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Harris E. Missed Vaccine Doses Tied to Worse COVID-19 Outcomes. JAMA 2024; 331:554. [PMID: 38294786 DOI: 10.1001/jama.2023.28340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
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Deghan Manshadi S, Dehghan K, Robertson DI, Reimer C, Zevin B. Safety and outcomes of performing laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy at an ambulatory site of a tertiary care hospital in Ontario. Can J Surg 2022; 65:E38-E44. [PMID: 35042719 PMCID: PMC8900739 DOI: 10.1503/cjs.007120] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background: In Ontario, bariatric surgery is publicly funded and is performed only in accredited tertiary care hospitals. The purpose of our study was to report on the safety and outcomes of performing bariatric surgery at an ambulatory site of a tertiary care hospital in southern Ontario. Methods: We conducted a retrospective cohort study of all adult (age ≥ 18 yr) patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) at the ambulatory site of our tertiary care hospital between September 2016 and August 2018. The 2 sites are 1.4 km apart. Patient demographic characteristics, duration of surgery, intraoperative and 90-day postoperative complications, number of transfers and readmission to the tertiary care hospital, and emergency department visits were collected. Results: A total of 314 patients (285 women [90.8%] and 29 men [9.2%] with a mean age of 41.8 yr [standard deviation (SD) 8.9 yr]) underwent surgery: LRYGB in 295 cases (93.9%) and LSG in 19 (6.0%). The mean body mass index was 45.3 (SD 5.1), the median American Society of Anesthesiologists score was 3 (range 2–4), and the median Edmonton Obesity Staging System score was 2 (range 0–4). The mean operative time was 119.8 (SD 23.1) minutes for LRYGB and 96.2 (SD 22.0) minutes for LSG, and the mean length of stay was 2.1 (SD 0.6) days and 2.1 (SD 0.2) days, respectively. Thirteen patients (4.1%) required transfer to the tertiary care hospital for a postoperative complication. Of 312 patients, 29 (9.3%) presented to emergency department within 90 days after surgery, and 8 (2.6%) required readmission to hospital; no deaths were reported. Conclusion: The findings suggest that LRYGB and LSG can be performed safely at an ambulatory site of a tertiary care hospital. However, caution should be exercised in performing these procedures at an ambulatory site without a tertiary care hospital affiliation, as patients may require urgent transfer for a serious postoperative complication.
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Affiliation(s)
- Shaidah Deghan Manshadi
- From the Division of General Surgery, Department of Surgery, Queen's University, Kingston, Ont. (Deghan Manshadi, Robertson, Zevin); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Dehghan); and the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Reimer)
| | - Kooroush Dehghan
- From the Division of General Surgery, Department of Surgery, Queen's University, Kingston, Ont. (Deghan Manshadi, Robertson, Zevin); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Dehghan); and the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Reimer)
| | - David I Robertson
- From the Division of General Surgery, Department of Surgery, Queen's University, Kingston, Ont. (Deghan Manshadi, Robertson, Zevin); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Dehghan); and the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Reimer)
| | - Cara Reimer
- From the Division of General Surgery, Department of Surgery, Queen's University, Kingston, Ont. (Deghan Manshadi, Robertson, Zevin); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Dehghan); and the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Reimer)
| | - Boris Zevin
- From the Division of General Surgery, Department of Surgery, Queen's University, Kingston, Ont. (Deghan Manshadi, Robertson, Zevin); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Dehghan); and the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Reimer)
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Acuña-Zegarra MA, Díaz-Infante S, Baca-Carrasco D, Olmos-Liceaga D. COVID-19 optimal vaccination policies: A modeling study on efficacy, natural and vaccine-induced immunity responses. Math Biosci 2021; 337:108614. [PMID: 33961878 PMCID: PMC8095066 DOI: 10.1016/j.mbs.2021.108614] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/28/2021] [Accepted: 04/04/2021] [Indexed: 12/23/2022]
Abstract
About a year into the pandemic, COVID-19 accumulates more than two million deaths worldwide. Despite non-pharmaceutical interventions such as social distance, mask-wearing, and restrictive lockdown, the daily confirmed cases remain growing. Vaccine developments from Pfizer, Moderna, and Gamaleya Institute reach more than 90% efficacy and sustain the vaccination campaigns in multiple countries. However, natural and vaccine-induced immunity responses remain poorly understood. There are great expectations, but the new SARS-CoV-2 variants demand to inquire if the vaccines will be highly protective or induce permanent immunity. Further, in the first quarter of 2021, vaccine supply is scarce. Consequently, some countries that are applying the Pfizer vaccine will delay its second required dose. Likewise, logistic supply, economic and political implications impose a set of grand challenges to develop vaccination policies. Therefore, health decision-makers require tools to evaluate hypothetical scenarios and evaluate admissible responses. Following some of the WHO-SAGE recommendations, we formulate an optimal control problem with mixed constraints to describe vaccination schedules. Our solution identifies vaccination policies that minimize the burden of COVID-19 quantified by the number of disability-adjusted years of life lost. These optimal policies ensure the vaccination coverage of a prescribed population fraction in a given time horizon and preserve hospitalization occupancy below a risk level. We explore "via simulation" plausible scenarios regarding efficacy, coverage, vaccine-induced, and natural immunity. Our simulations suggest that response regarding vaccine-induced immunity and reinfection periods would play a dominant role in mitigating COVID-19.
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Affiliation(s)
- Manuel Adrian Acuña-Zegarra
- Departamento de Matemáticas, Universidad de Sonora, Blvd. Luis Encinas y Rosales S/N, Hermosillo, Col. Centro, Sonora, C.P. 83000, Mexico.
| | - Saúl Díaz-Infante
- CONACYT-Universidad de Sonora, Departamento de Matemáticas, Blvd. Luis Encinas y Rosales S/N, Hermosillo, Col. Centro, Sonora, C.P. 83000, Mexico.
| | - David Baca-Carrasco
- Departamento de Matemáticas, Instituto Tecnológico de Sonora, 5 de Febrero 818 Sur, Col. Centro, Ciudad Obregón, Sonora, C.P. 85000, Mexico.
| | - Daniel Olmos-Liceaga
- Departamento de Matemáticas, Universidad de Sonora, Blvd. Luis Encinas y Rosales S/N, Hermosillo, Col. Centro, Sonora, C.P. 83000, Mexico.
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Gu J, Huckfeldt P, Sood N. The Effects of Accountable Care Organizations Forming Preferred Skilled Nursing Facility Networks on Market Share, Patient Composition, and Outcomes. Med Care 2021; 59:354-361. [PMID: 33704104 PMCID: PMC7959004 DOI: 10.1097/mlr.0000000000001493] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Through participation in payment reforms such as bundled payment and accountable care organizations (ACOs), hospitals are increasingly financially responsible for health care use and adverse health events occurring after hospital discharge. To improve management and coordination of postdischarge care, ACO hospitals are establishing a closer relationship with skilled nursing facilities (SNFs) through the formation of preferred SNF networks. RESEARCH DESIGN We evaluated the effects of preferred SNF network formation on care patterns and outcomes. We included 10 ACOs that established preferred SNF networks between 2014 and 2015 in the sample. We first investigated whether hospitals "steer" patients to preferred SNFs by examining the percentage of patients sent to preferred SNFs within each hospital before and after network formation. We then used a difference-in-difference model with SNF fixed effects to evaluate the changes in patient composition and outcomes of preferred SNF patients from ACO hospitals after network formation relative to patients from other hospitals. RESULTS We found that preferred network formation was not associated with higher market share or better outcomes for preferred SNF patients from ACO hospitals. However, we found a small increase in the average number of Elixhauser comorbidities for patients from ACO hospitals after network formation, relative to patients from non-ACO hospitals. CONCLUSIONS After preferred SNF network formation, there is some evidence that ACO hospitals sent more complex patients to preferred SNFs, but there was no change in the volume of patients received by these SNFs. Furthermore, preferred network formation was not associated with improvement in patient outcomes.
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Affiliation(s)
- Jing Gu
- School of Pharmacy, University of Southern California, Los Angeles, CA
| | - Peter Huckfeldt
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA
| | - Neeraj Sood
- School of Public Health, University of Minnesota, Minneapolis, MN
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Hobeika C, Fuks D, Cauchy F, Goumard C, Gayet B, Laurent A, Soubrane O, Salamé E, Cherqui D, Regimbeau JM, Mabrut JY, Scatton O, Vibert E. Benchmark performance of laparoscopic left lateral sectionectomy and right hepatectomy in expert centers. J Hepatol 2020; 73:1100-1108. [PMID: 32407812 DOI: 10.1016/j.jhep.2020.05.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 02/24/2020] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Herein, we aimed to establish benchmark values - based on a composite indicator of healthcare quality - for the performance of laparoscopic left lateral sectionectomy (LLLS) and laparoscopic right hepatectomy (LRH) using data from expert centers. METHODS Data from a nationwide multicenter survey including all patients undergoing LLLS and LRH between 2000 and 2017 were analyzed. Textbook outcome (TO) completion was considered in patients fulfilling all 6 of the following characteristics: negative margins, no transfusion, no complication, no prolonged hospital stay, no readmission and no mortality. For each procedure, a cut-off laparoscopic liver resection (LLR) volume by center was associated with TO on multivariable analysis. These cut-offs defined the expert centers. The benchmark values were set at the 75th percentile of median outcomes among these expert centers. RESULTS Among 4,400 LLRs performed in 29 centers, 855 patients who underwent LLLS and 488 who underwent LRH were identified. The overall incidences of TO after LLLS and LRH were 43.7% and 23.8%, respectively. LLR volume cut-offs of 25 LLR/year (odds ratio [OR] 2.45; bootstrap 95% CI 1.65-3.69; p = 0.001) and 35 LLR/year (OR 2.55; bootstrap 95% CI 1.34-5.63; p = 0.003) were independently associated with completion of TO after LLLS and LRH, respectively. Eight centers for LLLS and 6 centers for LRH, including 516 and 346 patients undergoing LLLS/LRH respectively, reached these cut-offs and were identified as expert centers. After LLLS, benchmark values of severe complication, mortality and TO completion were defined as ≤5.3%, ≤1.2% and ≥46.6%, respectively. After LRH, benchmark values of severe complication, mortality and TO completion were ≤20.4%, ≤2.8% and ≥24.2%, respectively. CONCLUSIONS This study provides an up-to-date reference on the benchmark performance of LLLS and LRH in expert centers. LAY SUMMARY In a nationwide French survey of laparoscopic liver resection, expert centers were defined according to the completion of a textbook outcome, which is a composite indicator of healthcare quality. Benchmark values regarding intra-operative details and outcomes were established using data from 516 patients with laparoscopic left lateral sectionectiomy and 346 patients with laparoscopic right hepatectomy from expert centers. These values should be used as a reference point to improve the quality of laparoscopic resections.
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Affiliation(s)
- Christian Hobeika
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation - Sorbonne Université, CRCA Saint Antoine, Hôpital Pitié Salpétrière, 47 boulevard de l'hôpital, 75013, Paris, France.
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery - Institut Mutualiste Montsouris, University Paris Descartes, 42 Boulevard Jourdan, 75014 Paris, France
| | - François Cauchy
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation - Hôpital Beaujon, 100 Boulevard Général Leclerc, 92118 Clichy, France
| | - Claire Goumard
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation - Sorbonne Université, CRCA Saint Antoine, Hôpital Pitié Salpétrière, 47 boulevard de l'hôpital, 75013, Paris, France
| | - Brice Gayet
- Department of Digestive, Oncologic and Metabolic Surgery - Institut Mutualiste Montsouris, University Paris Descartes, 42 Boulevard Jourdan, 75014 Paris, France
| | - Alexis Laurent
- Department of Digestive Surgery, APHP, Henri Mondor Hospital, Créteil, Île-de-France, France
| | - Olivier Soubrane
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation - Hôpital Beaujon, 100 Boulevard Général Leclerc, 92118 Clichy, France
| | - Ephrem Salamé
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Trousseau Hospital, University Hospital of Tours, France
| | - Daniel Cherqui
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation - Centre hépato-biliaire de Paul Brousse, 38 rue de la Chapelle, 94800, Villejuif, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens, France; SSPC (Simplification des Soins des Patients Complexes) - Unit of Clinical Research, University of Picardie Jules Verne, Amiens, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Olivier Scatton
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation - Sorbonne Université, CRCA Saint Antoine, Hôpital Pitié Salpétrière, 47 boulevard de l'hôpital, 75013, Paris, France
| | - Eric Vibert
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation - Centre hépato-biliaire de Paul Brousse, 38 rue de la Chapelle, 94800, Villejuif, France
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Abstract
Introduction: Matching available mental health services to patients' preferences, as well as is possible, may increase patient satisfaction and help increase adherence to certain treatments. This study systematically reviewed discrete-choice experiments (DCEs) on patients' preferences for treatment of depressive and anxiety disorders and assessed the relative importance of outcome, process and cost attributes to improve the current and future treatment situations.Methods: A systematic literature review using PubMed, EMBASE and PsychInfo was conducted to retrieve all relevant DCEs published up to 15 April 2019, eliciting patient preferences for treatment of depressive and anxiety disorders. Data were extracted using an extraction sheet, and attributes were classified into outcome, process and cost attributes. The relative importance of each attribute category was then assessed, and studies were evaluated according to their reporting quality, using validated checklists.Results: A total of 11 studies were identified for qualitative analysis. All studies received an aggregate score of 4 on the five-point PREFS checklist (Purpose, Respondents, Explanation, Findings and Significance). Most attributes were outcome related (52%), followed by process (42%) and cost (6%) attributes. Comparing the attribute categories and summing up the relative importance weights for each category within the studies, process attributes were ranked as most important, followed by cost and outcome attributes.Conclusions: In this systematic review, heterogeneous results were observed regarding the inclusion and framing of different attributes across studies. Overall, patients considered process and cost attributes to be more important than outcome attributes. Outcomes and process are important for patients, and thus clinicians should be particularly aware of this and take patients' preferences into account, although the attribute importance may depend on chosen attributes and related levels.
