Ambulatory Data Research Articles

Antimuscarinic Medication Use in Elderly Patients with Overactive Bladder.

Antimuscarinic medications are the first-line pharmacological treatment for overactive bladder (OAB); however, little is known about the utilization pattern of antimuscarinic agents in elderly patients with OAB. This study examined the prevalence and predictors of antimuscarinic medication prescribing in elderly patients with OAB, using national ambulatory survey data. This cross-sectional study utilized the 2009-2010 National Ambulatory Medical Care Survey and the outpatient component of the National Hospital Ambulatory Medical Care Survey. The study included patients aged ≥65years diagnosed with OABbased on the International Classification of Diseases. Antimuscarinic medications were operationally defined using the American Hospital Formulary Service classification and identified using Multum Lexicon codes. Descriptive statistics using sampling weights were used to estimate the prevalence of antimuscarinic medication prescription, while multivariable logistic regression within the conceptual framework of the Anderson Behavioral Model was used to identify the factors associated with antimuscarinic medication prescription in elderly patients with OAB. According to the national surveys, 2.18 million (95% confidence interval [CI] 1.62-2.75) elderly outpatient visits were made for OAB, of which 0.90 million (41.43%) visits involved prescribing of antimuscarinic medications. The most frequently prescribed drugs were solifenacin (14.25%), oxybutynin (10.50%), and tolterodine (6.89%). Multivariable analysis revealed that patients ≥85years of age (odds ratio [OR] 3.50, 95% CI 1.23-9.92) were more likely to receive antimuscarinic medications,and the South region (OR 2.78, 95% CI 1.01-7.66) increased the likelihood of receiving antimuscarinic medications in elderly patients with OAB. This study found that antimuscarinic medications are commonly prescribed for elderly patients with OAB and there is variation in antimuscarinic use across age and region.

OS 18-06 COMPARISON OF THE MORTALITY PREDICTION CAPABILITY OF VISIT-TO VISIT AND AMBULATORY BLOOD PRESSURE VARIABILITY

Objective: Differences in blood pressure (BP) reading between multiple measurements, known as BP variability, is a strong predictor of cardiovascular and all-cause mortality. Lack of consensus on quantifying and reporting BP variability has limited its use in clinical practice. We aimed to determine the best possible way to quantify BP variability that would improve predictability of long-term mortality among elderly hypertensive population. Design and Method: We used data from a subset of patients (n = 694) aged > 65 years from the Second Australian National Blood Pressure (ANBP2) study. To calculate Systolic BP (SBP) and Diastolic BP (DBP) variability, 24-hours ambulatory BP monitoring data at study entry and visit-to-visit clinic BP data over a median 4.1 years follow-up were used. BP variability was defined as within-individual standard deviations in BP across measurements for 24 hours, day-time, night-time and visit-to-visit. Cox-proportional hazard models were used to explore the relationship between outcome and BP variability. Results: Over a median of 10.8 years, 161 patients died from any cause, of which 81 deaths were due to cardiovascular causes. We observed an increased risk of all cause and cardiovascular mortality with per mm increase in BP variability on univariate analyses irrespective of 24hrs, day-time, night-time and visit-to-visit BP variability, except DBP visit-to-visit BP variability. However, only day-time SBP and DBP variability from 24-hours ABPM were a strong predictor of long-term all-cause and cardiovascular mortality, when adjusted for age, gender and other possible risk factors (Table 1). Conclusions: Day-time BP variability, both SBP and DBP, measured by 24-hours ambulatory BP monitoring is a better predictor of mortality over the long-term in elderly hypertensive patients than visit-to-visit clinic BP variability.

