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Fraslin AM, Benhamou S, Lebret T, Radvanyi F, Allory Y, Karimi M, Bonastre J. Incidence of Bladder Cancer, Healthcare Pathways, and Economic Burden: A Real-World Observational Study From the French National Healthcare System Database. Clin Genitourin Cancer 2025; 23:102344. [PMID: 40286514 DOI: 10.1016/j.clgc.2025.102344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 03/31/2025] [Accepted: 03/31/2025] [Indexed: 04/29/2025]
Abstract
PURPOSE To assess the incidence (all lesions) of bladder cancer (BC) in France, describe patient characteristics and healthcare pathways during the first year after diagnosis, and estimate medical costs. METHODS All adult patients with an initial BC diagnosis (ICD-10 codes: C67, D09.0, D41.4) in 2017 were selected from the French National Healthcare System Database. Patients were classified according to the most invasive surgical procedure they underwent. Treatments included cystectomy, transurethral resection of bladder tumor (TURBT), intravesical therapy, chemotherapy, and radiotherapy. Healthcare pathways were analyzed as sequences and grouped using hierarchical clustering. Medical costs during the first year of the disease were estimated for each cluster. RESULTS Out of 24,737 incident BC patients selected, the median age at diagnosis was 72 years, and 80.2% were men. Nearly 20% had received treatment for a cancer other than BC in the previous year. The majority (n = 9501, 38.4%) underwent TURBT only with a mean medical cost of €4435 [95% CI: 4322; 4548]. A total of 3037 patients (12.3%) underwent cystectomy as their initial treatment. The estimated costs for the group receiving intravesical instillations following a single TURBT (€6129 [5994; 6264]) were lower than those for the group with repeated TURBT (€9357 [9086; 9628]). Costs for patients who received systemic treatment after cystectomy were the highest at €25,636 [24,519; 26,752]. CONCLUSION Our study estimates the incidence of BC in France, describes healthcare pathways at the national level, and analyses the associated economic burden.
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Affiliation(s)
- Aldéric Masoandro Fraslin
- Department of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, Villejuif, France; University Paris-Saclay, Oncostat U1018, INSERM, Labeled Ligue Contre le Cancer, Villejuif, France.
| | - Simone Benhamou
- Department of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, Villejuif, France; University Paris-Saclay, Oncostat U1018, INSERM, Labeled Ligue Contre le Cancer, Villejuif, France
| | | | - François Radvanyi
- Department of Pathology, Université Paris-Saclay, UVSQ, Institut Curie, Paris, France
| | - Yves Allory
- Department of Pathology, Université Paris-Saclay, UVSQ, Institut Curie, Paris, France
| | - Maryam Karimi
- Department of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, Villejuif, France; University Paris-Saclay, Oncostat U1018, INSERM, Labeled Ligue Contre le Cancer, Villejuif, France
| | - Julia Bonastre
- Department of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, Villejuif, France; University Paris-Saclay, Oncostat U1018, INSERM, Labeled Ligue Contre le Cancer, Villejuif, France
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2
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Zago A, Augustynen A, Obongo-Anga FR, Loeb A, Merle V, Vermeulin T. Determinants of a longer length of stay in major head and neck cancer surgery: A national study based on the French hospital discharge database. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109634. [PMID: 40009929 DOI: 10.1016/j.ejso.2025.109634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Revised: 01/10/2025] [Accepted: 01/23/2025] [Indexed: 02/28/2025]
Abstract
BACKGROUND In many countries where hospitals are funded by a prospective payment scheme based on Diagnosis Related Groups (DRG), two risks may arise whenever legitimate extra costs are not considered: patient selection and/or lower care quality. We aimed to analyse determinants of an increased length of stay (LOS) used as a proxy for costs, in major head and neck cancer surgery. METHODS We selected all hospitalisations in France between 2015 and 2021 classified in the DRG « Major head and neck surgery », with a main diagnosis of cancer. We analysed determinants of the LOS using a multivariate linear model. RESULTS We analysed 19380 stays. We found several factors associated with increased LOS, that are not taken into account in the hospital funding scheme: complexity of surgical procedures, type of admission, patients' comorbidities. CONCLUSIONS Some of these factors should be considered in the hospital funding model.
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Affiliation(s)
- Alessandra Zago
- Henri Becquerel Comprehensive Cancer Center, Public Health and Cancer Prevention Service, Rouen, France; Research team "Dynamique et Evénements des Soins et des Parcours", Rouen, France.
| | - Aline Augustynen
- Henri Becquerel Comprehensive Cancer Center, Public Health and Cancer Prevention Service, Rouen, France
| | - Franchel Raïs Obongo-Anga
- Henri Becquerel Comprehensive Cancer Center, Department of Head and Neck Cancer and ENT Surgery, Rouen, France
| | - Agnès Loeb
- Henri Becquerel Comprehensive Cancer Center, Public Health and Cancer Prevention Service, Rouen, France
| | - Véronique Merle
- Hospital Group Le Havre, Department of Healthcare Quality and Patient Safety, France; Normandie University, UNICAEN, Inserm U 1086, Caen, France; Research team "Dynamique et Evénements des Soins et des Parcours", Rouen, France
| | - Thomas Vermeulin
- Henri Becquerel Comprehensive Cancer Center, Public Health and Cancer Prevention Service, Rouen, France; Research team "Dynamique et Evénements des Soins et des Parcours", Rouen, France
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3
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Boulware LE, Ephraim PL, Shafi T, Green JA, Browne T, Strigo TS, Peskoe S, Wilson J, Lokhnygina Y, Alkon A, Jackson GL, Ellis MJ, Sudan D, Cameron B, Vaitla PK, Cabacungan A, Brubaker L, Obermiller EL, Diamantidis CJ. System Interventions to Achieve Early and Equitable Kidney Transplants (STEPS): Protocol for STEPS, a randomized comparative effectiveness clinical trial. Contemp Clin Trials 2025; 153:107911. [PMID: 40199386 DOI: 10.1016/j.cct.2025.107911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Revised: 03/25/2025] [Accepted: 04/04/2025] [Indexed: 04/10/2025]
Abstract
The System Interventions to Achieve Early and Equitable Kidney Transplants Study (STEPS) is an ongoing pragmatic clinical trial investigating the effectiveness of an equitable and patient-centered approach to kidney care on equitable access to early kidney transplants for individuals with chronic kidney disease not on dialysis. The STEPS intervention combines active electronic health record surveillance to equitably identify all potentially eligible kidney transplant candidates in three health systems ('STEPS Surveillance') with a 'STEPS Outreach Program' (comprised of equity-conscious patient-centered transplant social worker and transplant coordinator outreach and navigation activities). Identified eligible participants are randomly assigned to receive either (a) Augmented Usual Kidney Care (routine care plus electronic surveillance and best practice alerts), or (b) the STEPS Health System Surveillance and Outreach Intervention plus Augmented Usual Kidney Care to improve access to kidney transplants overall as well as among Black and rural residing individuals. STEPS recruited all planned 1168 participants from March 2022 to March 2024. Outcomes will quantify differences between the study arms in progress toward and completion of kidney transplant evaluations, assessed via medical records, and patient-reported outcomes. Registration of clinical trials This study is registered at ClinicalTrials.gov under the identifier NCT05014256.
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Affiliation(s)
- L Ebony Boulware
- Wake Forest University School of Medicine, 525 Vine Street, Winston-Salem, NC 27101, USA.
| | - Patti L Ephraim
- Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY 11030, USA.
| | - Tariq Shafi
- University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA.
| | - Jamie A Green
- Geisinger Health System, 100 N Academy Ave, Danville, PA 17822, USA.
| | - Teri Browne
- University of South Carolina College of Social Work, 1705 College St, Columbia, SC 29208, USA.
| | - Tara S Strigo
- Wake Forest University School of Medicine, 525 Vine Street, Winston-Salem, NC 27101, USA.
| | - Sarah Peskoe
- Duke University, 2080 Duke University Rd, Durham, NC 27708, USA.
| | - Jonathan Wilson
- Duke University, 2080 Duke University Rd, Durham, NC 27708, USA.
| | | | - Aviel Alkon
- Duke University, 2080 Duke University Rd, Durham, NC 27708, USA.
| | - George L Jackson
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; Durham Veterans Affairs Health Care System, Implementation and Improvement Science Lab, Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), HSR&D (152), Suite 600, 411 West Chapel Hill Street, Durham, NC 27701, USA.
| | - Matthew J Ellis
- Duke University Health System, 2200 W Main St, Durham, NC 27705, USA.
| | - Debra Sudan
- Duke University Health System, 2200 W Main St, Durham, NC 27705, USA.
| | - Blake Cameron
- Duke University Health System, 2200 W Main St, Durham, NC 27705, USA.
| | - Pradeep K Vaitla
- University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA.
| | | | - Lauren Brubaker
- Geisinger Health System, 100 N Academy Ave, Danville, PA 17822, USA.
| | - Emily L Obermiller
- Wake Forest University School of Medicine, 525 Vine Street, Winston-Salem, NC 27101, USA.
| | - Clarissa J Diamantidis
- Wake Forest University School of Medicine, 525 Vine Street, Winston-Salem, NC 27101, USA.
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Griffin JM, Kaufman BG, Vanderboom CE, Mandrekar JN, Harmsen WS, Gustavson AM, Ingram C, Wild EM, Dose AM, Taylor EE, Stiles CJ, Holland DE. Caregiver Communication and Preparedness During Transitions in Care: Results from a Randomized Controlled Trial. J Palliat Med 2025. [PMID: 40387577 DOI: 10.1089/jpm.2024.0459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2025] Open
Abstract
Background: Patients with severe and life-limiting illnesses transitioning out of the hospital often rely on family caregivers (FCGs) to manage communication with health care teams during hospitalizations and outpatient care. However, FCGs infrequently receive adequate training or support to prepare for these responsibilities. Effective communication between FCGs and health care teams is critical for preparing FCGs and reducing risks for poor outcomes. This study tested an eight-week intervention to improve FCG preparedness and communication practices during transitions out of the hospital. Methods: Conducted from 2018 to 2022, this randomized controlled trial included adult FCGs in rural areas in the United States (Minnesota, Wisconsin, and Iowa). FCGs caring for adults who received inpatient palliative care and were transitioning out of the hospital were eligible. The intervention group received teaching, guidance, and counseling from a palliative care nurse interventionist via video visits before and for eight weeks after discharge. The control group received monthly phone calls but no intervention. Outcomes included changes in FCG-reported preparedness for caregiving and communication with health care teams. Results: Of the 429 consented, 367 (183 intervention and 184 control participants) initiated the intervention; 164 had complete preparedness data, and 161 had complete communication data at baseline and eight weeks. In unadjusted analyses, the intervention group showed statistically significant improvements in preparedness but not communication practices. After adjusting for factors associated with care transitions, the findings persisted. Conclusion: Partnering rural FCGs with palliative care nurses via video can improve caregiver preparedness during care transitions. Improving communication practices may need more targeted strategies.
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Affiliation(s)
- Joan M Griffin
- Kern Center for the Science of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Brystana G Kaufman
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA
- Durham U.S. Department of Veterans Affairs, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Catherine E Vanderboom
- Kern Center for the Science of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Jay N Mandrekar
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - William S Harmsen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Allison M Gustavson
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cory Ingram
- Department of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, Minnesota, USA
| | - Ellen M Wild
- Department of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, Minnesota, USA
| | - Ann Marie Dose
- Kern Center for the Science of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Erin E Taylor
- Department of Social Work, Mayo Clinic, Rochester, Minnesota, USA
| | - Carole J Stiles
- Department of Social Work, Mayo Clinic, Rochester, Minnesota, USA
| | - Diane E Holland
- Kern Center for the Science of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
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Bel Alonso E, Grember A, Cheval C, Papillon R, Mairot L, Deroux A, Bouillet L, Bellier A, Dumanoir P. Interest of Lung Ultrasound in the Management of Acute Heart Failure in Post-Emergency Service. Life (Basel) 2025; 15:752. [PMID: 40430180 DOI: 10.3390/life15050752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2025] [Revised: 04/27/2025] [Accepted: 04/29/2025] [Indexed: 05/29/2025] Open
Abstract
Lung ultrasound (LUS) has emerged as a simple, rapid, and non-invasive method for the dynamic assessment of pulmonary congestion, a major prognostic factor and a therapeutic target in acute heart failure (AHF). In a single-center prospective observational study, 42 patients hospitalized for AHF in the post-emergency polyvalent medicine department of CHU Grenoble were successively included between May 2021 and July 2022. Patients undergoing hemodialysis, those with pneumonectomy or lung fibrosis, or those placed under guardianship or deprived of freedom were excluded. Clinical examination, LUS, and electrolyte panel results were collected daily. Vital status was assessed 30 days after the last LUS. The primary endpoint was the evolution of the number of B-lines in relation to the dose of diuretic administered. Secondary endpoints included the evolution of B-lines according to clinical signs of congestion and plasma creatinine levels, the agreement between LUS and clinical findings at discharge, and the prognostic value of LUS at discharge for 30-day re-admission for AHF and all-cause mortality. A total of 188 LUS were performed. The patients were elderly (85.8 years [SD 8.1]) and comorbid. The median number of B-lines decreased from 17 at admission to 7 mid-hospitalization, then stabilized. The median daily intravenous diuretic dose declined from 40 mg to 20 mg. Patients with chronic kidney disease (CKD) had more B-lines at admission (24.2 (SD 11.6) vs. 8.2 (SD 8.8)). However, B-line evolution was independent of creatinine levels. Higher B-lines at discharge were significantly associated with 30-day mortality (15.2 vs. 3.9, p < 0.001). In the absence of a gold standard for the assessment of pulmonary congestion, LUS appears to be an additional tool for optimizing the management of AHF.
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Affiliation(s)
- E Bel Alonso
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, 38700 La Tronche, France
| | - A Grember
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, 38700 La Tronche, France
| | - C Cheval
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Besançon, 25030 Besançon, France
| | - R Papillon
- Department of Internal Medicine, University Hospital of Grenoble Alpes, 38700 La Tronche, France
| | - L Mairot
- Department of Internal Medicine, University Hospital of Grenoble Alpes, 38700 La Tronche, France
| | - A Deroux
- Department of Internal Medicine, University Hospital of Grenoble Alpes, 38700 La Tronche, France
| | - L Bouillet
- Department of Internal Medicine, University Hospital of Grenoble Alpes, 38700 La Tronche, France
| | - A Bellier
- CNRS TIMC Laboratory, UMR 5525, University of Grenoble Alpes, 38700 La Tronche, France
| | - P Dumanoir
- Department of Internal Medicine, University Hospital of Grenoble Alpes, 38700 La Tronche, France
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Qiu Y, Xiong W, Fang X, Li P, Conroy S, Maynou L, Rockwood K, Liu X, Wu J, Street A. Validation of the hospital frailty risk score in China. Eur Geriatr Med 2025:10.1007/s41999-025-01212-0. [PMID: 40314855 DOI: 10.1007/s41999-025-01212-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Accepted: 04/07/2025] [Indexed: 05/03/2025]
Abstract
PURPOSE To validate the Hospital Frailty Risk Score (HFRS) in Chinese hospital settings, describing how patients are allocated to frailty risk groups and how frailty risk is associated with length of stay (LoS) and hospital costs. DESIGN Retrospective observational study. SETTING Forty-eight hospitals in Lvliang City, Shanxi Province, China. SUBJECTS Patients aged 75 years or older hospitalised between 1 January 2022 and 31 December 2023 (n = 34,731). METHODS A logistic regression model examined the association between long length of stay (LoS) and frailty risk. A generalised linear model assessed the association between hospital costs and frailty risk. Subgroup analyses of age group, sex, and hospital tiers were conducted. RESULTS 22.2% of patients were categorised as having zero risk, 62.4% as low risk, 15.3% as intermediate risk, and 0.08% as high risk. Compared to the zero risk group: for those with low risk, the probability of long LoS was 1.92 (95% CI 1.79-2.06) times higher and hospital costs were ¥1926 (95% CI 1655-2197) higher; for those with intermediate risk, the probability of long LoS was 2.7 (95% CI 2.49-2.96) times higher and hospital costs were ¥4284 (95% CI 3916-4653) higher; and for those with high risk, the probability of long LoS was 6.7 (95% CI 3.06-14.43) times higher and hospital costs were ¥16,613 (95% CI 12,827-20,399) higher. The explanatory power of the HFRS held across subgroups. CONCLUSIONS Compared to patients aged 75 + elsewhere, those in China had lower frailty risk scores, likely reflecting a younger age structure and recording of fewer diagnosis codes. Even so, the HFRS is a powerful predictor of long length of stay and hospital costs in China.