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Affiliation(s)
- Maike Tünneßen
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI - Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Vera Vennedey
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
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Devapriam J, Fosker H, Chester V, Gangadharan S, Hiremath A, Alexander RT. Characteristics and outcomes of patients with intellectual disability admitted to a specialist inpatient rehabilitation service. J Intellect Disabil 2020; 24:21-34. [PMID: 29444613 DOI: 10.1177/1744629518756698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Rehabilitation services for people with mental illnesses have been extensively researched. However, services with similar aims and specifications for patients with intellectual disabilities (IDs) have had little focus. This study describes the characteristics and outcomes of 21 patients admitted to a specialist ID rehabilitation service over an 8-year time frame. Rather that solely accepting 'step-down' referrals, some patients were referred from community settings. During the study, 20 patients were discharged, 80% to lower levels of service restriction, while 14.3% to higher levels. The study suggested that rehabilitation services have an important role within the wider service model for people with ID. Within the service studied, patients were referred from both higher and lower levels of restriction, suggesting the rehabilitation service 'bridged the gap' between inpatient and community settings, supporting the aim of caring for patients in the least restrictive setting for their needs.
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Affiliation(s)
- J Devapriam
- Leicestershire Partnership NHS Trust, UK; Care Quality Commission, UK
| | - H Fosker
- Leicestershire Partnership NHS Trust, UK
| | | | | | - A Hiremath
- Leicestershire Partnership NHS Trust, UK
| | - R T Alexander
- St Johns House, UK; Leicestershire Partnership NHS Trust, UK
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Byvaltsev VA, Stepanov IA, Kerimbayev TT. A systematic review and meta-analysis comparing open versus endoscopic in situ decompression for the treatment of cubital tunnel syndrome. Acta Neurol Belg 2020; 120:1-8. [PMID: 31065909 DOI: 10.1007/s13760-019-01149-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/25/2019] [Indexed: 01/11/2023]
Abstract
To examine whether endoscopic in situ decompression (EISD) or open in situ decompression (OISD) would have superior outcomes with lower morbidity in patients with idiopathic cubital tunnel syndrome, we reviewed all studies compared both surgical techniques with regard to postoperative outcomes and complication profile in a systematic review design with meta-analysis. Two independent reviewers conducted a PRISMA-compliant search of PubMed, EMBASE, and the Cochrane Library databases for relevant studies about clinical comparisons of OISD and EISD in cubital tunnel syndrome. We performed all meta-analyses with the Review Manager 5.3 software. For dichotomous variables, the risk ratio (RR) and 95% confidence intervals (CIs) were calculated. For continuous variables, the mean difference (MD) and 95% CIs were calculated. The level of significance was set as p < 0.05. Finally, 8 articles with 582 patients finally were included in this meta-analysis. Pooled analysis showed that the difference in Bishop score, visual analogue scale score reduction, postoperative satisfaction, postoperative hematoma rate and secondary surgical procedures were not statistically significant between the EISD group and the OISD group (p > 0.05). However, pooled results showed that patients who underwent EISD had a greater improvement in the scar tenderness/elbow pain than did those who underwent OISD with statistical significance (p < 0.0001). This meta-analysis demonstrated that EISD and OISD for surgical treating cubital tunnel syndrome had equivalent efficacy regarding postoperative clinical recovery, whereas the incidences of adverse events of EISD were also same as those with the OISD technique.
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Affiliation(s)
- Vadim A Byvaltsev
- Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, 1 Krasnogo Vosstaniya Street, Irkutsk, Irkutskaya Oblast, 664003, Russia.
- Department of Neurosurgery, Irkutsk Scientific Center of Surgery and Traumatology, 1 Bortsov Revolutsii Street, Irkutsk, Irkutskaya Oblast, 664003, Russia.
| | - Ivan A Stepanov
- Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, 1 Krasnogo Vosstaniya Street, Irkutsk, Irkutskaya Oblast, 664003, Russia
| | - Talgat T Kerimbayev
- Department of Spine Surgery and Pathology of Peripheral Nervous System, National Neurosurgical Center, 34/1 Turan Avenue, Astana, 010000, Kazakhstan
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Levine MD, Emery RL, Kolko Conlon RP, Marcus MD, Germeroth LJ, Salk RH, Cheng Y. Depressive Symptoms Assessed Near the End of Pregnancy Predict Differential Response to Postpartum Smoking Relapse Prevention Intervention. Ann Behav Med 2020; 54:119-124. [PMID: 31219152 PMCID: PMC7170725 DOI: 10.1093/abm/kaz026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depressive symptoms are prevalent during pregnancy and the postpartum period and affect risk for smoking relapse. Whether and how depression affects response to postpartum interventions designed to sustain smoking abstinence is unknown. PURPOSE We examined end-of-pregnancy depressive symptoms as a moderator of response to two postpartum-adapted smoking relapse prevention interventions. METHODS Women (N = 300) who quit smoking during pregnancy were randomized to receive either a postpartum intervention focused on psychosocial factors linked to postpartum smoking (Strategies to Avoid Returning to Smoking [STARTS]) or an attention-controlled comparison intervention (SUPPORT). Women completed the Edinburgh Postnatal Depression Scale at the end of pregnancy. Smoking status was biochemically assessed at the end of pregnancy and at 12, 24, and 52 weeks postpartum. RESULTS End-of-pregnancy depressive symptoms moderated response to postpartum smoking relapse prevention interventions (χ2 = 10.18, p = .001). After controlling for variables previously linked to postpartum smoking relapse, women with clinically significant end-of-pregnancy depressive symptoms (20%) were more likely to sustain abstinence through 52 weeks postpartum if they received STARTS. In contrast, women with few end-of-pregnancy depressive symptoms were more likely to sustain abstinence through 52 weeks postpartum if they received SUPPORT. Changes in the psychosocial factors addressed in the STARTS intervention did not mediate this moderation effect. CONCLUSION Assessment of end-of-pregnancy depressive symptoms may help determine success following postpartum smoking relapse prevention interventions. Women with elevated end-of-pregnancy depressive symptoms benefited from postpartum relapse prevention intervention tailored to their psychosocial needs, while those with few symptoms were more successful in postpartum intervention that used standard behavioral components. CLINICAL TRIAL REGISTRATION NCT00757068.
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Affiliation(s)
- Michele D Levine
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rebecca L Emery
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rachel P Kolko Conlon
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Marsha D Marcus
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lisa J Germeroth
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rachel H Salk
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yu Cheng
- Department of Statistics and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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Abstract
INTRODUCTION Measuring quality of care in low-income and middle-income countries is complicated by the lack of a standard, universally accepted definition for 'quality' for any particular service, as well as limited guidance on which indicators to include in measures of quality of care, and how to incorporate those indicators into summary indices. The aim of this paper is to develop, characterise and compare a set of antenatal care (ANC) indices for facility readiness and provision of care. METHODS We created nine indices for facility readiness using three methods for selecting items and three methods for combining items. In addition, we created three indices for provision of care using one method for selecting items and three methods for combining items. For each index, we calculated descriptive statistics, categorised the continuous index scores using tercile cut points to assess comparability of facility classification, and examined the variability and distribution of scores. RESULTS Our results showed that, within a country, the indices were quite similar in terms of mean index score, facility classification, coefficient of variation, floor and ceiling effects, and the inclusion of items in an index with a range of variability. Notably, the indices created using principal components analysis to combine the items were the most different from the other indices. In addition, the index created by taking a weighted average of a core set of items had lower agreement with the other indices when looking at facility classification. CONCLUSIONS As improving quality of care becomes integral to global efforts to produce better health outcomes, demand for guidance on creating standardised measures of service quality will grow. This study provides health systems researchers with a comparison of methodologies commonly used to create summary indices of ANC service quality and it highlights the similarities and differences between methods.
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Affiliation(s)
- Ashley Sheffel
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Scott Zeger
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rebecca Heidkamp
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Melinda Kay Munos
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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LeMasters T, Madhavan SS, Sambamoorthi U, Hazard-Jenkins HW, Kelly KM, Long D. Receipt of Guideline-Concordant Care Among Older Women With Stage I-III Breast Cancer: A Population-Based Study. J Natl Compr Canc Netw 2019; 16:703-710. [PMID: 29891521 DOI: 10.6004/jnccn.2018.7004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 01/03/2018] [Indexed: 11/17/2022]
Abstract
Background: This study examined receipt of guideline-concordant care (GCC) according to evidence-based treatment guidelines and quality measures and specific types of treatment among older women with breast cancer. Patients and Methods: A total of 142,433 patients aged ≥66 years diagnosed with stage I-III breast cancer between 2007 and 2011 were identified in the SEER-Medicare linked database. Algorithms considering cancer characteristics and the appropriate course of care as per guidelines versus actual care received determined receipt of GCC. Multivariable logistic regression estimated the likelihood of GCC and specific types of treatment for women aged ≥75 versus 66 to 74 years. Results: Overall, 39.7% of patients received GCC. Patients diagnosed at stage II or III, with certain preexisting conditions, and of nonwhite race were less likely to receive GCC. Patients with hormone-negative tumors, higher grade tumors, and greater access to oncology care resources were more likely to receive GCC. Patients aged ≥75 years were approximately 40% less likely to receive GCC or adjuvant endocrine therapy, 78% less likely to have any surgery, 61% less likely to have chemotherapy, and about half as likely to have radiation therapy than those aged 66 to 74 years. Conclusions: Fewer than half of older women with breast cancer received GCC, with the lowest rates observed among the oldest age groups, racial/ethnic minorities, and women with later-stage cancers. However, patients with more aggressive tumor characteristics and greater access to oncology resources were more likely to receive GCC. Considering that older women have the highest incidence of breast cancer and that many are diagnosed at stages requiring more aggressive treatment, efforts to increase rates of earlier stage diagnosis and the development of less toxic treatments could help improve GCC and survival while preserving quality of life.
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Helsingen LM, Vandvik PO, Jodal HC, Agoritsas T, Lytvyn L, Anderson JC, Auer R, Murphy SB, Almadi MA, Corley DA, Quinlan C, Fuchs JM, McKinnon A, Qaseem A, Heen AF, Siemieniuk RAC, Kalager M, Usher-Smith JA, Lansdorp-Vogelaar I, Bretthauer M, Guyatt G. Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a clinical practice guideline. BMJ 2019; 367:l5515. [PMID: 31578196 DOI: 10.1136/bmj.l5515] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
CLINICAL QUESTION Recent 15-year updates of sigmoidoscopy screening trials provide new evidence on the effectiveness of colorectal cancer screening. Prompted by the new evidence, we asked: "Does colorectal cancer screening make an important difference to health outcomes in individuals initiating screening at age 50 to 79? And which screening option is best?" CURRENT PRACTICE Numerous guidelines recommend screening, but vary on recommended test, age and screening frequency. This guideline looks at the evidence and makes recommendations on screening for four screening options: faecal immunochemical test (FIT) every year, FIT every two years, a single sigmoidoscopy, or a single colonoscopy. RECOMMENDATIONS These recommendations apply to adults aged 50-79 years with no prior screening, no symptoms of colorectal cancer, and a life expectancy of at least 15 years. For individuals with an estimated 15-year colorectal cancer risk below 3%, we suggest no screening (weak recommendation). For individuals with an estimated 15-year risk above 3%, we suggest screening with one of the four screening options: FIT every year, FIT every two years, a single sigmoidoscopy, or a single colonoscopy (weak recommendation). With our guidance we publish the linked research, a graphic of the absolute harms and benefits, a clear description of how we reached our value judgments, and linked decision aids. HOW THIS GUIDELINE WAS CREATED A guideline panel including patients, clinicians, content experts and methodologists produced these recommendations using GRADE and in adherence with standards for trustworthy guidelines. A linked systematic review of colorectal cancer screening trials and microsimulation modelling were performed to inform the panel of 15-year screening benefits and harms. The panel also reviewed each screening option's practical issues and burdens. Based on their own experience, the panel estimated the magnitude of benefit typical members of the population would value to opt for screening and used the benefit thresholds to inform their recommendations. THE EVIDENCE Overall there was substantial uncertainty (low certainty evidence) regarding the 15-year benefits, burdens and harms of screening. Best estimates suggested that all four screening options resulted in similar colorectal cancer mortality reductions. FIT every two years may have little or no effect on cancer incidence over 15 years, while FIT every year, sigmoidoscopy, and colonoscopy may reduce cancer incidence, although for FIT the incidence reduction is small compared with sigmoidoscopy and colonoscopy. Screening related serious gastrointestinal and cardiovascular adverse events are rare. The magnitude of the benefits is dependent on the individual risk, while harms and burdens are less strongly associated with cancer risk. UNDERSTANDING THE RECOMMENDATION Based on benefits, harms, and burdens of screening, the panel inferred that most informed individuals with a 15-year risk of colorectal cancer of 3% or higher are likely to choose screening, and most individuals with a risk of below 3% are likely to decline screening. Given varying values and preferences, optimal care will require shared decision making.
