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Fee R, Webb N, Dick L, White J, Essoi B, Walker V, Zacker C. Patterns of care and costs of switching oral antipsychotic medications in patients with schizophrenia initiating monotherapy treatment: A US claims analysis. J Manag Care Spec Pharm 2024:1-12. [PMID: 38591754 DOI: 10.18553/jmcp.2024.23274] [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: 04/10/2024]
Abstract
BACKGROUND Antipsychotic medications are the mainstay of schizophrenia therapy but may need to be changed over the course of a patient's illness to achieve the desired therapeutic goals or minimize medication side effects. Investigations of real-world treatment patterns and economic consequences associated with antipsychotic changes, including switching, are limited. OBJECTIVE To describe treatment patterns among patients with schizophrenia who initiated oral antipsychotic medication (OAM) monotherapy and assess switching-related health care resource utilization (HCRU) and costs in US Medicare Advantage and commercially insured patients. METHODS Adults with at least 2 claims with a schizophrenia diagnosis who initiated (or reinitiated after ≥6 months) OAM monotherapy between January 1, 2015, and June 30, 2021, were identified in the Optum Research Database. A claims-based algorithm using timing of therapies and treatment gaps identified medication changes, specifically OAM monotherapy switches, among OAM initiators over a period of up to 7 years. Patients who switched from their initial OAM monotherapy to a second OAM monotherapy (initial OAM switchers) were matched based on clinical and demographic characteristics to OAM initiators who had not switched OAMs; switch-related HCRU and costs (incurred up to 3 months before and 3 months after the initial OAM switch) were compared between matched initial OAM switchers and nonswitchers. RESULTS Among 6,425 OAM monotherapy initiators, 1,505 (23.4%) had at least 1 OAM monotherapy switch at any time during follow-up, with a mean (SD) time to first switch of 209 (333) days (median, 67 days), a rate of 0.65 switches per person-year of follow-up, and 56% of first switches occurring within 3 months of OAM initiation. Of all OAM initiators, 947 (14.7%) were initial OAM switchers. Compared with 865 matched nonswitchers, 865 initial OAM switchers had greater mean counts of all-cause medical visits and greater mean counts of schizophrenia-related emergency and inpatient visits and longer inpatient stays per patient per month. Mean (SD) total schizophrenia-related costs per patient per month were $1,252 ($2,602) for switchers compared with $402 ($2,027) for nonswitchers (P < 0.001). CONCLUSIONS Changes to antipsychotic therapy in our sample of patients with schizophrenia were common, with nearly one-fourth switching OAMs, the majority within the first 3 months of therapy. Initial OAM switchers experienced greater HCRU and costs than nonswitchers. These findings highlight the importance of initiating OAM monotherapy that effectively maintains symptom control and minimizes tolerability issues, which would limit the need to switch OAMs and therefore prevent excess HCRU and treatment costs.
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Harris SB, Mohammedi K, Bertolini M, Carlyle M, Walker V, Zhou FL, Anderson JE, Seufert J. Patient and physician perspectives and experiences of basal insulin titration in type 2 diabetes in the United States: Cross-sectional surveys. Diabetes Obes Metab 2023; 25:3478-3489. [PMID: 37749746 DOI: 10.1111/dom.15240] [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: 04/13/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 09/27/2023]
Abstract
AIM Patient- and physician-associated barriers impact the effectiveness of basal insulin (BI) titration in the management of type 2 diabetes (T2D). We evaluated the experiences of patients with T2D and physicians with BI titration education. MATERIALS AND METHODS In this observational, cross-sectional study, patients with T2D and physicians treating patients with T2D were identified by claims in the Optum Research Database and were invited to complete a survey. Eligible patients had 12 months of continuous health-plan enrolment with medical and pharmacy benefits during the baseline period, and recent initiation of BI therapy. Eligible physicians had initiated BI for ≥1 eligible patient with T2D during the past 6 months. RESULTS In total, 416 patients and 386 physicians completed the survey. Ninety per cent of physicians reported treating ≥50 patients with T2D; 66% treated ≥25% of patients with BI. Whereas 74% of patients reported that BI titration was explained to them by a physician, 96% of physicians reported doing so. Furthermore, 20% of patients stated they were offered educational materials whereas 56% of physicians reported having provided materials. Physicians had higher expectations of glycaemic target achievement than were seen in the patient survey; their main concern was the patients' ability to titrate accurately (79%). CONCLUSIONS There is a marked difference in patients' and physicians' experiences of BI titration education. Novel tools and strategies are required to enable effective BI titration, with more educational resources at the outset, and ongoing access to tools that provide clear, simple direction for self-titration with less reliance on physicians/health care providers.
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Affiliation(s)
- Stewart B Harris
- Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | | | | | | | | | | | | | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Schrader R, Posner N, Dorling P, Senerchia C, Chen Y, Beaverson K, Seare J, Garnier N, Walker V, Alvir J, Mahn M, Merla V, Zhang Y, Landis C, Buikema AR. Development and electronic health record validation of an algorithm for identifying patients with Duchenne muscular dystrophy in US administrative claims. J Manag Care Spec Pharm 2023; 29:1033-1044. [PMID: 37610111 PMCID: PMC10508712 DOI: 10.18553/jmcp.2023.29.9.1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND: Muscular dystrophies (MDs) comprise a heterogenous group of genetically inherited conditions characterized by progressive muscle weakness and increasing disability. The lack of separate diagnosis codes for Duchenne MD (DMD) and Becker MD, 2 of the most common forms of MD, has limited the conduct of DMD-specific real-world studies. OBJECTIVE: To develop and validate administrative claims-based algorithms for identifying patients with DMD and capturing their nonambulatory and ventilation-dependent status. METHODS: This was a retrospective cohort study using the statistically deidentified Optum Market Clarity Database (including patient claims linked with electronic health records [EHRs] data) to develop and validate the following algorithms: DMD diagnosis, nonambulatory status, and ventilation-dependent status. The initial study sample consisted of US patients in the database who had a diagnosis code for Duchenne/Becker MD (DBMD) between October 1, 2018, and September 30, 2020, who were male, aged 40 years or younger on their first DBMD diagnosis, and met continuous enrollment and 1-day minimal clinical activities requirement in a 12-month measurement period between October 1, 2017, and September 30, 2020. The algorithms, developed by a cross-functional team of DMD specialists (including patient advocates), were based on administrative claims data with International Classification of Diseases, Tenth Revision, Clinical Modifications coding, using information of diagnosis codes for DBMD, sex, age, treatment, and disease severity (eg, evidence of ambulation assistance/support and/or evidence of ventilation support or dependence). Patients who met each algorithm and had EHR notes available were then validated against structured fields and unstructured provider notes from their own linked EHR to confirm patients' DMD diagnoses, nonambulatory status, and ventilation-dependent status. Algorithm performance was assessed by positive predictive value with 95% CIs. RESULTS: A total of 1,300 patients were included in the initial study sample. Of these, EHR were available and reviewed for 303 patients. The mean age of the 303 patients was 14.8 years, with 61.7% being non-Hispanic White. A majority had a Charlson comorbidity index score of 0 (59.4%) or 1-2 (27.7%). Positive predictive value (95% CI) was 91.6% (85.8%-95.6%) for the DMD diagnosis algorithm, 88.4% (80.2%-94.1%) for the nonambulatory status algorithm, and 77.8% (62.9%-88.8%) for the ventilation-dependent status algorithm. CONCLUSIONS: This work provides the means to more accurately identify patients with DMD from administrative claims data without a specific diagnosis code. The algorithms validated in this study can be applied to assess treatment effectiveness and other outcomes among patients with DMD treated in clinical practice. DISCLOSURES: This study was funded by Pfizer, which contracted with Optum to perform the study and provide medical writing assistance. Ms Schrader reports being an employee of Parent Project Muscular Dystrophy. Mr Posner reports being an employee and stockholder of Pfizer and receiving support from Pfizer for attending conferences not related to this manuscript. Dr Dorling reports being an employee and stockholder of Pfizer at the time the study was conducted and is a current employee of Chiesi USA, Inc. Ms Senerchia reports being an employee of Optum and owning stock in Pfizer and UnitedHealth Group, the parent company of Optum. Dr Chen reports being an employee and stockholder of Pfizer. Ms Beaverson reports being an employee of Pfizer and owning stock in Pfizer and Amicus Therapeutics. Dr Seare reports being an employee of Optum at the time the study was conducted. Dr Garnier and Ms Merla report being employees of Pfizer. Ms Walker reports being an employee of Optum. Dr Alvir reports being an employee and stockholder of Pfizer. Dr Mahn reports being an employee and stockholder of Pfizer. Dr Zhang reports being an employee of Optum. Ms Landis reports being an employee of Optum. Ms Buikema reports being an employee of Optum and holding stock in UnitedHealth Group, the parent company of Optum.