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Affiliation(s)
- Yue Qiu
- Tsinghua Medicine, Tsinghua University, Haidian District, Beijing, 100084, China
| | - Weiqing Xiong
- Tsinghua Medicine, Tsinghua University, Haidian District, Beijing, 100084, China
| | - Xinyue Fang
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, Guangdong, 518055, China
| | - Pei Li
- Tsinghua Medicine, Tsinghua University, Haidian District, Beijing, 100084, China
| | - Simon Conroy
- Wolfson Institute of Population Health, Queen Mary University of London, Mile End Road, E1 4NS, London, UK
| | - Laia Maynou
- Department of Econometrics, Statistics and Applied Economics, Universitat de Barcelona, Barcelona, Spain
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Frailty Elder Care Network, Nova Scotia Health, Dalhousie University, Halifax, NS, B3H2E1, Canada
| | - Xien Liu
- Department of Electronic Engineering, Tsinghua University, Beijing, 100084, China
| | - Ji Wu
- Department of Electronic Engineering, Tsinghua University, Beijing, 100084, China
- College of AI, Tsinghua University, Beijing, 100084, China
| | - Andrew Street
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
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7
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Thereaux J, Badic B, Fuchs B, Leven C, Caillard A, Lacut K, Metges JP, Couturaud F. Comprehensive assessment of 1-year postoperative venous thromboembolism and associated mortality risks in hepatopancreatobiliary cancer surgeries: A national survey. Surgery 2025; 181:109171. [PMID: 39952022 DOI: 10.1016/j.surg.2025.109171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 12/13/2024] [Accepted: 01/08/2025] [Indexed: 02/17/2025]
Abstract
BACKGROUND Venous thromboembolism is a well-recognized complication after hepatopancreatobiliary surgery. However, there is a paucity of nationwide data on risk factors and incidence within 1 year of surgery in patients undergoing hepatopancreatobiliary surgery. METHODS This nationwide observational population-based cohort study used data extracted from all patients undergoing surgery for cancer surgery of the liver and the pancreas in France between 1 January 2015 and 31 December 2017. Estimation of 1 postoperative year cumulative incidence of venous thromboembolism and Cox proportional hazards model on 1-year global mortality were performed. RESULTS During the study period, 16,960 patients underwent cancer surgery of the liver (n = 9,381) or pancreas (n = 7,579). The 90-day postoperative rate of venous thromboembolism was 6.1% (cancer surgery of the liver) and 6.7% (cancer surgery of the pancreas). Main risk factors of 90-day postoperative rate of venous thromboembolism were major hepatectomy (1.85; 1.55-2.21), left pancreatectomy (1.45; 1.18-1.79), presence of obesity (1.41; 1.16-1.71), history of venous thromboembolism (4.58; 3.41-6.14), open approach (1.31; 1.06-1.62), and the occurrence of serious surgical complication (1.55; 1.35-1.79). At 1 year, patients undergoing cancer surgery of the liver were at a lower risk of cumulative incidence (%) of venous thromboembolism compared with the cancer surgery of the pancreas group (P < .001) (7.0; 6.5-7.6 vs 9.8; 9.1-10.4). Patients with venous thromboembolism within 1 year had greater risks of 1-year global mortality for each hepatopancreatobiliary surgery group: 3.58 (95% confidence interval, 3.02-4.23) and 3.97 (95% confidence interval, 3.40-4.63), respectively. CONCLUSION Postoperative venous thromboembolism is a significant issue after hepatopancreatobiliary surgery, within 90 days postoperatively and up to 1 year, with the cancer surgery of the pancreas group being particularly at risk. A greater risk of global mortality within 1 year for patients experiencing early or late venous thromboembolism was found.
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Affiliation(s)
- Jérémie Thereaux
- University Brest, CHU Brest, Brest, France; Department of General, Digestive and Metabolic Surgery, La Cavale Blanche University Hospital, Boulevard Tanguy Prigent, Brest, France.
| | - Bogdan Badic
- Department of General, Digestive and Metabolic Surgery, La Cavale Blanche University Hospital, Boulevard Tanguy Prigent, Brest, France; Univ Brest, CHU Brest, UMR 1304, Western Brittany Thrombosis Group, Brest, France
| | - Basil Fuchs
- Department of Medical Information, La Cavale Blanche University Hospital, Boulevard Tanguy Prigent, Brest, France
| | - Cyril Leven
- University Brest, CHU Brest, Brest, France; Department of Biochemistry and Pharmaco-Toxicology, La Cavale Blanche University Hospital, Boulevard Tanguy Prigent, Brest, France
| | - Anais Caillard
- Department of Anesthesia and Intensive Care, La Cavale Blanche and Morvan University Hospitals, Boulevard Tanguy Prigent, Brest, France
| | - Karin Lacut
- University Brest, CHU Brest, Brest, France; Department of Internal Medicine, Vascular Medicine and Pneumology, La Cavale Blanche University Hospital, Boulevard Tanguy Prigent, Brest, France
| | | | - Francis Couturaud
- University Brest, CHU Brest, Brest, France; Department of Internal Medicine, Vascular Medicine and Pneumology, La Cavale Blanche University Hospital, Boulevard Tanguy Prigent, Brest, France
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8
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Costa N, Gombault E, Marcélo C, Pagès A, Molinier L, de Souto Barreto P, Rolland Y. Association between intrinsic capacities limitations and annual healthcare costs in Nursing Home residents. BMC Geriatr 2025; 25:301. [PMID: 40312672 PMCID: PMC12044873 DOI: 10.1186/s12877-025-05914-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/08/2025] [Indexed: 05/03/2025] Open
Abstract
BACKGROUND The aim of this study is to analyse the associations of annual Intrinsic Capacities (IC) impairment evolution with the annual cost of care in Nursing Home (NH) residents. This was a prospective, longitudinal and multicenter study. NH residents in the Occitanie region (south of France), 60 years and older with moderate level of dependency were included in the study and were followed during 12 months. METHODS IC was assessed for four of the six IC domains (Cognitive, locomotion, vitality and psychological). Longitudinal IC impairment trajectories of residents were built using the K-means Longitudinal method. Costs were assessed from the healthcare payer's perspective and include direct medical and non-medical costs. Descriptive analyses of costs and characteristics as well as general linear models were carried out. RESULTS Three hundred forty-five residents (86 years old on average and mostly women) were included. Mild, moderate and severe impairment profiles were clustered. For the cognitive domain, we observe a total cost decrease of 1552€ between the most severe impairment profile and the less severe profile, led by medication costs. For the locomotion, psychological and vitality domains we observed a total cost increase of 1,672€, 3,869 € and 1,709€ for the most severe impairment profile in comparison with the less severe profile, respectively. This cost increase was driven by hospitalisation for the psychological and the vitality domains and by physiotherapist costs for the locomotion domain. Medication costs decrease with the severity of impairment whatever the IC domain considered. CONCLUSIONS Our study is the first aiming to estimate the association between impairment on IC domains and healthcare costs in NH. The implementation of clusterization highlight resident's profiles using data driven process, which may facilitate the implementation of personalized health strategies.
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Affiliation(s)
- N Costa
- Health Economic Unit, University Hospital of Toulouse, Toulouse, 31059, France.
- CERPOP, Inserm 1295, Toulouse, France.
| | - E Gombault
- Health Economic Unit, University Hospital of Toulouse, Toulouse, 31059, France
- CERPOP, Inserm 1295, Toulouse, France
- Université de Toulouse, UPS, Toulouse, France
| | - C Marcélo
- Health Economic Unit, University Hospital of Toulouse, Toulouse, 31059, France
| | - A Pagès
- CERPOP, Inserm 1295, Toulouse, France
- Department of Pharmacy, Hôpital Paule de Viguier, CHU de Toulouse, 330, Avenue de Grande Bretagne - TSA 7003431059 Cedex 9, Toulouse, France
- Gérontopôle, Institute of Aging, CHU de Toulouse, INSPIRE Project, Toulouse, France
| | - L Molinier
- Health Economic Unit, University Hospital of Toulouse, Toulouse, 31059, France
- CERPOP, Inserm 1295, Toulouse, France
- Université de Toulouse, UPS, Toulouse, France
| | - P de Souto Barreto
- CERPOP, Inserm 1295, Toulouse, France
- Université de Toulouse, UPS, Toulouse, France
- Gérontopôle, Institute of Aging, CHU de Toulouse, INSPIRE Project, Toulouse, France
| | - Y Rolland
- CERPOP, Inserm 1295, Toulouse, France
- Université de Toulouse, UPS, Toulouse, France
- Gérontopôle, Institute of Aging, CHU de Toulouse, INSPIRE Project, Toulouse, France
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9
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Akhmedullin R, Gusmanov A, Zhakhina G, Crape B, Aimyshev T, Semenova Y, Kyrgyzbay G, Gaipov A. The Regional Burden of Parkinson's Disease in Kazakhstan 2014-2021: Insights From National Health Data. PARKINSON'S DISEASE 2025; 2025:4317554. [PMID: 40342812 PMCID: PMC12061520 DOI: 10.1155/padi/4317554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 04/12/2025] [Indexed: 05/11/2025]
Abstract
Background: This study explores the burden of Parkinson's disease (PD) in Kazakhstan, the largest country in Central Asia, a region where data on neurological disorders are notably sparse. Methods: Utilizing data from Kazakhstan's Unified National Electronic Health System during 2014-2021, the study investigates the epidemiology, disability-adjusted life years (DALYs), and survival outcomes in a cohort of PD patients. The authors employed Cox proportional hazards regression models and Kaplan-Meier analysis, alongside sensitivity analyses, to assess the impact of demographic factors, hypertension, and the Charlson Comorbidity Index (CCI) on survival. Results: The study cohort included 10,125 patients, revealing a tenfold increase in PD prevalence during the study period. Mortality rates varied significantly, with the highest rates observed in the eldest age group (137.05 per 1000 person-years). PD contributed to a loss of 156.12 DALYs per 100,000 population, primarily driven by years of life lost. The analysis identified an increased risk of all-cause mortality among males (adjusted hazard ratio (aHR) 1.6; 1.5-1.8), older individuals (aHR 1.05; 1.04-1.06), those with higher CCIs, and individuals of Kazakh ethnicity. Interestingly, patients with comorbid hypertension had a higher probability of survival (aHR 0.67; 0.60-0.73). Conclusion: This study is the first of its kind in Central Asia to examine the burden of PD using a large-scale outpatient registry. The findings underscore the need for targeted interventions to address the growing burden of PD, particularly among males and ethnic Kazakhs. Additionally, further research is needed to explore the inverse association between hypertension and survival in the PD cohort.
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Affiliation(s)
- Ruslan Akhmedullin
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Arnur Gusmanov
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Gulnur Zhakhina
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Byron Crape
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Temirgali Aimyshev
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Yuliya Semenova
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Gaziz Kyrgyzbay
- Department of Functional Diagnostics, RSE Medical Centre Hospital of the President's Affairs Administration of the Republic of Kazakhstan, Astana, Kazakhstan
| | - Abduzhappar Gaipov
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
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10
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Mizuno K, Kishimoto Y, Takeuchi M, Omori K, Kawakami K. Demographic and Clinical Trends in Adult Tracheostomy: Analysis of a Japanese Inpatient Database. Laryngoscope 2025. [PMID: 40292961 DOI: 10.1002/lary.32206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 03/10/2025] [Accepted: 04/03/2025] [Indexed: 04/30/2025]
Abstract
OBJECTIVE To analyze demographics, underlying diseases, and clinical outcomes of adult patients undergoing tracheostomy over 6 years, identifying annual changes and significant trends. METHODS This study is a descriptive analysis of a retrospective cohort. Data were obtained from the Diagnosis Procedure Combination inpatient database in Japan between January 2016 and December 2021. Adult patients (≥ 20 years) who underwent tracheostomy were included, excluding those from facilities inconsistently included in the database. Trends in demographics, underlying diseases, Charlson Comorbidity Index scores, departments performing tracheostomies, intensive care unit (ICU) admissions, body mass index at admission, hospital stay duration, timing of mechanical ventilation initiation, and discharge routes were analyzed. RESULTS A total of 22,480 patients were included (66.0% men; median age, 73 years). Respiratory diseases (36.6%) were the most common condition, followed by neurological diseases (29.4%), cardiovascular diseases (21.2%), and cancer and benign tumors (19.9%). The median hospital stay was 56 days, which slightly decreased to 53 days in 2021. Transfers to other hospitals increased from 51.0% in 2016 to 55.9% in 2021. Among 10,499 patients requiring ICU ventilatory management, 2756 (26.3%) underwent tracheostomy within 7 days of initiating mechanical ventilation, with no significant increase in early tracheostomy rates over the study period. CONCLUSION The study highlights that respiratory diseases are the leading indication for tracheostomy in adults. The majority of tracheostomies were performed after the initiation of mechanical ventilation, underscoring prolonged ventilation as a primary indication. Further research is warranted to optimize guidelines for tracheostomy timing and indications in adult patients. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Kayoko Mizuno
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
- Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Yo Kishimoto
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masato Takeuchi
- Department of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Koichi Omori
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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11
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Iacono S, Schirò G, Aridon P, Andolina M, Sorbello G, Calì A, D'Amelio M, Salemi G, Ragonese P. Performance of a Modified Version of the Charlson Comorbidity Index in Predicting Multiple Sclerosis Disability Accrual. Neuroepidemiology 2025:1-11. [PMID: 40288366 DOI: 10.1159/000539829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 06/04/2024] [Indexed: 04/29/2025] Open
Abstract
BACKGROUND The natural history of multiple sclerosis (MS) is highly heterogeneous and almost unpredictable since several factors may affect the disease course including comorbidities. The aims of this study were to predict the risk of disability worsening and disease progression at the first patient's visit by using a modified version of the Charlson Comorbidity Index (mCCI). METHODS the mCCI was obtained by incorporating the grade of pyramidal functional system scores extracted by the Expanded Disability Status Scale (EDSS) into the original CCI version. The risk of reaching EDSS 4, EDSS 6, and secondary MS progression (SPMS) associated to mCCI classes was calculated by carrying out multivariable Cox-regression models and it was reported as hazard ratios (HRs) and 95% confidence intervals (95% CIs). The accuracy of mCCI for the recognition of individuals who reached the study milestones was estimated by building the receiving operator curves and the optimal cut-off values were estimated. RESULTS A total of n = 622 individuals were enrolled (72.7% women; median age 30.8 years [24-40]). Compared with patients with a mCCI equal to zero, the HRs for those with a mCCI comprised between 1 and 2 at the first visit were 1.53 (1.1-2.1), 2.17 (1.48-2.96), and 1.57 (1.16-2.1) for the reaching of EDSS 4, EDSS 6, and SPMS, respectively. Moreover, individuals with a mCCI equal or higher than 3 were at even higher risk of reaching EDSS 6 (HR = 2.34 [1.44-3.8]) and SPMS conversion (HR = 2.38 [1.29-4.01]). The mCCI cut-off value of 3 reached a sensitivity and specificity of 88.1% and 77.8%, respectively, for the recognition of EDSS 4, while the mCCI cut-off of 4 reached a sensitivity of 83.1% and a specificity of 80.7% for the recognition of EDSS 6 and a sensitivity and a specificity of 76.8% and 87.5%, respectively, for the recognition of SPMS conversion. CONCLUSION mCCI appeared a simple and fast tool for the prediction of MS prognosis since the first patient's visit and its best cut-off values showed higher sensitivity and specificity for the recognition of patients who undergo disability worsening and SPMS conversion.
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Affiliation(s)
- Salvatore Iacono
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
- Neurology and Multiple Sclerosis Center, Foundation Institute "G. Giglio,", Cefalù, Italy
| | - Giuseppe Schirò
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
- Neurology and Multiple Sclerosis Center, Foundation Institute "G. Giglio,", Cefalù, Italy
| | - Paolo Aridon
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Michele Andolina
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Gabriele Sorbello
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Andrea Calì
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Marco D'Amelio
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Paolo Ragonese
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
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12
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Liu C, Beresford A, Saleeb M, Liu G, Crump T, Warburton R, Pao JS, Dingee CK, Bazzarelli A, Sutherland JM, McKevitt EC. Preoperative and Postoperative Change in Patient-Reported Health-Related Quality of Life Outcomes in Breast Cancer Surgery Patients Across Surgical Modalities: A Prospective Study. Cancers (Basel) 2025; 17:1409. [PMID: 40361335 PMCID: PMC12071003 DOI: 10.3390/cancers17091409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2025] [Revised: 04/16/2025] [Accepted: 04/18/2025] [Indexed: 05/15/2025] Open
Abstract
Background: This study compared the change in pre- and postoperative health-related quality of life (HRQoL) among breast cancer patients undergoing breast-conserving surgery (BCS), total mastectomy no reconstruction (TMNR), and total mastectomy immediate breast reconstruction (MIBR). Patient factors associated with postoperative anxiety and depression were also identified. Methods: This prospective cohort study enrolled breast cancer patients between September 2017 and August 2020. HRQoL changes from preoperative to six months postoperative were compared using patient-reported outcome tools assessing anxiety, depression, pain, perceived health, breast satisfaction, psychosocial, physical, and sexual well-being and analyzed with ANOVA and linear regression. Results: A total of 471 patients completed preoperative and postoperative surveys (BCS: 313, TMNR: 60, MIBR: 98). Postoperative anxiety decreased across all modalities, with MIBR showing the greatest reduction (p = 0.03), though still exhibiting the highest postoperative anxiety (p = 0.05). Depression and perceived health scores showed no significant difference in change across modalities (p = 0.15, p = 0.48). MIBR patients showed the greatest increase in pain (p = 0.05) and the highest postoperative pain scores (p = 0.04). All three modalities showed a clinically significant decline in physical and sexual well-being. TMNR and MIBR had additional reductions in breast satisfaction, with TMNR also showing a decline in psychosocial well-being. Absolute postoperative scores for breast satisfaction, psychosocial, physical, and sexual well-being remained highest in BCS compared to TMNR and MIBR (p < 0.01, for each domain). In multivariable regression analysis, postoperative depression and anxiety scores did not differ between surgical modalities, but younger age was significantly associated with higher postoperative depression, pain and anxiety (p < 0.01), and adjuvant chemotherapy with higher postoperative depression (p < 0.01). Conclusions: BCS may have better overall HRQoL outcomes, specifically in breast satisfaction, psychosocial, physical, and sexual well-being, compared to TMNR and MIBR. Additionally, younger age, rather than surgical modality, was found to be associated with higher postoperative depression, pain, and anxiety scores.
