Clinical Characteristics Of Population Research Articles

Experiences and Outcomes of Using e-Prescribing for Opioids: Rapid Scoping Review.

e-Prescribing is designed to assist in facilitating safe and appropriate prescriptions for patients. Currently, it is unknown to what extent e-prescribing for opioids influences experiences and outcomes. To address this gap, a rapid scoping review was conducted. This rapid scoping review aims to (1) explore how e-prescribing has been used clinically; (2) examine the effects of e-prescribing on clinical outcomes, the patient or clinician experience, service delivery, and policy; and (3) identify current gaps in the present literature to inform future studies and recommendations. A rapid scoping review was conducted following the guidance of the JBI 2020 scoping review methodology and the World Health Organization guide to rapid reviews. A comprehensive literature search was completed by an expert librarian from inception until November 16, 2022. Three databases were electronically searched: MEDLINE (Ovid), Embase (Ovid), and Scopus (Elsevier). The search criteria were as follows: (1) e-prescribing programs targeted to the use or misuse of opioids, including those that were complemented or accompanied by clinically focused initiatives, and (2) a primary research study of experimental, quasi-experimental, observational, qualitative, or mixed methods design. An additional criterion of an ambulatory component of e-prescribing (eg, e-prescribing occurred upon discharge from acute care) was added at the full-text stage. No language limitations or filters were applied. All articles were double screened by trained reviewers. Gray literature was manually searched by a single reviewer. Data were synthesized using a descriptive approach. Upon completing screening, 34 articles met the inclusion criteria: 32 (94%) peer-reviewed studies and 2 (6%) gray literature documents (1 thesis study and 1 report). All 33 studies had a quantitative component, with most highlighting e-prescribing from acute care settings to community settings (n=12, 36%). Only 1 (3%) of the 34 articles provided evidence on e-prescribing in a primary care setting. Minimal prescriber, pharmacist, and clinical population characteristics were reported. The main outcomes identified were related to opioid prescribing rates, alerts (eg, adverse drug events and drug-drug interactions), the quantity and duration of opioid prescriptions, the adoption of e-prescribing technology, attitudes toward e-prescribing, and potential challenges with the implementation of e-prescribing into clinical practice. e-Prescribing, including key features such as alerts and dose order sets, may reduce prescribing errors. This rapid scoping review highlights initial promising results with e-prescribing and opioid therapy management. It is important that future work explores the experience of prescribers, pharmacists, and patients using e-prescribing for opioid therapy management with an emphasis on prescribers in the community and primary care. Developing a common set of quality indicators for e-prescribing of opioids will help build a stronger evidence base. Understanding implementation considerations will be of importance as the technology is integrated into clinical practice and health systems.

Efficacy of repetitive transcranial magnetic stimulation for improving lower limb function in individuals with neurological disorders: A systematic review and meta-analysis of randomized sham-controlled trials.

ObjectiveTo determine the efficacy of repetitive transcranial magnetic stimulation vs sham stimulation on improving lower-limb functional outcomes in individuals with neurological disorders.Data sourcesPubMed, CINAHL, Embase and Scopus databases were searched from inception to 31 March 2020 to identify papers (n = 1,198). Two researchers independently reviewed studies for eligibility. Randomized clinical trials with parallel-group design, involving individuals with neurological disorders, including lower-limb functional outcome measures and published in scientific peer-reviewed journals were included.Data extractionTwo researchers independently screened eligible papers (n = 27) for study design, clinical population characteristics, stimulation protocol and relevant outcome measures, and assessed study quality.Data synthesisStudies presented a moderate risk of selection, attrition and reporting bias. An overall effect of repetitive transcranial magnetic stimulation was found for outcomes: gait (effect size [95% confidence interval; 95% CI]: 0.51 [0.29; 0.74], p = 0.003) and muscle strength (0.99 [0.40; 1.58], p = 0.001) and disorders: stroke (0.20 [0.00; 0.39], p = 0.05), Parkinson’s disease (1.01 [0.65; 1.37], p = 0.02) and spinal cord injury (0.50 [0.14; 0.85], p = 0.006), compared with sham. No effect was found for outcomes: mobility and balance.ConclusionSupplementary repetitive transcranial magnetic stimulation may promote rehabilitation focused on ambulation and muscle strength and overall lower-limb functional recovery in individuals with stroke, Parkinson’s disease and spinal cord injury. Further evidence is needed to extrapolate these findings.LAY ABSTRACTNon-invasive magnetic brain stimulation can cause beneficial changes in the central nervous system of individuals with neurological disorders, which, in turn, may have a number of therapeutic qualities. This paper summarizes current knowledge about whether the technique can be used to promote recovery of leg movement function. By searching the available literature for studies on individuals with neurological disorders that have compared the effects of magnetic brain stimulation with placebo stimulation, 27 relevant studies were identified. Combined data from these studies suggested that real stimulation, compared with placebo, had positive effects specifically for recovery of walking ability and maximal leg muscle strength, as well as for improvement in overall leg movement function in individuals with stroke, Parkinson’s disease and spinal cord injury. These findings are important for patients and therapists seeking to improve rehabilitation outcomes. This research area deserves increased scientific focus.

