Rural-Urban Differences in the Effect of Follow-Up Care on Postdischarge Outcomes.
Health Serv Res. 2017 Aug;52(4):1473-1493
Authors: Toth M, Holmes M, Van Houtven C, Toles M, Weinberger M, Silberman P
OBJECTIVE: To assess rural-urban differences in quality of postdischarge care among Medicare beneficiaries, controlling for selection bias of postdischarge services.
DATA SOURCES: The Medicare Current Beneficiary Survey (MCBS), Cost and Use Files from 2000 to 2010, the Area Resource File, Provider of Services File, and the Dartmouth Atlas of Health Care.
STUDY DESIGN: Retrospective analysis of 30- and 60-day hospital readmission, emergency department (ED) use, and mortality using two-stage residual inclusion; receipt of 14-day follow-up care was the main independent variable.
DATA EXTRACTION METHOD: We defined index admission from the MCBS as any admission without a previous admission within 60 days.
PRINCIPAL FINDINGS: Noninstrumental variables estimation was the preferred estimation strategy. Fourteen-day follow-up care reduced the risk of readmission, ED use, and mortality. There were no rural- urban differences in the effect of 14-day follow-up care on readmission and mortality. Rural beneficiaries experienced a greater effect of 14-day follow-up care on reducing 30-day ED use compared to urban beneficiaries.
CONCLUSIONS: Follow-up care reduces 30- and 60-day readmission, ED use, and mortality. Rural and urban Medicare beneficiaries experience similar beneficial effects of follow-up care on the outcomes. Policies that improve follow-up care in rural settings may be beneficial.
PMID: 27500788 [PubMed - indexed for MEDLINE]
Patient Outcomes in Dose Reduction or Discontinuation of Long-Term Opioid Therapy: A Systematic Review.
Ann Intern Med. 2017 Aug 01;167(3):181-191
Authors: Frank JW, Lovejoy TI, Becker WC, Morasco BJ, Koenig CJ, Hoffecker L, Dischinger HR, Dobscha SK, Krebs EE
Background: Expert guidelines recommend reducing or discontinuing long-term opioid therapy (LTOT) when risks outweigh benefits, but evidence on the effect of dose reduction on patient outcomes has not been systematically reviewed.
Purpose: To synthesize studies of the effectiveness of strategies to reduce or discontinue LTOT and patient outcomes after dose reduction among adults prescribed LTOT for chronic pain.
Data Sources: MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library from inception through April 2017; reference lists; and expert contacts.
Study Selection: Original research published in English that addressed dose reduction or discontinuation of LTOT for chronic pain.
Data Extraction: Two independent reviewers extracted data and assessed study quality using the U.S. Preventive Services Task Force quality rating criteria. All authors assessed evidence quality using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Prespecified patient outcomes were pain severity, function, quality of life, opioid withdrawal symptoms, substance use, and adverse events.
Data Synthesis: Sixty-seven studies (11 randomized trials and 56 observational studies) examining 8 intervention categories, including interdisciplinary pain programs, buprenorphine-assisted dose reduction, and behavioral interventions, were found. Study quality was good for 3 studies, fair for 13 studies, and poor for 51 studies. Many studies reported dose reduction, but rates of opioid discontinuation ranged widely across interventions and the overall quality of evidence was very low. Among 40 studies examining patient outcomes after dose reduction (very low overall quality of evidence), improvement was reported in pain severity (8 of 8 fair-quality studies), function (5 of 5 fair-quality studies), and quality of life (3 of 3 fair-quality studies).
Limitation: Heterogeneous interventions and outcome measures; poor-quality studies with uncontrolled designs.
Conclusion: Very low quality evidence suggests that several types of interventions may be effective to reduce or discontinue LTOT and that pain, function, and quality of life may improve with opioid dose reduction.
Primary Funding Source: Veterans Health Administration. (PROSPERO: CRD42015020347).
PMID: 28715848 [PubMed - indexed for MEDLINE]
Can patients with femoral neck fracture benefit from preoperative thromboprophylaxis?: A prospective randomized controlled trial.
Medicine (Baltimore). 2017 Jul;96(29):e7604
Authors: Li Q, Dai B, Xu J, Yao Y, Song K, Zhang H, Chen D, Jiang Q
BACKGROUND: The effectiveness of preoperative thromboprophylaxis remains obscure in patients with femoral neck fracture. The purpose of the current study was to investigate whether these patients benefit from preoperative thromboprophylaxis.
METHODS: In this prospective, randomized controlled trial, a total of 80 patients with femoral neck fracture were randomly assigned to receive either rivaroxaban or conservative treatment before surgery. For all patients, color Doppler ultrasound of both lower extremities was performed immediately after admission. The primary efficacy outcome was venous thromboembolism (VTE) defined as deep vein thrombosis (DVT) or pulmonary embolism (PE). The primary safety outcome was major bleeding.
RESULT: Compared with conservative treatment, rivaroxaban could significantly reduce the incidence of DVT from 19.5% (8/41) to 2.6% (1/39) (P = .016). Preoperatively, there were a total of 9 occurrences of DVT including 8 DVT in the conservative treatment group and 1 in the oral rivaroxaban group. All cases of DVT were asymptomatic, with 8 of them diagnosed as isolated muscular calf vein thromboses. There were no differences between the 2 groups in terms of the overall incidence of major bleeding.
CONCLUSION: Thromboprophylaxis with rivaroxaban prior to surgery can effectively reduce the risk of preoperative DVT for patients with femoral neck fracture without increasing the risk of bleeding.
PMID: 28723807 [PubMed - indexed for MEDLINE]
Caregiver Treatment Preferences for Children with a New Versus Existing Attention-Deficit/Hyperactivity Disorder Diagnosis.
J Child Adolesc Psychopharmacol. 2017 Apr;27(3):234-242
Authors: dosReis S, Park A, Ng X, Frosch E, Reeves G, Cunningham C, Janssen EM, Bridges JFP
OBJECTIVES: Parental experiences with managing their child's attention-deficit/hyperactivity disorder (ADHD) can influence priorities for treatment. This study aimed to identify the ADHD management options caregivers most prefer and to determine if preferences differ by time since initial ADHD diagnosis.
