohort studies also provided qualitative data. Three cohort studies looked at contact tracing during an outbreak, whilst three emulated an outbreak in non-outbreak settings (schools). Of the six modelling studies, four evaluated digital solutions for contact tracing in simulated COVID-19 scenarios, while two simulated close contacts in non-specific outbreak settings. Modelling studies Two modelling studies provided low-certainty evidence of a reduction in secondary cases using digital contact tracing (measured as average number of secondary cases per index case - effective reproductive number (R eff)). One study estimated an 18% reduction in R eff with digital contact tracing compared to self-isolation alone, and a 35% reduction with manual contact-tracing. Another found a reduction in R eff for digital contact tracing compared to self-isolation alone (26% reduction) and a reduction in R eff for manual contact tracing compared to self-isolation alone (53% reduction). However, the certainty of evidence was reduced by unclear specifications of their models, and assumptions about the effectiveness of manual contact tracing (assumed 95% to 100% of contacts traced), and the proportion of the population who would have the app (53%). Cohort studies Two cohort studies provided very low-certainty evidence of a benefit of digital over manual contact tracing. During an Ebola outbreak, contact tracers using an app found twice as many close contacts per case on average than those using paper forms. Similarly, after a pertussis outbreak in a US hospital, researchers found that radio-frequency identification identified 45 close contacts but searches of electronic medical records found 13. The certainty of evidence was reduced by concerns about imprecision, and serious risk of bias due to the inability of contact tracing study designs to identify the true number of close contacts. One cohort study provided very low-certainty evidence that an app could reduce the time to complete a set of close contacts. The certainty of evidence for this outcome was affected by imprecision and serious risk of bias. Contact tracing teams reported that digital data entry and management systems were faster to use than paper systems and possibly less prone to data loss. Two studies from lower- or middle-income countries, reported that contact tracing teams found digital systems simpler to use and generally preferred them over paper systems; they saved personnel time, reportedly improved accuracy with large data sets, and were easier to transport compared with paper forms. However, personnel faced increased costs and internet access problems with digital compared to paper systems. Devices in the cohort studies appeared to have privacy from contacts regarding the exposed or diagnosed users. However, there were risks of privacy breaches from snoopers if linkage attacks occurred, particularly for wearable devices. AUTHORS' CONCLUSIONS The effectiveness of digital solutions is largely unproven as there are very few published data in real-world outbreak settings. Modelling studies provide low-certainty evidence of a reduction in secondary cases if digital contact tracing is used together with other public health measures such as self-isolation. Cohort studies provide very low-certainty evidence that digital contact tracing may produce more reliable counts of contacts and reduce time to complete contact tracing. Digital solutions may have equity implications for at-risk populations with poor internet access and poor access to digital technology. Stronger primary research on the effectiveness of contact tracing technologies is needed, including research into use of digital solutions in conjunction with manual systems, as digital solutions are unlikely to be used alone in real-world settings. Future studies should consider access to and acceptability of digital solutions, and the resultant impact on equity. Studies should also make acceptability and uptake a primary research question, as privacy concerns can prevent uptake and effectiveness of these technologies.
Collapse
Affiliation(s)
- Andrew Anglemyer
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Methods Support Unit, Editorial Methods Department, London, UK
| | - Theresa Hm Moore
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Methods Support Unit, Editorial Methods Department, London, UK
- NIHR ARC West, Bristol, UK
| | - Lisa Parker
- Sydney School of Pharmacy, The University of Sydney, Sydney, Australia
| | - Timothy Chambers
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Alice Grady
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Kellia Chiu
- Charles Perkins Centre and School of Pharmacy, The University of Sydney, Sydney, Australia
| | - Matthew Parry
- Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
| | - Magdalena Wilczynska
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Ella Flemyng
- Editorial and Methods Department, Cochrane, London, UK
| | - Lisa Bero
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, Australia
| |
Collapse
|
21
|
Tian Y, Suo X. Surgical treatment of acute calculous cholecystitis complicated with hepatic dysfunction. Medicine (Baltimore) 2020; 99:e20239. [PMID: 32541450 PMCID: PMC7302637 DOI: 10.1097/md.0000000000020239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
To evaluate the timing, feasibility, and necessity of early laparoscopic cholecystectomy (LC) in the management of patients with acute calculous cholecystitis complicated with hepatic dysfunction.The clinical data of 60 patients with acute calculous cholecystitis complicated with hepatic dysfunction treated from January 2016 to January 2018 were analyzed retrospectively. A total of 32 patients underwent LC within 72 hours of the cholecystitis attack, 28 patients after 72 hours. The results were compared with those from 28 patients with delayed LC.All the patients were operated by experienced surgeons, and no LC transfer to open operation. No significant differences were detected in the operation time, postoperative complications, intraoperative blood loss, white TBIL, ALT, GGT before and after the operation between the 2 groups (P > .05). Patients who underwent early LC had a short hospital stay and fewer hospital costs (P < .05). All the patients were cured.It is safe, feasible, and necessary to perform LC within 72 hours in patients with acute calculous cholecystitis complicated with hepatic dysfunction. Such patients show a high positive correlation between the inflammation of acute calculous cholecystitis and the damage of hepatic function.
Collapse
|
22
|
Ivers NM, Schwalm JD, Bouck Z, McCready T, Taljaard M, Grace SL, Cunningham J, Bosiak B, Presseau J, Witteman HO, Suskin N, Wijeysundera HC, Atzema C, Bhatia RS, Natarajan M, Grimshaw JM. Interventions supporting long term adherence and decreasing cardiovascular events after myocardial infarction (ISLAND): pragmatic randomised controlled trial. BMJ 2020; 369:m1731. [PMID: 32522811 PMCID: PMC7284284 DOI: 10.1136/bmj.m1731] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To test a scalable health system intervention to improve long term adherence to secondary prevention treatments among patients who have had a recent myocardial infarction. DESIGN Three arm, pragmatic randomised controlled trial with blinded outcome assessment. SETTING Nine cardiac centres in Ontario, Canada. PARTICIPANTS 2632 patients with obstructive coronary artery disease after a myocardial infarction, identified from a centralised cardiac registry. INTERVENTIONS Participants were randomised 1:1:1 to receive usual care, five mail-outs developed through a user centred design process, or mail-outs plus phone calls. The phone calls were delivered first by an interactive automated system to screen for non-adherence to treatment. Trained lay health workers followed up as necessary. Interventions were coordinated centrally but delivered from each patient's hospital site. MAIN OUTCOME MEASURES Co-primary outcomes were completion of cardiac rehabilitation and adherence to recommended medication. Data were collected by blinded assessors through patient report and from administrative health databases at 12 months. RESULTS 2632 patients (mean age 66, 71% male) were randomised: 878 to the full intervention (mail plus phone calls), 878 to mail only, and 876 to usual care. Of the respondents, 174 (27%) of 643 in the usual care group, 200 (32%) of 628 in the mail only group, and 196 (37%) of 531 allocated to the full intervention completed cardiac rehabilitation (adjusted odds ratio 1.55, 95% confidence interval 1.18 to 2.03). In the mail plus phone group, 11.7%, 6.0%, 14.4%, 32.9%, and 35.0% reported adherence to 0, 1, 2, 3, and 4 drug classes after one year, respectively, in comparison with 12.5%, 6.8%, 13.6%, 30.2%, and 36.8% in the mail only group, and 12.2%, 8.4%, 13.1%, 30.3%, and 36.1% in the usual care group, respectively (mail only v usual care, odds ratio 0.98, 95% confidence interval 0.81 to 1.19; full intervention v usual care, 0.99, 0.82 to 1.20). CONCLUSIONS Scalable interventions delivered by mail plus phone can increase completion of cardiac rehabilitation after myocardial infarction but not adherence to medication. More intensive interventions should be tested to improve adherence to medication and to evaluate the association between attendance at cardiac rehabilitation and adherence to medication. TRIAL REGISTRATION ClinicalTrials.gov NCT02382731, registered 9 March 2015 before any patient enrolment.
Collapse
Affiliation(s)
- Noah M Ivers
- Department of Family and Community Medicine, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S1B2, Canada
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto ON, Canada
| | - Jon-David Schwalm
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Cardiology, Hamilton Health Sciences, and McMaster University, Hamilton, ON, Canada
| | - Zachary Bouck
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Tara McCready
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Monica Taljaard
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Population and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, ON, Canada
- KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Jennifer Cunningham
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Beth Bosiak
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Justin Presseau
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Population and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Neville Suskin
- Cardiac Rehabilitation and Secondary Prevention Programme of St Joseph's Health Care London, ON, Canada
- Lawson Health Research Institute, Departments of Medicine, Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Harindra C Wijeysundera
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Clare Atzema
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - R Sacha Bhatia
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Madhu Natarajan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Cardiology, Hamilton Health Sciences, and McMaster University, Hamilton, ON, Canada
| | - Jeremy M Grimshaw
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Population and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
23
|
Gaudry S, Hajage D, Benichou N, Chaïbi K, Barbar S, Zarbock A, Lumlertgul N, Wald R, Bagshaw SM, Srisawat N, Combes A, Geri G, Jamale T, Dechartres A, Quenot JP, Dreyfuss D. Delayed versus early initiation of renal replacement therapy for severe acute kidney injury: a systematic review and individual patient data meta-analysis of randomised clinical trials. Lancet 2020; 395:1506-1515. [PMID: 32334654 DOI: 10.1016/s0140-6736(20)30531-6] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/10/2020] [Accepted: 02/26/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The timing of renal replacement therapy (RRT) for severe acute kidney injury is highly debated when no life-threatening complications are present. We assessed whether a strategy of delayed versus early RRT initiation affects 28-day survival in critically ill adults with severe acute kidney injury. METHODS In this systematic review and individual patient data meta-analysis, we searched MEDLINE (via PubMed), Embase, and the Cochrane Central Register of Controlled Trials for randomised trials published from April 1, 2008, to Dec 20, 2019, that compared delayed and early RRT initiation strategies in patients with severe acute kidney injury. Trials were eligible for inclusion if they included critically ill patients aged 18 years or older with acute kidney injury (defined as a Kidney Disease: Improving Global Outcomes [KDIGO] acute kidney injury stage 2 or 3, or, where KDIGO was unavailable, a renal Sequential Organ Failure Assessment score of 3 or higher). We contacted the principal investigator of each eligible trial to request individual patient data. From the included trials, any patients without acute kidney injury or who were not randomly allocated were not included in the individual patient data meta-analysis. The primary outcome was all-cause mortality at day 28 after randomisation. This study is registered with PROSPERO (CRD42019125025). FINDINGS Among the 1031 studies identified, one study that met the eligibility criteria was excluded because the recruitment period was not recent enough, and ten (including 2143 patients) were included in the analysis. Individual patient data were available for nine studies (2083 patients), from which 1879 patients had severe acute kidney injury and were randomly allocated: 946 (50%) to the delayed RRT group and 933 (50%) to the early RRT group. 390 (42%) of 929 patients allocated to the delayed RRT group and who had available data did not receive RRT. The proportion of patients who died by day 28 did not significantly differ between the delayed RRT group (366 [44%] of 837) and the early RRT group (355 [43%] of 827; risk ratio 1·01 [95% CI 0·91 to 1·13], p=0·80), corresponding to an overall risk difference of 0·01 (95% CI -0·04 to 0·06). There was no heterogeneity across studies (I2=0%; τ2=0), and most studies had a low risk of bias. INTERPRETATION The timing of RRT initiation does not affect survival in critically ill patients with severe acute kidney injury in the absence of urgent indications for RRT. Delaying RRT initiation, with close patient monitoring, might lead to a reduced use of RRT, thereby saving health resources. FUNDING None.