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Affiliation(s)
- Lise M Helsingen
- Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
- Frontier Science Foundation, Boston, Massachusetts, USA
| | - Per Olav Vandvik
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Henriette C Jodal
- Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
- Frontier Science Foundation, Boston, Massachusetts, USA
| | - Thomas Agoritsas
- Division General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Joseph C Anderson
- Veterans Affairs Medical Center, White River Junction, Vermont, USA
- The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- University of Connecticut Health Center, Farmington, USA
| | - Reto Auer
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | | | - Majid Abdulrahman Almadi
- Division of Gastroenterology, Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
- Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada
| | - Douglas A Corley
- Division of Research, Kaiser Permanente, Oakland, California, USA
- Department of Gastroenterology, San Francisco Medical Center, California, USA
| | - Casey Quinlan
- Cochrane Consumers
- Society for Participatory Medicine, Boston, Massachusetts, USA
- Mighty Casey Media, LLC, Richmond, Virginia, USA
| | | | | | - Amir Qaseem
- American College of Physicians, Philadelphia, USA
| | - Anja Fog Heen
- Department of Medicine, Innlandet Hospital Trust-division, Gjøvik, Norway
| | - Reed A C Siemieniuk
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Mette Kalager
- Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
- Frontier Science Foundation, Boston, Massachusetts, USA
| | - Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
- Frontier Science Foundation, Boston, Massachusetts, USA
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
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Buskermolen M, Cenin DR, Helsingen LM, Guyatt G, Vandvik PO, Haug U, Bretthauer M, Lansdorp-Vogelaar I. Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a microsimulation modelling study. BMJ 2019; 367:l5383. [PMID: 31578177 PMCID: PMC6774435 DOI: 10.1136/bmj.l5383] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To estimate benefits and harms of different colorectal cancer screening strategies, stratified by (baseline) 15-year colorectal cancer risk. DESIGN Microsimulation modelling study using MIcrosimulation SCreening ANalysis-Colon (MISCAN-Colon). SETTING A parallel guideline committee (BMJ Rapid Recommendations) defined the time frame and screening interventions, including selection of outcome measures. POPULATION Norwegian men and women aged 50-79 years with varying 15-year colorectal cancer risk (1-7%). COMPARISONS Four screening strategies were compared with no screening: biennial or annual faecal immunochemical test (FIT) or single sigmoidoscopy or colonoscopy at 100% adherence. MAIN OUTCOME MEASURES Colorectal cancer mortality and incidence, burdens, and harms over 15 years of follow-up. The certainty of the evidence was assessed using the GRADE approach. RESULTS Over 15 years of follow-up, screening individuals aged 50-79 at 3% risk of colorectal cancer with annual FIT or single colonoscopy reduced colorectal cancer mortality by 6 per 1000 individuals. Single sigmoidoscopy and biennial FIT reduced it by 5 per 1000 individuals. Colonoscopy, sigmoidoscopy, and annual FIT reduced colorectal cancer incidence by 10, 8, and 4 per 1000 individuals, respectively. The estimated incidence reduction for biennial FIT was 1 per 1000 individuals. Serious harms were estimated to be between 3 per 1000 (biennial FIT) and 5 per 1000 individuals (colonoscopy); harms increased with older age. The absolute benefits of screening increased with increasing colorectal cancer risk, while harms were less affected by baseline risk. Results were sensitive to the setting defined by the guideline panel. Because of uncertainty associated with modelling assumptions, we applied a GRADE rating of low certainty evidence to all estimates. CONCLUSIONS Over a 15 year period, all screening strategies may reduce colorectal cancer mortality to a similar extent. Colonoscopy and sigmoidoscopy may also reduce colorectal cancer incidence, while FIT shows a smaller incidence reduction. Harms are rare and of similar magnitude for all screening strategies.
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Affiliation(s)
- Maaike Buskermolen
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| | - Dayna R Cenin
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Lise M Helsingen
- Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Clinical Effecitveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
- Frontier Science Foundation, Boston, MA, USA
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada
| | - Per Olav Vandvik
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Clinical Effecitveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
- Frontier Science Foundation, Boston, MA, USA
| | - Iris Lansdorp-Vogelaar
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
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Anderson KK, Norman R, MacDougall AG, Edwards J, Palaniyappan L, Lau C, Kurdyak P. Estimating the incidence of first-episode psychosis using population-based health administrative data to inform early psychosis intervention services. Psychol Med 2019; 49:2091-2099. [PMID: 30311590 DOI: 10.1017/s0033291718002933] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Discrepancies between population-based estimates of the incidence of psychotic disorder and the treated incidence reported by early psychosis intervention (EPI) programs suggest additional cases may be receiving services elsewhere in the health system. Our objective was to estimate the incidence of non-affective psychotic disorder in the catchment area of an EPI program, and compare this to EPI-treated incidence estimates. METHODS We constructed a retrospective cohort (1997-2015) of incident cases of non-affective psychosis aged 16-50 years in an EPI program catchment using population-based linked health administrative data. Cases were identified by either one hospitalization or two outpatient physician billings within a 12-month period with a diagnosis of non-affective psychosis. We estimated the cumulative incidence and EPI-treated incidence of non-affective psychosis using denominator data from the census. We also estimated the incidence of first-episode psychosis (people who would meet the case definition for an EPI program) using a novel approach. RESULTS Our case definition identified 3245 cases of incident non-affective psychosis over the 17-year period. We estimate that the incidence of first-episode non-affective psychosis in the program catchment area is 33.3 per 100 000 per year (95% CI 31.4-35.1), which is more than twice as high as the EPI-treated incidence of 18.8 per 100 000 per year (95% CI 17.4-20.3). CONCLUSIONS Case ascertainment strategies limited to specialized psychiatric services may substantially underestimate the incidence of non-affective psychotic disorders, relative to population-based estimates. Accurate information on the epidemiology of first-episode psychosis will enable us to more effectively resource EPI services and evaluate their coverage.
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Affiliation(s)
- Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ross Norman
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Arlene G MacDougall
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Jordan Edwards
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Cindy Lau
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Wray AM, Hoyt T, Welch S, Civetti S, Anthony N, Ballester E, Tandon R. Veterans Engaged in Treatment, Skills, and Transitions for Enhancing Psychiatric Safety (VETSTEPS). Psychiatr Rehabil J 2019; 42:277-283. [PMID: 30932507 DOI: 10.1037/prj0000360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The transition after inpatient psychiatric care is a critical time with increased risk. This brief report evaluates Veterans Engaged in Treatment, Skills, and Transitions for Enhancing Psychiatric Safety (VETSTEPS), a program designed for this critical time. METHOD Three "bridging" strategies were employed: (a) using inpatient-outpatient care collaboration; (b) four phone calls within seven days of discharge; and (c) a 4-week, evidence-based intervention that provided safety planning, coping skills, and triage services for postdischarge needs. Using retrospective data from 219 military veterans, VETSTEPS impact on treatment follow-up rates and veteran readmissions was examined. RESULTS Group participation was associated with significantly sooner mental health follow-up access, for both first and second follow-up appointments. Greater group participation was associated with lower rates of 12-month readmission, with more attended sessions associated with fewer readmissions when controlling for length of stay and previous readmissions. Following a hospital-wide strategy to implement VETSTEPS team phone calls, exploratory analyses indicate the facility's mental health care follow-up rate significantly improved from 55% to 79%, with sustained gains above 80% for two years. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Program evaluation data suggest that bridging critical time interventions may improve outcomes for veterans recently discharged from psychiatric hospitalization. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Alisha M Wray
- Mental Health Service Line, North Florida/South Georgia Veterans Affairs Health Care System
| | - Tim Hoyt
- National Center for Telehealth and Technology, Defense Health Agency, Joint Base Lewis-McChord
| | - Stephen Welch
- Mental Health Service Line, North Florida/South Georgia Veterans Affairs Health Care System
| | - Sara Civetti
- Mental Health Service Line, North Florida/South Georgia Veterans Affairs Health Care System
| | | | | | - Rajiv Tandon
- Mental Health Service Line, North Florida/South Georgia Veterans Affairs Health Care System
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Abstract
OBJECTIVES To evaluate the impact of nurse practitioner (NP) service in Australian public hospital emergency departments (EDs) on service and patient safety and quality indicators. DESIGN AND SETTING Cohort study comprising ED presentations (July 2013-June 2014) for a random sample of hospitals, stratified by state/territory and metropolitan versus non-metropolitan location; and a retrospective medical record audit of ED re-presentations. METHODS Service indicator data (patient waiting times for Australasian Triage Scale categories 2, 3, 4 and 5; number of patients who did not-wait; length of ED stay for non-admitted patients) were compared between EDs with and without NPs using logistic regression and Cox proportional hazards regression, adjusting for hospital and patient characteristics and correlation of outcomes within hospitals. Safety and quality indicator data (rates of ED unplanned re-presentations) for a random subset of re-presentations were compared using Poisson regression. RESULTS Of 66 EDs, 55 (83%) provided service indicator data on 2 463 543 ED patient episodes while 58 (88%) provided safety and quality indicator data on 2853 ED re-presentations. EDs with NPs had significantly (p<0.001) higher rates of waiting times compared with EDs without NPs. Patients presenting to EDs with NPs spent 13 min (8%) longer in ED compared with EDs without NPs (median, (first quartile-third quartile): 156 (93-233) and 143 (84-217) for EDs with and without NPs, respectively). EDs with NPs had 1.8% more patients who did not wait, but similar re-presentations rates as EDs with NPs. CONCLUSIONS EDs with NPs had statistically significantly lower performance for service indicators. However, these findings should be treated with caution. NPs are relatively new in the ED workforce and low NP numbers, staffing patterns and still-evolving roles may limit their impact on service indicators. Further research is needed to explain the dichotomy between the benefits of NPs demonstrated in individual clinical outcomes research and these macro system-wide observations.
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Mutiso VN, Pike KM, Musyimi CW, Gitonga I, Tele A, Rebello TJ, Thornicroft G, Ndetei DM. Feasibility and effectiveness of nurses and clinical officers in implementing the WHO mhGAP intervention guide: Pilot study in Makueni County, Kenya. Gen Hosp Psychiatry 2019; 59:20-29. [PMID: 31096165 DOI: 10.1016/j.genhosppsych.2019.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVES (1) To determine the feasibility and effectiveness of nurses and clinical officers in using the mental health Global Action Programme Intervention Guide (mhGAP-IG) as an intervention tool in reducing disability, improving quality of life in the clinical outcomes in patients with the mhGAP-IG priority mental disorders in a Kenyan rural setting. (2) To identify any gaps that can be contributed towards future research. METHODS This study was conducted in 20 healthcare facilities across Makueni County in the South East of Kenya. This county had a population of approximately one million people, with no psychiatrist or clinical psychologist. We recruited 2306 participants from the healthcare facilities in the catchment areas that had previously been exposed to the community mental health awareness campaigns, while being subjected to screening for the mhGAP-IG disorders. We used the Mini-International Neuropsychiatric Interview for adults (MINI-Plus) for DSM-IV confirmatory diagnosis on those who screened positive on the mhGAP-IG. We measured disability using WHO-Disability Assessment Schedule II (DAS II), Quality of Life (QoL) using the WHO QoL-BREF, depression using Patient Health Questionnaire (PHQ-9), suicidality using The Beck Suicide Scale (BSS), psychosis using the Washington Early Recognition Center Affectivity and Psychosis (WERCAP), epilepsy using a seizure questionnaire and alcohol and substance abuse using The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). These measurements were at the baseline, followed by the training for the health professionals on using the WHO mhGAP-IG as an interventional tool. The measurements were repeated at 3 and 6 months post-intervention. RESULTS Of the 2306 participants enrolled in the study, we followed 1718 at 3 months and 1371 at 6 months a follow-up rate of 74.5% and 59.4% respectively. All participants received psycho-education and most depending on condition also received medication. Overall, there was significant decline in disabilities, improvement in seizure control and improvement in clinical outcomes on the identified mental disorders. CONCLUSIONS Trained, supervised and supported nurses and clinical officers can produce good outcomes using the mhGAP-IG for mental health.
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Affiliation(s)
- V N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - K M Pike
- Columbia University, Global Mental Health Program, New York, USA.
| | - C W Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - I Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - A Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - T J Rebello
- Columbia University, Global Mental Health Program, New York, USA.
| | | | - D M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Nairobi, Kenya.
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Thompson H, Faig W, Gupta N, Lahey R, Golden R, Pollack M, Karnik N. Collaborative Care for Depression of Adults and Adolescents: Measuring the Effectiveness of Screening and Treatment Uptake. Psychiatr Serv 2019; 70:604-607. [PMID: 31023189 PMCID: PMC6602801 DOI: 10.1176/appi.ps.201800257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study analyzed effectiveness of screening, referrals, and treatment uptake of a collaborative care for depression intervention across 10 primary care clinics in Chicago. METHODS Between November 2016 and December 2017, patients (N=25,369) were screened with the Patient Health Questionnaire-2 and the Patient Health Questionnaire-9 on the basis of an eligibility algorithm. Electronic health record data were analyzed for sample characteristics, screening rates, referrals, and treatment pathways. To identify disparities, a test of proportions was conducted between eligible and screened patients as well as referred and treated patients. RESULTS Screenings, referrals, and uptake occurred proportionately across subgroups except for patients ages 12-17. Adolescent age was associated with disproportionate Patient Health Questionnaire-9 screenings and with treatment disengagement. CONCLUSIONS The intervention shows promise in expanding access to care and reducing disparities. Greater access to psychotherapies and innovative treatment modalities, particularly for adolescents, may improve overall treatment uptake.
