Differences In Treatment Of Patients Research Articles

Calibrating Observational Health Record Data Against a Randomized Trial

The conditions required for health record data sources to accurately assess treatment effectiveness remain unclear. Emulation of randomized clinical trials (RCTs) with health record data and subsequent calibration of the results can help elucidate this. To pilot an emulation of the KEYNOTE-189 RCT using a commercially available electronic health record (EHR) data source. This retrospective cohort study used an EHR database spanning from April 2007 to February 2023. Follow-up began on treatment initiation and proceeded until an outcome event, loss to follow-up, end of data, or end of study period (640 days). The population-based cohort was ascertained from EHRs provided by 52 health systems across the US. Eligibility criteria were defined as closely as possible to the benchmark RCT. Patients with non-small cell lung cancer initiating first-line treatment for metastatic disease were included. Patients with evidence of squamous non-small cell lung cancer, primary nonlung malignant neoplasms, or identified EGFR/ALK variations were excluded. Data were analyzed from June to October 2023. Initiation of first-line pembrolizumab and chemotherapy and chemotherapy alone. Chemotherapy in both groups was defined as a combination of pemetrexed and platinum-based (carboplatin or cisplatin) therapy. Outcomes of interest were 12-month survival probability and mortality hazard ratio (HR). A total of 1854 patients (mean [SD] age, 63.7 [9.6] years; 971 [52.4%] men) were eligible, including 589 patients who initiated pembrolizumab and chemotherapy and 1265 patients who initiated chemotherapy only. The cohort included 364 Black patients (19.6%) and 1445 White patients (77.9%). The 12-month survival probabilities were 0.60 (95% CI, 0.54-0.65) in the pembrolizumab group and 0.58 (95% CI, 0.55-0.62) in the chemotherapy-only group, compared with 0.69 (95% CI, 0.64-0.74) in the KEYNOTE-189 pembrolizumab group and 0.49 (95% CI, 0.42-0.56) in the KEYNOTE-189 chemotherapy-only group. The mortality HR was 0.95 (95% CI, 0.78-1.16), compared with 0.49 (95% CI, 0.38-0.64) in the KEYNOTE-189 RCT. In this cohort study piloting an RCT emulation, results were incongruous with the benchmark trial. Differences in patient treatment and data capture between the RCT and EHR populations, confounding by indication, treatment crossover, and accuracy of captured diagnoses may explain these findings. Future feasibility assessments will require data sources to have important oncology-specific measures curated.

Relationship between ICD implantation volume and treatment parameters of patients receiving an ICD with remote monitoring.

Both highly specialized heart centres and less specialized hospitals care for patients with implantable ICDs/CRT-Ds with remote monitoring. To investigate potential differences in patient treatment according to centre's ICD implantation volume. Based on their 2012 ICD/CRT-D implantation volume, centres enrolled in the NORDIC ICD trial in Germany were assigned to one of three groups: high- (HV, n= 345), medium- (MV, n= 340) or low-volume (LV, n= 189). The HV-centres had a significant higher CRT-D proportion (41.7%; LV: 36.5%; MV: 23.2%; P𝑔𝑙𝑜𝑏𝑎𝑙< 0.001), significant shorter median procedure duration (49 min; MV: 58 min; LV: 60 min; P𝑔𝑙𝑜𝑏𝑎𝑙< 0.001) but significant longer median hospital stay (4 days; MV and LV: 3 days; P𝑔𝑙𝑜𝑏𝑎𝑙< 0.001) compared to MV- and LV-centres. The X-ray exposure was shorter in MV/HV-centres (MV: 3.4 min; HV: 3.6 min; LV: 5.5 min; P𝑔𝑙𝑜𝑏𝑎𝑙< 0.001). Only 3.5% (LV: 2.6%; HV: 3.5%; MV: 4.1%) patients received at least one delivered inappropriate shock and 2.5% (HV: 2.0%; LV: 2.6%; MV: 2.9%) patients had withheld inappropriate ICD shocks without subsequent inappropriate shock delivery within 24.5 months of median follow-up. Implantation volume-dependent differences were observed in the device selection, procedure duration and x-ray exposure duration. Remote monitoring in combination with adequate response pattern prevented imminent inappropriate shocks in all three groups.