Autism in girls and the pre-referral environment

AimsThis literature review sought to identify and highlight any sex specific factors in the diagnosis of autism spectrum conditions during the pre-referral period which might affect diagnosis rates in ASD in girls. The null hypothesis was that there are no sex specific factors that affect referral and diagnosis of ASD in girls.BackgroundHistorically, boys are diagnosed with ASD more than girls but rates vary depending on clinical population characteristics. Diagnosis trends continue to demonstrate a large male excess. The concept of autism as a predominantly male condition has been challenged and there is increased focus on females with high functioning autism who are not being detected as easily.Various theories exist as to why this is the case.There are high rates of suicidality in ASD and risk of death by suicide is higher in ASD women (the reciprocal of the suicide rates in general population where more men complete suicide). Women with high functioning autism represent an at risk group. Undetected autism in females may be complicated by ‘camouflaging’ or masking of symptoms which puts a large strain on individuals functioning and mental health. Costs to society and the individual are large.However, early identification and intervention improves outcomes such as activities of daily living and social behaviours.MethodAn electronic literature search was completed using MEDLINE, PsycINFO and EMBASE in November 2018. Key terms were: (‘child*’ OR ‘adolescent’ OR ‘young pe*’) AND (‘ASD’ OR ‘autism’ OR ‘asperger*’ OR ‘high functioning*’ OR ‘PDD’ OR ‘Pervasive developmental*’) AND (‘girl*’ OR ‘sex’ OR ‘gender’). Papers were excluded on a number of grounds.Result11 papers were included in the review from an initial 2823 abstracts.ConclusionA number of papers highlighted important learning points. Some of the more original conclusions included that we require more studies comparing populations of girls with ASD to high risk, high functioning girls and female controls to clarify features particular to the ‘female phenotype’. Delays in diagnosis in girls appears to pre-date assessment so further thought on how to educate and support referral sources (caregivers and schools) on how to identify girls with autism is recommended and would be informed by further research focus on the previous point. Active case ascertainment should be considered in future research and follow-up of girls who do not receive a diagnosis at initial assessment were additional learning points that came from the review.

Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II): protocol for an observational study using linked Scottish national data

IntroductionFollowing the emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019 and the ensuing COVID-19 pandemic, population-level surveillance and rapid assessment of the effectiveness of...

High incidence of brain metastasis in young patients with lung adenocarcinoma.

e21677 Background: Young patients with lung cancer are unusual. This paper focuses on our experience with Young Patients (<45 yo) with Lung Adenocarcinoma (YPLA), treated at Instituto Oncológico Henry Moore (IOHM). Methods: Out of all lung cancer patients, we selected YPLA admitted between September 2012 and September 2019. We analyzed their medical history forms, electronic clinical records, treatments and outcomes. Results: We included 31 out of 1,119 Pt (3%) patients. Median Age: 39 (24-44). Sex F/M: 15/16. The table shows the clinical characteristics of population and outcomes. Conclusions: 1) Young patients with lung adenocarcinoma presented aggressive tumors, as evidenced by: advanced stages, poor performance status and CNS compromise. 2) In our series, smoking is a predominant etiological factor. 3) Further research will analyze genomic profiles of these tumors. 4) Screening for CNS metastasis should be mandatory in this population. [Table: see text]

P124 COMPARISONS OF HOLISTIC PATIENT-REPORTED OUTCOMES BY BIOLOGIC DRUG CLASS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A REAL-WORLD STUDY IN IBD PARTNERS