METHODS: Primary caregivers (n = 184) of a child aged 4-14 years old in care for ADHD were recruited from January 2013 through March 2015 from community-based pediatric and mental health clinics and family support organizations across the state of Maryland. Participants completed a survey that included child/family demographics, child clinical treatment, and a Best-Worst Scaling (BWS) experiment to elicit ADHD management preferences. The BWS comprised 18 ADHD management profiles showing seven treatment attributes, where the best and worst attribute levels were selected from each profile. A conditional logit model using effect-coded variables was used to estimate preference weights stratified by time since ADHD diagnosis.
RESULTS: Participants were primarily the mother (84%) and had a college or postgraduate education (76%) with 75% of the children on stimulant medications. One-on-one caregiver behavior training, medication use seven days a week, therapy in a clinic, and an individualized education program were most preferred for managing ADHD. Aside from caregiver training and monthly out-of-pocket costs, caregivers of children diagnosed with ADHD for less than two years prioritized medication use lower than other care management attributes and caregivers of children diagnosed with ADHD for two or more years preferred school accommodations, medication, and provider specialty.
CONCLUSIONS: Preferences for ADHD treatment differ based on the duration of the child's ADHD. Acknowledging that preferences change over the course of care could facilitate patient/family-centered care planning across a range of resources and a multidisciplinary team of professionals.
PMID: 27991834 [PubMed - indexed for MEDLINE]
Hospital discharges and patient activity associated with chronic pancreatitis in Ireland 2009-2013.
Pancreatology. 2017 Jan - Feb;17(1):56-62
Authors: Ní Chonchubhair HM, Bashir Y, McNaughton D, Barry JM, Duggan SN, Conlon KC
OBJECTIVE: To investigate trends in acute public hospital patient discharges in Ireland, to analyse hospital discharge activity for geographical variations, aetiological differences, and to estimate a national prevalence for chronic pancreatitis.
METHOD: We performed a nationwide retrospective study of all in-patient discharges from acute public hospitals in Ireland, participating in the Hospital In-Patient Enquiry (HIPE) reporting system. We searched for International Classification of Disease, Tenth Revision, Australian Modification (ICD-10-AM) codes K86.0 alcohol-induced chronic pancreatitis, and K86.1 other chronic pancreatitis, and data were extracted for the years 2009-2013.
RESULTS: There were 4098 emergency admissions for any aetiology chronic pancreatitis during the 5 year study period. Total discharges ranged from 753 in 2009 to 999 in 2013. Total patients ranged from 530 in 2009 to 601 in 2013. Prevalence of chronic pancreatitis is estimated at 11.6 per 100,000 to 13.0 per 100,000 over the five years. 'Other aetiology chronic pancreatitis' discharges were almost double that of 'alcohol chronic pancreatitis'. We found notable geographical variation in hospital discharge activity for chronic pancreatitis.
CONCLUSIONS: We report a prevalence which is similar to those worldwide studies who adopted a similar methodology utilising exact counts of patients. Our data are an underestimated as they are based on in-patient discharges only, excluding those attending primary care, outpatient or emergency room visits without admission. Despite studying this disease in a population with high per capita alcohol consumption, we report almost twice as many discharges for non-alcohol aetiology chronic pancreatitis.
PMID: 27916415 [PubMed - indexed for MEDLINE]
Ann Intern Med. 2017 Aug 01;167(3):ITC17-ITC32
Authors: Ensrud KE, Crandall CJ
Osteoporosis is a common systemic skeletal disorder resulting in bone fragility and increased fracture risk. However, management of osteoporosis and fracture prevention strategies are often not addressed by primary care clinicians, even in older patients with recent fractures. Evidence-based screening strategies will improve identification of patients who are most likely to benefit from drug treatment to prevent fracture. In addition, careful consideration of when pharmacotherapy should be started and choice of medication and duration of treatment will maximize the benefits of fracture prevention while minimizing potential harms of long-term drug exposure.
PMID: 28761958 [PubMed - indexed for MEDLINE]
General Practitioners' Attitudes towards Essential Competencies in End-of-Life Care: A Cross-Sectional Survey.
PLoS One. 2017;12(2):e0170168
Authors: Giezendanner S, Jung C, Banderet HR, Otte IC, Gudat H, Haller DM, Elger BS, Zemp E, Bally K
BACKGROUND: Identifying essential competencies in end-of-life care, as well as general practitioners' (GPs) confidence in these competencies, is essential to guide training and quality improvement efforts in this domain.
AIM: To determine which competencies in end-of-life care are considered important by GPs, to assess GPs' confidence in these competencies in a European context and their reasons to refer terminally ill patients to a specialist.
DESIGN AND SETTING: Cross-sectional postal survey involving a stratified random sample of 2000 GPs in Switzerland in 2014.
METHOD: Survey development was informed by a previous qualitative exploration of relevant end-of-life GP competencies. Main outcome measures were GPs' assessment of the importance of and confidence in 18 attributes of end-of-life care competencies, and reasons for transferring care of terminally-ill patients to a specialist. GP characteristics associated with main outcome measures were tested using multivariate regression models.
RESULTS: The response rate was 31%. Ninety-nine percent of GPs considered the recognition and treatment of pain as important, 86% felt confident about it. Few GPs felt confident in cultural (16%), spiritual (38%) and legal end-of-life competencies such as responding to patients seeking assisted suicide (35%) although more than half of the respondents regarded these competencies as important. Most frequent reasons to refer terminally ill patients to a specialist were lack of time (30%), better training of specialists (23%) and end-of-life care being incompatible with other duties (19%). In multiple regression analyses, confidence in end-of-life care was positively associated with GPs' age, practice size, home visits and palliative training.