Comparative analysis of data sciences international PhysioTel™ D70 and PhysioTel™ digital telemetry platforms

Telemetric evaluations are largely conducted as part of the Safety Pharmacology core battery to satisfy ICH S7A and ICH S7B requirements for assessment of changes in hemodynamic and electrocardiographic measurements, respectively. Such evaluations have allowed for the collection of conscious ambulatory data from unanesthetized animal models. However; historically, acquisition limitations have precluded social housing of animals during the telemetric evaluation period due to signal interference. Technological advances in implantable telemetry devices and supporting hardware now offer benefits of greater signal quality, greater durations of implantation (due to upgraded battery usage and device construction), with the added capacity to offer group housing during the collection period. The current study was conducted to assess the enhancements offered by the PhysioTel Digital (digital) platform. Telemetric data were compared between moxifloxacin-treated animals using each telemetry platform. Both system evaluations were completed using a latin square cross-over dose design. Single-housed animals were used for the evaluation of the PhysioTelD70 (legacy) transmitter, while socially housed animals were used during the evaluation of the digital system. While both systems demonstrated equivalent changes in the potential for delayed ventricular repolarization (QTcV = >270 msec; up to ~45 msec from control at 15-16 hrs post dose), the digital telemetry system offers advantages by way of study setup efficiencies, reduced potential for collection error, and extended implant battery life, all while satisfying expectations for group housing of social animals. Under the current study condition, no meaningful differences in cardiovascular parameters were noted between individually and social housed animals. While no contamination issues were observed as a result of the social housing paradigm, considerations should be made to limit potential for contamination between treatment groups, and contamination of control, when evaluating socially housed animals.

Monitoring and detecting atrial fibrillation using wearable technology.

Atrial fibrillation (AFib) is diagnosed by analysis of the morphological and rhythmic properties of the electrocardiogram. It was recently shown that accurate detection of AFib is possible using beat-to-beat interval variations. This raises the question of whether AFib detection can be performed using a pulsatile waveform such as the Photoplethysmogram (PPG). The recent explosion in use of recreational and professional ambulatory wrist-based pulse monitoring devices means that an accurate pulse-based AFib screening algorithm would enable large scale screening for silent or undiagnosed AFib, a significant risk factor for multiple diseases. We propose a noise-resistant machine learning approach to detecting AFib from noisy ambulatory PPG recorded from the wrist using a modern research watch-based wearable device (the Samsung Simband). Ambulatory pulsatile and movement data were recorded from 46 subjects, 15 with AFib and 31 non symptomatic. Single channel electrocardiogram (ECG), multi-wavelength PPG and tri-axial accelerometry were recorded simultaneously at 128 Hz from the non-dominant wrist using the Simband. Recording lengths varied from 3.5 to 8.5 minutes. Pulse (beat) detection was performed on the PPG waveforms, and eleven features were extracted based on beat-to-beat variability and waveform signal quality. Using 10-fold cross validation, an accuracy of 95 % on out-of-sample data was achieved, with a sensitivity of 97%, specificity of 94%, and an area under the receiver operating curve (AUROC) of 0.99. The described approach provides a noise-resistant, accurate screening tool for AFib from PPG sensors located in an ambulatory wrist watch. To our knowledge this is the first study to demonstrate an algorithm with a high enough accuracy to be used in general population studies that does not require an ambulatory Holter electrocardiographic monitor.

PM007 Essentials of 24-H Bio-Rhythm of Cardiovascular Hemodynamics Among Office Workers: Perspectives of Lifestyle Improvement from Ambulatory Blood Pressure, Hemodynamics, and Electrocardiographic Data

Urbach's formula for evaluation of electron trapping parameter that happens to be the earliest has emerged as a popular method amongst researchers of persistent luminescence. In this study, we analysed the thermoluminescence curves of glow-in-the-dark phosphors. Those included some curves recorded by us and others that solely used the Urbach's formula. Using the parameter obtained by rigorous analysis by fitting the whole TL curves, we presented a comprehensive picture of the potentialities and limitations of the simple Urbach's relation E=Tm/500, where E is the trap-depth and Tm the peak temperature in absolute scale, first proposed by Urbach in 1930. Some simple thumb rules on the use of the formula were presented for beginners as well as non-specialists so that entry of physically unrealistic data into the literature was prevented.

