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Using claims data to attribute patients with breast, lung, or colorectal cancer to prescribing oncologists. 使用索赔数据将乳腺癌、肺癌或结直肠癌患者归为开处方的肿瘤学家。
IF 8.9 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2019-03-29 eCollection Date: 2019-01-01 DOI: 10.2147/POR.S197252
Ezra Fishman, John Barron, Ying Liu, Santosh Gautam, Justin E Bekelman, Amol S Navathe, Michael J Fisch, Ann Nguyen, Gosia Sylwestrzak

Background: Alternative payment models frequently require attribution of patients to individual physicians to assign cost and quality outcomes. Our objective was to examine the performance of three methods for attributing a patient with cancer to the likeliest physician prescriber of anticancer drugs for that patient using administrative claims data.

Methods: We used the HealthCore Integrated Research Environment to identify patients who had claims for anticancer medication along with diagnosis codes for breast, lung, or colorectal lung cancer between July 2013 and September 2017. The index date was the first date with a record for anticancer medication and cancer diagnosis code. Included patients had continuous medical coverage from 6 months before index to at least 7 days after index. Patients who received anticancer drugs during the 6 months prior to index were excluded. The three methods attributed each patient to the physician with whom the patient had the most evaluation and management (E&M) visits within a 90-day window around the index date (Method 1); the most E&M visits with no time window (Method 2); or the E&M visit nearest in time to the index date (Method 3). We assessed the performance of the methods using the percentage of the study cohort successfully attributed to a physician, and the positive predictive value (PPV) relative to available physician-reported data on patient(s) they treat.

Results: In total, 70,641 patients were available for attribution to physicians. Percentages of the study cohort attributed to a physician were: Method 1, 92.6%; Method 2, 96.9%; and Method 3, 96.9%. PPVs for each method were 84.4%, 80.6%, and 75.8%, respectively.

Conclusion: We found that a claims-based algorithm - specifically, a plurality method with a 90-day time window - correctly attributed nearly 85% of patients to a prescribing physician. Claims data can reliably identify prescribing physicians in oncology.

背景:可选择的支付模式通常需要将患者归属于个别医生,以分配成本和质量结果。我们的目标是检查三种方法的性能,这些方法使用行政索赔数据将癌症患者归因于最有可能为该患者开抗癌药物的医生。方法:我们使用HealthCore综合研究环境来识别2013年7月至2017年9月期间有抗癌药物声明以及乳腺癌、肺癌或结直肠癌诊断代码的患者。索引日期是第一个记录抗癌药物和癌症诊断代码的日期。纳入的患者在指数前6个月至指数后至少7天有持续的医疗覆盖。排除指数前6个月内接受过抗癌药物治疗的患者。三种方法将每位患者归为患者在索引日期前后90天窗口内就诊评估和管理(E&M)次数最多的医生(方法1);无时间窗口的机电探访次数(方法二);或最接近索引日期的E&M访问(方法3)。我们使用成功归因于医生的研究队列的百分比,以及相对于他们治疗的患者的可用医生报告数据的阳性预测值(PPV)来评估方法的性能。结果:共有70,641名患者可归因给医生。归于内科医生的研究队列的百分比为:方法1,92.6%;方法2,96.9%;方法3,96.9%。两种方法的ppv分别为84.4%、80.6%和75.8%。结论:我们发现基于索赔的算法-特别是具有90天时间窗口的多个方法-正确地将近85%的患者归因于处方医生。索赔数据可以可靠地识别肿瘤学的处方医生。
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引用次数: 7
The effect of lercanidipine or lercanidipine/enalapril combination on blood pressure in treatment-naïve patients with stage 1 or 2 systolic hypertension. 来卡尼地平或来卡尼地平/依那普利联合用药对treatment-naïve期1或2期收缩期高血压患者血压的影响
IF 8.9 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2019-01-22 eCollection Date: 2019-01-01 DOI: 10.2147/POR.S186070
Brian Rayner

Purpose: To describe the efficacy of a stratified approach on automatic office blood pressure (BP), 24-hour ambulatory BP, and BP variability (BPV) in treatment-naïve patients with systolic hypertension using lercanidipine for stage 1 and lercanidipine/enalapril for stage 2.

Patients and methods: This was an open-label, prospective interventional study conducted in 22 general practices in South Africa. Treatment-naïve patients with stage 1 hypertension received lercanidipine 10 mg and patients with stage 2 received lercanidipine 10 mg/enalapril 10 mg. After 6 weeks, patients not reaching target (<140/90 mmHg) were up-titrated to lercanidipine 10 mg/enalapril 10 mg or lercanidipine 10 mg/enalapril 20 mg, respectively, for a further 6 weeks. Office BP was determined at each visit, and 24-hour ambulatory BP monitor (ABPM) at baseline and 12 weeks. The primary end point was changes in office BP, and secondary end points were changes in 24-hour ABPM and BPV.

Results: Of the 198 patients, 48% had stage 1 and 52% stage 2 hypertension. The mean age was 55 years, body mass index was 29.2 kg/m2, 48.5% were female, and 15.1% were diabetic. The mean (SD) office SBP and DBP at baseline, 6 weeks, and 12 weeks was 158.2 (13.8), 141.6 (11.1), and 138.7 (16.7) mmHg (P<0.00001), and 92.2 (10.6), 84.6 (11.1), and 82 (13.3) mmHg (P<0.00001), respectively. The mean (SD) systolic and diastolic daytime ABPM at baseline and 12 weeks was 157 (16.63) and 142 (14.41) mmHg (P<0.0001) and 88 (12.34) and 81 (10.79) mmHg (P<0.0001), and the nighttime ABPM was 146 (15.68) and 133 (13.94) mmHg (P<0.0001) and 79.5 (11.64) and 72.5 (10.05) mmHg (P<0.009), respectively. There were few adverse events.

Conclusion: Lercanidipine and lercanidipine/enalapril for stage 1 or 2 hypertension highly improves office SBP and DBP, overall 24-hour BP, daytime BP, and nighttime BP, also reducing BPV with few adverse effects.