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Affiliation(s)
- Hale Thompson
- Department of Psychiatry & Behavioral Sciences, Rush Medical College, Rush University, Chicago, IL USA
| | - Walter Faig
- Department of Psychiatry & Behavioral Sciences, Rush Medical College, Rush University, Chicago, IL USA
| | - Neha Gupta
- Department of Psychiatry & Behavioral Sciences, Rush Medical College, Rush University, Chicago, IL USA
| | - Rebecca Lahey
- Department of Social Work & Community Health, Rush University Medical Center, Chicago, IL USA
| | - Robyn Golden
- Department of Social Work & Community Health, Rush University Medical Center, Chicago, IL USA
| | - Mark Pollack
- Department of Psychiatry & Behavioral Sciences, Rush Medical College, Rush University, Chicago, IL USA
| | - Niranjan Karnik
- Department of Psychiatry & Behavioral Sciences, Rush Medical College, Rush University, Chicago, IL USA
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Witt K, Boland A, Lamblin M, McGorry PD, Veness B, Cipriani A, Hawton K, Harvey S, Christensen H, Robinson J. Effectiveness of universal programmes for the prevention of suicidal ideation, behaviour and mental ill health in medical students: a systematic review and meta-analysis. Evid Based Ment Health 2019; 22:84-90. [PMID: 30918000 PMCID: PMC10270399 DOI: 10.1136/ebmental-2019-300082] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 01/11/2019] [Revised: 02/25/2019] [Accepted: 01/17/2019] [Indexed: 12/15/2022]
Abstract
QUESTION A growing body of work suggests that medical students may be particularly at risk of mental ill health, suicidal ideation and behaviour, resulting in recent calls to develop interventions to prevent these outcomes. However, few reviews have synthesised the current evidence base regarding the effectiveness of these interventions and provided guidance to improve future intervention efforts. STUDY SELECTION AND ANALYSIS The authors conducted a systematic review to identify studies of any design reporting the effectiveness of any universal intervention to address these outcomes in medical students. Embase, MEDLINE and PsycINFO databases were searched from their respective start dates until 1 December 2017. FINDINGS Data from 39 studies were included. Most investigated the effectiveness of relatively brief interventions designed to reduce stress; most commonly using mindfulness-based or guided meditation approaches. Only one implemented an intervention specifically designed to address suicidal ideation; none investigated the effectiveness of an intervention specifically designed to address suicidal behaviour. Five investigated the effects of curriculum-level changes. Overall, there was limited evidence of an effect for these programmes at both the postintervention and longest follow-up assessment on depression, anxiety and stress. CONCLUSIONS Relatively brief, individually focused, mindfulness-based interventions may be effective in reducing levels of anxiety, depression and stress in medical students in the short term. Effects on suicidal ideation and behaviour, however, remain to be determined. There has been a significant lack of attention on organisational-level stressors associated with medical education and training.
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Affiliation(s)
- Katrina Witt
- Turning Point, Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia
- Orygen, The National Centre for Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexandra Boland
- Orygen, The National Centre for Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle Lamblin
- Orygen, The National Centre for Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick D McGorry
- Orygen, The National Centre for Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Keith Hawton
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Samuel Harvey
- Black Dog Institute, Sydney, New South Wales, Australia
| | | | - Jo Robinson
- Orygen, The National Centre for Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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Johns L, Jolley S, Garety P, Khondoker M, Fornells-Ambrojo M, Onwumere J, Peters E, Milosh C, Brabban A, Byrne M. Improving Access to psychological therapies for people with severe mental illness (IAPT-SMI): Lessons from the South London and Maudsley psychosis demonstration site. Behav Res Ther 2019; 116:104-110. [PMID: 30877877 DOI: 10.1016/j.brat.2019.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 09/09/2018] [Revised: 02/05/2019] [Accepted: 03/04/2019] [Indexed: 11/18/2022]
Abstract
Implementation of evidence-based cognitive behavioural therapy for psychosis (CBTp) remains low in routine services. The United Kingdom Improving Access to Psychological Therapies for people with Severe Mental Illness (IAPT-SMI) initiative aimed to address this issue. The project evaluated whether existing services could improve access to CBTp and demonstrate effectiveness using a systematic approach to therapy provision and outcome monitoring (in a similar way to the Improving Access to Psychological Therapies (IAPT) model for people with anxiety and depression). We report the clinical outcomes and key learning points from the South London and Maudsley NHS Foundation Trust IAPT-SMI demonstration site for psychosis. Additional funding enabled increased therapist capacity within existing secondary care community mental health services. Self-reported wellbeing and psychotic symptom outcomes were assessed, alongside service use and social/occupational functioning. Accepted referrals/year increased by 89% (2011/12: n = 106/year; 2012-2015: n = 200/year); 90% engaged (attended ≥5 sessions) irrespective of ethnicity, age and gender. The assessment protocol proved feasible, and pre-post outcomes (n = 280) showed clinical improvements and reduced service use, with medium effects. We conclude that, with appropriate service structure, investment allocated specifically for competent therapy provision leads to increased and effective delivery of CBTp. Our framework is replicable in other settings and can inform the wider implementation of psychological therapies for psychosis.
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Affiliation(s)
- Louise Johns
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK; University of Oxford, Department of Psychiatry, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Suzanne Jolley
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Philippa Garety
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust (SLaM), UK
| | | | - Miriam Fornells-Ambrojo
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK; University College London, Department of Clinical, Educational and Health Psychology, London, UK
| | - Juliana Onwumere
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Emmanuelle Peters
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Craig Milosh
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Majella Byrne
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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Di Lorenzo R, Olmi T, Rioli G, Galeazzi GM, Ferri P. Factors Associated with Long-Stays in an Italian Psychiatric Intensive Treatment Facility: 1-Year Retrospective Observational Analysis. Psychiatr Q 2019; 90:185-196. [PMID: 30488329 DOI: 10.1007/s11126-018-9616-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Psychiatric Intensive Treatment Facilities (PITF) are health inpatient settings for patients affected by sub-acute psychiatric disorders with impaired personal and social functioning. The aim of this study is to analyse the demographic and clinical variables related to long-stays in an Italian PITF in order to highlight the risk factors for stay lengthening. We retrospectively collected the selected variables from all patients and their stays in a PITF from 1 to 11-2016 to 31-10-2017. We divided the stays according to the median of duration, ≤29 and > 29 days, to compare selected variables in the two groups of stay length. Patients hospitalized for >29 days more frequently presented "Self-neglect", nursing diagnosis NANDA-I, and needed economic social service support. Multiple linear regression revealed that the presence of some variables as "many medical consultations", "economic social service support", "clinical interviews extended to institutional figures" were statistically significantly associated with an increased stay duration, suggesting that both clinical severity and difficult economic conditions were associated with the lengthening of stay. The knowledge of these factors can contribute to improve psychiatric treatments, reducing potential risk conditions for patient institutional dependence.
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Affiliation(s)
- Rosaria Di Lorenzo
- Psychiatric Intensive Treatment Facility, Department of Mental Health and Drug Abuse, AUSL Modena, 41122, Modena, Italy.
| | - Teresa Olmi
- School of Nursing, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Giulia Rioli
- Section of Clinical Neuroscience, Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Gian Maria Galeazzi
- Section of Clinical Neuroscience, Department of Biomedical Metabolic and Neural Sciences. Department of Mental Health and Drug Abuse, AUSL Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Paola Ferri
- Section of Clinical Neuroscience, Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124, Modena, Italy
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Abstract
Digital interventions for anxiety disorders have been well-researched over the past two decades. However, reviews to date have focused on internet-based cognitive behavioural therapy (iCBT), whereas other psychological interventions have received less attention. The aim of this review was therefore to evaluate the effectiveness of digitally delivered psychological therapies (CBT, Attention Bias Modification, Exposure Therapy, Applied Relaxation, Bibliotherapy, Psychodynamic Therapy, Mindfulness, Behavioural Stress Management, Counselling) compared with control conditions and/or other psychological interventions for anxiety disorders (Social Anxiety Disorder (SAD), Health Anxiety, Obsessive-Compulsive Disorder (OCD), Post-traumatic Stress Disorder (PTSD), Specific Phobias, Panic Disorder (PD), Generalised Anxiety Disorder (GAD)]. 68 randomised controlled trials (RCTs) were reviewed. SAD was the anxiety disorder for which the most RCTs were conducted. Overall, findings support the effectiveness of iCBT for SAD; for the remaining interventions, although some RCTs indicated significant improvement (within groups) at post-treatment and/or follow up, between group findings were less consistent and overall, methodological differences across trials failed to provide strong supporting evidence. Finally, the level of therapist contact or expertise did not appear to affect much treatment effectiveness. Additional large, methodologically rigorous trials are needed to investigate further whether different digitally delivered psychological interventions are equally effective for anxiety disorders. Moreover, further studies are pertinent in order to examine the maintenance of therapy gains after the end of treatments and understand how these work [(e.g. the influence of therapist factors, user engagement and/or satisfaction, potential access barriers and treatments with diverse population groups (e.g. BME groups)].
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Affiliation(s)
- Evgenia Stefanopoulou
- Turning Point, Registered Charity, Standon House, 21 Mansell Street, London, E1 8AA, UK.
| | - David Lewis
- Turning Point, Registered Charity, Standon House, 21 Mansell Street, London, E1 8AA, UK
| | - Matthew Taylor
- Turning Point, Registered Charity, Standon House, 21 Mansell Street, London, E1 8AA, UK
| | - James Broscombe
- Turning Point, Registered Charity, Standon House, 21 Mansell Street, London, E1 8AA, UK
| | - Jan Larkin
- Turning Point, Registered Charity, Standon House, 21 Mansell Street, London, E1 8AA, UK
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23
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Mericle AA, Mahoney E, Korcha R, Delucchi K, Polcin DL. Sober living house characteristics: A multilevel analyses of factors associated with improved outcomes. J Subst Abuse Treat 2019; 98:28-38. [PMID: 30665601 PMCID: PMC6605057 DOI: 10.1016/j.jsat.2018.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/06/2018] [Accepted: 12/13/2018] [Indexed: 12/14/2022]
Abstract
Safe and stable housing is integral to addiction recovery. Across numerous studies, recovery housing has been found to be associated with improvements in a variety of domains. Although procedures for operating some types of recovery housing have been manualized and national standards established, there are few empirical findings identifying which recovery residence characteristics may lead to improved outcomes. Using data from 330 newly admitted residents recruited from 49 sober living houses in California and re-contacted for 6- and 12-month follow-up interviews, this study examines the effects of organizational, operational, and programming characteristics on substance use, criminal justice, and employment outcomes. Results from multilevel analyses adjusting for resident demographics and length of stay indicate that organizational characteristics were associated with outcomes. Residents recruited from houses that were part of a larger organization or group of houses had increased odds of total abstinence (aOR = 3.98, p < 0.001) and drug abstinence (aOR = 3.19, p < 0.001). Residents recruited from houses that were affiliated with a treatment program had increased odds of employment (aOR = 2.92, p = 0.003). Operational characteristics such as where the house was located and whether the house required incoming residents to be sober for at least 30 days prior to entry were also related to improved outcomes, but additional work is needed to develop tools to assess and measure recovery housing characteristics and to better understand how these factors contribute to improved outcomes.
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Affiliation(s)
- Amy A Mericle
- Alcohol Research Group at the Public Health Institute, Emeryville, CA 94608, USA.
| | - Elizabeth Mahoney
- Alcohol Research Group at the Public Health Institute, Emeryville, CA 94608, USA
| | - Rachael Korcha
- Alcohol Research Group at the Public Health Institute, Emeryville, CA 94608, USA
| | - Kevin Delucchi
- University of California San Francisco, San Francisco, CA 94143, USA
| | - Douglas L Polcin
- Alcohol Research Group at the Public Health Institute, Emeryville, CA 94608, USA
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24
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Zhang W, Wang BY, Du XY, Fang WW, Wu H, Wang L, Zhuge YZ, Zou XP. Big-data analysis: A clinical pathway on endoscopic retrograde cholangiopancreatography for common bile duct stones. World J Gastroenterol 2019; 25:1002-1011. [PMID: 30833805 PMCID: PMC6397721 DOI: 10.3748/wjg.v25.i8.1002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A clinical pathway (CP) is a standardized approach for disease management. However, big data-based evidence is rarely involved in CP for related common bile duct (CBD) stones, let alone outcome comparisons before and after CP implementation.
AIM To investigate the value of CP implementation in patients with CBD stones undergoing endoscopic retrograde cholangiopancreatography (ERCP).
METHODS This retrospective study was conducted at Nanjing Drum Tower Hospital in patients with CBD stones undergoing ERCP from January 2007 to December 2017. The data and outcomes were compared by using univariate and multivariable regression/linear models between the patients who received conventional care (non-pathway group, n = 467) and CP care (pathway group, n = 2196).
RESULTS At baseline, the main differences observed between the two groups were the percentage of patients with multiple stones (P < 0.001) and incidence of cholangitis complication (P < 0.05). The percentage of antibiotic use and complications in the CP group were significantly less than those in the non-pathway group [adjusted odds ratio (OR) = 0.72, 95% confidence interval (CI): 0.55-0.93, P = 0.012, adjusted OR = 0.44, 95%CI: 0.33-0.59, P < 0.001, respectively]. Patients spent lower costs on hospitalization, operation, nursing, medication, and medical consumable materials (P < 0.001 for all), and even experienced shorter length of hospital stay (LOHS) (P < 0.001) after the CP implementation. No significant differences in clinical outcomes, readmission rate, or secondary surgery rate were presented between the patients in the non-pathway and CP groups.
CONCLUSION Implementing a CP for patients with CBD stones is a safe mode to reduce the LOHS, hospital costs, antibiotic use, and complication rate.
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Affiliation(s)
- Wei Zhang
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Bing-Yi Wang
- Medical Division, Yidu Cloud (Beijing) Technology Co., Ltd. Beijing 100101, China
| | - Xiao-Yan Du
- Medical Division, Yidu Cloud (Beijing) Technology Co., Ltd. Beijing 100101, China
| | - Wei-Wei Fang
- Medical Division, Yidu Cloud (Beijing) Technology Co., Ltd. Beijing 100101, China
| | - Han Wu
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Lei Wang
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Yu-Zheng Zhuge
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Xiao-Ping Zou
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
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Abstract
Despite concerted efforts to improve the reading skills of English language learners (ELLs), it remains unclear if the interventions they have been receiving produce any positive results. Thus, the purpose of this meta-analysis was to examine how effective reading interventions are in improving ELLs' reading skills and what factors may influence their effectiveness. Twenty-six studies with reported outcomes for pretest and posttest were selected, and four moderators (group size, intensity of intervention, students' risk status, and type of intervention) were coded. The results of random-effects analyses showed that the reading interventions had a large effect on ELLs' reading accuracy ( d = 1.221) and reading fluency ( d = 0.802) and a moderate effect on reading comprehension ( d = 0.499). In addition, for real-word reading accuracy, intervention groups composed of more than five students were less effective than groups composed of two to five students, and longer intervention sessions were less effective than shorter ones. Overall, our findings suggest that reading interventions have positive effects on ELLs' reading skills, and they should not be delayed until these students have reached a certain level of oral English proficiency.