Impact of Introducing Catheter-based Renal Denervation into Japan for Hypertension Management: Estimation of Number of Target Patients and Clinical Relevance of Ambulatory Blood Pressure Reduction.

New medical approaches to the autonomic nervous system, such as catheterbased renal denervation, have been introduced into clinical practice in the recent years for patients who have resistant hypertension. We estimate the number of subjects in Japan who would benefit from renal denervation when this treatment is introduced into Japan, based on data from the Jichi Medical University clinical trials. We also discuss the logical basis of changing the formerly used primary endpoint, i.e., office BP, to 24-hr ambulatory BP in future clinical trials. Among JAMP registry data, the total number of hypertensives was 5,858 and the patients who were prescribed ≥ 3 drugs including diuretics were 749. The poorly controlled hypertension rate was 32% in the group prescribed ≥ 3 drugs including diuretics and it constitutes 4.1% of the total hypertensive patients. We also analyzed the data of JMS ABPM cohort study wave 1 (811 patients). The hazard ratios (HRs) for each 10-mmHg increase in BP was 1.38 (95%CI 1.17-1.63, p<0.001) for 24-hr BP and 1.18 (95%CI 1.05-1.33, p=0.006) for office BP. However, the significance for office BP was lost once the 24-hr, daytime and nighttime ambulatory BP data were added to the covariates. The prevalence of resistant hypertensive patients among all of the hypertensive patients is 4.1%. Based on this prevalence, the number of resistant hypertensive individuals in Japan would be 1,870,000 patients. In future renal denervation clinical studies in Japan, we should set the primary endpoint as a 24-hr systolic BP reduction measured by ABPM.

Semiparametric Mixed Models for Nested Repeated Measures Applied to Ambulatory Blood Pressure Monitoring Data.

Semiparametric mixed models are increasingly popular for statistical analysis of medical device studies in which long sequences of repeated measurements are recorded. Monitoring these sequences at different periods over time on the same individual, such as before and after an intervention, results in nested repeated measures (NRM). Covariance models to account for NRM and simultaneously address mean profile estimation with penalized splines via semiparametric regression are considered with application to a prospective study of 24-hour ambulatory blood pressure and the impact of surgical intervention on obstructive sleep apnea.

Abstract C42: Investigating racial inequalities in rates of premenopausal bilateral oophorectomy using claims-based data, North Carolina 2011-2012

Abstract Background: Surgical menopause, or removal of both ovaries in premenopausal women, is associated with decreased incidence of and mortality from ovarian and breast cancer. As a result, racial differences in surgical menopause rates could unintentionally contribute to cancer disparities. Unfortunately, self-reported data on surgical menopause underestimate rates by 36%, and nationally representative clinical data exclude outpatient surgeries. Therefore, there are no reliable data on racial inequalities in surgical menopause. Aims: This study estimated age- and race-specific rates of surgical menopause using claims-based data on every surgery conducted in North Carolina in 2011 and 2012. Methods: Using data from North Carolina's Hospital Discharge Data and Ambulatory Surgery Visit Data, we enumerated, respectively, all inpatient and outpatient surgeries conducted in the state. We restricted the data to bilateral oophorectomies conducted among women aged 20-44 years who were not being treated for cancer. Claims-based procedure codes were used to identify oophorectomies. Diagnostic codes were used to exclude surgeries for malignant conditions. Census data represented the at-risk population. Deviance-adjusted Poisson models assessed whether rates differed by age or race. Results: Oophorectomy rates were 15.0 per 10,000 women aged 20-44 years (n=4,904). The majority of surgeries, 71.3% (n=3,495) were conducted in outpatient settings. Rates increased with age (p<0.01), ranging from 1.2 per 10,000 for 20-24 year-olds to 33.2 for 40-44 year-olds. Rates were higher among non-Hispanic White (17.4 per 10,000) than non-Hispanic Black (13.3) women (p<0.01). In a sensitivity analysis including surgeries with unclear oophorectomy coding, rates were as high as 30.1 and 23.7 for White women and Black women, respectively. Conclusions: In the first population-representative study to use clinical data and include outpatient surgeries, we show that surgical menopause rates are higher than previously reported. Additionally, today, these surgeries are primarily conducted in outpatient settings. Finally, rates are greater among non-Hispanic White versus Black women. Impact: While overall rates of breast and ovarian cancer incidence decreased since 2000, Black-White racial inequalities worsened. Rates decreased among White women while remaining steady or increasing among Black women. Lower rates of surgical menopause among Black women may have the unintentional consequence of contributing to worsening racial inequalities in breast and ovarian cancer incidence and mortality. Citation Format: Whitney R. Robinson, Mariah M. Cheng, Kemi M. Doll. Investigating racial inequalities in rates of premenopausal bilateral oophorectomy using claims-based data, North Carolina 2011-2012. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C42.