目的:描述分层方法对收缩期高血压treatment-naïve患者的自动办公室血压(BP)、24小时动态血压和血压变异性(BPV)的疗效,这些患者使用莱卡尼地平治疗1期,使用莱卡尼地平/依那普利治疗2期。患者和方法:这是一项开放标签的前瞻性介入研究,在南非的22家全科医院进行。Treatment-naïve 1期高血压患者接受来卡尼地平10mg, 2期患者接受来卡尼地平10mg /依那普利10mg。结果:198例患者中,1期高血压占48%,2期高血压占52%。平均年龄55岁,体重指数29.2 kg/m2,女性48.5%,糖尿病患者15.1%。基线、6周和12周时办公室收缩压和舒张压的平均值(SD)分别为158.2(13.8)、141.6(11.1)和138.7 (16.7)mmHg (ppppppp)。结论:来卡尼地平和来卡尼地平/依那普利治疗1期或2期高血压可显著改善办公室收缩压和舒张压、总24小时血压、白天血压和夜间血压,同时降低BPV,副作用少。
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引用次数: 0
Low-fluoroscopy atrial fibrillation ablation with contact force and ultrasound technologies: a learning curve. 低透视心房颤动消融与接触力和超声技术:一个学习曲线。
IF 8.9 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2019-01-10 eCollection Date: 2019-01-01 DOI: 10.2147/POR.S181220
Paul C Zei, Tina D Hunter, Larry M Gache, Gerri O'Riordan, Tina Baykaner, Chad R Brodt
Background Fluoroscopy exposure during catheter ablation is a health hazard to patients and operators. This study presents the results of implementing a low-fluoroscopy workflow using modern contact force (CF) technologies in paroxysmal atrial fibrillation (PAF) ablation. Methods A fluoroscopy reduction workflow was implemented and subsequent catheter ablations for PAF were evaluated. After vascular access with ultrasound guidance, a THERMOCOOL SMARTTOUCH® Catheter (ST) was advanced into the right atrium. The decapolar catheter was placed without fluoroscopy. A double-transseptal puncture was performed under intracardiac echocardiography guidance. ST and mapping catheters were advanced into the left atrium. A left atrial map was created, and pulmonary vein (PV) isolation was confirmed via entrance and exit block before and after the administration of isoproterenol or adenosine. Results Forty-three patients underwent PAF ablation with fluoroscopy reduction workflow (mean age: 66±9 years; 70% male), performed by five operators. Acute success rate (PV isolation) was 96.5% of PVs. One case of pericardial effusion, not requiring intervention, was the only acute complication. Mean procedure time was 217±42 minutes. Mean fluoroscopy time was 2.3±3.0 minutes, with 97.7% of patients having < 10 minutes and 86.0% having < 5 minutes. A significant downward trend over time was observed, suggesting a rapid learning curve for fluoroscopy reduction. Freedom from any atrial arrhythmias without reablation was 80.0% after a mean follow-up of 12±3 months. Conclusion Low fluoroscopy time is achievable with CF technologies after a short learning curve, without compromising patient safety or effectiveness.
背景:导管消融过程中的透视暴露对患者和手术者都是一种健康危害。本研究介绍了在阵发性心房颤动(PAF)消融中使用现代接触力(CF)技术实现低透视工作流程的结果。方法:实施透视复位工作流程,并对PAF的后续导管消融进行评估。在超声引导下进入血管后,将THERMOCOOL SMARTTOUCH®导管(ST)推进至右心房。在没有透视的情况下放置脱斜导管。在超声心动图引导下行双隔穿刺。ST和定位导管进入左心房。在异丙肾上腺素或腺苷给药前后,绘制左心房图,通过进出阻断确认肺静脉(PV)隔离。结果:43例患者行PAF消融加透视复位流程(平均年龄66±9岁;70%为男性),由5名操作人员执行。急性成功率(PV分离)为96.5%。1例心包积液是唯一的急性并发症,无需干预。平均手术时间217±42分钟。平均透视时间为2.3±3.0分钟,97.7%的患者< 10分钟,86.0%的患者< 5分钟。随着时间的推移,观察到明显的下降趋势,表明透视复位的快速学习曲线。平均随访12±3个月,无房性心律失常复发率为80.0%。结论:CF技术在短时间学习曲线后可以实现低透视时间,而不会影响患者的安全性或有效性。
{"title":"Low-fluoroscopy atrial fibrillation ablation with contact force and ultrasound technologies: a learning curve.","authors":"Paul C Zei,&nbsp;Tina D Hunter,&nbsp;Larry M Gache,&nbsp;Gerri O'Riordan,&nbsp;Tina Baykaner,&nbsp;Chad R Brodt","doi":"10.2147/POR.S181220","DOIUrl":"https://doi.org/10.2147/POR.S181220","url":null,"abstract":"Background Fluoroscopy exposure during catheter ablation is a health hazard to patients and operators. This study presents the results of implementing a low-fluoroscopy workflow using modern contact force (CF) technologies in paroxysmal atrial fibrillation (PAF) ablation. Methods A fluoroscopy reduction workflow was implemented and subsequent catheter ablations for PAF were evaluated. After vascular access with ultrasound guidance, a THERMOCOOL SMARTTOUCH® Catheter (ST) was advanced into the right atrium. The decapolar catheter was placed without fluoroscopy. A double-transseptal puncture was performed under intracardiac echocardiography guidance. ST and mapping catheters were advanced into the left atrium. A left atrial map was created, and pulmonary vein (PV) isolation was confirmed via entrance and exit block before and after the administration of isoproterenol or adenosine. Results Forty-three patients underwent PAF ablation with fluoroscopy reduction workflow (mean age: 66±9 years; 70% male), performed by five operators. Acute success rate (PV isolation) was 96.5% of PVs. One case of pericardial effusion, not requiring intervention, was the only acute complication. Mean procedure time was 217±42 minutes. Mean fluoroscopy time was 2.3±3.0 minutes, with 97.7% of patients having < 10 minutes and 86.0% having < 5 minutes. A significant downward trend over time was observed, suggesting a rapid learning curve for fluoroscopy reduction. Freedom from any atrial arrhythmias without reablation was 80.0% after a mean follow-up of 12±3 months. Conclusion Low fluoroscopy time is achievable with CF technologies after a short learning curve, without compromising patient safety or effectiveness.","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"10 ","pages":"1-7"},"PeriodicalIF":8.9,"publicationDate":"2019-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/POR.S181220","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36926484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 7
Acute cholecystitis - a cohort study in a real-world clinical setting (REWO study, NCT02796443). 急性胆囊炎——现实世界临床环境中的队列研究(REWO研究,NCT02796443)。
IF 8.9 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2018-10-25 eCollection Date: 2018-01-01 DOI: 10.2147/POR.S169255
Jennifer Blythe, Eva Herrmann, Dominik Faust, Stephan Falk, Tina Edwards-Lehr, Florian Stockhausen, Ernst Hanisch, Alexander Buia

Background: For decades, the optimal timing of surgery for acute cholecystitis has been controversial. Recent meta-analyses and population-based studies favor early surgery. One recent large randomized trial has demonstrated that a delayed approach increases morbidity and cost compared to early surgery within 24 hours of hospital admission. Since cases of severe cholecystitis were excluded from this trial, we argue that these results do not reflect real-world clinical situations. From our point of view, these results were in contrast to the clinical experience with our patients; so, we decided to analyze critically all our patients with the null hypothesis that the patients treated with a delayed cholecystectomy after an acute cholecystitis have a similar or even better outcome than those treated with an early operative approach.