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Affiliation(s)
| | - Kan Guo
- 2 Beijing Normal University, Beijing, China
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26
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Segal SP, Rimes L, Hayes SL. The utility of outpatient commitment: Reduced-risks of victimization and crime perpetration. Eur Psychiatry 2019; 56:97-104. [PMID: 30654319 DOI: 10.1016/j.eurpsy.2018.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/06/2018] [Accepted: 12/08/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Outpatient civil commitment (OCC) provisions, community treatment orders (CTOs) in Australia and Commonwealth nations, are part of mental health law worldwide. This study considers whether and by what means OCC provides statutorily required "needed-treatment" addressing two aspects of its legal mandate to protect the safety of self (exclusive of deliberate-self-harm) and others. METHOD Over a 12.4-year period, records of hospitalized-psychiatric-patients, 11,424 with CTO-assignment and 16,161 without CTO-assignment were linked to police-records. Imminent-safety-threats included perpetrations and victimizations by homicides, rapes, assaults/abductions, and robberies. "Need for treatment" determinations were validated independently by Health of the Nations Scale (HoNOS) severity-score-profiles. Logistic regressions, with propensity-score- adjustment and control for 46 potential confounding-factors, were used to evaluate the association of CTO-assignment with occurrence-risk of perpetrations and victimizations. RESULTS CTO-assignment was associated with reduced safety-risk: 17% in initial-perpetrations, 11% in initial-victimizations, and 22% for repeat-perpetrations. Each ten-community-treatment-days in interaction with CTO-assignment was associated with a 3.4% reduced-perpetration-risk. CTO-initiated-re-hospitalization was associated with a 13% reduced-initial-perpetration-risk, a 17% reduced-initial-victimization-risk, and a 22% reduced-repeat-victimization-risk. All risk-estimates appear to be the unique contributions of the CTO, CTO-initiated-re-hospitalization, or the provision of ten-community-treatment-days-i.e. after accounting for the influence of prior crimes and victimizations, ethnic-bias, neighborhood disadvantage and other between-group differences in the analysis. CONCLUSIONS CTO assignment's association with reduced criminal-victimization and perpetration-risk, in conjunction with requiring participation in needed-treatment via re-hospitalization and community-service, adds support to the conclusion that OCC is to some extent fulfilling its legal objectives related to protecting safety of self (exclusive of deliberate-self-harm), and others.
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Affiliation(s)
- Steven P Segal
- University of California, Berkeley, U.S.A. & University of Melbourne, Australia.
| | - Lachlan Rimes
- Victorian Department of Health and Human Services, Australia
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Senanayake HM, Patabendige M, Ramachandran R. Piloting of WHO Safe Childbirth Checklist using a modified version in Sri Lanka. BMC Res Notes 2018; 11:896. [PMID: 30547838 PMCID: PMC6295046 DOI: 10.1186/s13104-018-4009-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/10/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Data was gathered to study the impact of a context-specific modified WHO Safe Childbirth Checklist (mSCC) at two tertiary care settings in Sri Lanka, as a part of an implementation program. DATA DESCRIPTION We provide data sets of a prospective observational study which was conducted in the University Obstetrics Unit at De Soysa Hospital for Women (DSHW), Colombo and two Obstetric Units at Teaching Hospital, Mahamodara, Galle (THMG), Sri Lanka. These consist of demographic and checklist implementation details and data on the level of acceptance. The study was conducted over 8 weeks at DSHW and over 4 weeks at THMG. Checklists were kept attached to clinical records at admission and collected on discharge. Level of acceptance was assessed using a self-administered questionnaire. Outcome measures were adoption rate (percentage of deliveries where mSCC was used), adherence to practices (mean percentage of items checked in each checklist), response rate (percentage of staff members who responded to questionnaire) and level of acceptance (percentage of "strongly agree/agree" in Likert scale to five questions regarding acceptance of modified SCC).
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Affiliation(s)
- H. M. Senanayake
- Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- University Obstetrics Unit, De Soysa Hospital for Women, Colombo, Sri Lanka
| | - M. Patabendige
- University Obstetrics Unit, Teaching Hospital, Mahamodara, Galle, Sri Lanka
| | - R. Ramachandran
- University Obstetrics Unit, De Soysa Hospital for Women, Colombo, Sri Lanka
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Cedars E, Kriss H, Lazar AA, Chan C, Chan DK. Use of otoacoustic emissions to improve outcomes and reduce disparities in a community preschool hearing screening program. PLoS One 2018; 13:e0208050. [PMID: 30532159 PMCID: PMC6287830 DOI: 10.1371/journal.pone.0208050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/09/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Hearing loss substantially impacts pediatric development, and early identification improves outcomes. While intervening before school-entry is critical to optimize learning, early-childhood hearing screening practices are highly variable. Conditioned play audiometry (CPA) is the gold standard for preschool hearing screening, but otoacoustic emission (OAE) testing provides objective data that may improve screening outcomes. OBJECTIVES To compare outcomes of a community-based low-income preschool hearing program before and after implementation of OAE in a single-visit, two-tiered paradigm. We hypothesized that this intervention would reduce referral rates and improve follow-up while maintaining stable rates of diagnosed sensorineural hearing loss. METHODS We performed a cohort study of 3257 children screened from July 2014-June 2016. Department of Public Health data were analyzed pre- and post-implementation of second-line OAE testing for children referred on CPA screening with targeted follow-up by DPH staff. Primary outcomes included referral rates, follow-up rates, and diagnosis of sensorineural hearing loss. RESULTS Demographics, pure-tone pass rates, and incidence of newly-diagnosed permanent hearing loss were similar across years. After intervention, overall pass rates increased from 92% to 95% (P = 0.0014), while only 0.7% remained unable to be tested (P<0.0001). 5% of children were unable to be tested by CPA screening but passed OAE testing, obviating further evaluation. Referral rate decreased from 8% to 5% (P = 0.0014), and follow-up improved from 36% to 91% (P<0.0001). Identification of pathology in children with follow-up increased from 19% to over 50%. Further, disparities in pass rates and ability to test seen in Year 1 were eliminated in Year 2. CONCLUSION AND RELEVANCE In a community setting, implementation of second-line OAE screening for CPA referrals reduced referral rates, increased identification of hearing loss, reduced outcome disparities, and improved follow-up rates. This study provides lessons in how to improve outcomes and reduce disparities in early-childhood hearing screening.
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Affiliation(s)
- Elizabeth Cedars
- University of California San Francisco, Department of Otolaryngology–Head and Neck Surgery, San Francisco, CA, United States of America
| | - Hayley Kriss
- San Francisco Department of Public Health, San Francisco, CA, United States of America
| | - Ann A. Lazar
- University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, United States of America
| | - Curtis Chan
- San Francisco Department of Public Health, San Francisco, CA, United States of America
| | - Dylan K. Chan
- University of California San Francisco, Department of Otolaryngology–Head and Neck Surgery, San Francisco, CA, United States of America
- * E-mail:
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Sousa Santos F, Nunes Dias L, Henriques V, Canas Marques C, Chorão M, Sequeira Duarte J, Limbert C, Costa J, Graça J, Vasconcelos C, Cabral J, Ramos S. Non-adenomatous sellar lesions: single-centre 10-year experience. Hormones (Athens) 2018; 17:557-563. [PMID: 30284206 DOI: 10.1007/s42000-018-0064-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/13/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE A minority of lesions found in the sellar region are non-adenomatous neoplastic, inflammatory, or cystic masses. Our study aims to describe the prevalence and characteristics of these lesions in a multidisciplinary pituitary outpatient clinic. DESIGN We conducted an observational study which included 36 patients (15.9% of those followed up in this outpatient clinic between 2006 and 2016 who had pituitary surgery) submitted to pituitary surgery with histological results showing a non-adenomatous sellar lesion. We evaluated clinical, radiological, and biochemical (pituitary function) characteristics during the pre-operative and post-operative period. RESULTS Thirty-six patients (50% female) with a mean age of 41.3 ± 21.9 years and a mean follow-up duration of 8.0 ± 9.0 years were included. Histologic diagnoses were divided into benign neoplasms (80.6%), malignant neoplasms (11.1%), inflammatory lesions (5.6%), and cystic masses (2.8%). The most common clinical presentation was headache (66.7%) and visual defects (61.1%). Forty-seven percent of patients had at least one pituitary axis insufficiency at the time of diagnosis. In the majority of cases (58.3%), a transsphenoidal approach was used for the initial pituitary surgery. Thirteen patients had more than one pituitary surgery and eight also had radiotherapy. At the time of data retrieval, five patients had no pituitary hormonal insufficiency and 13 patients had some visual defect improvement. CONCLUSIONS Although rare, non-adenomatous sellar lesions may be associated with significant causes of morbidity, such as hypopituitarism and visual defects, per se or due to the various treatment modalities employed. Moreover, since the lesions are difficult to distinguish from adenomas, these patients require a careful multidisciplinary approach.
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Affiliation(s)
- Francisco Sousa Santos
- Endocrinology Department, Hospital Egas Moniz, Rua José Lins do Rego, nr.26, 4th floor (left side), 1700-264, Lisbon, Portugal.
| | | | | | | | | | - João Sequeira Duarte
- Endocrinology Department, Hospital Egas Moniz, Rua José Lins do Rego, nr.26, 4th floor (left side), 1700-264, Lisbon, Portugal
| | - Clotilde Limbert
- Endocrinology Department, Hospital Egas Moniz, Rua José Lins do Rego, nr.26, 4th floor (left side), 1700-264, Lisbon, Portugal
| | - João Costa
- Neuropthalmology Department, Hospital Egas Moniz, Lisbon, Portugal
| | - Joana Graça
- Neuroradiology Department, Hospital Egas Moniz, Lisbon, Portugal
| | - Carlos Vasconcelos
- Endocrinology Department, Hospital Egas Moniz, Rua José Lins do Rego, nr.26, 4th floor (left side), 1700-264, Lisbon, Portugal
| | - José Cabral
- Neurosurgery Department, Hospital Egas Moniz, Lisbon, Portugal
| | - Sância Ramos
- Pathology Department, Hospital Egas Moniz, Lisbon, Portugal
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Kwack WG, Yun M, Lee DS, Min H, Choi YY, Lim SY, Kim Y, Lee SH, Lee YJ, Park JS, Cho YJ. Effectiveness of intrahospital transportation of mechanically ventilated patients in medical intensive care unit by the rapid response team: A cohort study. Medicine (Baltimore) 2018; 97:e13490. [PMID: 30508979 PMCID: PMC6283106 DOI: 10.1097/md.0000000000013490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Critically ill patients could experience various risks including life-threatening events during intrahospital transportation (IHT), with a global incidence of 20% to 79.8%. Evidence on the clinical benefits of the presence of specialized intensive care members such as the rapid response team (RRT) during their transportation is limited. We aimed to elucidate the RRT's effectiveness in promoting patient's safety outcomes during transportation by comparing with those transport by general members.A single-center retrospective cohort study was conducted from January 2016 to February 2017, including critically ill patients admitted to the medical intensive care unit (ICU) due to respiratory failure under mechanical ventilation. Patients who underwent out-of-ICU transportation supported by RRT members, including a portable ventilator, were categorized as the RRT group, whereas those transported by general members, such as residents or interns, were the general group. Propensity score matching (PSM) was conducted due to several significant differences in the baseline characteristics between the 2 groups. Adverse events were defined as any situation requiring cardiopulmonary resuscitation (CPR), any physiologic deteriorations requiring immediate intervention or equipment dysfunctions.The median age of the 184 subjects included was 72 (inter quartile range, 62-75) years, and 114 (62.3%) of them were male. Thirty-six (19.6%) transports were supported by RRT, with significant higher APACHE II score than general groups (36.7 ± 6.0 vs 32.4 ± 7.7, P = .002). There was no critical event requiring CPR in both groups. However, adverse events were more frequently observed in the RRT than the general group (27.8% vs 8.1%, P = .001). PSM revealed insignificant difference in adverse events (26.7% vs 10.0%, P = .228).In critically ill patients in the medical ICU, IHT supported by the RRT did not show a more preventative effect on adverse events than that by the general group.
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Affiliation(s)
- Won Gun Kwack
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Miae Yun
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Dong Seon Lee
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Hyunju Min
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Yun Young Choi
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Sung Yoon Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Youlim Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Sang Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
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Ramirez MG, Deutsch H, Khanna N, Cheatem D, Yang D, Kuntze E. Floseal only versus in combination in spine surgery: a comparative, retrospective hospital database evaluation of clinical and healthcare resource outcomes. Hosp Pract (1995) 2018; 46:189-196. [PMID: 29986148 DOI: 10.1080/21548331.2018.1498279] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Flowable agents such as Floseal® (F) are often reserved as adjuncts to non-flowable agents (i.e. gelatin (G) sponges and thrombin (T)) when bleeding is not sufficiently controlled. Based on their perceived positive impact, it is postulated that flowable agents alone may result in better clinical and resource utilization outcomes. Clinical and health-care utilization outcomes were compared in this retrospective analysis of spine surgery cases with charges for Floseal only (FO) and F + G/T. METHODS The United States Premier Hospital Database was searched for adult spine surgeries performed between October 2010 and September 2015 with FO or F and G/T charges. To obtain an unbiased treatment estimate, 1:1 propensity-score matching was used to identify FO and F + G/T cohorts. The cohorts were compared for rates of intraoperative, perioperative, postoperative and transfusion; blood loss-related, serious and other complications; hospital length-of-stay (LOS), surgical time, and volume of hemostat charged. RESULTS Among 40,335 spine surgeries, 15,105 FO and F + G/T matched pairs were compared. Significantly (p < 0.0001) lower percentages of FO than F + G/T cases received intraoperative (1.4% vs. 2.5%), perioperative (1.6% vs. 2.8%), postoperative (1.6% vs 3.0%), and any transfusion (2.3% vs. 4.3%). FO cases had significantly less blood loss complications than F + G/T cases (0.5% vs. 0.8%, p = 0.0022) and significantly (p < 0.0001) shorter hospital LOS (-0.45 days), surgical time (-39.0 min), and used less hemostat (-12.5 mL). CONCLUSIONS Results from this observational hospital database analyses indicate that FO use in spine surgery is associated with lower blood transfusion use and blood loss complications compared to its use with adjunct non-flowable hemostatic agents. The shorter hospital stay, reduced surgical time, and less hemostat volume health-care utilization outcomes that favored FO versus combination use may translate to health system cost savings. Further validation of these findings using controlled clinical trials and cost-consequence studies is warranted. CLINICAL RELEVANCE The use of flowable hemostatic agents alone may result in better clinical and possibly economic outcomes in spine surgery.