Abstract Background Increasing numbers of biologic agents are now available for the treatment of Crohn’s disease (CD) and ulcerative colitis (UC). Limited data are available on clinical characteristics of populations initiating these therapies and relevant holistic patient-reported outcomes (PROs) in the real-world. Methods We used data from IBD Partners from May 2014-May 2019. Individuals initiating an anti-tumor necrosis factor (anti-TNF) agent or vedolizumab (VDZ) were included. A subgroup with at least 6 months of follow-up who had baseline data within 90 days of therapy initiation were included in longitudinal analyses. We aimed to: 1) compare clinical characteristics of patients initiating each biologic therapy and 2) compare PROs at follow-up by drug class. Outcomes included Patient-Reported Outcomes Measurement Information System (PROMIS) T scores for anxiety, depression, fatigue, pain interference, and social satisfaction. We used logistic regression models controlling for prior biologic exposure, age, sex, prior hospitalization, disease duration, surgery (for CD), and baseline values of each PRO to compare PROs at follow-up by drug class. Levels of each PRO within a half standard deviation of the general population T score represented wellness. Results A total of 878 patients initiating anti-TNF (625 CD, 253 UC) and 651 initiating VDZ (415 CD, 236 UC) were included. Patients with CD initiating VDZ were more likely to be older, had longer disease duration, increased IBD-related hospitalization, more prior surgeries, and were more likely to be biologic exposed (P<0.05 for all). Patients with UC initiating VDZ were more likely to be male and biologic exposed (P<0.05 for both) (Table 1). In longitudinal analyses, a total of 198 patients on anti-TNF and 168 on VDZ were included for CD; a total of 85 on anti-TNF and 96 on VDZ were included for UC. Individuals with CD initiating VDZ had significantly greater fatigue, pain interference, and reduced social satisfaction at baseline compared with the anti-TNF population. For UC, PROs at baseline were similar across drug groups. In both CD and UC, there were no significant differences in adjusted odds of wellness for each PRO at follow-up by drug class (Table 2). Conclusions CD patients initiating VDZ in this real-world cohort had multiple factors consistent with more severe disease compared with those initiating anti-TNF. In longitudinal analyses after at least 6 months of treatment with VDZ or anti-TNF, there were no differences in wellness of PROs, such as anxiety, depression, fatigue, pain interference, or social satisfaction by drug class for CD or UC.

Paraoxonase-1 Q192R polymorphism and its association with hs-CRP and fasting blood glucose levels and risk of coronary artery disease

AimsParaoxonase-1 (PON1) has been shown to protect low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) against oxidative-modification and thereby might protect against coronary-artery-disease (CAD). Here we explored the relationship of a genetic variant (a substitution (R) Arg with (Q) Gln at position 192) of PON1 in 250 patients with/without CAD. Materials and methodsGenotyping of PON1 Q192R was carried out using Real-Time-PCR TaqMan-based-probe. Demographic-characteristics and biochemical-analyses, including fasting blood sugar (FBS), HDL, LDL, triglycerides (TG) and C-reactive protein (CRP) were evaluated. Univariate/multivariate analyses were performed to determine the association of the genetic polymorphism and CAD as well as with clinical-characteristics of population. ResultsOur findings showed that RR-genotype was more frequent in CAD-patients, compared to the wild-type genotype. Moreover, CAD patients with RR-genotype had an odd ratio of 5.0 (95% CI: 1.3–18.6; p = 0.017), versus wild-type genotype, in multivariate-analysis. Of note we also observed that CAD-patients with QQ-genotype had a significantly lower Hs-CRP level, compared to the RR-genotype. Conclusionwe demonstrate that PON1-Q192R-polymorphism was associated with CRP and FBS levels; R-allele of PON1-Q192R may be an independent risk factor for CAD. Further studies are warranted to determine the value of this marker as a surrogate marker in CAD patients.

Diagnostic tests for autism spectrum disorder (ASD) in preschool children.

Diagnostic tests for autism spectrum disorder (ASD) in preschool children.

Clinical characteristics of population referred to an Italian center for dementia

Clinical characteristics of population referred to an Italian center for dementia

CONTINUITY OF CARE AND USE OF HIGH-RISK PSYCHOACTIVE MEDICATIONS BY PERSONS WITH DEVELOPMENTAL DISABILITIES.