Collapse
Affiliation(s)
- Stéphane Gaudry
- Département de Réanimation Médico-Chirurgicale, AP-HP Hôpital Avicenne, Bobigny, France; Health Care Simulation Center, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France; Common and Rare Kidney Diseases, Sorbonne Université, INSERM, UMR-S 1155, Paris, France; Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, Bobigny, France
| | - David Hajage
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France
| | - Nicolas Benichou
- Common and Rare Kidney Diseases, Sorbonne Université, INSERM, UMR-S 1155, Paris, France
| | - Khalil Chaïbi
- Common and Rare Kidney Diseases, Sorbonne Université, INSERM, UMR-S 1155, Paris, France
| | - Saber Barbar
- Département de Réanimation Médicale, Hôpital Carémeau, Nîmes, France
| | - Alexander Zarbock
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Nuttha Lumlertgul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Critical Care Nephrology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Ron Wald
- Division of Nephrology, St Michael's Hospital and the University of Toronto, Toronto, ON, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Critical Care Nephrology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Excellence Center for Critical Care Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Academy of Science, Royal Society of Thailand, Bangkok, Thailand
| | - Alain Combes
- INSERM, UMR-S 1166 ICAN, Institute of Cardiometabolism and Nutrition, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, AP-HP Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Guillaume Geri
- Service de Médecine Intensive Réanimation, AP-HP Hôpital Ambroise Paré, Université Paris-Saclay, INSERM UMR 1018, Paris, France
| | - Tukaram Jamale
- Department of Nephrology, Seth GS Medical College, KEM Hospital, Mumbai, India
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France; Department of Lipness Team, INSERM Research Center LNC-UMR 1231 and LabExLipSTIC, University of Burgundy, Dijon, France; Department of Clinical Epidemiology, INSERM CIC 1432, University of Burgundy, Dijon, France
| | - Didier Dreyfuss
- Common and Rare Kidney Diseases, Sorbonne Université, INSERM, UMR-S 1155, Paris, France; Médecine Intensive-Réanimation, Université de Paris, AP-HP Hôpital Louis Mourier, Colombes, France.
| |
Collapse
|
24
|
Demicheli R, Desmedt C, Retsky M, Sotiriou C, Piccart M, Biganzoli E. Late effects of adjuvant chemotherapy adumbrate dormancy complexity in breast cancer. Breast 2020; 52:64-70. [PMID: 32428688 PMCID: PMC7375586 DOI: 10.1016/j.breast.2020.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 12/18/2022] Open
Abstract
Background Dormant avascular micrometastases and single, or small groups of, non-proliferating cells are currently assumed to explain the multipeak dynamics of distant metastases (DM) following primary breast cancer surgical removal. Methods The hazard rate pattern for DM was analysed in 1518 premenopausal node-positive patients, enrolled in a series of randomized clinical trials on early breast cancer, which were carried out in Italy and Belgium. Patients underwent surgery alone (n = 397) or surgery plus adjuvant chemotherapy (n = 1121) and the minimal follow up was 15 years. Results The DM hazard rate for patients undergoing surgery alone displayed two early sharp peaks at 9 and 33 months, a wide intermediate one spanning from about 50 to 90 months and a late peak at 115–120 months. Adjuvant chemotherapy was associated with a prominent reduction of the two early peaks leaving a residual one at about 18 months and a reduction of the intermediate peak leaving two small peaks at about 50 and 80 months. The late peak remained unchanged. Conclusions Present results reveal the ability of adjuvant chemotherapy to reduce not only the rate of early relapses, but also the rate of intermediate relapses at about the sixth year of follow up. Adjuvant chemotherapy is not impacting on the development of metastases underlying the late peak detected at the tenth year. These findings suggest the existence of a previously unknown dormancy state that, at the primary tumour surgical removal, results in evolving chemo-sensitive metastatic processes, and, moreover, of a later chemo-refractory dormancy state. Breast cancer removal wakes dormant micro foci causing peaks in recurrence dynamics. Recurrence dynamics in premenopausal patients displays four peaks during 10 years. Adjuvant chemo cuts peaks at years 1, 3, 6 while the peak at year 10 is unchanged. Data support a multiplicity of chemo sensitive and chemo refractory dormant states.
Collapse
Affiliation(s)
- Romano Demicheli
- Unit of Medical Statistics, Biometry and Bioinformatics "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan Campus Cascina Rosa, Fondazione IRCCS Istituto Nazionale Tumouri, Milan, Italy.
| | - Christine Desmedt
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, 3000, Leuven, Belgium.
| | - Mike Retsky
- Harvard School of Public Health, BLDG I, Rm 1311, 665 Huntington, Ave, Boston, MA 02115, USA.
| | - Christos Sotiriou
- Breast Cancer Translational Research Laboratory, Université Libre de Bruxelles, Institut Jules Bordet, 1000, Brussels, Belgium.
| | - Martine Piccart
- Department of Oncology, Université Libre de Bruxelles, Institut Jules Bordet, 1000, Brussels, Belgium.
| | - Elia Biganzoli
- Unit of Medical Statistics, Biometry and Bioinformatics "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan Campus Cascina Rosa, Fondazione IRCCS Istituto Nazionale Tumouri, Milan, Italy.
| |
Collapse
|
25
|
Wang CA, Hsieh YC, Huang CY, Liu JC, Hsieh MH, Lin YK, Yeh JS. Comparison between ticagrelor versus clopidogrel in long term outcomes of Taiwanese diabetic subjects with acute coronary syndrome undergoing successful revascularization: From TSOC ACS-DM registry. Medicine (Baltimore) 2020; 99:e19969. [PMID: 32384446 PMCID: PMC7220397 DOI: 10.1097/md.0000000000019969] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Although previous clinical trials demonstrated that ticagrelor could reduce cardiovascular events and mortality versus clopidogrel in patients with acute coronary syndrome (ACS), the real-world evidence of its clinical impacts on East Asian Diabetic population has rarely been investigated.Between November 2013 and June 2015, 1534 patients were recruited into the Acute Coronary Syndrome-Diabetes Mellitus Registry of the Taiwan Society of Cardiology (TSOC ACS-DM registry). After propensity score matching, a total of 730 patients undergoing successful revascularization and discharged on ticagrelor (N = 365) or clopidogrel (N = 365) were analyzed. The primary and secondary endpoints were all-cause mortality and re-hospitalization, respectively. The all-cause death associated with ticagrelor vs clopidogrel was 3.6% vs 7.4% (adjusted hazard ratio (HR) 0.34 [0.15-0.80]; P = .0138) at 24 months. The re-hospitalization rate at 24 months was 38.9% vs 39.2% (P = .3258).For diabetic patients with ACS, ticagrelor provided better survival benefit than clopidogrel without an increase of re-hospitalization in 24 months after successful percutaneous coronary intervention. This study in real-world circumstance provided valuable complementary data to externally validate platelet inhibition and patient outcomes (PLATO) finding especially in Asian diabetic population.
Collapse
Affiliation(s)
- Cheng-An Wang
- Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei Municipal Wan-Fang Hospital, Taipei
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei
- Taipei Heart Institute
| | - Yi-Chen Hsieh
- Ph.D Program of Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University
- Ph.D Program in Biotechnology Research and Development, College of Pharmacy, Taipei Medical University
- Master Program in Applied Molecular Epidemiology, College of Public Health, Taipei Medical University
| | - Chun-Yao Huang
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei
- Taipei Heart Institute
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei
| | - Ju-Chi Liu
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei
- Taipei Heart Institute
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taiwan
| | - Ming-Hsiung Hsieh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei Municipal Wan-Fang Hospital, Taipei
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei
- Taipei Heart Institute
| | - Yung-Kuo Lin
- Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei Municipal Wan-Fang Hospital, Taipei
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei
- Taipei Heart Institute
| | - Jong-Shiuan Yeh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei Municipal Wan-Fang Hospital, Taipei
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei
- Taipei Heart Institute
| |
Collapse
|
26
|
Hallensleben ND, Umans DS, Bouwense SAW, Verdonk RC, Romkens TEH, Witteman BJ, Schwartz MP, Spanier MB, Laheij R, van Santvoort HC, Besselink MG, van Hooft JE, Bruno MJ. The diagnostic work-up and outcomes of 'presumed' idiopathic acute pancreatitis: A post-hoc analysis of a multicentre observational cohort. United European Gastroenterol J 2020; 8:340-350. [PMID: 32213015 PMCID: PMC7184667 DOI: 10.1177/2050640619890462] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 08/15/2019] [Accepted: 10/28/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION After standard diagnostic work-up, the aetiology of acute pancreatitis remains unknown in 16-27% of cases, a condition referred to as idiopathic acute pancreatitis (IAP). Determining the aetiology of pancreatitis is essential, as it may direct treatment in the acute phase and guides interventions to prevent recurrent pancreatitis. METHODS Between 2008 and 2015, patients with acute pancreatitis were registered prospectively in 19 Dutch hospitals. Patients who had a negative initial diagnostic work-up with regard to the underlying aetiology of their pancreatitis were labelled 'presumed' IAP. The aim of this study was to assess the use of diagnostic modalities and their yield to establish an aetiology in 'presumed' IAP, and to assess recurrence rates both with and without treatment. RESULTS Out of the 1632 registered patients, 191 patients had a first episode of 'presumed' IAP, of whom 176 (92%) underwent additional diagnostic testing: CT (n = 124, diagnostic yield 8%), EUS (n = 62, yield 35%), MRI/MRCP (n = 56, yield 33%), repeat ultrasound (n = 97, yield 21%), IgG4 (n = 54, yield 9%) and ERCP (n = 15, yield 47%). In 64 of 176 patients (36%) an aetiological diagnosis was established, mostly biliary (n = 39). In 13 out of 176 of patients (7%) a neoplasm was diagnosed. If additional diagnostic workup revealed an aetiology, the recurrence rate was lower in the treated patients than in the patients without a definite aetiology (15% versus 43%, p = 0.014). CONCLUSION Additional diagnostic testing revealed an aetiology in one-third of 'presumed' IAP patients. The aetiology found was mostly biliary, but occasionally neoplasms were found. Identification of an aetiology with subsequent treatment reduced the rate of recurrence.
Collapse
Affiliation(s)
- Nora D Hallensleben
- Department of Gastroenterology, Erasmus
MC University Medical Centre, Rotterdam, the Netherlands
- Department of Research and Development,
St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Devica S Umans
- Department of Research and Development,
St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Gastroenterology,
Amsterdam UMC, Amsterdam, the Netherlands
| | - Stefan AW Bouwense
- Department of Surgery, Radboud
University Medical Centre, Nijmegen, the Netherlands
| | - Robert C Verdonk
- Department of Gastroenterology, St
Antonius Hospital, Nieuwegein, the Netherlands
| | - Tessa EH Romkens
- Department of Gastroenterology, Jeroen
Bosch Hospital, ‘s Hertogenbosch, the Netherlands
| | - Ben J Witteman
- Department of Gastroenterology, Gelderse
Vallei Hospital, Ede, the Netherlands
| | - Matthijs P Schwartz
- Department of Gastroenterology, Meander
Medical Centre, Amersfoort, the Netherlands
| | - Marcel B Spanier
- Department of Gastroenterology,
Rijnstate Hospital, Arnhem, the Netherlands
| | - Robert Laheij
- Department of Gastroenterology, St.