Patients and methods: We retrospectively analyzed clinical data from all patients with cholecystectomies in the period between January 2006 and September 2015. A total of 1,723 patients were categorized into four groups: early (n=138): urgent surgery of patients with acute cholecystitis within the first 72 hours of the onset of symptoms; intermediate (n=297): surgery of patients with acute cholecystitis within an average of 10 days after the onset of symptoms; delayed (n=427): initial non-surgical treatment of acute cholecystitis with surgery performed within 6-12 weeks of the onset of symptoms; and elective (n=868): cholecystectomy within a symptom-free interval of choice in patients with symptomatic cholecystolithiasis without signs of acute cholecystitis.

Results: In a real-world scenario, early/intermediate cholecystectomy in acute cholecystitis was associated with a significant increase in morbidity and mortality (Clavien-Dindo score) compared to a delayed approach with surgery performed 6-12 weeks after the onset of symptoms. The adjusted linear rank statistics showed a decrease in the complication score with values of 2.29 in the early group, 0.48 in the intermediate group, -0.26 in the delayed group and -2.12 in the elective group. The results translate into a continuous decrease of the complication score from early over intermediate and delayed to the elective group.

Conclusion: These results demonstrate that delayed cholecystectomy can be performed safely. In cases with severe cholecystitis, early and/or intermediate approaches still have a relatively high risk of morbidity and mortality.

背景:几十年来,急性胆囊炎的最佳手术时机一直存在争议。最近的荟萃分析和基于人群的研究倾向于早期手术。最近的一项大型随机试验表明,与入院24小时内的早期手术相比,延迟手术会增加发病率和成本。由于严重胆囊炎病例被排除在本试验之外,我们认为这些结果并不能反映真实的临床情况。从我们的角度来看,这些结果与我们患者的临床经验相反;因此,我们决定严格分析我们所有的病人,零假设在急性胆囊炎后接受延迟胆囊切除术的病人与那些接受早期手术治疗的病人有相似甚至更好的结果。患者和方法:我们回顾性分析2006年1月至2015年9月期间所有胆囊切除术患者的临床资料。共有1723例患者被分为四组:早期(n=138):急性胆囊炎患者在症状出现后72小时内进行紧急手术;中级(n=297):急性胆囊炎患者在出现症状后平均10天内进行手术;延迟(n=427):急性胆囊炎的初始非手术治疗,在症状出现后6-12周内进行手术;选择性(n=868):在无急性胆囊炎体征的症状性胆囊结石患者的无症状间隔内选择胆囊切除术。结果:在现实世界中,急性胆囊炎的早期/中期胆囊切除术与症状出现6-12周后延迟手术相比,发病率和死亡率(Clavien-Dindo评分)显著增加。经调整线性秩统计,并发症评分降低,早期组为2.29,中间组为0.48,延迟组为-0.26,择期组为-2.12。结果转化为并发症评分从早期超过中期和延迟到择期组持续下降。结论:迟发性胆囊切除术是安全可行的。在严重胆囊炎病例中,早期和/或中期入路仍有较高的发病率和死亡率风险。
{"title":"Acute cholecystitis - a cohort study in a real-world clinical setting (REWO study, NCT02796443).","authors":"Jennifer Blythe,&nbsp;Eva Herrmann,&nbsp;Dominik Faust,&nbsp;Stephan Falk,&nbsp;Tina Edwards-Lehr,&nbsp;Florian Stockhausen,&nbsp;Ernst Hanisch,&nbsp;Alexander Buia","doi":"10.2147/POR.S169255","DOIUrl":"https://doi.org/10.2147/POR.S169255","url":null,"abstract":"<p><strong>Background: </strong>For decades, the optimal timing of surgery for acute cholecystitis has been controversial. Recent meta-analyses and population-based studies favor early surgery. One recent large randomized trial has demonstrated that a delayed approach increases morbidity and cost compared to early surgery within 24 hours of hospital admission. Since cases of severe cholecystitis were excluded from this trial, we argue that these results do not reflect real-world clinical situations. From our point of view, these results were in contrast to the clinical experience with our patients; so, we decided to analyze critically all our patients with the null hypothesis that the patients treated with a delayed cholecystectomy after an acute cholecystitis have a similar or even better outcome than those treated with an early operative approach.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed clinical data from all patients with cholecystectomies in the period between January 2006 and September 2015. A total of 1,723 patients were categorized into four groups: early (n=138): urgent surgery of patients with acute cholecystitis within the first 72 hours of the onset of symptoms; intermediate (n=297): surgery of patients with acute cholecystitis within an average of 10 days after the onset of symptoms; delayed (n=427): initial non-surgical treatment of acute cholecystitis with surgery performed within 6-12 weeks of the onset of symptoms; and elective (n=868): cholecystectomy within a symptom-free interval of choice in patients with symptomatic cholecystolithiasis without signs of acute cholecystitis.</p><p><strong>Results: </strong>In a real-world scenario, early/intermediate cholecystectomy in acute cholecystitis was associated with a significant increase in morbidity and mortality (Clavien-Dindo score) compared to a delayed approach with surgery performed 6-12 weeks after the onset of symptoms. The adjusted linear rank statistics showed a decrease in the complication score with values of 2.29 in the early group, 0.48 in the intermediate group, -0.26 in the delayed group and -2.12 in the elective group. The results translate into a continuous decrease of the complication score from early over intermediate and delayed to the elective group.</p><p><strong>Conclusion: </strong>These results demonstrate that delayed cholecystectomy can be performed safely. In cases with severe cholecystitis, early and/or intermediate approaches still have a relatively high risk of morbidity and mortality.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"9 ","pages":"69-75"},"PeriodicalIF":8.9,"publicationDate":"2018-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/POR.S169255","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36737243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 13
Postoperative swallowing disorder after thyroid and parathyroid resection. 甲状腺及甲状旁腺切除术后吞咽障碍。
IF 8.9 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2018-10-16 eCollection Date: 2018-01-01 DOI: 10.2147/POR.S172059
Andreas Hillenbrand, Gregor Cammerer, Lisa Dankesreiter, Johannes Lemke, Doris Henne-Bruns

Introduction: Dysphagia is frequently reported after thyroidectomy. Here, we investigated the incidence of postoperative dysphagia after uncomplicated thyroidectomy and parathyroidectomy. Further, we analyzed diagnosis and types of therapy to identify possible patients at risk.