Accounting for treatment during the development or validation of prediction models

Clinical prediction models are widely used to predict adverse outcomes in patients, and are often employed to guide clinical decision-making. Clinical data typically consist of patients who received different treatments. Many prediction modeling studies fail to account for differences in patient treatment appropriately, which results in the development of prediction models that show poor accuracy and generalizability. In this paper, we list the most common methods used to handle patient treatments and discuss certain caveats associated with each method. We believe that proper handling of differences in patient treatment is crucial for the development of accurate and generalizable models. As different treatment strategies are employed for different diseases, the best approach to properly handle differences in patient treatment is specific to each individual situation. We use the Ma-Spore acute lymphoblastic leukemia data set as a case study to demonstrate the complexities associated with differences in patient treatment, and offer suggestions on incorporating treatment information during evaluation of prediction models. In clinical data, patients are typically treated on a case by case basis, with unique cases occurring more frequently than expected. Hence, there are many subtleties to consider during the analysis and evaluation of clinical prediction models.

Outcomes of COVID-19 patients with STEMI undergoing primary PCI

Abstract Introduction and aim Coronavirus disease (COVID-19) has substantial impact on acute myocardial infarction (AMI) clinical course and outcome. In Poland during early phase of COVID-19 pandemic a network of dedicated hospitals was set to treat SARS-Cov2 positive patients. There is scarce data on STEMI patients outcome treated in this setting. Our aim was to compare outcomes of STEMI patients treated with primary PCI in hospitals dedicated to treat COVID-19 and referral high volume haemodynamic centres. Methods Study was a retrospective analysis of 115 consecutive COVID-19 patients with STEMI, treated with primary PCI, admitted to 4 high volume centres (2 referral hospitals and 2 COVID dedicated sites) in southern Poland between May 2020 and November 2021. Data was obtained from patients' electronic medical records. Results Detailed characteristics are presented in Table 1 and 2. In general in all hospitals, patients were similar in terms of age (median 69 y.o., IQR: 60–73), with similar profile of comorbidities. All patients used acetylsalicylic acid and unfractioned heparin. In referral centres, as compared with COVID-19 dedicated sites, there was a higher use of mechanical thrombectomy (p&amp;lt;0.001) and adenosine (p&amp;lt;0.001). Overall mortality rate was higher in COVID-19 centres (50% vs 25%, p=0.008). Detailed results are presented in Table 3. Conclusions There is a significantly higher mortality in COVID patients who develop STEMI than in patients with STEMI who were tested positive on admission. Patients in COVID-19 hospitals had higher levels of CRP and NT-proBNP at baseline. There are substantial differences in treatment of patients in referral centres and COVID dedicated hospitals. Funding Acknowledgement Type of funding sources: None.

Hypoglycemia in Older Adults: Time Trends and Treatment Differences in Patients Aged ≥75 Years With Type 2 Diabetes

ObjectivesHypoglycemia is a potentially life-threatening drug event under antidiabetic treatment. The aim of the study was to examine time trends in severe hypoglycemia in older adults with type 2 diabetes mellitus (T2DM) and antidiabetic treatment. DesignMulticenter prospective diabetes patient follow-up registry (DPV). Setting and ParticipantsPatients aged ≥75 years with T2DM and documented treatment between 2005 and 2019. MethodsOutcomes of interest were rates of severe hypoglycemia, diabetes therapy, body mass index, HbA1c, and estimated glomerular filtration rate. Time trends of outcomes were analyzed in the whole cohort and compared between age groups (75–<80, 80–<85, ≥85 years). ResultsA total of 136,931 patients from 188 diabetes centers were included. The adjusted HbA1c decreased from 7.3% (95% confidence interval 7.3–7.4) in 2005 to 7.2% (7.2–7.2) in 2019 (P < .001), with no significant difference between age groups (P = .47). Rates of severe hypoglycemia decreased from 6.7 (6.0–7.4) to 4.1 of 100 person-years (3.7–4.5) (P < .001) in the entire population. Patients aged ≥85 years had constantly lower HbA1c levels compared with younger groups (P < .001). Although severe hypoglycemia decreased the most in the ≥85 age group (P < .001), severe hypoglycemia remained consistently higher in this group compared with the 75 to <80 years group (P < .001). Conclusions and ImplicationsDuring the analyzed time, the risk for severe hypoglycemia decreased. Although drugs with intrinsic risk for hypoglycemia were used less frequently, antidiabetic treatment in older adults should be further improved to continue reducing severe hypoglycemia in this age group, potentially accepting less strict metabolic control and age-specific target ranges.