Elisabeth – Tweesteden Hospital, Tilburg, the Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, St. Antonius
Hospital, Nieuwegein, the Netherlands
- Department of Surgery, University
Medical Centre, Utrecht, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC,
Amsterdam, the Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology,
Amsterdam UMC, Amsterdam, the Netherlands
| | - Marco J Bruno
- Department of Gastroenterology, Erasmus
MC University Medical Centre, Rotterdam, the Netherlands
| | | |
Collapse
|
27
|
Voultsos P, Tsamadou E, Karakasi MV, Raikos N, Pavlidis P. Involuntary psychiatric hospitalization of children and adolescents in Northern Greece: Retrospective epidemiological study and related ethical issues. Psychiatriki 2020; 31:129-139. [PMID: 32840217 DOI: 10.22365/jpsych.2020.312.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of the present study was to investigate epidemiological data on involuntary hospitalization of underage patients in psychiatric settings and illustrate the related ethical issues. The medical records of 131 involuntary psychiatric admissions of children and adolescents ordered by public prosecutor between 2005 and 2014 were examined carefully. The examined variables involved the place of origin, the place of residence of minors after discharge, the length of stay in hospitals, the discharge diagnosis, the rate at which the minors were introduced to police and other authorities before their hospitalization, and the results of the neuropsychological assessment (WISC II). Data were analyzed by SPSS (Statistical Package for the Social Sciences). The mean age of the minors was 14.19 years (Male: Female ratio; 1.6:1). First, a high rate of incidences of compulsory admissions was found [5-year period (2005-2009):(2010-2014) ratio; 1:1.85] most likely due to organizational factors, which, however, could have been avoided in a more patient-oriented healthcare system. It is most likely that the criteria used for making decisions in favor of compulsory admissions were disproportionately (unduly) broad. In parallel, it was observed that, during 2010-2014, despite the increase in the rate of the prosecutor's orders, there was a decrease in the duration of coercive hospitalization of minors in psychiatric departments of hospitals in comparison to the period 2005-2009 [5-year period duration of hospitalization (2005-2009):(2010-2014) ratio; 2.33:1]. Furthermore, family was found likely to wield considerable influence on the decision-making for compulsory admissions. In addition, the effectiveness of a compulsory hospitalization of minors in a child and adolescent psychiatry department was found largely dependent on the type of the underlying mental health problem. In that respect, low rates of recidivism (7.6%) indicated that the measure of involuntary hospitalization was necessary and effective. It was also observed that the short-term removal of the minor from the family environment was a potentially relieving strategy for both the child and the family apart from the need for therapeutic intervention. The paper concludes by highlighting the role of a multi-stakeholder decision-making process (which entails shared decision-making as an integral component of providing mental healthcare to minors) in facilitating a decision about involuntary psychiatric hospitalization that is proportional and respectful to patient autonomy.
Collapse
Affiliation(s)
- P Voultsos
- Laboratory of Forensic Medicine and Toxicology, Faculty of Medicine, Aristotle University, Thessaloniki
| | - E Tsamadou
- Department of Child & Adolescent Psychiatry, Hippokration General Hospital of Thessaloniki, Thessaloniki
| | - M-V Karakasi
- Third University Department of Psychiatry, AHEPA University General Hospital-Department of Mental Health, Aristotle University-Faculty of Medicine, Thessaloniki
- Laboratory of Forensic Sciences, Democritus University of Thrace, School of Medicine, Alexandroupolis, Greece
| | - N Raikos
- Laboratory of Forensic Medicine and Toxicology, Faculty of Medicine, Aristotle University, Thessaloniki
| | - P Pavlidis
- Laboratory of Forensic Sciences, Democritus University of Thrace, School of Medicine, Alexandroupolis, Greece
| |
Collapse
|
28
|
Levine MD, Emery RL, Kolko Conlon RP, Marcus MD, Germeroth LJ, Salk RH, Cheng Y. Depressive Symptoms Assessed Near the End of Pregnancy Predict Differential Response to Postpartum Smoking Relapse Prevention Intervention. Ann Behav Med 2020; 54:119-124. [PMID: 31219152 PMCID: PMC7170725 DOI: 10.1093/abm/kaz026] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depressive symptoms are prevalent during pregnancy and the postpartum period and affect risk for smoking relapse. Whether and how depression affects response to postpartum interventions designed to sustain smoking abstinence is unknown. PURPOSE We examined end-of-pregnancy depressive symptoms as a moderator of response to two postpartum-adapted smoking relapse prevention interventions. METHODS Women (N = 300) who quit smoking during pregnancy were randomized to receive either a postpartum intervention focused on psychosocial factors linked to postpartum smoking (Strategies to Avoid Returning to Smoking [STARTS]) or an attention-controlled comparison intervention (SUPPORT). Women completed the Edinburgh Postnatal Depression Scale at the end of pregnancy. Smoking status was biochemically assessed at the end of pregnancy and at 12, 24, and 52 weeks postpartum. RESULTS End-of-pregnancy depressive symptoms moderated response to postpartum smoking relapse prevention interventions (χ2 = 10.18, p = .001). After controlling for variables previously linked to postpartum smoking relapse, women with clinically significant end-of-pregnancy depressive symptoms (20%) were more likely to sustain abstinence through 52 weeks postpartum if they received STARTS. In contrast, women with few end-of-pregnancy depressive symptoms were more likely to sustain abstinence through 52 weeks postpartum if they received SUPPORT. Changes in the psychosocial factors addressed in the STARTS intervention did not mediate this moderation effect. CONCLUSION Assessment of end-of-pregnancy depressive symptoms may help determine success following postpartum smoking relapse prevention interventions. Women with elevated end-of-pregnancy depressive symptoms benefited from postpartum relapse prevention intervention tailored to their psychosocial needs, while those with few symptoms were more successful in postpartum intervention that used standard behavioral components. CLINICAL TRIAL REGISTRATION NCT00757068.
Collapse
Affiliation(s)
- Michele D Levine
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rebecca L Emery
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rachel P Kolko Conlon
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Marsha D Marcus
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lisa J Germeroth
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rachel H Salk
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yu Cheng
- Department of Statistics and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
29
|
Wotring A, Paprzycki P, Wagner-Green V, Wygonik QR, Blavos AA, Kruger J, Castor T, Diehr AJ, Glassman TJ. Primary versus secondary prevention messages: College students' perceptions of effectiveness by marijuana user status. J Am Coll Health 2019; 67:743-752. [PMID: 30240330 DOI: 10.1080/07448481.2018.1506790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/14/2018] [Revised: 06/04/2018] [Accepted: 07/26/2018] [Indexed: 06/08/2023]
Abstract
Objective: With medical and recreational marijuana legislation expanding throughout the country, the need to educate high-risk populations is evident. The purpose of this study was to assess college students' perceptions of health communication messages comparing primary and secondary prevention messages concerning marijuana. Participants: Participants (n = 487) included college students, ages 18-25, enrolled in a Midwestern University. Methods: Participants assessed messages based on likeability, creativity, believability, persuasiveness, relevance, and usefulness using an online questionnaire that also included open-end comments. Results: Rasch analyses indicate that nonmarijuana users rated primary prevention messages higher than secondary prevention messages, whereas marijuana users ranked secondary prevention messages more favorably than primary prevention messages. Conclusion: Interventions designed to address marijuana use among college students may be more effective if tailored toward user status. Specifically, primary prevention materials should be designed for abstainers, while secondary prevention messages that focus on harm reduction strategies should be used with marijuana users.
Collapse
Affiliation(s)
- Amy Wotring
- University of Toledo, School of Population Health, College of Health & Human Services, Toledo, Ohio, USA
| | - Peter Paprzycki
- Department of Educational Research and Administration, Dissertation Research Support Center, The University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Victoria Wagner-Green
- University of Toledo, School of Population Health, College of Health & Human Services, Toledo, Ohio, USA
| | - Quri R Wygonik
- University of Toledo, School of Population Health, College of Health & Human Services, Toledo, Ohio, USA
| | | | - Jessica Kruger
- SUNY at Buffalo, Community Health and Health Behavior, Buffalo, New York, USA
| | - Tom Castor
- University of Toledo, School of Population Health, College of Health & Human Services, Toledo, Ohio, USA
| | - Aaron J Diehr
- Department of Public Health & Recreation Professions, Southern Illinois University, Carbondale, Illinois, USA
| | - Tavis J Glassman
- University of Toledo, School of Population Health, College of Health & Human Services, Toledo, Ohio, USA
| |
Collapse
|
30
|
Magrath M, Yang E, Ahn C, Mayorga CA, Gopal P, Murphy CC, Gupta S, Agrawal D, Halm EA, Borton EK, Skinner CS, Singal AG. Impact of a Clinical Decision Support System on Guideline Adherence of Surveillance Recommendations for Colonoscopy After Polypectomy. J Natl Compr Canc Netw 2019; 16:1321-1328. [PMID: 30442733 DOI: 10.6004/jnccn.2018.7050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/29/2018] [Indexed: 02/06/2023]
Abstract
Background: Surveillance colonoscopy is required in patients with polyps due to an elevated colorectal cancer (CRC) risk; however, studies suggest substantial overuse and underuse of surveillance colonoscopy. The goal of this study was to characterize guideline adherence of surveillance recommendations after implementation of an electronic medical record (EMR)-based Colonoscopy Pathology Reporting and Clinical Decision Support System (CoRS). Methods: We performed a retrospective cohort study of patients who underwent colonoscopy with polypectomy at a safety-net healthcare system before (n=1,822) and after (n=1,320) implementation of CoRS in December 2013. Recommendations were classified as guideline-adherent or nonadherent according to the US Multi-Society Task Force on CRC. We defined surveillance recommendations shorter and longer than guideline recommendations as potential overuse and underuse, respectively. We used multivariable generalized linear mixed models to identify correlates of guideline-adherent recommendations. Results: The proportion of guideline-adherent surveillance recommendations was significantly higher post-CoRS than pre-CoRS (84.6% vs 77.4%; P<.001), with fewer recommendations for potential overuse and underuse. In the post-CoRS period, CoRS was used for 89.8% of cases and, compared with cases for which it was not used, was associated with a higher proportion of guideline-adherent recommendations (87.0% vs 63.4%; RR, 1.34; 95% CI, 1.23-1.42). In multivariable analysis, surveillance recommendations were also more likely to be guideline-adherent in patients with adenomas but less likely among those with fair bowel preparation and those with family history of CRC. Of 203 nonadherent recommendations, 70.4% were considered potential overuse, 20.2% potential underuse, and 9.4% were not provided surveillance recommendations. Conclusions: An EMR-based CoRS was widely used and significantly improved guideline adherence of surveillance recommendations.
