Comorbidity Profile Of Patients Research Articles

SOCIODEMOGRAPHIC AND COMORBIDITY PROFILES OF MIGRAINE PATIENTS: AN OUTPATIENT-BASED STUDY IN A TERTIARY CARE HOSPITAL

Objective: Migraine is a primary headache disorder. The study was undertaken to assess correlation between sociodemographic characteristics of migraineurs with their various comorbidities so as to determine most important factors influencing their comorbidity profile.
 Methods: A prospective study was conducted between June 2018 –April 2020 in 323 patients suffering from migraine in out-patient department of Neurology. Patients were labeled as migraine on the basis of Simplified Diagnostic Criteria for Migraine. A structured questionnaire was used for evaluation of sociodemographic variables and evidence based approach was adapted to fill psychiatric and comorbidity profiles of patients.
 Results: In 323 patients of migraine males were 30 (9.3%) and females 293 (90.7%). Mean age of males is 38.80±17.53 years and of females 35.38±13.29 years, (p=0.307). Most of them were in 21-30 years age group followed by 31-40 years Majority of patients were from district Srinagar followed by Ganderbal. Housewives formed major group of patients followed by students It was seen more in the illiterate class than in literates. 57% patients belonged to lower middle class. Psychiatric comorbidities including anxiety,depression and physical comorbidities like hypertension, hypothyroidism and comorbid pains were common associations. Comorbidities have been compared with mean age of the patients and it was found that psychiatric comorbidities, neuropathic pain, hypothyroidism, hypertension, Type 2 DM, comorbid pains and PCOD were statistically significant, (p=≤0.05).
 Conclusion: Most common comorbidities associated with migraine are anxiety, depression, neuropathic pain, hypothyroidism, hypertension, Type 2 DM and comorbid pain. Comorbidities have direct impact on nature of treatment protocol and need to be addressed to achieve outcome based treatment.

Outcomes of Elective Total Hip Arthroplasty in Nonagenarians and Centenarians

BackgroundNonagenarians and centenarians are among the fastest growing demographics in the United States. Although consequent demand for joint replacement is projected to rise precipitously, outcomes of total hip arthroplasty (THA) have seldom been studied in this population. MethodsA retrospective cohort of patients undergoing primary THA was established using the 2008-2017 American College of Surgeons National Quality Improvement Program. Propensity scores were used to match 858 patients aged 90 or older to 858 patients aged 65-89, controlling for demographic factors and comorbidities. Thirty-day outcomes were compared between matched age cohorts using multiple regression modeling. ResultsStatistically equivalent 30-day rates of surgical infection (P = .73), pneumonia (P = .39), deep venous thrombosis/thrombophlebitis (P = .55), pulmonary embolism (P = .69), stroke (P = .73), myocardial infarction (P = .44), cardiac arrest (P = .69), and sepsis (P = .77) were observed between matched age cohorts, although nonagenarians and centenarians were significantly more likely to experience urinary tract infection (2.8% vs 0.9%, P = .004). In addition, matched patients aged 90 or older were more likely to have longer hospital stays (3.52 vs 2.81 days, P < .001) and be discharged to a nonhome facility (75.4% vs 34.6%, P < .001) but were at no higher than 30-day risk of reoperation (P = .45), readmission (P = .23), or mortality (P = .59). ConclusionOverall, THA remains a safe and viable treatment modality beyond the ninth decade of life. Patient comorbidity profiles, rather than age, should principally guide shared clinical decision making.

A Monocentric Retrospective Observational Study of Comorbidities in Patients Affected by Autoimmune Bullous Diseases.

Autoimmune bullous diseases (AIBDs) of the skin and mucosae include a heterogeneous group of chronic diseases, which could be associated with various comorbidities. The purpose of this study was to evaluate the comorbidity profiles of patients affected by AIBDs, who referred to the Dermatological Clinic of Padua from December 2015 to June 2018. A monocentric retrospective observational study was conducted on 157 patients with diagnosis of AIBDs. Patients' comorbidities were investigated during the periodic visits of follow-up and through the analysis of computerized medical records. Among the 157 patients, 40 (25.5%) were diagnosed with PV, 15 (9.6%) with PF, and 102 (64.9%) with BP. Nine different comorbidities were observed, but only two of these were statistically significantly associated with BP: type 2 diabetes (p=0.0142) and neuropsychiatric disorders (p=0.015). BP is statistically significantly associated with type 2 diabetes mellitus and neuropsychiatric diseases. The correlation with neuropsychiatric pathologies is interesting for the possible bidirectional role in their etiology. The association with type 2 diabetes mellitus could suggest more caution in the administration of systemic corticosteroids, especially in elderly patients.