CONCLUSIONS: GPs considered non-somatic competencies (such as spiritual, cultural, ethical and legal aspects) nearly as important as pain and symptom control. Yet, few GPs felt confident in these non-somatic competencies. These findings should inform training and quality improvement efforts in this domain, in particular for younger, less experienced GPs.
PMID: 28146566 [PubMed - indexed for MEDLINE]
Prevalence and psychosocial correlates of food addiction in persons with obesity seeking weight reduction.
Compr Psychiatry. 2017 Feb;73:97-104
Authors: Chao AM, Shaw JA, Pearl RL, Alamuddin N, Hopkins CM, Bakizada ZM, Berkowitz RI, Wadden TA
INTRODUCTION: Food addiction is a controversial concept. The potential influence of food addiction on patients' psychosocial functioning and well-being has not been well established. The purpose of this study was to examine the relationships between psychosocial functioning (depressive symptoms and health-related quality of life [HRQOL]) and food addiction as measured by the Yale Food Addiction Scale (YFAS). We also explored whether food addiction contributed additional variance in explaining psychosocial functioning, beyond demographic and clinical factors (e.g., binge eating).
METHODS: The sample included 178 participants (mean age=44.2±11.2years; BMI=40.9±5.9kg/m(2); 88.2% female; 70.8% Black) with obesity seeking treatment for weight loss. Participants completed the Medical Outcomes Study 36-Item Short-Form Health Survey, Impact of Weight on Quality of Life-Lite, Patient Health Questionnaire, YFAS, and Questionnaire on Eating and Weight Patterns-5.
RESULTS: Twelve (6.7%) participants met criteria for food addiction, with 4 (33.3%) of these participants having co-occurring binge eating disorder. After adjusting for covariates, the number of food addiction symptoms accounted for 6.5% to 16.3% of additional variance in general HRQOL, 5.0% to 21.5% in weight-related HRQOL, and 19.1% in symptoms of depression.
CONCLUSIONS: In this treatment-seeking sample of participants, we found a low prevalence of food addiction, suggesting that addictive-like eating is unlikely to be a causal mechanism for most people with obesity. However, individuals who met criteria for food addiction had reduced psychosocial functioning compared to those who did not meet criteria. Individuals with addictive-like eating may require additional psychosocial support.
PMID: 27930952 [PubMed - indexed for MEDLINE]
Uncovering degrees of workplace bullying: A comparison of baccalaureate nursing students' experiences during clinical placement in Australia and the UK.
Nurse Educ Pract. 2017 Jul;25:14-21
Authors: Birks M, Cant RP, Budden LM, Russell-Westhead M, Sinem Üzar Özçetin Y, Tee S
Bullying in health workplaces has a negative impact on nurses, their families, multidisciplinary teams, patient care and the profession. This paper compares the experiences of Australian and UK baccalaureate nursing students in relation to bullying and harassment during clinical placement. A secondary analysis was conducted on two primary cross-sectional studies of bullying experiences of Australian and UK nursing students. Data were collected using the Student Experience of Bullying during Clinical Placement (SEBDCP) questionnaire and analysed using descriptive and inferential statistics. The total sample was 833 Australian and 561 UK students. Australian nursing students experienced a higher rate of bullying (50.1%) than UK students (35.5%). Students identified other nurses as the main perpetrators (Aust 53%, UK 68%), although patients were the main source of physical acts of bullying. Few bullied students chose to report the episode/s. The main reason for non-reporting was fear of being victimised. Sadly, some students felt bullying and harassment was 'part of the job'. A culture of bullying in nursing persists internationally. Nursing students are vulnerable and can question their future in the 'caring' profession of nursing after experiencing and/or witnessing bullying during clinical placement. Bullying requires a zero tolerance approach. Education providers must develop clearer policies and implement procedures to protect students - the future nursing workforce.
PMID: 28456062 [PubMed - indexed for MEDLINE]
Midwifery participatory curriculum development: Transformation through active partnership.
Nurse Educ Pract. 2017 Jul;25:5-13
Authors: Sidebotham M, Walters C, Chipperfield J, Gamble J
Evolving knowledge and professional practice combined with advances in pedagogy and learning technology create challenges for accredited professional programs. Internationally a sparsity of literature exists around curriculum development for professional programs responsive to regulatory and societal drivers. This paper evaluates a participatory curriculum development framework, adapted from the community development sector, to determine its applicability to promote engagement and ownership during the development of a Bachelor of Midwifery curriculum at an Australian University. The structures, processes and resulting curriculum development framework are described. A representative sample of key curriculum development team members were interviewed in relation to their participation. Qualitative analysis of transcribed interviews occurred through inductive, essentialist thematic analysis. Two main themes emerged: (1) 'it is a transformative journey' and (2) focused 'partnership in action'. Results confirmed the participatory curriculum development process provides symbiotic benefits to participants leading to individual and organisational growth and the perception of a shared curriculum. A final operational model using a participatory curriculum development process to guide the development of accredited health programs emerged. The model provides an appropriate structure to create meaningful collaboration with multiple stakeholders to produce a curriculum that is contemporary, underpinned by evidence and reflective of 'real world' practice.
PMID: 28437691 [PubMed - indexed for MEDLINE]
Can Early Intervention Improve Maternal Well-Being? Evidence from a Randomized Controlled Trial.
PLoS One. 2017;12(1):e0169829
Authors: Doyle O, Delaney L, O'Farrelly C, Fitzpatrick N, Daly M
OBJECTIVE: This study estimates the effect of a targeted early childhood intervention program on global and experienced measures of maternal well-being utilizing a randomized controlled trial design. The primary aim of the intervention is to improve children's school readiness skills by working directly with parents to improve their knowledge of child development and parenting behavior. One potential externality of the program is well-being benefits for parents given its direct focus on improving parental coping, self-efficacy, and problem solving skills, as well as generating an indirect effect on parental well-being by targeting child developmental problems.
METHODS: Participants from a socio-economically disadvantaged community are randomly assigned during pregnancy to an intensive 5-year home visiting parenting program or a control group. We estimate and compare treatment effects on multiple measures of global and experienced well-being using permutation testing to account for small sample size and a stepdown procedure to account for multiple testing.