Patients and methods: A questionnaire was sent to 372 consecutive patients whose thyroid or parathyroid glands were operated on between May 2013 and October 2014 at Ulm University Hospital. Patients were questioned at least 6 months postoperatively.

Results: In the evaluation, 219 questionnaires could be included. Fifty-three (21.3%) patients reported that the overall postoperative swallowing process was better or more trouble-free. In 110 (50.2%) patients, dysphagia was reported only immediately postoperative and disappeared later spontaneously. Sixteen patients (7.3%) stated that after a maximum of 3 months after surgery they suffered from dysphagia. One (0.5%) patient stated that up to 3 months postoperatively, swallowing problems had been successfully treated by logopedic therapy. In 39 (17.6%) patients, the complaints persisted for more than 3 months or still existed at the time of the interview. We found no correlation between dysphagia and patients' age or gender, the specimen volume, and patients' body mass index. The more invasive the operation was, the more patients suffered from dysphagia. Analyzing the frequency of dysphagia according to different diagnoses, we found a significant risk of postoperative dysphagia in patients with Graves' disease and carcinoma. Patients operated on for hyperparathyroidism were at significantly decreased risk of dysphagia.

Conclusion: Nearly 20% of patients reported postoperative dysphagia after uncomplicated thyroidectomy and parathyroidectomy, especially after major surgical intervention. We found a significant risk of postoperative dysphagia in patients with Graves' disease and carcinoma and a decreased risk for patients operated on for hyperparathyroidism.

摘要:吞咽困难是甲状腺切除术后常见的症状。在这里,我们调查了单纯甲状腺切除术和甲状旁腺切除术后吞咽困难的发生率。此外,我们分析了诊断和治疗类型,以确定可能存在风险的患者。患者和方法:对2013年5月至2014年10月在乌尔姆大学医院连续行甲状腺或甲状旁腺手术的372例患者进行问卷调查。患者在术后至少6个月接受问询。结果:评估共纳入问卷219份。53例(21.3%)患者报告术后整体吞咽过程更好或更无故障。110例(50.2%)患者术后立即出现吞咽困难,随后自行消失。16例患者(7.3%)表示在术后最多3个月后出现吞咽困难。一名(0.5%)患者表示,术后3个月,吞咽问题已通过喉道治疗成功解决。39例(17.6%)患者的抱怨持续3个月以上或在访谈时仍存在。我们发现吞咽困难与患者的年龄或性别、标本体积和患者的体重指数之间没有相关性。手术侵入性越强,患者出现吞咽困难的几率越大。根据不同的诊断分析吞咽困难的频率,我们发现Graves病和癌患者术后出现吞咽困难的风险显著。手术治疗甲状旁腺功能亢进的患者发生吞咽困难的风险显著降低。结论:无并发症甲状腺切除术和甲状旁腺切除术后,有近20%的患者报告术后吞咽困难,特别是在大手术干预后。我们发现Graves病和癌患者术后吞咽困难的风险显著,甲状旁腺功能亢进患者术后吞咽困难的风险降低。
{"title":"Postoperative swallowing disorder after thyroid and parathyroid resection.","authors":"Andreas Hillenbrand,&nbsp;Gregor Cammerer,&nbsp;Lisa Dankesreiter,&nbsp;Johannes Lemke,&nbsp;Doris Henne-Bruns","doi":"10.2147/POR.S172059","DOIUrl":"https://doi.org/10.2147/POR.S172059","url":null,"abstract":"<p><strong>Introduction: </strong>Dysphagia is frequently reported after thyroidectomy. Here, we investigated the incidence of postoperative dysphagia after uncomplicated thyroidectomy and parathyroidectomy. Further, we analyzed diagnosis and types of therapy to identify possible patients at risk.</p><p><strong>Patients and methods: </strong>A questionnaire was sent to 372 consecutive patients whose thyroid or parathyroid glands were operated on between May 2013 and October 2014 at Ulm University Hospital. Patients were questioned at least 6 months postoperatively.</p><p><strong>Results: </strong>In the evaluation, 219 questionnaires could be included. Fifty-three (21.3%) patients reported that the overall postoperative swallowing process was better or more trouble-free. In 110 (50.2%) patients, dysphagia was reported only immediately postoperative and disappeared later spontaneously. Sixteen patients (7.3%) stated that after a maximum of 3 months after surgery they suffered from dysphagia. One (0.5%) patient stated that up to 3 months postoperatively, swallowing problems had been successfully treated by logopedic therapy. In 39 (17.6%) patients, the complaints persisted for more than 3 months or still existed at the time of the interview. We found no correlation between dysphagia and patients' age or gender, the specimen volume, and patients' body mass index. The more invasive the operation was, the more patients suffered from dysphagia. Analyzing the frequency of dysphagia according to different diagnoses, we found a significant risk of postoperative dysphagia in patients with Graves' disease and carcinoma. Patients operated on for hyperparathyroidism were at significantly decreased risk of dysphagia.</p><p><strong>Conclusion: </strong>Nearly 20% of patients reported postoperative dysphagia after uncomplicated thyroidectomy and parathyroidectomy, especially after major surgical intervention. We found a significant risk of postoperative dysphagia in patients with Graves' disease and carcinoma and a decreased risk for patients operated on for hyperparathyroidism.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"9 ","pages":"63-68"},"PeriodicalIF":8.9,"publicationDate":"2018-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/POR.S172059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36660174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 9
Attitudes and beliefs related to reporting alcohol consumption in research studies: a case from Jordan. 调查研究中与报告饮酒有关的态度和信念:来自约旦的一个案例。
IF 8.9 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2018-10-09 eCollection Date: 2018-01-01 DOI: 10.2147/POR.S172613
Farah H Alhashimi, Omar F Khabour, Karem H Alzoubi, Samah F Al-Shatnawi

Background: Acceptability of alcohol consumption varies wildly across cultures. Several factors such as religious beliefs and social desirability might influence reporting of such behaviors to researchers during relevant investigations.

Aims: This study aimed at assessing reporting of alcohol consumption during participation in research studies in Jordan, and identifying potential reasons and ethical challenges associated with reporting this behavior.

Subjects and methods: A sample of 400 Jordanians was anonymously surveyed regarding alcohol consumption reporting.

Results: The study showed a tendency of not reporting alcohol consumption in research (56.8%). Religious belief and trust issues regarding reporting sensitive information during participation in research were significantly the main reasons of not reporting alcohol drinking (P<0.05), while social shame effect was limited to rural areas (P<0.05).