Collapse
|
31
|
Cui Y, Lix LM, Yang S, Morin SN, Leslie WD. A population-based study of postfracture care in Manitoba, Canada 2000/2001-2014/2015. Osteoporos Int 2019. [PMID: 31267162] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
UNLABELLED We previously found that population-based postfracture notification, which informed primary care physicians of their patient's recent fracture and suggested assessment for osteoporosis, led to an improvement in postfracture care in the context of a randomized controlled trial ( ClinicalTrials.gov identifier NCT00594789, fractures from late 2007 to mid-2010). Since June 2010, a province-wide postfracture notification program was implemented. This study was to (1) determine whether this program has resulted in sustained improvement in postfracture care and (2) test factors associated with receiving osteoporosis care. METHODS A retrospective matched cohort study was performed using population-based health administrative data in Manitoba, Canada. We selected individuals aged 50+ years with an incident major osteoporosis fracture (MOF; N = 18,541) in fiscal years 2000/2001 to 2013/2014 and controls without a MOF (N = 92,705) matched (5:1) on age, sex, and residential area. The Cochran-Armitage test tested for a linear trend in osteoporosis care outcomes for cases and controls. Logistic regressions were used to test characteristics associated with the likelihood of receiving osteoporosis care. RESULTS The percentage of individuals receiving DXA testing and/or osteoporosis medication increased in fracture cases (p < 0.001), but decreased in controls (p < 0.001). Odds ratios for osteoporosis care in years following the postfracture notification program were approximately double of those prior to the clinical trial. In addition to prior MOF (OR 9.03, 95% CI 8.60-9.48), factors associated with osteoporosis care included lower income (OR 0.72, 95% CI 0.67-0.78), glucocorticoid use (OR 4.37, 95% CI 3.72-5.14), diabetes diagnosis (OR = 0.74, 95% CI 0.68-0.80), and Charlson Comorbidity Index (indexes 1-2: OR 1.27, 95% CI 1.20-1.34; indexes 3-5: OR 1.26, 95% CI 1.13-1.40). CONCLUSIONS Adopting a population-based postfracture notification program led to sustained improvements in postfracture care.
Collapse
Affiliation(s)
- Y Cui
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - L M Lix
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - S N Morin
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - W D Leslie
- Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0W3, Canada.
| |
Collapse
|
32
|
Mert GÖ, Başaran Ö, Mert KU, Doğan V, Özlek B, Çelik O, Özlek E, Çil C, Özdemir İH, Rencüzoğulları İ, Karadeniz FÖ, Bekar L, Aktaş M, Resulzade MM, Kalçık M, Aksan G, Çinier G, Akay K, Pekel N, Şenol U, Biteker M, Kayıkçıoğlu M. The reasons of poor lipid target attainment for secondary prevention in real life practice: Results from EPHESUS. Int J Clin Pract 2019; 73:1-9. [PMID: 31038781 DOI: 10.1111/ijcp.13358] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/09/2019] [Accepted: 04/26/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE There are lack of studies considering the suboptimal management of dyslipidemia especially in cardiology outpatient clinics. This study was conducted to assess the patient adherence to cholesterol treatment recommendations and attainment of low-density-lipoprotein cholesterol (LDL-C) goals. METHODS EPHESUS (NCT02608645) is a national, observational and multicenter registry which has been designed as a cross-sectional study to allow inclusion of all consecutive patients with hypercholesterolemia in cardiology outpatient clinics. The present subgroup analyses of the EPHESUS trial included patients with known peripheral artery disease or atherosclerotic cerebrovascular disease, and coronary heart disease namely secondary prevention. RESULTS The present analysis of the EPHESUS study included 1482 patients (62.79 ± 10.4 years, 38.2% female) with secondary prevention from 40 sites in Turkey. Regarding recommended lipid targets for LDL-C, only 267 patients (18%) were below the target of 70 mg/dL. Females were significantly more off-target when compared with male patients (396, 85.5% vs 67, 14.5%; P = 0.017). Moreover, the achievement of LDL-C goal was significantly decreased with illiteracy (233, 19.2% vs 35, 13.1%; P = 0.02). Patients who think that the cholesterol treatment should be terminated when the cholesterol level of a patient has normalised were higher in the off-target group (34.0% vs 24.7%, P < 0.001). Besides, physician perceptions about LDL-C goal for secondary prevention were significantly related with LDL-C target attainment. CONCLUSIONS EPHESUS is an important study with large population in terms of representing real-life practice of the adherence to dyslipidemia guidelines in secondary prevention patients in Turkey. Perceptions, knowledge, and compliance with the guidelines for secondary prevention have increased, but it is far below from the desired levels even in cardiology outpatient clinics. There is a need for patients' and physicians' education regarding the treatment of hyperlipidemia.
Collapse
Affiliation(s)
- Gurbet Özge Mert
- Department of Cardiology, Eskişehir Yunus Emre State Hospital, Eskişehir, Turkey
| | - Özcan Başaran
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Kadir Uğur Mert
- Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Volkan Doğan
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Bülent Özlek
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Eda Özlek
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Cem Çil
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | | | | | | | - Lütfü Bekar
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Müjdat Aktaş
- Department of Cardiology, Faculty of Medicine Regional Training and Research Hospital, Kocaeli University, Kocaeli, Turkey
| | | | - Macit Kalçık
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Gökhan Aksan
- Department of Cardiology, Sıslı Hamıdıye Etfal Research and Training Hospital, İstanbul, Turkey
| | - Göksel Çinier
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, İstanbul, Turkey
| | - Kadriye Akay
- Department of Cardiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - Nihat Pekel
- Department of Cardiology, Tekden Private Hospital, Denizli, Turkey
| | - Utku Şenol
- Department of Cardiology, Eskisehir Acıbadem Hospital, Eskişehir, Turkey
| | - Murat Biteker
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Meral Kayıkçıoğlu
- Department of Cardiology, Ege University Faculty of Medicine, İzmir, Turkey
| |
Collapse
|
33
|
Kristensen PK, Ehrenstein V, Shetty N, Pedersen AB. Use of anti-osteoporosis medication dispensing by patients with hip fracture: could we do better? Osteoporos Int 2019; 30:1817-1825. [PMID: 31263921 DOI: 10.1007/s00198-019-05066-8] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
UNLABELLED Although Scandinavian countries have the highest incidence of hip fracture in the world, trends in anti-osteoporosis medication use have not been studied. We found less than one-third of Danish hip fracture patients had dispensing of anti-osteoporosis medication over a 10-year period using routinely collected data from population-based registries. INTRODUCTION To examine trend in dispensing of anti-osteoporosis medication before and after hip fracture surgery in Denmark over a 10-year period using routinely collected data from population-based registries. METHODS From the Danish Multidisciplinary Hip Fracture Registry, we included 65,011 patients aged 65 years or older with an incident hip fracture in 2005-2015. We calculated, for each calendar year of hip fracture diagnosis, the prevalence of use of anti-osteoporosis medication (at least one dispensing of bisphosphonates, strontium ranelate, denosumab, selective estrogen receptor modulators, or teriparatide) in the year before and in the year following hip fracture diagnosis. Among those without a dispensing in the year before hip fracture, we computed 1-year cumulative incidence of use following hip fracture. We treated death as a competing risk and stratified the analysis on sex, age, and comorbidity. RESULTS The prevalence of use before hip fracture varied between 7 and 12%, increasing slightly from 2005 to 2015. The cumulative incidence of use following hip fracture decreased from 16% in 2005 to 13% in 2010, whereupon it increased to 20%. A similar pattern was seen with each stratum of sex, age groups, and comorbidity. The overall prevalence of use after hip fracture was below 22% in all calendar years. CONCLUSIONS Less than one-third of hip fracture patients had dispensing of anti-osteoporosis medication up to 1 year after hip fracture. We observed only a slight increase in dispensing after hip fracture over the study period, irrespective of patient sex, age, and comorbidity at the time of hip fracture.
Collapse
Affiliation(s)
- P K Kristensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark.
- Department of Orthopaedic Surgery, Horsens Regional Hospital, Sundvej 30, DK-8700, Horsens, Denmark.
| | - V Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark
| | - N Shetty
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark
- Department of Bioscience, Applied Marine Ecology and Modelling, Frederiksborgvej 399, building B1.18, 4000, Roskilde, Denmark
| | - A B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark
| |
Collapse
|
34
|
Gaziano TA, Pandya A, Sy S, Jardim TV, Ogden JM, Rodgers A, Weinstein MC. Modeling the cost effectiveness and budgetary impact of Polypills for secondary prevention of cardiovascular disease in the United States. Am Heart J 2019; 214:77-87. [PMID: 31174054 DOI: 10.1016/j.ahj.2019.04.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 04/26/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is underutilization of appropriate medications for secondary prevention of cardiovascular disease (CVD). METHODS Usual care (UC) was compared to polypill-based care with 3 versions using a validated micro-simulation model in the NHANES population with prior CVD. UC included individual prescription of up to 4 drug classes (antiplatelet agents, beta-blockers, renin-angiotensin-aldosterone inhibitors and statins). The polypills modeled were aspirin 81 mg, atenolol 50 mg, ramipril 5 mg, and either simvastatin 40 mg (Polypill I), atorvastatin 80 mg (Polypill II), or rosuvastatin 40 mg (Polypill III). Baseline medication use and adherence came from United Healthcare claims data. RESULTS When compared to UC, there were annual reductions of 130,000 to 178,000 myocardial infarctions and 54,000 to 74,000 strokes using Polypill I and II, respectively. From a health sector perspective, in incremental analysis the ICERs for Polypill I and II were $20,073/QALY and $21,818/QALY respectively; Polypill III was dominated but had a similar cost-effectiveness ratio to Polypill II when compared directly to usual care. From a societal perspective, Polypill II was cost-saving and dominated all strategies. Over a 5-year period, those taking Polypill I and II compared to UC saved approximately $12 and $6 per-patient-per-year alive, respectively. Polypill II was the preferred strategy in 98% of runs at a willingness to pay of $50,000 in the probability sensitivity analysis. CONCLUSIONS Use of a polypill has a favorable cost profile for secondary CVD prevention in the United States. Reductions in CVD-related healthcare costs outweighed medication cost increases on a per-patient-per-year basis, suggesting that a polypill would be economically advantageous to both patients and payers.
Collapse
Affiliation(s)
- Thomas A Gaziano
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA.
| | - Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Stephen Sy
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Thiago Veiga Jardim
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jenna M Ogden
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | | | - Milton C Weinstein
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| |
Collapse
|
35
|
Gürünlüoğlu K, Yıldırım İO, Kutlu R, Saraç K, Sığırcı A, Bağ HG, Demircan M. Advantages of early intervention with arterial embolization for intra-abdominal solid organ injuries in children. Diagn Interv Radiol 2019; 25:310-319. [PMID: 31199287 PMCID: PMC6622444 DOI: 10.5152/dir.2019.18559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Active bleeding due to abdominal trauma is an important cause of mortality in childhood. The aim of this study is to demonstrate the advantages of early percutaneous transcatheter arterial embolization (PTAE) procedures in children with intra-abdominal hemorrhage due to blunt trauma. METHODS Children with blunt abdominal trauma were retrospectively included. Two groups were identified for inclusion: patients with early embolization (EE group, n=10) and patients with late embolization (LE group, n=11). Both groups were investigated retrospectively and statistically analyzed with regard to lengths of stay in the intensive care unit and in the hospital, first enteral feeding after trauma, blood transfusion requirements, and cost. RESULTS The duration of stay in the intensive care unit was greater in the LE group than in the EE group (4 days vs. 2 days, respectively). The duration of hospital stay was greater in the LE group than in the EE group (14 days vs. 6 days, respectively). Blood transfusion requirements (15 cc/kg of RBC packs) were greater in the LE group than in the EE group (3 vs. 1, respectively). The total hospital cost was higher in the LE group than in the EE group (4502 USD vs. 1371.5 USD, respectively). The time before starting enteral feeding after first admission was higher in the LE group than in the EE group (4 days vs. 1 day, respectively). CONCLUSION Early embolization with PTAE results in shorter intensive care and hospitalization stays, earlier enteral feeding, and lower hospital costs for pediatric patients with intra-abdominal hemorrhage due to blunt trauma.