Psychosocial Correlates of Nocturnal Blood Pressure Dipping in African Americans: The Jackson Heart Study.

African Americans exhibit a lower degree of nocturnal blood pressure (BP) dipping compared with Whites, but the reasons for reduced BP dipping in this group are not fully understood. The aim of this study was to identify psychosocial factors associated with BP dipping in a population-based cohort of African Americans. This cross-sectional study included 668 Jackson Heart Study (JHS) participants with valid 24-hour ambulatory BP data and complete data on psychosocial factors of interest including stress, negative emotions, and psychosocial resources (e.g., perceived support). The association of each psychosocial factor with BP dipping percentage and nondipping status (defined as <10% BP dipping) was assessed using linear and Poisson regression models, respectively, with progressive adjustment for demographic, socioeconomic, biomedical, and behavioral factors. The prevalence of nondipping was 64%. Higher depressive symptoms, higher hostility, and lower perceived social support were associated with a lower BP dipping percentage in unadjusted models and after adjustment for age, sex, body mass index, and mean 24-hour systolic BP (P < 0.05). Only perceived support was associated with BP dipping percentage in fully adjusted models. Also, after full multivariable adjustment, the prevalence ratio for nondipping BP associated with 1 SD (7.1 unit) increase in perceived support was 0.93 (95% CI: 0.88-0.99). No other psychosocial factors were associated with nondipping status. Lower perceived support was associated with reduced BP dipping in this study. The role of social support as a potentially modifiable determinant of nocturnal BP dipping warrants further investigation.

Older Adult Falls Seen by Emergency Medical Service Providers: A Prevention Opportunity.

Among people aged ≥65 years, falling is the leading cause of emergency department visits. Emergency medical services (EMS) are often called to help older adults who have fallen, with some requiring hospital transport. Chief aims were to determine where falls occurred and the circumstances under which patients were transported by EMS, and to identify future fall prevention opportunities. In 2012, a total of 42 states contributed ambulatory data to the National EMS Information System, which were analyzed in 2014 and 2015. Using EMS records from 911 call events, logistic regression examined patient and environmental factors associated with older adult transport. Among people aged ≥65 years, falls accounted for 17% of all EMS calls. More than one in five (21%) of these emergency 911 calls did not result in a transport. Most falls occurred at home (60.2%) and residential institutions such as nursing homes (21.7%). Logistic regression showed AORs for transport were greatest among people aged ≥85 years (AOR=1.14, 95% CI=1.13, 1.16) and women (AOR=1.30, 95% CI=1.29, 1.32); for falls at residential institutions or nursing homes (AOR=3.52, 95% CI=3.46, 3.58) and in rural environments (AOR=1.15, 95% CI=1.13, 1.17); and where the EMS impression was a stroke (AOR=2.96, 95% CI=2.11, 4.10), followed by hypothermia (AOR=2.36, 95% CI=1.33, 4.43). This study provides unique insight into fall circumstances and EMS transport activity. EMS personnel are in a prime position to provide interventions that can prevent future falls, or referrals to community-based fall prevention programs and services.