Lending a hand for laparoscopic distal pancreatectomy: the optimal approach?

BackgroundBoth minimally invasive surgery (MIS) and open approaches for distal pancreatectomy are acceptable. MIS options include total laparoscopic/robotic (TLR) and hand-assist laparoscopy (HAL). When considering safety profile and specimen quality, the optimal approach is unknown. MethodsPatients who underwent distal pancreatectomy from 2010-2018 at two major academic institutions were included. Converted procedures were categorized into final approach. Ninety-day perioperative/pathologic outcomes of MIS and open were compared. Subset analyses between TLR vs HAL and HAL vs open were performed. Intent-to-treat analysis was performed. ResultsAmong 1006 patients, resection was performed by MIS in 35% (n = 352), open in 65% (n = 654). MIS had similar patient comorbidity profile as open but had increased operative time (183 vs 162 min; p < 0.01), lower estimated-blood-loss (EBL; 131 vs 341 mL; p < 0.01), fewer intraoperative blood transfusions (1.4 vs 5%; p < 0.01), shorter LOS (5.2 vs 7.2 days; p < 0.01). Tumor size was smaller (3.2 vs 4.4 cm; p < 0.01) with lower lymph node (LN) yield (14 vs 16; p < 0.01). When comparing HAL (n = 109) to TLR (n = 243), despite increased prior abdominal operations (60 vs 43%; p = 0.008), HAL had shorter operative time (167 vs 191 min; p < 0.01), similar length-of-stay (LOS; 5.4 vs 5.1 days; p = 0.27), and readmission rate (15 vs 13%; p = 0.47). When comparing HAL to open, the advantages of TLR approach persisted including lower EBL (171 vs 342 mL; p < 0.01), and shorter LOS (5.4 vs 7.2 days; p < 0.01). Although HAL had smaller tumors, it had a similar LN yield (16 vs 16; p = 0.80), and higher R0-rate (97 vs 83%; p < 0.01). ConclusionHand-assist laparoscopy is safe and feasible for distal pancreatectomy as operative time, complication profile, lymph node yield, and R0-rates are similar to open procedures, while maintaining the associated the advantages of a total laparoscopic/robotic approach with reduced blood loss and shorter length-of-stay.

A study of prevalence of metabolic syndrome in patients with type 2 diabetes mellitus in a tertiary care referral hospital in West Bengal

Background: The terms "metabolic syndrome", "insulin resistance syndrome" and "syndrome X" are now used specifically to define a constellation of abnormalities that is associated with increased risk for the development of type 2 diabetes and atherosclerotic vascular disease. It is a state of chronic low grade inflammation with the profound systemic effects. Several organisations gave several criteria to diagnose it. Effective preventive approaches include lifestyle changes, primarily weight loss, diet, and exercise, the appropriate use of pharmacological agents to reduce the specific risk factors.Methods: A cross-sectional study was done to evaluate the co-morbidity profile of patients, with metabolic syndrome and correlate clinical manifestations with specific components or metabolic syndrome, at the OPD of Bankura Sammilani Medical College and Hospitals, West Bengal. American Association of Clinical Endocrinologists criteria were chosen for diagnosis.Results: 100 patients were recruited having type II diabetes mellitus. Most of the patients were male between 20-70 years and maximum was on oral hypoglycemic agent with app 40% patient was without any glycemic control. In comorbidities hypertension was highest, followed by coronary artery disease, hypothyroidism and cerebrovascular accident. Waist-hip ratio was highest in female. All of the patients were having some cardiac risk factor assessed by ECG, echocardiography and thread mill test.Conclusions: The data demonstrates that metabolic syndrome is extremely common among diabetic patients. Frequency was much higher in women than men. Obesity is a key element in causing the metabolic syndrome and this factor was also more common in women.

Understanding the links between cardiovascular disease and Parkinson's disease.

