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Walker J, Wilson B, Laing-Herridge K, Edwards C. Standardized 100% single rooms in new hospital builds: a high-cost strategy with low use of showers. J Hosp Infect 2023; 138:89-91. [PMID: 37075819 DOI: 10.1016/j.jhin.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/06/2023] [Indexed: 04/21/2023]
Affiliation(s)
- J Walker
- Department of Infectious Diseases, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK.
| | - B Wilson
- Department of Infection Prevention and Control, Balfour Hospital, NHS Orkney, Kirkwall, UK
| | - K Laing-Herridge
- Department of Infection Prevention and Control, Balfour Hospital, NHS Orkney, Kirkwall, UK
| | - C Edwards
- Department of Infection Prevention and Control, Balfour Hospital, NHS Orkney, Kirkwall, UK
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Smitherman EA, Chahine RA, Beukelman T, Lewandowski LB, Rahman AKMF, Wenderfer SE, Curtis JR, Hersh AO, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar‐Smiley F, Barillas‐Arias L, Basiaga M, Baszis K, Becker M, Bell‐Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang‐Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel‐Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie‐Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui‐Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein‐Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PM, McGuire S, McHale I, McMonagle A, McMullen‐Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O'Brien B, O'Brien T, Okeke O, Oliver M, Olson J, O'Neil K, Onel K, Orandi A, Orlando M, Osei‐Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan‐Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas‐Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth‐Wojcicki E, Rouster – Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert‐Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner‐Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care. Arthritis Care Res (Hoboken) 2023; 75:1553-1562. [PMID: 36775844 PMCID: PMC10500561 DOI: 10.1002/acr.25002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/14/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis. METHODS We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded. RESULTS We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers. CONCLUSION In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.
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Inkster T, Walker J, Weinbren M. Waterborne infections in haemato-oncology units - a narrative review. J Hosp Infect 2023:S0195-6701(23)00165-2. [PMID: 37290689 DOI: 10.1016/j.jhin.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/10/2023]
Abstract
Bone marrow transplant and haemato-oncology patients are at risk of healthcare associated infections due to waterborne pathogens. We undertook a narrative review of waterborne outbreaks in haemato-oncology patients from 2000-2022. Databases searched included Pubmed, DARE and CDSR and were undertaken by two authors. We analysed the organisms implicated, sources identified and infection prevention and control strategies implemented. The most commonly implicated pathogens were Pseudomonas aeruginosa, non-tuberculous mycobacteria and Legionella pneumophila. Bloodstream infection was the most common clinical presentation. The majority of incidents employed multimodal strategies to achieve control, addressing both the water source and routes of transmission. This review highlights the risk to haemato-oncology patients from waterborne pathogens and discusses future preventative strategies and the requirement for new UK guidance for haemato-oncology units.
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Affiliation(s)
- T Inkster
- Department of Microbiology, Queen Elizabeth University Hospital, Glasgow, UK.
| | - J Walker
- Walker on Water, 23 Anderson Road, Bishopdown, Salisbury, UK
| | - M Weinbren
- Department of Microbiology, Kings Mill Hospital, Sutton-in -Ashfield, UK
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Yin K, Whitaker L, Hojo E, McLenachan S, Walker J, McKillop G, Stubbs C, Priest L, Cruz M, Roberts N, Critchley H. Measurement of changes in uterine and fibroid volume during treatment of heavy menstrual bleeding (HMB). Hum Reprod Open 2023; 2023:hoad021. [PMID: 37304815 PMCID: PMC10247393 DOI: 10.1093/hropen/hoad021] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/28/2023] [Indexed: 06/13/2023] Open
Abstract
STUDY QUESTION Does application of an unbiased method for analysis of magnetic resonance (MR) images reveal any effect on uterine or fibroid volume from treatment of heavy menstrual bleeding (HMB) with three 12-week courses of the selective progesterone receptor modulator ulipristal acetate (SPRM-UPA)? SUMMARY ANSWER Application of an unbiased method for analysis of MR images showed that treatment of HMB with SPRM-UPA was not associated with a significant reduction in the volume of the uterus or in the volume of uterine fibroids. WHAT IS KNOWN ALREADY SPRM-UPA shows therapeutic efficacy for treating HMB. However, the mechanism of action (MoA) is not well understood and there have been mixed reports, using potentially biased methodology, regarding whether SPRM-UPA has an effect on the volume of the uterus and fibroids. STUDY DESIGN SIZE DURATION In a prospective clinical study (with no comparator), 19 women with HMB were treated over a period of 12 months with SPRM-UPA and uterine and fibroid size were assessed with high resolution structural MRI and stereology. PARTICIPANTS/MATERIALS SETTING METHODS A cohort of 19 women aged 38-52 years (8 with and 11 without fibroids) were treated with three 12-week courses of 5 mg SPRM-UPA given daily, with four weeks off medication in-between treatment courses. Unbiased estimates of the volume of uterus and total volume of fibroids were obtained at baseline, and after 6 and 12 months of treatment, by using the Cavalieri method of modern design-based stereology in combination with magnetic resonance imaging (MRI). MAIN RESULTS AND THE ROLE OF CHANCE Bland-Altman plots showed good intra-rater repeatability and good inter-rater reproducibility for measurement of the volume of both fibroids and the uterus. For the total patient cohort, two-way ANOVA did not show a significant reduction in the volume of the uterus after two or three treatment courses of SPRM-UPA (P = 0.51), which was also the case when the groups of women with and without fibroids were considered separately (P = 0.63). One-way ANOVA did not show a significant reduction in total fibroid volume in the eight patients with fibroids (P = 0.17). LIMITATIONS REASONS FOR CAUTION The study has been performed in a relatively small cohort of women and simulations that have subsequently been performed using the acquired data have shown that for three time points and a group size of up to 50, with alpha (Type I Error) and beta (Type II Error) set to 95% significance and 80% power, respectively, at least 35 patients would need to be recruited in order for the null hypothesis (that there is no significant reduction in total fibroid volume) to be potentially rejected. WIDER IMPLICATIONS OF THE FINDINGS The imaging protocol that we have developed represents a generic paradigm for measuring the volume of the uterus and uterine fibroids that can be readily incorporated in future studies of medical treatments of HMB. In the present study, SPRM-UPA failed to produce a significant reduction in the volume of the uterus or the total volume of fibroids (which were present in approximately half of the patients) after either two or three 12-week courses of treatment. This finding represents a new insight in respect of the management of HMB using treatment strategies that target hormone-dependence. STUDY FUNDING/COMPETING INTERESTS The UPA Versus Conventional Management of HMB (UCON) trial was funded by the EME Programme (Medical Research Council (MRC) and National Institutes of Health Research (NIHR)) (12/206/52). The views expressed in this publication are those of the authors and not necessarily those of the Medical Research Council, National Institute for Health Research, or Department of Health and Social Care.Medical Research Council (MRC) Centre grants to the Centre for Reproductive Health (CRH) (G1002033 and MR/N022556/1) are also gratefully acknowledged. H.C. has clinical research support for laboratory consumables and staff from Bayer AG and provides consultancy advice (All paid to Institution) for Bayer AG, PregLem SA, Gedeon Richter, Vifor Pharma UK Ltd, AbbVie Inc., and Myovant Sciences GmbH. H.C. has received royalties from UpToDate for an article on abnormal uterine bleeding. L.W. has received grant funding from Roche Diagnostics (Paid to Institution). All other authors have no conflicts to declare. TRIAL REGISTRATION NUMBER The study reported here is an embedded mechanism of action study (no comparator) within the UCON clinical trial (registration ISRCTN: 20426843).