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Affiliation(s)
- Claire Liu
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Aidan Beresford
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC V6T 1Z3, Canada (J.M.S.)
| | - Maria Saleeb
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC V6T 1Z3, Canada (J.M.S.)
| | - Guiping Liu
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC V6T 1Z3, Canada (J.M.S.)
| | - Trafford Crump
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H4A 3J1, Canada
| | - Rebecca Warburton
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
| | - Jin-Si Pao
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
| | - Carol K. Dingee
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
| | - Amy Bazzarelli
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
| | - Jason M. Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC V6T 1Z3, Canada (J.M.S.)
| | - Elaine C. McKevitt
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
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13
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Francis G, Romain C, Jonathan E, Yohann F, David L, Hamza A, Fabien R, Emmanuelle L, Sandra V. Prognostic factors of disability progression in multiple sclerosis in real life: the OFSEP-high definition (OFSEP-HD) prospective cohort in France. BMJ Open 2025; 15:e094688. [PMID: 40194873 PMCID: PMC12001352 DOI: 10.1136/bmjopen-2024-094688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2024] [Accepted: 03/20/2025] [Indexed: 04/09/2025] Open
Abstract
PURPOSE To determine prognostic factors of disability in multiple sclerosis (MS), that is, (1) identify determinants of the dynamics of disability progression; (2) study the effectiveness of disease-modifying treatments (DMTs); (3) merge determinants and DMTs for creating patient-centred prognostic tools and (4) conduct an economic analysis. PARTICIPANTS Individuals registered in the French Observatoire Français de la Sclérose en Plaques (OFSEP) database were included in this OFSEP-high definition cohort if they had a diagnosis of MS, were ≥15 years old and had an Expanded Disability Status Scale (EDSS) score <7. The outcomes will be assessed annually: (1) time to reach irreversible EDSS scores of 4, 6 and 7; (2) relapses and disease progression; (3) MRI-based progression, patient-reported outcomes, social consequences; and (4) combined outcomes on activity and progression. Clinical and quality-of-life data, MRI results and biological (blood, serum) samples will be collected at each follow-up. FINDINGS TO DATE A cohort of 2842 individuals, 73.4% women, mean (SD) age of 42.7 (11.6) years, median disease duration of 8.8 years, has been recruited from July 2018 to September 2020. The course of MS was relapsing remitting in 67.7%, secondary progressive in 11.9%. The mean annual relapse rate was 0.98. The disease-modifying treatment received was highly effective therapy in 50.3% and moderately effective therapy in 30.7%. FUTURE PLANS The participants will be followed until December 2026. Disease course up to four landmarks will be examined as predictors of disease progression: (1) diagnosis of MS; (2) relapse activity worsening and independent progression; (3) any recent disease activity and (4) any visit with absence of disease activity in the past 5 years. The marginal effectiveness and tolerability of treatments will be assessed. Stratified algorithms will be proposed for medical decision-making. Economic evaluation of disease cost and cost-effectiveness of new DMTs will be conducted from a public payer perspective. TRIAL REGISTRATION NUMBER NCT03603457.
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Affiliation(s)
- Guillemin Francis
- CHRU, INSERM, Université de Lorraine, CIC Clinical Epidemiology, Nancy, Grand Est, France
- Université de Lorraine, INSERM, INSPIIRE, Paris, Île-de-France, France
| | - Casey Romain
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Epstein Jonathan
- CHRU, INSERM, Université de Lorraine, CIC Clinical Epidemiology, Nancy, Grand Est, France
- Université de Lorraine, INSERM, INSPIIRE, Paris, Île-de-France, France
| | - Foucher Yohann
- CIC 1402 INSERM, CHU de Poitiers, Université de Poitiers, Poitiers, France
| | - Laplaud David
- CHU Nantes, Service de Neurologie, CRC-SEP, Nantes Université, INSERM, CIC 1413, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000, Nantes, France
| | - Achit Hamza
- CHRU, INSERM, Université de Lorraine, CIC Clinical Epidemiology, Nancy, Grand Est, France
| | - Rollot Fabien
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Leray Emmanuelle
- Univ Rennes, EHESP, CNRS, INSERM, Arènes-UMR 6051, RSMS (Recherche sur les Services et Management en Santé)-U 1309, Rennes, France
| | - Vukusic Sandra
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
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14
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Zumeta-Olaskoaga L, Ibarrondo O, Del Pozo R, Zapiain A, Larrañaga I, Mar J. The Excess Direct Social Costs of Dementia-Related Neuropsychiatric Symptoms: A Regionwide Cohort Study Beyond Silos. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2025; 28:536-544. [PMID: 39733834 DOI: 10.1016/j.jval.2024.10.3855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 09/19/2024] [Accepted: 10/15/2024] [Indexed: 12/31/2024]
Abstract
OBJECTIVES To estimate the excess formal social costs or direct non-healthcare costs of dementia-related neuropsychiatric symptoms (NPS). METHODS The presence of dementia, NPS, antipsychotic and antidepressant use, somatic and psychiatric comorbidities, and formal social benefits were studied in a regionwide cohort of all 60-year-old and older individuals. A random forest-based algorithm identified NPS, and 2-part regression models and entropy balance were used. RESULTS Of the 215 859 individuals, 7553 (3.50%) had dementia, 74 845 (34.7%) had some NPS, and 20 787 (9.63%) received long-term care benefits. Notably, nearly two-thirds (63.9%) of people with dementia received benefits. The probability of having social costs varied markedly with age (odds ratio [OR] 12.28 [10.17-14.82] for >90-year-olds category), and the presence of dementia (OR 7.36 [6.13-8.84]) or NPS (OR 3.23 [2.69-3.88]). NPS (relative change [RC] 1.39 [1.31-1.49]) and dementia (RC 1.32 [1.24-1.41]) were associated with higher average benefit costs. Low socioeconomic status was significantly associated with both a higher probability of receiving benefits (OR 1.52 [1.38-1.68]) and higher costs of their provision (RC 1.18 [1.15-1.21]). CONCLUSIONS The burden of caring for NPS is greater than that indicated by the literature as these symptoms multiply the social costs of dementia by more than 3, owing to the greater use of residential care and formal coverage reaching more patients than that indicated by the literature. The greater presence of dementia and NPS in the population of lower socioeconomic status indicates an inequality in health attenuated by greater use of social benefits.
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Affiliation(s)
| | - Oliver Ibarrondo
- Research Unit, Biogipuzkoa Health Research Institute, Donostia-San Sebastián, Spain; Research Unit, Osakidetza Basque Health Service, Debagoiena Integrated Health Organization, Arrasate-Mondragón, Spain
| | - Raúl Del Pozo
- Department of Economics, University of Castilla la Mancha, Cuenca, Spain
| | - Ander Zapiain
- Department of Social Welfare, Provincial Council of Gipuzkoa, Donostia-San Sebastián, Spain
| | - Igor Larrañaga
- Research Unit, Biosistemak Institute for Health Services Research, Barakaldo, Spain
| | - Javier Mar
- Research Unit, Biogipuzkoa Health Research Institute, Donostia-San Sebastián, Spain.
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15
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Grimaud O, Kerbrat S, Menant L, Timsit S, André JM, Nowak E, Olié V, Padilla C, Le Meur N. Ischemic stroke care for patients affiliated to the French agricultural health insurance scheme: A national study. Rev Neurol (Paris) 2025; 181:298-304. [PMID: 39988496 DOI: 10.1016/j.neurol.2025.01.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 01/20/2025] [Accepted: 01/22/2025] [Indexed: 02/25/2025]
Abstract
BACKGROUND Health disparities along the rural-urban spectrum are a growing concern. The objective of this study was to determine whether in France, clinical profile, care and outcome after ischemic stroke differed between patients affiliated to the statutory health insurance system dedicated to the agricultural economic sector (i.e., Mutualité Sociale Agricole [MSA]) and all other patients. METHODS Data on all patients aged≥20 years hospitalized for ischemic stroke in mainland France in 2018 were extracted from the French National Health Insurance Data System. Age-standardized percentages were used to compare the care accessed by MSA versus other stroke patients. Associations between health insurance scheme and case fatality were assessed using Poisson regression. RESULTS Of 87,864 stroke cases 7928 (9%) were MSA patients. MSA patients were more often rural dwellers (75.4 versus 32%) and older (median age: 84 versus 76 years). In the 12 months prior to the stroke, access to general practitioner (GP) was similar, but MSA patients were less likely to have an appointment with a cardiologist. Pre-stroke drug prescriptions suggested a better cardiovascular profile in male MSA patients (e.g., antidiabetics: 18.1 versus 21.5%). A part from a lower access to stroke unit (e.g., women: 55.3 versus 59%) other acute care indicators, including reperfusion therapy, were comparable. The crude 7-day case fatality was higher for MSA patients (Relative Risk [RR]: 1.44, 95% CI [1.32-1.57]), but this disadvantage reduced to non-significant level after adjustment for age, comorbidities and stroke management (adjusted RR: 1.07 95% CI [0.98-1.18]) CONCLUSIONS: For the mostly farming, rural, MSA population, pre-stroke, acute and post-stroke care did not differ markedly from that provided to other patients. The lower density of GP in rural areas and the remoteness from specialized center did not result in less access to preventive and acute stroke care for MSA patients in 2018.
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Affiliation(s)
- O Grimaud
- EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, Rennes University, Rennes, France.
| | | | - L Menant
- EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, Rennes University, Rennes, France
| | - S Timsit
- Neurology and Stroke Unit Department, CHRU de Brest, Inserm 1078, université de Bretagne Occidentale, Brest, France
| | - J-M André
- EHESP, CNRS, ARENES UMR 6051, Rennes University, Rennes, France
| | - E Nowak
- DAMAD, 29280 Plouzane, France
| | - V Olié
- Santé Publique France, Saint Maurice, France
| | - C Padilla
- EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, Rennes University, Rennes, France
| | - N Le Meur
- EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, Rennes University, Rennes, France
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Wang SJ, Sun L, Shih YH, Lu TF, Chen YF, Hsu ST, Liu CK, Hwang SF, Chen JK, Chen HH, Lu CH. Lenvatinib plus pembrolizumab compared to carboplatin plus paclitaxel for carboplatin and paclitaxel pretreated, recurrent, or advanced endometrial cancer. BMC Med 2025; 23:160. [PMID: 40087652 PMCID: PMC11909920 DOI: 10.1186/s12916-025-03989-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 03/06/2025] [Indexed: 03/17/2025] Open
Abstract
BACKGROUND Lenvatinib plus pembrolizumab has demonstrated improved survival compared with doxorubicin or paclitaxel monotherapy in patients with advanced or recurrent endometrial cancers (ECs). However, response rates to monotherapy are poor in recurrent settings. Herein, we performed a retrospective analysis using real-world data to compare the outcomes of lenvatinib plus pembrolizumab, carboplatin plus paclitaxel (PT), and doxorubicin for patients with PT-pretreated, advanced, or recurrent ECs. METHODS We performed a multi-institutional retrospective analysis using de-identified electronic health record database (TriNetX) to compare lenvatinib plus pembrolizumab, carboplatin plus paclitaxel (PT), and doxorubicin outcomes in patients with PT-pretreated, advanced, or recurrent ECs. A 1:1 propensity score matching (PSM) was conducted. The primary outcome was the overall survival (OS) among treatment groups. The secondary outcome was the adverse event profile. RESULTS Between January 2012 and September 2023, we identified 397 patients with PT-treated, advanced, or recurrent ECs who received lenvatinib plus pembrolizumab, and 469 patients receiving PT at a platinum-free interval of over 6 months. Following PSM, no significant difference in median OS was observed between the lenvatinib plus pembrolizumab and re-challenge PT groups (19.1 vs. 18.5 months, p = 0.60; hazard ratio: 1.08, 95% confidence interval 0.81-1.46). However, lenvatinib plus pembrolizumab provided better survival benefits than doxorubicin. Adverse event analysis showed more hypothyroidism, hypertension, and proteinuria with lenvatinib plus pembrolizumab, and more hematologic toxicities in both chemotherapy groups. CONCLUSIONS Lenvatinib plus pembrolizumab was not associated with improved survival when compared with re-challenge PT in patients with a platinum-free interval of over 6 months. Re-challenge PT remains a valid option for PT-treated, recurrent, or advanced ECs, especially in patients with a substantially long platinum-free interval.
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Affiliation(s)
- Shao-Jing Wang
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, ROC, 40705, Taiwan
| | - Lou Sun
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, ROC, 40705, Taiwan
- Department of Food and Nutrition, Providence University, Taichung, Taiwan
| | - Yu-Hsiang Shih
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, ROC, 40705, Taiwan
- College of Health Care and Management, Chung Shan Medical University, Taichung, Taiwan
| | - Ting-Fang Lu
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, ROC, 40705, Taiwan
| | - Yen-Fu Chen
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, ROC, 40705, Taiwan
| | - Shih-Tien Hsu
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, ROC, 40705, Taiwan
- Center for General Education, Ling Tung University, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Ku Liu
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, ROC, 40705, Taiwan
- Department of Animal Science and Biotechnology, Tung Hai University, Taichung, Taiwan
| | - Sheau-Feng Hwang
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, ROC, 40705, Taiwan
- Department of Palliative Care Unit, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jem-Kun Chen
- Department of Materials Science and Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Hsin-Hua Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
- Department of Post-Baccalaureate Medicine, College of Medicine, Precision Medicine Research Center, National Chung Hsing University, Taichung, Taiwan.
- Institute of Biomedicine Science, National Chung Hsing University, Taichung, Taiwan.
- College of Medicine, National Chung Hsing University, Taichung, Taiwan.
| | - Chien-Hsing Lu
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, ROC, 40705, Taiwan.
- Institute of Biomedical Sciences, Ph.D. Program in Translational Medicine, and Rong-Hsing Research Center for Translational Medicine, National Chung-Hsing University, Taichung, Taiwan.
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Estadilla CDS, Cicolani C, Blasco-Aguado R, Saldaña F, Borri A, Mar J, Van-Dierdonck JB, Ibarrondo O, Stollenwerk N, Aguiar M. The impact of non-pharmaceutical interventions on COVID-19 transmission and its effect on life expectancy in two European regions. BMC Public Health 2025; 25:1004. [PMID: 40087626 PMCID: PMC11907853 DOI: 10.1186/s12889-025-22239-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/07/2025] [Indexed: 03/17/2025] Open
Abstract
BACKGROUND In response to the rapid global transmission of COVID-19, governments worldwide enacted lockdowns and other non-pharmaceutical interventions (NPI) to control the disease. In this study, we aim to quantify the influence of NPIs on the transmission of COVID-19 within selected European regions, specifically Spain (including the Basque Country) and Italy (including Tuscany), during the period of February to December 2020, which predates the initiation of COVID-19 vaccinations. We investigate potential correlations and associations between the implementation of NPIs, changes in COVID-19 transmission rates, and alterations in life expectancy across different age and sex categories from the year 2019 to 2020. METHODS We use a Susceptible-Hospitalized-Asymptomatic/Mild-Recovered-Deceased (SHARD) ordinary differential equations model to analyze COVID-19 dynamics in the studied regions. The model calibration process was performed with empirical data on hospitalization and death to estimate the weekly transmission and death rates. To quantify reductions in life expectancy, we used established survival analysis techniques. RESULTS The SHARD model effectively captures multiple waves of COVID-19, accurately representing peaks and aligning with the instantaneous reproduction number. Our analysis reveals a 66-78% reduction in transmission rates during the initial set of NPIs in March 2020, followed by a 34-55% reduction during the subsequent NPIs in October 2020. Additionally, the elderly and individuals with comorbidities experienced the most pronounced reductions in life expectancy. CONCLUSIONS Our model calibration approach provides a valuable tool for evaluating the effectiveness of interventions across multiple waves of an epidemic. By applying this method to COVID-19 dynamics, we have demonstrated the capacity to quantify the impact of non-pharmaceutical interventions (NPIs) on transmission rates. These findings offer practical insights into the effectiveness of NPIs in mitigating COVID-19 spread and contribute to the broader understanding of epidemic control strategies.
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Affiliation(s)
- Carlo Delfin S Estadilla
- BCAM-Basque Center for Applied Mathematics, Bilbao, Basque Country, Spain
- Preventive Medicine and Public Health Department, University of the Basque Country (UPV/EHU), Leioa, Basque Country, Spain
| | - Chiara Cicolani
- BCAM-Basque Center for Applied Mathematics, Bilbao, Basque Country, Spain
- Università degli studi dell'Aquila, L'Aquila, Italy
| | | | - Fernando Saldaña
- BCAM-Basque Center for Applied Mathematics, Bilbao, Basque Country, Spain
| | - Alessandro Borri
- Università degli studi dell'Aquila, L'Aquila, Italy
- IASI-Institute for System Analysis and Computer Science, Rome, Italy
| | - Javier Mar
- Osakidetza Basque Health Service, Arrasate-Mondragón, Basque Country, Spain
- Biodonostia Health Research Institute, Donostia-San Sebastián, Basque Country, Spain
| | | | - Oliver Ibarrondo
- Osakidetza Basque Health Service, Arrasate-Mondragón, Basque Country, Spain
| | - Nico Stollenwerk
- BCAM-Basque Center for Applied Mathematics, Bilbao, Basque Country, Spain
| | - Maíra Aguiar
- BCAM-Basque Center for Applied Mathematics, Bilbao, Basque Country, Spain.
- Ikerbasque, Basque Foundation for Science, Bilbao, Basque Country, Spain.
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18
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Joly F, Culine S, Roupret M, Tricotel A, Casarotto E, Brice S, Minacori R, Vuillet M, Thomas MC, Leyland K, Upadhyay A, Munro V, Strunz-McKendry T. Epidemiology, resource use, and treatment patterns of locally advanced or metastatic urothelial carcinoma in France. Future Oncol 2025; 21:665-679. [PMID: 39973175 PMCID: PMC11881851 DOI: 10.1080/14796694.2025.2459058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 01/23/2025] [Indexed: 02/21/2025] Open
Abstract
AIM Describe real-world epidemiology, treatment patterns, health care resource utilization, and costs of locally advanced or metastatic urothelial carcinoma (la/mUC) in France. PATIENTS & METHODS Retrospective study including all adults with la/mUC diagnosis during January 2017 to December 2020 in the PMSI database. RESULTS Annual prevalence and incidence ranged from 36.4 to 38.9 and 16.4 to 18.5 cases per 100,000 people, respectively. Of the 25,314 patients with incident la/mUC, 37.6% did not receive first-line systemic treatment. Of the 14,656 patients who started first-line systemic treatment, 66.6%, 22.5%, and 10.9% received 1, 2, and 3 lines of therapy, respectively. Annual per-patient costs in second-/third-line setting ranged from €8803 to €16,012. CONCLUSION The substantial disease burden of la/mUC in France highlights the unmet need for new therapies.