Collapse
Affiliation(s)
- Kubilay Gürünlüoğlu
- From the Departments of Pediatric Surgery (K.G., M.D. ), Radiology (İ.O.Y., R.K., K.S., A.S.) and Biostatistics and Medical Informatics (H.G.B.), İnönü University School of Medicine, Malatya, Turkey
| | - İsmail Okan Yıldırım
- From the Departments of Pediatric Surgery (K.G., M.D. ), Radiology (İ.O.Y., R.K., K.S., A.S.) and Biostatistics and Medical Informatics (H.G.B.), İnönü University School of Medicine, Malatya, Turkey
| | - Ramazan Kutlu
- From the Departments of Pediatric Surgery (K.G., M.D. ), Radiology (İ.O.Y., R.K., K.S., A.S.) and Biostatistics and Medical Informatics (H.G.B.), İnönü University School of Medicine, Malatya, Turkey
| | - Kaya Saraç
- From the Departments of Pediatric Surgery (K.G., M.D. ), Radiology (İ.O.Y., R.K., K.S., A.S.) and Biostatistics and Medical Informatics (H.G.B.), İnönü University School of Medicine, Malatya, Turkey
| | - Ahmet Sığırcı
- From the Departments of Pediatric Surgery (K.G., M.D. ), Radiology (İ.O.Y., R.K., K.S., A.S.) and Biostatistics and Medical Informatics (H.G.B.), İnönü University School of Medicine, Malatya, Turkey
| | - Harika Gözükara Bağ
- From the Departments of Pediatric Surgery (K.G., M.D. ), Radiology (İ.O.Y., R.K., K.S., A.S.) and Biostatistics and Medical Informatics (H.G.B.), İnönü University School of Medicine, Malatya, Turkey
| | - Mehmet Demircan
- From the Departments of Pediatric Surgery (K.G., M.D. ), Radiology (İ.O.Y., R.K., K.S., A.S.) and Biostatistics and Medical Informatics (H.G.B.), İnönü University School of Medicine, Malatya, Turkey
| |
Collapse
|
36
|
Thørrisen MM, Skogen JC, Kjeken I, Jensen I, Aas RW. Current practices and perceived implementation barriers for working with alcohol prevention in occupational health services: the WIRUS OHS study. Subst Abuse Treat Prev Policy 2019; 14:30. [PMID: 31242911 PMCID: PMC6595559 DOI: 10.1186/s13011-019-0217-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/18/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Alcohol is associated with detrimental health and work performance outcomes, and one to three out of ten employees may benefit from interventions. The role of occupational health services (OHS) in alcohol prevention has received little attention in research. The primary aims of this study were to explore current practices of alcohol prevention targeting employees in occupational health settings, and examine whether and which perceived implementation barriers were associated with alcohol prevention activity. The secondary aim was to explore whether barriers were differentially associated with primary, secondary and tertiary prevention activities. METHODS In this cross-sectional study, survey data were collected from 295 OHS professionals in Norway in 2018. Data were analysed by means of descriptive statistics, one-way analysis of variance, paired samples t-tests, and multivariate linear regression analyses. RESULTS Overall, seven out of ten OHS professionals worked with alcohol-related cases less than monthly, while only one out of ten did so on a weekly basis. Their activities were more focused on tertiary prevention than on primary and secondary prevention. Physicians, psychologists and nurses reported to handle alcohol-related issues more often than occupational therapists and physical therapists. Higher levels of implementation barriers internal to the OHS' organisation (competence, time and resources) were associated with lower alcohol prevention activity. Barriers external to the OHS' organisation (barriers concerning employers and employees) were not. This pattern was evident for primary, secondary and tertiary prevention activities. A majority of OHS professionals agreed that employees' alcohol consumption constitute a public health challenge, and that OHS' should focus more on alcohol prevention targeting employees. CONCLUSIONS Occupational health settings at workplaces may be particularly serviceable for alcohol prevention programmes since the majority of the population is employed and the majority of employees consume alcohol. An increase in overall prevention activity, and a shift from mainly focusing on tertiary prevention to an increased emphasis on primary and secondary prevention, may both hinge on increased training of OHS professionals, emphasising knowledge on the importance of working with alcohol prevention, and training in administering alcohol prevention programmes. Making alcohol prevention a priority may also require increased allocation of time and resources.
Collapse
Affiliation(s)
- Mikkel Magnus Thørrisen
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, OsloMet – Oslo Metropolitan University, PO box 4 St. Olavs plass, NO-0130 Oslo, Norway
- Presenter – Making Sense of Science, PO box 8118, NO-4068 Stavanger, Norway
| | - Jens Christoffer Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, PO box 973, NO-5808 Bergen, Norway
- Center for Alcohol & Drug Research, Stavanger University Hospital, PO box 8100, NO-4068 Stavanger, Norway
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, PO box 8600, Forus, NO-4036 Stavanger, Norway
| | - Ingvild Kjeken
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, OsloMet – Oslo Metropolitan University, PO box 4 St. Olavs plass, NO-0130 Oslo, Norway
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, PO box 23, Vindern, NO-0319 Oslo, Norway
| | - Irene Jensen
- Institute of Environmental Medicine, Division of Intervention and Implementation Research for Worker Health, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Randi Wågø Aas
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, OsloMet – Oslo Metropolitan University, PO box 4 St. Olavs plass, NO-0130 Oslo, Norway
- Presenter – Making Sense of Science, PO box 8118, NO-4068 Stavanger, Norway
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, PO box 8600, Forus, NO-4036 Stavanger, Norway
| |
Collapse
|
37
|
Miró Ò, Nayla Brizzi B, Aguiló S, Alemany X, Jacob J, Llorens P, Herrero Puente P, González Ramón B, Castro Jiménez V, Torres Machado V, Cenjor R, Gil A, Rico V, Martínez Nadal G, Lázaro Del Nogal M, Martín-Sánchez FJ. Profile of older patients attended in the emergency department after falls: a FALL-ER registry study of the magnitude of the problem and opportunities for improving hospital emergency care. Emergencias 2019; 30:231-240. [PMID: 30033696] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To profile patients aged 65 years or older who are attended in a hospital emergency department after falls. To describe the falls, their severity, and factors relevant to recommended preventive measures. MATERIAL AND METHODS The FALL-ER is a multipurpose, multicenter prospective registry of a systematically described cohort of patients aged 65 years or older attended in 5 hospital emergency departments on 52 days of the same year. We collected data on 68 independent variables. Patients were classified according to whether they had received recommendations related to preventing falls in any of the following categories: exercise, education on fall prevention, referral to a specialist or changes in medication. RESULTS . A total of 1507 patients or carers were interviewed (93.6% of the 1610 patients in the registry). The cohort was of advanced age and had high rates of comorbidity, polypharmacy, and history of geriatric syndromes. The majority of falls occurred during the day and in the patients home. Half the falls were not witnessed. Forty-eight percent of the patients reported fear of falling, 22% had acute functional impairment, 16% were admitted, and 0.6% died in the hospital. Recommendations directed to preventing falls were received by 509 (33.8%) cases. Loss of hearing acuity, self-reported cognitive impairment, emergency first aid at the site of the fall, fear of falling again, acute functional impairment, and hospitalization were associated with a greater likelihood of receiving recommendations for preventing falls. Loss of visual acuity was associated with a lower likelihood of receiving recommendations. CONCLUSION Only a third of elderly patients attended in an emergency department after falls receive recommendations that target preventing further falls. Certain patient and fall characteristics are associated with a greater likelihood of receiving such recommendations.
Collapse
Affiliation(s)
- Òscar Miró
- Área de Urgencias, Hospital Clínic, Barcelona, España. Universitat de Barcelona, Barcelona, España
| | | | - Sira Aguiló
- Área de Urgencias, Hospital Clínic, Barcelona, España
| | | | - Javier Jacob
- Servicio de Urgencias. Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Pere Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital Universitario General de Alicante, España. Universidad Miguel Hernández, Elche, Alicante, España
| | - Pablo Herrero Puente
- Servicio de Urgencias. Hospital Central de Asturias, España. Instituto de Investigación Sanitaria del Principado de Asturias, Asturias, España
| | | | | | | | - Raquel Cenjor
- Servicio de Urgencias. Hospital Central de Asturias, España
| | - Adriana Gil
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital Universitario General de Alicante, España
| | - Verònica Rico
- Área de Urgencias, Hospital Clínic, Barcelona, España
| | | | - Montserrat Lázaro Del Nogal
- Unidad de Caídas. Servicio de Geriatría del Hospital Clínico San Carlos. Madrid, España. Facultad de Medicina de la Universidad Complutense, Madrid, España
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España. Facultad de Medicina de la Universidad Complutense, Madrid, España. Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, España
| |
Collapse
|
38
|
Notley C, Brown TJ, Bauld L, Hardeman W, Holland R, Naughton F, Orton S, Ussher M. Development of a Complex Intervention for the Maintenance of Postpartum Smoking Abstinence: Process for Defining Evidence-Based Intervention. Int J Environ Res Public Health 2019; 16:E1968. [PMID: 31163663 PMCID: PMC6603989 DOI: 10.3390/ijerph16111968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 11/17/2022]
Abstract
Relapse to tobacco smoking for pregnant women who quit is a major public health problem. Evidence-based approaches to intervention are urgently required. This study aimed to develop an intervention to be integrated into existing healthcare. A mixed methods approach included a theory-driven systematic review identifying promising behaviour change techniques for targeting smoking relapse prevention, and qualitative focus groups and interviews with women (ex-smokers who had remained quit and those who had relapsed), their partners and healthcare professionals (N = 74). A final stage recruited ten women to refine and initially test a prototype intervention. Our qualitative analysis suggests a lack, but need for, relapse prevention support. This should be initiated by a trusted 'credible source'. For many women this would be a midwife or a health visitor. Support needs to be tailored to individual needs, including positive praise/reward, novel digital and electronic support and partner or social support. Advice and support to use e cigarettes or nicotine replacement therapy for relapse prevention was important for some women, but others remained cautious. The resulting prototype complex intervention includes face-to-face support reiterated throughout the postpartum period, tailored digital and self-help support and novel elements such as gifts and nicotine replacement therapy (NRT).
Collapse
Affiliation(s)
- Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Tracey J Brown
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH8 9YL, UK.
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Richard Holland
- Leicester Medical School, University of Leicester, Leicester LE1 7RH, UK.
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Sophie Orton
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK.
| | - Michael Ussher
- Population Health Research Institute, St George's, University of London, London WC1E 7HU, UK.