Studies investigating the associations between genetic or environmental factors and Parkinson's disease (PD) have uncovered a number of factors shared with cardiovascular disease, either as risk factors or manifestations of cardiovascular disease itself. Older age, male sex, and possibly type 2 diabetes are examples. On the other hand, coffee consumption and physical activity are each associated with a lower risk of both PD and cardiovascular disease. This observation raises questions about the underlying pathophysiological links between cardiovascular disease and PD. There is evidence for common mechanisms in the areas of glucose metabolism, cellular stress, lipid metabolism, and inflammation. On the other hand, smoking and total/low-density lipoprotein cholesterol appear to have opposite associations with cardiovascular disease and PD. Thus, it is uncertain whether the treatment of cardiovascular risk factors will impact on the onset or progression of PD. The available data suggest that a nuanced approach is necessary to manage risk factors such as cholesterol levels once the associations are better understood. Ultimately, the choice of therapy may be tailored to a patient's comorbidity profile. This review presents the epidemiological evidence for both concordant and discordant associations between cardiovascular disease and PD, discusses the cellular and metabolic processes that may underlie these links, and explores the implications this has for patient care and future research. © 2019 International Parkinson and Movement Disorder Society.

Hip Fractures in Older Adults in Ontario, Canada-Monthly Variation, Insights, and Implications.

BackgroundIn older adults, hip fractures have been described to peak in cooler months. Seasonal differences in patient vulnerability to fracture and social/behavioural factors might contribute to these trends.MethodsUsing linked health-care databases in Ontario Canada, we examined monthly variation in hip fracture hospitalizations in those > 65 years (2011–2015). We stratified results by age category (66–79, ≥80 years). We then examined for variation in the demographic and comorbidity profiles of patients across the months, and as an index of contributing social/behavioural factors, noted variation in health-care behaviours.ResultsThere were 47,971 and 52,088 hospitalizations for hip fracture in those 66–79, and ≥80 years, respectively. There was strong seasonality in fractures in both groups. Peaks occurred in October and December when patients appeared most vulnerable. Rates fell in the summer in those 66–79 years, and in the late winter in those ≥80 years (when health-care utilization also declined). A smaller peak in fractures occurred in May in both groups.ConclusionsHip fractures peak in the autumn, early winter, and spring in Canada. A dip in fractures occurs in the late winter in the oldest old. Environmental factors might play a role, but seasonal vulnerability to fracture and winter isolation might also be influential.

PB1933 CLINICAL FEATURES AND TREATMENT OUTCOMES OF CHRONIC PHASE‐CHRONIC MYELOID LEUKEMIA PATIENTS IN TURKEY: REAL‐WORLD DATA

Background:Tyrosine kinase inhibitors (TKIs) have been standard‐of‐care for patients with chronic myeloid leukemia (CML) and improvements with TKIs have been obtained in survival rates. In Turkey, imatinib is the only reimbursed TKI for first line treatment and second generation TKI's are reserved for later lines. Some concerns such as TKI tolerability, adverse event profile, patient comorbidities, and concomitant drug use may affect the choice of second generation TKIs.Aims:This study aimed to evaluate demographic and clinical features and treatment patterns of chronic phase CML (CP‐CML) patients treated with TKIs in Turkey.Methods:This study was a national, multicenter, retrospective study conducted on CP‐CML patients followed‐up between 2005‐2018. After approval of the Ethics Committee, demographic and clinical data, certain laboratory findings, BCR‐ABL levels, applied treatments, response to treatment, comorbidities, and adverse events were recorded on the data collection form. It was predicted that 1000 patients would have been recruited and data collection would have ended in April 2019. Herein, the interim results of this study are presented.Results:Data of 487 patients with a median age of 55 years (17‐88) who were followed‐up median 57 months (3‐168) were included in the analysis. Demographics and treatment outcomes of the patients are summarized in Table 1. Of the patients, 68.2% were still on the first line treatment and the median duration for the second, third, and fourth line treatments in the remaining patients were 18 months (3‐109), 36 months (7‐143), and 36 months (24‐84), respectively. The main reason for switching to subsequent treatment was disease progression and/or loss /depth of response. The rate of complete hematological response (CHR) with any TKI was 96.2% in all patients and time to CHR was median 2 months (0‐123.07). The rate of molecular response (MR) in any TKI was 76.6% in all patients and time to MR was median 12 months (0‐120). The rate of complete cytogenetic response (CCyR) in any TKI was 74.8% in all patients and time to CCyR was median 12 months (0‐71.07). Leukemic transformation to acute phase in any time point was 4.4% and mortality rate was 6.1% for all patients. The rate of comorbid diseases were 9.9%, 11.9%, 1.9%, and 23.6% for diabetes mellitus (DM), cardiovascular disorders (CVDs), pulmonary disorders (PDs), and other reported concomitant disorders, respectively.The frequencies of adverse events during the second, third, and fourth line treatments were 24.8%, 25.7%, and 50.0%, respectively.Summary/Conclusion:This study analyzed one of the largest CML cohorts in Turkey in terms of demographic and clinical characteristics and treatment outcomes. Success rates regarding CHR, CCyR, and MR in patients treated with imatinib, dasatinib, and nilotinib were relatively high and satisfactory. Although the study population is relatively young, there were surprisingly high comorbidities including DM, CVD, and PD which may have an effect on choice of TKI. The choice of treatment, based on patient's comorbidity profile should be personalized as it is an important factor in the management of CML.image