RESULTS: The intervention has no impact on global well-being as measured by life satisfaction and parenting stress or experienced negative affect using episodic reports derived from the Day Reconstruction Method (DRM). Treatment effects are observed on measures of experienced positive affect derived from the DRM and a measure of mood yesterday.
CONCLUSION: The limited treatment effects suggest that early intervention programs may produce some improvements in experienced positive well-being, but no effects on negative aspects of well-being. Different findings across measures may result as experienced measures of well-being avoid the cognitive biases that impinge upon global assessments.
PMID: 28095505 [PubMed - indexed for MEDLINE]
Ageism in Studies on the Management of Osteoporosis.
J Am Geriatr Soc. 2017 Jul;65(7):1566-1568
Authors: McGarvey C, Coughlan T, O'Neill D
OBJECTIVES: To review the literature to assess whether the fact that osteoporosis is chiefly considered a disease of the older population was reflected in research in the area of the management of osteoporosis and to determine the extent of ageism in studies on the management of osteoporosis.
SETTING: All randomized control trials on the management of osteoporosis entered in the Cochrane Library Database that reported mean age were included. Exclusion criteria were also examined. Of 284 randomized control trials identified, 102 were eligible for inclusion.
PARTICIPANTS: Older adult trail participants.
MEASUREMENTS: Mean age of participants and exclusion criteria used were analyzed.
RESULTS: The mean age of all participants was 64.0, despite the fact that the average age at hip fracture is 83 for women and 84 for men. Overall, the mean age of those presenting with hip fractures is 84.8. Twenty-four (23%) of the 102 trials used older age as an exclusion factor. Other exclusion factors were long time since menopause, impaired cardiac or pulmonary function, dependent in ambulation, any severe comorbidity, dementia or any cognitive impairment, recent history of peptic ulcer disease or erosive gastric disease, uncontrolled hypertension, and psychiatric illness.
CONCLUSION: These data show a distinct difference between the mean age of participants in studies of the management of osteoporosis and the mean age of those presenting with hip fractures. Given that osteoporosis is the leading cause of hip fractures, this finding could have a significant effect on future studies in this area. It would follow that future research should include a cohort of an age that is more reflective of those most likely to experience the adverse effects of osteoporosis.
PMID: 28263366 [PubMed - indexed for MEDLINE]
Procedures in child deaths in The Netherlands: a comparison with child death review.
Z Gesundh Wiss. 2017;25(4):357-370
Authors: Gijzen S, Petter J, L'Hoir MP, Boere-Boonekamp MM, Need A
AIM: Child Death Review (CDR) is a method in which every child death is systematically and multidisciplinary examined to (1) improve death statistics, (2) identify factors that give direction for prevention, (3) translate the results into possible interventions, and (4) support families. The aim of this study was to determine to what extent procedures of organizations involved in the (health) care for children in The Netherlands cover these four objectives of CDR.
SUBJECT AND METHODS: Organizations in the Eastern part of The Netherlands and Dutch umbrella organizations involved in child (health) care were asked to provide their protocols, guidelines or other working agreements that describe their activities and responsibilities in case of a child's death. Eighteen documents and nine interview reports were made available. For the analyses we used scorecards for each CDR objective.
RESULTS: The procedures of Perined, the National Cot Death Study Group, Dutch Cot Death Foundation and Child Protection Service cover the largest part of the objectives of CDR. Organizations pay most attention to the translation of results into possible interventions. Family support gets the least attention in protocols, guidelines and other working agreements.
CONCLUSION: Dutch organizations separately cover parts of CDR. When the procedures of organizations are combined, all CDR objectives are covered in the response to only specific groups of child deaths, i.e., perinatal deaths, Sudden Unexpected Deaths in Infants and fatal child abuse cases. Further research into the conditions that are needed for an optimal implementation of CDR in The Netherlands is necessary. This research should also evaluate the recently implemented NODOK procedure (Further Examination of the Causes of death in Children), directed to investigate unexplained deaths in minors 0-18 years old.
PMID: 28781935 [PubMed]
Barriers and facilitators to healthy eating and disease self-management among older adults residing in subsidized housing.
Nutr Health. 2017 Jan 01;:260106017722724
Authors: Petroka K, Campbell-Bussiere R, Dychtwald DK, Milliron BJ
BACKGROUND: As adults transition into older ages, meeting age-specific dietary recommendations can become increasingly challenging, especially for low-income seniors who reside in publicly subsidized rental housing.
AIM: The primary objectives of this study were to: 1) identify barriers and facilitators to healthy eating and self-management of nutrition-related chronic illnesses experienced by low-income seniors residing in a subsidized housing setting; and 2) assess the interest in community nutrition programming among low-income seniors residing in a subsidized housing setting.
METHOD: A qualitative study design, using food focus groups and food pantry observations, was used. Participants included 24 male and female senior adults, between 65 and 75 years of age, residing in a subsidized housing community in Philadelphia, PA. This setting also included the unique features of a community garden and food pantry. Data were manually analyzed using a content analysis approach, which included familiarization, identification of themes, categorization and interpretation; and verified using NVivo 10.
RESULTS: Personal barriers, including food cost and accessibility, physical limitations, desire for convenience, and low self-efficacy to change dietary habits, inhibited motivation to change. External barriers in the food environment, including lack of transportation and distance of markets to access fresh produce, were commonly cited; as well as negative influences of the internal environment, such as the presence of vending machines, common cultural cooking and eating practices, and the lack of social cohesion. Facilitators focused on food preparation and recipe adaptation.
CONCLUSIONS: Participants expressed an interest in learning more about food, nutrition, and health through community-based programming.
PMID: 28748738 [PubMed - as supplied by publisher]
The impact of a history of asthma on long-term outcomes of people with newly diagnosed chronic obstructive pulmonary disease: A population study.