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Affiliation(s)
- K Yin
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | - L Whitaker
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - E Hojo
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - S McLenachan
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - J Walker
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - G McKillop
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - C Stubbs
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - L Priest
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - M Cruz
- Departamento de Matemáticas Estadística y Computación, University of Cantabria, Santander, Spain
| | - N Roberts
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - H Critchley
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
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Jacob J, Tesch F, Wende D, Batram M, Loser F, Weidinger O, Roessler M, Seifert M, Risch L, Nagel O, König C, Jucknewitz R, Treskova-Schwarzbach M, Hertle D, Scholz S, Stern S, Ballesteros P, Baßler S, Bertele B, Repschläger U, Richter N, Riederer C, Sobik F, Schramm A, Schulte C, Walker J, Schmitt J. Development of a risk score to identify patients at high risk for a severe course of COVID-19. Z Gesundh Wiss 2023:1-10. [PMID: 37361269 PMCID: PMC10032626 DOI: 10.1007/s10389-023-01884-7] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/03/2023] [Indexed: 03/24/2023]
Abstract
Aim We aimed to develop a risk score to calculate a person's individual risk for a severe COVID-19 course (POINTED score) to support prioritization of especially vulnerable patients for a (booster) vaccination. Subject and methods This cohort study was based on German claims data and included 623,363 individuals with a COVID-19 diagnosis in 2020. The outcome was COVID-19 related treatment in an intensive care unit, mechanical ventilation, or death after a COVID-19 infection. Data were split into a training and a test sample. Poisson regression models with robust standard errors including 35 predefined risk factors were calculated. Coefficients were rescaled with a min-max normalization to derive numeric score values between 0 and 20 for each risk factor. The scores' discriminatory ability was evaluated by calculating the area under the curve (AUC). Results Besides age, down syndrome and hematologic cancer with therapy, immunosuppressive therapy, and other neurological conditions were the risk factors with the highest risk for a severe COVID-19 course. The AUC of the POINTED score was 0.889, indicating very good predictive validity. Conclusion The POINTED score is a valid tool to calculate a person's risk for a severe COVID-19 course. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-023-01884-7.
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Affiliation(s)
- Josephine Jacob
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Falko Tesch
- Center for Evidence-Based Healthcare (ZEGV), University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Danny Wende
- BARMER Institut für Gesundheitssystemforschung (bifg), Berlin, Germany
| | | | | | | | - Martin Roessler
- Center for Evidence-Based Healthcare (ZEGV), University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Martin Seifert
- Center for Evidence-Based Healthcare (ZEGV), University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Lisa Risch
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Oliver Nagel
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | | | | | | | - Dagmar Hertle
- BARMER Institut für Gesundheitssystemforschung (bifg), Berlin, Germany
| | | | | | - Pedro Ballesteros
- BARMER Institut für Gesundheitssystemforschung (bifg), Berlin, Germany
| | | | | | - Uwe Repschläger
- BARMER Institut für Gesundheitssystemforschung (bifg), Berlin, Germany
| | | | | | | | | | - Claudia Schulte
- BARMER Institut für Gesundheitssystemforschung (bifg), Berlin, Germany
| | - Jochen Walker
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare (ZEGV), University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
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Derrick K, Ortiz C, Borrego M, Parker M, Walker J. Abstract No. 525 Investigation of an Ex Vivo Perfusion Model for Teaching Angiographic Procedures to Novice Trainees. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Jacob J, Walker J, Swart E, Baum F, Rößler M, Tesch F, Walther F, Wiegand HF, Ihle P, Schmitt J. [Recommendations for the Utilization of Claims Data During a Pandemic: Lessons Learned from the Project EgePan-Unimed of the Netzwerk Universitätsmedizin (NUM)]. Gesundheitswesen 2023; 85:S171-S177. [PMID: 36170864 DOI: 10.1055/a-1915-4526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
For appropriate response to the COVID-19 pandemic, and for obtaining answers to various relevant research questions, empirical data are required. Claims data of health insurances are a valid data source in such a situation. Within the project egePan-Unimed of the Netzwerk Universitätsmedizin (NUM) we investigated five COVID-19-related research questions using German claims data of statutory health insurances. We studied the prevalence and relevance of risk factors for a severe course of COVID-19, the background incidence of cerebral venous sinus thrombosis and myocarditis, the frequency and symptoms of post-COVID as well as the care of people with a psychiatric condition during the COVID-19 pandemic. Based on these cases, context-specific recommendations regarding the use of German claims data for future pandemics or other public health emergencies were derived, namely that the utilization of established and interdisciplinary project teams enables a timely project start and furthermore, meta-analytic methods are a valuable way to pool aggregated results of claims data analyses when data protection regulations do not allow a consolidation of data sets from different statutory health insurances. Under these circumstances, claims data are a readily available and valid data source of empirical evidence base necessary for public health measures during a pandemic.
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Affiliation(s)
- Josephine Jacob
- InGef - Institut für angewandte Gesundheitsforschung Berlin GmbH, InGef - Institut für angewandte Gesundheitsforschung Berlin GmbH, Berlin, Germany
| | - Jochen Walker
- InGef - Institut für angewandte Gesundheitsforschung Berlin GmbH, InGef - Institut für angewandte Gesundheitsforschung Berlin GmbH, Berlin, Germany
| | - Enno Swart
- Institut für Sozialmedizin und Gesundheitssystemforschung, Otto-von-Guericke-Universitat Magdeburg Medizinische Fakultat, Magdeburg, Germany
| | - Fabian Baum
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, Dresden, Germany
- Qualitäts- und Medizinisches Risikomanagement, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
| | - Martin Rößler
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus Zentrum für Evidenzbasierte Gesundheitsversorgung, Dresden, Germany
| | - Falko Tesch
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, Dresden, Germany
| | - Felix Walther
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, Dresden, Germany
| | - Hauke Felix Wiegand
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Peter Ihle
- PMV forschungsgruppe, Universität zu Köln, Köln, Germany
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Medizinische Fakultät Carl Gustav Carus der Technischen Universität Dresden, Dresden, Germany
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Diab MA, Osman M, Hassan FIA, Walker J. Development of isolated left deltoid compartment syndrome due to meth intoxication with associated Rhabdomyolysis leading to significant kidney damage. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00496-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Diab MA, Osman M, Hassan FIA, Walker J. Miller fisher syndrome in a 20 year old female following infection with SARS-CoV-2. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00591-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Hassan FIA, Hafiz S, Al-Bayati M, Dweik A, Walker J. Inferior vena cava syndrome: a neglected entity. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00208-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Al-Bayati M, Roy A, Dweik A, Dharmarpandi G, Hassan FIA, Walker J. Experiencing years of progressive muscle weakness and dehabilitation, a case of missed amyotrophic lateral sclerosis. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Hassan FIA, Hafiz S, Mohammed B, Dharmarpandi G, Walker J. Weakness in rhabdomyolysis: a dismissed symptom. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00350-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Dweik A, Waqas R, Hassan FIA, Al-Bayati M, Dharmarpandi G, Walker J. Acute renal infarction presenting as hypertensive urgency. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00223-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Dweik A, Dharmarpandi G, Al-Bayati M, Hassan FIA, Waqas R, Walker J. Vaping induced platelet dysfunction. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00224-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Roy A, Afroze T, Al-Bayati M, Mohanakrishnan B, Walker J. Persistent abdominal pain after cholecystectomy. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Hassan FIA, Al-Bayati M, Tanami SA, Dharmarpandi G, Walker J. Lipase negative severe acute pancreatitis: a rare but overlooked entity. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00150-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Tanami SA, Mohanakrishnan B, Tanbir MA, Walker J. A postmenopausal woman present with Takotsubo cardiomyopathy without any major risk factors. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Sankoorikkal N, Walker J, Cutts A, Tilley E, Cutts K, Vasylyeva T. Strengthening capacity to achieve equity in access to rare disease clinical trials. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00201-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Osman M, Diab MA, Dharmarpandi G, Mirembe L, Hassan FIA, Walker J. Chronic gastric volvulus as a rare cause of iron deficiency anemia. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00166-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Douros A, Basedow F, Cui Y, Dimakos J, Walker J, Enders D, Tagalakis V. Effectiveness and Safety of Direct Oral Anticoagulants Among Octogenarians with Venous Thromboembolism: An International Multidatabase Cohort Study. Am J Med 2023; 136:79-87.e7. [PMID: 36150513 DOI: 10.1016/j.amjmed.2022.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The effects of direct oral anticoagulants (DOACs) among octogenarian patients with venous thromboembolism remains poorly understood. To address this knowledge gap, our study aimed to assess the effectiveness and safety of DOACs compared to vitamin K antagonists (VKAs) among octogenarians with venous thromboembolism. METHODS We conducted an international cohort study using administrative health care databases from Québec, Canada, and Germany. We assembled 2 population-based cohorts of octogenarians with incident venous thromboembolism initiating treatment with DOACs or VKAs. The study period spanned from January 2012 to the most recent date of data availability (Québec: December 2016; Germany: December 2019). Using an as-treated exposure definition, we compared use of DOACs to use of VKAs, applying inverse probability of treatment weighting based on high-dimensional propensity scores to balance exposure groups. Cox proportional hazards models estimated site-specific hazard ratios (HRs) and 95% confidence intervals (CIs) of recurrent venous thromboembolism, major bleeding, and all-cause mortality. The results were meta-analyzed using random-effects models. RESULTS Overall, our study included 6737 octogenarians with venous thromboembolism (Québec: n = 2556; Germany: n = 4181) who initiated use of DOACs (n = 3778) or VKAs (n = 2959). When compared to VKAs, DOACs were associated with similar risks of recurrent venous thromboembolism (weighted HR, 0.80; 95% CI, 0.43-1.46; I2 = 0.00), major bleeding (weighted HR, 0.96; 95% CI, 0.57-1.63; I2 = 0.59), and all-cause mortality (weighted HR, 1.04; 95% CI, 0.81-1.34; I2 = 0.00). CONCLUSIONS Among octogenarians with venous thromboembolism, DOACs showed a comparable effectiveness and safety compared to VKAs. Our results support the use of DOACs in this high-risk group.