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Affiliation(s)
| | - Nate Posner
- Parent Project Muscular Dystrophy, Washington, DC
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Kennedy J, Parker M, Seaborne M, Mhereeg M, Walker A, Walker V, Denaxas S, Kennedy N, Katikireddi SV, Brophy S. Healthcare use attributable to COVID-19: a propensity-matched national electronic health records cohort study of 249,390 people in Wales, UK. BMC Med 2023; 21:259. [PMID: 37468884 PMCID: PMC10354936 DOI: 10.1186/s12916-023-02897-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 05/10/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND To determine the extent and nature of changes associated with COVID-19 infection in terms of healthcare utilisation, this study observed healthcare contact 1 to 4 and 5 to 24 weeks following a COVID-19 diagnosis compared to propensity-matched controls. METHODS Two hundred forty nine thousand three hundred ninety Welsh individuals with a positive reverse transcription-polymerase chain reaction (RT-PCR) test were identified from data from national PCR test results. After elimination criteria, 98,600 positive individuals were matched to test negative and never tested controls using propensity matching. Cohorts were split on test location. Tests could be taken in either the hospital or community. Controls were those who had tested negative in their respective environments. Survival analysis was utilised for first clinical outcomes which are grouped into primary and secondary. Primary outcomes include post-viral-illness and fatigue as an indication of long-COVID. Secondary outcomes include clinical terminology concepts for embolism, respiratory conditions, mental health conditions, fit notes, or hospital attendance. Increased instantaneous risk for positive individuals was quantified using hazard ratios (HR) from Cox regression, while absolute risk (AR) and relative risk were quantified using life table analysis. RESULTS Analysis was conducted using all individuals and stratified by test location. Cases are compared to controls from the same test location. Fatigue (HR: 1.77, 95% CI: 1.34-2.25, p = < 0.001) and embolism (HR: 1.50, 95% CI: 1.15-1.97, p = 0.003) were more likely to occur in all positive individuals in the first 4 weeks; however, anxiety and depression (HR: 0.83, 95% CI: 0.73-0.95, p = 0.007) were less likely. Positive individuals continued to be more at risk of fatigue (HR: 1.47, 95% CI: 1.24-1.75, p = < 0.001) and embolism (HR: 1.51, 95% CI: 1.13-2.02, p = 0.005) after 4 weeks. All positive individuals are also at greater risk of post-viral illness (HR: 4.57, 95% CI: 1.77-11.80, p = 0.002). Despite statistical association between testing positive and several conditions, life table analysis shows that only a small minority of the study population were affected. CONCLUSIONS Community COVID-19 disease is associated with increased risks of post-viral-illness, fatigue, embolism, and respiratory conditions. Despite elevated risks, the absolute healthcare burden is low. Subsequently, either very small proportions of people experience adverse outcomes following COVID-19 or they are not presenting to healthcare.
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Affiliation(s)
- J Kennedy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
| | - M Parker
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK.
| | - M Seaborne
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
| | - M Mhereeg
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
| | - A Walker
- Datalab, Nuffield Dept of Primary Care Health Science, Radcliffe Primary Care Building, Oxford, OX2 6GG, UK
| | - V Walker
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - S Denaxas
- Institute for Health Informatics, UCL, London, UK
| | - N Kennedy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
| | - S V Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S Brophy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
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Harris SB, Mohammedi K, Bertolini M, White J, Walker V, Zhou FL, Anderson JE, Seufert J. Patient perspectives and experiences with basal insulin titration in type 2 diabetes in the United States: A cross-sectional survey. Diabetes Obes Metab 2023; 25:1408-1412. [PMID: 36633521 DOI: 10.1111/dom.14973] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/21/2022] [Accepted: 01/08/2023] [Indexed: 01/13/2023]
Affiliation(s)
- Stewart B Harris
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | | | | | | | | | | | | | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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White J, Simmons D, Blank S, ElNaggar A, Munley J, Walker V, Murali S, McLaurin K. Validation of an ovarian cancer line of therapy algorithm for real- world outcomes research in insurance claims (375). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01597-9] [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: 11/24/2022]
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Walker V, Trope M, Tichavakunda AA, Speth MM, Sedaghat AR, Phillips KM. Disease control in chronic rhinosinusitis: a qualitative study of patient perspectives. Rhinology 2022; 60:282-292. [PMID: 35608041 DOI: 10.4193/rhin21.448] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The definition of disease control in chronic rhinosinusitis (CRS) is an active area of study. However, investigations have not engaged CRS patients in how they think about disease control. This study seeks to understand the patient perspective on CRS disease control. METHODS Qualitative phenomenological study using constant comparative methodology was applied. The research team conducted 10, one-on-one interviews with CRS patients ranging from 22 to 55 minutes in length. The content of the interview protocol was determined through iterative discussion amongst all authors. Two authors served as coders to identify recurrent themes. Themes were analyzed for meaning and conclusions were summarized. RESULTS Three recurring themes determined from patients were that (1) use of the terminology "control" adequately represents this phenomenon, (2) components of control could be classified into four main themes relating to CRS symptomatology, exacerbation of comorbid disease, quality of life and acute exacerbations of CRS, and (3) when patients deem their CRS is uncontrolled they are more willing to escalate their treatment to include escalating their daily maintenance regimen, seeking otolaryngology referral, taking rescue medication or undergoing endoscopic sinus surgery. CONCLUSIONS CRS patients consider their daily symptoms, the severity and frequency of CRS exacerbations, impact on quality of life as well as exacerbation of comorbid disease when thinking about their disease control. Disease control is a goal of treatment for patients and uncontrolled disease motivates patients to seek further treatment. Physicians should explore all components of CRS control when considering disease status and need for further treatment.
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Affiliation(s)
- V Walker
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - M Trope
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - A A Tichavakunda
- Department of Education Leadership, School of Education, University of Cincinnati, Cincinnati, OH, USA
| | - M M Speth
- Department of Otorhinolaryngology, Kantonsspital Aarau, Aarau, Switzerland
| | - A R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - K M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Brakenridge SC, Wilfret DA, Maislin G, Andrade KE, Walker V, May AK, Dankner WM, Bulger EM. Resolution of organ dysfunction as a predictor of long-term survival in necrotizing soft tissue infections: Analysis of the AB103 Clinical Composite Endpoint Study in Necrotizing Soft Tissue Infections trial and a retrospective claims database-linked chart study. J Trauma Acute Care Surg 2021; 91:384-392. [PMID: 33797490 DOI: 10.1097/ta.0000000000003183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Necrotizing soft tissue infections (NSTIs) are an acute surgical condition with high morbidity and mortality. Timely identification, resuscitation, and aggressive surgical management have significantly decreased inpatient mortality. However, reduced inpatient mortality has shifted the burden of disease to long-term mortality associated with persistent organ dysfunction. METHODS We performed a combined analysis of NSTI patients from the AB103 Clinical Composite Endpoint Study in Necrotizing Soft Tissue Infections randomized-controlled interventional trial (ATB-202) and comprehensive administrative database (ATB-204) to determine the association of persistent organ dysfunction on inpatient and long-term outcomes. Persistent organ dysfunction was defined as a modified Sequential Organ Failure Assessment (mSOFA) score of 2 or greater at Day 14 (D14) after NSTI diagnosis, and resolution of organ dysfunction defined as mSOFA score of 1 or less. RESULTS The analysis included 506 hospitalized NSTI patients requiring surgical debridement, including 247 from ATB-202, and 259 from ATB-204. In both study cohorts, age and comorbidity burden were higher in the D14 mSOFA ≥2 group. Patients with D14 mSOFA score of 1 or less had significantly lower 90-day mortality than those with mSOFA score of 2 or higher in both ATB-202 (2.4% vs. 21.5%; p < 0.001) and ATB-204 (6% vs. 16%: p = 0.008) studies. In addition, in an adjusted covariate analysis of the combined study data sets D14 mSOFA score of 1 or lesss was an independent predictor of lower 90-day mortality (odds ratio, 0.26; 95% confidence interval, 0.13-0.53; p = 0.001). In both studies, D14 mSOFA score of 1 or less was associated with more favorable discharge status and decreased resource utilization. CONCLUSION For patients with NSTI undergoing surgical management, persistent organ dysfunction at 14 days, strongly predicts higher resource utilization, poor discharge disposition, and higher long-term mortality. Promoting the resolution of acute organ dysfunction after NSTI should be considered as a target for investigational therapies to improve long-term outcomes after NSTI. LEVEL OF EVIDENCE Prognostic/epidemiology study, level III.