Prevalence of resistant hypertension and associated factors for blood pressure control status with optimal medical therapy using Korean ambulatory blood pressure monitoring registry data.

BackgroundResistant hypertension (RH) may be one of the cause of the plateau in improving the control rate in hypertension (HT) management. The misdiagnosis of RH by clinic blood pressure (BP) is important clinical problem. Aim of the study were to investigate the prevalence of RH by ambulatory blood pressure monitoring (ABPM) and the factor associated with control status of ambulatory BPs.MethodsFor 1230 subjects taking one or more antihypertensive medication (AHM) enrolled in the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) registry, the prevalence of RH was calculated which was defined as uncontrolled BP by three AHM classes including diuretic or BP in need of four or more AHM classes. The prevalence determined by clinic versus ambulatory BP was compared.ResultsThe age was 59.3 ± 12.5 years, and 44.3 % were female (n = 1230). Among them 72 subjects were taking three AHM drugs including diuretics and 105 subjects were taking four or more AHM classes. With uncontrolled daytime ambulatory BP in 41 among 72 subjects, prevalence of RH was 11.9 % (146/1230). By using nighttime BP criteria, there was significant difference in the prevalence of RH for clinic versus nighttime BP (146/177 vs. 159/177, p = 0.0124). For control status of daytime BP, masked uncontrolled BP was 16.9 % and controlled BP with white-coat effect was 14.1 %. For nighttime BP control status, odd ratios for smoking (0.624), drinking (1.512), coronary artery disease (0.604), calcium antagonist (1.705), and loop diuretics (0.454) were all significant.ConclusionThe prevalence itself was 11.9 % by daytime BP and it was significantly higher when using nighttime BP criteria. Control status of daytime BP was misclassified in 31.0 %. Smoking, drinking, coronary artery disease, calcium antagonist, and loop diuretics were associated with nighttime BP control status.

What happens at work stays at work? Workplace supervisory social interactions and blood pressure outcomes.

We investigated the relationship between workplace supervisory social interactions and blood pressure outcomes using hourly diary entries and ambulatory blood pressure data from an experience sampling study of 55 long-term care employees. After accounting for relevant cardiovascular controls, significant effects of supervisory interactions on cardiovascular reactivity and recovery were found. Multilevel analyses revealed that negatively perceived supervisory interactions predicted higher systolic blood pressure at work (B = -1.59, p < .05, N observations = 422). Using time-lagged hierarchical regression analyses, the average perceived valence of supervisory interactions at work predicted average systolic blood pressure recovery after work (B = -14.52, p < .05, N = 33). Specifically, negatively perceived supervisory interactions at work predicted poorer cardiovascular recovery after work. Suggestions for improving practices in organizations and in experience sampling research are discussed.

Nocturnal and Circadian Rhythm of Blood Pressure Is Associated with Renal Structure Damage and Function in Patients with IgAN

Abnormal circadian rhythm of blood pressure (BP) is closely related to target organ damage in hypertension. However, the association between abnormal circadian rhythm of BP and renal injury is not clear. We investigated whether renal injury is associated with nocturnal BP and circadian rhythm of BP in Chinese IgAN patients. Clinic and 24h ambulatory BP monitoring data were obtained from 330 Chinese IgAN patients with mean 24h BP < 130/80 and mean daytime BP < 135/85mmHg. Renal histopathological injury was determined according to the Oxford classification of IgAN. Among the 330 IgAN subjects, 35.8% suffered from nocturnal hypertension, 61.5% had abnormal circadian BP, and 27% had nocturnal hypertension with a nondipping pattern. Compared with nocturnal normotensive patients, patients with nocturnal hypertension had significantly higher levels of blood cystatin C, blood uric acid, and lower estimated glomerular filtration rate (eGFR), and significantly a higher mean renal tissue injury score. The nondipping hypertensive group had significantly higher nocturnal diastolic and systolic BP, blood uric acid, and glomerulosclerosis rates, whereas eGFR was lower. In nondipping hypertensive patients, urinary sodium excretion and renal tissue injury scores were significantly higher than dipping patients. Nocturnal hypertension and abnormal circadian BP correlated with renal tissue injury, renal interstitial fibrosis, and aortic arch atherosclerosis. Abnormal circadian rhythm of BP and nocturnal hypertension are common clinical manifestations in Chinese IgAN patients with normal mean 24h BP. Abnormal circadian BP and nocturnal hypertension may accelerate IgAN progression by inducing renal dysfunction and histopathological damage.