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Affiliation(s)
- Florence Joly
- INSERM, U1086 ANTICIPE, Normandie University, UNICAEN, Caen, France
- Clinical Research Department, Centre François Baclesse, Caen, France
- Medical Oncology Department, CHU de Caen, Caen, France
| | - Stephane Culine
- Department of Medical Oncology, Hôpital Saint-Louis, AP-HP, Paris, France
- Paris-Diderot University, Paris, France
| | - Morgan Roupret
- GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Aurore Tricotel
- Real World Evidence Solutions, IQVIA, La Défense Cedex, France
| | | | - Sandrine Brice
- Real World Evidence Solutions, IQVIA, La Défense Cedex, France
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19
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Červený J, Ours JCV. Long-term returns to local health-care spending. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2025; 26:153-182. [PMID: 38762706 PMCID: PMC11889031 DOI: 10.1007/s10198-024-01695-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 04/16/2024] [Indexed: 05/20/2024]
Abstract
This paper investigates the effects of health-care spending on mortality rates of patients who experienced a heart attack. We relate in-hospital deaths to in-hospital spending and post-discharge deaths to post-discharge health-care spending. In our analysis, we use detailed administrative data on individual personal characteristics including comorbidities, information about the type of medical treatment and information about health-care expenses at the regional level. To account for potential selectivity in the region of health-care treatment we compare local patients with visitors and stayers with recent movers from a different region. We find that in regions with higher health-care spending mortality after heart attacks is substantially lower. From this we conclude that there are long-term returns to local health-care spending.
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Affiliation(s)
- Jakub Červený
- Institute for Health Care Analyses, Ministry of Health of the Slovak Republic, Bratislava, Slovakia
- National Health Information Center, Bratislava, Slovakia
- Institute of Economic Research, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Jan C van Ours
- Erasmus School of Economics, Erasmus University, Rotterdam, The Netherlands.
- Tinbergen Institute, Amsterdam/Rotterdam, The Netherlands.
- CEPR, London, UK.
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20
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Kinoshita S, Shimizu A, Yamada N, Momosaki R, Wakabayashi H, Sakai K, Tohara H, Yanagida R, Isowa T, Ushida K, Abo M. Association between Mortality and Time Spent Out of Bed in Older-Adult Nursing Home Residents. J Am Med Dir Assoc 2025; 26:105458. [PMID: 39805324 DOI: 10.1016/j.jamda.2024.105458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Revised: 11/26/2024] [Accepted: 12/03/2024] [Indexed: 01/16/2025]
Abstract
OBJECTIVES For older adults, spending time out of bed is important for preventing functional decline, but its relationship to mortality is not clear. In this study, we aimed to investigate the association between mortality and time spent out of bed in Japanese older-adult nursing home residents. DESIGN We conducted a cohort study using data from the Long-term Care Information System for Evidence database. SETTING AND PARTICIPANTS We used data collected between April 2022 and March 2024 from older-adult nursing home residents who required assistance with the activities of daily living. METHODS We compared outcome data between residents who spent 6 or more hours per day out of bed (group L) and those who spent less than 6 hours per day out of bed (group S). The outcome was all-cause mortality. Data were analyzed using Kaplan-Meier curves and Cox regression models. RESULTS Data from 185 older-adult nursing home residents (median age: 89 years; 141 women) were analyzed. Group L included 144 residents (77.8% of all participants). Of the 185 participants, 40 died during the observation period. Mortality in group L was significantly lower than in group S (16.7% vs 39.0%, P = .002). Kaplan-Meier curve analysis after the log-rank test revealed a significantly higher mortality in group S than group L. Univariate and multivariate Cox regression analyses with robust (Huber-White) standard errors identified the factor of time spent out of bed (≥6 h) as a significant and independent risk factor for mortality. CONCLUSION AND IMPLICATIONS More time spent out of bed is associated with lower mortality in older-adult nursing home residents who require assistance with the activities of daily living.
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Affiliation(s)
- Shoji Kinoshita
- Department of Rehabilitation Medicine, Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
| | - Akio Shimizu
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Naoki Yamada
- Department of Rehabilitation Medicine, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Kotomi Sakai
- Department of Research, Heisei Medical Welfare Group Research Institute, Shibuya-ku, Tokyo, Japan
| | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Ryosuke Yanagida
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Tokiko Isowa
- Department of Nursing, Graduate School of Medicine, Mie University, Tsu, Mie, Japan
| | - Kenta Ushida
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
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Kanagaratnam L, Semenzato L, Baudouin EP, Ankri J, Weill A, Zureik M. Medication Use in People Aged 90 Years and Older: A Nationwide Study. J Am Med Dir Assoc 2025; 26:105459. [PMID: 39805323 DOI: 10.1016/j.jamda.2024.105459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 12/03/2024] [Accepted: 12/05/2024] [Indexed: 01/16/2025]
Abstract
OBJECTIVE We aimed to describe the medications prescribed to people aged ≥90 years. DESIGN A cohort study was performed using data from the year 2022. SETTING AND PARTICIPANTS Using data from the French National Health Data System, people aged ≥90 years affiliated with the general insurance scheme were included. METHODS Medications dispensed, polypharmacy (≥5 drugs), and hyperpolypharmacy (≥10 drugs) were described in the total population and according to sex, age group (90-94 years, 95-99 years, ≥100 years), and place of residence. All analyses were conducted by quarter because of the high mortality rate in this population. RESULTS In total, 696,498 subjects were included in the study. Among them, 73.2% were women, 75.9% were aged 90-94 years, and 2.9% were ≥100 years. Treatment for hypertension was prescribed to 77%, 50.4% had cardiovascular disease, and 17.7% had dementia. During the first quarter, 77.7% experienced polypharmacy. The most prescribed drugs were antihypertensive medications (73.8%), analgesics (58.8%), antithrombotics (55.3%), vitamin D (51.1%), and psychotropics (42%). There was a decrease in preventive drugs and an increase in symptom management drugs with increasing age. Subjects in nursing homes were more likely to take psychotropics and less likely to receive cardiovascular drugs. The results for the other quarters were similar. CONCLUSIONS AND IMPLICATIONS Our results suggest a progressive, but probably insufficient decrease in the prescription of certain medications with age and to a lesser extent, in nursing homes. The discontinuation of treatments should be discussed in the context of short life expectancy to avoid the harmful effects of polypharmacy.
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Affiliation(s)
- Lukshe Kanagaratnam
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France; Université de Reims Champagne-Ardenne, UR 3797 VieFra, CHU Reims, Unité d'Aide Méthodologique, Reims, France.
| | - Laura Semenzato
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - Edouard-Pierre Baudouin
- Department of Geriatry, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse, Villejuif, France
| | - Joël Ankri
- Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France; Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France
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22
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Bonnet JB, Duflos C, Huguet H, Avignon A, Sultan A. Epidemiology of major amputation following diabetic foot ulcer: Insights from recent nationwide data in the french national health registry (SNDS). DIABETES & METABOLISM 2025; 51:101606. [PMID: 39814334 DOI: 10.1016/j.diabet.2025.101606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Revised: 12/13/2024] [Accepted: 12/16/2024] [Indexed: 01/18/2025]
Abstract
OBJECTIVE The out-of-hospital care pathways of people with DFU have been little studied. We used the French National Health Data System (SNDS) to collect refund and care pathway data for all French residents. The aim of this study was to determine the incidence of major lower limb amputation (MA) and associated risk factors in a population with an incident DFU. RESEARCH DESIGN AND METHODS We included any person living with diabetes and incident DFU. The primary endpoint was the occurrence of MA within one year. We considered the course and consumption of care one year before and one year after the initial event. RESULTS In 2018, 133,791 people were included, and during the follow-up, MA was performed in 4,733 (3.5 %). Among these people with MAs, 16.4 % were included via the out-of-hospital part of the protocol, and their first contact with the hospital led to MA. Factors associated (hazard ratio, HR [95 % confidence interval, CI]) with MA were: being male (1.92 [1.78;2.08]), arteriopathy of the lower limb (10.16 [9.36;11.03]), psychiatric disease (1.10 [1.01;1.20]) and end-stage renal disease (2.12 [1.93;2.33]). Regarding the care pathway, associations (HR [95 %CI]) were observed between lower MA rates and people with more general practitioner (0.83 [0.75-0.91]), private nurse (0.88 [0.81-0.95]) and diabetologist (0.88 [0.81-0.95]) visits. Living in the most disadvantaged municipalities was associated (HR [95 %CI]) with a higher MA rate (1.17[1.06-1.29]). CONCLUSION This is the first national study of the care pathways followed by people with DFU. Failures in the care pathway, precariousness and several comorbidities were identified, with an impact on the MA risk.
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Affiliation(s)
- Jean-Baptiste Bonnet
- Nutrition-Diabetes Department, University Hospital of Montpellier, Montpellier, France; Joint Research Unit (UMR) 1302, Desbrest Institute of Epidemiology and Public Health, University of Montpellier, INSERM, Montpellier, France
| | - Claire Duflos
- Joint Research Unit (UMR) 1302, Desbrest Institute of Epidemiology and Public Health, University of Montpellier, INSERM, Montpellier, France; Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Helena Huguet
- Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Antoine Avignon
- Nutrition-Diabetes Department, University Hospital of Montpellier, Montpellier, France; Joint Research Unit (UMR) 1302, Desbrest Institute of Epidemiology and Public Health, University of Montpellier, INSERM, Montpellier, France
| | - Ariane Sultan
- Nutrition-Diabetes Department, University Hospital of Montpellier, Montpellier, France; PhyMedExp, INSERM U1046, National Centre for Scientific Research (CNRS) Joint Research Unit (UMR) 9214, University of Montpellier, Montpellier, France.
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23
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Ma R, Fan X, Tao X, Zhang W, Li Z. Development and validation of risk-predicting model for oral frailty in older adults patients with stroke. BMC Oral Health 2025; 25:263. [PMID: 39972478 PMCID: PMC11841317 DOI: 10.1186/s12903-025-05428-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Accepted: 01/03/2025] [Indexed: 02/21/2025] Open
Abstract
OBJECTIVE This study aimed to construct a nomogram predicting oral frailty risk in Older adults patients with stroke. DESIGN A cross-sectional study. METHODS We selected 664 hospitalised older adults patients with stroke in a tertiary hospital from January 2023 to March 2024. Among them, 451 cases from January to December 2023 formed the modelling group, and 213 cases from January to March 2024 served as the validation group. Univariate and multivariate logistic regression analyses identified independent risk factors for oral frailty. A nomogram was developed and visualised using columnar charts. The model's predictive performance was assessed using the receiver operating characteristic curve and the Hosmer-Lemeshow test. FINDINGS The prevalence of oral frailty was 47.7% in the modelling group and 47.9% in the validation groups, respectively. Age (OR = 10.351), frailty (OR = 9.171), number of comorbidities (OR = 11.301), nutritional risk (OR = 17.419), NIHSS (OR = 13.234), oral health evaluation index (OR = 0.316), Barthel index (OR = 0.247) were identified as significant independent risk factors. The areas under the receiver operating characteristic curve for the modelling and validation groups were 0.945 and 0.915, respectively. CONCLUSION A high prevalence of oral frailty was observed among Older adults patients with stroke with diverse risk factors. The nomogram provides an effective screening tool for identifying patients at high risk of oral frailty early in their hospital stay. The risk-prediction model showed good predictive efficacy and clinical utility.This study introduces a nomogram to predict oral frailty and identify associated risk factors in Older adults patients with stroke early on. It supports personalised care and precision medicine approaches in clinical practice.
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Affiliation(s)
- Ruirui Ma
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Xiaoli Fan
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China.
| | - Xiubin Tao
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Wei Zhang
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Zibao Li
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
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24
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Gorostiza I, Bilbao-Gonzalez A, Mar J. Cost-effectiveness of direct oral anticoagulants in non-valvular atrial fibrillation. GACETA SANITARIA 2025:102451. [PMID: 39971633 DOI: 10.1016/j.gaceta.2025.102451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 12/20/2024] [Accepted: 12/24/2024] [Indexed: 02/21/2025]
Abstract
OBJECTIVE There is evidence on the efficiency of new direct oral anticoagulants (DOAC), mostly based on experimental efficacy data, but there is also a need to assess their cost-effectiveness in routine clinical practice using patient-level data. We designed a retrospective cohort study to assess the cost-effectiveness of DOAC compared to acenocoumarol in patients with non-valvular atrial fibrillation (NVAF) with a follow-up of up to 7 years. METHOD Basque Health Service-registered patients who started oral anticoagulant treatment between 2013 and 2016 were included in the study and followed up until the end of 2019. Data were extracted from an electronic medical record management system. Effectiveness was expressed in terms of life years gained and adjusted for health-related quality of life (i.e., quality-adjusted life years [QALY]). Propensity score techniques were used to adjust the estimates for differences between groups in baseline characteristics. RESULTS A total of 10,843 new users of oral anticoagulants with a mean follow-up of 4.1 years were included. The incremental cost-effectiveness ratio of DOAC compared to acenocoumarol ranged from €1,732 to €2,556/QALY, while the incremental net benefit for different willingness-to-pay thresholds was only negative for values below €3,000/QALY. CONCLUSIONS Based on the analysis of data from clinical practice and the similarity of results using several different techniques to adjust for bias associated with observational studies, we conclude that DOAC would be an efficient alternative for the treatment of patients with NVAF.
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Affiliation(s)
- Inigo Gorostiza
- Osakidetza Basque Health Service, Basurto University Hospital, Research and Innovation Unit, Bilbao, Spain; Institute for Health Services Research (Kronikgune), Barakaldo, Bizkaia, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain.
| | - Amaia Bilbao-Gonzalez
- Osakidetza Basque Health Service, Basurto University Hospital, Research and Innovation Unit, Bilbao, Spain; Institute for Health Services Research (Kronikgune), Barakaldo, Bizkaia, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Javier Mar
- Institute for Health Services Research (Kronikgune), Barakaldo, Bizkaia, Spain; Osakidetza Basque Health Service, Debagoiena Integrated Healthcare Organisation, Research Unit, Arrasate-Mondragon, Gipuzkoa, Spain; Biogipuzkoa Health Research Institute, Donostia-San Sebastian, Gipuzkoa, Spain
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25
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Arnaud L, Fabry-Vendrand C, Todea R, Vidal B, Cottin J, Bureau I, Bouée S, Thabut G. Real-world oral glucocorticoid use in SLE: a nation-wide population-based study using the French medico-administrative (SNDS) claim database. Lupus Sci Med 2025; 12:e001428. [PMID: 39965876 PMCID: PMC11836812 DOI: 10.1136/lupus-2024-001428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 02/07/2025] [Indexed: 02/20/2025]
Abstract
BACKGROUND Oral glucocorticoids (OCS) remain one of the most important treatments for SLE but are associated with damage. Evidence regarding the real-world use of OCS in nationwide SLE populations is currently lacking. The aim of this study was to analyse OCS use and SLE treatments in French patients with SLE at the national level. METHODS The nationwide French health insurance claims database, which contains pseudonymised data for ≈66 million people, was used. Prevalent patients with SLE (International Classification of Diseases, 10th Revision code M32, recorded as a chronic condition or associated with hospital stay) were identified over the year 2019. SLE treatments were captured through actual drug deliveries by pharmacies and mean daily OCS doses (prednisone equivalent) were calculated for the year 2019. RESULTS The 2019 French prevalent SLE population comprised 31 852 patients (86.3% of women, with a mean age of 49.7 (±15.9) years) with a mean disease duration of 7.1 (±6.2) years. Among these, 48.3% were treated with OCS. The mean daily OCS dose was ≤5 mg/day in 35.9%, more than 5 mg but <7.5 mg/day in 6.4% and ≥7.5 mg/day in 6.0%. The use of other SLE treatments was significantly increased in patients with higher doses of OCS (p<0.0001). Potential complications of OCS, including cardiovascular diseases, infections and osteoporosis, were significantly increased in patients with SLE receiving more than 5 mg of OCS per day (p<0.0001, for all). Strikingly, 13.6% of patients receiving mean daily OCS doses >5 mg/day were not treated with antimalarial, immunosuppressant or biologic drugs for SLE. CONCLUSIONS In total, 48.2% of French patients with SLE were treated with OCS in 2019, including 12.4% at a mean dose >5 mg/day, with an increased risk of OCS complications and a limited use of antimalarials, immunosuppressants or biologics. These results highlight the urgent need for the implementation of more robust OCS-sparing strategies in SLE.
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Affiliation(s)
- Laurent Arnaud
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Systémiques Auto-immunes Rares Est Sud-Ouest, INSERM UMRS-1109, Université de Strasbourg, Strasbourg, France
| | | | - Remus Todea
- AstraZeneca, Tour Carpe Diem, Courbevoie, France
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Liu Y, Fisk-Hoffman RJ, Patel M, Cook RL, Prosperi M. Receipt of long-acting injectable antiretroviral therapy among people with HIV in Southern US states: an assessment using electronic health records and claims data. AIDS Res Ther 2025; 22:9. [PMID: 39893464 PMCID: PMC11787751 DOI: 10.1186/s12981-024-00690-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Accepted: 12/13/2024] [Indexed: 02/04/2025] Open
Abstract
BACKGROUND In January 2021, the United States (US) Food and Drug Administration (FDA) approved the first long-acting injectable antiretroviral therapy (LAI ART) regimen for the treatment of HIV providing an alternative to daily oral regimens. We analyzed electronic health records (EHRs) to provide real-world evidence of demographic and clinical characteristics associated with the receipt of LAI ART among people with HIV (PWH). METHODS Leveraging EHRs from a large clinical research network in the Southern US - OneFlorida + linked with Medicaid (updated to 08/2022) - we identified a cohort of PWH who have been prescribed at least one dose of LAI ART since January 2021 and characterized their demographics, clinical characteristics, and HIV care outcomes. RESULTS A total of 233 LAI ART recipients were identified: 56.7% female, 45.1% aged 30 to 44, 51.3% non-Hispanic Black, 78.1% on Medicaid and 4.7% on private insurance. Approximately three-quarters of injections (71.2%) were received within 37 days of the previous dose, and 84.4% were received within 67 days. About 8% of LAI ART recipients did not have optimal care engagement the year before LAI ART initiation; one in five recipients had a diagnosis of alcohol or substance use disorder in lifetime. All achieved viral suppression (< 50 copies/mL) before starting LAI ART. Of a subset of patients with HIV viral load test records, only 1 record of virologic failure (viral load > 200 copies/ml) was observed after the initiation of LAI ART. DISCUSSION There has been an increasing trend of LAI ART initiation since approval. People with suboptimal care engagement and with substance use disorder in lifetime were not excluded from LAI ART treatment.