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Affiliation(s)
- Antonios Douros
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada; Department of Medicine, McGill University, Montreal, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ying Cui
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Jenny Dimakos
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Jochen Walker
- InGef - Institute for Applied Health Research, Berlin, Germany
| | - Dirk Enders
- InGef - Institute for Applied Health Research, Berlin, Germany
| | - Vicky Tagalakis
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada; Department of Medicine, McGill University, Montreal, QC, Canada; Division of General Internal Medicine, Jewish General Hospital, Montreal, QC, Canada.
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Catalano P, Walker J, El Mardeeni D, Schlewet M. Minimally Invasive Nasal Airway Surgery Can Reverse ADHD in Children. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hahn T, Daymont C, Beukelman T, Groh B, Hays K, Bingham CA, Scalzi L, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J 2022; 20:107. [PMID: 36434731 PMCID: PMC9701017 DOI: 10.1186/s12969-022-00770-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months. METHODS We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed. RESULTS We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05). CONCLUSION While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.
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Affiliation(s)
- Timothy Hahn
- Department of Pediatrics, Penn State Children's Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA, 17033-0855, USA.
| | - Carrie Daymont
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Timothy Beukelman
- grid.265892.20000000106344187Department of Pediatrics, University of Alabama at Birmingham, CPPN G10, 1600 7th Ave South, Birmingham, AL 35233 USA
| | - Brandt Groh
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | | | - Catherine April Bingham
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Lisabeth Scalzi
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
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Ohaegbulam K, Pennock N, Walker J. Evaluation of a Sumoylation Inhibitor as an Intrinsic and Extrinsic Radiosensitizer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Roessler M, Tesch F, Batram M, Jacob J, Loser F, Weidinger O, Wende D, Vivirito A, Toepfner N, Ehm F, Seifert M, Nagel O, König C, Jucknewitz R, Armann JP, Berner R, Treskova-Schwarzbach M, Hertle D, Scholz S, Stern S, Ballesteros P, Baßler S, Bertele B, Repschläger U, Richter N, Riederer C, Sobik F, Schramm A, Schulte C, Wieler L, Walker J, Scheidt-Nave C, Schmitt J. Post-COVID-19-associated morbidity in children, adolescents, and adults: A matched cohort study including more than 157,000 individuals with COVID-19 in Germany. PLoS Med 2022; 19:e1004122. [PMID: 36355754 DOI: 10.1101/2021.10.21.21265133] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 02/22/2022] [Accepted: 10/12/2022] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Long-term health sequelae of the Coronavirus Disease 2019 (COVID-19) are a major public health concern. However, evidence on post-acute COVID-19 syndrome (post-COVID-19) is still limited, particularly for children and adolescents. Utilizing comprehensive healthcare data on approximately 46% of the German population, we investigated post-COVID-19-associated morbidity in children/adolescents and adults. METHODS AND FINDINGS We used routine data from German statutory health insurance organizations covering the period between January 1, 2019 and December 31, 2020. The base population included all individuals insured for at least 1 day in 2020. Based on documented diagnoses, we identified individuals with polymerase chain reaction (PCR)-confirmed COVID-19 through June 30, 2020. A control cohort was assigned using 1:5 exact matching on age and sex, and propensity score matching on preexisting medical conditions. The date of COVID-19 diagnosis was used as index date for both cohorts, which were followed for incident morbidity outcomes documented in the second quarter after index date or later.Overall, 96 prespecified outcomes were aggregated into 13 diagnosis/symptom complexes and 3 domains (physical health, mental health, and physical/mental overlap domain). We used Poisson regression to estimate incidence rate ratios (IRRs) with 95% confidence intervals (95% CIs). The study population included 11,950 children/adolescents (48.1% female, 67.2% aged between 0 and 11 years) and 145,184 adults (60.2% female, 51.1% aged between 18 and 49 years). The mean follow-up time was 236 days (standard deviation (SD) = 44 days, range = 121 to 339 days) in children/adolescents and 254 days (SD = 36 days, range = 93 to 340 days) in adults. COVID-19 and control cohort were well balanced regarding covariates. The specific outcomes with the highest IRR and an incidence rate (IR) of at least 1/100 person-years in the COVID-19 cohort in children and adolescents were malaise/fatigue/exhaustion (IRR: 2.28, 95% CI: 1.71 to 3.06, p < 0.01, IR COVID-19: 12.58, IR Control: 5.51), cough (IRR: 1.74, 95% CI: 1.48 to 2.04, p < 0.01, IR COVID-19: 36.56, IR Control: 21.06), and throat/chest pain (IRR: 1.72, 95% CI: 1.39 to 2.12, p < 0.01, IR COVID-19: 20.01, IR Control: 11.66). In adults, these included disturbances of smell and taste (IRR: 6.69, 95% CI: 5.88 to 7.60, p < 0.01, IR COVID-19: 12.42, IR Control: 1.86), fever (IRR: 3.33, 95% CI: 3.01 to 3.68, p < 0.01, IR COVID-19: 11.53, IR Control: 3.46), and dyspnea (IRR: 2.88, 95% CI: 2.74 to 3.02, p < 0.01, IR COVID-19: 43.91, IR Control: 15.27). For all health outcomes combined, IRs per 1,000 person-years in the COVID-19 cohort were significantly higher than those in the control cohort in both children/adolescents (IRR: 1.30, 95% CI: 1.25 to 1.35, p < 0.01, IR COVID-19: 436.91, IR Control: 335.98) and adults (IRR: 1.33, 95% CI: 1.31 to 1.34, p < 0.01, IR COVID-19: 615.82, IR Control: 464.15). The relative magnitude of increased documented morbidity was similar for the physical, mental, and physical/mental overlap domain. In the COVID-19 cohort, IRs were significantly higher in all 13 diagnosis/symptom complexes in adults and in 10 diagnosis/symptom complexes in children/adolescents. IRR estimates were similar for age groups 0 to 11 and 12 to 17. IRs in children/adolescents were consistently lower than those in adults. Limitations of our study include potentially unmeasured confounding and detection bias. CONCLUSIONS In this retrospective matched cohort study, we observed significant new onset morbidity in children, adolescents, and adults across 13 prespecified diagnosis/symptom complexes, following COVID-19 infection. These findings expand the existing available evidence on post-COVID-19 conditions in younger age groups and confirm previous findings in adults. TRIAL REGISTRATION ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT05074953.