Psychiatric Comorbidity in Droup Out from Educational Attainment Attending Tertiary Care Hospital

Background: Studies of the impact of mental disorders on educational attainment are rare. Mental disorders, those beginning in childhood or adolescence may increase the risk of early droup out from education. The latter has been shown to have adverse life-course consequences on individuals such as greater demand on social welfare entitlements.Objective: To find out socio-demographic status and psychiatric comorbidity profile of patients with education droup out.Design: Descriptive cross sectional study.Setting: All cases were selected from patients attending at Comilla Medical College hospital and Tertiary Care hospitals in Comilla City from August 2014 to April 2015.Methods: A total of 50 droup out patients aged 10 to 30 years who fullfiled the enrolment criteria included in the study. A semi structural questionnaire, DSM-5 and ICD-10 have been used as research instruments. The Frequency tables, summary tables and appropriate graphs were prepared to describe the population characteristics and study finding.Result: Total 62 participants were approach for interview. Considering inclusion and exclusion criteria finally 50 patients were selected for the study. In this study, anxiety disorders was 8%, behaviour/ impulse control disorders was 8%, mood disorders was 16%, substance use disorders was 24%, schizophrenia spectrum disorders was 12% and composite psychiatric disorders was 32%. Among droup out patient’s non- completion of primary education was 14%, non- completion of secondary education was 20%, non- completion of higher secondary education was 24%, not entry to tertiary education was 12% and non- completion of tertiary education was 30%. Among behaviour/impulse control disorders non- completion of primary education was 6%, substance use disorders non- completion of higher secondary education was 10%, mood disorder both non- completion of higher secondary education and non- completion of tertiary education were 6%. Among composite psychiatric disorders non- completion of secondary education, non- completion of higher secondary education and non- completion of tertiary education were 8%, 6% and 12% respectively. Socioeconomic status represented the homogenous result in this study. Most of the psychiatric morbidity was male (62%) and age group of 18-24 years (54%).Conclusion: Onset of mental disorder and subsequent droup out from education that was found in this study. Further multi-centered prospective and population-based studies should be desined to fint out the exact situation.TAJ 2013; 26: 38-42

The contribution of comorbidities to mortality in hospitalized patients with heart failure.