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Affiliation(s)
- Yiyang Liu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, US.
| | - Rebecca J Fisk-Hoffman
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, US
| | - Maitri Patel
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, US
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, US
| | - Mattia Prosperi
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, US
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Lebrun-Frenay C, Kerbrat S, Okuda DT, Landes-Chateau C, Kantarci OH, Pierret C, Drezen E, Nowak E, Siva A, Azevedo CJ, Cohen M, Leray E. Analysis of healthcare utilization before the diagnosis of radiologically isolated syndrome. Mult Scler 2025; 31:184-196. [PMID: 39797434 DOI: 10.1177/13524585241291471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2025]
Abstract
BACKGROUND Previous studies have shown that people with multiple sclerosis (MS) had frequent healthcare visits up to 10 years before being diagnosed but with no information from magnetic resonance imaging (MRI) scans of the connection with the radiologically isolated syndrome (RIS). OBJECTIVE To analyze healthcare use 3 years before the RIS diagnosis. METHODS We examined healthcare usage before the first scan in RIS cases from 2010 to 2019. RIS subjects were identified from the French National MS observatory and compared to the general population (matched 10:1) and MS patients (matched 4:1). RESULTS Among 482 RIS individuals, 223 (46.3%) were not linked to the healthcare resources database. The remaining RIS individuals (53.7%) had higher healthcare usage before their RIS diagnosis for issues related to neurology visits, headaches (odds ratio (OR): 3.34, confidence interval (CI): [2.00-5.57], p < 0.0001), and the use of anti-migraine drugs (OR: 2.61, CI: [1.37-4.99], p = 0.004) compared to MS. CONCLUSION Only about half of RIS patients had MS-selected healthcare resources, which allowed for data linkage. Those who did seek care before their RIS diagnosis were most commonly known for other neurological comorbidities. These findings do not support the idea of a systemic prodrome before RIS diagnosis.
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Affiliation(s)
- Christine Lebrun-Frenay
- CRCSEP Neurology, CHU Nice, UR2CA-URRIS, Université Nice Cote d'Azur, Hôpital Pasteur, Nice, France; CRCSEP Nice, Neurologie CHU de Nice Pasteur 2, Nice, France
| | | | - Darin T Okuda
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Peter O'Donnell Jr. Brain Institute, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Chloe Pierret
- Rennes University, EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, Rennes, France
| | | | | | - Aksel Siva
- Department of Neurology, School of Medicine, Istanbul University Cerrahpasa, Istanbul, Turky
| | - Christina J Azevedo
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mikael Cohen
- CRCSEP Neurology, CHU Nice, UR2CA-URRIS, Université Nice Cote d'Azur, Hôpital Pasteur, Nice, France; CRCSEP Nice, Neurologie CHU de Nice Pasteur 2, Nice, France
| | - Emmanuelle Leray
- Rennes University, EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, Rennes, France
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Xiang X, Dai YQ, Li S, Li DL, Chen JK, Zhang C. Developing a Prognostic Model for Predicting the Risk of Outcome in Patients With Novel Bunyavirus Infection: A Retrospective Study. J Med Virol 2025; 97:e70208. [PMID: 39891609 DOI: 10.1002/jmv.70208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 01/05/2025] [Accepted: 01/24/2025] [Indexed: 02/03/2025]
Abstract
The study aims to investigate the key risk factors influencing the prognosis of patients with severe fever with thrombocytopenia syndrome (SFTS) and develop a prognostic warning model based on these factors. A total of 264 SFTS patients treated at Tongji Hospital from April 1, 2023, to July 30, 2024, were included as the research sample. Retrospective analysis was conducted based on the final prognostic status of the patients, dividing them into a survival group (n = 165) and a death group (n = 99). Univariate and multivariate analyses were performed along with LASSO and logistic regression on baseline information and the first laboratory indicators within 24 h after admission to identify independent risk factors affecting prognosis. A warning model was constructed based on these factors. The analysis revealed that age (OR = 1.098, 95% CI: 1.054-1.149, p < 0.001), presence of consciousness disorders (OR = 2.506, 95% CI: 1.042-6.187, p = 0.042), BUN (OR = 1.248, 95% CI: 1.154-1.369, p < 0.001), and viral load (OR = 3.598, 95% CI: 2.572-5.288, p < 0.001) were identified as independent risk factors significantly impacting the prognosis of SFTS patients. A nomogram warning model was developed incorporating these four risk factors, which demonstrated excellent predictive performance (ROC = 0.917, 95% CI: 0.882-0.948, p < 0.001). The prognostic risk prediction model successfully established for SFTS patients in this study exhibits robust predictive performance, and it is anticipated to serve as a practical clinical tool for predicting disease progression and prognosis in SFTS patients.
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Affiliation(s)
- Xu Xiang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue-Qing Dai
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Song Li
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - De-Lei Li
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun-Kun Chen
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chi Zhang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Zhu Z, Du W, Yang Y, Zhang Y, Feng J, Wang Y. Enterococci independently increase the risk for initial antibiotic treatment failure and prolonged hospitalization in adult patients with complicated urinary tract infection: a retrospective cohort study. Infection 2025; 53:307-315. [PMID: 39196517 DOI: 10.1007/s15010-024-02372-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 08/06/2024] [Indexed: 08/29/2024]
Abstract
OBJECTIVES We aimed to investigate the impact of enterococci on initial antibiotic treatment (IAT) failure and prolonged hospitalization in complicated urinary tract infection (cUTI) cases, and to identify risk factors for enterococcal cUTI. METHODS Adult cUTI patients were analyzed to compare the differences between the Enterococcus and non-Enterococcus groups. Univariate and multivariate analyses were employed to identify independent risk factors. RESULTS This study included 419 patients, with the Enterococcus group showing significantly higher IAT failure rates and an extended average length of stay by 4.4 days compared to the non-Enterococcus group. Multivariate analysis identified enterococci, hospital-acquired UTIs (HA-UTI), indwelling catheters, and bed rest (bedridden) as independent risk factors for IAT failure. Enterococci were notably linked to prolonged hospitalization, other independent risk factors included IAT failure, prior antimicrobial use, age-adjusted Charlson comorbidity index (ACCI) ≥ 4, hypoalbuminemia, and bed rest. Urological cancer, HA-UTI, indwelling catheters, urinary retention, and urologic surgery were risk factors for enterococcal cUTI. CONCLUSION We provide the first evidence that enterococci independently increase the risk for IAT failure and prolonged hospitalization in adults with cUTIs, highlighting the significance of timely identification to optimize measures including antibiotic regimens. Risk factors for enterococcal cUTI have also been identified to aid clinicians in managing this condition.
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Affiliation(s)
- Zhigang Zhu
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Department of Infectious Diseases, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Wenying Du
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Department of Infectious Diseases, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Yuze Yang
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Department of Infectious Diseases, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Yan Zhang
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Department of Infectious Diseases, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Jing Feng
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yubao Wang
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin, 300052, China.
- Department of Infectious Diseases, Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
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Marant Micallef C, Belhassen M, Ader F, Martinez V, Van Ganse E, Bérard M, Née M, Dziadzko M, Aubrun F. Distinct phenotypes of patients and healthcare resource utilization after hospitalization for COVID-19: an observational study. BMC Health Serv Res 2025; 25:148. [PMID: 39871299 PMCID: PMC11771006 DOI: 10.1186/s12913-025-12308-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 01/20/2025] [Indexed: 01/29/2025] Open
Abstract
BACKGROUND Little is known about postdischarge healthcare resource use (HCU) among patients hospitalized for coronavirus disease 2019 (COVID-19). The objective was to identify distinct profiles of patients based on postdischarge cares. METHODS This was a retrospective cohort study using the French National Health System claims database. We followed up all patients hospitalized for COVID-19 between 2020/02/01 and 2020/06/30 for 6 months; the discharge date was the index date. We excluded patients who died during the index stay or within 30 days after discharge. We described patients' HCU over 5 months from day 31 after the index date to the end of follow-up, i.e., the post-COVID-19 period. We described the sociodemographic and clinical characteristics of the participants and 44 selected types of HCU, including medical and emergency room visits, medications, medical and biological tests, oxygen therapy, rehabilitation, rehospitalization, nurse visits, and sick leave. We performed Ward's ascendant hierarchical clustering (AHC) analysis to identify groups of patients with similar post-COVID-19 HCU and described HCU and clinical characteristics by cluster. RESULTS The study population included 68,822 patients (median age: 64.8 years, 47% women). Eight clusters of patients were identified, each comprising between 1,163 and 35,501 patients. Four clusters were characterized by older patients and high proportions of comorbidities, i.e. cancer (cluster 3), mental disorders (cluster 4), cardiac insufficiency (cluster 5) and respiratory failure (cluster 6). Cluster 8 was characterized by younger patients, often obese and with low mortality. Another cluster was characterized by complex index stays (cluster 7) and a last cluster (cluster 2) by specific medical contacts and therapy. The main cluster (cluster 1, n = 35,501) was similar to the overall study population. The duration and complexity of the index stay also varied across clusters. CONCLUSIONS Based on HCU data, AHC identified 8 clinically relevant profiles of patients surviving the acute episode of COVID-19 hospitalization. The clusters illustrate the many impacts of COVID on the health status of infected patients and may help anticipate future needs of care in a similar context.
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Affiliation(s)
| | - Manon Belhassen
- PELyon, Pharmacoépidémiologie Lyon, 210 Avenue Jean Jaurès, Lyon, 69007, France
| | - Florence Ader
- Infectious and Tropical Diseases Department, Hospices Civils de Lyon, Hôpital de La Croix-Rousse, 103 Gd Rue de La Croix-Rousse, Lyon, 69004, France
- Université Claude Bernard Lyon 1, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, Lyon, F-69372, France
| | - Valeria Martinez
- Service d'Anésthésie Douleur, Raymond Poincaré Hospital, Assistance Publique Hôpitaux de Paris, 104 Boulevard Raymond Poincaré, Garches, 92380, France
- INSERM, U-987, Hôpital Ambroise Paré, Centre d'Évaluation Et de Traitement de La Douleur, 9 Av. Charles de Gaulle, 92100, Boulogne Billancourt, F-92100, France
- Université Versailles Saint-Quentin, 55 Avenue de Paris, Versailles, 78035, France
| | - Eric Van Ganse
- Hospices Civils de Lyon, Croix Rousse University Hospital, Respiratory Medicine, 103 Gd Rue de La Croix-Rousse, Lyon, 69004, France
- Laboratoire RESHAPE, Université Claude Bernard Lyon 1, INSERM UMR 1290, 8 Av. Rockefeller, Lyon, 69008, France
| | - Marjorie Bérard
- PELyon, Pharmacoépidémiologie Lyon, 210 Avenue Jean Jaurès, Lyon, 69007, France
| | - Mélanie Née
- PELyon, Pharmacoépidémiologie Lyon, 210 Avenue Jean Jaurès, Lyon, 69007, France
| | - Mikhail Dziadzko
- Université Versailles Saint-Quentin, 55 Avenue de Paris, Versailles, 78035, France
- Département d'Anesthésie-Réanimation, Hospices Civils de Lyon, Hôpital de La Croix Rousse, Douleur, 103 Gd Rue de La Croix-Rousse, Lyon, 69004, France
| | - Frédéric Aubrun
- Laboratoire RESHAPE, Université Claude Bernard Lyon 1, INSERM UMR 1290, 8 Av. Rockefeller, Lyon, 69008, France
- Département d'Anesthésie-Réanimation, Hospices Civils de Lyon, Hôpital de La Croix Rousse, Douleur, 103 Gd Rue de La Croix-Rousse, Lyon, 69004, France
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Hwang H, Lee S, Heo YW, Ha WS, Kim KM, Cha YS. Carbon monoxide poisoning is associated with increased risk of migraine in the long term: a nationwide population-based cohort study. FRONTIERS IN TOXICOLOGY 2025; 7:1532584. [PMID: 39917277 PMCID: PMC11794217 DOI: 10.3389/ftox.2025.1532584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Accepted: 01/06/2025] [Indexed: 02/09/2025] Open
Abstract
Objective Carbon monoxide poisoning can cause migraine-like attacks. However, the association between carbon monoxide poisoning and the risk of migraine has not been thoroughly studied. This study aimed to investigate the long-term risk of migraine in patients with carbon monoxide poisoning. Methods This nationwide, population-based cohort study was conducted using the administrative database of the National Health Insurance Service of Korea from 2002 to 2021. Patients with carbon monoxide poisoning with at least one visit documented according to the International Classification of Diseases, 10th Revision code T58 were included. Patients were only included if they had the same diagnostic code at two or more outpatient clinic visits. The primary outcome of this study was the incidence of migraine after carbon monoxide poisoning. Results The overall risk of migraine was higher in the carbon monoxide poisoning group regardless of age, sex, or use of hyperbaric oxygen therapy (adjusted hazard ratio, 1.37; 95% confidence interval, 1.28-1.48). The carbon monoxide poisoning group had a persistently higher cumulative incidence of migraine during the observation period than the control group. Conclusion Carbon monoxide poisoning was associated with an increased overall risk of developing migraine during long-term follow-up.
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Affiliation(s)
- Heewon Hwang
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Solam Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yeon-Woo Heo
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Woo-Seok Ha
- Department of Neurology, Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Min Kim
- Department of Neurology, Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Sung Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Research Institute of Hyperbaric Medicine and Science, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Zadro Y, Lafaurie M, Michel M, Lapeyre-Mestre M, Moulis G. Risk of hospitalization with infection in adults with primary AIHA treated with rituximab: a French nationwide study. Blood Adv 2025; 9:231-238. [PMID: 39189926 PMCID: PMC11788127 DOI: 10.1182/bloodadvances.2024013067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 07/08/2024] [Accepted: 08/03/2024] [Indexed: 08/28/2024] Open
Abstract
ABSTRACT Autoimmune hemolytic anemia (AIHA) is a rare and sometimes life-threatening disease. Infections are frequent and often severe during the course of AIHA. Rituximab is commonly used to treat patients with AIHA. This study aimed to assess the risk of hospitalization with infection after rituximab in patients with primary AIHA. We selected all adult patients newly diagnosed for primary AIHA and treated with rituximab between 2012 and 2018 in the French national health database. Patients were considered exposed to rituximab within 6 months after the first infusion. The main outcome was hospitalization with infection, identified by a discharge diagnosis of infection during the rituximab exposure. The cohort consisted of 959 patients (mean age of 67 years, standard deviation of 17.8 years; 60.5% of women). The 6-month cumulative incidence of hospitalization with infection was 17.6% (95% confidence interval [CI], 15.2-20.0). The most frequently characterized infections were pulmonary (40.2%). Opportunistic infections were observed in 28 (16.6%) patients, including 11 cases of pneumocystosis. All cases of pneumocystosis occurred in patients concomitantly exposed to corticosteroids, none of them had prophylaxis and all but 2 were aged ≥70 years. Overall, the main factors associated with hospitalization with infection were an age ≥70 years and the exposure to corticosteroids. The 30-day overall mortality after hospitalization with infection was 12.5% (95% CI, 8.0-18.0). In conclusion, the incidence of hospitalizations with infection, including opportunistic infections, as well as the subsequent mortality, are high in adult patients with primary AIHA treated with rituximab. Pneumocystosis prophylaxis should be encouraged in older patients exposed to corticosteroids.
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Affiliation(s)
- Yoann Zadro
- Department of Internal Medicine, Toulouse University Hospital, Toulouse University, Toulouse, France
- Clinical Investigation Center 1436, Toulouse University Hospital, Toulouse University, Toulouse, France
| | - Margaux Lafaurie
- Clinical Investigation Center 1436, Toulouse University Hospital, Toulouse University, Toulouse, France
- Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse University, Toulouse, France
| | - Marc Michel
- Department of Internal Medicine, National Referral Center for Immune Cytopenias in Adults, Henri Mondor University Hospital, Paris-Est Créteil University, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Maryse Lapeyre-Mestre
- Clinical Investigation Center 1436, Toulouse University Hospital, Toulouse University, Toulouse, France
- Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse University, Toulouse, France
| | - Guillaume Moulis
- Department of Internal Medicine, Toulouse University Hospital, Toulouse University, Toulouse, France
- Clinical Investigation Center 1436, Toulouse University Hospital, Toulouse University, Toulouse, France
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Danchin N, Lemesle G, Mazighi M, Mohammedi K, Schiele F, Sibon I, Caron A, Emery C, Nevoret C, Vigié L, Massien C, Detournay B, Fauchier L. Cardiovascular risk associated with glucagon-like peptide-1 receptor agonists versus other conventional glucose-lowering drugs in patients with type-2 diabetes: protocol for a nationwide observational comparative study in routine care. BMJ Open 2025; 15:e087790. [PMID: 39788759 PMCID: PMC11751855 DOI: 10.1136/bmjopen-2024-087790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 11/08/2024] [Indexed: 01/12/2025] Open
Abstract
INTRODUCTION Several cardiovascular outcome trials have been conducted to assess the cardiovascular safety and efficacy of glucagon-like peptide-1 receptor agonists (GLP1-RAs) on cardiorenal outcomes in patients with type-2 diabetes (T2D). However, the strict requirements of randomised controlled trials to avoid most confounding factors are at the expense of external validity. Using national real-world data, we aimed to evaluate the effectiveness of GLP-1RAs in association with metformin especially on cardiovascular events, hospitalisation for heart failure and all-cause death in comparison with other diabetes treatment schemes using dipeptidyl peptidase IV inhibitors, sulfonylureas/glinides or insulin also associated with metformin. Sodium-glucose transport protein 2 inhibitors (SGLT-2i) will be excluded as comparators, as this class of oral hypoglycaemic agents just started in 2020 to be marketed in France. METHODS AND ANALYSIS The Système National des Données de Santé is a comprehensive nationwide administrative healthcare database in France that covers approximately 67 million people.Several cohorts of adult patients with T2D initiating any GLP1-RA in dual or triple therapies, as recommended by the French Health authorities, will be identified in this database over the period 2016-2021. These cohorts will be defined by the combination of glucose-lowering drugs prescribed simultaneously with GLP1-RA and diabetes treatment received over a 6-month period before GLP1-RA initiation. They will be first matched with T2D controls (1:3 ratio) based on the year of drug initiation and treatment regimens before and simultaneously with GLP1-RA in the different selected cohorts. Comparative analyses will be conducted versus these control groups, adjusting for cardiovascular event history and a propensity score considering age, sex, area of residence, deprivation index, comorbidities, duration of diabetes, use of lipid-lowering drugs, anticoagulants, antiplatelet therapies and blood pressure-lowering therapies. Comparative analyses will be conducted versus these control groups, using a high-dimensional propensity scores method and fixed baseline characteristics. Treatment effects on the different outcomes measured will be estimated for each GLP1-RA group, through HR and their corresponding CIs (95% CI) using Cox regressions and/or competitive risk regressions when necessary. ETHICS AND DISSEMINATION The study has been approved by an independent ethics committee (Comité éthique et scientifique pour les recherches, les études et les évaluations dans le domaine de la santé, Paris, France; reference: 8699786, dated 2 June 2022) and has been registered with the French National Data Protection Commission (Commission Nationale de l'Informatique et des Libertés, Paris, France; reference: 922161, dated 26 June 2022). The findings of this study will be published in peer-reviewed scientific journals and presented at international conferences. TRIAL REGISTRATION NUMBER F20220803152803.