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Affiliation(s)
- Scott C Brakenridge
- From the Department of Surgery (S.C.B.), University of Florida College of Medicine, Gainesville, Florida; Atox Bio, Ltd (D.A.W., W.M.D.), Durham, North Carolina; Biomedical Statistical Consulting (G.M.), Wynnewood, Pennsylvania; Health Economics and Outcomes Research, Optum (K.E.A., V.W.), Eden Prairie, Minnesota; Division of Acute Care Surgery (A.K.M.), Atrium Health, Charlotte, North Carolina; Department of Surgery (E.M.B.) University of Washington, Harborview Medical Center, Seattle, Washington
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Jacob S, Walker V, Fondard O, Jimenez G, Camilleri J, Panh L, Broggio D, Bernier M, Laurier D, Ferrières J, Lairez O. Myocardial deformation after radiotherapy for breast cancer: A layer-specific and territorial longitudinal strain analysis (BACCARAT study). Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.046] [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: 10/22/2022]
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Geraghty R, Cook P, Walker V, Somani B. Evaluation of the economic burden of kidney stone disease in the UK: A retrospective cohort study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33381-4] [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: 10/23/2022] Open
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Marx M, Wolf D, Pheng L, Walker V, Elises A, Feldman R, Werner P, Cohen-Mansfield J, Dubroff S, Lipson S. Eye Care in a Nursing Home. Journal of Visual Impairment & Blindness 2020. [DOI: 10.1177/0145482x9108500305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes an example of an in-house eye care clinic for elderly nursing home residents. The success of this clinic is due not to any one person, but to the combined efforts of a team: a clinic supervisor, a nursing assistant, a medical assistant, an ophthalmic technician, and an ophthalmologist. The implications of providing good and effective eye care to nursing home residents are discussed.
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Affiliation(s)
- M.S. Marx
- Research Institute, Hebrew Home of Greater Washington, 6121 Montrose Road, Rockville, MD 20852
| | - D. Wolf
- Eye Care Clinic, Hebrew Home of Greater Washington
| | - L. Pheng
- Hebrew Home of Greater Washington
| | | | - A. Elises
- Dubroff Eye Surgery Center, Silver Spring, MD
| | | | - P. Werner
- Research Institute, Hebrew Home of Greater Washington
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Strange C, Walker V, DePietro M, Tong J, Kurlander J, Carlyle M, Millette LA, Wittbrodt E. Patient-reported outcomes of dual bronchodilator fixed-dose combination versus bronchodilator monotherapy in individuals with COPD. Int J Chron Obstruct Pulmon Dis 2019; 14:1377-1388. [PMID: 31303751 PMCID: PMC6612016 DOI: 10.2147/copd.s194856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/12/2019] [Indexed: 11/23/2022] Open
Abstract
Background: This study compared real-world patient-reported outcomes (PROs) measured by the Clinical COPD Questionnaire (CCQ), the London Chest Activities of Daily Living (LCADL) scale, and the Work Productivity and Activity Impairment (WPAI) questionnaire between individuals with COPD initiating LAMA/LABA fixed-dose combination (FDC) dual therapy versus either long-acting muscarinic antagonist (LAMA) or long-acting beta2-agonist (LABA) monotherapy. Methods: Individuals with COPD aged ≥40 years initiating a LAMA/LABA FDC dual therapy or a LAMA or LABA monotherapy (index date = first prescription date) between January 1, 2016 and December 31, 2016 were identified from a large US administrative claims database. Individuals were excluded if they were prescribed an inhaled corticosteroid (ICS) or ICS/LABA two months prior to the index date or were diagnosed with cystic fibrosis, idiopathic pulmonary fibrosis, or asthma. The cohorts were propensity score matched (PSM) 1:1 for COPD severity using baseline measures. Each participant completed a survey. Results: Surveys were completed by 399 participants in the dual therapy cohort, and 718 participants in the monotherapy cohort. Following PSM, 379 participants remained in each cohort for analysis (monotherapy: 369 LAMA and 10 LABA). The dual therapy cohort reported fewer COPD-related symptoms (CCQ symptom score 2.75 vs 2.97, respectively, P=0.023), and, fewer limitations in leisure activities (LCADL leisure score 4.78 vs 5.17, respectively, P=0.021) versus the monotherapy cohort. No significant differences were found in the WPAI. A greater percentage of participants in the dual therapy cohort stayed on index therapy (63.1%) when compared with the monotherapy cohort (30.3%, P<0.0001). Conclusions: Only 30% of the participants prescribed monotherapy, usually with a LAMA, remained on index therapy alone at the time of survey administration. In the dual therapy cohort, 63% of the participants remained on the index medication and had fewer COPD-related symptoms and fewer limitations in leisure activities compared with participants in the monotherapy cohort.
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Affiliation(s)
- Charlie Strange
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Valery Walker
- Health Economics and Outcomes Research, Optum, Inc., Eden Prairie, MN, USA
| | | | - Junliang Tong
- Health Economics and Outcomes Research, Optum, Inc., Eden Prairie, MN, USA
| | - Jonathan Kurlander
- Health Economics and Outcomes Research, Optum, Inc., Eden Prairie, MN, USA
| | - Maureen Carlyle
- Health Economics and Outcomes Research, Optum, Inc., Eden Prairie, MN, USA
| | | | - Eric Wittbrodt
- Health Economics and Outcomes Research, AstraZeneca, Wilmington, DE, USA
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Walker V, Lairez O, Fondard O, Jimenez G, Broggio D, Laurier D, Ferrières J, Jacob S. Utilisation de l’imagerie 2D-strain du myocarde pour la détection précoce de la cardiotoxicité induite par la radiothérapie chez les patientes atteintes d’un cancer du sein (étude BACCARAT). Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.03.032] [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: 10/27/2022] Open
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Walker V, Broggio D, Derreumaux S, Camilleri J, Bruguière E, Lapeyre M, Fondard O, Lairez O, Bernier M, Laurier D, Chevelle C, Jimenez G, Ferrières J, Jacob S. Cardiac radiation exposure associated with breast cancer radiotherapy: Dose distribution to the heart substructures and coronary arteries (BACCARAT study). Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.344] [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: 11/27/2022]
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Jacob S, Walker V, Fondard O, Chevelle C, Jimenez G, Bernier M, Laurier D, Ferrières J, Lairez O. Use of myocardial strain imaging by echocardiography for the early detection of radiotherapy-induced cardiotoxicity in breast cancer patients (BACCARAT Study). Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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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Walker V, Jacob S, Crijns A, Langendijk J, Spoor D, Vliegenthart R, Combs S, Mayinger M, Borm K, Eraso A, Guedea F, Fiuza M, Constantino Rosa Santos S, Tamarat R, Laurier D, Ferrières J, Cardis E, Mousseaux E. Radiotherapy-induced cardiotoxicity in breast cancer patients: New approaches of early detection and prediction based on cardiac imaging and circulating biomarkers (European MEDIRAD EARLY-HEART study). Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Strange C, Walker V, Tong J, Kurlander J, Carlyle M, Millette LA, Wittbrodt E. A Retrospective Claims Analysis of Dual Bronchodilator Fixed-Dose Combination Versus Bronchodilator Monotherapy in Patients with Chronic Obstructive Pulmonary Disease. Chronic Obstr Pulm Dis 2019; 6:221-232. [PMID: 31342728 DOI: 10.15326/jcopdf.6.3.2018.0160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction Patients with chronic obstructive pulmonary disease (COPD) increasingly receive combination bronchodilator therapies. Real world evidence for the benefits of combination therapy compared to monotherapy is lacking. Methods COPD patients aged ≥ 40 years initiating monotherapy (MT) with either a long-acting muscarinic antagonist (LAMA) or long-acting beta2-agonist (LABA) or dual therapy (DT) with a LAMA/LABA fixed dose combination (FDC) between January 1, 2016 and December 31, 2016 were identified from a large U.S. administrative claims database. Patients diagnosed with cystic fibrosis, idiopathic pulmonary fibrosis, or asthma were excluded. Cohorts were propensity score matched 1:1 using baseline measures (e.g., exacerbations, hospitalizations) as proxies for COPD severity to create balanced cohorts. Results Following propensity score matching (PSM), 1286 patients remained in each cohort for analysis. Patients were followed for approximately 1 year. Patients in the DT versus MT cohort had lower rates of exacerbations leading to hospitalization (incidence rate ratio 0.7886; p=0.019), lower mean COPD-related pharmacy costs per patient per month (PPPM) ($300 versus $379, respectively; p<0.001) and total costs PPPM ($990 versus $1203, respectively; p=0.003). This occurred despite lower mean COPD-related pharmacy fills PPPM in the DT versus MT cohorts (1.41 versus 1.51, respectively; p=0.038). Patients in the DT cohort had lower rates of switching (p<0.001) and augmentation (p<0.001), and higher rates of non-persistence (p<0.001) versus the MT cohort. Rates of discontinuation were similar. Conclusions Patients in the DT cohort had lower rates of exacerbations leading to hospitalization, lower COPD-related pharmacy and total costs PPPM, and lower rates of switching and augmentation compared to patients in the MT cohort.