Heart failure (HF) with reduced ejection fraction (HFrEF) has a worse prognosis than HF with preserved EF (HFpEF). The study aimed to evaluate whether different comorbidity profiles of HFrEF- and HFpEF-patients or HF-specific mechanisms contribute to a greater extent to this difference. We linked data from two health insurances to data from a cardiology clinic hospital information system. Patients with a hospitalization with HF in 2005-2011, categorized as HFrEF (EF < 45%) or HFpEF (EF ≥ 45%), were propensity score (PS) matched to controls without HF on comorbidites and medication to assure similar comorbidity profiles of patients and their respective controls. The balance of the covariates in patients and controls was compared via the standardized difference (SDiff). Age-standardized 1-year mortality rates (MR) with 95% confidence intervals (CI) were calculated. 777 HFrEF-patients (1135 HFpEF-patients) were PS-matched to 3446 (4832) controls. Balance between patients and controls was largely achieved with a SDiff < 0.1 on most variables considered. The age-standardized 1-year MRs per 1000 persons in HFrEF-patients and controls were 267.8 (95% CI 175.9-359.8) and 86.1 (95% CI 70.0-102.3). MRs in HFpEF-patients and controls were 166.2 (95% CI 101.5-230.9) and 61.5 (95% CI 52.9-70.1). Thus, differences in MRs between patients and their controls were higher for HFrEF (181.7) than for HFpEF (104.7). Given the similar comorbidity profiles between HF-patients and controls, the higher difference in mortality rates between HFrEF-patients and controls points more to HF-specific mechanisms for these patients, whereas for HFpEF-patients a higher contribution of comorbidity is suggested by our results.

Mortality and Comorbidity Profiles of Patients with Bullous Pemphigoid in Korea.

BackgroundBullous pemphigoid (BP) is a common autoimmune-mediated blistering skin disease that is significantly associated with mortality and morbidity. However, few studies regarding the mortality and comorbidity profiles of BP have been reported in Korea.ObjectiveTo evaluate and compare the mortality, comorbidity profiles, and risk factors between patients with BP who visited our clinic and an age-matched general population of Korea.MethodsWe retrospectively evaluated 103 patients diagnosed with BP between 2006 and 2013 at Chonnam National University Hospital in Gwangju, Korea.ResultsThe 1-year, 2-year, and 5-year mortality rates of the patients were 18.44%, 28.16%, and 42.00%, respectively. The median age was 76 years (range, 41~96 years). The standardized mortality ratio of patients with BP was 1.83 times that of the age- and sex-matched general population of Korea. Old age at the time of diagnosis, cardiac disease and renal disease were associated with increased 5-year mortality. In addition, the prevalence of diabetes, stroke, dementia, and Parkinson's disease was higher among BP patients than in the general population.ConclusionThe mortality rate of patients with BP is higher than that of the general Korean population. Korean patients with BP are more likely to have dementia, Parkinson's disease, diabetes, and stroke. Risk factors for increased 5-year mortality include old age at the time of diagnosis and medical comorbidities, especially cardiac disease and renal disease.

Is there seasonality in hospitalizations for major depressive disorder in Canada?

Abstract Background Canada, a temperate country with four defined seasons incurs an annual productivity loss of over $30 billion on major depressive disorder (MDD); however it remains unknown whether inpatient hospitalization for MDD exhibits seasonal variations. Objective Our study objective was to determine if there are seasonal variations in hospitalization rates for MDD in Canada. Methods We used time series analysis to determine monthly rates of hospitalizations for MDD from 2006 – 2013, on data from population level health-administrative databases in Ontario, Canada. We also stratified analysis by gender and three age groups: 18 to 39, 40 to 65 and those over 65. We compared demographic and comorbidity profiles of patients admitted in April, August and December to elucidate if patient characteristics differed by season of admission. Results We identified a total of 130,336 admissions for MDD for 95,439 unique patients. Baseline characteristics of the patients were similar across seasons. We did not detect significant seasonality of hospitalizations for MDD across any of the gender or age subgroups. Discussion Our results question the popularly held belief that hospitalizations for MDD vary with seasons. These findings highlight the need for uniform hospital resource allocation for MDD throughout the year in Canada.

First-line treatment selection and early monitoring patterns in chronic phase-chronic myeloid leukemia in routine clinical practice: SIMPLICITY.