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Affiliation(s)
- Nicolas Danchin
- Department of Cardiology, Hôpital Paris St Joseph and Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Gilles Lemesle
- Heart and Lung Institute, Lille University Hospital, University of Lille, Lille, France
- FACT (French Alliance for Cardiovascular Trials), Paris, France
- Inserm U1011, University of Lille, Lille, France
- Institut Pasteur de Lille, Lille, France
| | - Mikael Mazighi
- Department of Neurology, Hôpital Lariboisière, Paris, France
- FHU NeuroVasc, INSERM 1144, Paris Cité University, Paris, France
| | - Kamel Mohammedi
- Neurology and Neuro-Vascular Unit, CHU de Bordeaux, Bordeaux, France
- INSERM, BMC, U1034, Université de Bordeaux, Pessac, France
| | - Francois Schiele
- Cardiology and Vascular Diseases, CHU de Besançon Hôpital Jean Minjoz, Besancon, France
- EA3920, Université de Franche-Comté, Besancon, France
| | - Igor Sibon
- Neurology and Neuro-Vascular Unit, CHU de Bordeaux, Bordeaux, France
| | | | | | | | | | | | | | - Laurent Fauchier
- Cardiologie, Trousseau Hospital, Chambray-les-Tours, France
- Université François-Rabelais de Tours, Tours, France
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Attarian S, Camdessanché J, Echaniz‐Laguna A, Ciumas M, Blein C, Grenier B, Solé G. Tracking myasthenia gravis severity over time: Insights from the French health insurance claims database. Eur J Neurol 2025; 32:e16518. [PMID: 39494501 PMCID: PMC11622507 DOI: 10.1111/ene.16518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 09/10/2024] [Accepted: 09/26/2024] [Indexed: 11/05/2024]
Abstract
BACKGROUND AND PURPOSE Few data are available on the course of myasthenia gravis (MG) regarding disease severity and stability over time in real-world settings. This study used the French National Health Insurance Database (SNDS) to assess markers of disease severity in patients with MG longitudinally. METHODS All patients with MG-related claims in the SNDS between 2013 and 2020 were identified. Patients were followed for up to 8 years after the first claim. Intensive care unit (ICU) stays, treatment with intravenous immunoglobulin (IVIg) or plasma exchange (PE), and death were documented throughout the follow-up period. Standardized mortality rates were estimated, and mortality-related variables were identified using a Cox model. RESULTS In all, 14,459 individuals constituted the full study population, including 6354 incident patients. In the incident population, 2199 (34.6%) were admitted to ICUs at least once, principally during the first year after the index date (N = 1477; 23.3%). This proportion decreased progressively to reach 3.0% in the seventh year. A total of 2817 patients received IVIg and 432 PE, again principally in the first year. In the full study population, the standardized mortality rate was 1.08 (95% confidence interval [CI] 1.03-1.13), being lower in men (0.95, 95% CI 0.89-1.02) than in women (1.15, 95% CI 1.07-1.23) and in patients aged >65 years (1.06, 95% CI 1.01-1.11) than in younger patients (1.50, 95% CI 1.24-1.76). Male gender, older age and higher comorbidity were independently associated with mortality. CONCLUSIONS A subgroup of patients with MG require ICU admission and rescue therapy with IVIg or PE, indicative of poor disease control. New therapies are needed to improve disease control and reduce disease burden.
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Affiliation(s)
- Shahram Attarian
- Reference Centre for Neuromuscular Disease and ALSTimone University Hospital, Aix‐Marseille University, CHU Timone, Filnemus, Euro‐NMDMarseilleFrance
| | - Jean‐Philippe Camdessanché
- Department of Neurology, Neuromuscular Disease Reference Centre, Hôpital NordUniversity Hospital of Saint‐ÉtienneSaint‐ÉtienneFrance
| | - Andoni Echaniz‐Laguna
- Department of Neurology, APHP, CHU de BicêtreINSERM U1195, Paris‐Saclay UniversityParisFrance
| | | | | | | | - Guilhem Solé
- Neurology and Neuromuscular Diseases Department, Neuromuscular Reference Centre AOC, Pellegrin HospitalBordeaux University HospitalsBordeauxFrance
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Mahé I, Gusto G, Quignot N, Khachatryan A, Chaves J, Moniot A, Andre L, Van Roy S, Mokgokong R, Bertoletti L. Occurrence and management of thrombosis recurrence and bleeding in low-molecular-weight heparin-treated patients with cancer-associated thrombosis: a French nationwide cohort study. Res Pract Thromb Haemost 2025; 9:102642. [PMID: 39868402 PMCID: PMC11759555 DOI: 10.1016/j.rpth.2024.102642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 11/07/2024] [Accepted: 11/19/2024] [Indexed: 01/28/2025] Open
Abstract
Background Rates of venous thromboembolism (VTE) recurrence and bleeding remain high in patients with cancer who are prescribed anticoagulants (ACs) such as low-molecular-weight heparin (LMWH) after an initial VTE event. Objectives To identify patient characteristics associated with VTE recurrence and bleeding in patients receiving LMWH for cancer-associated VTE and to explore secondary AC management and clinical outcomes in these patients. Methods An observational study was conducted using nationwide French data for adults with active cancer who were hospitalized with VTE in 2013-2018 and were reimbursed for LMWH ≤ 30 days after hospital discharge. The main outcomes were VTE recurrence and bleeding. For both outcomes, the proportions of patients who experienced the outcome were calculated for different patient characteristics. AC switching following VTE recurrence and bleeding was tracked using Anatomical Therapeutic Chemical codes. Results A total of 31,771 patients received LMWH, of whom 1925 (6.1%) experienced VTE recurrence and 1804 (5.7%) bleeding. Most recurrent VTE and bleeding events occurred within 6 months after the initial VTE event. The proportion of patients with VTE recurrence and bleeding varied between cancer types. Most patients who experienced VTE recurrence or bleeding continued to receive LMWH. Eleven percent of patients with VTE recurrence experienced a further recurrent VTE event within 3 months. Conclusion More than 10% of patients who received LMWH for cancer-associated VTE experienced VTE recurrence or bleeding. AC management options in this patient population should be prospectively assessed in clinical trials.
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Affiliation(s)
- Isabelle Mahé
- Université Paris Cité, Paris, France
- Assistance Publique des Hôpitaux de Paris, Hôpital Louis Mourier, Service de Médecine Interne, Inserm Unité Mixte de Recherche_S1140, Innovations Thérapeutiques en Hémostase, Paris, France
| | | | | | | | | | | | | | | | | | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, Centre Hospitalo Universitaire de St-Etienne, Saint-Etienne, France
- Institut national de la santé et de la recherche médicale, Unité Mixte de Recherche1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
- Institut national de la santé et de la recherche médicale, Centre d'Investigation Clinique-1408, Centre Hospitalo Universitaire de Saint-Etienne, Saint-Etienne, France
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Belhassen M, Marchal C, Deygas F, Jacoud F, Van Ganse E. In patients with asthma, obesity status is associated with poor control and high exacerbation rates, which are reversed after bariatric surgery. Respir Med 2025; 236:107917. [PMID: 39710277 DOI: 10.1016/j.rmed.2024.107917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Revised: 12/18/2024] [Accepted: 12/20/2024] [Indexed: 12/24/2024]
Abstract
BACKGROUND In asthma, obesity status is associated with poor control and high exacerbation rates. The primary objective was to determine the effect of bariatric surgery (BS) on asthma control and exacerbations. METHODS Retrospective study with a 3-year cohort of obese patients before and after BS: a baseline period (P0) covering the 12 months before BS and P1 and P2 periods covering the first and second years after BS, respectively. Asthma control was assessed from the use of relievers, and severe exacerbation rates, i.e. use of oral corticosteroids and asthma-related hospitalizations (ARHs). P1 and P2 measures were compared with those of P0. Patients were matched with non-obese patients and compared over P0 using a generalized linear mixed model with random effects. RESULTS 2601 asthma patients undergoing BS were included. Of these, 2556 patients were matched with 2556 nonobese asthma patients. After BS, the risk of poor control decreased [OR = 0.26 (95 % CI: 0.21-0.32)] together with the mean exacerbation rate, with IRRs of 0.54 (95 % CI: 0.51-0.58) and 0.60 (95 % CI: 0.56-0.64) for P1 and P2, respectively, compared with P0. The incidence risk ratios (IRRs) were of 1.19 (95 % CI: 1.04-1.35) and 1.28 (95 % CI: 1.20-1.37) for poor control and severe exacerbation rates, respectively, in obese vs. nonobese asthma patients. CONCLUSION In patients with asthma, obesity is a major risk factor for poor control and increased exacerbation rates, with both outcomes highly reversible for at least two years following BS.
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Affiliation(s)
| | | | | | | | - Eric Van Ganse
- PELyon, PharmacoEpidemiologie Lyon, France; Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, France; Respiratory Medicine, Croix Rousse University Hospital, Lyon, France
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Fang KH, Lo SW, Kudva A, De Vito A, Tsai YH, Hsu CM, Chang GH, Huang EI, Tsai MS, Lai CH, Tsai MH, Liao CT, Kang CJ, Tsai YT. Prognostic Utility of the Modified Systemic Inflammation Score for Patients Undergoing Oral Cavity Cancer Surgery. Diagnostics (Basel) 2024; 14:2856. [PMID: 39767217 PMCID: PMC11674824 DOI: 10.3390/diagnostics14242856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 12/12/2024] [Accepted: 12/18/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND/OBJECTIVES Chronic inflammation significantly contributes to human malignancies. We investigated the prognostic significance of the preoperative modified systemic inflammation score (mSIS) in patients with primary oral cavity squamous cell carcinoma (OCSCC). METHODS We retrospectively reviewed data from 320 OCSCC patients who underwent curative surgery between 2007 and 2017. Based on preoperative lymphocyte-to-monocyte ratio (LMR) and serum albumin levels, patients were classified into three groups: mSIS = 2 (LMR < 3.4 and albumin < 4.0 g/dL), mSIS = 1 (LMR < 3.4 or albumin < 4.0 g/dL), and mSIS = 0 (LMR ≥ 3.4 and albumin ≥ 4.0 g/dL). We explored the associations between the preoperative mSIS and overall survival (OS) and disease-free survival (DFS). We developed a nomogram based on mSIS for OS prediction. RESULTS The distribution was mSIS = 0 (n = 197, 61.6%), mSIS = 1 (n = 99, 30.9%), and mSIS = 2 (n = 24, 7.5%). Kaplan-Meier estimated OS and DFS for the mSIS = 0, mSIS = 1, and mSIS = 2 groups demonstrated a sequential decrease (both p < 0.001). The prognostic significance of mSIS was consistent across subgroup analyses. Multivariable analysis revealed that mSIS = 1 and mSIS = 2 were independent negative prognostic indicators. The mSIS-based nomogram effectively predicted OS (concordance index: 0.755). CONCLUSIONS The mSIS reliably predicts OS and DFS in OCSCC patients undergoing surgery, with the nomogram providing individualized OS estimates, enhancing mSIS's clinical utility.
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Affiliation(s)
- Ku-Hao Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan; (K.-H.F.); (C.-T.L.); (C.-J.K.)
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (Y.-H.T.); (C.-M.H.); (G.-H.C.); (E.I.H.); (M.-S.T.); (C.-H.L.); (M.-H.T.)
| | - Sheng-Wei Lo
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan;
| | - Adarsh Kudva
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal 576104, India;
| | - Andrea De Vito
- Ear Nose Throat (ENT) Unit, Department of Surgery, Forlì Hospital Health Local Agency of Romagna, 47121 Forlì, Italy;
| | - Yuan-Hsiung Tsai
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (Y.-H.T.); (C.-M.H.); (G.-H.C.); (E.I.H.); (M.-S.T.); (C.-H.L.); (M.-H.T.)
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan
| | - Cheng-Ming Hsu
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (Y.-H.T.); (C.-M.H.); (G.-H.C.); (E.I.H.); (M.-S.T.); (C.-H.L.); (M.-H.T.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan;
| | - Geng-He Chang
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (Y.-H.T.); (C.-M.H.); (G.-H.C.); (E.I.H.); (M.-S.T.); (C.-H.L.); (M.-H.T.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan;
| | - Ethan I. Huang
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (Y.-H.T.); (C.-M.H.); (G.-H.C.); (E.I.H.); (M.-S.T.); (C.-H.L.); (M.-H.T.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan;
| | - Ming-Shao Tsai
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (Y.-H.T.); (C.-M.H.); (G.-H.C.); (E.I.H.); (M.-S.T.); (C.-H.L.); (M.-H.T.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan;
| | - Chia-Hsuan Lai
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (Y.-H.T.); (C.-M.H.); (G.-H.C.); (E.I.H.); (M.-S.T.); (C.-H.L.); (M.-H.T.)
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan
| | - Ming-Hsien Tsai
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (Y.-H.T.); (C.-M.H.); (G.-H.C.); (E.I.H.); (M.-S.T.); (C.-H.L.); (M.-H.T.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Kaohsiung 833253, Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan; (K.-H.F.); (C.-T.L.); (C.-J.K.)
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (Y.-H.T.); (C.-M.H.); (G.-H.C.); (E.I.H.); (M.-S.T.); (C.-H.L.); (M.-H.T.)
| | - Chung-Jan Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan; (K.-H.F.); (C.-T.L.); (C.-J.K.)
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (Y.-H.T.); (C.-M.H.); (G.-H.C.); (E.I.H.); (M.-S.T.); (C.-H.L.); (M.-H.T.)
| | - Yao-Te Tsai
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (Y.-H.T.); (C.-M.H.); (G.-H.C.); (E.I.H.); (M.-S.T.); (C.-H.L.); (M.-H.T.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan;
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Montégut C, Falandry C, Cinieri S, Cropet C, Montane L, Rousseau F, Joly F, Moubarak M, Mosconi AM, Guerra-Alía EM, Schauer C, Fujiwara H, Vergote I, Parma G, Lindahl G, Anota A, Canzler U, Marmé F, Pujade-Lauraine E, Ray-Coquard I, Sabatier R. Safety and quality of life with maintenance olaparib plus bevacizumab in older patients with ovarian cancer: subgroup analysis of PAOLA‑1/ENGOT-ov25. Oncologist 2024:oyae322. [PMID: 39673779 DOI: 10.1093/oncolo/oyae322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 09/10/2024] [Indexed: 12/16/2024] Open
Abstract
BACKGROUND In PAOLA-1/ENGOT-ov25, the addition of olaparib to bevacizumab maintenance improved overall survival in patients with newly diagnosed advanced ovarian cancer. We describe the safety profile and quality of life (QoL) of this combination in older patients in PAOLA-1. METHODS Safety (CTCAE v4.03) and QoL (EORTC QoL Questionnaires Core 30 and Ovarian 28) data were collected. We compared safety by age (≥70 vs <70 years) in the olaparib-containing arm. QoL by treatment arm was assessed in older patients. Geriatric features, including Geriatric Vulnerability Score (GVS), were also gathered. RESULTS Of 806 patients randomized, 142 were ≥70 years old (olaparib-containing arm: n = 104; placebo arm: n = 38). Older patients treated with olaparib exhibited a similar safety profile to younger patients, except for higher rates of all grades of lymphopenia and grade ≥3 hypertension (31.7% vs 21.6%, P =.032 and 26.9% vs 16.7%, P =.019, respectively). No hematological malignancy was reported. Two years after randomization, mean Global Health Status and cognitive functioning seemed better with olaparib than bevacizumab alone (adjusted mean difference: +4.47 points [95% CI, -0.49 to 9.42] and +4.82 [-0.57 to 10.21], respectively), and other QoL items were similar between arms. In the olaparib-containing arm, older patients with baseline GVS ≥ 1 (n = 48) exhibited increased toxicity and poorer QoL than those with GVS of 0 (n = 34). CONCLUSION Among older patients in PAOLA-1, olaparib plus bevacizumab had a manageable safety profile and no adverse impact on QoL. Additional data are required to confirm these results in more vulnerable patients.(ClinicalTrials.gov Identifier: NCT02477644).