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK.
| |
Collapse
|
39
|
Kurowski A, Pransky G, Punnett L. Impact of a Safe Resident Handling Program in Nursing Homes on Return-to-Work and Re-injury Outcomes Following Work Injury. J Occup Rehabil 2019; 29:286-294. [PMID: 29785467 PMCID: PMC6422723 DOI: 10.1007/s10926-018-9785-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Purpose This study examined the impact of a Safe Resident Handling Program (SRHP) on length of disability and re-injury, following work-related injuries of nursing home workers. Resident handling-related injuries and back injuries were of particular interest. Methods A large national nursing home corporation introduced a SRHP followed by three years of training for 136 centers. Lost-time workers' compensation claims (3 years pre-SRHP and 6 years post-SRHP) were evaluated. For each claim, length of first episode of disability and recurrence of disabling injury were evaluated over time. Differences were assessed using Chi square analyses and a generalized linear model, and "avoided" costs were projected. Results The SRHP had no impact on length of disability, but did appear to significantly reduce the rate of recurrence among resident handling-related injuries. As indemnity and medical costs were three times higher for claimants with recurrent disabling injuries, the SRHP resulted in significant "avoided" costs due to "avoided" recurrence. Conclusions In addition to reducing overall injury rates, SRHPs appear to improve long-term return-to-work success by reducing the rate of recurrent disabling injuries resulting in work disability. In this study, the impact was sustained over years, even after a formal training and implementation program ended. Since back pain is inherently a recurrent condition, results suggest that SRHPs help workers remain at work and return-to-work.
Collapse
Affiliation(s)
- Alicia Kurowski
- Department of Biomedical Engineering, University of Massachusetts Lowell, 1 University Ave., Lowell, MA, 01854, USA.
| | - Glenn Pransky
- Department of Biomedical Engineering, University of Massachusetts Lowell, 1 University Ave., Lowell, MA, 01854, USA
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Laura Punnett
- Department of Biomedical Engineering, University of Massachusetts Lowell, 1 University Ave., Lowell, MA, 01854, USA
| |
Collapse
|
40
|
Al-Shahi Salman R, Murray GD, Dennis MS, Newby DE, Sandercock PAG, Sprigg N, Sudlow CLM, Werring DJ, White PM, Whiteley WN. The REstart or STop Antithrombotics Randomised Trial (RESTART) after stroke due to intracerebral haemorrhage: statistical analysis plan for a randomised controlled trial. Trials 2019; 20:183. [PMID: 30909946 PMCID: PMC6434884 DOI: 10.1186/s13063-019-3270-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/01/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND For adults surviving stroke due to spontaneous (non-traumatic) intracerebral haemorrhage (ICH) who had taken an antithrombotic (i.e. anticoagulant or antiplatelet) drug for the prevention of vaso-occlusive disease before the ICH, it is unclear whether starting antiplatelet therapy modifies the risks of recurrent ICH, major haemorrhagic events, major occlusive vascular events, or a composite of all major vascular events compared to avoiding antiplatelet therapy. METHODS/DESIGN The REstart or STop Antithrombotics Randomised Trial (RESTART) is an investigator-led, parallel group, open, assessor-blind, randomised trial comparing starting versus avoiding antiplatelet therapy for adults surviving antithrombotic-associated ICH. Recruitment began on 22 May 2013 and ended on 31 May 2018. Follow-up ended on 30 November 2018. This update to the protocol describes the statistical analysis plan (version 1.7, finalised on 25 January 2019). Database lock and un-blinding occurred on 29 January 2019, after which the un-masked trial statistician conducted the final analyses according to this statistical analysis plan. DISCUSSION Final results of RESTART will be analysed and disseminated in May 2019. TRIAL REGISTRATION ISRCTN registry 71907627 . Prospectively registered on 25 April 2013.
Collapse
Affiliation(s)
- Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Gordon D. Murray
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Martin S. Dennis
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
| | - David E. Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Peter A. G. Sandercock
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
| | - Nikola Sprigg
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Cathie L. M. Sudlow
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Philip M. White
- Institute of Neuroscience and Newcastle University Institute for Ageing, Newcastle-upon-Tyne, UK
| | - William N. Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
| |
Collapse
|
41
|
Proclemer A, Zecchin M, D'Onofrio A, Ricci RP, Boriani G, Rebellato L, Ghidina M, Bianco G, Bernardelli E, Miconi A, Zorzin AF, Gregori D. [The Pacemaker and Implantable Cardioverter-Defibrillator Registry of the Italian Association of Arrhythmology and Cardiac Pacing - Annual report 2017]. G Ital Cardiol (Rome) 2019; 20:136-148. [PMID: 30821295 DOI: 10.1714/3108.30963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The pacemaker (PM) and implantable cardioverter-defibrillator (ICD) Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) monitors the main epidemiological data in real-world practice. The survey for the 2017 activity collects information about demographics, clinical characteristics, main indications for PM/ICD therapy and device types from the Italian collaborating centers. METHODS The Registry collects prospectively national PM and ICD implantation activity on the basis of European cards. RESULTS PM Registry: data about 23 457 PM implantations were collected (19 378 first implant and 4079 replacements). The number of collaborating centers was 185. Median age of treated patients was 81 years (75 quartile I; 86 quartile III). ECG indications included atrioventricular conduction disorders in 37.1% of first PM implants, sick sinus syndrome in 19.5%, atrial fibrillation plus bradycardia in 13.2%, other in 30.2%. Among atrioventricular conduction defects, third-degree atrioventricular block was the most common type (21.0% of first implants). Use of single-chamber PMs was reported in 25.6% of first implants, of dual-chamber PMs in 66.7%, of PMs with cardiac resynchronization therapy (CRT) in 1.4%, and of single lead atrial-synchronized ventricular stimulation (VDD/R PMs) in 6.3%. ICD Registry: data about 19 023 ICD implantations were collected (13 898 first implants and 5125 replacements). The number of collaborating centers was 437. Median age of treated patients was 71 years (63 quartile I; 78 quartile III). Primary prevention indication was reported in 81.8% of first implants, secondary prevention in 18.2% (cardiac arrest in 6.4%). A single-chamber ICD was used in 27.0% of first implants, dual-chamber in 33.6% and biventricular in 39.3%. CONCLUSIONS The PM and ICD Registry appears fundamental for monitoring PM and ICD utilization on a large national scale with rigorous examination of demographics and clinical indications. The PM Registry showed stable electrocardiographic and symptom indications, with an important prevalence of dual-chamber pacing. The use of CRT-PM regards a very limited number of patients. The ICD Registry documented a large use of prophylactic and biventricular ICD, reflecting a favorable adherence to trials and guidelines in clinical practice. In order to increase and optimize the cooperation of Italian implanting centers, online data entry (http://www.aiac.it/riprid) should be adopted at large scale.
Collapse
Affiliation(s)
- Alessandro Proclemer
- S.O.C. Cardiologia e Fondazione IRCAB, Azienda Sanitaria Universitaria Integrata S. Maria della Misericordia, Udine
| | - Massimo Zecchin
- S.O.C. Cardiologia, Azienda Sanitaria Universitaria Integrata, Trieste
| | - Antonio D'Onofrio
- U.O.S.D. Aritmologia, A.O.R.N. dei Colli, Ospedale V. Monaldi, Napoli
| | | | | | - Luca Rebellato
- S.O.C. Cardiologia e Fondazione IRCAB, Azienda Sanitaria Universitaria Integrata S. Maria della Misericordia, Udine
| | - Marco Ghidina
- S.O.C. Cardiologia e Fondazione IRCAB, Azienda Sanitaria Universitaria Integrata S. Maria della Misericordia, Udine
| | - Giulia Bianco
- S.O.C. Cardiologia e Fondazione IRCAB, Azienda Sanitaria Universitaria Integrata S. Maria della Misericordia, Udine
| | - Emanuela Bernardelli
- S.O.C. Cardiologia e Fondazione IRCAB, Azienda Sanitaria Universitaria Integrata S. Maria della Misericordia, Udine
| | - Antonella Miconi
- S.O.C. Cardiologia e Fondazione IRCAB, Azienda Sanitaria Universitaria Integrata S. Maria della Misericordia, Udine
| | | | - Dario Gregori
- Dipartimento di Medicina Ambientale e Salute Pubblica, Università degli Studi, Padova
| |
Collapse
|
42
|
Minichino A, Rutigliano G, Merlino S, Davies C, Oliver D, De Micheli A, Patel R, McGuire P, Fusar-Poli P. Unmet needs in patients with brief psychotic disorders: Too ill for clinical high risk services and not ill enough for first episode services. Eur Psychiatry 2019; 57:26-32. [PMID: 30658277 DOI: 10.1016/j.eurpsy.2018.12.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with acute and transient psychotic disorders (ATPDs) are by definition remitting, but have a high risk of developing persistent psychoses, resembling a subgroup of individuals at Clinical High Risk for Psychosis (CHR-P). Their pathways to care, treatment offered and long-term clinical outcomes beyond risk to psychosis are unexplored. We conducted an electronic health record-based retrospective cohort study including patients with ATPDs within the SLaM NHS Trust and followed-up to 8 years. METHODS A total of 2561 ATPDs were included in the study. A minority were detected (8%) and treated (18%) by Early Intervention services (EIS) and none by CHR-P services. Patients were offered a clinical follow-up of 350.40 ± 589.90 days. The cumulative incidence of discharges was 40% at 3 months, 60% at 1 year, 69% at 2 years, 77% at 4 years, and 82% at 8 years. Treatment was heterogeneous: the majority of patients received antipsychotics (up to 52%), only a tiny minority psychotherapy (up to 8%). RESULTS Over follow-up, 32.88% and 28.54% of ATPDS received at least one mental health hospitalization or one compulsory hospital admission under the Mental Health Act, respectively. The mean number of days spent in psychiatric hospital was 66.39 ± 239.44 days. CONCLUSIONS The majority of ATPDs are not detected/treated by EIS or CHR-P services, receive heterogeneous treatments and short-term clinical follow-up. ATPDs have a high risk of developing severe clinical outcomes beyond persistent psychotic disorders and unmet clinical needs that are not targeted by current mental health services.
Collapse
Affiliation(s)
- Amedeo Minichino
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Grazia Rutigliano
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Sergio Merlino
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Cathy Davies
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Dominic Oliver
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Andrea De Micheli
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Rashmi Patel
- Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; OASIS Service, South London and the Maudsley NHS Foundation Trust, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| |
Collapse
|
43
|
Tarasov EE, Bagin VA, Nishnevich EV, Astafyeva MN, Rudnov VA, Prudkov MI. [Epidemiology and risk factors of adverse outcome in nonvariceal upper gastrointestinal bleeding]. Khirurgiia (Mosk) 2019:31-37. [PMID: 31169816 DOI: 10.17116/hirurgia201905131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/09/2023]
Abstract
AIM To identify risk factors of adverse outcomes in patients with nonvariceal upper gastrointestinal bleeding. MATERIAL AND METHODS Epidemiological observational analytical longitudinal retrospective cohort study included 312 patients who were hospitalized in the Clinical Hospital #40 of Yekaterinburg in 2014-2016. The main inclusion criterion was nonvariceal upper gastrointestinal bleeding. RESULTS In-hospital mortality was 31 (9.9%) of 312 patients. Multivariate analysis confirmed the following risk factors of mortality: severity of blood loss (OR 22.70, 95% CI 5.08-102.00); open surgery (OR 15.20, 95% CI 2.71-74.80); M. Charlson comorbidity index (OR 2.15, 95% CI 1.34-3.43); risk of recurrent bleeding according to T. Rockall scale (OR 1.76, 95% CI 1.18-2.64). CONCLUSION Independent risk factors of adverse outcomes in patients with nonvariceal upper gastrointestinal bleeding are severe hemorrhagic shock, open surgery, high M. Charlson comorbidity index and risk of recurrent bleeding according to T. Rockall scale.