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Affiliation(s)
- Martin Roessler
- Center for Evidence-Based Healthcare (ZEGV), University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Falko Tesch
- Center for Evidence-Based Healthcare (ZEGV), University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Manuel Batram
- Vandage GmbH, Bielefeld, Germany and Faculty for Business Administration and Economics, Bielefeld University, Bielefeld, Germany
| | - Josephine Jacob
- InGef-Institute for Applied Health Research Berlin, Berlin, Germany
| | | | | | - Danny Wende
- BARMER Institut für Gesundheitssystemforschung (bifg), Berlin, Germany
| | - Annika Vivirito
- InGef-Institute for Applied Health Research Berlin, Berlin, Germany
| | - Nicole Toepfner
- Department of Pediatrics, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Franz Ehm
- Center for Evidence-Based Healthcare (ZEGV), University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Martin Seifert
- Center for Evidence-Based Healthcare (ZEGV), University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Oliver Nagel
- InGef-Institute for Applied Health Research Berlin, Berlin, Germany
| | | | | | - Jakob Peter Armann
- Department of Pediatrics, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Reinhard Berner
- Department of Pediatrics, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | | | - Dagmar Hertle
- BARMER Institut für Gesundheitssystemforschung (bifg), Berlin, Germany
| | | | - Stefan Stern
- AOK Bayern-Die Gesundheitskasse, Regensburg, Germany
| | - Pedro Ballesteros
- BARMER Institut für Gesundheitssystemforschung (bifg), Berlin, Germany
| | | | | | - Uwe Repschläger
- BARMER Institut für Gesundheitssystemforschung (bifg), Berlin, Germany
| | | | | | | | - Anja Schramm
- AOK Bayern-Die Gesundheitskasse, Regensburg, Germany
| | - Claudia Schulte
- BARMER Institut für Gesundheitssystemforschung (bifg), Berlin, Germany
| | | | - Jochen Walker
- InGef-Institute for Applied Health Research Berlin, Berlin, Germany
| | | | - Jochen Schmitt
- Center for Evidence-Based Healthcare (ZEGV), University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
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Vernon I, Owen J, Aylett-Bullock J, Cuesta-Lazaro C, Frawley J, Quera-Bofarull A, Sedgewick A, Shi D, Truong H, Turner M, Walker J, Caulfield T, Fong K, Krauss F. Bayesian emulation and history matching of JUNE. Philos Trans A Math Phys Eng Sci 2022; 380:20220039. [PMID: 35965471 PMCID: PMC9376712 DOI: 10.1098/rsta.2022.0039] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Received: 02/18/2022] [Accepted: 06/07/2022] [Indexed: 05/21/2023]
Abstract
We analyze JUNE: a detailed model of COVID-19 transmission with high spatial and demographic resolution, developed as part of the RAMP initiative. JUNE requires substantial computational resources to evaluate, making model calibration and general uncertainty analysis extremely challenging. We describe and employ the uncertainty quantification approaches of Bayes linear emulation and history matching to mimic JUNE and to perform a global parameter search, hence identifying regions of parameter space that produce acceptable matches to observed data, and demonstrating the capability of such methods. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.
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Affiliation(s)
- I. Vernon
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Department of Mathematical Sciences, Durham University, Durham DH13LE, UK
| | - J. Owen
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Department of Mathematical Sciences, Durham University, Durham DH13LE, UK
| | - J. Aylett-Bullock
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
| | - C. Cuesta-Lazaro
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Computational Cosmology, Durham University, Durham DH13LE, UK
| | - J. Frawley
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Advanced Research Computing, Durham University, Durham DH13LE, UK
| | - A. Quera-Bofarull
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Computational Cosmology, Durham University, Durham DH13LE, UK
| | - A. Sedgewick
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Centre for Extragalactic Astronomy, Durham University, Durham DH13LE, UK
| | - D. Shi
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Computational Cosmology, Durham University, Durham DH13LE, UK
| | - H. Truong
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
| | - M. Turner
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Advanced Research Computing, Durham University, Durham DH13LE, UK
| | - J. Walker
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
| | - T. Caulfield
- Department of Computer Science, Durham University, Durham DH13LE, UK
| | - K. Fong
- Department of Science, Technology, Engineering and Public Policy, University College London, London WC1E6BT, UK
- Department of Anaesthesia, University College London Hospital, London NW12BU, UK
| | - F. Krauss
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
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Vernon I, Owen J, Aylett-Bullock J, Cuesta-Lazaro C, Frawley J, Quera-Bofarull A, Sedgewick A, Shi D, Truong H, Turner M, Walker J, Caulfield T, Fong K, Krauss F. Bayesian emulation and history matching of JUNE. Philos Trans A Math Phys Eng Sci 2022; 380:20210039. [PMID: 35965471 DOI: 10.1098/rsta.2021.0039] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/06/2021] [Indexed: 05/21/2023]
Abstract
We analyze JUNE: a detailed model of COVID-19 transmission with high spatial and demographic resolution, developed as part of the RAMP initiative. JUNE requires substantial computational resources to evaluate, making model calibration and general uncertainty analysis extremely challenging. We describe and employ the uncertainty quantification approaches of Bayes linear emulation and history matching to mimic JUNE and to perform a global parameter search, hence identifying regions of parameter space that produce acceptable matches to observed data, and demonstrating the capability of such methods. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.
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Affiliation(s)
- I Vernon
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Department of Mathematical Sciences, Durham University, Durham DH13LE, UK
| | - J Owen
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Department of Mathematical Sciences, Durham University, Durham DH13LE, UK
| | - J Aylett-Bullock
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
| | - C Cuesta-Lazaro
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Computational Cosmology, Durham University, Durham DH13LE, UK
| | - J Frawley
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Advanced Research Computing, Durham University, Durham DH13LE, UK
| | - A Quera-Bofarull
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Computational Cosmology, Durham University, Durham DH13LE, UK
| | - A Sedgewick
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Centre for Extragalactic Astronomy, Durham University, Durham DH13LE, UK
| | - D Shi
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Computational Cosmology, Durham University, Durham DH13LE, UK
| | - H Truong
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
| | - M Turner
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Advanced Research Computing, Durham University, Durham DH13LE, UK
| | - J Walker
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
| | - T Caulfield
- Department of Computer Science, Durham University, Durham DH13LE, UK
| | - K Fong
- Department of Science, Technology, Engineering and Public Policy, University College London, London WC1E6BT, UK
- Department of Anaesthesia, University College London Hospital, London NW12BU, UK
| | - F Krauss
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
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Kutuk T, Walker J, Ballo M, Cameron R, Bustamante Alvarez J, Chawla S, Luk E, Behl D, Dal Pra A, Morganstein N, Refaat T, Sheybani A, Squillante C, Zhang J, Kotecha R. EP07.01-019 Multiinstitutional Patterns of Use and Compliance with Tumor Treating Fields for Patients with Unresectable Malignant Pleural Mesothelioma. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sødahl E, Walker J, Seyedraoufi S, Gørbitz C, Berland K. Rotationally-driven piezoelectricity: computational assessment of ionic plastic molecular crystals. Acta Cryst Sect A 2022. [DOI: 10.1107/s2053273322092518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Sfontouris I, Nikiforaki D, Liarmakopoulou S, Sialakouma A, Koutsi A, Polia A, Belmpa M, Theodoratos S, Walker J, Makrakis E. P-280 Potential for improvement and current limitations of Artificial Intelligence (AI) for embryo selection: analysis of external validation data. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
What are the prospects of improvement and the limitations of an AI system for embryo selection?
Summary answer
The predictive performance of AI can be enhanced by including additional factors, on top of embryo images, and by assessing images with centered blastocysts.
What is known already
We previously reported the external validation of IVFvision.ai, an AI algorithm that differentiates between Day-5 blastocysts with a positive or negative implantation outcome. IVFvision.ai had higher AUC and overall accuracy in predicting implantation compared to KIDScoreD5 and senior embryologists. Here we report a secondary analysis of external validation data, focusing on a) the improvement of the predictive ability of IVFvision.ai by incorporating data from additional sources, and b) the impact of the blastocyst image quality on the performance of IVFvision.ai.
Study design, size, duration
This is a secondary analysis of external validation data. External validation of IVFvision.ai was performed at a University IVF Clinic using 113 anonymised Embryoscope images of single D5 blastocyst transfers with known implantation outcome.
Participants/materials, setting, methods
The performance of IVFvision.ai and three senior Embryologists to correctly classify blastocysts according to implantation outcome were compared in images in which the whole blastocyst was visible (centred blastocysts, n = 62) vs images in which part of the blastocyst was not visible (off-centred blastocysts, n = 51). Logistic regression models were created: a) IVFvision alone, b) IVFvision+age, c) IVFvision+fertilisation_method, d) IVFvision+KIDScoreD5, e) IVFvision+age+Fertilisation_method+KIDScoreD5. The AUC of each model in predicting implantation was estimated using ROC curve analysis.
Main results and the role of chance
The AUC of IVFVision.ai (0.675 vs 0.432), Embryologist 1 (0.570 vs 0.390), Embryologist 2 (0.663 vs 0.448) and Embryologist 3 (0.628 vs 0.485) were higher for images with centered blastocysts compared to non-centered blastocysts, respectively. There was a progressive increase of AUC with the addition of more factors in the predictive models. a) IVFvision alone: AUC=0.675, b) IVFvision+age: AUC=0.675 c) IVFvision+KIDScoreD5: AUC=0.721 d) IVFvision+fertilisation_method=0.740, e) IVFvision+age+Fertilisation_method+KIDScoreD5=0.768.