A Comparison of Australasian Jurisdictional Ambulance Services’ Paramedic Clinical Practice Guidelines Series: Adult Sepsis

Introduction This article forms part of a series that seeks to identify interjurisdictional differences in the scope of paramedic practice and differences in patient treatment based upon which jurisdiction a patient is geographically located within at the time of their complaint. Methods The current CPGs of each JAS were accessed during June 2020, and updated in August 2021. Content was extracted and verified. Results Nine services provide antibiotics for meningococcal septicaemia, with dosage ranging from 1 – 4 grams. Five services provide antibiotics for non-meningococcal sepsis (three under doctor approval), with choice of antibiotic including Ceftriaxone, Benzylpenicillin, Amoxicillin, and Gentamicin. Three services provide antipyretics, one provides corticosteroids under doctor approval, and all provide fluids (with dosage ranging from 20 – 60 ml/kg). ICPs are allowed to provide adrenaline infusions in nine services, noradrenaline in three services (one requiring doctor approval), and metaraminol in three services. Two additional services restrict metaraminol to specialist paramedics, with one of these requiring doctor approval. Two services perform phlebotomy and one takes lactate. Paramedics perform unassisted intubation in one service, with nine restricting this to ICPs. Facilitated or Ketamine-only intubation is performed by ICPs in one service. Rapid or delayed sequence induction is performed by ICPs in six services, and restricted to specialists in two services. Conclusion The domestic jurisdictional ambulance services in Australasia have each created unique treatment clinical practice guidelines that are heterogeneous in their treatments and scopes of practice. A review of the evidence underlying each intervention is appropriate to determining best practice.

A Comparison of Australasian Jurisdictional Ambulance Services’ Paramedic Clinical Practice Guidelines Series: Adult Anaphylaxis

Introduction This article forms part of a series that seeks to identify interjurisdictional differences in the scope of paramedic practice and, consequently, differences in patient treatment based on which jurisdiction a patient is geographically located within at the time of their complaint. Methods The current Clinical Practice Guidelines of each Australasian domestic jurisdictional ambulance service (JAS) were accessed during June 2020 and updated in August 2021. Content was extracted and verified by 18 paramedics or managers representing all 10 JASs. Results All JASs use intramuscular adrenaline as a first-line agent for adult anaphylaxis. Beyond this, significant differences exist in all treatments: five services provide nebulised adrenaline; 10 services provide adrenaline infusions (one requires doctor approval; one provides repeat boluses); six services provide nebulised salbutamol; two services provide salbutamol infusions (one requires doctor approval; one provides repeat boluses); five services provide nebulised ipratropium bromide; eight services provide corticosteroids (two restricted to intensive care paramedics (ICPs)); five services provide antihistamines for non-anaphylactic or post-anaphylactic reactions; four services provide glucagon (one requires doctor approval); magnesium is infused by ICPs in two services; 10 services allow unassisted intubation in anaphylactic arrest; one service allows ICPs to provide sedation-facilitated intubation or ketamine-only breathing intubation; eight services allow rapid sequence induction (two restricted to specialist roles). Conclusion The JASs in Australasia have each created unique treatment clinical practice guidelines that are heterogeneous in their treatments and scopes of practice. A review of the evidence underlying each intervention is appropriate to determining best practice.

A Comparison of Australasian Jurisdictional Ambulance Services’ Clinical Practice Guidelines Series: An Introduction

Introduction There are 10 emergency paramedic services in Australia and New Zealand (Australasia), referred to as jurisdictional ambulance services (JASs). All 10 of the JASs in Australasia produce their own clinical practice guidelines (CPGs). With differing approaches to their review and implementation of new evidence, there is opportunity for differences to arise between guidelines. This article outlines a new series that will aim to identify interjurisdictional differences in CPGs and paramedic scopes of practice, and consequently differences in patient treatment depending on which jurisdiction a patient is geographically located within at the time of their complaint. Methods The current CPGs of each JAS will be obtained from each JAS, and content extracted by registered paramedics. The scope of practice for each intervention presented in the guideline will be classified as being at the level of ‘paramedic’, ‘intensive care paramedic’ (or equivalent, as titles vary by jurisdiction), or ‘restricted’. Each paper will be provided to each JAS for optional verification of content before publication, and the results of this will be stated. Conclusion This series will aim to provide a contemporary overview of Australasian JAS clinical practice guidelines and scopes of practice.