J Allergy Clin Immunol. 2017 Mar;139(3):835-843
Authors: Kendzerska T, To TM, Aaron SD, Lougheed MD, Sadatsafavi M, FitzGerald JM, Gershon AS, Canadian Respiratory Research Network
BACKGROUND: Little is known about the natural history of chronic obstructive pulmonary disease (COPD) that has developed from airway remodeling due to asthma, as compared with other COPD phenotypes.
OBJECTIVE: We compared long-term health outcomes of individuals with COPD with and without a history of asthma in a population-based cohort study.
METHODS: All individuals with physician-diagnosed COPD between the ages 40 and 55 years from 2009 and 2011 were identified and followed until March 2013 through provincial health administrative data (Ontario, Canada). The exposure was a history of asthma at least 2 years before the diagnosis of COPD to ensure it preceded COPD. The hazards of COPD-, respiratory-, and cardiovascular (CV)-related hospitalizations and all-cause mortality were compared between groups using a Cox regression model controlling for demographic characteristics, comorbidities, and level of health care.
RESULTS: Among 9053 patients with COPD, 2717 (30%) had a history of asthma. Over a median of 2.9 years, 712 (8%) individuals had a first COPD hospitalization, 964 (11%) a first respiratory-related and 342 (4%) a first CV-related hospitalization, and 556 (6%) died. Controlling for confounding, a history of asthma was significantly associated with COPD and respiratory-related hospitalizations (hazard ratio, 1.53 [95% CI, 1.29-1.82] and hazard ratio, 1.63 [95% CI, 1.14-1.88], respectively), but not with CV-related hospitalizations or all-cause mortality. Additional analyses confirmed that these findings were not likely a result of unmeasured confounding or misclassification.
CONCLUSIONS: Middle-aged individuals with physician-diagnosed COPD and a history of asthma had a higher hazard of hospitalizations due to COPD and other respiratory diseases than did those without.
PMID: 27641119 [PubMed - indexed for MEDLINE]
Source: HSE & HPSC
Chlorhexidine mouthrinse as an adjunctive treatment for gingival health.
Cochrane Database Syst Rev. 2017 03 31;3:CD008676
Authors: James P, Worthington HV, Parnell C, Harding M, Lamont T, Cheung A, Whelton H, Riley P
BACKGROUND: Dental plaque associated gingivitis is a reversible inflammatory condition caused by accumulation and persistence of microbial biofilms (dental plaque) on the teeth. It is characterised by redness and swelling of the gingivae (gums) and a tendency for the gingivae to bleed easily. In susceptible individuals, gingivitis may lead to periodontitis and loss of the soft tissue and bony support for the tooth. It is thought that chlorhexidine mouthrinse may reduce the build-up of plaque thereby reducing gingivitis.
OBJECTIVES: To assess the effectiveness of chlorhexidine mouthrinse used as an adjunct to mechanical oral hygiene procedures for the control of gingivitis and plaque compared to mechanical oral hygiene procedures alone or mechanical oral hygiene procedures plus placebo/control mouthrinse. Mechanical oral hygiene procedures were toothbrushing with/without the use of dental floss or interdental cleaning aids and could include professional tooth cleaning/periodontal treatment.To determine whether the effect of chlorhexidine mouthrinse is influenced by chlorhexidine concentration, or frequency of rinsing (once/day versus twice/day).To report and describe any adverse effects associated with chlorhexidine mouthrinse use from included trials.
SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 28 September 2016); the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8) in the Cochrane Library (searched 28 September 2016); MEDLINE Ovid (1946 to 28 September 2016); Embase Ovid (1980 to 28 September 2016); and CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to 28 September 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA: We included randomised controlled trials assessing the effects of chlorhexidine mouthrinse used as an adjunct to mechanical oral hygiene procedures for at least 4 weeks on gingivitis in children and adults. Mechanical oral hygiene procedures were toothbrushing with/without use of dental floss or interdental cleaning aids and could include professional tooth cleaning/periodontal treatment. We included trials where participants had gingivitis or periodontitis, where participants were healthy and where some or all participants had medical conditions or special care needs.
DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results extracted data and assessed the risk of bias of the included studies. We attempted to contact study authors for missing data or clarification where feasible. For continuous outcomes, we used means and standard deviations to obtain the mean difference (MD) and 95% confidence interval (CI). We combined MDs where studies used the same scale and standardised mean differences (SMDs) where studies used different scales. For dichotomous outcomes, we reported risk ratios (RR) and 95% CIs. Due to anticipated heterogeneity we used random-effects models for all meta-analyses.
MAIN RESULTS: We included 51 studies that analysed a total of 5345 participants. One study was assessed as being at unclear risk of bias, with the remaining 50 being at high risk of bias, however, this did not affect the quality assessments for gingivitis and plaque as we believe that further research is very unlikely to change our confidence in the estimate of effect. Gingivitis After 4 to 6 weeks of use, chlorhexidine mouthrinse reduced gingivitis (Gingival Index (GI) 0 to 3 scale) by 0.21 (95% CI 0.11 to 0.31) compared to placebo, control or no mouthrinse (10 trials, 805 participants with mild gingival inflammation (mean score 1 on the GI scale) analysed, high-quality evidence). A similar effect size was found for reducing gingivitis at 6 months. There were insufficient data to determine the reduction in gingivitis associated with chlorhexidine mouthrinse use in individuals with mean GI scores of 1.1 to 3 (moderate or severe levels of gingival inflammation). Plaque Plaque was measured by different indices and the SMD at 4 to 6 weeks was 1.45 (95% CI 1.00 to 1.90) standard deviations lower in the chlorhexidine group (12 trials, 950 participants analysed, high-quality evidence), indicating a large reduction in plaque. A similar large reduction was found for chlorhexidine mouthrinse use at 6 months. Extrinsic tooth staining There was a large increase in extrinsic tooth staining in participants using chlorhexidine mouthrinse at 4 to 6 weeks. The SMD was 1.07 (95% CI 0.80 to 1.34) standard deviations higher (eight trials, 415 participants analysed, moderate-quality evidence) in the chlorhexidine mouthrinse group. There was also a large increase in extrinsic tooth staining in participants using chlorhexidine mouthrinse at 7 to 12 weeks and 6 months. Calculus Results for the effect of chlorhexidine mouthrinse on calculus formation were inconclusive. Effect of concentration and frequency of rinsing There were insufficient data to determine whether there was a difference in effect for either chlorhexidine concentration or frequency of rinsing. Other adverse effects The adverse effects most commonly reported in the included studies were taste disturbance/alteration (reported in 11 studies), effects on the oral mucosa including soreness, irritation, mild desquamation and mucosal ulceration/erosions (reported in 13 studies) and a general burning sensation or a burning tongue or both (reported in nine studies).