Conclusion: Raising Jordanians' awareness of benefits of reporting alcohol consumption is highly recommended. Improving confidence in privacy and data confidentiality among Jordanians might help in improving the level of reporting during participation in research.

背景:不同文化对酒精消费的接受程度差异很大。在相关调查中,宗教信仰和社会期望等几个因素可能会影响向研究人员报告此类行为。目的:本研究旨在评估参与约旦研究期间的饮酒报告,并确定与报告这种行为相关的潜在原因和伦理挑战。对象和方法:对400名约旦人的样本进行了关于酒精消费报告的匿名调查。结果:研究中有不报告饮酒情况的倾向(56.8%)。宗教信仰和在参与研究期间报告敏感信息的信任问题是不报告饮酒的主要原因(PPConclusion:强烈建议提高约旦人对报告饮酒的好处的认识。提高约旦人对隐私和数据保密的信心可能有助于提高参与研究期间的报告水平。
{"title":"Attitudes and beliefs related to reporting alcohol consumption in research studies: a case from Jordan.","authors":"Farah H Alhashimi,&nbsp;Omar F Khabour,&nbsp;Karem H Alzoubi,&nbsp;Samah F Al-Shatnawi","doi":"10.2147/POR.S172613","DOIUrl":"https://doi.org/10.2147/POR.S172613","url":null,"abstract":"<p><strong>Background: </strong>Acceptability of alcohol consumption varies wildly across cultures. Several factors such as religious beliefs and social desirability might influence reporting of such behaviors to researchers during relevant investigations.</p><p><strong>Aims: </strong>This study aimed at assessing reporting of alcohol consumption during participation in research studies in Jordan, and identifying potential reasons and ethical challenges associated with reporting this behavior.</p><p><strong>Subjects and methods: </strong>A sample of 400 Jordanians was anonymously surveyed regarding alcohol consumption reporting.</p><p><strong>Results: </strong>The study showed a tendency of not reporting alcohol consumption in research (56.8%). Religious belief and trust issues regarding reporting sensitive information during participation in research were significantly the main reasons of not reporting alcohol drinking (<i>P</i><0.05), while social shame effect was limited to rural areas (<i>P</i><0.05).</p><p><strong>Conclusion: </strong>Raising Jordanians' awareness of benefits of reporting alcohol consumption is highly recommended. Improving confidence in privacy and data confidentiality among Jordanians might help in improving the level of reporting during participation in research.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"9 ","pages":"55-61"},"PeriodicalIF":8.9,"publicationDate":"2018-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/POR.S172613","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36651503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 11
Real-life treatment of rhinitis in Australia: a historical cohort study of prescription and over-the-counter therapies for patients with and without additional respiratory disease. 澳大利亚鼻炎的真实生活治疗:一项针对患有和不患有其他呼吸道疾病患者的处方和非处方疗法的历史队列研究。
IF 8.9 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2018-08-15 DOI: 10.2147/POR.S153266
David B Price, Pete K Smith, Richard John Harvey, A Simon Carney, Vicky Kritikos, Sinthia Z Bosnic-Anticevich, Louise Christian, Derek Skinner, Victoria Carter, Alice Ms Durieux

Background: The aim of the study was to explore rhinitis therapy purchases in different Australian regions for patients with and without additional respiratory disease, using both doctor's prescriptions and over-the-counter (OTC) medications.

Patients and methods: It was a historical cohort study of pharmacy-related claims that included prescription or OTC rhinitis therapy, with or without asthma/COPD therapy, from January 2013 to December 2014.

Results: Overall, 4,247,193 prescription and OTC rhinitis treatments were purchased from 909 pharmacies over a calendar year; the majority were single-therapy purchases for rhinitis only patients. More multiple-therapy was purchased for rhinitis and asthma/COPD patients (4.4%) than for rhinitis only patients (4.0%), with a greater proportion purchased in VIC, SA and TAS (4.7% of rhinitis only patients and 4.5% of rhinitis and asthma/COPD patients) than in other areas. Dual therapy of oral antihistamine (OAH) and intranasal corticosteroid (INS) were the most frequently purchased multiple-therapy, with higher purchasing rates for rhinitis and asthma/COPD patients (2.6%) than for rhinitis only patients (1.6%). The most frequently purchased single therapy was OAH (70.1% of rhinitis only patients and 57.3% of rhinitis and asthma/COPD patients). First-line INS therapy was more likely to be purchased for rhinitis and asthma/COPD patients (15.3% by prescription and 11.7% OTC) than for rhinitis only patients (5.0% by prescription and 9.2% OTC); however, geographical differences in the proportion of therapies purchased OTC were noted, with a lower proportion of OTC OAH and INS purchases in Queensland and the Northern Territory for patients with and without comorbid respiratory disease.

Conclusion: Purchases of first-line INS therapy are more likely for patients with comorbid respiratory disease if they have received prescriptions and information/advice from their general practitioner. The study results indicate a need for patient information/education at the point-of-sale of OTC OAHs to enable patients to assess their nasal symptoms and receive treatment support from pharmacists. Greater availability to INSs in pharmacies as well as guidance from current guidelines and instruction in correct intranasal technique may also lead to greater uptake of INSs.