Achieving successful outcomes in chronic phase‐chronic myeloid leukemia (CP‐CML) requires careful monitoring of cytogenetic/molecular responses (CyR/MR). SIMPLICITY (NCT01244750) is an observational study exploring tyrosine kinase inhibitor use and management patterns in patients with CP‐CML receiving first‐line imatinib (n = 416), dasatinib (n = 418) or nilotinib (n = 408) in the US and 6 European countries in routine clinical practice. Twelve‐month follow‐up data of 1242 prospective patients (enrolled October 01 2010‐September 02 2015) are reported. 81% of patients had baseline comorbidities. Treatment selection was based on perceived efficacy over patient comorbidity profile. There was a predominance of imatinib‐treated patients enrolled earlier in the study, with subsequent shift toward dasatinib‐ and nilotinib‐treated patients by 2013/2014. Monitoring for either CyR/MR improved over time and was documented for 36%, 82%, and 95% of patients by 3, 6, and 12 months, respectively; 5% had no documentation of CyR/MR monitoring during the first year of therapy. Documentation of MR/CyR testing was higher in Europe than the US (P < .001) and at academic versus community practices (P = .001). Age <65 years, patients being followed at sites within Europe, those followed at academic centers and patients no longer on first‐line therapy were more likely to be monitored by 12 months. SIMPLICITY demonstrates that the NCCN and ELN recommendations on response monitoring have not been consistently translated into routine clinical practice. In the absence of appropriate monitoring practices, clinical response to TKI therapy cannot be established, any needed changes to treatment strategy will thus not be implemented, and long‐term patient outcomes are likely to be impacted.

Impact of an Age-Adjusted Co-morbidity Index on Survival of Patients With Heart Failure Implanted With Cardiac Resynchronization Therapy Devices

Age is an adverse prognostic factor in patients with heart failure. We aimed to assess the impact of age and noncardiac co-morbidities in the outcome of patients undergoing cardiac resynchronization therapy (CRT), and determine which of these two factors is the most important predictor of survival. The study involved a single-center retrospective assessment of 697 consecutive CRT implants during a 12-year period. Patient co-morbidity profile was assessed using the Charlson Co-morbidity Index (CCI) and the Charlson Age-Co-morbidity Index (CACI). Predictors of survival free from heart transplantation were assessed. CRT-related complications and cause of death analysis were assessed within tertiles of the CACI. During a mean follow-up of 1,813 ± 1,177 days, 347 patients (49.9%) died and 37 (5.3%) underwent heart transplantation. On multivariate Cox regression, female gender (HR = 0.78, 95% confidence interval [CI] 0.62 to 0.99, p = 0.041), estimated glomerular filtration rate (HR per ml/min = 0.99, 95% CI 0.98 to 0.99, p < 0.001), left ventricular ejection fraction (HR per % = 0.99, 95% CI 0.98 to 1.00, p = 0.022), New York Heart Association class (HR = 1.83, 95% CI 1.53 to 2.20, p < 0.001), presence of left bundle branch block (HR = 0.70, 95% CI 0.56 to 0.87, p = 0.001), and CACI tertile (HR = 1.37, 95% CI 1.18 to 1.59, p < 0.001) were independent predictors of all-cause mortality or heart transplantation. Compared with age and the CCI, the CACI was the best discriminator of all-cause mortality. Inappropriate therapies occurred less frequently in higher co-morbidity tertiles. In conclusion, patient co-morbidity profile adjusted to age impacts on mortality after CRT implantation. Use of the CACI may help refine guideline criteria to identify patients more likely to benefit from CRT.

Demographic and clinical profiles of type 2 diabetes mellitus patients initiating sitagliptin in the real-world setting

Objective: Dipeptidyl peptidase-4 (DPP-4) inhibitors have been used for the management of type 2 diabetes (T2D) for over a decade; however, there is a limited understanding of the evolution of their use in the real-world setting over this time period. This study evaluated the demographics and clinical characteristics of patients initiating sitagliptin over a 10 year period in the United States.Research design and methods: Quintiles electronic medical records database was used to identify adults with a new prescription of sitagliptin over two 5 year time periods: 2006–2010 (n = 57,604), and 2011–2015 (n = 147,326). In addition, we also evaluated how the most recent (year 2015) profile of sitagliptin initiators (n = 29,295) compares to the treated T2D patients (N = 474,877) in 2015.Main outcome measures: No outcomes were assessed. Descriptive statistics were used to summarize baseline patient characteristics.Results: The overall demographics and clinical characteristics of patients initiating sitagliptin were generally similar over the two time periods; however, baseline HbA1c (median) was higher in the later time period: 7.6% vs. 7.9% respectively. Sitagliptin was initiated in patients across a broad range of age (18–79) years, body mass index (BMI) (10–70) kg/m2 and HbA1c (3–20) %. The most prevalent comorbidities observed in these patients were hypertension (93%), hyperlipidemia (81%), obesity (55%), chronic kidney disease (22%) and cardiovascular disease (21%). Additionally, when we assessed the treated T2D patients and patients initiating sitagliptin in 2015, several characteristics were comparable such as age (median) (64 vs. 63) years and BMI (33 vs. 33) kg/m2, and the most prevalent comorbidities were hypertension (97 vs. 95) %, and hyperlipidemia (86 vs. 81) % respectively.Conclusion: The overall demographic and comorbidity profile of patients initiating sitagliptin did not substantially change over the last decade and is similar to the treated T2D population.