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Affiliation(s)
- Charlie Strange
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston
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Jacob S, Broggio D, Derreumaux S, Camilleri J, Lapeyre M, Bruguiere E, Fondard O, Lairez O, Walker V, Bernier MO, Laurier D, Chevelle C, Jimenez G, Ferrieres J. P3505Cardiac radiation exposure due to breast cancer radiotherapy: why mean heart dose is a limited parameter for cardiotoxicity studies? (BACCARAT Study). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Jacob
- IRSN, Laboratory of Epidemiology, Fontenay-aux-Roses, France
| | - D Broggio
- IRSN, Laboratoire d'Evaluation de la Dose Interne, Fontenay-Aux-Roses, France
| | - S Derreumaux
- IRSN, Unité d'Expertise en radioprotection Médicale, Fontenay-Aux-Roses, France
| | - J Camilleri
- Clinic Pasteur of Toulouse, Radiothérapie (Oncorad), Toulouse, France
| | - M Lapeyre
- Clinic Pasteur of Toulouse, Radiologie, Toulouse, France
| | - E Bruguiere
- Clinic Pasteur of Toulouse, Radiologie, Toulouse, France
| | - O Fondard
- Clinic Pasteur of Toulouse, Cardiologie générale et interventionnelle, Toulouse, France
| | - O Lairez
- Toulouse Rangueil University Hospital (CHU), Cardiologie, Toulouse, France
| | - V Walker
- IRSN, Laboratory of Epidemiology, Fontenay-aux-Roses, France
| | - M O Bernier
- IRSN, Laboratory of Epidemiology, Fontenay-aux-Roses, France
| | - D Laurier
- IRSN, Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants, Fontenay-Aux-Roses, France
| | - C Chevelle
- Clinic Pasteur of Toulouse, Radiothérapie (Oncorad), Toulouse, France
| | - G Jimenez
- Clinic Pasteur of Toulouse, Radiothérapie (Oncorad), Toulouse, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Cardiologie, INSERM UMR1027, Toulouse, France
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Silverberg J, Ghorayeb E, Chen Z, Andria M, Kennedy M, Miao R, Walker V, Mallya U, Gadkari A, Lio P. 345 A real-world study evaluating ade: QUacy of existing systemic treatments for patients with moderate-to-severe atopic dermatitis (AD-QUEST): 6-month survey data on flares. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.351] [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: 10/17/2022]
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Thorne C, Boire G, Chow A, Garces K, Liu F, Poulin-Costello M, Walker V, Haraoui B. Dose Escalation and Co-therapy Intensification Between Etanercept, Adalimumab, and Infliximab: The CADURA Study. Open Rheumatol J 2017; 11:123-135. [PMID: 29296125 PMCID: PMC5744265 DOI: 10.2174/1874312901711010123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/29/2017] [Revised: 09/05/2017] [Accepted: 09/26/2017] [Indexed: 01/04/2023] Open
Abstract
Objective To compare anti-TNF dose escalation, DMARD and/or glucocorticoid intensification, switches to another biologic, and drug and drug-related costs over 12 and 18 months for rheumatoid arthritis (RA) patients initiating etanercept (ETN), adalimumab (ADA), or infliximab (IFX) in routine clinical practice across Canada. Methods A retrospective chart review of biologic-naïve adult RA patients newly initiating ADA, ETN, or IFX between January 01, 2006 and December 31, 2012 from 11 practices across Canada. Results There were 314 patients in the 12-month analysis and 217 in the 18-month analysis. No dose escalation occurred with ETN over 12 and 18 months versus 38% and 32% for IFX (p<0.001) and 2% and 2% for ADA (p=0.199, p=0.218). Over 18 months, dose escalation and/or DMARD and/or glucocorticoid intensification was less frequent among ETN (16%) versus IFX (44%, p=0.005) and ADA (34%, p=0.004). By 18 months, 22% of patients initiating ADA had switched to another biologic compared with 6% of ETN patients (p=0.001).Patients initiating ETN had lower total (drug and drug-related) costs over 12 and 18 months compared to IFX, and no difference compared to ADA when adjusted for potential confounders. Patients with dose escalation had higher costs compared to those with no dose escalation. Conclusion Physicians were more likely to escalate the dose of IFX, but optimize co-therapy with ADA and ETN. ETN patients had no dose escalation and were less likely to have DMARD and/or glucocorticoid intensification than ADA patients. ETN-treated patients had lower costs compared to IFX patients.