背景:本研究的目的是探索在澳大利亚不同地区为患有和不患有其他呼吸道疾病的患者购买鼻炎治疗药物,同时使用医生处方和非处方药。患者和方法:这是一项关于2013年1月至2014年12月期间药房相关索赔的历史队列研究,包括处方或非处方鼻炎治疗,包括哮喘/慢性阻塞性肺病治疗。结果:在一个日历年内,总共从909家药房购买了4247193种处方和非处方鼻炎疗法;大多数是针对仅鼻炎患者的单一疗法购买。鼻炎和哮喘/慢性阻塞性肺病患者(4.4%)比仅鼻炎患者(4.0%)购买了更多的多种治疗方法,VIC、SA和TAS的购买比例(仅鼻炎患者的4.7%和鼻炎和哮喘COPD患者的4.5%)比其他地区更高。口服抗组胺药(OAH)和鼻内皮质类固醇(INS)的双重治疗是购买频率最高的多种治疗方法,鼻炎和哮喘/慢性阻塞性肺病患者的购买率(2.6%)高于仅鼻炎患者(1.6%)。最频繁购买的单一治疗方法是OAH(70.1%的仅鼻炎患者和57.3%的鼻炎和哮喘COPD患者)。与仅鼻炎患者(处方占5.0%,非处方占9.2%)相比,一线INS治疗更有可能购买给鼻炎和哮喘/慢性阻塞性肺病患者(15.3%通过处方购买,11.7%通过非处方购买);然而,注意到购买OTC疗法的比例存在地域差异,昆士兰和北领地患有和不患有合并呼吸系统疾病的患者购买OTC OAH和INS的比例较低。结论:如果患有合并呼吸系统疾病的患者收到了全科医生的处方和信息/建议,那么他们更有可能购买一线INS治疗。研究结果表明,在OTC OAH的销售点需要患者信息/教育,使患者能够评估自己的鼻腔症状并获得药剂师的治疗支持。药店更容易获得INSs,以及现行指南和正确鼻内技术指导也可能导致INSs的更多吸收。
{"title":"Real-life treatment of rhinitis in Australia: a historical cohort study of prescription and over-the-counter therapies for patients with and without additional respiratory disease.","authors":"David B Price,&nbsp;Pete K Smith,&nbsp;Richard John Harvey,&nbsp;A Simon Carney,&nbsp;Vicky Kritikos,&nbsp;Sinthia Z Bosnic-Anticevich,&nbsp;Louise Christian,&nbsp;Derek Skinner,&nbsp;Victoria Carter,&nbsp;Alice Ms Durieux","doi":"10.2147/POR.S153266","DOIUrl":"10.2147/POR.S153266","url":null,"abstract":"<p><strong>Background: </strong>The aim of the study was to explore rhinitis therapy purchases in different Australian regions for patients with and without additional respiratory disease, using both doctor's prescriptions and over-the-counter (OTC) medications.</p><p><strong>Patients and methods: </strong>It was a historical cohort study of pharmacy-related claims that included prescription or OTC rhinitis therapy, with or without asthma/COPD therapy, from January 2013 to December 2014.</p><p><strong>Results: </strong>Overall, 4,247,193 prescription and OTC rhinitis treatments were purchased from 909 pharmacies over a calendar year; the majority were single-therapy purchases for rhinitis only patients. More multiple-therapy was purchased for rhinitis and asthma/COPD patients (4.4%) than for rhinitis only patients (4.0%), with a greater proportion purchased in VIC, SA and TAS (4.7% of rhinitis only patients and 4.5% of rhinitis and asthma/COPD patients) than in other areas. Dual therapy of oral antihistamine (OAH) and intranasal corticosteroid (INS) were the most frequently purchased multiple-therapy, with higher purchasing rates for rhinitis and asthma/COPD patients (2.6%) than for rhinitis only patients (1.6%). The most frequently purchased single therapy was OAH (70.1% of rhinitis only patients and 57.3% of rhinitis and asthma/COPD patients). First-line INS therapy was more likely to be purchased for rhinitis and asthma/COPD patients (15.3% by prescription and 11.7% OTC) than for rhinitis only patients (5.0% by prescription and 9.2% OTC); however, geographical differences in the proportion of therapies purchased OTC were noted, with a lower proportion of OTC OAH and INS purchases in Queensland and the Northern Territory for patients with and without comorbid respiratory disease.</p><p><strong>Conclusion: </strong>Purchases of first-line INS therapy are more likely for patients with comorbid respiratory disease if they have received prescriptions and information/advice from their general practitioner. The study results indicate a need for patient information/education at the point-of-sale of OTC OAHs to enable patients to assess their nasal symptoms and receive treatment support from pharmacists. Greater availability to INSs in pharmacies as well as guidance from current guidelines and instruction in correct intranasal technique may also lead to greater uptake of INSs.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"9 ","pages":"43-54"},"PeriodicalIF":8.9,"publicationDate":"2018-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/POR.S153266","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36431412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 5
Performance of database-derived severe exacerbations and asthma control measures in asthma: responsiveness and predictive utility in a UK primary care database with linked questionnaire data. 数据库衍生的哮喘严重恶化和哮喘控制措施的性能:英国初级保健数据库与关联问卷数据的响应性和预测效用。
IF 8.9 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2018-08-10 eCollection Date: 2018-01-01 DOI: 10.2147/POR.S151615
Gene Colice, Alison Chisholm, Alexandra L Dima, Helen K Reddel, Annie Burden, Richard J Martin, Guy Brusselle, Todor A Popov, Julie von Ziegenweidt, David B Price

Background: Observational research is essential to evaluate the real-life effectiveness of asthma treatments and can now make use of outcomes derived from electronic medical records.

Aim: The aim of this study was to investigate the utility of several database outcome measures in asthma.

Methods: This study identified cohorts of patients with active asthma from a UK primary care database - Optimum Patient Care Research Database - approximately 10% of which was prospectively supplemented with questionnaire data. The "Questionnaire cohort" included patients aged 18-60 years with valid questionnaire data and 1 year of continuous primary care data. Separate "ICS initiation" and "ICS step-up" cohorts included patients aged 5-60 years initiated on inhaled corticosteroids (ICSs), who had 1 year of continuous primary care data before, and after, this index visit. Database measures of asthma symptom control and exacerbations were identified in the Optimum Patient Care Research Database and cross-tabulated with corresponding patient-reported (questionnaire) data. Responsiveness of the database outcomes was analyzed, using McNemar's and Wilcoxon's signed rank tests, and Poisson regression was used to estimate the association between database outcomes and future risk of database exacerbations, in the ICS initiation cohort.

Results: The final study included 2,366 Questionnaire cohort patients and 51,404 ICS initiation patients. Agreement between patient-reported and database-recorded exacerbations was fair (kappa 0.35). Following the initiation of ICS, database risk domain asthma control (based on exacerbations) improved (proportion of patients with uncontrolled asthma decreased from 24.9% to 18.6%; P<0.001) and mean number of database exacerbations decreased from 0.09 to 0.08 per patient per year (P=0.001). However, another measure of asthma control which includes short-acting beta-agonist prescription as part of the definition did not show this improvement. Patients with prior exacerbations had a higher risk of future exacerbation (rate ratio [95% confidence interval], 3.23 [3.03-3.57]).

Conclusion: Asthma control and exacerbations derived from primary care databases were responsive, with the exception of short-acting beta-agonist prescriptions, and useful for risk prediction.