Contemporary update on neoadjuvant therapy for bladder cancer.

Administration of neoadjuvant chemotherapy preceding radical cystectomy in patients with bladder cancer remains a matter of debate. Results of prospective, randomized studies have demonstrated an overall absolute survival benefit of 5% at 5 years, provided cisplatin-based combination regimens are used. Owing to the perception of a modest survival benefit, the medical community has been slow to adopt the use of neoadjuvant chemotherapy. Other reasons for the underuse of neoadjuvant chemotherapy range from patient ineligibility to fear of delaying potentially curative surgery in nonresponders. Instead, several institutions have adopted an individualized, risk-adapted approach, in which the decision to administer chemotherapy is based on clinical stage and patient comorbidity profile. The development of new cytotoxic and targeted therapies, in particular immune checkpoint inhibitors, warrants well-designed prospective studies to test their efficacy alone or in combination in the neoadjuvant setting. Moving forward, genomic characterization of muscle-invasive bladder cancer could offer information that aids clinicians in selecting the appropriate chemotherapy regimen. Following neoadjuvant therapy, every effort should be made to ensure optimal surgery, as surgical margins and the number of removed lymph nodes are prognostic factors; thus, radical cystectomy and a meticulous extended pelvic lymph node dissection should be performed by expert surgeons.

Is there seasonality in hospitalizations for Major Depressive Disorder in Canada?

Abstract Background Canada, a temperate country with four defined seasons incurs an annual productivity loss of over $30 billion on major depressive disorder (MDD); however it remains unknown whether inpatient hospitalization for MDD exhibits seasonal variations. Objective Our study objective was to determine if there are seasonal variations in hospitalization rates for MDD in Canada. Methods We used time series analysis to determine monthly rates of hospitalizations for MDD from 2006 – 2013, on data from population level health-administrative databases in Ontario, Canada. We also stratified analysis by gender and three age groups: 18 to 39, 40 to 65 and those over 65. We compared demographic and comorbidity profiles of patients admitted in April, August and December to elucidate if patient characteristics differed by season of admission. Results We identified a total of 130,336 admissions for MDD for 95,439 unique patients. Baseline characteristics of the patients were similar across seasons. We did not detect significant seasonality of hospitalizations for MDD across any of the gender or age subgroups. Discussion Our results question the popularly held belief that hospitalizations for MDD vary with seasons. These findings highlight the need for uniform hospital resource allocation for MDD throughout the year in Canada.

Prevalence of comorbidity and associated risk factors in adults with atopic dermatitis.

Atopic dermatitis (AD) is a common chronic skin disorder, which may persist into adulthood; however, the prevalence of comorbidities in patients with AD is not well characterized. AD is considered a systemic disorder like psoriasis, which has raised a need for data on the comorbidity profile of patients with AD, to assess the potential risks, benefits, and complications in management of patients with AD. We described the occurrence of medical and psychiatric comorbidities and associated risk factors in adults with AD compared with psoriasis and the general population. All Danish individuals aged ≥18 years with a hospital (inpatient or ambulatory) diagnosis of AD or psoriasis during the study period (January 1, 1995-December 31, 2012) were linked in administrative registers. Overall, prevalence of smoking and alcohol abuse was higher among patients with AD than the general population, but lower than psoriasis patients. Similarly, patients with AD had more risk factors and higher prevalence of comorbidity than the general population, but lower prevalence and reduced risk compared to psoriasis patients, except for use of anxiolytics, which was higher in severe AD. Prevalence of diabetes was lower in AD than psoriasis patients as well as general population controls. Despite an increased risk of various medical and psychiatric comorbidities compared to general population controls, adult patients with AD had markedly lower prevalence of cardiovascular disease than psoriasis patients. However, prevalence of psychiatric comorbidity and tobacco smoking was alarmingly high in severe patients with AD, which might be target for intervention in patient management.