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Affiliation(s)
- Coline Montégut
- Département d'Oncologie Médicale, Institut Paoli-Calmettes, Marseille, France
- GINECO, France
| | - Claire Falandry
- GINECO, France
- Hospices Civils de Lyon, Université Lyon 1, Lyon, France
| | - Saverio Cinieri
- U.O.C. Oncologia Medica, Ospedale Senatore Antonio Perrino, Puglia, Italy
- MITO, Italy
| | - Claire Cropet
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Laure Montane
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Frédérique Rousseau
- Département d'Oncologie Médicale, Institut Paoli-Calmettes, Marseille, France
- GINECO, France
| | - Florence Joly
- GINECO, France
- University Unicaen, Inserm U1086 Anticipe, Centre François Baclesse, Caen, France
| | - Malak Moubarak
- Department of Gynecology & Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Anna M Mosconi
- MITO, Italy
- S.C. di Oncologia Medica, Ospedaliera S. Maria della Misericordia, AO di Perugia, Perugia, Italy
| | | | | | | | - Ignace Vergote
- University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
- BGOG, Belgium
| | - Gabriella Parma
- European Institute of Oncology IRCCS, Milan, Italy
- MANGO, Italy
| | - Gabriel Lindahl
- Department of Oncology, Linköping University Hospital, Linköping, Sweden
- NSGO, Sweden
| | - Amélie Anota
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Ulrich Canzler
- Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT), Dresden, Germany
- AGO, Germany
| | - Frederik Marmé
- AGO, Germany
- Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Isabelle Ray-Coquard
- GINECO, France
- University Unicaen, Inserm U1086 Anticipe, Centre François Baclesse, Caen, France
- Centre Léon BERARD and University Claude Bernard Lyon I, Lyon, France
| | - Renaud Sabatier
- Département d'Oncologie Médicale, Institut Paoli-Calmettes, Marseille, France
- GINECO, France
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Zhakhina G, Sakko Y, Yerdessov S, Aimyshev T, Makhammajanov Z, Abbay A, Vinnikov D, Fakhradiyev I, Yermakhanova Z, Solak Y, Salustri A, Gaipov A. Temporal Trends and Mortality Patterns in Peripheral Arterial Disease: A Comprehensive Analysis of Hospitalized Patients in Kazakhstan between 2014 and 2021. J Epidemiol Glob Health 2024; 14:1609-1618. [PMID: 39400655 PMCID: PMC11652560 DOI: 10.1007/s44197-024-00313-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 09/30/2024] [Indexed: 10/15/2024] Open
Abstract
BACKGROUND Peripheral artery disease (PAD) is a global health concern associated with arterial narrowing or blockage, leading to significant morbidity and mortality. The aim of this study is to assess the disease burden and trends in mortality utilizing nationwide administrative health data. METHODS This retrospective study utilized data from the Unified National Electronic Healthcare System (UNEHS) from 2014 to 2021. Patients meeting PAD criteria were included, with demographic and clinical data analyzed. Cox regression and Competing Risk Analysis assessed mortality risks. RESULTS Between 2014 and 2021, 19,507 individuals were hospitalized due to PAD, with 8,332 (43%) being women and 11,175 (57%) men. The incidence of PAD increased markedly over the observation period, rising from 79 individuals per million population (PMP) in 2014 to 309 PMP in 2021. Concurrent heart failure (HF), acute myocardial infarction (AMI), diabetes, and essential hypertension were prevalent in 50%, 27%, 27%, and 26% of the PAD patients, respectively. Competing Risk Analysis showed a subdistribution hazard ratio (SHR) of 6.53 [95% CI: 4.65-9.19] for individuals over 80 years. Heart failure was associated with lower all-cause HR [0.80, 95% CI: 0.76-0.86, p < 0.001] but higher SHR [1.30, 95% CI: 1.18-1.44, p < 0.001]. Comorbidities such as heart failure, stroke, and acute myocardial infarction significantly increased mortality risks, while essential hypertension was associated with lower risk of death. CONCLUSION The significant rise in the incidence rate of PAD underscores the growing burden of the disease, highlighting the urgent need for targeted preventive and management strategies in Kazakhstan.
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Affiliation(s)
- Gulnur Zhakhina
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Yesbolat Sakko
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Sauran Yerdessov
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Temirgali Aimyshev
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | | | - Anara Abbay
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Denis Vinnikov
- Environmental Health Lab, Al-Farabi Kazakh National University, Almaty, Kazakhstan
- Occupational Health Risks Lab, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - Ildar Fakhradiyev
- Department of Medicine, Kazakh National Medical University, Almaty, Kazakhstan
| | - Zhanar Yermakhanova
- Department of Special Clinical Disciplines, Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkestan, Kazakhstan
| | - Yalcin Solak
- Nefromed Private Hemodialysis Clinic, Sakarya, Turkey
| | - Alessandro Salustri
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Abduzhappar Gaipov
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan.
- Clinical Academic Department of Internal Medicine, University Medical Center, Astana, Kazakhstan.
- , Astana city, Republic of Kazakhstan.
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Ahn GJ, Lee S, Heo YW, Cha YS. Mortality Risks and Causes in Previous Carbon Monoxide Poisoning: A Nationwide Population-Based Cohort Study. Crit Care Med 2024; 52:1866-1876. [PMID: 39298511 DOI: 10.1097/ccm.0000000000006414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2024]
Abstract
OBJECTIVES Carbon monoxide (CO) poisoning can cause brain, heart, and kidney injuries. We aimed to determine the association of risks of all-cause and cause-specific mortality in patients with previous CO poisoning. DESIGN, SETTING, AND PATIENTS This population-based cohort study used data from the National Health Insurance Service database and the National Death Registry of Korea. Adult patients diagnosed with CO poisoning and controls between 2002 and 2020 were included. Patients were matched with controls on a 1:1 ratio, considering age, sex, insurance type, income level, residential location, smoking status, alcohol consumption, obesity status, medical and psychiatric illness history, and Charlson Comorbidity Index at the index date. The cohort was monitored from 2002 to 2022 or until death or emigration in terms of all-cause and cause-specific mortality. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 48,600 patients with CO poisoning and matched controls were included. The cohort included 41.30% females, and the mean age was 48.05 years. Patients with CO poisoning exhibited a substantially elevated risk of all-cause mortality compared with those in the control group, with an adjusted hazard ratio (aHR) of 15.67 (95% CI, 12.58-19.51). The mortality associated with infectious (aHR, 6.71; 95% CI, 1.51-29.72), neoplasm/oncologic (aHR, 5.20; 95% CI, 3.39-7.99), endocrine (aHR, 13.44; 95% CI, 1.76-102.70), neurologic (aHR, 7.42; 95% CI, 2.91-18.90), cardiovascular (aHR, 8.97; 95% CI, 5.05-15.93), respiratory (aHR, 17.54; 95% CI, 5.48-56.17), and gastrointestinal (aHR, 24.72; 95% CI, 3.34-182.69) disorders was significantly greater in the former. Deaths due to external causes, including suicide, were significantly higher in the CO poisoning group (aHR, 50.07; 95% CI, 30.98-80.90). CONCLUSIONS Patients with CO poisoning exhibited a heightened risk of all-cause mortality compared with the matched controls. Additionally, the cause-specific mortality risk differed between the groups.
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Affiliation(s)
- Gyo J Ahn
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Solam Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yeon-Woo Heo
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yong S Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Research Institute of Hyperbaric Medicine and Science, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Bettuzzi T, Lebrun-Vignes B, Ingen-Housz-Oro S, Sbidian E. Incidence, In-Hospital and Long-Term Mortality, and Sequelae of Epidermal Necrolysis in Adults. JAMA Dermatol 2024; 160:1288-1296. [PMID: 39356525 PMCID: PMC11447629 DOI: 10.1001/jamadermatol.2024.3575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 07/29/2024] [Indexed: 10/03/2024]
Abstract
Importance The incidence of epidermal necrolysis (EN), including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), varies across studies. While in-hospital mortality rates range from 15% to 20%, contributors to long-term mortality have been rarely evaluated and remain unknown. Objective To assess the incidence of and compare factors associated with in-hospital mortality and postdischarge mortality and sequelae among patients with EN. Design, Setting, and Participants This cohort study used French Health System data from January 1, 2013, to December 31, 2022, and included all adult patients (aged ≥18 years) with EN identified using International Statistical Classification of Diseases, Tenth Revision codes combined with a validated algorithm. Exposure Epidermal necrolysis. Main Outcomes and Measures Incidence, in-hospital mortality, postdischarge mortality, and sequelae were assessed as main outcomes. Factors associated with mortality were assessed using a multivariable Cox proportional hazards model. Results A total of 1221 adult patients with EN (median [IQR] age, 66 [49-79] years; 688 females [56.3%]) were included. Incidence was 2.6 (95% CI, 2.5-2.7) cases per million person-years. The in-hospital mortality rate was 19% (95% CI, 17%-21%) and postdischarge mortality rate, 15% (95% CI, 13%-17%) for an overall mortality of 34% (95% CI, 31%-36%). In multivariable analysis, factors associated with in-hospital mortality were age (adjusted hazard ratio [AHR], 1.03 per year of age; 95% CI, 1.02-1.04 per year of age), history of cancer (AHR, 2.04; 95% CI, 1.53-2.72), dementia (AHR, 1.85; 95% CI, 1.12-3.07), liver disease (AHR, 1.81; 95% CI, 1.24-2.64), and EN severity (TEN vs SJS: AHR, 2.14; 95% CI, 1.49-3.07). Cancer, liver disease, and dementia remained associated with postdischarge mortality (AHR, 3.26 [95% CI, 2.35-4.53], 1.86 [95% CI, 1.11-3.13], and 1.95 [95% CI, 1.11-3.43], respectively). Conversely, EN initial severity was not associated with mortality after hospital discharge (TEN vs SJS: AHR, 0.95; 95% CI, 0.60-1.47), but acute complications remained associated (AHR, 2.14 [95% CI, 1.26-3.63] and 2.44 [95% CI, 1.42-4.18] for acute kidney injury and sepsis, respectively). The main sequelae were ophthalmologic and mood disorders. Conclusion The findings of this cohort study suggest that although EN is a rare condition, it is associated with high rates of in-hospital and postdischarge mortality among patients who are older and have comorbid conditions. However, in contrast with in-hospital mortality, postdischarge mortality is not associated with EN initial severity but with acute in-hospital complications (eg, acute kidney injury and sepsis). Future studies are needed to construct models to estimate long-term outcomes and sequelae in patients with EN.
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Affiliation(s)
- Thomas Bettuzzi
- Service de Dermatologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), Université Paris Est Créteil (UPEC), Créteil, France
- Centre de Référence des Dermatoses Bulleuses Toxiques et Toxidermies Graves, TOXIBUL, Créteil, France
| | - Bénédicte Lebrun-Vignes
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), Université Paris Est Créteil (UPEC), Créteil, France
- Centre de Référence des Dermatoses Bulleuses Toxiques et Toxidermies Graves, TOXIBUL, Créteil, France
- Service de Pharmacologie Médicale, Centre Régional de Pharmacovigilance, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Saskia Ingen-Housz-Oro
- Service de Dermatologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), Université Paris Est Créteil (UPEC), Créteil, France
- Centre de Référence des Dermatoses Bulleuses Toxiques et Toxidermies Graves, TOXIBUL, Créteil, France
| | - Emilie Sbidian
- Service de Dermatologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), Université Paris Est Créteil (UPEC), Créteil, France
- Centre de Référence des Dermatoses Bulleuses Toxiques et Toxidermies Graves, TOXIBUL, Créteil, France
- Centre d’Investigation Clinique 1430, Institut National de la Santé et de la Recherche Médicale (INSERM), Créteil, France
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Hao A, Sadrolashrafi K, Kikuchi R, Guo L, Yamamoto RK, Tolson HC, Bilimoria S, Yee D, Hu JC, Armstrong AW. Teledermatology Use in the Elderly: An Analysis of Teledermatology Utilization Patterns Across Age Groups. Telemed J E Health 2024; 30:2669-2675. [PMID: 39119704 DOI: 10.1089/tmj.2024.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
Introduction: Telehealth is an emerging tool used to improve access to care for patients. However, there is a lack of literature comparing the use of telehealth between patients of different age groups in dermatology. Our study aims to determine whether differences exist in teledermatology usage between elderly and younger dermatology patients. Methods: We conducted a cross-sectional study using the 2020-2021 Medical Expenditure Panel Survey. Our study population included a weighted total of 150,290,604 patients: Of these, 16.35% were young adults (18-44 years old), 26.32% were midlife adults (45-64 years old), and 57.33% were elderly (65+ years old). Results: Our results showed that elderly patients had significantly lower rates of teledermatology use than young adults (odds ratio [OR] = 0.184, (confidence interval [CI]: 0.081-0.421)), p < 0.000) and midlife adults (OR = 0.193, [CI: 0.091-0.406], p < 0.000). Midlife adults had similar rates of telehealth use when compared with young adults (OR = 1.044, [CI: 0.508-2.145], p = 0.907). Our results were adjusted for sex, race, ethnicity, insurance type, education level, income, travel time, and medical comorbidities. Discussion: We found that elderly patients seeking dermatology care are less likely to use telehealth than younger dermatology patients. Our results demonstrate that barriers to telehealth use for the elderly may be more prohibitive than expected. Understanding these differences in teledermatology use is essential for improving teledermatology delivery across all age groups.
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Affiliation(s)
- Audrey Hao
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | | | - Robin Kikuchi
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Lily Guo
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Rebecca K Yamamoto
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Hannah C Tolson
- University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Sara Bilimoria
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
| | - Danielle Yee
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
| | - Jenny C Hu
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - April W Armstrong
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
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Rouhi AD, Leon S, Roberson JL, Shreve LA, Nadolski GJ, Williams NN, Dumon KR. Comparison of Gastrostomy Techniques in Stroke Patients With Dysphagia: An Entropy-Balanced Analysis. J Surg Res 2024; 303:579-586. [PMID: 39437597 DOI: 10.1016/j.jss.2024.09.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 09/10/2024] [Accepted: 09/19/2024] [Indexed: 10/25/2024]
Abstract
INTRODUCTION Enteral nutrition is commonly placed via percutaneous endoscopic gastrostomy (PEG) or radiologically inserted gastrostomy (RIG) techniques. This study compared perioperative outcomes of PEG and RIG in adults with dysphagia caused by cerebral infarction. METHODS Adult stroke patients who underwent either PEG or RIG between 2018 and 2020 at a tertiary care center were reviewed retrospectively. Differences in baseline characteristics between PEG and RIG patients were adjusted using entropy-balanced weights. Multivariable weighted logistic and linear regressions were subsequently developed to evaluate the independent association between RIG and outcomes of interest. RESULTS 217 stroke patients met inclusion criteria, of whom 37 (17.0%) received PEG and 180 (83.0%) received RIG. Compared to PEG, patients with RIG were more commonly Medicare beneficiaries and had a higher burden of comorbidities as measured by the Charlson comorbidity index. Time to achieve goal feeds was comparable between PEG and RIG (3 d [interquartile range 2-5] vs 4 d [interquartile range 3-5], respectively, P = 0.059). After multivariate adjustment, RIG was associated with significantly lower odds of reoperation (adjusted odds ratio [AOR] 0.10, 95% CI 0.02-0.50, P = 0.005), cerebrovascular accident (AOR 0.24, 95% CI 0.00-0.74, P = 0.030), and intensive care unit admission (AOR 0.14, 95% CI 0.03-0.70, P = 0.017). Risk factors for in-hospital mortality among RIG included arrhythmia (AOR 6.54, 95% CI 1.67-15.48, P = 0.009), myocardial infarction (AOR 4.78, 95% CI 2.25-10.23, P = 0.009), and obesity (AOR 4.48, 95% CI 1.03-9.61, P = 0.047). CONCLUSIONS While both techniques are effective methods of enteral feeding in stroke patients, RIG may confer lower perioperative morbidity. Local referral patterns and individual patient comorbidities could influence outcomes following PEG or RIG, necessitating careful patient selection.
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Affiliation(s)
- Armaun D Rouhi
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sebastian Leon
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey L Roberson
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lauren A Shreve
- Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory J Nadolski
- Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Noel N Williams
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristoffel R Dumon
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Lee SW, Werner B, Park H, DeAndrea J, Ayutyanont N, York H. Epidemiology of demographic, clinical characteristics and hospital course of patients with spinal cord injury associated with vertebral fracture in a large private health care system in the United States. J Spinal Cord Med 2024; 47:933-943. [PMID: 37428444 PMCID: PMC11533260 DOI: 10.1080/10790268.2023.2228582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Objectives: To evaluate the demographics, clinical characteristics, hospital course, and factors associated with outcomes in patients with spinal cord injury associated with vertebral fracture (SCI-VF).Design: Retrospective analysis of data collected from electronic health record.Setting: A large for-profit United States health care system.Participants: 2219 inpatients with SCI-VF between 2014 and 2020 identified using International Classification of Disease codes.Main Outcome Measure: In-hospital mortality, and disposition (home vs. no-home discharge) after hospitalization.Results: The mean age of patients admitted with a diagnosis of SCI-VF was 54.80 ± 20.85 years with 68.27% identified as male. The cervical spine was the most prevalent site of fracture, displaced vertebral fracture was the most common radiographic diagnosis, and the majority of injuries were classified as incomplete. 836 (37.67% of all 2219) patients were discharged home and had a shorter length of stay (7.56 ± 13.58 days) when compared to the average of the total study population (11.56 ± 19.2 days). The most common hospital-acquired complication (HAC) was falls (n = 259, 11.67%). Characteristics associated with in-hospital mortality in the 96 patients (6.94% of 1,383 patients with no-home discharge) included initial respiratory failure, ICU stay, increased medical comorbidity index value, insulin use, and presence of cardiovascular, pulmonary, and gastrointestinal HACs.Conclusions: A large observational study of patients with SCI-VF can add to the knowledge of SCI characteristics in the U.S. population. Recognizing the common hospital-acquired conditions and clinical characteristics associated with increased in-hospital mortality can be helpful to improve the care of patients with SCI-VF.