Limitations, reasons for caution
The retrospective nature of the study and the small sample of the study raise the need for further prospective studies with a larger number of embryos.
Wider implications of the findings
The highest performance of IVFvision.ai is achieved in images with centred blastocysts, suggesting that implantation cannot be predicted accurately in images with non-centred blastocysts. In addition, we provide provide proof of concept that training AI systems using data from different sources, in addition to embryo images, may increase overall accuracy.
Trial registration number
not applicable
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Affiliation(s)
- I Sfontouris
- Hygeia IVF - Embryogenesis, Embryology Laboratory , Athens, Greece
| | - D Nikiforaki
- Hygeia IVF - Embryogenesis, Embryology Laboratory , Athens, Greece
| | - S Liarmakopoulou
- Hygeia IVF - Embryogenesis, Embryology Laboratory , Athens, Greece
| | - A Sialakouma
- Hygeia IVF - Embryogenesis, Embryology Laboratory , Athens, Greece
| | - A Koutsi
- Hygeia IVF - Embryogenesis, Embryology Laboratory , Athens, Greece
| | - A Polia
- Hygeia IVF - Embryogenesis, Embryology Laboratory , Athens, Greece
| | - M Belmpa
- Hygeia IVF - Embryogenesis, Embryology Laboratory , Athens, Greece
| | - S Theodoratos
- IVF Vision Limited, IVF Vision Limited , Cambridge, United Kingdom
| | - J Walker
- IVF Vision Limited, IVF Vision Limited , Cambridge, United Kingdom
| | - E Makrakis
- Hygeia IVF - Embryogenesis, Embryology Laboratory , Athens, Greece
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Joseph A, Clothier W, Hernandez J, Madsen C, Kouam J, Ortiz C, Parker M, Walker J, Lopera J. Abstract No. 86 Distal glue splenic artery embolization versus other embolics: a single-center analysis. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Derrick K, Ortiz C, Funk P, Dang A, Fanous N, Lugosi S, Bunegin L, Borrego M, Parker M, Walker J, Lopera J. Abstract No. 61 Assessing probe orientation and renal collecting system injury during microwave ablation in a perfused ex vivo porcine model. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ludwig M, Enders D, Basedow F, Walker J, Jacob J. Sampling strategy, characteristics and representativeness of the InGef research database. Public Health 2022; 206:57-62. [DOI: 10.1016/j.puhe.2022.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/31/2022] [Accepted: 02/08/2022] [Indexed: 12/14/2022]
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Schnabel RB, Witt H, Walker J, Ludwig M, Geelhoed B, Kossack N, Schild M, Miller R, Kirchhof P. Machine learning-based identification of risk-factor signatures for undiagnosed atrial fibrillation in primary prevention and post-stroke in clinical practice. Eur Heart J Qual Care Clin Outcomes 2022; 9:16-23. [PMID: 35436783 PMCID: PMC9745664 DOI: 10.1093/ehjqcco/qcac013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/24/2022] [Accepted: 03/08/2022] [Indexed: 12/15/2022]
Abstract
AIMS Atrial fibrillation (AF) carries a substantial risk of ischemic stroke and other complications, and estimates suggest that over a third of cases remain undiagnosed. AF detection is particularly pressing in stroke survivors. To tailor AF screening efforts, we explored German health claims data for routinely available predictors of incident AF in primary care and post-stroke using machine learning methods. METHODS AND RESULTS We combined AF predictors in patients over 45 years of age using claims data in the InGef database (n = 1 476 391) for (i) incident AF and (ii) AF post-stroke, using machine learning techniques. Between 2013-2016, new-onset AF was diagnosed in 98 958 patients (6.7%). Published risk factors for AF including male sex, hypertension, heart failure, valvular heart disease, and chronic kidney disease were confirmed. Component-wise gradient boosting identified additional predictors for AF from ICD-codes available in ambulatory care. The area under the curve (AUC) of the final, condensed model consisting of 13 predictors, was 0.829 (95% confidence interval (CI) 0.826-0.833) in the internal validation, and 0.755 (95% CI 0.603-0.890) in a prospective validation cohort (n = 661). The AUC for post-stroke AF was of 0.67 (95% CI 0.651-0.689) in the internal validation data set, and 0.766 (95% CI 0.731-0.800) in the prospective clinical cohort. CONCLUSION ICD-coded clinical variables selected by machine learning can improve the identification of patients at risk of newly diagnosed AF. Using this readily available, automatically coded information can target AF screening efforts to identify high-risk populations in primary care and stroke survivors.
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Affiliation(s)
- Renate B Schnabel
- Corresponding author. Tel: +49-1522-2816064, Fax: +49 (0)40 7410-55310,
| | - Henning Witt
- Pfizer Pharma GmbH, Linkstraße 10, 10785 Berlin, Germany
| | - Jochen Walker
- InGef - Institute for Applied Health Research Berlin GmbH, Spittelmarkt 12, 10117 Berlin, Germany
| | - Marion Ludwig
- InGef - Institute for Applied Health Research Berlin GmbH, Spittelmarkt 12, 10117 Berlin, Germany
| | - Bastian Geelhoed
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20251 Hamburg, Germany,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany
| | | | - Marie Schild
- Pfizer Pharma GmbH, Linkstraße 10, 10785 Berlin, Germany
| | - Robert Miller
- Pfizer Pharma GmbH, Linkstraße 10, 10785 Berlin, Germany,Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20251 Hamburg, Germany,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany,Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, Medical School, University of Birmingham, Edgbaston, Birmingham UK
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Jongerius N, Wainwright B, Walker J, Bissas A. The biomechanics of maintaining effective force application across cycling positions. J Biomech 2022; 138:111103. [DOI: 10.1016/j.jbiomech.2022.111103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
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Soulsby WD, Balmuri N, Cooley V, Gerber LM, Lawson E, Goodman S, Onel K, Mehta B, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis. Pediatr Rheumatol Online J 2022; 20:18. [PMID: 35255941 PMCID: PMC8903717 DOI: 10.1186/s12969-022-00676-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. METHODS In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months. RESULTS One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability. CONCLUSION High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.
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Affiliation(s)
- William Daniel Soulsby
- University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA, 94158, USA.
| | - Nayimisha Balmuri
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Victoria Cooley
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Linda M. Gerber
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Erica Lawson
- grid.266102.10000 0001 2297 6811University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA 94158 USA
| | - Susan Goodman
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Karen Onel
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Bella Mehta
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
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Hohmann C, Ludwig M, Walker J, Iliadis C, Schipper JH, Baldus S, Pfister R. Real-world anticoagulatory treatment after percutaneous mitral valve repair using MitraClip: a retrospective, observational study on 1300 patients. Clin Res Cardiol 2022; 111:889-899. [PMID: 35220447 PMCID: PMC9334399 DOI: 10.1007/s00392-022-01988-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/02/2022] [Indexed: 11/22/2022]
Abstract
Aims This study sought to investigate current anticoagulatory treatment patterns and clinical outcome in patients undergoing transcatheter mitral valve repair (MitraClip). Methods and results In a retrospective study of a German claims database (InGef research database), anticoagulatory treatment regimens were assessed using any drug prescription post discharge within the first 90 days after MitraClip procedure. Clinical events between 30 days and 6 months were examined by treatment regime. The study population comprised 1342 patients undergoing MitraClip procedure between 2014 and 2018. 22.4% received antiplatelet monotherapy, 20.8% oral anticoagulation (OAC) plus antiplatelet therapy, 19.4% OAC monotherapy, 11.7% dual antiplatelet therapy, 2.8% triple therapy and 21.0% did not receive any anticoagulatory drugs. 63% of patients with OAC received non-vitamin-K antagonist oral anticoagulants (NOAC). A total of 168 patients were newly prescribed OAC after MitraClip, of whom 12 patients (7.1%) had no diagnosis of atrial fibrillation or venous thromboembolism. 40% of patients with OAC prior to MitraClip did not have any OAC after MitraClip. The adjusted risk of all-cause mortality was significantly increased in patients with no anticoagulatory treatment (HR 3.84, 95% CI 2.33–6.33, p < 0.0001) when compared to antiplatelet monotherapy whereas the other regimes were not significantly different. Conclusions This large real-world data analysis demonstrates a heterogeneous spectrum of prescriptions for anticoagulant therapies after MitraClip. Considering relevant differences in clinical outcome across treatment groups, major effort is warranted for controlled trials in order to establish evidence-based recommendations on anticoagulatory treatment after percutaneous mitral valve repair. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-022-01988-2.