PHS148 - France-Spain Comparison of Hospital Delivery Mode Between 2006 And 2014 According Comorbidity Profiles of Patients

The aim of the study is to compare delivery mode in hospital (vaginal and cesarean) between two European countries, according to patient’s comorbidities as diabetes, age, multiple pregnancies, obesity, and prematurity. A retrospective cohort was performed from national PMSI (France) and CMBD (Spain) public databases 2006 to 2014. Multivariate regression was done to model cesarean delivery according to comorbidities. All of childbirth hospitalizations were extracted by selecting DRG. Comorbidities were identified according to each country diagnosis classification’s (ICD 10 for France and ICD-9 for Spain). The number of annual hospitalization for childbirth is stable in France around 800,000 stays (-2% between 2006 and 2014). In the public Spain sector, we observed a decrease of 12% between 2006 and 2014 with almost 330,000 stays in 2014. The cesarean rate in 2014 is 20% in France versus 22% in Spain and increased by 2% between 2006 and 2014 for France and decreased by 12% for Spain. The median age is 30 years in 2014 for France versus 32 years for Spain and has increased by one year between 2006 and 2014 in the two countries. The standardized caesarean rate is 1% higher in Spain and + 1.2% for prematurity, and + 0.3% for multiple births. Multivariate analysis of cesarean deliveries highlights a significance of all risk factors (age, prematurity, diabetes, obesity and multiple births). The multiple pregnancy is the first risk of cesarean delivery with an OR of 5.36 (5.10-5.63) for Spain versus 3.85 (3.72-3.98) in France. The second risk is the prematurity in France with an OR of 2.03(1.98-2.08) and the diabetes in Spain with an OR of 1.90(1.81-2.00). Multiple pregnancy is the most important risk factor for cesarean delivery for Spain and France. The second risk factor is obesity for Spain and prematurity for France.

Predicting surgical site infection after spine surgery: a validated model using a prospective surgical registry

Background contextThe impact of surgical site infection (SSI) is substantial. Although previous study has determined relative risk and odds ratio (OR) values to quantify risk factors, these values may be difficult to translate to the patient during counseling of surgical options. Ideally, a model that predicts absolute risk of SSI, rather than relative risk or OR values, would greatly enhance the discussion of safety of spine surgery. To date, there is no risk stratification model that specifically predicts the risk of medical complication. PurposeThe purpose of this study was to create and validate a predictive model for the risk of SSI after spine surgery. Study designThis study performs a multivariate analysis of SSI after spine surgery using a large prospective surgical registry. Using the results of this analysis, this study will then create and validate a predictive model for SSI after spine surgery. Patient sampleThe patient sample is from a high-quality surgical registry from our two institutions with prospectively collected, detailed demographic, comorbidity, and complication data. Outcome measuresAn SSI that required return to the operating room for surgical debridement. Materials and methodsUsing a prospectively collected surgical registry of more than 1,532 patients with extensive demographic, comorbidity, surgical, and complication details recorded for 2 years after the surgery, we identified several risk factors for SSI after multivariate analysis. Using the beta coefficients from those regression analyses, we created a model to predict the occurrence of SSI after spine surgery. We split our data into two subsets for internal and cross-validation of our model. We created a predictive model based on our beta coefficients from our multivariate analysis. ResultsThe final predictive model for SSI had a receiver-operator curve characteristic of 0.72, considered to be a fair measure. The final model has been uploaded for use on SpineSage.com. ConclusionsWe present a validated model for predicting SSI after spine surgery. The value in this model is that it gives the user an absolute percent likelihood of SSI after spine surgery based on the patient's comorbidity profile and invasiveness of surgery. Patients are far more likely to understand an absolute percentage, rather than relative risk and confidence interval values. A model such as this is of paramount importance in counseling patients and enhancing the safety of spine surgery. In addition, a tool such as this can be of great use particularly as health care trends toward pay for performance, quality metrics (such as SSI), and risk adjustment. To facilitate the use of this model, we have created a Web site (SpineSage.com) where users can enter patient data to determine likelihood for SSI.