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Affiliation(s)
| | - Harel Deutsch
- b Department of Neurosurgery , Rush University , Chicago , IL , USA
| | - Nitin Khanna
- c Department of Orthopedics , Indiana University School of Medicine , Munster , IN , USA
| | | | - Dongyan Yang
- a Baxter Healthcare Corporation , Deerfield , IL , USA
| | - Erik Kuntze
- a Baxter Healthcare Corporation , Deerfield , IL , USA
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Abstract
Medical case management (MCM) is a core medical service in The Ryan White HIV/AIDS Program and aims to provide treatment and care for people living with HIV/AIDS by engaging, identifying and eliminating barriers to HIV care. Little research has examined the impact of this intervention; therefore, the purpose of this study was to examine the how MCM affects HIV clinical outcomes. The study took place at a midwestern, outpatient infectious diseases clinic. This study utilized a longitudinal, retrospective study design to analyze to the impact of MCM engagement on HIV clinical outcomes (viral loads, CD4 counts) from 2009 to 2015 as a time-varying predictor. A total of 2773 patients were included in this study, of which 975 patients (35.2%) engaged in MCM. Among those in MCM, approximately 90% of the population were between 25 and 64 years of age, more than three-quarters were African American men, mean time of HIV care engagement in at this clinic care was 3.2 (± 4.1), while mean years living with HIV was 10.5 (± 7.1). Throughout the study period, those engaged in MCM had a significantly faster improvement in their HIV clinical outcomes compared to the non-MCM group (p < 0.001). The study highlights the significant impact MCM services have on improving CD4 T cell counts and HIV viral loads. The successful care coordination that MCM offers clearly improves health outcomes while creating a network of patient care.
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Affiliation(s)
- Julia D López
- Department of Behavioral Sciences and Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA.
| | - Enbal Shacham
- Department of Behavioral Sciences and Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
| | - Tawnya Brown
- Washington University School of Medicine, Infectious Diseases Clinic, 620 South Taylor Avenue, Saint Louis, MO, 63110, USA
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Ang LPA. Reducing inpatient suicide rates: The success of a suicide management programme in a general hospital. Gen Hosp Psychiatry 2018; 54:60-61. [PMID: 29807670 DOI: 10.1016/j.genhosppsych.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Lye Poh Aaron Ang
- Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore.
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Pompoli A, Furukawa TA, Efthimiou O, Imai H, Tajika A, Salanti G. Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis. Psychol Med 2018; 48:1945-1953. [PMID: 29368665 PMCID: PMC6137372 DOI: 10.1017/s0033291717003919] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 12/23/2022]
Abstract
Cognitive-behaviour therapy (CBT) for panic disorder may consist of different combinations of several therapeutic components such as relaxation, breathing retraining, cognitive restructuring, interoceptive exposure and/or in vivo exposure. It is therefore important both theoretically and clinically to examine whether specific components of CBT or their combinations are superior to others in the treatment of panic disorder. Component network meta-analysis (NMA) is an extension of standard NMA that can be used to disentangle the treatment effects of different components included in composite interventions. We searched MEDLINE, EMBASE, PsycINFO and Cochrane Central, with supplementary searches of reference lists and clinical trial registries, for all randomized controlled trials comparing different CBT-based psychological therapies for panic disorder with each other or with control interventions. We applied component NMA to disentangle the treatment effects of different components included in these interventions. After reviewing 2526 references, we included 72 studies with 4064 participants. Interoceptive exposure and face-to-face setting were associated with better treatment efficacy and acceptability. Muscle relaxation and virtual-reality exposure were associated with significantly lower efficacy. Components such as breathing retraining and in vivo exposure appeared to improve treatment acceptability while having small effects on efficacy. The comparison of the most v. the least efficacious combination, both of which may be provided as 'evidence-based CBT,' yielded an odds ratio for the remission of 7.69 (95% credible interval: 1.75 to 33.33). Effective CBT packages for panic disorder would include face-to-face and interoceptive exposure components, while excluding muscle relaxation and virtual-reality exposure.
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Affiliation(s)
| | - Toshi A. Furukawa
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Hissei Imai
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Aran Tajika
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Georgia Salanti
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
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Puliti D, Zappa M, Giorgi Rossi P, Pierpaoli E, Manneschi G, Ambrogetti D, Ventura L, Mantellini P. Volumetric breast density and risk of advanced cancers after a negative screening episode: a cohort study. Breast Cancer Res 2018; 20:95. [PMID: 30092817 PMCID: PMC6085631 DOI: 10.1186/s13058-018-1025-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/18/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND We evaluated the association between volumetric breast density (BD) and risk of advanced cancers after a negative screening episode. METHODS A cohort of 16,752 women aged 49-54 years at their first screening mammography in the Florence screening programme was followed for breast cancer (BC) incidence until the second screening round. Volumetric BD was measured using fully automated software. The cumulative incidence of advanced cancer after a negative screening episode (including stage II or more severe cancer during the screening interval - on average 28 months - and at the subsequent round) was calculated separately for Volpara density grade (VDG) categories. RESULTS BC incidence gradually increased with the increas in BD: 3.7‰, 5.1‰, 5.4‰ and 9.1‰ in the VDG categories 1-4, respectively (p trend < 0.001). The risk of advanced cancers after a negative screening episode was 1.0‰, 1.3‰, 1.1‰, and 4.2‰ (p trend = 0.003). The highest BD category, compared with the other three together, has double the invasive BC risk (RR = 2.0; 95% CI 1.5-2.8) and almost fourfold risk of advanced cancer (RR = 3.8; 95% CI 1.8-8.0). CONCLUSION BD has a strong impact on the risk of advanced cancers after a negative screening episode, the best early surrogate of BC mortality. Therefore, our results suggest that screening effectiveness is quite different among BD categories.
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Affiliation(s)
- Donella Puliti
- Clinical Epidemiology Unit, ISPRO - Oncological network, prevention and research institute, Via delle Oblate 4, 50141 Florence, Italy
| | - Marco Zappa
- Clinical Epidemiology Unit, ISPRO - Oncological network, prevention and research institute, Via delle Oblate 4, 50141 Florence, Italy
| | - Paolo Giorgi Rossi
- Interinstitutional Epidemiology Unit, 42122 AUSL Reggio Emilia, Italy and Arcispedale Santa Maria Nuova-IRCCS, 42123 Reggio Emilia, Italy
| | - Elena Pierpaoli
- Screening Unit, ISPRO - Oncological network, prevention and research institute, Florence, Italy
| | - Gianfranco Manneschi
- Clinical Epidemiology Unit, ISPRO - Oncological network, prevention and research institute, Via delle Oblate 4, 50141 Florence, Italy
| | - Daniela Ambrogetti
- Screening Unit, ISPRO - Oncological network, prevention and research institute, Florence, Italy
| | - Leonardo Ventura
- Clinical Epidemiology Unit, ISPRO - Oncological network, prevention and research institute, Via delle Oblate 4, 50141 Florence, Italy
| | - Paola Mantellini
- Screening Unit, ISPRO - Oncological network, prevention and research institute, Florence, Italy
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Abstract
INTRODUCTION The integration of behavioral health into medical care is related to positive results including improved patient health outcomes, provider satisfaction, and cost-offset. Indigenous people suffer from the highest health disparities in the nation and disproportionately experience barriers to health care; yet it is unknown if integrated care is effective for this population. METHODS A systematic literature review was completed on the state of integrated care at Indigenous-serving health care sites in 2014 and was updated in 2016. Three databases were selected (Eric, Medline, and PsycInfo) and keywords pertaining to an Indigenous population and integrated care services (e.g., Native American, American Indian, or First Nations with integrated care, primary care, or family medicine) were used. After inclusion and exclusion criteria were applied, nine articles were selected out of the 2,889 articles found. Five additional articles were added in the 2016-update search. The selected articles were then evaluated using standards of integrated care. RESULTS The selected articles demonstrated wide-ranging and positive results including improved physical and mental health symptoms, reduced substance use, improvements in education and employment status, as well as a decreased involvement with the criminal justice system. It appears that interventions that additionally integrated culturally relevant health beliefs and practices experienced the largest gains in health outcomes. DISCUSSION Integrated care appears to be an intervention that can ameliorate these disparities by reducing stigma for those seeking care and providing coordinated care to prevent or reduce health care disparities in this population. While integrated care appears to be an effective system of care for Indigenous people, it must be noted that integration of local Indigenous health beliefs and practices is equally necessary.
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Abstract
Optimizing clinician education is an essential step toward enhancing health outcomes, and graduate medical education (GME)-as the pipeline for producing the nation's physicians-is an appropriate target for improvement. This Invited Commentary focuses on the need to clarify the specific goals of GME and measure achievement of those goals, using consistent metrics. The authors report on an October 2017 National Academies of Sciences, Engineering, and Medicine (NASEM) workshop focused on this agenda. A broadly representative group of participants reflected strong consensus in support of using GME outcomes data to develop better approaches to education and related policy. Implementation challenges include identifying meaningful metrics, minimizing administrative burden, addressing privacy concerns, and recognizing variability in institutional mission and capabilities. The authors recommend creating a national inventory of current data sources and initiating a pilot program to collect and share common metrics, while advancing a national effort via a "neutral" convener, such as the NASEM. The authors assert that measuring and reporting GME outcomes is a professional responsibility that must now be tackled.
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Affiliation(s)
- Debra F Weinstein
- D.F. Weinstein is associate professor of medicine, Harvard Medical School, and vice president for graduate medical education, Partners HealthCare, Boston, Massachusetts. G.E. Thibault is president, Josiah Macy Jr. Foundation, New York, New York
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Abstract
There is a lack of knowledge about specific components that make interventions effective in preventing or reducing child maltreatment. The aim of the present meta-analysis was to increase this knowledge by summarizing findings on effects of interventions for child maltreatment and by examining potential moderators of this effect, such as intervention components and study characteristics. Identifying effective components is essential for developing or improving child maltreatment interventions. A literature search yielded 121 independent studies (N = 39,044) examining the effects of interventions for preventing or reducing child maltreatment. From these studies, 352 effect sizes were extracted. The overall effect size was significant and small in magnitude for both preventive interventions (d = 0.26, p < .001) and curative interventions (d = 0.36, p < .001). Cognitive behavioral therapy, home visitation, parent training, family-based/multisystemic, substance abuse, and combined interventions were effective in preventing and/or reducing child maltreatment. For preventive interventions, larger effect sizes were found for short-term interventions (0-6 months), interventions focusing on increasing self-confidence of parents, and interventions delivered by professionals only. Further, effect sizes of preventive interventions increased as follow-up duration increased, which may indicate a sleeper effect of preventive interventions. For curative interventions, larger effect sizes were found for interventions focusing on improving parenting skills and interventions providing social and/or emotional support. Interventions can be effective in preventing or reducing child maltreatment. Theoretical and practical implications are discussed.
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Affiliation(s)
- Claudia E van der Put
- Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15780, 1001 NG, Amsterdam, The Netherlands.
| | - Mark Assink
- Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15780, 1001 NG, Amsterdam, The Netherlands
| | - Jeanne Gubbels
- Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15780, 1001 NG, Amsterdam, The Netherlands
| | - Noëlle F Boekhout van Solinge
- Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15780, 1001 NG, Amsterdam, The Netherlands
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Flash CA, Frost ELT, Giordano TP, Amico KR, Cully JA, Markham CM. HIV Pre-exposure Prophylaxis Program Implementation Using Intervention Mapping. Am J Prev Med 2018; 54:519-529. [PMID: 29433956 DOI: 10.1016/j.amepre.2017.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/22/2017] [Accepted: 12/13/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION HIV pre-exposure prophylaxis has been proven to be an effective tool in HIV prevention. However, numerous barriers still exist in pre-exposure prophylaxis implementation. METHODS The framework of Intervention Mapping was used from August 2016 to October 2017 to describe the process of adoption, implementation, and maintenance of an HIV prevention program from 2012 through 2017 in Houston, Texas, that is nested within a county health system HIV clinic. Using the tasks outlined in the Intervention Mapping framework, potential program implementers were identified, outcomes and performance objectives established, matrices of change objectives created, and methods and practical applications formed. RESULTS Results include the formation of three matrices that document program outcomes, change agents involved in the process, and the determinants needed to facilitate program adoption, implementation, and maintenance. Key features that facilitated successful program adoption and implementation were obtaining leadership buy-in, leveraging existing resources, systematic evaluation of operations, ongoing education for both clinical and nonclinical staff, and attention to emergent issues during launch. CONCLUSIONS The utilization of Intervention Mapping to delineate the program planning steps can provide a model for pre-exposure prophylaxis implementation in other settings.