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Abstract
Background Accurate prediction of healthcare costs is important for optimally managing health costs. However, methods leveraging the medical richness from data such as health insurance claims or electronic health records are missing. Methods Here, we developed a deep neural network to predict future cost from health insurance claims records. We applied the deep network and a ridge regression model to a sample of 1.4 million German insurants to predict total one-year health care costs. Both methods were compared to existing models with various performance measures and were also used to predict patients with a change in costs and to identify relevant codes for this prediction. Results We showed that the neural network outperformed the ridge regression as well as all considered models for cost prediction. Further, the neural network was superior to ridge regression in predicting patients with cost change and identified more specific codes. Conclusion In summary, we showed that our deep neural network can leverage the full complexity of the patient records and outperforms standard approaches. We suggest that the better performance is due to the ability to incorporate complex interactions in the model and that the model might also be used for predicting other health phenotypes. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01743-z.
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Affiliation(s)
- Philipp Drewe-Boss
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Robert-Rössle-Strasse 10, 13125, Berlin, Germany.
| | - Dirk Enders
- Institute for Applied Health Research (InGef), Spittelmarkt 12, 10117, Berlin, Germany
| | - Jochen Walker
- Institute for Applied Health Research (InGef), Spittelmarkt 12, 10117, Berlin, Germany
| | - Uwe Ohler
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Robert-Rössle-Strasse 10, 13125, Berlin, Germany
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Hohmann C, Ludwig M, Walker J, Wienemann H, Baldus S, Pfister R. Real-World Anticoagulatory Treatment After Transcatheter Aortic Valve Replacement: A Retrospective, Observational Study on 4,800 Patients. Front Cardiovasc Med 2022; 8:780762. [PMID: 35004894 PMCID: PMC8733398 DOI: 10.3389/fcvm.2021.780762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has developed to the therapy of choice for patients with symptomatic severe aortic stenosis who are unsuitable for surgical aortic valve replacement and elderly patients with intermediate or high operative risk. However, the optimal anticoagulant therapy post-TAVR still remains a matter of debate. Aims: This study sought to investigate current anticoagulant treatment patterns and clinical outcome in patients undergoing TAVR. Methods: In a retrospective study based on anonymized health claims data of approximately seven million Germans with statutory health insurance (InGef database), anticoagulant treatment regimens were assessed using any drug prescription post discharge within the first 90 days after TAVR procedure. Clinical events between 30 days and 6 months were examined by treatment regime. Results: The study population comprised 4,812 patients with TAVR between 2014 and 2018: 29.4% received antiplatelet monotherapy, 17.8% dual antiplatelet therapy, 17.4% oral anticoagulation (OAC) plus antiplatelet therapy, 12.9% OAC monotherapy, 2.2% triple therapy and 19.2% did not receive any anticoagulatory drugs. Sixty-four percentage of patients with OAC received direct oral anticoagulants (DOAC). Hence, 68% of all patients were treated non-adherent to current guidelines. Forty percentage of patients with OAC prior to TAVR did not have any OAC after TAVR. The adjusted risk of all-cause mortality was significantly increased in patients with OAC (HR 1.40, 95% CI 1.03–1.90, p = 0.03) and no anticoagulatory treatment (HR 3.95, 95% CI 2.95–5.27, p < 0.0001) when compared to antiplatelet monotherapy. Conclusions: This large real-world data analysis demonstrates substantial deviations from guideline recommendations and treatment after TAVR. Considering relevant differences in clinical outcome across treatment groups, major effort is warranted to examine underlying causes and improve guideline adherence.
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Affiliation(s)
- Christopher Hohmann
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Heart Center, University of Cologne, Cologne, Germany
| | - Marion Ludwig
- InGef-Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Jochen Walker
- InGef-Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Hendrik Wienemann
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Heart Center, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Heart Center, University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Heart Center, University of Cologne, Cologne, Germany
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Douros A, Basedow F, Cui Y, Walker J, Enders D, Tagalakis V. Effectiveness and safety of direct oral anticoagulants with antiplatelet agents in patients with venous thromboembolism: A multi-database cohort study. Res Pract Thromb Haemost 2022; 6:e12643. [PMID: 35036824 PMCID: PMC8749078 DOI: 10.1002/rth2.12643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/29/2021] [Accepted: 11/29/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Patients with venous thromboembolism (VTE) often have comorbidities that require use of antiplatelets. However, evidence on the effects of concomitant use of direct oral anticoagulants (DOACs) and antiplatelets in this high-risk population is scarce. Our international, multi-database cohort study assessed the real-world effectiveness and safety of concomitant use of DOACs and antiplatelets among patients with VTE. METHODS We assembled two population-based cohorts using administrative health care databases from Québec and Germany. We included patients with incident VTE who initiated treatment with a DOAC or a vitamin K antagonist (VKA), while being exposed to antiplatelets (acetylsalicylic acid, clopidogrel, ticagrelor, prasugrel, dipyridamole). The study period spanned from 2012 to 2016 (Québec) or 2019 (Germany). Concomitant use of DOACs and antiplatelets was compared with concomitant use of VKAs and antiplatelets, using inverse probability of treatment weighting to balance exposure groups. Cox proportional hazards models estimated site-specific hazard ratios (HRs) and 95% confidence intervals (CIs) of major bleeding, all-cause mortality (primary outcomes), and recurrent VTE (secondary outcome). Site-specific estimates were meta-analyzed using random-effects models. RESULTS Overall, 4971 patients with VTE initiated concomitant use of a DOAC (n = 2289) or a VKA (n = 2682) and antiplatelets. Compared with concomitant use of VKAs and antiplatelets, concomitant use of DOACs and antiplatelets was associated with similar risks of major bleeding (HR, 0.81; 95% CI, 0.46-1.45), all-cause mortality (HR, 1.25; 95% CI, 0.87-1.79), and recurrent VTE (HR, 0.96; 95% CI, 0.40-2.27). CONCLUSIONS Among patients with VTE using antiplatelets, there were no major differences in effectiveness and safety between DOACs and VKAs.
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Affiliation(s)
- Antonios Douros
- Centre for Clinical EpidemiologyLady Davis InstituteMontrealQuebecCanada
- Department of MedicineMcGill UniversityMontrealQuebecCanada
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
- Institute of Clinical Pharmacology and ToxicologyCharité‐Universitätsmedizin BerlinBerlinGermany
| | | | - Ying Cui
- Centre for Clinical EpidemiologyLady Davis InstituteMontrealQuebecCanada
| | - Jochen Walker
- InGef ‐ Institute for Applied Health Research BerlinBerlinGermany
| | - Dirk Enders
- InGef ‐ Institute for Applied Health Research BerlinBerlinGermany
| | - Vicky Tagalakis
- Centre for Clinical EpidemiologyLady Davis InstituteMontrealQuebecCanada
- Department of MedicineMcGill UniversityMontrealQuebecCanada
- Division of General Internal MedicineJewish General HospitalMontrealQuebecCanada
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Bothe T, Walker J, Kröger C. Gender-related differences in health-care and economic costs for eating disorders: A comparative cost-development analysis for anorexia and bulimia nervosa based on anonymized claims data. Int J Eat Disord 2022; 55:61-75. [PMID: 34599621 DOI: 10.1002/eat.23610] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) and bulimia nervosa (BN) impose a significant financial burden and immense sufferings on affected individuals. Yet little is known about the differences between how each disorder affects males and females, respectively. METHOD We performed a retrospective cost-development analysis of anonymized claims data from the German statutory health-insurance system. Insured persons who suffered from an onset of AN (F50.0; N = 1,242 females and 71 males) or BN (F50.2; N = 1,104 females and 64 males) were analyzed for cost-of-illness over a 5-year period, beginning 2 years before the index diagnosis. RESULTS In total, all groups incurred similar distributions of total costs over the 5-year observation period, with roughly 14,000-20,000 EUR median costs. About two-thirds of the total costs for females and males with AN are associated with mental illness, whereas for females and males with BN, this applies to approximately half the total costs. Analyses revealed differences between disorders and genders for single outcomes. AN is associated with a stronger increase in costs within a short period following onset and higher inpatient treatment costs, whereas BN entails more instances of incapacity to work before and after onset. Compared to females, males incurred lower costs in outpatient treatments. DISCUSSION Our study adds evidence as to the disparities in health-care utilizations and costs over the course of illness, in outcome ratios, and between genders, for both AN and BN.