Effect of Therapy on Radiographic Progression in Axial Spondyloarthritis: A Systematic Review and Meta-Analysis.

To investigate the effect of therapies on radiographic progression in patients with axial spondyloarthritis (SpA). A comprehensive database search for studies assessing radiographic progression in axial SpA (particular treatment versus no treatment of interest) was performed. Study-specific standardized mean differences in treatment outcomes at 2 and ≥4 years were estimated and combined using random-effects models. Twenty-four studies in patients with axial SpA were identified, of which 18 involved tumor necrosis factor inhibitors (TNFi), 8 involved nonsteroidal antiinflammatory drugs (NSAIDs), and 1 involved secukinumab. Spinal radiographic progression, as measured by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), was not significantly different between TNFi-treated and biologics-naive patients at 2 years (mSASSS difference -0.73 [95% confidence interval (95% CI) -1.52, 0.12], I2 = 28%) and ≥4 years (mSASSS difference -2.03 [95% CI -4.63, 0.72], I2 = 63%). Sensitivity analyses restricted to studies with a low risk of bias showed a significant difference in spinal radiographic progression between TNFi-treated and biologics-naive patients at ≥4 years (mSASSS difference -2.17 [95% CI -4.19, -0.15]). No significant difference in spinal radiographic progression was observed between NSAID-treated and control patients (mSASSS difference -0.30 [95% CI -2.62, 1.31], I2 = 71%) or between secukinumab-treated and biologics-naive patients (mSASSS difference -0.34 [95% CI -0.85, 0.17]). With regard to treatment differences in patients with nonradiographic axial SpA or in patients with radiographic progression measured using the sacroiliac joint score, an insufficient number of studies were available for analysis. Although no significant protective effect of TNFi treatment on spinal radiographic progression was seen over the course of 2 years or ≥4 years in patients with axial SpA, our analysis restricted to studies with a low risk of bias showed a protective effect of TNFi after ≥4 years. Therefore, long-term TNFi exposure might confer beneficial effects on spinal radiographic progression in axial SpA. No difference in radiographic progression at 2 years was seen in either the NSAID or secukinumab treatment groups compared to their controls. Future studies should explore the effects of biologic treatment on radiographic progression, as well as the effects of long-term biologics exposure, in patients with early axial SpA or those with nonradiographic axial SpA.

PND153 - ANALYSIS OF RESPONSES TO SF-36V2 ITEMS FOR PATIENTS WITH HATTR AMYLOIDOSIS: RESULTS FROM A DOUBLE-BLIND PLACEBO-CONTROLLED TRIAL

Hereditary transthyretin (hATTR) amyloidosis is a systemic disease in which misfolded protein deposits (amyloids) gather in the peripheral nervous system and/or cardiac tissues, as well as tissues in other organs and systems, producing clinical manifestations such as polyneuropathy, cardiomyopathy, and gastrointestinal and visual problems. hATTR amyloidosis is rare, progressive, degenerative, and fatal, and lacks established treatments. This analysis examined the real world impact of this disease and treatment with inotersen on patients’ everyday activities. Data were from a multinational, double-blind, placebo-controlled trial of inotersen for 172 adults with hATTR amyloidosis (NCT01737398). The SF-36v2® Health Survey (SF-36v2) was administered to patients at baseline and 15 months post-baseline. Descriptive analysis examined treatment differences in patients’ item-level responses to contextually-meaningful items on the SF-36v2 physical functioning, role-physical, pain, social functioning, and role-emotional scales. The percentage of patients indicating they were ‘limited a lot’ in physical activities; whose physical or emotional health interfered with work and other activities ‘most of the time’ or ‘all of the time’; and whose health or pain interfered with social activities ‘extremely’ or ‘quite a bit’ were tallied at baseline and month 15. At month 15, the inotersen group experienced improvements from baseline in having severe impairments in numerous outcomes, including engaging in moderate activities, lifting/carrying groceries, climbing several flights of stairs, bending/kneeling/stooping, walking several hundred yards, reducing their amount of work and other activities, and health impacts on social activities (decreases ranging from 2% to 8% of the sample). The placebo group was more likely to experience severe impairments in these outcomes (increases ranging from 16% to 28% of the sample). Among patients with hATTR amyloidosis, the group receiving inotersen for 15 months showed improvements in numerous concrete aspects of their daily lives, while the group receiving placebo showed worsening in these same activities.