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Affiliation(s)
- Carter Thorne
- The Arthritis Program Research Group, Southlake Regional Health Centre, c/o 43 Lundy's Lane, Newmarket, ON, L3Y 3R7, Canada
| | - Gilles Boire
- Centre Hospitalier Universitaire de Sherbrooke (CIUSSS de l'Estrie-CHUS), Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Andrew Chow
- Credit Valley Rheumatology, Mississauga, ON, Canada
| | | | - Fang Liu
- Optum, 5500 North Service Road, Suite 501, Burlington, ON, L7L 6W6, Canada
| | | | - Valery Walker
- Optum, 5500 North Service Road, Suite 501, Burlington, ON, L7L 6W6, Canada
| | - Boulos Haraoui
- Institut de Rhumatologie de Montreal, Montreal, QC, Canada
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Wei W, Ghorayeb E, Andria M, Walker V, Chao J, Schnitzer J, Kennedy M, Chen Z, Belland A, White J, Silverberg J. 204 A real-world study evaluating adeQUacy of Existing Systemic Treatments for patients with moderate-to-severe Atopic Dermatitis (AD-QUEST): Baseline treatment patterns and unmet needs assessment. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dyson S, Tranquille C, Walker V, Guire R, Fisher M, Murray R. A subjective descriptive study of the warm-up and turn to a fence, approach, take-off, suspension, landing and move-off in 10 showjumpers. EQUINE VET EDUC 2016. [DOI: 10.1111/eve.12699] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S. Dyson
- Centre for Equine Studies; Animal Health Trust; Lanwades Park; Newmarket Suffolk UK
| | - C. Tranquille
- Centre for Equine Studies; Animal Health Trust; Lanwades Park; Newmarket Suffolk UK
| | - V. Walker
- Centre for Equine Studies; Animal Health Trust; Lanwades Park; Newmarket Suffolk UK
| | - R. Guire
- Centaur Biomechanics; Warwickshire UK
| | - M. Fisher
- Woolcroft Equine Services Ltd.; Wisbech Cambridgeshire UK
| | - R. Murray
- Centre for Equine Studies; Animal Health Trust; Lanwades Park; Newmarket Suffolk UK
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Tomalty H, Storey K, Walker V. Identification of ice-binding activity in the gall fly and its goldenrod host. Cryobiology 2016. [DOI: 10.1016/j.cryobiol.2016.09.155] [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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Calkins K, Roy D, Molchan L, Bradley L, Grogan T, Elashoff D, Walker V. Predictive value of cord blood bilirubin for hyperbilirubinemia in neonates at risk for maternal-fetal blood group incompatibility and hemolytic disease of the newborn. J Neonatal Perinatal Med 2016; 8:243-50. [PMID: 26518407 DOI: 10.3233/npm-15814111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the predictive ability of cord blood bilirubin (CBB) for hyperbilirubinemia in a population at risk for maternal-fetal blood group incompatibility and hemolytic disease of the newborn. STUDY DESIGN This is a single center retrospective case-control study. Cases received phototherapy; controls did not. Cases were matched 1:3 to controls by gender and treating physician. Inclusion criteria included: ≥35 weeks gestation, CBB, and one or more total serum bilirubin (TSB) concentrations. The primary outcome was CBB. Secondary outcomes were a TSB >75th percentile, length of stay, and neonatal intensive care unit admission. The prognostic ability of CBB for phototherapy and TSB >75th percentile was assessed using area under the receiver operating characteristic (ROC) curve. Logistic regression analyses were performed to determine predictors for phototherapy and TSB >75th percentile. RESULT When compared to controls (n = 142), cases (n = 54) were more likely to have a positive Coombs' test (82% vs. 41% , p < 0.001) and TSB >75th percentile (85% vs. 21% , p < 0.001). When compared to controls, cases had a higher mean (±SD) CBB (2.5 ± 0.5 vs. 1.8 ± 0.4 mg/dL, p < 0.001). The area under the ROC curve (±SEM) for CBB for phototherapy and TSB >75th percentile was 0.87 ± 0.03 (p < 0.001, 95% CI 0.82, 0.93) and 0.87 ± 0.03 (p < 0.001, 95% CI 0.82, 0.92), respectively. CONCLUSION In this study, the mean CBB concentration was higher in neonates who received phototherapy compared to those who did not. CBB concentrations may help predict severe hyperbilirubinemia and phototherapy in a population at risk for hemolytic disease of the newborn.
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Affiliation(s)
- K Calkins
- Department of Pediatrics, Division of Neonatology and Developmental Biology, Neonatal Research Center, David Geffen School of Medicine, University of California, and Mattel Children's Hospital at UCLA, Los Angeles, CA, USA
| | - D Roy
- Department of Pediatrics, Division of Neonatology and Developmental Biology, Neonatal Research Center, David Geffen School of Medicine, University of California, and Mattel Children's Hospital at UCLA, Los Angeles, CA, USA
| | - L Molchan
- Department of Pediatrics, Division of Neonatology and Developmental Biology, Neonatal Research Center, David Geffen School of Medicine, University of California, and Mattel Children's Hospital at UCLA, Los Angeles, CA, USA
| | | | - T Grogan
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California and Mattel Children's Hospital at UCLA, Los Angeles, CA, USA
| | - D Elashoff
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California and Mattel Children's Hospital at UCLA, Los Angeles, CA, USA
| | - V Walker
- Department of Pediatrics, Division of Neonatology and Developmental Biology, Neonatal Research Center, David Geffen School of Medicine, University of California, and Mattel Children's Hospital at UCLA, Los Angeles, CA, USA
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Walker V, Patel H, Kurlander JL, Essoi B, Yang J, Mahableshwarkar AR, Samp JC, Akhras KS. Association Between Cognitive Function and Health Care Costs 3 Months and 6 Months After Initiating Antidepressant Medication for Depressive Disorders. J Manag Care Spec Pharm 2015; 21:742-52, 752a-752e. [PMID: 26308222 PMCID: PMC10398000 DOI: 10.18553/jmcp.2015.21.9.742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Major depressive disorder is one of the most common and disabling mental health disorders and is associated with substantial costs in terms of direct health care utilization and workplace productivity. Cognitive dysfunction, which alone substantially increases health care costs, is commonly associated with major depressive disorder. However, the health care costs of cognitive dysfunction in the context of depressive disorder are unknown. Recovery from mood symptoms is not always associated with resolution of cognitive dysfunction. Thus, cognitive dysfunction may contribute to health care burden even with successful antidepressant therapy. OBJECTIVE To compare health care utilization and costs for patients with a depressive disorder with and without cognitive dysfunction, at 3 and 6 months after initiation of antidepressant medication. METHODS This was an observational study, combining a cross-sectional patient survey, administered during a telephone interview, with health care claims data from a large, geographically diverse U.S. health plan. Included patients had at least 1 pharmacy claim for an antidepressant medication between August 1 and September 30, 2012, and no claim for any antidepressant during the 6 months prior to the index date. In addition to other criteria assessed in the claims data, patients confirmed a diagnosis of depression or major depressive disorder and the absence of any exclusionary neurological diagnoses possibly associated with cognitive impairment. Eligible patients were administered validated cognitive function assessments of verbal episodic memory (Hopkins Verbal Learning Test-Revised, Delayed and Total); attention (Digit Span Forward Maximum Sequence Length); working memory (Digit Span Backward Maximum Sequence Length); and executive function (D-KEFS-Letter Fluency Test). Based on comparison of scores with normative data, patients were assigned to cognitive dysfunction or cognitive normal cohorts. All-cause (all diagnoses) and depressive disorder-related health care utilization and costs (all from a payer perspective) were assessed 6 months prior (baseline) to antidepressant initiation and 3 months and 6 months after (follow-up) initiation of antidepressant medication. Health care utilization and costs included ambulatory (office and hospital outpatient), emergency room, inpatient hospital, pharmacy, other medical (e.g., laboratory and diagnostics), and total (all categories combined). All-cause and depressive disorder-related total costs during the 3- and 6-month follow-up periods were modeled with generalized linear modeling with gamma distribution and log link, while adjusting for potential confounders (age, race, gender, education, employment, and comorbidities). RESULTS Of the 13,537 patients who were mailed an invitation, 824 (6%) were eligible and agreed to participate. Of these, 563 patients provided informed consent, completed the interview, maintained eligibility, and were included in the 3-month calculations. Among these, 255 (45%) were classified as having cognitive dysfunction. Mean patient age was 41.3 (± 12.5) years; 80% were female. Most patients were white and employed. More patients in the cognitive normal cohort were white (P less than 0.001) and employed full time (P = 0.029), had higher education attainment (P less than 0.001), and had fewer comorbidities (P = 0.007) than those in the cognitive dysfunction cohort. Over the first 3 months, patients with cognitive dysfunction had higher adjusted all-cause costs ($3,309 vs. $2,157, P = 0.002) and higher adjusted depressive disorder-related costs ($718 vs. $406, P less than 0.001) than patients without cognitive dysfunction. At 6 months, data from 4 patients were removed from the analysis because of exclusionary diagnoses. Over 6 months, patients with cognitive dysfunction had higher adjusted all-cause costs ($4,793) than patients without cognitive dysfunction ($3,683, P = 0.034). Over 6 months, depressive disorder-related costs did not significantly differ between patients with ($771) and without cognitive dysfunction ($594, P = 0.071). The main drivers of all-cause costs were office visits, outpatient hospital visits, and inpatient costs, and the main driver of depressive disorder-related costs was inpatient costs. CONCLUSIONS Cognitive dysfunction was associated with higher adjusted all-cause and depressive disorder-related costs 3 months after initiation of an antidepressant medication. This difference persisted for all-cause costs through 6 months. Identification and treatment of cognitive dysfunction in patients with depressive disorder might reduce health care costs.