Economic Evaluation of Exercise-Based Cardiac Rehabilitation Programs for Chronic Heart Failure Patients in Colombia.

Cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) has met with resistance from third-party payers in low- and middle-income countries because of lack of evidence regarding its cost-effectiveness. We aimed to provide information to help better inform this decision-making process. Costs associated with a 12-week exercise-based rehabilitation program in Colombia for patients with CHF were estimated. We collected data on all medical resources used in ambulatory care and data on hospital costs incurred for treating patients with uncompensated CHF. A literature search to establish the hospitalization rates because of uncompensated CHF, death because of CHF, and potential decreases in these data because of the utilization of CR was conducted. We modeled incremental costs and effectiveness over a period of 5 years from the perspective of the third-party payer. All costs were converted from Colombian pesos to US dollars. For an exercise-based CR program of 12-week duration (36 sessions), costs ranged from US$265 to US$369 per patient. Monthly costs associated with ambulatory care of CHF averaged US$128 ± US$321 per patient, and hospitalization costs were US$3621 ± US$5 444 per event. Yearly hospitalization incidence rates with and without CR were 0.154 and 0.216, respectively. The incremental cost of CR would be US$998 per additional quality-adjusted life-year. Sensitivity analysis did not significantly change these results. Cardiac rehabilitation in patients with CHF in settings such as Colombia can be a cost-effective strategy, with minimal incremental costs and better quality of life, mainly because of decreased rates of hospitalization.

Human focal seizures are characterized by populations of fixed duration and interval.

We report on a quantitative analysis of data from a study that acquired continuous long-term ambulatory human electroencephalography (EEG) data over extended periods. The objectives were to examine the seizure duration and interseizure interval (ISI), their relationship to each other, and the effect of these features on the clinical manifestation of events. Chronic ambulatory intracranial EEG data acquired for the purpose of seizure prediction were analyzed and annotated. A detection algorithm identified potential seizure activity, which was manually confirmed. Events were classified as clinically corroborated, electroencephalographically identical but not clinically corroborated, or subclinical. K-means cluster analysis supplemented by finite mixture modeling was used to locate groupings of seizure duration and ISI. Quantitative analyses confirmed well-resolved groups of seizure duration and ISIs, which were either mono-modal or multimodal, and highly subject specific. Subjects with a single population of seizures were linked to improved seizure prediction outcomes. There was a complex relationship between clinically manifest seizures, seizure duration, and interval. These data represent the first opportunity to reliably investigate the statistics of seizure occurrence in a realistic, long-term setting. The presence of distinct duration groups implies that the evolution of seizures follows a predetermined course. Patterns of seizure activity showed considerable variation between individuals, but were highly predictable within individuals. This finding indicates seizure dynamics are characterized by subject-specific time scales; therefore, temporal distributions of seizures should also be interpreted on an individual level. Identification of duration and interval subgroups may provide a new avenue for improving seizure prediction.