Plerixafor in non-Hodgkin\u2019s lymphoma patients: a German analysis of time, effort and costs

Mobilization and collection of peripheral blood stem cells is part of the standard treatment procedure for non-Hodgkin’s lymphoma patients eligible for high-dose chemotherapy with autologous stem cell transplantation. Mobilization is usually achieved with chemotherapy and/or cytokines, but plerixafor might be added in case of poor mobilization. Due to the high cost several institutions have developed their own management pathway to optimize use of plerixafor. Such models are however rarely generalizable; in a multi-center, European, non-interventional study, evaluating the impact of plerixafor in poor mobilizers, country specific differences in patient treatment and cost structure were obvious. For German centers, there was a non-significant reduction in the number of apheresis sessions carried out and in apheresis costs. In contrast to other European countries the majority of German Plerixafor patients were very poor mobilizing patients with initial CD34+ cell count ≤ 10/µl (40/51). In this group the number of apheresis sessions decreased from 2.1 to 1.6 sessions per patient (p = 0.01) and costs decreased from €6246 to €4758 (p = 0.01). Our results show that preemptive plerixafor use has a strong effect in poor mobilizers with an initial CD34+ cell count ≤ 10 cells/µl.

Standardised education and training for respiratory physiotherapists

The mission of ERS is to alleviate suffering from respiratory disease and to promote lung health through research, sharing of knowledge and through medical and public education. Within this context, respiratory physiotherapy plays a fundamental role in improving ventilation, and enhancing quality of life [1] for patients with respiratory disease. Physiotherapists work with patients in a variety of settings including patients' homes, pulmonary rehabilitation programmes, wards and intensive care units. Although physiotherapy is globally recognised within the healthcare profession, some respiratory physiotherapy techniques have been clouded by a lack of scientific evidence [2] and insufficient clinical data [3] on the benefits of specific techniques in the treatment of patients suffering from respiratory disease. In recent decades, evidence (or absence thereof) has been emerging for many techniques related to exercise training, mucus transport and breathing retraining strategies. The field is rapidly evolving. In 1995 a specific group involving respiratory physiotherapists was established. This active group exists under the European Respiratory Society assembly for allied health professionals (ERS group 9.02), and gathers annually during the ERS Annual Congress, keeping an open channel of communication with physiotherapists throughout the year. Stiller [3] reported that while “some physiotherapists routinely treat most if not all ICU patients with a combination of techniques, […] other physiotherapists use such techniques selectively when they believe they are specifically indicated”, thereby highlighting the differences in treatment of patients by respiratory physiotherapists just over a decade ago. In 2009, Bott et al. [2] published guidelines with the distinct purpose of producing evidence-based recommendations for practice. In recent years, great strides have been taken in research of respiratory physiotherapy to accumulate and report on the supporting rationale and effectiveness of respiratory physiotherapy techniques and combinations of techniques used in …

Diagnosis and initial evaluation of patients with gastrointestinal stromal tumor (GIST): An observational study of 1,226 patients.