背景:观察性研究对于评估哮喘治疗的实际效果至关重要,现在可以利用从电子病历中获得的结果:本研究从英国初级医疗数据库--最佳患者护理研究数据库--中确定了活动性哮喘患者队列,其中约 10%的患者前瞻性地补充了问卷调查数据。问卷队列 "包括年龄在 18-60 岁之间、拥有有效问卷数据和 1 年连续初级保健数据的患者。独立的 "开始使用 ICS "和 "逐步使用 ICS "队列包括 5-60 岁开始使用吸入式皮质类固醇(ICS)的患者,这些患者在指标访问前后均有 1 年的连续初级保健数据。在最佳患者护理研究数据库中确定了哮喘症状控制和病情恶化的数据库测量指标,并与相应的患者报告(问卷)数据进行了交叉分析。使用 McNemar 和 Wilcoxon 符号秩检验分析了数据库结果的响应性,并使用泊松回归估计了开始使用 ICS 的队列中数据库结果与未来数据库恶化风险之间的关联:最终研究包括 2,366 名问卷队列患者和 51,404 名开始使用 ICS 的患者。患者报告的病情加重情况与数据库记录的病情加重情况之间的一致性尚可(kappa 0.35)。开始使用 ICS 后,数据库风险域的哮喘控制情况(基于恶化情况)有所改善(哮喘未得到控制的患者比例从 24.9% 降至 18.6%;PP=0.001)。然而,另一种哮喘控制测量方法(将短效β-激动剂处方作为定义的一部分)并没有显示出这种改善。曾有过病情恶化的患者今后病情恶化的风险更高(比率比[95% 置信区间],3.23 [3.03-3.57]):结论:从初级保健数据库中得出的哮喘控制和病情恶化情况,除短效β-激动剂处方外,都是反应灵敏的,有助于进行风险预测。
{"title":"Performance of database-derived severe exacerbations and asthma control measures in asthma: responsiveness and predictive utility in a UK primary care database with linked questionnaire data.","authors":"Gene Colice, Alison Chisholm, Alexandra L Dima, Helen K Reddel, Annie Burden, Richard J Martin, Guy Brusselle, Todor A Popov, Julie von Ziegenweidt, David B Price","doi":"10.2147/POR.S151615","DOIUrl":"10.2147/POR.S151615","url":null,"abstract":"<p><strong>Background: </strong>Observational research is essential to evaluate the real-life effectiveness of asthma treatments and can now make use of outcomes derived from electronic medical records.</p><p><strong>Aim: </strong>The aim of this study was to investigate the utility of several database outcome measures in asthma.</p><p><strong>Methods: </strong>This study identified cohorts of patients with active asthma from a UK primary care database - Optimum Patient Care Research Database - approximately 10% of which was prospectively supplemented with questionnaire data. The \"Questionnaire cohort\" included patients aged 18-60 years with valid questionnaire data and 1 year of continuous primary care data. Separate \"ICS initiation\" and \"ICS step-up\" cohorts included patients aged 5-60 years initiated on inhaled corticosteroids (ICSs), who had 1 year of continuous primary care data before, and after, this index visit. Database measures of asthma symptom control and exacerbations were identified in the Optimum Patient Care Research Database and cross-tabulated with corresponding patient-reported (questionnaire) data. Responsiveness of the database outcomes was analyzed, using McNemar's and Wilcoxon's signed rank tests, and Poisson regression was used to estimate the association between database outcomes and future risk of database exacerbations, in the ICS initiation cohort.</p><p><strong>Results: </strong>The final study included 2,366 Questionnaire cohort patients and 51,404 ICS initiation patients. Agreement between patient-reported and database-recorded exacerbations was fair (kappa 0.35). Following the initiation of ICS, database risk domain asthma control (based on exacerbations) improved (proportion of patients with uncontrolled asthma decreased from 24.9% to 18.6%; <i>P</i><0.001) and mean number of database exacerbations decreased from 0.09 to 0.08 per patient per year (<i>P</i>=0.001). However, another measure of asthma control which includes short-acting beta-agonist prescription as part of the definition did not show this improvement. Patients with prior exacerbations had a higher risk of future exacerbation (rate ratio [95% confidence interval], 3.23 [3.03-3.57]).</p><p><strong>Conclusion: </strong>Asthma control and exacerbations derived from primary care databases were responsive, with the exception of short-acting beta-agonist prescriptions, and useful for risk prediction.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"9 ","pages":"29-42"},"PeriodicalIF":8.9,"publicationDate":"2018-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b5/65/por-9-029.PMC6092127.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36414174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Factors associated with early cardiac complications following transcatheter aortic valve implantation with transapical approach. 经导管经根尖入路主动脉瓣置入术后早期心脏并发症的相关因素。
IF 8.9 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2018-07-10 eCollection Date: 2018-01-01 DOI: 10.2147/POR.S157843
Vasileios Patris, Konstantinos Giakoumidakis, Mihalis Argiriou, Katerina K Naka, Efstratios Apostolakis, Mark Field, Manoj Kuduvalli, Aung Oo, Stavros Siminelakis

Purpose: To estimate the incidence of postprocedural early cardiac complications among patients undergoing transcatheter aortic valve implantation, through transapical approach (TA-TAVI), and to identify factors independently associated with the occurrence of them.

Patients and methods: A retrospective cohort study of 90 patients, who had undergone TA-TAVI in a tertiary hospital of Liverpool, UK, during a 5-year period (September 2008-October 2013), was conducted. Data on patient demographics, periprocedural characteristics and cardiac complications presented within 30-day post TA-TAVI were collected, retrospectively, using the hospital's electronic database.

Results: The overall 30-day incidence of cardiac complications was estimated at 18.9% (n=17/90). The rate of new onset of atrial fibrillation (AF), atrioventricular block requiring permanent pacemaker implantation, shockable cardiac arrest rhythm and cardiac tamponade was 11.1%, 3.3%, 2.2% and 2.2%, respectively. Bivariate analysis found that absence of preoperative AF (p=0.01), receiving of oral inotropes preprocedurally (p=0.01), intravenous inotropic support postprocedurally (p=0.01) and requirement for postprocedural tracheal intubation (p=0.001) were the main factors associated with increased probability for patient cardiac morbidity.

Conclusion: It seems that patients with absence of AF and oral inotropic support preprocedurally and those with post TA-TAVI mechanical ventilatory and intravenous inotropic support have greater probability to develop cardiac complications. This knowledge allows the early identification of high-risk patients and supports clinicians to apply both preventive and therapeutic interventions for the optimum patient management and care. In addition, administrators could allocate the health care system resources effectively.