Nocturnal Hypertension and Attenuated Nocturnal Blood Pressure Dipping is Common in Pediatric Lupus

Hypertension is an important manifestation of systemic lupus erythematosus (SLE) but reports of prevalence vary between 20-70% in published reports of adult and pediatric patients. For both children and adults with SLE, the clinical diagnosis and management of hypertension has traditionally been based on guidelines developed for the general population. In clinical trials, the criteria used for defining participants with hypertension are mostly undefined. As a first step towards formally assessing the blood pressure (BP) patterns of children diagnosed with SLE, 24-hr ambulatory BP monitoring data was analyzed on clinic patients who presented with prehypertension or stage I hypertension. In this pediatric SLE cohort (n=10), 20% met daytime criteria for a diagnosis of hypertension. Patterns of BP elevation varied widely with white coat, masked, isolated systolic, and diastolic nocturnal hypertension all identified. Nocturnal hypertension was detected in 60% and attenuated nocturnal BP dipping in 90% of both hypertensive and normotensive SLE patients. In SLE patients, the median nighttime systolic and diastolic loads were 25% and 15.5% compared with median daily loads of 12.5% and 11.5%. Daytime and nighttime systolic and diastolic BP load and nocturnal dipping was compared to a control population consisting of 85 non-SLE patients under 21 years old with prehypertension or stage 1 hypertension presenting to hypertension clinic. Median systolic BP dipped 5.3 mmHg in SLE patients compared to 11.9 mmHg in non-lupus ( p-value = 0.001). Median diastolic BP dipped 12.9 mmHg versus 18.5 mmHg in non-lupus ( p-value = 0.003). Patterns of BP dysregulation in pediatric SLE merit further exploration. Children with or without SLE displaying prehypertensive or stage 1 casual BP measurements had similar rates of hypertension by ambulatory BP monitoring. However, regardless of BP diagnosis, and independent of kidney involvement, there was an increased proportion with attenuated nocturnal dipping and nocturnal hypertension in SLE patients.

EFFECTIVENESS OF PERINDOPRIL AND AMLODIPINE COMBINATION IN HYPERTENSIVES WITH COPD

Aim. To study efficacy of the standard combination of perindopril and amlodipine in target blood pressure levels achievement in COPD patients with AH. Material and methods. Totally 28 patients included 17 men and 11 women, mean age 51,42±1,45 y.o. with the COPD II-III stage established, with arterial hypertension II stage, 2 grade. In treatment we used fixed antihypertensive combination of ACE inhibitor and calcium channel blocker amlodipine. The values of “office BP” were measured, with ambulatory blood pressure monitoring and spirometry data. Results. After 30 days there was significant decrease of the mean “office BP” values, in 24 (85,7%) patients there was decrease of target BP. By ABPM data the decrease of mean clock-round, daytime and nocturnal BP values revealed. There was increase of the quantity of patients with physiological sleep pattern of BP from 5 to 12 (17,8% to 42,8%). Various dose regimens of perindopril/arginine combinations in 27 patients (96,4%) made it to achieve the BP level less than 140/90 mmHg. Long-term outcomes, tracked in the most of patients, showed good tolerability andhigh antihypertensive efficacy of the fixed perindopril and arginine combination. Conclusion. The use of fixed ACE inhibitor and calcium channel blocker combination fulfilled effective, dose dependent BP decrease and let most of COPD and AH patients reach the target BP. The treatment was followed by significant decrease of mean, daytime and nocturnal levels of ABPM. With the treatment there was recovery of physiological circle-round BP with reliable decrease at night. The possible side effect — dry cough — was rare and did not lead to the decrease of spirography parameters.

Advantages and psychometric validation of proximal intensive assessments of patient-reported outcomes collected in daily life.

Ambulatory assessment data collection methods are increasingly used to study behavior, experiences, and patient-reported outcomes (PROs), such as emotions, cognitions, and symptoms in clinical samples. Data collected close in time at frequent and fixed intervals can assess PROs that are discrete or changing rapidly and provide information about temporal dynamics or mechanisms of change in clinical samples and individuals, but clinical researchers have not yet routinely and systematically investigated the reliability and validity of such measures or their potential added value over conventional measures. The present study provides a comprehensive, systematic evaluation of the psychometrics of several proximal intensive assessment (PIA) measures in a clinical sample and investigates whether PIA appears to assess meaningful differences in phenomena over time. Data were collected on a variety of psychopathology constructs on handheld devices every 4 h for 7 days from 62 adults recently exposed to traumatic injury of themselves or a family member. Data were also collected on standard self-report measures of the same constructs at the time of enrollment, 1 week after enrollment, and 2 months after injury. For all measure scores, results showed good internal consistency across items and within persons over time, provided evidence of convergent, divergent, and construct validity, and showed significant between- and within-subject variability. Results indicate that PIA measures can provide valid measurement of psychopathology in a clinical sample. PIA may be useful to study mechanisms of change in clinical contexts, identify targets for change, and gauge treatment progress.