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Affiliation(s)
- Se Won Lee
- Sunrise Health GME Consortium, HCA Healthcare, Las Vegas, Nevada,USA
| | - Bryan Werner
- Sunrise Health GME Consortium, HCA Healthcare, Las Vegas, Nevada,USA
| | - Hyeyoung Park
- Sunrise Health GME Consortium, HCA Healthcare, Las Vegas, Nevada,USA
| | - Justin DeAndrea
- Sunrise Health GME Consortium, HCA Healthcare, Las Vegas, Nevada,USA
| | | | - Henry York
- Department of Physical Medicine and Rehabilitation, VA San Diego Healthcare system, San Diego, California, USA
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Bettuzzi T, Welfringer-Morin A, Ingen-Housz-Oro S, Bataille P, Lebrun-Vignes B, Bodemer C, Sbidian E. Comparison of incidence, causes and prognosis of adult and paediatric epidermal necrolysis: a French population-based study. Br J Dermatol 2024; 191:698-705. [PMID: 38848542 DOI: 10.1093/bjd/ljae240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/29/2024] [Accepted: 06/02/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Epidermal necrolysis (EN), comprising Stevens-Johnson syndrome and toxic EN, is a rare and severe blistering reaction, mainly induced by drugs. Differences between paediatric and adult patients regarding incidence, causes and outcomes have been discussed but are based on a limited number of patients from small case series. OBJECTIVES To directly compare the incidence, cause and prognosis of adult and paediatric EN. METHODS We used data from the French Health System Database (1 January 2013-31 December 2022). We identified adult and paediatric patients hospitalized for EN using the International Classification of Diseases, 10th Revision codes combined with validated algorithms. Outcomes were the incidence of EN; the presence of a suspected drug before EN onset (defined as a new drug dispensation from 5 to 56 days prehospitalization); and in-hospital mortality. To estimate the association between paediatric EN and the presence of a suspect drug, we computed a multivariable logistic regression with odd ratios (ORs). To estimate the association with mortality, we computed a multivariable Cox proportional hazard ratio (HR) model. RESULTS A total of 1440 patients [799 (55.5%) female] with EN were included, comprising 219 children and 1221 adults. Among children, the incidence of EN was 1.5 cases [95% confidence interval (CI) 1.3-1.7] per 1 million person-years vs. 2.6 cases (95% CI 2.5-2.7) in adults. Moreover, children had less chance of being given a culprit drug before the onset of EN [n = 93/219 (42.5%) vs. n = 829/1221 (67.9%)], with an adjusted OR of 0.43 (95% CI 0.32-0.59; P < 0.001), together with a better prognosis: the mortality rate in paediatric patients was 1.4% (95% CI 0.4-3.7) vs. 19.4% (95% CI 17.3-21.7) in adults. The adjusted HR for in-hospital mortality in children was 0.12 (95% CI 0.04-0.38; P < 0.001). CONCLUSIONS Paediatric EN appears to be rarer, with less chance of being caused by drugs and has a better prognosis than adult EN. These results suggest the existence of different underlying pathophysiological mechanisms and clinical particularities between adult and paediatric patients with EN.
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Affiliation(s)
- Thomas Bettuzzi
- Service de Dermatologie, Hôpital Henri Mondor, AP-HP, Créteil, France
- EpiDermE, Université Paris Est Créteil Val de Marne, UPEC, Créteil, France
- ToxiBUL, Centre de Référence des Dermatoses Bulleuses Toxiques, Créteil, France
| | - Anne Welfringer-Morin
- ToxiBUL, Centre de Référence des Dermatoses Bulleuses Toxiques, Créteil, France
- Service de Dermatologie, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | - Saskia Ingen-Housz-Oro
- Service de Dermatologie, Hôpital Henri Mondor, AP-HP, Créteil, France
- EpiDermE, Université Paris Est Créteil Val de Marne, UPEC, Créteil, France
- ToxiBUL, Centre de Référence des Dermatoses Bulleuses Toxiques, Créteil, France
| | - Pauline Bataille
- Service de Dermatologie, Hôpital Necker Enfants Malades, AP-HP, Paris, France
- Université Paris Cité, Paris, France
| | - Bénédicte Lebrun-Vignes
- Service de Pharmacologie Médicale, Centre Régional de Pharmacovigilance, Hôpital Pitié Salpétrière, AP-HP, Sorbonne Université, Paris, France
| | - Christine Bodemer
- ToxiBUL, Centre de Référence des Dermatoses Bulleuses Toxiques, Créteil, France
- Service de Dermatologie, Hôpital Necker Enfants Malades, AP-HP, Paris, France
- Université Paris Cité, Paris, France
| | - Emilie Sbidian
- Service de Dermatologie, Hôpital Henri Mondor, AP-HP, Créteil, France
- EpiDermE, Université Paris Est Créteil Val de Marne, UPEC, Créteil, France
- ToxiBUL, Centre de Référence des Dermatoses Bulleuses Toxiques, Créteil, France
- CIC Centre d'Investigation Clinique 1430, Inserm, Créteil, France
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Yazici M, Yeter AS, Genç S, Koca A, Oğuz AB, Günalp Eneyli M, Polat O. Predictability of adult patient medical emergency condition from triage vital signs and comorbidities: a single-center, observational study. BMC Emerg Med 2024; 24:185. [PMID: 39390424 PMCID: PMC11468850 DOI: 10.1186/s12873-024-01101-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 10/03/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Vital signs and comorbid diseases are the first information evaluated in patients admitted to the emergency department (ED). In most EDs, triage of patients takes place with vital signs and admission complaints only. Comorbidities are generally underestimated when determining the patient's status at the triage area. This study aims to assess the relationship between initial vital signs, comorbid diseases, and medical emergency conditions (MEC) in patients admitted to the ED. METHODS This prospective study was designed as a single-center observational study, including patients admitted to a tertiary ED between 16.06.2022 and 09.09.2022. Patients younger than 18, readmitted to the ED within 24 h, or absence of vital signs due to cardiac arrest were excluded from the study. Vital signs and comorbid diseases of all patients were recorded. The mortality within 24 h, the need for intensive care unit admission, emergency surgery, and life-saving procedures were considered "medical emergency conditions". The role of vital signs and comorbid diseases in predicting emergencies was analyzed by binary logistic regression. RESULTS A total of 10,022 patients were included in the study; 5056 (50.4%) were female, and 4966 (49.6%) were male. Six hundred four patients presented with an MEC. All vital signs -except diastolic hypertension and tachycardia- and comorbidities were found statistically significant. Hypoxia (Odd's Ratio [OR]: 1.73), diastolic hypotension (OR: 3.71), tachypnea (OR: 8.09), and tachycardia (OR: 1.61) were associated with MECs. Hemiplegia (OR: 5.7), leukemia (OR: 4.23), and moderate-severe liver disease (OR: 2.99) were the most associated comorbidities with MECs. In our study, an MEC was detected in 3.6% (186 patients) of the patients with no abnormal vital signs and without any comorbidities. CONCLUSION Among the vital signs, hypoxia, diastolic hypotension, tachypnea, and tachycardia should be considered indicators of an MEC. Hemiplegia, leukemia, and moderate-severe liver disease are the most relevant comorbidities that may accompany the MECs.
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Affiliation(s)
- Maral Yazici
- Pazarcık State Hospital, Emergency Service, Kahramanmaraş, Türkiye
| | - Ahmet Sefa Yeter
- Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Emergency Service, Ankara, Türkiye.
| | - Sinan Genç
- Department of Emergency Medicine, Ankara University School of Medicine, Ankara, Türkiye, Türkiye
| | - Ayça Koca
- Department of Emergency Medicine, Ankara University School of Medicine, Ankara, Türkiye, Türkiye
| | - Ahmet Burak Oğuz
- Department of Emergency Medicine, Ankara University School of Medicine, Ankara, Türkiye, Türkiye
| | - Müge Günalp Eneyli
- Department of Emergency Medicine, Ankara University School of Medicine, Ankara, Türkiye, Türkiye
| | - Onur Polat
- Department of Emergency Medicine, Ankara University School of Medicine, Ankara, Türkiye, Türkiye
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Chierici A, Bulsei J, Alromayan M, Alamri A, Pavone G, Fontas E, Iannelli A. Bariatric surgery reduces the incidence of hidradenitis suppurativa in individuals with obesity: results of a nationwide administrative data study in France. Surg Obes Relat Dis 2024; 20:947-952. [PMID: 38760298 DOI: 10.1016/j.soard.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/03/2024] [Accepted: 03/09/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a systemic inflammatory condition associated with obesity, metabolic syndrome, and environmental factors. Bariatric surgery (BS) is effective in reducing weight and resolving obesity-related medical problems. OBJECTIVES The aim of this case-control study is to evaluate the effects of BS on the occurrence and recurrence of HS in individuals with obesity. SETTING Nationwide administrative data study using the French national discharge database. METHODS We compared 297,776 individuals with obesity and without a history of HS who underwent BS (BS group) with 2,735,930 individuals with obesity who did not receive BS (control group) to assess the incidence of de novo HS. From the same database, we compared hospitalization rates for HS recurrence between 310 individuals with obesity and HS who had BS (HS_BS group) and 3875 individuals with obesity who did not have BS (HS_control group). Propensity score matching using the nearest-neighbor method was implemented to create comparable patient groups. RESULTS Individuals with obesity and without a history of HS who received BS exhibited a significantly reduced risk of developing de novo HS (RR = .736 [.639; .847]). Among patients with a history of HS, those who underwent BS had a nonsignificantly reduced risk of HS recurrence (RR = .676 [.369; 1.238]) compared with those who did not. CONCLUSION BS reduces the risk of developing de novo HS and seems to have a protective effect on its recurrence in individuals with obesity, although the latter effect was not statistically significant.
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Affiliation(s)
- Andrea Chierici
- Centre Hospitalier Universitaire de Nice-Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France
| | - Julie Bulsei
- Centre Hospitalier Universitaire de Nice, Department of Clinical Research and Innovation, Nice, France
| | - Mohamed Alromayan
- Centre Hospitalier Universitaire de Nice-Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France; Security Forces Medical City, Riyadh, Saudi Arabia
| | - Abdulrahmane Alamri
- Centre Hospitalier Universitaire de Nice-Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France; Department of Surgery, Medical College, Najran University, Najran, Saudi Arabia
| | - Giovanna Pavone
- Centre Hospitalier Universitaire de Nice-Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France
| | - Eric Fontas
- Centre Hospitalier Universitaire de Nice, Department of Clinical Research and Innovation, Nice, France
| | - Antonio Iannelli
- Centre Hospitalier Universitaire de Nice-Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France; Université Côte d'Azur, Nice, France; Inserm, U1065, Team 8 "Hepatic complications of obesity and alcohol," Nice, France.
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Karimova K, Friedmacher CM, Lemke D, Glushan A. Development of diabetes complications within coordinated and structured primary health care: a 10-year retrospective cohort study in Germany. BJGP Open 2024; 8:BJGPO.2024.0061. [PMID: 38565252 PMCID: PMC11523505 DOI: 10.3399/bjgpo.2024.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Diabetes mellitus is a growing, costly, and potentially preventable public health issue. In 2004, Germany introduced the GP-centred healthcare programme to strengthen primary care. AIM To assess the hazards of the most common diabetes-related complications in patients enrolled in GP-centred health care in comparison with usual primary care. DESIGN & SETTING A retrospective cohort study based on German claims data (4 million members) from 2011-2020. METHOD In total, 217 964 patients with diabetes were monitored from 2011-2020. Endpoints were blindness, amputation, myocardial infarction, stroke, coronary heart disease, dialysis, hypoglycaemia, and all-cause mortality. Cox proportional-hazards regression models were used for multivariable analysis and adjusted for sociodemographic, practice, and disease-specific characteristics. RESULTS Compared with usual care (n = 98 609 patients), GP-centred health care (n = 119 355 patients) showed a relative risk reduction of blindness of 12%, and amputation of 20% over 10 years. The estimated impact of GP-centred health care on myocardial infarction, stroke, coronary artery disease, dialysis, and all-cause mortality is significantly favourable in comparison with usual care. However, the proportional risk of hypoglycaemia (+1.2%) in the interventional group is higher than in usual care. CONCLUSION Enrolment in GP-centred health care appears to result in a consistent reduction of the relative risk of diabetes-related complications over 10 years. The significant difference in contrast to usual care may be explained by robust, structured primary care provision, including the diabetes disease management programme, and improved coordination and networking of care within primary and secondary care.
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Affiliation(s)
- Kateryna Karimova
- Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany
| | | | - Dorothea Lemke
- Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany
| | - Anastasiya Glushan
- Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany
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Dziadzko M, Belhassen M, Van Ganse E, Heritier F, Berard M, Marant-Micallef C, Aubrun F. Health Care Resource Use and Total Mortality After Hospital Admission for Severe COVID-19 Infections During the Initial Pandemic Wave in France: Descriptive Study. JMIR Public Health Surveill 2024; 10:e56398. [PMID: 39259961 PMCID: PMC11425017 DOI: 10.2196/56398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 06/28/2024] [Accepted: 07/21/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Little is known about post-hospital health care resource use (HRU) of patients admitted for severe COVID-19, specifically for the care of patients with postacute COVID-19 syndrome (PACS). OBJECTIVE A list of HRU domains and items potentially related to PACS was defined, and potential PACS-related HRU (PPRH) was compared between the pre- and post-COVID-19 periods, to identify new outpatient care likely related to PACS. METHODS A retrospective cohort study was conducted with the French National Health System claims data (SNDS). All patients hospitalized for COVID-19 between February 1, 2020, and June 30, 2020 were described and investigated for 6 months, using discharge date as index date. Patients who died during index stay or within 30 days after discharge were excluded. PPRH was assessed over the 5 months from day 31 after index date to end of follow-up, that is, for the post-COVID-19 period. For each patient, a pre-COVID-19 period was defined that covered the same calendar time in 2019, and pre-COVID-19 PPRH was assessed. Post- or pre- ratios (PP ratios) of the percentage of users were computed with their 95% CIs, and PP ratios>1.2 were considered as "major HRU change." RESULTS The final study population included 68,822 patients (median age 64.8 years, 47% women, median follow-up duration 179.3 days). Altogether, 23% of the patients admitted due to severe COVID-19 died during the hospital stay or within the 6 months following discharge. A total of 8 HRU domains were selected to study PPRH: medical visits, technical procedures, dispensed medications, biological analyses, oxygen therapy, rehabilitation, rehospitalizations, and nurse visits. PPRs showed novel outpatient care in all domains and in most items, without specificity, with the highest ratios observed for the care of thoracic conditions. CONCLUSIONS Patients hospitalized for severe COVID-19 during the initial pandemic wave had high morbi-mortality. The analysis of HRU domains and items most likely to be related to PACS showed that new care was commonly initiated after discharge but with no specificity, potentially suggesting that any impact of PACS was part of the overall high HRU of this population after hospital discharge. These purely descriptive results need to be completed with methods for controlling for confusion bias through subgroup analyses. TRIAL REGISTRATION ClinicalTrials.gov NCT05073328; https://clinicaltrials.gov/ct2/show/NCT05073328.
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Affiliation(s)
- Mikhail Dziadzko
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Département d'Anesthésie-Réanimation, Douleur, Lyon, France
- Laboratoire RESHAPE, Université Claude Bernard Lyon 1, INSERM UMR 1290, Lyon, France
| | | | - Eric Van Ganse
- Laboratoire RESHAPE, Université Claude Bernard Lyon 1, INSERM UMR 1290, Lyon, France
- PELyon, Lyon, France
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Département de la Médecine Respiratoire, Lyon, France
| | - Fabrice Heritier
- Centre Hospitalier de Roanne, Département d'Anesthésie-Réanimation, Roanne, France
| | | | | | - Frederic Aubrun
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Département d'Anesthésie-Réanimation, Douleur, Lyon, France
- Laboratoire RESHAPE, Université Claude Bernard Lyon 1, INSERM UMR 1290, Lyon, France
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Leon S, Rouhi AD, Roberson JL, Shreve LA, Nadolski GJ, Williams NN, Dumon KR. Safety of elective enteral access in elderly patients: a comparative analysis of perioperative risk. J Gastrointest Surg 2024; 28:1472-1478. [PMID: 38878956 DOI: 10.1016/j.gassur.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Elderly patients can experience torpid hospitalization that is often characterized by malnutrition. In this setting, enteral feeding may facilitate improvement in nutritional status. This study aimed to compare the perioperative outcomes between elderly (age of ≥65 years old) and nonelderly (age of <65 years old) patients undergoing elective enteral access placement. METHODS Adult patients who underwent enteral access procedures between 2018 and 2020 at a tertiary care facility were retrospectively reviewed. Differences in baseline characteristics between nonelderly and elderly patients were adjusted using entropy-balanced weights. Subsequently, multivariate logistic and linear regression models were developed to evaluate the association between elderly status and outcomes of interest. RESULTS Overall, 914 patients with enteral access met the inclusion criteria, of whom 471 (51.5%) were elderly. Elderly patients more commonly received percutaneous gastrostomy and had a higher burden of comorbidities as measured using the Charlson Comorbidity Index than nonelderly patients. Multivariate risk adjustment generated a strongly balanced distribution of baseline covariates between patient groups. After adjustment, despite no significant association with inhospital mortality, reoperation, or time to feeding goals, elderly status was linked to an approximately 8-day reduction in length of stay (95% CI, -14.28 to -2.30; P = .007) and significantly lower odds of total parenteral nutrition (adjusted odds ratio [AOR], 0.59; 95% CI, 0.37-0.94; P = .026) and nonelective readmission (AOR, 0.65; 95% CI, 0.49-0.86; P = .003). In addition, elderly status was associated with significantly greater odds of nonhome discharge (AOR, 1.58; 95% CI, 1.17-2.13; P = .003). CONCLUSION Despite having more comorbidities than their nonelderly counterparts, elderly patients experienced favorable nutritional and perioperative outcomes after enteral access placement.
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Affiliation(s)
- Sebastian Leon
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Armaun D Rouhi
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Jeffrey L Roberson
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Lauren A Shreve
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Gregory J Nadolski
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Noel N Williams
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Kristoffel R Dumon
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
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