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Affiliation(s)
- Charlene A Flash
- Department of Internal Medicine, Division of Infectious Disease, Baylor College of Medicine, Houston, Texas.
| | - Elizabeth L T Frost
- Department of Internal Medicine, Division of Infectious Disease, Baylor College of Medicine, Houston, Texas
| | - Thomas P Giordano
- Department of Internal Medicine, Division of Infectious Disease, Baylor College of Medicine, Houston, Texas; Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - K Rivet Amico
- Department of Health Behavior and Health Education, University of Michigan, School of Public Health, Ann Arbor, Michigan
| | - Jeffrey A Cully
- Department of Health Behavior and Health Education, University of Michigan, School of Public Health, Ann Arbor, Michigan; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Christine M Markham
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas
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Jansen IGH, Mulder MJHL, Goldhoorn RJB. Endovascular treatment for acute ischaemic stroke in routine clinical practice: prospective, observational cohort study (MR CLEAN Registry). BMJ 2018; 360:k949. [PMID: 29523557 PMCID: PMC5844245 DOI: 10.1136/bmj.k949] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine outcomes and safety of endovascular treatment for acute ischaemic stroke, due to proximal intracranial vessel occlusion in the anterior circulation, in routine clinical practice. DESIGN Ongoing, prospective, observational cohort study. SETTING 16 centres that perform endovascular treatment in the Netherlands. PARTICIPANTS 1488 patients included in the Multicentre Randomised Controlled Trial of Endovascular Treatment for Acute Ischaemic Stroke in the Netherlands (MR CLEAN) Registry who had received endovascular treatment, including stent retriever thrombectomy, aspiration, and all alternative methods for acute ischaemic stroke within 6.5 hours from onset of symptoms between March 2014 and June 2016. MAIN OUTCOME MEASURES The primary outcome was the modified Rankin Scale (mRS) score, ranging from 0 (no symptoms) to 6 (death) at 90 days after the onset of symptoms. Secondary outcomes were excellent functional outcome (mRS score 0-1), good functional outcome (mRS score 0-2), and favourable functional outcome (mRS score 0-3) at 90 days; score on the extended thrombolysis in cerebral infarction scale at the end of the intervention procedure; National Institutes of Health Stroke Scale score 24-48 hours after intervention; and complications that occurred during intervention, hospital admission, or three months' follow up period. Outcomes and safety variables in the MR CLEAN Registry were compared with the MR CLEAN trial intervention and control arms. RESULTS A statistically significant shift was observed towards better functional outcome in patients in the MR CLEAN Registry compared with the MR CLEAN trial intervention arm (adjusted common odds ratio 1.30, 95% confidence interval 1.02 to 1.67) and the MR CLEAN trial control arm (1.85, 1.46 to 2.34). The reperfusion rate, with successful reperfusion defined as a score of 2B-3 on the extended thrombolysis in cerebral infarction score, was 58.7%, the same as for patients in the MR CLEAN trial. Duration from onset of stroke to start of endovascular treatment and from onset of stroke to successful reperfusion or last contrast bolus was one hour shorter for patients in the MR CLEAN Registry. Symptomatic intracranial haemorrhage occurred in 5.8% of patients in the MR CLEAN Registry compared with 7.7% in the MR CLEAN trial intervention arm and 6.4% in the MR CLEAN trial control arm. CONCLUSION In routine clinical practice, endovascular treatment for patients with acute ischaemic stroke is at least as effective and safe as in the setting of a randomised controlled trial.
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Devriendt F, Moldovan D, Verbeke W. A Literature Survey and Experimental Evaluation of the State-of-the-Art in Uplift Modeling: A Stepping Stone Toward the Development of Prescriptive Analytics. Big Data 2018; 6:13-41. [PMID: 29570415 DOI: 10.1089/big.2017.0104] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Prescriptive analytics extends on predictive analytics by allowing to estimate an outcome in function of control variables, allowing as such to establish the required level of control variables for realizing a desired outcome. Uplift modeling is at the heart of prescriptive analytics and aims at estimating the net difference in an outcome resulting from a specific action or treatment that is applied. In this article, a structured and detailed literature survey on uplift modeling is provided by identifying and contrasting various groups of approaches. In addition, evaluation metrics for assessing the performance of uplift models are reviewed. An experimental evaluation on four real-world data sets provides further insight into their use. Uplift random forests are found to be consistently among the best performing techniques in terms of the Qini and Gini measures, although considerable variability in performance across the various data sets of the experiments is observed. In addition, uplift models are frequently observed to be unstable and display a strong variability in terms of performance across different folds in the cross-validation experimental setup. This potentially threatens their actual use for business applications. Moreover, it is found that the available evaluation metrics do not provide an intuitively understandable indication of the actual use and performance of a model. Specifically, existing evaluation metrics do not facilitate a comparison of uplift models and predictive models and evaluate performance either at an arbitrary cutoff or over the full spectrum of potential cutoffs. In conclusion, we highlight the instability of uplift models and the need for an application-oriented approach to assess uplift models as prime topics for further research.
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Affiliation(s)
- Floris Devriendt
- 1 Faculty of Economic and Social Sciences and Solvay Business School, Vrije Universiteit Brussel , Brussels, Belgium
| | - Darie Moldovan
- 2 Business Information Systems Department, Babeş-Bolyai University , Cluj-Napoca, Romania
| | - Wouter Verbeke
- 1 Faculty of Economic and Social Sciences and Solvay Business School, Vrije Universiteit Brussel , Brussels, Belgium
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Heinrichs A, Nikoubashman O, Schürmann K, Tauber SC, Wiesmann M, Schulz JB, Reich A. Relevance of standard intravenous thrombolysis in endovascular stroke therapy of a tertiary stroke center. Acta Neurol Belg 2018; 118:105-111. [PMID: 29435828 DOI: 10.1007/s13760-018-0892-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/01/2018] [Indexed: 11/26/2022]
Abstract
The majority of patients undergoing endovascular stroke treatment (EST) in randomized controlled trials received additional systemic thrombolysis ("combination or bridging therapy (C/BT)"). Nevertheless, its usefulness in this subtype of acute ischemic stroke (AIS) is discussed controversially. Of all consecutive AIS patients, who received any kind of reperfusion therapy in a tertiary university stroke center between January 2015 and March 2016, those with large vessel occlusions (LVO) and EST with or without additional C/BT, were compared primarily regarding procedural aspects. Data were extracted from an investigator-initiated, single-center, prospective and blinded end-point study. 70 AIS patients with EST alone and 118 with C/BT were identified. Significant baseline differences existed in pre-existing cardiovascular disease (52.9% (EST alone) vs. 35.6% (C/BT), p = 0.023), use of anticoagulation (30.6% vs. 5.9%, p < 0.001), and frequency of unknown time of symptom onset (65.7% vs. 32.2%, p < 0.001), in-hospital stroke (18.6% vs. 1.7%, p < 0.001), pre-treatment ASPECT scores (7.9 vs. 8.9, p = 0.004), and frequency of occlusion in the posterior circulation (18.6% vs. 5.1%, p = 0.003). Pre-interventional procedural time intervals tended to be shorter in the C/BT group, reaching statistical significance in door-to-image time (30.3 (EST alone) vs. 22.2 min (C/BT), p < 0.001). Good clinical outcome (mRS d90) was reached more often in the C/BT group (24.5% vs. 11.8%, p = 0.064). Rates of symptomatic intracranial hemorrhages (sICH) were comparable (4.3% (EST alone) vs. 6.8% (C/BT), p = 0.481). Additional systemic thrombolysis did not delay EST. On the contrary, application of IVRTPA seemed to be a positive indicator for faster EST without increased side effects.
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Affiliation(s)
- Annette Heinrichs
- Department of Neurology, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, 52074, Aachen, Germany
| | - Kolja Schürmann
- Department of Neurology, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Simone C Tauber
- Department of Neurology, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, 52074, Aachen, Germany
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Arno Reich
- Department of Neurology, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
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Abstract
A retrospective analysis of 208 flying squad attendances was performed to assess the effect of pre-hospital care by the team on outcome in emergency medical conditions, and in the trauma victim. Sixty-two (26%) of these cases were medical, but only 24 (11.5%) required immediate cardiopulmonary resuscitation. Only one out of the four successful resuscitations finally left hospital alive. In trauma, there was no significant enhancement of survival due to the presence of the team by comparing the expected against observed mortality and the injury severity score for age-matched groups. The value of flying squads as a training aid, perception of the local community and relationships with other emergency services are discussed. Alternative solutions to improving pre-hospital care include advanced trained ambulance and bystander resuscitation schemes. Although difficult to quantify the authors feel that flying squads are of benefit.
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Affiliation(s)
- A R Cope
- Accident Emergency Department, Nottingham University Hospital
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Abstract
This controlled trial was performed in London and compared outcomes of patients treated by ambulance staff using either basic life support alone or an automated external defibrillator (AED) as an adjunct to basic life support. Five of the 212 (2%) patients were successfully resuscitated by crews using basic life support alone, compared with seven of 186 (4%) patients treated by crews equipped with the AED. Neurological outcomes in the AED group were better. However, meaningful statistical comparisons are not possible with so few survivors. The AED used (Lifepak 200, PhysioControl Corp) was found to be sensitive and specific, and ambulance staff operated the defibrillator correctly. The use of AEDs in an option to maximize the provision of defibrillators in the community and could readily be incorporated into basic ambulance training.
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Affiliation(s)
- G Walters
- Accident & Emergency Department, King's College Hospital, London
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Magill M, Apodaca TR, Borsari B, Gaume J, Hoadley A, Gordon REF, Tonigan JS, Moyers T. A meta-analysis of motivational interviewing process: Technical, relational, and conditional process models of change. J Consult Clin Psychol 2018; 86:140-157. [PMID: 29265832 PMCID: PMC5958907 DOI: 10.1037/ccp0000250] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In the present meta-analysis, we test the technical and relational hypotheses of Motivational Interviewing (MI) efficacy. We also propose an a priori conditional process model where heterogeneity of technical path effect sizes should be explained by interpersonal/relational (i.e., empathy, MI Spirit) and intrapersonal (i.e., client treatment seeking status) moderators. METHOD A systematic review identified k = 58 reports, describing 36 primary studies and 40 effect sizes (N = 3,025 participants). Statistical methods calculated the inverse variance-weighted pooled correlation coefficient for the therapist to client and the client to outcome paths across multiple target behaviors (i.e., alcohol use, other drug use, other behavior change). RESULTS Therapist MI-consistent skills were correlated with more client change talk (r = .55, p < .001) as well as more sustain talk (r = .40, p < .001). MI-inconsistent skills were correlated with more sustain talk (r = .16, p < .001), but not change talk. When these indicators were combined into proportions, as recommended in the Motivational Interviewing Skill Code, the overall technical hypothesis was supported. Specifically, proportion MI consistency was related to higher proportion change talk (r = .11, p = .004) and higher proportion change talk was related to reductions in risk behavior at follow up (r = -.16, p < .001). When tested as two independent effects, client change talk was not significant, but sustain talk was positively associated with worse outcome (r = .19, p < .001). Finally, the relational hypothesis was not supported, but heterogeneity in technical hypothesis path effect sizes was partially explained by inter- and intrapersonal moderators. CONCLUSIONS This meta-analysis provides additional support for the technical hypothesis of MI efficacy; future research on the relational hypothesis should occur in the field rather than in the context of clinical trials. (PsycINFO Database Record
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Affiliation(s)
- Molly Magill
- Center for Alcohol and Addiction Studies, Brown University
| | - Timothy R Apodaca
- Children's Mercy Kansas City, University of Missouri- Kansas City School of Medicine
| | | | - Jacques Gaume
- Department of Community Health and Medicine, Lausanne University Hospital
| | - Ariel Hoadley
- Center for Alcohol and Addiction Studies, Brown University
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Gory B, Armoiry X, Sivan-Hoffmann R, Piotin M, Mazighi M, Lapergue B, Blanc R, Turjman F. A direct aspiration first pass technique for acute stroke therapy: a systematic review and meta-analysis. Eur J Neurol 2018; 25:284-292. [PMID: 29053904 DOI: 10.1111/ene.13490] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 10/16/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE A direct aspiration first pass technique (ADAPT), involving the first-line use of a large-bore distal aspiration catheter, is a new strategy in the mechanical thrombectomy of acute ischemic stroke caused by large-vessel occlusion. However, its impact on reperfusion rates, clinical outcomes and complication rates has not been fully examined. METHODS We conducted a systematic review of the literature searching multiple databases for reports on thrombectomy of acute stroke with ADAPT and performed meta-analyses of clinical and radiographic outcomes. RESULTS We selected 16 articles that included a total of 1378 patients treated with ADAPT. The mean admission National Institutes of Health Stroke Scale score was 17 and pre-treatment intravenous thrombolysis was used in 51% of cases. The successful recanalization (thrombolysis in cerebral ischemia 2b-3) rate was 66% [95% confidence interval (CI), 59-72%] with ADAPT and a rescue stent retriever was used in 31% of cases (95% CI, 24-37%) yielding an overall thrombolysis in cerebral ischemia 2b-3 rate of 89% (95% CI, 85-92%). We found a pooled estimate of 50% (95% CI, 45-54%) for functional independence (modified Rankin Scale score 0-2) at 90 days, 15% (95% CI, 10-21%) for mortality within 90 days and 5% (95% CI, 3-7%) for symptomatic intracranial hemorrhage. CONCLUSIONS ADAPT therapy is associated with similar reperfusion rates, clinical outcomes and complication rates compared with thrombectomy with stent retrievers. However, the major limitations of current evidence (i.e. retrospective studies and selection bias) indicate a need for adequately powered, multicenter randomized controlled trials to determine the best strategy.