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Affiliation(s)
- Tim Bothe
- InGef-Institute for Applied Health Research Berlin, Berlin, Germany.,Department of Psychology, University of Hildesheim, Hildesheim, Germany
| | - Jochen Walker
- InGef-Institute for Applied Health Research Berlin, Berlin, Germany
| | - Christoph Kröger
- Department of Psychology, University of Hildesheim, Hildesheim, Germany
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Abe K, Bronner C, Hayato Y, Hiraide K, Ikeda M, Imaizumi S, Kameda J, Kanemura Y, Kataoka Y, Miki S, Miura M, Moriyama S, Nagao Y, Nakahata M, Nakayama S, Okada T, Okamoto K, Orii A, Pronost G, Sekiya H, Shiozawa M, Sonoda Y, Suzuki Y, Takeda A, Takemoto Y, Takenaka A, Tanaka H, Watanabe S, Yano T, Han S, Kajita T, Okumura K, Tashiro T, Xia J, Megias G, Bravo-Berguño D, Labarga L, Marti L, Zaldivar B, Pointon B, Blaszczyk F, Kearns E, Raaf J, Stone J, Wan L, Wester T, Bian J, Griskevich N, Kropp W, Locke S, Mine S, Smy M, Sobel H, Takhistov V, Hill J, Kim J, Lim I, Park R, Bodur B, Scholberg K, Walter C, Cao S, Bernard L, Coffani A, Drapier O, El Hedri S, Giampaolo A, Gonin M, Mueller T, Paganini P, Quilain B, Ishizuka T, Nakamura T, Jang J, Learned J, Anthony L, Martin D, Scott M, Sztuc A, Uchida Y, Berardi V, Catanesi M, Radicioni E, Calabria N, Machado L, De Rosa G, Collazuol G, Iacob F, Lamoureux M, Mattiazzi M, Ospina N, Ludovici L, Maekawa Y, Nishimura Y, Friend M, Hasegawa T, Ishida T, Kobayashi T, Jakkapu M, Matsubara T, Nakadaira T, Nakamura K, Oyama Y, Sakashita K, Sekiguchi T, Tsukamoto T, Kotsar Y, Nakano Y, Ozaki H, Shiozawa T, Suzuki A, Takeuchi Y, Yamamoto S, Ali A, Ashida Y, Feng J, Hirota S, Kikawa T, Mori M, Nakaya T, Wendell R, Yasutome K, Fernandez P, McCauley N, Mehta P, Tsui K, Fukuda Y, Itow Y, Menjo H, Niwa T, Sato K, Tsukada M, Lagoda J, Lakshmi S, Mijakowski P, Zalipska J, Jiang J, Jung C, Vilela C, Wilking M, Yanagisawa C, Hagiwara K, Harada M, Horai T, Ishino H, Ito S, Kitagawa H, Koshio Y, Ma W, Piplani N, Sakai S, Barr G, Barrow D, Cook L, Goldsack A, Samani S, Wark D, Nova F, Boschi T, Di Lodovico F, Gao J, Migenda J, Taani M, Zsoldos S, Yang J, Jenkins S, Malek M, McElwee J, Stone O, Thiesse M, Thompson L, Okazawa H, Kim S, Seo J, Yu I, Nishijima K, Koshiba M, Iwamoto K, Nakagiri K, Nakajima Y, Ogawa N, Yokoyama M, Martens K, Vagins M, Kuze M, Izumiyama S, Yoshida T, Inomoto M, Ishitsuka M, Ito H, Kinoshita T, Matsumoto R, Ohta K, Shinoki M, Suganuma T, Ichikawa A, Nakamura K, Martin J, Tanaka H, Towstego T, Akutsu R, Gousy-Leblanc V, Hartz M, Konaka A, de Perio P, Prouse N, Chen S, Xu B, Zhang Y, Posiadala-Zezula M, Hadley D, O’Flaherty M, Richards B, Jamieson B, Walker J, Minamino A, Okamoto K, Pintaudi G, Sano S, Sasaki R. Diffuse supernova neutrino background search at Super-Kamiokande. Int J Clin Exp Med 2021. [DOI: 10.1103/physrevd.104.122002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Hainer N, Velineni S, Bowers A, Waite C, Walker J, Wilmes L, Tague A, King V, Millership J, Martorell S. Oral vaccination of dogs with a monovalent live-avirulent vaccine confers 1 year of immunity against Bordetella bronchiseptica challenge. Vet J 2021; 278:105775. [PMID: 34800656 DOI: 10.1016/j.tvjl.2021.105775] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
This experimental challenge study assessed immune protection 1 year after a single dose of live-attenuated oral Bordetella bronchiseptica (Bb) vaccine in dogs. Forty Bb-seronegative 7-9-week-old puppies were randomly assigned at Day 0 to receive a single oral dose of either Bb vaccine (n = 20; vaccinated group) or sterile water (n = 20; control group). Groups were housed separately until comingling 1 day pre-challenge (Day 365). Challenge with virulent aerosolized Bb occurred at Day 366. Clinical scores were obtained at Days 1-7, and 366-380. Bb microagglutination test (MAT) titers were obtained at Days -7, 0, monthly post-vaccination, and Days 358, 365, and 380. Nasal swabs were collected for microbiological assessment at Days -7, 0, 365, and 367-380. Oral Bb vaccination was not associated with side effects. Pre-challenge, vaccinated dogs developed persistent Bb MAT titers and control dogs remained seronegative. Post-challenge, duration of cough was longer in control dogs (least square means [LSM], 8.6 days) than vaccinated dogs (LSM, 1.5 days; P < 0.0001), with more control dogs having cough on 2 or more consecutive days (control group, n = 17/19, 89.5%; vaccinated group, n = 3/19, 15.8%; P = 0.0011). Post-challenge, Bb shedding occurred in all control dogs and 5/19 (26%) vaccinated dogs. Average duration of Bb shedding was longer in the control group (11.9 days vs. 0.6 days; P < 0.0001) and nasal Bb loads were higher in the control group (P < 0.00001). Orally administered Bb vaccine stimulated immunity that was still protective against virulent Bb challenge after 1 year.
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Affiliation(s)
- N Hainer
- Veterinary Medicine Research and Development, Zoetis Inc., 333 Portage Street, Kalamazoo, MI, 49007, USA.