National Trends in Ambulatory Surgery for Intervertebral Disc Disorders and Spinal Stenosis: A 12-Year Analysis of the National Surveys of Ambulatory Surgery.

A descriptive epidemiology study. The aim of this study is to investigate changes in the utilization of ambulatory surgical procedures performed for intervertebral disc disorders and spinal stenosis between 1994 and 2006 in the United States. Understanding trends in the utilization of ambulatory spine surgery may improve health care delivery in the Unites States. Epidemiologic studies evaluating national practice patterns for ambulatory spine surgery are limited. The National Survey of Ambulatory Surgery conducted in 1994, 1996, and 2006 by the Centers for Disease Control and Prevention was analyzed to identify surgically managed patients with intervertebral disc disorders and spinal stenosis. Patients were divided into 1 of 3 groups: discectomy, laminectomy, or fusion. The data were analyzed for trends in demographics, treatment, and utilization. Between 1994 and 2006, the number of procedures increased by 540% for intervertebral disc disorders (6.1/100 000 capita to 34.2/100 000 capita) and 926% for spinal stenosis (0.38/100 000 capita to 3.46 per 100 000 capita). Intervertebral fusions increased from 5% of outpatient spine surgeries in 1994 to 17% in 2006. The utilization of freestanding ambulatory facilities as the location of surgery increased 340% for intervertebral disc disorders and more than 2000% for stenosis. Private insurance was the largest compensator, representing 91% of cases in 2006. An increasing proportion of females underwent surgery for intervertebral disc disorders and stenosis at these ambulatory facilities over this time period. Lumbar disc displacement remained the most common diagnosis at each time point. The rate of ambulatory surgery for intervertebral disc disorders and spinal stenosis increased dramatically between 1994 and 2006 based upon the National Survey of Ambulatory Surgery data, which are the most up-to-date ambulatory surgery data available. These findings may aid policy-makers and caregivers in allocating health care resources to ensure the delivery of quality patient care. N/A.

Health insurance database for post-discharge surveillance of surgical site infection following arthroplasty

Surgical site infection surveillance (SSI) is important for the improvement of care and patient safety. Most SSI surveillance systems focus on hospital settings, whereas numerous infectious events occur after discharge. To evaluate the patient care trajectory after discharge, we linked the hospital discharge database and the National Health Insurance Cross-Schemes Information System (NHI-CIS) to trace hip or knee arthroplasty infection (HKAI). A retrospective analysis was performed using the permanent 1/97th sample of the whole NHI-CIS database. A total of 1739 patients underwent hip or knee arthroplasty between January 1st, 2011 and December 31st, 2011. Patients rehospitalized for HKAI were detected using a specific published algorithm. Non-rehospitalized HKAI patients were identified using a novel tracking algorithm based on ambulatory care consumption: nurse intervention, antibiotics and bandage purchase. Of the 1739 studied patients, 20 patients (1.1%) were rehospitalized for HKAI. Fourteen (70%) of the HKAI events occurred within the first two months after surgery, two occurring during the patients' surgical hospital stay. Using ambulatory care data, 10 additional cases were suspected of developing HKAI in the year following their surgery. HKAI incidence rate was then estimated to be 1.76% (95% confidence interval: 1.14-2.38%). Although the study sample was limited, we demonstrated that each HKAI occurring after discharge could not be traced by the in-hospital information system alone. This result emphasizes the need for having a passive routine tool for post-discharge surveillance such as the NHI-CIS database.