AUTHORS' CONCLUSIONS: There is high-quality evidence from studies that reported the Löe and Silness Gingival Index of a reduction in gingivitis in individuals with mild gingival inflammation on average (mean score of 1 on the 0 to 3 GI scale) that was not considered to be clinically relevant. There is high-quality evidence of a large reduction in dental plaque with chlorhexidine mouthrinse used as an adjunct to mechanical oral hygiene procedures for 4 to 6 weeks and 6 months. There is no evidence that one concentration of chlorhexidine rinse is more effective than another. There is insufficient evidence to determine the reduction in gingivitis associated with chlorhexidine mouthrinse use in individuals with mean GI scores of 1.1 to 3 indicating moderate or severe levels of gingival inflammation. Rinsing with chlorhexidine mouthrinse for 4 weeks or longer causes extrinsic tooth staining. In addition, other adverse effects such as calculus build up, transient taste disturbance and effects on the oral mucosa were reported in the included studies.
PMID: 28362061 [PubMed - indexed for MEDLINE]
Seeking Web-Based Information About Attention Deficit Hyperactivity Disorder: Where, What, and When.
J Med Internet Res. 2017 Apr 21;19(4):e126
Authors: Rosenblum S, Yom-Tov E
BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder, prevalent among 2-10% of the population.
OBJECTIVE: The objective of this study was to describe where, what, and when people search online for topics related to ADHD.
METHODS: Data were collected from Microsoft's Bing search engine and from the community question and answer site, Yahoo Answers. The questions were analyzed based on keywords and using further statistical methods.
RESULTS: Our results revealed that the Internet indeed constitutes a source of information for people searching the topic of ADHD, and that they search for information mostly about ADHD symptoms. Furthermore, individuals personally affected by the disorder made 2.0 more questions about ADHD compared with others. Questions begin when children reach 2 years of age, with an average age of 5.1 years. Most of the websites searched were not specifically related to ADHD and the timing of searches as well as the query content were different among those prediagnosis compared with postdiagnosis.
CONCLUSIONS: The study results shed light on the features of ADHD-related searches. Thus, they may help improve the Internet as a source of reliable information, and promote improved awareness and knowledge about ADHD as well as quality of life for populations dealing with the complex phenomena of ADHD.
PMID: 28432038 [PubMed - indexed for MEDLINE]
Preparing nursing students for enhanced roles in primary care: The current state of prelicensure and RN-to-BSN education.
Nurs Outlook. 2017 Mar - Apr;65(2):222-232
Authors: Wojnar DM, Whelan EM
BACKGROUND: With the current emphasis on including registered nurses (RNs) on the primary care teams, it is essential that nursing programs prepare students for employment in these settings.
PURPOSE: This study explored the current state of prelicensure and RN-to-Bachelor of Science in Nursing (BSN) online education regarding the implementation of primary care content in the curricula.
METHODS: A sample of 1,409 schools and/or colleges from across the United States was invited to participate in an online survey. About 529 surveys were returned for an overall response rate of 37.5%. Summative content analysis was used to analyze survey data.
DISCUSSION: Although most respondents have implemented some primary care content, some found it challenging and others have demurred from incorporating primary care content altogether.
CONCLUSION: Nursing leaders and faculty in academia must collaborate with clinical partners to design and expand didactic and clinical learning experiences that emphasize primary care content in the prelicensure and RN-to-BSN education.
PMID: 28034448 [PubMed - indexed for MEDLINE]
Dietary advice interventions in pregnancy for preventing gestational diabetes mellitus.
Cochrane Database Syst Rev. 2017 01 03;1:CD006674
Authors: Tieu J, Shepherd E, Middleton P, Crowther CA
BACKGROUND: Gestational diabetes mellitus (GDM) is a form of diabetes occurring during pregnancy which can result in short- and long-term adverse outcomes for women and babies. With an increasing prevalence worldwide, there is a need to assess strategies, including dietary advice interventions, that might prevent GDM.
OBJECTIVES: To assess the effects of dietary advice interventions for preventing GDM and associated adverse health outcomes for women and their babies.
SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (3 January 2016) and reference lists of retrieved studies.
SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs assessing the effects of dietary advice interventions compared with no intervention (standard care), or to different dietary advice interventions. Cluster-RCTs were eligible for inclusion but none were identified.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of the included studies. Data were checked for accuracy. The quality of the evidence was assessed using the GRADE approach.