| | - S Velineni
- Veterinary Medicine Research and Development, Zoetis Inc., 333 Portage Street, Kalamazoo, MI, 49007, USA
| | - A Bowers
- Veterinary Medicine Research and Development, Zoetis Inc., 333 Portage Street, Kalamazoo, MI, 49007, USA
| | - C Waite
- Veterinary Medicine Research and Development, Zoetis Inc., 333 Portage Street, Kalamazoo, MI, 49007, USA
| | - J Walker
- Veterinary Medicine Research and Development, Zoetis Inc., 333 Portage Street, Kalamazoo, MI, 49007, USA
| | - L Wilmes
- Veterinary Medicine Research and Development, Zoetis Inc., 333 Portage Street, Kalamazoo, MI, 49007, USA
| | - A Tague
- Veterinary Medicine Research and Development, Zoetis Inc., 333 Portage Street, Kalamazoo, MI, 49007, USA
| | - V King
- Veterinary Medicine Research and Development, Zoetis Inc., 333 Portage Street, Kalamazoo, MI, 49007, USA
| | - J Millership
- Veterinary Medicine Research and Development, Zoetis Inc., 333 Portage Street, Kalamazoo, MI, 49007, USA
| | - S Martorell
- Veterinary Medicine Research and Development, Zoetis Inc., 333 Portage Street, Kalamazoo, MI, 49007, USA
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Dinakaran D, Jha N, Joseph K, Walker J. Response and Toxicity Patterns Seen in Patients Treated With Combination Immunotherapy and Radiotherapy in the UNSCARRed (UNresectable Squamous Cell Carcinoma treated With Avelumab and Radical Radiotherapy) Study. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hanusch B, Prediger M, Tuck SP, Walker J, McNally R, Datta HK. Bone turnover markers as determinants of bone density and fracture in men with distal forearm fractures: the pathogenesis examined in the Mr F study. Osteoporos Int 2021; 32:2267-2277. [PMID: 33990874 DOI: 10.1007/s00198-021-06001-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
UNLABELLED The pathogenesis for low-trauma wrist fractures in men is not fully understood. This study found that these men had evidence of significantly higher bone turnover compared with control subjects. Bone turnover markers were negative predictors of bone mineral density and were a predictor of fracture. INTRODUCTION Men with distal forearm fractures have reduced bone density, an increased risk of osteoporosis and of further fractures. The aim of this study was to investigate whether or not men with distal forearm fractures had evidence of altered bone turnover activity. METHODS Fifty eight men with low-trauma distal forearm fracture and 58 age-matched healthy control subjects were recruited. All subjects underwent a DXA scan of the forearm, both hips, and lumbar spine, biochemical investigations, and health questionnaires. Measurements of beta crosslaps (βCTX), procollagen type I N-terminal propeptide (PINP), sclerostin, Dickkopf-1 (Dkk1), and fibroblast growth factor 23 (FGF 23) were made. RESULTS Men with fracture had significantly higher PINP than controls at 39.2 ng/ml (SD 19.5) versus 33.4 ng/ml (SD13.1) (p<0.001). They also had significantly higher βCTX at 0.45 ng/ml (SD 0.21) versus 0.37 ng/ml (SD 0.17) (p= 0.037). Fracture subjects had significantly lower aBMD and PINP was a negative predictor of aBMD at the total hip and βCTX a negative predictor of forearm aBMD. Sclerostin was a positive predictor of aBMD at the lumbar spine and hip sites. Sex hormone binding globulin (SHBG) at 37nmol/L (SD 15.0) was lower in fracture cohort compared to 47.9 nmol/L (SD 19.2) (p=0.001) in control. Multiple regression revealed that the best model for prediction of fracture included SHBG, P1NP, and ultra-distal forearm aBMD. The likelihood of distal forearm fracture was decreased by 5.1% for each nmol/L increase in SHBH and by 1.4% for every mg/cm2 increase in ultra-distal forearm aBMD, but increased by 6.1 % for every ng/ml increase in P1NP. Men in the highest quartile of PINP had a significantly greater likelihood of distal forearm fracture than those in the lowest quartile. CONCLUSION The fracture group had significantly higher PINP and βCTX compared with the control group, and these markers were negative predictors of aBMD at the total hip and forearm sites, respectively. Sclerostin was a positive predictor of the variance of spinal and hip aBMD. Likelihood of forearm fracture was best predicted by a combination of SHBG, PINP, and ultra-distal forearm aBMD. Findings of such cross-sectional data should be treated with caution, as longitudinal studies would be required to confirm or refute them.
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Affiliation(s)
- B Hanusch
- Institute of Cellular Medicine, Newcastle University, Newcastle, Upon Tyne, UK
- James Cook University Hospital, Middlesbrough, UK
| | - M Prediger
- Institute of Cellular Medicine, Newcastle University, Newcastle, Upon Tyne, UK
- Blood Sciences, Royal Victoria Infirmary, Newcastle, Upon Tyne, UK
| | - S P Tuck
- Institute of Cellular Medicine, Newcastle University, Newcastle, Upon Tyne, UK.
- James Cook University Hospital, Middlesbrough, UK.
| | - J Walker
- James Cook University Hospital, Middlesbrough, UK
| | - R McNally
- Institute of Health and Society, Newcastle University, Newcastle, Upon Tyne, UK
| | - H K Datta
- Institute of Cellular Medicine, Newcastle University, Newcastle, Upon Tyne, UK
- James Cook University Hospital, Middlesbrough, UK
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Tanna S, Walker J. 1037 Early Detection and Management of Preoperative Anaemia in An Elective Vascular Surgery Cohort. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Iron deficiency anaemia is the most common cause of anaemia in the surgical population. Patients receiving transfusions during major surgery encounter more adverse outcomes compared to those that do not, indicating the early management of pre-operative anemia is likely to reduce major surgical patient morbidity and mortality. Previous studies have demonstrated that 33% of patients undergoing major vascular surgery operations are anaemic (haemaglobin, Hb, <130g/L).
Aim
We aim to reduce the proportion of anaemic patients undergoing major vascular surgery by 50%.
Method
A point-of-care HemoCue machine was used to measure Hb in patients who were referred for elective major surgery in 11 vascular clinics. Patients with Hb < 130g/L were prescribed a 1-month course of Ferrous Sulfate (200mg TDS), and a letter was sent to their GP requesting iron function tests. Post-intervention Hb levels were rechecked following the preoperative anaesthetics review.
Results
11 patients were referred for major surgery, of which 4 were identified as anaemic (36%). The mean Hb concentration was 121.3g/L, which increased to 137.3g/L following oral iron therapy. The mean duration of follow up was 36 days (range 0-94 days).
Conclusions
The implementation of a HemoCue machine to identify and manage preoperative anaemia was successful in our pilot study. Further work should include full integration of our pathway into current vascular clinics without student support. This will enable evaluation of the impact of our intervention on a wider scale.
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Affiliation(s)
- S Tanna
- King's College London, London, United Kingdom
| | - J Walker
- King's College London, London, United Kingdom
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Clough O, Lee G, Walker J. 423 Patient Perspective on the Use of the Independent Sector to Maintain Elective NHS Services During the COVID-19 Pandemic. Br J Surg 2021. [PMCID: PMC8524587 DOI: 10.1093/bjs/znab259.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
COVID-19 resulted in the suspension of planned treatments for patients worldwide leaving millions suffering the physical and mental effects of delay. Reports indicate that when services have been re-established, patients have been afraid to take up appointments. Hospitals put processes in place to counter this, notably separating emergency and elective patient cohorts. Most notably seen by the co-operation between the NHS and independent private healthcare providers in March 2020 at the height of the pandemic. We undertook a study to ascertain the perceptions of NHS patients who underwent elective treatment at independent ‘cold’ sites during the COVID-19 pandemic.
Method
A cross-sectional study with structured telephone interviews of patients who had planned elective treatments at ‘cold’ independent hospitals between March and September 2020. 1150 patients were identified, and a 20% sample formed a 230 patient study group, with 158 (70%) agreeing to participate.
Results
30% of patients delayed their treatment due to COVID related concerns, with 76% of these only accepting treatment because this was at a ‘cold’ site. 46% of patients perceived treatment at a ‘cold’ site as the most important factor contributing to their safety. 153 patients (97%) supported the paid arrangement between the NHS and the independent sector to provide separate ‘cold’ sites for elective treatments.
Discussion
Safely restarting elective services to allow important planned treatments to take place, as was the pandemic continues, is a priority. Our study indicates that physical separation of patient pathways impacted most on patient confidence, and that the use of ‘cold’ sites is a viable option.
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Affiliation(s)
- O Clough
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - G Lee
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - J Walker
- Imperial College Healthcare NHS Trust, London, United Kingdom
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Youn S, Eurich D, McCall M, Walker J, Smylie M, Sawyer M. 1051P Impacts of skeletal muscle on survival in resected stage III malignant melanoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bellmunt J, Powles T, van der Heijden M, Galsky M, He P, Wang Z, Xiao F, Jones F, Scott M, Walker J, Angra N, Gupta A, Drakaki A, Kimura G, Mizokami A, Wildsmith S. 708P PD-L1 as a predictor of survival in patients with metastatic urothelial carcinoma (mUC) from the phase III DANUBE trial of durvalumab (D) or durvalumab plus tremelimumab (D+T) versus standard of care chemotherapy (SoC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Renouard B, Aleksandrovskiy I, Neumeister J, Al-Bassam M, El-Badri S, Alterman T, Walker J, Desai B, Falgiani M, Ganti L. 11 Impact of BMI on Outcomes in Patients Hospitalized for COVID-19. Ann Emerg Med 2021. [PMCID: PMC8335525 DOI: 10.1016/j.annemergmed.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Joseph K, Wong J, Abraham A, Menon A, Ghosh S, Warkentin H, Walker J, Salopek T. PH-0331 Patterns And Predictors Of Relapse In Merkel Cell Carcinoma :Results From A Population Based Study. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07304-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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