Collapse
Affiliation(s)
- E E Tarasov
- City Clinical Hospital #40, Yekaterinburg, Russian Federation
| | - V A Bagin
- City Clinical Hospital #40, Yekaterinburg, Russian Federation
| | - E V Nishnevich
- City Clinical Hospital #40, Yekaterinburg, Russian Federation; Ural state medical university, Ministry of health of the Russian Federation, Yekaterinburg, Russian Federation
| | - M N Astafyeva
- City Clinical Hospital #40, Yekaterinburg, Russian Federation
| | - V A Rudnov
- City Clinical Hospital #40, Yekaterinburg, Russian Federation; Ural state medical university, Ministry of health of the Russian Federation, Yekaterinburg, Russian Federation
| | - M I Prudkov
- Ural state medical university, Ministry of health of the Russian Federation, Yekaterinburg, Russian Federation
| |
Collapse
|
44
|
Abstract
BACKGROUND Epistaxis (nosebleed) most commonly affects children and the elderly. The majority of episodes are managed at home with simple measures. In more severe cases medical intervention is required to either cauterise the bleeding vessel, or to pack the nose with various materials. Tranexamic acid is used in a number of clinical settings to stop bleeding by preventing clot breakdown (fibrinolysis). It may have a role in the management of epistaxis as an adjunct to standard treatments, reducing the need for further intervention. OBJECTIVES To determine the effects of tranexamic acid (oral, intravenous or topical) compared with placebo, no additional intervention or any other haemostatic agent in the management of patients with epistaxis. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Register (via CRS Web); Central Register of Controlled Trials (CENTRAL) (via CRS Web); PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 29 October 2018. SELECTION CRITERIA Randomised controlled trials (RCTs) of tranexamic acid (in addition to usual care) compared with usual care plus placebo, usual care alone or usual care plus any other haemostatic agent, to control epistaxis in adults or children. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. The primary outcomes were control of epistaxis: re-bleeding (as measured by the proportion of patients re-bleeding within a period of up to 10 days) and significant adverse effects (seizures, thromboembolic events). Secondary outcomes were control of epistaxis as measured by the time to stop initial bleeding (the proportion of patients whose bleeding is controlled within a period of up to 30 minutes); severity of re-bleeding (as measured by (a) the proportion of patients requiring any further intervention and (b) the proportion of patients requiring blood transfusion); length of hospital stay and other adverse effects. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. MAIN RESULTS We included six RCTs (692 participants). The overall risk of bias in the studies was low. Two studies assessed oral administration of tranexamic acid, given regularly over several days, and compared it to placebo. In the other four studies, a single application of topical tranexamic acid was compared with placebo (one study) and a combination of epinephrine and lidocaine or phenylephrine (three studies). All participants were adults.Tranexamic acid versus placeboFor our primary outcome, control of epistaxis: re-bleeding (proportion re-bleeding within 10 days), we were able to pool data from three studies. The pooled result demonstrated a benefit of tranexamic acid compared to placebo, the risk of re-bleeding reducing from 67% to 47% (risk ratio (RR) 0.71, 95% confidence interval (CI) 0.56 to 0.90; three studies; 225 participants; moderate-quality evidence).When we compared the effects of oral and topical tranexamic acid separately the risk of re-bleeding with oral tranexamic acid reduced from 69% to 49%, RR 0.73 (95% CI 0.55 to 0.96; two studies, 157 participants; moderate-quality evidence) and with topical tranexamic acid it reduced from 66% to 43%, RR 0.66 (95% CI 0.41 to 1.05; single study, 68 participants). We rated the quality of evidence provided by the single study as low, therefore it is uncertain whether topical tranexamic acid is effective in stopping bleeding in the 10-day period after a single application.No study specifically sought to identify and report our primary outcome: significant adverse effects (i.e. seizures, thromboembolic events).The secondary outcome time to stop initial bleeding (proportion with bleeding controlled within 30 minutes) was measured in one study using topical tranexamic acid and there was no evidence of a difference at 30 minutes (RR 0.79, 95% CI 0.56 to 1.11; 68 participants; low-quality evidence).No studies reported the proportion of patients requiring any further intervention (e.g. repacking, surgery, embolisation).One study of oral tranexamic acid reported the proportion of patients requiring blood transfusion and found no difference between groups: 5/45 (11%) versus 6/44 (14%) (RR 0.81, 95% CI 0.27 to 2.48; 89 participants; low-quality evidence).Two studies reported hospital length of stay. One study reported a significantly shorter stay in the oral tranexamic acid group (mean difference (MD) -1.60 days, 95% CI -2.49 to -0.71; 68 participants). The other study found no evidence of a difference between the groups.Tranexamic acid versus other haemostatic agentsWhen we pooled the data from three studies the proportion of patients whose bleeding stopped within 10 minutes was significantly higher in the topical tranexamic acid group compared to the group receiving another haemostatic agent (70% versus 30%: RR 2.35, 95% CI 1.90 to 2.92; 460 participants) (moderate-quality evidence).Adverse effects across all studiesFive studies recorded 'adverse effects' in a general way. None found any difference between the groups in the occurrence of minor adverse effects (e.g. mild nausea and diarrhoea, 'bad taste' of gel). In one study a patient developed a superficial thrombophlebitis of both legs following discharge, however it is not reported in which group this occurred. No "other serious adverse effect" was reported in any study. AUTHORS' CONCLUSIONS We found moderate-quality evidence that there is probably a reduction in the risk of re-bleeding with the use of either oral or topical tranexamic acid in addition to usual care in adult patients with epistaxis, compared to placebo with usual care. However, the quality of evidence relating solely to topical tranexamic acid was low (one study only), so we are uncertain whether or not topical tranexamic acid is effective in stopping bleeding in the 10-day period after a single application. We found moderate-quality evidence that topical tranexamic acid is probably better than other topical agents in stopping bleeding in the first 10 minutes.There have been only three RCTs on this subject since 1995. Since then there have been significant changes in nasal cauterisation and packing techniques (for example, techniques including nasal endoscopy and more invasive approaches such as endoscopic sphenopalatine artery ligation). New trials would inform us about the effectiveness of tranexamic acid in light of these developments.
Collapse
Affiliation(s)
- Jonathan Joseph
- Royal National Throat, Nose and Ear Hospital330 Gray's Inn RoadLondonUKWC1X 8DA
| | | | - Jenny Bellorini
- Nuffield Department of Surgical Sciences, University of OxfordCochrane ENTc/o Cochrane UK18 Middle WayOxfordUKOX2 7LG
| | - Martin J Burton
- Cochrane UKSummertown Pavilion18 ‐ 24 Middle WayOxfordUKOX2 7LG
| | | |
Collapse
|
45
|
Andreasen C, Solberg LB, Basso T, Borgen TT, Dahl C, Wisløff T, Hagen G, Apalset EM, Gjertsen JE, Figved W, Hübschle LM, Stutzer JM, Elvenes J, Joakimsen RM, Syversen U, Eriksen EF, Nordsletten L, Frihagen F, Omsland TK, Bjørnerem Å. Effect of a Fracture Liaison Service on the Rate of Subsequent Fracture Among Patients With a Fragility Fracture in the Norwegian Capture the Fracture Initiative (NoFRACT): A Trial Protocol. JAMA Netw Open 2018; 1:e185701. [PMID: 30646281 PMCID: PMC6324344 DOI: 10.1001/jamanetworkopen.2018.5701] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
IMPORTANCE Fragility fracture is a major health issue because of the accompanying morbidity, mortality, and financial cost. Despite the high cost to society and personal cost to affected individuals, secondary fracture prevention is suboptimal in Norway, mainly because most patients with osteoporotic fractures do not receive treatment with antiosteoporotic drugs after fracture repair. OBJECTIVES To improve secondary fracture prevention by introducing a standardized intervention program and to investigate the effect of the program on the rate of subsequent fractures. DESIGN, SETTING, AND PARTICIPANTS Trial protocol of the Norwegian Capture the Fracture Initiative (NoFRACT), an ongoing, stepped wedge cluster randomized clinical trial in 7 hospitals in Norway. The participating hospitals were cluster randomized to an intervention starting date: May 1, 2015; September 1, 2015; and January 1, 2016. Follow-up is through December 31, 2019. The outcome data were merged from national registries of women and men 50 years and older with a recent fragility fracture treated at 1 of the 7 hospitals. DISCUSSION The NoFRACT trial is intended to enroll 82 000 patients (intervention period, 26 000 patients; control period, 56 000 patients), of whom 23 578 are currently enrolled by January 2018. Interventions include a standardized program for identification, assessment, and treatment of osteoporosis in patients with a fragility fracture that is led by a trained coordinating nurse. The primary outcome is rate of subsequent fracture (per 10 000 person-years) based on national registry data. Outcomes before (2008-2015; control period) and after (2015-2019; intervention period) the intervention will be compared, and each hospital will act as its own control. Use of outcomes from national registry data means that all patients are included in the analysis regardless of whether they are exposed to the intervention (intention to treat). A sensitivity analysis with a transition window will be performed to mitigate possible within-cluster contamination. RESULTS Results are planned to be disseminated through publications in peer-reviewed journals and presented at local, national, and international conferences. CONCLUSIONS By introducing a standardized intervention program for assessment and treatment of osteoporosis in patients with fragility fractures, we expect to document reduced rates of subsequent fractures and fracture-related mortality. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02536898.
Collapse
Affiliation(s)
- Camilla Andreasen
- Department of Orthopedic Surgery, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Arctic University of Norway, Tromsø, Norway
| | - Lene B. Solberg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Trude Basso
- Department of Orthopedic Surgery, St Olav’s University Hospital, Trondheim, Norway
| | - Tove T. Borgen
- Department of Rheumatology, Vestre Viken Hospital Trust, Hospital of Drammen, Drammen, Norway
| | - Cecilie Dahl
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Torbjørn Wisløff
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| | - Gunhild Hagen
- Department of Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway
| | - Ellen M. Apalset
- Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease, Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jan-Erik Gjertsen
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Wender Figved
- Department of Orthopedic Surgery, Bærum Hospital, Vestre Viken Hospital Trust, Bærum, Norway
| | - Lars M. Hübschle
- Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Hospital of Drammen, Drammen, Norway
| | - Jens M. Stutzer
- Department of Orthopedic Surgery, Møre and Romsdal Hospital Trust, Molde Hospital, Molde, Norway
| | - Jan Elvenes
- Department of Orthopedic Surgery, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Arctic University of Norway, Tromsø, Norway
| | - Ragnar M. Joakimsen
- Department of Clinical Medicine, Arctic University of Norway, Tromsø, Norway
- Department of Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Unni Syversen
- Department of Endocrinology, St Olav’s University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erik F. Eriksen
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars Nordsletten
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Frede Frihagen
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Tone K. Omsland
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Åshild Bjørnerem
- Department of Clinical Medicine, Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
46
|
Cohan S, Smoot K, Kresa-Reahl K, Garland R, Yeh WS, Wu N, Watson C. Outcomes of Stable Multiple Sclerosis Patients Staying on Initial Interferon Beta Therapy Versus Switching to Another Interferon Beta Therapy: A US Claims Database Study. Adv Ther 2018; 35:1894-1904. [PMID: 30341505 PMCID: PMC6223975 DOI: 10.1007/s12325-018-0799-5] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Indexed: 12/21/2022]
Abstract
Introduction This study was designed to assess real-world outcomes of patients with multiple sclerosis (MS) who were stable on interferon (IFN) beta therapy in the year prior to switching to another IFN beta therapy versus those who continued on the initial treatment. Methods This study used administrative claims from MarketScan Commercial Claims and Encounters Database, from January 1, 2010, to March 31, 2015, to identify MS patients aged 18–64 years who remained relapse free for at least 1 year while continuously treated with an IFN beta therapy. Stable patients remaining on their initial IFN beta therapy (no-switch patients) were matched with stable patients who switched IFN beta therapy (switch patients) using propensity score matching (first claim = index date). Outcome measures included annualized relapse rate (ARR), the percentage of patients who relapsed, medication possession ratio, and the proportion of days covered and were measured during the year following the index date. Results This study identified 531 patients in the no-switch group and 177 patients in the switch group, with subsets of 270 patients in the no-switch group and 90 patients in the switch group stable on intramuscular (IM) IFN beta-1a therapy. All outcomes during the follow-up year were significantly better in the no-switch group than in the switch group. For all patients, ARR in the switch group was more than twice that in the no-switch group (P = 0.002). For patients stable on IM IFN beta-1a at baseline, ARR was twice as high in the switch group as in the no-switch group (P = 0.012). Conclusion Among all patients stable on IFN beta therapy and the subset stable on IM IFN beta therapy in particular, those who remained on therapy had significantly better outcomes than those who switched to another IFN beta therapy. Funding Biogen (Cambridge, MA, USA).