MAIN RESULTS: We included 11 trials involving 2786 women and their babies, with an overall unclear to moderate risk of bias. Six trials compared dietary advice interventions with standard care; four compared low glycaemic index (GI) with moderate- to high-GI dietary advice; one compared specific (high-fibre focused) with standard dietary advice. Dietary advice interventions versus standard care (six trials) Considering primary outcomes, a trend towards a reduction in GDM was observed for women receiving dietary advice compared with standard care (average risk ratio (RR) 0.60, 95% confidence interval (CI) 0.35 to 1.04; five trials, 1279 women; Tau² = 0.20; I² = 56%; P = 0.07; GRADE: very low-quality evidence); subgroup analysis suggested a greater treatment effect for overweight and obese women receiving dietary advice. While no clear difference was observed for pre-eclampsia (RR 0.61, 95% CI 0.25 to 1.46; two trials, 282 women; GRADE: low-quality evidence) a reduction in pregnancy-induced hypertension was observed for women receiving dietary advice (RR 0.30, 95% CI 0.10 to 0.88; two trials, 282 women; GRADE: low-quality evidence). One trial reported on perinatal mortality, and no deaths were observed (GRADE: very low-quality evidence). None of the trials reported on large-for-gestational age or neonatal mortality and morbidity.For secondary outcomes, no clear differences were seen for caesarean section (average RR 0.98, 95% CI 0.78 to 1.24; four trials, 1194 women; Tau² = 0.02; I² = 36%; GRADE: low-quality evidence) or perineal trauma (RR 0.83, 95% CI 0.23 to 3.08; one trial, 759 women; GRADE: very low-quality evidence). Women who received dietary advice gained less weight during pregnancy (mean difference (MD) -4.70 kg, 95% CI -8.07 to -1.34; five trials, 1336 women; Tau² = 13.64; I² = 96%; GRADE: low-quality evidence); the result should be interpreted with some caution due to considerable heterogeneity. No clear differences were seen for the majority of secondary outcomes reported, including childhood/adulthood adiposity (skin-fold thickness at six months) (MD -0.10 mm, 95% CI -0.71 to 0.51; one trial, 132 children; GRADE: low-quality evidence). Women receiving dietary advice had a lower well-being score between 14 and 28 weeks, more weight loss at three months, and were less likely to have glucose intolerance (one trial).The trials did not report on other secondary outcomes, particularly those related to long-term health and health service use and costs. We were not able to assess the following outcomes using GRADE: postnatal depression; maternal type 2 diabetes; neonatal hypoglycaemia; childhood/adulthood type 2 diabetes; and neurosensory disability. Low-GI dietary advice versus moderate- to high-GI dietary advice (four trials) Considering primary outcomes, no clear differences were shown in the risks of GDM (RR 0.91, 95% CI 0.63 to 1.31; four trials, 912 women; GRADE: low-quality evidence) or large-for-gestational age (average RR 0.60, 95% CI 0.19 to 1.86; three trials, 777 babies; Tau² = 0.61; P = 0.07; I² = 62%; GRADE: very low-quality evidence) between the low-GI and moderate- to high-GI dietary advice groups. The trials did not report on: hypertensive disorders of pregnancy; perinatal mortality; neonatal mortality and morbidity.No clear differences were shown for caesarean birth (RR 1.27, 95% CI 0.79 to 2.04; two trials, 201 women; GRADE: very low-quality evidence) and gestational weight gain (MD -1.23 kg, 95% CI -4.08 to 1.61; four trials, 787 women; Tau² = 7.31; I² = 90%; GRADE: very low-quality evidence), or for other reported secondary outcomes.The trials did not report the majority of secondary outcomes including those related to long-term health and health service use and costs. We were not able to assess the following outcomes using GRADE: perineal trauma; postnatal depression; maternal type 2 diabetes; neonatal hypoglycaemia; childhood/adulthood adiposity; type 2 diabetes; and neurosensory disability. High-fibre dietary advice versus standard dietary advice (one trial) The one trial in this comparison reported on two secondary outcomes. No clear difference between the high-fibre and standard dietary advice groups observed for mean blood glucose (following an oral glucose tolerance test at 35 weeks), and birthweight.
AUTHORS' CONCLUSIONS: Very low-quality evidence from five trials suggests a possible reduction in GDM risk for women receiving dietary advice versus standard care, and low-quality evidence from four trials suggests no clear difference for women receiving low- versus moderate- to high-GI dietary advice. A possible reduction in pregnancy-induced hypertension for women receiving dietary advice was observed and no clear differences were seen for other reported primary outcomes. There were few outcome data for secondary outcomes.For outcomes assessed using GRADE, evidence was considered to be low to very low quality, with downgrading based on study limitations (risk of bias), imprecision, and inconsistency.More high-quality evidence is needed to determine the effects of dietary advice interventions in pregnancy. Future trials should be designed to monitor adherence, women's views and preferences, and powered to evaluate effects on short- and long-term outcomes; there is a need for such trials to collect and report on core outcomes for GDM research. We have identified five ongoing studies and four are awaiting classification. We will consider these in the next review update.
PMID: 28046205 [PubMed - indexed for MEDLINE]
Price comparison of high-cost originator medicines in European countries.
Expert Rev Pharmacoecon Outcomes Res. 2017 Apr;17(2):221-230
Authors: Vogler S, Zimmermann N, Babar ZU
BACKGROUND: In recent years, high-cost medicines have increasingly been challenging the public health
budget in all countries including high-income economies. In this context, this study aims to survey, analyze and compare prices of medicines that likely contribute to high expenditure for the public payers in high-income countries.
METHODS: We chose the following 16 European countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Hungary, Ireland
, Italy, the Netherlands, Portugal, Sweden, Slovakia, Spain and United Kingdom. The ex-factory price data of 30 medicines in these countries were collected in national databases accessible through the Pharmaceutical Price Information (PPI) service of Gesundheit Österreich GmbH (Austrian Public Health Institute).
RESULTS: The ex-factory prices (median) per unit (e.g. per tablet, vial) ranged from 10.67 cent (levodopa + decarboxylase inhibitor) to 17,000 euro (ipilimumab). A total of 53% of the medicines surveyed had a unit ex-factory price (median) above 200 Euro. For two thirds of the medicines, price differences between the highest-priced country and lowest-priced country ranged between 25 and 100%; the remaining medicines, mainly low-priced medicines, had higher price differential, up to 251%. Medicines with unit prices of a few euros or less were medicines for the treatment of diseases in the nervous system (anti-depressants, medicines to treat Parkinson and for the management of neuropathic pain), of obstructive airway diseases and cardio-vascular medicines (lipid modifying agents). High-priced medicines were particularly cancer medicines.
CONCLUSION: Medicine prices of Greece, Hungary, Slovakia and UK were frequently at the lower end, German and Swedish, as well as Danish and Irish
prices at the upper end. For high-priced medicines, actual paid prices are likely to be lower due to confidential discounts and similar funding arrangements between industry and public payers. Pricing authorities refer to the higher undiscounted prices when they use price data from other countries for their pricing decisions.