Objective Studies have found that high-risk psychotropic medication combinations are commonly prescribed to the developmentally disabled; however, causal factors for this observed phenomena are poorly understood. Our study explores the relationship between continuity of primary and psychiatric care and the receipt of high-risk psychoactive medications (two antipsychotics concurrently) by persons with MR/DD. Design Administrative files from Florida9s Program for Persons with Disabilities, which contains demographic and clinical information, from years 2000-2004 were used to identify 18,159 persons living in Florida with developmental disabilities. We merged these files with the Florida Medicaid Claims database for outpatient services and pharmacy claims and identified all primary care and psychiatric care visits over the 2-year prior to starting the high-risk medication regimen. We calculated the Modified Modified Continuity Index (MMCI) separately for primary and psychiatric care visits for 2 consecutive years. We used two-tailed t-tests, unbalanced ANOVA, and multivariable models tests to test the association between receiving prescriptions for high-risk psychoactive medications and demographic and clinical population characteristics and measures of primary care and psychiatric care continuity. Results Over 10% (10.82%) of the 18,159 individuals (1,964 individuals) were on two antipsychotic medications concurrently (high-risk regimen). The use of two antipsychotic medications varied by gender, race, and age, as well as by geographic and clinical characteristics of the population. Multivariate analyses controlling for sociodemographic and clinical characteristics showed that each primary care visit was associated with a 5% decrease, and each psychiatry visit was associated with a 5% increase in the likelihood of being on two antipsychotics. The Continuity Index for psychiatric care was a significant negative predictor of being on two antipsychotic medications. Persons with high continuity (seeing the same psychiatrist across visits) were eight times less likely (12.6% as likely) to be on two antipsychotic medications compared with persons with low continuity (seeing a different psychiatrist at each visit). Conclusion Our study shows that both primary and specialty care is associated the use of high-risk psychotropic medications for person with developmental disabilities. Continuity in psychiatric care is particularly important in preventing use of high-risk psychotropic medications in the developmentally disabled population.

Incidence of cockroach allergy in atopic Italian children.

Recent studies suggest that sensitization to cockroach allergens is common in urban areas and highlight the importance of cockroach allergens as a risk factor for asthma. To elucidate the prevalence of cockroach allergy in atopic Italian children and to evaluate the correlation between cockroach allergens and other major indoor allergens. Four hundred eighty two children with at least one positive skin test response to a common allergen and with personal history of atopic diseases, were investigated. A questionnaire was administered in order to obtain data on epidemiologic and clinical characteristics of the population. Skin tests to 24 common allergens (including extracts of two cockroach species) were carried out and serum total and cockroach specific IgE were evaluated. 61/482 (12.7%) children had positive skin test to cockroach extracts. Among them the frequency of children living in urban areas was higher (P < .05). In addition, a significant correlation between results of skin tests to cockroach and mite allergens was observed (P < .009). No correlation between cockroach allergy and the clinical characteristics of the study population was found. The results show that cockroach allergy affects a small portion of atopic Italian children and suggest that it is related with living in urban areas and with sensitization to other indoor allergens, such as dust mite.

Biographical and clinical characteristics of a low vision population

A retrospective survey of the optometry clinics at Manchester Royal Eye Hospital was undertaken in order to define the biographic and clinical characteristics of the population being provided with low vision rehabilitation. For the year quarter July‐September 1994, 288 patients were identified as having attended the low vision clinic. The hospital case notes were available for examination in 273 cases (94.8%). The results presented here relate to this latter sample of patients.Analysis of the records revealed that the major diagnostic categories were ARMD (55.7%), glaucoma (10.6%), diabetic retinopathy (8%), other macular disorders (5.9%) and myopic degeneration (5.5%). The median age of patients was 78 years (range 7–104) and the male : female ratio was 0.87 (i.e. 53.4% female). Distance visual acuities on entry to the clinic were 6/60 or better in 72.5% of the sample. A total of 141 patients (51.6%) were known to be registered as blind or partially sighted.A new spectacle prescription was issued to 21.6% of patients. The most frequent low vision aids (LVAs) issued were stand magnifiers (147 illuminated and 46 non‐illuminated), hand‐magnifiers (67 issued) and distance monocular/binoculars (51 issued). With appropriate low vision provision, 84.5% of the sample achieved a near acuity of N8 or better. A total of 371 LVAs were issued, representing an average number of 1.36 LVAs per patient. The total cost of all LVAs issued amounted to £7818.81, giving an average cost of £28.64 per patient.This survey has provided a useful insight into the characteristics of both the population our service provides and the LVAs prescribed. Studies to measure the outcomes of our low vision provision are presently being carried out.