Collapse
Affiliation(s)
- Stanley Cohan
- Providence MS Center, 9135 SW Barnes Road, Suite 461, Portland, OR, 97225, USA.
| | - Kyle Smoot
- Providence MS Center, 9135 SW Barnes Road, Suite 461, Portland, OR, 97225, USA
| | - Kiren Kresa-Reahl
- Providence MS Center, 9135 SW Barnes Road, Suite 461, Portland, OR, 97225, USA
| | | | | | | | | |
Collapse
|
47
|
Berni E, Murphy D, Whitehouse J, Conway P, Di Maggio P, Currie CJ, Poole C. Evaluation of the cost-effectiveness of rifaximin-α for the management of patients with hepatic encephalopathy in the United Kingdom. Curr Med Res Opin 2018; 34:2001-2008. [PMID: 29995455 DOI: 10.1080/03007995.2018.1499506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Rifaximin-α 550 mg twice daily plus lactulose has demonstrated efficacy in reducing recurrence of episodes of overt hepatic encephalopathy (OHE) and the risk of hepatic encephalopathy (HE)-related hospitalizations compared with lactulose alone. This analysis estimated the cost effectiveness of rifaximin-α 550 mg twice daily plus lactulose versus lactulose alone in United Kingdom (UK) cirrhotic patients with OHE. METHOD A Markov model was built to estimate the incremental cost-effectiveness ratio (ICER). The perspective was that of the UK National Health Service (NHS). Clinical data was sourced from a randomized controlled trial (RCT) and an open-label maintenance study in cirrhotic patients in remission from recurrent episodes of OHE. Health-related utility was estimated indirectly from disease-specific quality of life RCT data. Resource use data describing the impact of rifaximin-α on hospital admissions and length of stay for cirrhotic patients with OHE was from four single-center UK audits. Costs (2012) were derived from published sources; costs and benefits were discounted at 3.5%. The base-case time horizon was 5 years. RESULTS The average cost per patient was £22,971 in the rifaximin-α plus lactulose arm and £23,545 in the lactulose arm, a saving of £573. The corresponding values for benefit were 2.35 quality adjusted life years (QALYs) and 1.83 QALYs per person, a difference of 0.52 QALYs. This translated into a dominant base-case ICER. Key parameters that impacted the ICER included number of hospital admissions and length of stay. CONCLUSION Rifaximin-α 550 mg twice daily in patients with recurrent episodes of OHE was estimated to generate cost savings and improved clinical outcomes compared to standard care over 5 years.
Collapse
Affiliation(s)
| | - Daniel Murphy
- b Norgine Pharmaceuticals Limited , Harefield, Uxbridge , UK
| | | | | | - Paola Di Maggio
- b Norgine Pharmaceuticals Limited , Harefield, Uxbridge , UK
| | - Craig J Currie
- a Pharmatelligence , Cardiff , UK
- c Division of Population Medicine, School of Medicine , Cardiff University , UK
| | | |
Collapse
|
48
|
Wang CY, Fu SH, Huang CC, Hung CC, Yang RS, Hsiao FY. Visualisation of the unmet treatment need of osteoporotic fracture in Taiwan: A nationwide cohort study. Int J Clin Pract 2018; 72:e13246. [PMID: 30144247 DOI: 10.1111/ijcp.13246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/10/2018] [Accepted: 07/16/2018] [Indexed: 01/22/2023] Open
Abstract
AIMS Recent clinical guidelines have suggested that patients experience an osteoporotic fracture should initiate anti-osteoporosis medications (AOMs). However, whether clinical guidelines translate well in "real-world" practices remain questioned. This study aimed to evaluate the "real-world" prescription pattern of AOMs and visualise the unmet treatment needs in different geographical areas in Taiwan. METHODS Using Taiwan's National Health Insurance Research Database, we identified patients diagnosed with a hip or vertebral fracture between 2009 and 2012. The treatment rate was defined as the proportion of patients receiving AOMs within 1 year after their index fracture. The qualitative geographical information systems approach was adopted to visualise the treatment needs of postfracture patients in different geographical areas. RESULTS Our study included 276,492 patients diagnosed with a hip or vertebral fracture between 2009 and 2012. The proportion of patients who received AOMs within 1 year after their index fracture increased with age and differed with fracture types and sex. For patients with hip fractures, the treatment rate ranged from 3.43% to 20.88% for female patients and from 0.69% to 10.04% for male patients in different age groups. For patients with vertebral fractures, the treatment rate ranged from 3.23% to 37.08% for female patients and from 1.85% to 23.05% for male patients. Cities in the mid-northern and southern areas of Taiwan had the highest unmet treatment need, with a treatment rate of less than 15%. CONCLUSION The treatment rate of osteoporotic fractures with AOMs was diverse and suboptimal in Taiwan, especially among male patients. This study used a visualisation technique to display information about the treatment status in different geographical areas and help policymakers allocate resource appropriately.
Collapse
Affiliation(s)
- Chen-Yu Wang
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shau-Huai Fu
- Department of Orthopedics, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan
| | - Chuan-Ching Huang
- Department of Orthopedics, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan
| | - Chih-Chien Hung
- Department of Orthopedics, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan
| | - Rong-Sen Yang
- Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
49
|
de Abreu FG, Goulart AC, Birck MG, Benseñor IM. Stroke at baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): a cross-sectional analysis. SAO PAULO MED J 2018; 136:398-406. [PMID: 30570091 PMCID: PMC9907755 DOI: 10.1590/1516-3180.2018.0129060818] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 06/14/2018] [Accepted: 08/06/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Secondary prevention of stroke is a very important goal for achieving continuous reduction in stroke mortality rates over the next decades. DESIGN AND SETTING Cross-sectional analysis on the Brazilian Longitudinal Study of Adult Health -(ELSA-Brasil), with data from Salvador, Vitória, Belo Horizonte, Rio de Janeiro, São Paulo and Porto Alegre. METHODS This descriptive analysis focused on secondary prevention of stroke among participants who self-reported a medical diagnosis of stroke at the baseline of ELSA-Brasil, and its association with sociodemographic characteristics. RESULTS Overall, 197 participants (1.3%) reported a prior medical history of stroke. Participants with stroke were older and less educated and had lower mean monthly family income, compared with non-stroke participants. Among all stroke cases, 23.7% did not use any medication for secondary prevention of stroke. Use of secondary prevention was higher among men than among women (respectively, 59.6% versus 40.4%; P = 0.02 for aspirin; and 71.4% versus 28.6%; P = 0.04 for other antiplatelet drugs). Having private health insurance was associated with greater use of less cost-effective and more expensive medications (like angiotensinogen receptor blockers) and a tendency to use antiplatelet drugs other than aspirin, among participants reporting stroke, compared with others. Use of medication decreased as time passed after suffering a stroke. CONCLUSIONS In this sample of individuals with better access to healthcare services, use of secondary prevention for stroke was low, which may suggest that the situation in the general population is worse. Sex was the most important sociodemographic variable associated with low use of secondary prevention.
Collapse
Affiliation(s)
| | - Alessandra Carvalho Goulart
- MD, PhD. Assistant Professor, Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo (USP), São Paulo (SP), Brazil.
| | - Marina Gabriela Birck
- DPH. Master’s Student, Faculdade de Medicina da Universidade de São Paulo (FMUSP), and Associate Professor, Department of Internal Medicine, FMUSP, São Paulo (SP), Brazil.
| | - Isabela Martins Benseñor
- MD, PhD. Associate Professor, Department of Internal Medicine, School of Medicine, Universidade de São Paulo (USP), and Assistant Professor, Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo (SP), Brazil.
| |
Collapse
|
50
|
Nguyen ET, Posas-Mendoza T, Siu AM, Ahn HJ, Choi SY, Lim SY. Low rates of osteoporosis treatment after hospitalization for hip fracture in Hawaii. Osteoporos Int 2018; 29:1827-1832. [PMID: 29744567 DOI: 10.1007/s00198-018-4553-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 02/04/2018] [Accepted: 04/25/2018] [Indexed: 11/28/2022]
Abstract
UNLABELLED We evaluated osteoporosis treatment and DEXA utilization rates of patients who were admitted for hip fracture in a single healthcare system in Hawaii from 2015 to 2016. We found that osteoporosis treatment and DEXA utilization rates were low, highlighting a critical gap in osteoporosis care after admission for hip fracture. INTRODUCTION The objective of this study was to evaluate osteoporosis care after an admission for hip fracture at three community hospitals within a single healthcare system in Hawaii. METHODS A retrospective chart review was conducted (n = 428) of patients ≥ 50 years and hospitalized for hip fractures between January 1, 2015, and May 31, 2016, at three major hospitals within Hawaii Pacific Health, a large healthcare system in Hawaii. Basic demographics were collected, and medications prescribed were quantified and described within 1 year of hip fracture. Logistic regression was used to evaluate the association between collected variables and the odds of osteoporosis treatment. RESULTS Only 115 (26.9%) patients were prescribed a medication for osteoporosis as a secondary prevention within a year of hospitalization for hip fracture. DEXA scans were performed in 137 (32.0%) patients. Most of the treated patients were prescribed oral bisphosphonates. Treatment facility, female gender, and higher BMI were found to be predictive factors for osteoporosis treatment. CONCLUSION The use of osteoporosis medication for secondary prevention after admission for hip fracture in Hawaii is low. Efforts need to be made to improve treatment rates, especially among males.
Collapse
Affiliation(s)
- E T Nguyen
- Lewis and Clark College, Portland, OR, USA
| | - T Posas-Mendoza
- Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA
| | - A M Siu
- Hawaii Pacific Health Research Institute, Honolulu, HI, USA
| | - H J Ahn
- Department of Complementary and Integrative Medicine, University of Hawaii, Honolulu, HI, USA
| | - S Y Choi
- Department of Complementary and Integrative Medicine, University of Hawaii, Honolulu, HI, USA
| | - S Y Lim
- Hawaii Pacific Health, Bone and Joint Center, Straub Clinic, 888 S. King Street, Honolulu, HI, 96813, USA.
| |
Collapse
|