PMID: 27658050 [PubMed - indexed for MEDLINE]
Authors: Daly B, Arroll B, Sheridan N, Kenealy T, Scragg R.
Source: Prim Health Care Res Dev. 2016 Jan 8:1-6. [Epub ahead of print]
Authors: O'Connell R, Bradshaw C.
Source: Midwifery. 2015 Dec 19. pii: S0266-6138(15)00343-5. doi: 10.1016/j.midw.2015.12.005. [Epub ahead of print]
Authors: Sugrue, Sheila; Stuart, Cornelia
Source: Health Service Executive
Authors: Begum R, Riordan S.
Source: J Psychiatr Ment Health Nurs. 2016 Feb;23(1):45-53. doi: 10.1111/jpm.12276.
Authors: Alisic E, Hoysted C, Kassam-Adams N, Landolt MA, Curtis S, Kharbanda AB, Lyttle MD, Parri N, Stanley R, Babl FE; Pediatric Emergency Research Canada (PERC); Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics (PEMCRC); Pediatric Emergency Research in the United Kingdom and Ireland (PERUKI); Research in European Pediatric Emergency Medicine (REPEM); Pediatric Emergency Care Applied Research Network (PECARN); Pediatric Research in Emergency Departments International Collaborative (PREDICT); Pediatric Emergency Research Networks (PERN); Pediatric Emergency Research Canada PERC; Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics PEMCRC; Pediatric Emergency Research in the United Kingdom and Ireland PERUKI; Research in European Pediatric Emergency Medicine REPEM; Pediatric Emergency Care Applied Research Network PECARN; Pediatric Research in Emergency Departments International Collaborative PREDICT; Pediatric Emergency Research Networks PERN.
Source: J Pediatr. 2015 Dec 17. pii: S0022-3476(15)01306-2. doi: 10.1016/j.jpeds.2015.10.067. [Epub ahead of print]
Authors: Hanratty J, Livingstone N, Robalino S, Terwee CB, Glod M, Oono IP, Rodgers J, Macdonald G, McConachie H.
Source: PLoS One. 2015 Dec 14;10(12):e0144649. doi: 10.1371/journal.pone.0144649.
Authors: Malone C, Sharif F, Glennon-Slattery C.
Source: Ir J Med Sci. 2015 Nov 16. [Epub ahead of print]
Authors: Devaux M, Sassi F
Source: Eur J Public Health. 2015 Nov 19. pii: ckv190. [Epub ahead of print]
Authors: Hynes SM
Source: Aging Clin Exp Res. 2015 Nov 18. [Epub ahead of print]
Authors: Murphy A, Walsh E.
Source: Value Health. 2015 Nov;18(7):A554. doi: 10.1016/j.jval.2015.09.1788. Epub 2015 Oct 20.
Authors: National Self-Harm Registry Ireland
Source: National Office for Suicide Prevention
Authors: McVeigh TP, Sweeney KJ, Kerin MJ, Gallagher DJ.
Source: Ir J Med Sci. 2015 Oct 23. [Epub ahead of print]
Authors: Portwood, S.G., Shears, J., Brooks K.E. Nelson, M. Thomas L.M.
Source: Child & Family Social Work, 20: 480–493. doi: 10.1111/cfs.12097
Authors: Dennis M, Sandercock P, Graham C, Forbes J.
Source: Health Technol Assess. 2015 Sep;19(76):1-90. doi: 10.3310/hta19760.
Authors: World Health Organisation
Source: World Health Organisation
Authors: McHugh SM, Tyrrell E, Johnson B, Healy O, Perry IJ, Normand C.
Source: Health Policy. 2015 Sep 4. pii: S0168-8510(15)00218-3. doi: 10.1016/j.healthpol.2015.08.014. [Epub ahead of print]
Authors: Gvozdenović E1, Wolterbeek R, Allaart CF, Brenol C, Dougados M, Emery P, Ferraccioli G, van der Heijde D, Huizinga TW, Kay J, Martin Mola E, Moots RJ, da Silva JA, Smolen J, Veale D, Landewé RB.
Source: J Clin Rheumatol. 2015 Oct;21(7):349-54. doi: 10.1097/RHU.0000000000000296.
Authors: Costa E, Giardini A, Savin M, Menditto E, Lehane E, Laosa O, Pecorelli S, Monaco A, Marengoni A.
Source: Patient Prefer Adherence. 2015 Sep 14;9:1303-14. doi: 10.2147/PPA.S87551. eCollection 2015.
Authors: Sheridan-Pereira M, Murphy J, Sloan J, Crispino G, Leahy A, Corcoran JD, Dempsey E, Elnazir B, Gavin P, Sharif F, Gul R, Satas S, Murphy J, Gormally S, Shanaa I, Waldron D, Mc Mahon P, Carson J, Blanken M, Bont L, Paes B.
Source: Pediatr Infect Dis J. 2015 Sep 16. [Epub ahead of print]
Authors: Campana K.L., Hammoud S.
Source: Journal of Nursing Management 2015, 23, 716–725.
Authors: Henderson, A.
Source: Journal of Nursing Management, 23: 693–694. doi: 10.1111/jonm.12336
Source: Dementia Services, Information and Development Centre
Authors: Phillips CM, Perry IJ.
Source: Psychoneuroendocrinology. 2015 Jul 17;62:47-53. doi: 10.1016/j.psyneuen.2015.07.168. [Epub ahead of print]
Authors: Richardson N1, Osborne A, O'Neill B, Griffin P, McNamara J, Roche C, van Doorn D.
Source: J Agromedicine. 2015;20(3):381-5. doi: 10.1080/1059924X.2015.1047551.
Authors: Department of Children and Youth Affairs
Source: Department of Children and Youth Affairs
Authors: Murphy A, McElroy B.
Source: Ir J Med Sci. 2015 Mar;184(1):47-51. doi: 10.1007/s11845-014-1114-3. Epub 2014 Apr 18.