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Affiliation(s)
- B Gory
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy
- IADI, INSERM U947, University of Lorraine, Nancy
| | - X Armoiry
- Hospices Civils de Lyon/UMR-CNRS 5510/MATEIS, Lyon, France
- Warwick Medical School, Division of Health Sciences, University of Warwick, Coventry, UK
| | - R Sivan-Hoffmann
- Department of Interventional Neuroradiology, Rambam Health Care Campus, Haifa, Israel
| | - M Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris
| | - M Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris
| | - B Lapergue
- Department of Neurology, Stroke Center, Foch Hospital, Lyon
| | - R Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris
| | - F Turjman
- Department of Interventional Neuroradiology, Hospices Civils de Lyon, Lyon, France
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Ozdogu H, Boga C, Asma S, Kozanoglu I, Gereklioglu C, Yeral M, Buyukkurt NT, Solmaz S, Korur A, Aytan P, Maytalman E, Kasar M. Organ damage mitigation with the Baskent Sickle Cell Medical Care Development Program (BASCARE). Medicine (Baltimore) 2018; 97:e9844. [PMID: 29419693 PMCID: PMC5944669 DOI: 10.1097/md.0000000000009844] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The Eastern Mediterranean is among the regions where sickle cell disease (SCD) is common. The morbidity and mortality of this disease can be postponed to adulthood through therapies implemented in childhood. The present study focuses on the organ damage-reducing effects of the Baskent Sickle Cell Medical Care Development Program (BASCARE), which was developed by a team who lives in this region and has approximately 25 years of experience. The deliverables of the program included the development of an electronic health recording system (PRANA) and electronic vaccination system; the use of low citrate infusion in routine prophylactic automatic erythrocyte exchange (ARCE) programs including pregnant women; the use of leukocyte-filtered and irradiated blood for transfusion; the use of magnetic resonance imaging methods (T2) for the management of transfusion-related hemosiderosis; and the implementation of an allogeneic hematopoietic stem cell transplantation protocol for adult patients. The sample was composed of 376 study subjects and 249 control subjects. The hospital's Data Management System and the central population operating system were used for data collection. BASCARE enabled better analysis and interpretation of complication and mortality data. Vaccination rates against influenza and pneumococcal disease improved (21.5% vs 50.8% and 21.5% vs 49.2%, respectively). Effective and safe ARCE with low citrate infusion were maintained in 352 subjects (1003 procedures). Maternal and fetal mortality was prevented in 35 consecutive pregnant patients with ARCE. Chelating therapy rates reduced from 6.7% to 5%. Successful outcomes could be obtained in all 13 adult patients who underwent allogeneic peripheral stem cell transplantation from a fully matched, related donor. No patients died by day 100 or after the first year. Cure could be achieved without graft loss, grades III to IV acute graft versus host disease, extensive chronic graft versus host disease, or other major complications. The BASCARE program significantly improved patient care and thereby prolonged the life span of SCD patients (42 ± 13 years vs 29 ± 7 years, P < .001). We may recommend using such individualized programs in centers that provide health care for patients with SCD, in accordance with holistic approach due to the benign nature but malignant course of the disease.
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Affiliation(s)
- Hakan Ozdogu
- Adana Adult Bone Marrow Transplantation Center, University Hospital of Baskent, Adana
- Department of Hematology
| | - Can Boga
- Adana Adult Bone Marrow Transplantation Center, University Hospital of Baskent, Adana
- Department of Hematology
| | | | | | | | - Mahmut Yeral
- Adana Adult Bone Marrow Transplantation Center, University Hospital of Baskent, Adana
- Department of Hematology
| | | | | | | | - Pelin Aytan
- Adana Adult Bone Marrow Transplantation Center, University Hospital of Baskent, Adana
- Department of Hematology
| | - Erkan Maytalman
- Adana Adult Bone Marrow Transplantation Center, University Hospital of Baskent, Adana
| | - Mutlu Kasar
- Department of Immunology, Faculty of Medicine, University of Baskent, Ankara, Turkey
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Voon HY, Shafie AA, Bujang MA, Suharjono HN. Cost effectiveness analysis of carbetocin during cesarean section in a high volume maternity unit. J Obstet Gynaecol Res 2018; 44:109-116. [PMID: 29027315 PMCID: PMC5813149 DOI: 10.1111/jog.13486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/22/2017] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the cost effectiveness of carbetocin compared to oxytocin when used as prophylaxis against post-partum hemorrhage (PPH) during cesarean deliveries. METHODS A systematic review of the literature was performed to identify randomized controlled trials that compared the use of carbetocin to oxytocin in the context of cesarean deliveries. Cost effectiveness analysis was then performed using secondary data from the perspective of a maternity unit within the Malaysian Ministry of Health, over a 24 h time period. RESULTS Seven randomized controlled trials with over 2000 patients comparing carbetocin with oxytocin during cesarean section were identified. The use of carbetocin in our center, which has an average of 3000 cesarean deliveries annually, would have prevented 108 episodes of PPH, 104 episodes of transfusion and reduced the need for additional uterotonics in 455 patients. The incremental cost effectiveness ratio of carbetocin for averting an episode of PPH was US$278.70. CONCLUSION Reduction in retreatment, staffing requirements, transfusion and potential medication errors mitigates the higher index cost of carbetocin. From a pharmacoeconomic perspective, in the context of cesarean section, carbetocin was cost effective as prophylaxis against PPH. Ultimately, the relative value placed on the outcomes above and the individual unit's resources would influence the choice of uterotonic.
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Affiliation(s)
- Hian Yan Voon
- Department of Obstetrics and GynecologySri Aman HospitalSarawakMalaysia
| | - Asrul A. Shafie
- School of Pharmaceutical SciencesUniversity of Science MalaysiaPenangMalaysia
| | | | - Haris N. Suharjono
- Department of Obstetrics and GynecologySarawak General HospitalKuchingMalaysia
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Denchev P, Pearson JL, Allen MH, Claassen CA, Currier GW, Zatzick DF, Schoenbaum M. Modeling the Cost-Effectiveness of Interventions to Reduce Suicide Risk Among Hospital Emergency Department Patients. Psychiatr Serv 2018; 69:23-31. [PMID: 28945181 PMCID: PMC5750130 DOI: 10.1176/appi.ps.201600351] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study estimated the expected cost-effectiveness and population impact of outpatient interventions to reduce suicide risk among patients presenting to general hospital emergency departments (EDs), compared with usual care. Several such interventions have been found efficacious, but none is yet widespread, and the cost-effectiveness of population-based implementation is unknown. METHODS Modeled cost-effectiveness analysis compared three ED-initiated suicide prevention interventions previously found to be efficacious-follow-up via postcards or caring letters, follow-up via telephone outreach, and suicide-focused cognitive-behavioral therapy (CBT)-with usual care. Primary outcomes were treatment costs, suicides, and life-years saved, evaluated over the year after the index ED visit. RESULTS Compared with usual care, adding postcards improved outcomes and reduced costs. Adding telephone outreach and suicide-focused CBT, respectively, improved outcomes at a mean incremental cost of $4,300 and $18,800 per life-year saved, respectively. Monte Carlo simulation (1,000 repetitions) revealed the chance of incremental cost-effectiveness to be a certainty for all three interventions, assuming societal willingness to pay ≥$50,000 per life-year. These main findings were robust to various sensitivity analyses, including conservative assumptions about effect size and incremental costs. Population impact was limited by low sensitivity of detecting ED patients' suicide risk, and health care delivery inefficiencies. CONCLUSIONS The highly favorable cost-effectiveness found for each outpatient intervention provides a strong basis for widespread implementation of any or all of the interventions. The estimated population benefits of doing so would be enhanced by increasing the sensitivity of suicide risk detection among individuals presenting to general hospital EDs.
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Affiliation(s)
- Peter Denchev
- At the time of this research, Dr. Denchev was with the Office of Science Policy, Planning and Communication, National Institute of Mental Health (NIMH), Bethesda, Maryland. Dr. Pearson and Dr. Schoenbaum are with the Division of Services and Intervention Research, NIMH, Bethesda. Dr. Allen is with the Department of Psychiatry, University of Colorado Denver School of Medicine, Aurora, and with Rocky Mountain Crisis Partners, Denver. Dr. Claassen is with the Department of Psychiatry, University of North Texas Health Science Center, Fort Worth. Dr. Currier is with the Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa. Dr. Zatzick is with the Department of Psychiatry and Behavioral Sciences, University of Washington and Harborview Medical Center, Seattle
| | - Jane L Pearson
- At the time of this research, Dr. Denchev was with the Office of Science Policy, Planning and Communication, National Institute of Mental Health (NIMH), Bethesda, Maryland. Dr. Pearson and Dr. Schoenbaum are with the Division of Services and Intervention Research, NIMH, Bethesda. Dr. Allen is with the Department of Psychiatry, University of Colorado Denver School of Medicine, Aurora, and with Rocky Mountain Crisis Partners, Denver. Dr. Claassen is with the Department of Psychiatry, University of North Texas Health Science Center, Fort Worth. Dr. Currier is with the Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa. Dr. Zatzick is with the Department of Psychiatry and Behavioral Sciences, University of Washington and Harborview Medical Center, Seattle
| | - Michael H Allen
- At the time of this research, Dr. Denchev was with the Office of Science Policy, Planning and Communication, National Institute of Mental Health (NIMH), Bethesda, Maryland. Dr. Pearson and Dr. Schoenbaum are with the Division of Services and Intervention Research, NIMH, Bethesda. Dr. Allen is with the Department of Psychiatry, University of Colorado Denver School of Medicine, Aurora, and with Rocky Mountain Crisis Partners, Denver. Dr. Claassen is with the Department of Psychiatry, University of North Texas Health Science Center, Fort Worth. Dr. Currier is with the Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa. Dr. Zatzick is with the Department of Psychiatry and Behavioral Sciences, University of Washington and Harborview Medical Center, Seattle
| | - Cynthia A Claassen
- At the time of this research, Dr. Denchev was with the Office of Science Policy, Planning and Communication, National Institute of Mental Health (NIMH), Bethesda, Maryland. Dr. Pearson and Dr. Schoenbaum are with the Division of Services and Intervention Research, NIMH, Bethesda. Dr. Allen is with the Department of Psychiatry, University of Colorado Denver School of Medicine, Aurora, and with Rocky Mountain Crisis Partners, Denver. Dr. Claassen is with the Department of Psychiatry, University of North Texas Health Science Center, Fort Worth. Dr. Currier is with the Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa. Dr. Zatzick is with the Department of Psychiatry and Behavioral Sciences, University of Washington and Harborview Medical Center, Seattle
| | - Glenn W Currier
- At the time of this research, Dr. Denchev was with the Office of Science Policy, Planning and Communication, National Institute of Mental Health (NIMH), Bethesda, Maryland. Dr. Pearson and Dr. Schoenbaum are with the Division of Services and Intervention Research, NIMH, Bethesda. Dr. Allen is with the Department of Psychiatry, University of Colorado Denver School of Medicine, Aurora, and with Rocky Mountain Crisis Partners, Denver. Dr. Claassen is with the Department of Psychiatry, University of North Texas Health Science Center, Fort Worth. Dr. Currier is with the Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa. Dr. Zatzick is with the Department of Psychiatry and Behavioral Sciences, University of Washington and Harborview Medical Center, Seattle
| | - Douglas F Zatzick
- At the time of this research, Dr. Denchev was with the Office of Science Policy, Planning and Communication, National Institute of Mental Health (NIMH), Bethesda, Maryland. Dr. Pearson and Dr. Schoenbaum are with the Division of Services and Intervention Research, NIMH, Bethesda. Dr. Allen is with the Department of Psychiatry, University of Colorado Denver School of Medicine, Aurora, and with Rocky Mountain Crisis Partners, Denver. Dr. Claassen is with the Department of Psychiatry, University of North Texas Health Science Center, Fort Worth. Dr. Currier is with the Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa. Dr. Zatzick is with the Department of Psychiatry and Behavioral Sciences, University of Washington and Harborview Medical Center, Seattle
| | - Michael Schoenbaum
- At the time of this research, Dr. Denchev was with the Office of Science Policy, Planning and Communication, National Institute of Mental Health (NIMH), Bethesda, Maryland. Dr. Pearson and Dr. Schoenbaum are with the Division of Services and Intervention Research, NIMH, Bethesda. Dr. Allen is with the Department of Psychiatry, University of Colorado Denver School of Medicine, Aurora, and with Rocky Mountain Crisis Partners, Denver. Dr. Claassen is with the Department of Psychiatry, University of North Texas Health Science Center, Fort Worth. Dr. Currier is with the Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa. Dr. Zatzick is with the Department of Psychiatry and Behavioral Sciences, University of Washington and Harborview Medical Center, Seattle
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Khatib J, Schwartz N, Bisharat N. Twenty Year Trends of Survival after In-Hospital Cardiac Arrest. Isr Med Assoc J 2017; 19:756-760. [PMID: 29235738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND In 2006, the Israeli Ministry of Health distributed guidelines for improving cardiopulmonary resuscitation (CPR) knowledge among hospital staff. The impact of these guidelines on survival after in-hospital cardiac arrest (IHCA) is unclear. OBJECTIVES To compare rates of incidence and survival to discharge after IHCA, preceding and subsequent to issuance of the guidelines: 1995-2005 and 2006-2015. METHODS Data were retrieved from the computerized records of patients who had an IHCA and underwent CPR. In addition, we retrieved data available from the hospital's resuscitation committee that included number, type, methods of training in CPR refresher courses, type and number of audits carried out during the past 10 years, and type of CPR quality assessments. RESULTS From 1995 to 2015, IHCA incidence increased from 0.7 to 1.7 per 1000 admissions (P < 0.001), while survival rate did not increase (P = 0.37). Survival for shockable rhythms increased from 15.4 to 30.2% (P = 0.05) between the two time periods. The ratio of non-shockable to shockable rhythms increased from 2.4 to 4.6 (P = 0.01) between the two time periods. CONCLUSIONS Overall IHCA survival did not improve following the issuance of guidelines requiring CPR refresher courses, although survival improved for patients with initial shockable dysrhythmia. A decrease of events with initial shockable dysrhythmia, an increase with acute renal failure, and a decrease occurring in intensive care units contributed to understanding the findings. We found that CPR refresher courses were helpful, although an objective measure of their effectiveness is lacking.
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Affiliation(s)
- Jad Khatib
- Department of Anesthesiology, Emek Medical Center, Clalit Health Services, Afula, Israel
| | - Naama Schwartz
- Clinical Research Unit, Emek Medical Center, Clalit Health Services, Afula, Israel
| | - Naiel Bisharat
- Department of Medicine D, Emek Medical Center, Clalit Health Services, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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