目的:评估经导管主动脉瓣置入术(TA-TAVI)患者术后早期心脏并发症的发生率,并确定其发生的独立相关因素。患者和方法:对英国利物浦一家三级医院5年期间(2008年9月至2013年10月)接受TA-TAVI治疗的90例患者进行回顾性队列研究。回顾性收集TA-TAVI后30天内患者人口统计学、围手术期特征和心脏并发症的数据,使用医院的电子数据库。结果:30天心脏并发症的总发生率估计为18.9% (n=17/90)。新发房颤率为11.1%,需植入永久性起搏器的房室传导阻滞率为3.3%,突发性心搏骤停率为2.2%,心包填塞率为2.2%。双因素分析发现,术前无房颤(p=0.01)、术前口服肌力药物(p=0.01)、术后静脉肌力支持(p=0.01)和术后气管插管(p=0.001)是增加患者心脏发病率的主要因素。结论:术前没有房颤和口服肌力支持的患者以及TA-TAVI术后机械通气和静脉肌力支持的患者发生心脏并发症的可能性更大。这些知识允许早期识别高风险患者,并支持临床医生应用预防和治疗干预措施,以实现最佳的患者管理和护理。此外,管理员可以有效地分配卫生保健系统资源。
{"title":"Factors associated with early cardiac complications following transcatheter aortic valve implantation with transapical approach.","authors":"Vasileios Patris,&nbsp;Konstantinos Giakoumidakis,&nbsp;Mihalis Argiriou,&nbsp;Katerina K Naka,&nbsp;Efstratios Apostolakis,&nbsp;Mark Field,&nbsp;Manoj Kuduvalli,&nbsp;Aung Oo,&nbsp;Stavros Siminelakis","doi":"10.2147/POR.S157843","DOIUrl":"https://doi.org/10.2147/POR.S157843","url":null,"abstract":"<p><strong>Purpose: </strong>To estimate the incidence of postprocedural early cardiac complications among patients undergoing transcatheter aortic valve implantation, through transapical approach (TA-TAVI), and to identify factors independently associated with the occurrence of them.</p><p><strong>Patients and methods: </strong>A retrospective cohort study of 90 patients, who had undergone TA-TAVI in a tertiary hospital of Liverpool, UK, during a 5-year period (September 2008-October 2013), was conducted. Data on patient demographics, periprocedural characteristics and cardiac complications presented within 30-day post TA-TAVI were collected, retrospectively, using the hospital's electronic database.</p><p><strong>Results: </strong>The overall 30-day incidence of cardiac complications was estimated at 18.9% (n=17/90). The rate of new onset of atrial fibrillation (AF), atrioventricular block requiring permanent pacemaker implantation, shockable cardiac arrest rhythm and cardiac tamponade was 11.1%, 3.3%, 2.2% and 2.2%, respectively. Bivariate analysis found that absence of preoperative AF (<i>p</i>=0.01), receiving of oral inotropes preprocedurally (<i>p</i>=0.01), intravenous inotropic support postprocedurally (<i>p</i>=0.01) and requirement for postprocedural tracheal intubation (<i>p</i>=0.001) were the main factors associated with increased probability for patient cardiac morbidity.</p><p><strong>Conclusion: </strong>It seems that patients with absence of AF and oral inotropic support preprocedurally and those with post TA-TAVI mechanical ventilatory and intravenous inotropic support have greater probability to develop cardiac complications. This knowledge allows the early identification of high-risk patients and supports clinicians to apply both preventive and therapeutic interventions for the optimum patient management and care. In addition, administrators could allocate the health care system resources effectively.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"9 ","pages":"21-27"},"PeriodicalIF":8.9,"publicationDate":"2018-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/POR.S157843","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36323948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Perioperative predictors of delirium and incidence factors in adult patients post cardiac surgery. 心脏手术后成年患者围手术期谵妄的预测因素和发病率。
IF 8.9 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2018-05-08 eCollection Date: 2018-01-01 DOI: 10.2147/POR.S157909
Stavros Theologou, Konstantinos Giakoumidakis, Christos Charitos

Background: Delirium is a quite common complication in adult patients post-cardiac surgery. The purpose of our study was to identify perioperative characteristics and also focus on incidence factors that could predict delirium in the cardiac surgery intensive care unit (CICU) postoperatively.

Methods: We conducted a prospective study of 179 consecutive patients, who underwent open-heart surgical operation and were admitted to the CICU of a general tertiary hospital in Athens, Greece. The patients were screened for delirium by using the diagnostic tools of Rich-mond Agitation Sedation Scale (RASS score) and the Confusion Assessment Method - ICU (CAM-ICU). The delirium assessment was carried out on the 1st and the 2nd postoperative day, and was conducted twice every nursing shift. A short questionnaire on sociodemographics and clinical patient characteristics was used for data collection purposes.

Results: A total of 179 patients who underwent open-heart surgical operation with cardiopulmonary bypass (CPB) were enrolled in our study. The 2-day incidence of postoperative delirium in ICU was 11.2% (n=20/179). The main independent predictors of delirium on the 2nd postoperative day were neutrophil-to-lymphocyte ratio (p=0.001) and urea levels (p=0.016). Additionally, increased perioperative creatinine (p=0.006) and sodium (p=0.039) levels were significantly associated with delirium occurrence. Furthermore, elevated EuroSCORE (p=0.001), extended length of stay (LOS) in ICU (p<0.001), and extended LOS with endotracheal tube (p=0.001) were also statistically significant indicators.

Conclusion: Patients with extended LOS with endotracheal tube and prolonged stay in ICU in accordance with peaked urea, neutrophil-to-lymphocyte ratio, creatinine, and sodium levels seem to have a significantly greater probability of developing delirium in the ICU. Further research is needed in the field of postoperative cardiac patients in order to determine the causality and etiology of certain risk factors for delirium.

背景:谵妄是心脏手术后成年患者的一种相当常见的并发症。我们的研究旨在确定围手术期的特征,并重点研究可预测心脏手术后在重症监护室(CICU)出现谵妄的发病因素:我们对希腊雅典一家综合性三级医院的 179 名连续接受开胸手术并入住 CICU 的患者进行了前瞻性研究。研究人员使用里奇蒙德躁动镇静量表(RASS评分)和重症监护室意识混乱评估法(CAM-ICU)等诊断工具对患者进行了谵妄筛查。谵妄评估在术后第 1 天和第 2 天进行,每个护理班次进行两次。数据收集采用了一份关于社会人口学和临床患者特征的简短问卷:本研究共纳入了 179 名接受心肺旁路(CPB)开胸手术的患者。重症监护室术后 2 天谵妄发生率为 11.2%(n=20/179)。术后第2天谵妄的主要独立预测因素是中性粒细胞与淋巴细胞比值(P=0.001)和尿素水平(P=0.016)。此外,围手术期肌酐(p=0.006)和钠(p=0.039)水平升高也与谵妄发生显著相关。此外,EuroSCORE升高(p=0.001)、ICU住院时间延长(pp=0.001)也是具有统计学意义的指标:结论:根据尿素、中性粒细胞与淋巴细胞比值、肌酐和钠水平的峰值,延长气管插管时间和延长重症监护室住院时间的患者在重症监护室发生谵妄的概率似乎明显更高。为了确定谵妄的某些风险因素的因果关系和病因,还需要在心脏术后患者领域开展进一步研究。
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引用次数: 0
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