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Affiliation(s)
- Valery Walker
- Optum, 12125 Technology Dr., Eden Prairie, MN 55344.
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Caraway D, Walker V, Becker L, Hinnenthal J. Successful Discontinuation of Systemic Opioids After Implantation of an Intrathecal Drug Delivery System. Neuromodulation 2015; 18:508-15; discussion 515-6. [DOI: 10.1111/ner.12318] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 03/25/2015] [Accepted: 04/22/2015] [Indexed: 11/30/2022]
Affiliation(s)
- David Caraway
- Pain Relief Center; St. Mary's Regional Medical Center; Huntington WV USA
| | - Valery Walker
- Health Economic & Outcomes Research; Optum, Inc.; Eden Prairie MN USA
| | - Laura Becker
- Health Economic & Outcomes Research; Optum, Inc.; Eden Prairie MN USA
| | - Jennifer Hinnenthal
- Neuromodulation Global Reimbursement & Health Economics; HEOR
- Medtronic, Inc.; Minneapolis MN USA
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Papaioannou A, Khan A, Belanger A, Bensen W, Kendler D, Theoret F, Amin M, Brekke L, Erdmann M, Walker V, Adachi JD. Persistence with denosumab therapy among osteoporotic women in the Canadian patient-support program. Curr Med Res Opin 2015; 31:1391-401. [PMID: 25993017 DOI: 10.1185/03007995.2015.1053049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate persistence with denosumab among postmenopausal women with osteoporosis participating in the Canadian patient-support program (ProVital * ). Denosumab is an injectable therapeutic option for osteoporosis that is administered subcutaneously every 6 months. METHODS ProVital, a support program in which patients voluntarily enroll, provides next injection reminder calls and educational material. A retrospective database analysis of patient self-reported data was conducted among osteoporotic women aged ≥50 who enrolled in the ProVital program and received their first denosumab injection between August 2010 and June 2011. To achieve 12 month persistence patients had to receive at least two denosumab injections, and to achieve 24 month persistence patients had to receive at least four denosumab injections, with consecutive injections no more than 6 months + 8 weeks apart. Logistic regression analysis was used to identify predictors of persistence. RESULTS A total of 1676 patients (mean age 74 years) were included. The 12 month persistence with denosumab was 81.6% (1367/1676 patients), and the 24 month persistence was 59.1% (991/1676 patients). Characteristics associated with both 12 and 24 month persistence were possession of private medication insurance and residence in Quebec. Additionally, age greater than 75, previous postmenopausal osteoporosis medication use, and fracture were associated with 24 month persistence. LIMITATIONS Patient enrollment in the program was voluntary, so there may be selection bias for the patient population included in this study. Also, this study did not have a control group of patients who were not enrolled in a patient support program. CONCLUSIONS The persistence with denosumab among patients enrolled in the program was higher than historical persistence with oral bisphosphonates, and similar to persistence of patients in an education program taking teriparatide, patients taking bisphosphonates in a pharmaceutical care program, and two observational studies of denosumab.
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Khanna PP, Shiozawa A, Walker V, Bancroft T, Essoi B, Akhras KS, Khanna D. Health-related quality of life and treatment satisfaction in patients with gout: results from a cross-sectional study in a managed care setting. Patient Prefer Adherence 2015; 9:971-81. [PMID: 26185426 PMCID: PMC4501348 DOI: 10.2147/ppa.s83700] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient satisfaction with treatment directly impacts adherence to medication. OBJECTIVE The objective was to assess and compare treatment satisfaction with the Treatment Satisfaction Questionnaire for Medication (TSQM), gout-specific health-related quality of life (HRQoL) with the Gout Impact Scale (GIS), and generic HRQoL with the SF-12v2(®) Health Survey (SF-12) in patients with gout in a real-world practice setting. METHODS This cross-sectional mail survey included gout patients enrolled in a large commercial health plan in the US. Patients were ≥18 years with self-reported gout diagnosis, who filled ≥1 prescription for febuxostat during April 26, 2012 to July 26, 2012 and were not taking any other urate-lowering therapies. The survey included the TSQM version II (TSQM vII, score 0-100, higher scores indicate better satisfaction), GIS (score 0-100, higher scores indicate worse condition), and SF-12 (physical component summary and mental component summary). Patients were stratified by self-report of currently experiencing a gout attack or not to assess the discriminant ability of the questionnaires. RESULTS A total of 257 patients were included in the analysis (mean age, 54.9 years; 87% male). Patients with current gout attack (n=29, 11%) had worse scores than those without gout attack on most instrument scales. Mean differences between current attack and no current attack for the TSQM domains were: -20.6, effectiveness; -10.6, side effects; -12.1, global satisfaction (all P<0.05); and -6.1, convenience (NS). For the GIS, mean differences were: 30.5, gout overall concern; 14.6, gout medication side effects; 22.7, unmet gout treatment needs; 11.5, gout concern during attack (all P<0.05); and 7.9, well-being during attack (NS). Mean difference in SF-12 was -6.6 for physical component summary (P<0.05) and -2.9 for mental component summary (NS). Correlations between several TSQM and GIS scales were moderate. CONCLUSION The TSQM and GIS were complementary in evaluating the impact of gout flare on treatment satisfaction and HRQoL. Correlations between the two instruments supported the relationship between treatment satisfaction and HRQoL.
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Affiliation(s)
- Puja P Khanna
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Aki Shiozawa
- Global Outcome Research, Takeda Pharmaceuticals International, Inc., Deerfield, IL, USA
- Correspondence: Aki Shiozawa, Global Outcome Research, Takeda Pharmaceuticals International, Inc., One Takeda Parkway, Deerfield, IL 60015, USA, Tel +1 224 554 7161, Fax +1 224 554 7983, Email
| | - Valery Walker
- Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA
| | - Tim Bancroft
- Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA
| | - Breanna Essoi
- Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA
| | - Kasem S Akhras
- Novartis Pharmacy Services AG, Dubai, United Arab Emirates
| | - Dinesh Khanna
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Walker V, Tranquille C, Hoekstra R, Spear J, Bronsvoort M. Is Subjective Grading of Jumping Technique Related to Measurable Kinematic Parameters During Flight? Equine Vet J 2014. [DOI: 10.1111/evj.12267_154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- V Walker
- Animal Health Trust; Newmarket United Kingdom
| | | | | | - J Spear
- Animal Health Trust; Newmarket United Kingdom
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Affiliation(s)
- C Tranquille
- Animal Health Trust; Newmarket Suffolk United Kingdom
| | - V Walker
- Animal Health Trust; Newmarket Suffolk United Kingdom
| | - D Hodgins
- European Technology for Business LTD; Codicote Hertfordshire United Kingdom
| | - T Goosen
- BEF; Kenilworth Warwickshire United Kingdom
| | - J McEwen
- BEF; Kenilworth Warwickshire United Kingdom
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Affiliation(s)
- V Walker
- Animal Health Trust; Newmarket United Kingdom
| | | | - J McEwen
- British Equestrian Federation; Kenilworth United Kingdom
| | - V Spalding
- British Equestrian Federation; Kenilworth United Kingdom
| | - R Cnockaert
- British Equestrian Federation; Kenilworth United Kingdom
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Murray R, Walker V, Tranquille C, Adams V, Frost R. Effect of an Oral Joint Supplement on Orthopaedic Evaluation Scores and Limb Kinematics. Equine Vet J 2014. [DOI: 10.1111/evj.12267_134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R Murray
- Animal Health Trust; Newmarket United Kingdom
| | - V Walker
- Animal Health Trust; Newmarket United Kingdom
| | | | - V Adams
- Veterinary Epidemiology Consulting; Bury St Edmunds United Kingdom
| | - R Frost
- Science Supplements; Bury St Edmunds United Kingdom
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Affiliation(s)
- I Pettit
- Anglia Ruskin University; Cambridge United Kingdom
| | - V Walker
- Animal Health Trust; Newmarket United Kingdom
| | | | - J Spear
- Animal Health Trust; Newmarket United Kingdom
| | - R Murray
- Animal Health Trust; Newmarket United Kingdom
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Abstract
OBJECTIVE To investigate the feasibility and effectiveness of conducting two positive psychology interventions to improve mood and self-concept with survivors of traumatic brain injury (TBI), within a neuro-rehabilitation hospital. METHOD AND PROCEDURES Ten patients with brain injury were randomly allocated to an intervention and control group. The efficacy of the first intervention, 'three positive things in life' was measured via Seligman's Authentic Happiness Index (AHI), at base-line, directly following the intervention and at the end of the 12-week group programme. The second intervention, the 'Value in Action (VIA) signature strengths intervention' was measured by the Head Injury Semantic Differential Scale (HISDS) at baseline and at the end of the group. RESULTS Compared to baseline and control group scores, the AHI index showed an increase in the intervention group's happiness following the intervention and at the end of the 12-week programme, albeit the latter increase was non-significant. The HISDS showed non-significant improvement in self-concept and reduction in polarization of the self in the present, future and past in the second intervention. Anecdotal evidence revealed a clear improved mood following the interventions. CONCLUSION This study shows promising results for the effectiveness of Positive Psychology interventions and methods to improve feasibility when applying this treatment within a hospital setting.
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Affiliation(s)
- H E Andrewes
- Graham Anderson House, Brain Injury Rehabilitation Trust , Glasgow, Scotland , UK and
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Murray R, Adams V, Walker V, Tranquille C, Copeman S, Spear J, Frost R, Marlin D. To Determine the Effect of An Oral Joint Supplement on Orthopaedic, Physiotherapy and Handler Evaluation Scores in Horses. Equine Vet J 2013. [DOI: 10.1111/evj.12145_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- R. Murray
- Animal Health Trust; Lanwades Park; Kentford; Newmarket; Suffolk; CB8 7UU
| | - V. Adams
- Veterinary Epidemiology Consulting; Bury St Edmunds; Suffolk
| | - V. Walker
- Animal Health Trust; Lanwades Park; Kentford; Newmarket; Suffolk; CB8 7UU
| | - C. Tranquille
- Animal Health Trust; Lanwades Park; Kentford; Newmarket; Suffolk; CB8 7UU
| | - S. Copeman
- World Horse Welfare; Snetterton; Norfolk
| | - J. Spear
- Veterinary Epidemiology Consulting; Bury St Edmunds; Suffolk
| | - R. Frost
- Science Supplements; Bury St Edmunds; Suffolk; UK
| | - D. Marlin
- Science Supplements; Bury St Edmunds; Suffolk; UK
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Ashley ED, Drew R, Johnson M, Danna R, Dabrowski D, Walker V, Prasad M, Alexander B, Papadopoulos G, Perfect J. Cost of Invasive Fungal Infections in the Era of New Diagnostics and Expanded Treatment Options. Pharmacotherapy 2012; 32:890-901. [DOI: 10.1002/j.1875-9114.2012.01124] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Barbara Alexander
- Division of Infectious Diseases and International Health; Department of Medicine; Duke University Medical Center; Durham; North Carolina
| | | | - John Perfect
- Division of Infectious Diseases and International Health; Department of Medicine; Duke University Medical Center; Durham; North Carolina
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Ashley ED, Drew R, Johnson M, Danna R, Dabrowski D, Walker V, Prasad M, Alexander B, Papadopoulos G, Perfect J. Cost of Invasive Fungal Infections in the Era of New Diagnostics and Expanded Treatment Options. Pharmacotherapy 2012. [DOI: 10.1002/phar.1124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Barbara Alexander
- Division of Infectious Diseases and International Health; Department of Medicine; Duke University Medical Center; Durham; North Carolina
| | | | - John Perfect
- Division of Infectious Diseases and International Health; Department of Medicine; Duke University Medical Center; Durham; North Carolina
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Maleki-Yazdi MR, Kelly SM, Lam SY, Marin M, Barbeau M, Walker V. The burden of illness in patients with moderate to severe chronic obstructive pulmonary disease in Canada. Can Respir J 2012; 19:319-24. [PMID: 23061077 PMCID: PMC3473007 DOI: 10.1155/2012/328460] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION No recent Canadian studies with physician- and spirometry-confirmed diagnosis of chronic obstructive pulmonary disease (COPD) that assessed the burden of COPD have been published. OBJECTIVE To assess the costs associated with maintenance therapy and treatment for acute exacerbations of COPD (AECOPD) over a one-year period. METHODS Respirologists, internists and family practitioners from across Canada enrolled patients with an established diagnosis of moderate to severe COPD (Global initiative for chonic Obstructive Lung Disease stages 2 and 3) confirmed by postbronchodilator spirometry. Patient information and health care resources related to COPD maintenance and physician-documented AECOPD over the previous year were obtained by chart review and patient survey. RESULTS A total of 285 patients (59.3% male; mean age 70.4 years; mean pack years smoked 45.6; mean duration of COPD 8.2 years; mean postbronchodilator forced expiratory volume in 1 s 58.0% predicted) were enrolled at 23 sites across Canada. The average annual COPD-related cost per patient was $4,147. Across all 285 patients, maintenance costs were $2,475 per patient, of which medications accounted for 71%. AECOPD treatment costs were $1,673 per patient, of which hospitalizations accounted for 82%. Ninety-eight patients (34%) experienced a total of 157 AECOPD. Treatment of these AECOPD included medications and outpatient care, 19 emergency room visits and 40 hospitalizations (mean length of stay 8.9 days). The mean cost per AECOPD was $3,036. DISCUSSION The current costs associated with moderate and severe COPD are considerable and will increase in the future. Appropriate use of medications and strategies to prevent hospitalizations for AECOPD may reduce COPD-related costs because these were the major cost drivers.
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Affiliation(s)
- M Reza Maleki-Yazdi
- Department of Medicine, Women's College Hospital, University of Toronto, Ontario, Canada.
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Bombardier C, Barbieri M, Parthan A, Zack DJ, Walker V, Macarios D, Smolen JS. The relationship between joint damage and functional disability in rheumatoid arthritis: a systematic review. Ann Rheum Dis 2011; 71:836-44. [PMID: 22128079 DOI: 10.1136/annrheumdis-2011-200343] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To summarise the relationship between joint damage and functional disability in rheumatoid arthritis (RA) patients. METHODS A systematic review of the literature from 1990 to 2008 was conducted using MEDLINE and EMBASE databases. The search strategy focused on RA, joint damage and disability. Only longitudinal studies or randomised clinical trials with 1 year or more of follow-up containing data correlating joint damage and disability were included. The comparisons were categorised in four ways: baseline damage versus disability at end of follow-up (correlation A); damage versus disability measured cross-sectionally at each of several time points (correlation B); changes in damage versus final disability (correlation C) and changes in damage versus changes in disability (correlation D). RESULTS From a total of 1902 abstracts, 42 studies met the inclusion/exclusion criteria. More than 50% of the studies that measured baseline damage to later disability (A) reported a statistically significant association. Correlation was significant when measured at multiple time points over time (B; 16/19 studies). Statistically significant associations between changes in damage and either disability at end of follow-up or changes in disability were also found (C and D; 11/13 studies). CONCLUSIONS While many of the studies did not include multivariate analysis with confounder adjustment, the published evidence indicates a link between joint damage and functional disability and that an increase in joint damage is associated with an increase in disability over time. Treatments to limit progressive joint damage may lead to better joint function and improved patient outcome with less disability.
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Affiliation(s)
- Claire Bombardier
- Division of Rheumatology and Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Abstract
Inherited biochemical defects may present with acute life-threatening illness with a high mortality and morbidity. Some are treatable and have a good outcome with early appropriate intervention. However, because of their rarity, diagnosis is often delayed; they are not considered or investigated appropriately. This is especially likely in those presenting in previously healthy adults. The collection of acute samples is crucial. There are numerous disorders, and front-line tests must cast a wide net. A small core of emergency tests generally indicates which metabolic pathway is defective and provides a working diagnosis and basis for treatment. Later confirmation and identification of the precise defect are essential for long-term management and for genetic counselling and prenatal diagnosis of future pregnancies. An escalating number of specialist tests and mutation analyses are undertaken by metabolic laboratories worldwide, but they are not widely available, are expensive, and must be requested selectively. Guidelines are presented here for the front-line investigation of acutely ill children with hypoglycaemia, metabolic acidosis, encephalopathy and intractable seizures, and for a dying child with a suspected, undiagnosed, inherited metabolic defect. With modification, these are also applicable to adults with a metabolic defect. In order to guide further investigation, selected disorders are described briefly along with their diagnostic work-up. Information about sample collection and processing is provided.
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Maleki-Yazdi MR, Lam SS, Walker V, Rogoza R, Hass HE, Barbeau M, Kelly SM. Burden of Illness in Patients With Moderate to Severe Chronic Obstructive Pulmonary Disease (COPD) in Canada: Chart Review and Patient Survey. Chest 2010. [DOI: 10.1378/chest.10180] [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: 11/01/2022] Open
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Adachi JD, Kennedy CC, Papaioannou A, Ioannidis G, Leslie WD, Walker V. Treating osteoporosis in Canada: what clinical efficacy data should be considered by policy decision makers? Osteoporos Int 2009; 20:1785-93. [PMID: 19277810 PMCID: PMC5101050 DOI: 10.1007/s00198-009-0870-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Accepted: 01/09/2009] [Indexed: 10/21/2022]
Abstract
UNLABELLED SAUMMARY: Using a Markov state-transition model, we estimated fractures averted with risedronate using two different types of clinical efficacy data. Summary data, as opposed to individual patient data (IPD), underestimated the number of fractures averted when applied in a specified high risk population. The choice of clinical efficacy data is an important consideration in health economic models evaluating osteoporosis therapies. INTRODUCTION This paper contrasts fracture reduction estimates for risedronate utilizing efficacy data from two approaches to meta-analysis: summary data versus individual patient data. We also examined differences in fracture reduction explained by varied cohort selection, especially the inclusion of low- versus high-risk populations. METHODS Using a Markov state-transition model, we compared fractures averted over 3 years in a hypothetical cohort by inputting fracture risk reduction estimates (risedronate versus placebo) from two data sources (summary data versus IPD). The cohort consisted of 100,000 Canadian women, age > or =65 years with osteoporosis (WHO criteria T-score < or = -2.5) and prevalent morphometric vertebral fracture. RESULTS Non-vertebral fractures averted with risedronate were: 3,571 and 6,584 per 100,000 women for summary data and IPD, respectively. For vertebral fractures, the numbers were 8,552 and 10,127. When IPD versus summary data was used, an additional 3,013 more non-vertebral fractures and 1,575 vertebral fractures were averted. DISCUSSION Relative risk estimates from IPD analyses were the best choice for modelling fracture outcomes when applied in a specified high-risk population. In addition to superior statistical methodology, they utilized RCT cohorts that are more representative of higher risk patients requiring treatment (osteoporotic women > or =65 years with a prevalent vertebral fracture).
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Affiliation(s)
- J D Adachi
- Department of Medicine, St Joseph's, Healthcare-McMaster University, 25 Charlton Avenue East, Suite 501, Hamilton, Ontario, L8N 1Y2, Canada.
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Abstract
The urea cycle is the final pathway for removal of surplus nitrogen from the body, and the major route in humans for detoxification of ammonia. The full complement of enzymes is expressed only in liver. Inherited deficiencies of urea cycle enzymes lead to hyperammonaemia, which causes brain damage. Severe defects present with hyperammonaemic crises in neonates. Equally devastating episodes may occur in previously asymptomatic adults with mild defects, most often X-linked ornithine transcarbamylase (OTC) deficiency. Several mechanisms probably contribute to pathogenesis. Treatment aims to reduce plasma ammonia quickly, reduce production of waste nitrogen, dispose of waste nitrogen using alternative pathways to the urea cycle and replace arginine. These therapies have increased survival and probably improve the neurological outcome. Arginine, sodium benzoate, sodium phenylbutyrate and, less often, sodium phenylacetate are used. Long-term correction is achieved by liver transplantation. Gene therapy for OTC deficiency is effective in animals, and work is ongoing to improve persistence and safety.
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Affiliation(s)
- V Walker
- Department of Clinical Biochemistry, Southampton University Hospitals NHS Trust, Southampton General Hospital, Southampton, UK. valerie.walker @suht.swest.nhs.uk
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Abstract
In March 2007, a puppy that was recently imported from India into the United States was found to be positive for rabies by the Alaska Department of Health and Social Services. This case report highlights several important public health issues. First, recognizing that humans and animals are part of a global community with frequent travel and translocation, the risks of disease introduction, particularly with sub-clinical or incubating animals, are real and present. Animal-importation regulations, policies and practices are intended to minimize these risks and should be routinely evaluated and updated as needed in response to occurrences such as detailed in this communication. Second, veterinarians play key roles in safeguarding the public's health with regard to monitoring the movement of animals and diagnosing zoonoses. Third, investigating rabies cases that involve multiple jurisdictions are labour-intensive and require significant resources to ensure that all potentially exposed persons are identified and receive the appropriate rabies post-exposure prophylaxis.
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Affiliation(s)
- L Castrodale
- Alaska Department of Health and Social Services, Anchorage, AK 99503, USA.
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Bellamy N, Bell MJ, Pericak D, Goldsmith CH, Torrance GW, Raynauld JP, Walker V, Tugwell P, Polisson R. BLISS index for analyzing knee osteoarthritis trials data. J Clin Epidemiol 2007; 60:124-32. [PMID: 17208118 DOI: 10.1016/j.jclinepi.2006.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2005] [Revised: 11/24/2005] [Accepted: 04/18/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Different pain thresholds were investigated, using the WOMAC Pain Scale (WOMAC-P) to determine if they could differentiate between treatment groups (hylan G-F 20 vs. appropriate care) at low and very low levels of state attainment in patients with knee osteoarthritis (OA). A method, termed the BLISS (Bellamy et al. Low Intensity Symptom State-attainment) Index, for analyzing OA knee clinical trials data, was proposed. STUDY DESIGN AND SETTING Five analyses were performed: time to first BLISS day, BLISS days over 12 months, patients with a BLISS response at month 12, patients with a BLISS response at any time, and number of BLISS periods over 12 months. For each analysis, five levels of WOMAC-P were examined: <or=5 normalized units (NU), <or=10, <or=15, <or=20, and <or=25 (higher=more pain). RESULTS More patients in the hylan G-F 20 group achieved BLISS states in all five analyses. These differences were statistically significant for all pain threshold levels except <or=5 NU. CONCLUSION Five methods of measuring BLISS attainment using four prespecified threshold levels of pain were able to statistically discriminate between treatment groups. This method may potentially provide an approach, to defining which patients not only improve but also achieve a good state of health, at low and very low levels of pain intensity. BLISS-10 is a therapeutically attainable very low symptom state at which clinically important, statistically significant between-group differences are detectable, and therefore may provide a benchmark against which therapeutic interventions can be assessed. However, the value to patients, of this and other low and very low intensity pain states, requires further elaboration.
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Affiliation(s)
- Nicholas Bellamy
- Centre of National Research on Disability and Rehabilitation Medicine (CONROD), The University of Queensland, Queensland, Australia, 4006.
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Kar P, Walker V, Sharp P. Recurrent 'Lactic' Acidosis-a Cautionary Tale. Acute Med 2007; 6:128-130. [PMID: 21611589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Lactic acidosis can be caused by a variety of pathological conditions. We present a case of recurrent 'lactic' acidosis, which was eventually diagnosed to be secondary to ethylene glycol poisoning. Though there are a handful of cases reported in the literature, it is not widely known that glycolic acid (a metabolite of ethylene glycol) is measured spuriously as lactic acid by some point of care analysers. Literature review would indicate that this is a rare but potentially confounding factor in diagnosis. Given the nature of the pathology, we would suggest that greater awareness of the problem is important.
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Affiliation(s)
- P Kar
- Specialist Registrar in Diabetes and Endocrinology Southampton General Hospital Tremona Road Southampton SO16 6YD
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50
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Affiliation(s)
- V Walker
- Birmingham Children's Hospital, UK.
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