10088 Background: The GIST registry (reGISTry) is an observational database designed to determine diagnostic method and evaluation of GIST patients outside of clinical trials. We previously described differences in treatment of patients in community versus academic centers (Pisters, Ann Oncol 2011;22:2523-9). Herein we present distinct differences in the diagnosis and initial evaluation of patients with GIST. Methods: The analysis cutoff date was May 2010. Patient demographics, presenting symptoms, diagnostic methodology, and KIT and PDFGRA mutations were described. For localized tumors, size and mitotic index (MI) were collected. Results: 1226 patients were included in this analysis. Initial diagnosis was most commonly made by surgeons (54.6%) and gastroenterologists (15.7%). Primary management decisions were made at time of diagnosis by medical oncologists (53%) and surgeons (53%) (sum &gt;100% due to ≥1 responses/site). 84% were symptomatic at diagnosis, while 16% were diagnosed incidentally. Diagnostic procedure was performed during surgery (75%) and/or by endoscopy (22%) or interventional radiology (11%) using percutaneous core biopsy or fine needle aspirate. Initial diagnostic imaging was by CT scan (76%), endoscopy (25%), ultrasound (12%), or a combination. Most primary GISTs were located in the stomach (55%) or small intestine (28%). At diagnosis, localized and metastatic disease was seen in 83% and 17% of patients, respectively, with metastases mainly in the liver (62%) and/or peritoneum (36%). KIT immunostaining was performed in 93% of patients, with 98% positive. Mutation analysis was carried out in 8% of cases (57% KIT exon 11 and 12% exon 9 mutations). Of localized primary tumors, 52% were &gt;5 cm in size and 23% had &gt;5 mitoses per 50 high-power fields. Conclusions: We found that initial diagnosis is made by several different modalities. The majority of GIST patients are managed by medical and surgical oncologists. Most patients with localized tumor were at intermediate risk of recurrence and would be considered for adjuvant imatinib therapy.

Factors associated with mortality after breast cancer metastasis

It is generally accepted that patients with breast cancer metastases have very poor survival. Metastatic breast cancer patients can be considered a heterogeneous population with a varied clinical course, which underscores the need for accurate prediction of survival based on prognostic factors. The purpose of the present study was to identify factors related to survival in breast cancer patients after diagnosis with metastatic disease. A total of 557 patients with breast cancer metastasis diagnosis seen at one large urban practice have been followed up between 1 January, 1999 and 30 June, 2010. Demographic, tumor characteristics, clinical factors as predictors of survival were analyzed using log-rank test and Cox regression model. The median survival length was 39 months (range 1-138 months) with 154 (27.7%) alive and 403 (72.3%) dead at the end of follow-up period. This study demonstrated that a history of hypertension, ER/PR status, HER2 status, metastasis-free interval, metastatic location (including brain, bone and liver), and BMI at diagnosis with metastatic breast cancer were the most relevant prognostic factors for survival after metastatic disease diagnosis. Findings of this study may form a foundation for the growing corpus of knowledge explaining the outcome differences in treatment of patients with metastatic breast cancer, potentially helping to create tailored counseling and personalized treatment approaches for this vulnerable group.

Factors associated with mortality after breast cancer metastasis.

174 Background: It is generally accepted that patients with breast cancer metastases have poor survival. Metastatic breast cancer patients can be considered a heterogeneous population with a varied clinical course, which underscores the need for accurate prediction of survival based on prognostic factors. The purpose of the present study was to identify factors related to survival in breast cancer patients after diagnosis with metastatic disease. Methods: A total of 557 patients with breast cancer metastasis diagnosis seen at one large urban practice have been followed up between January 1, 1999 and June 30, 2008. Demographic, tumor characteristics, clinical factors as predictors of survival were analyzed using Cox regression model. Results: The median survival length was 40 months (range 1-114 months) with 269 (48.3%) alive and 288 (51.7%) dead. This study demonstrated that hypertension, estrogen receptor (ER) and/or progesterone receptor (PR) status, human epidermal growth factor receptor-2 (HER2) status, number of metastatic sites, and body mass index (BMI) at diagnosis with metastatic breast cancer were the most relevant prognostic factors for survival after metastasis. Conclusions: Findings of this study may form a foundation for the corpus of knowledge explaining the outcome differences in treatment of patients with metastatic breast cancer, potentially helping to create tailored counseling and personalized treatment approaches for this vulnerable group. [Table: see text]

Contralateral Prophylactic Mastectomy: Caveat Emptor

Contralateral Prophylactic Mastectomy: Caveat Emptor

Physiotherapy Treatment Approaches for Stroke

Graeme J. Hankey MD, FRCP Section Editor: There are several different approaches to physiotherapy treatment after stroke. These can broadly be divided into approaches that are based on neurophysiological, motor learning, or orthopaedic principles. Some physiotherapists base their treatment on a single approach, whereas others use a mixture of components from a number of different approaches. The practical application of these approaches can result in substantial differences in patient treatment. At present, the Bobath Approach, based on neurophysiological principles, probably remains the most widely used approach in the Western world.1–5 However, there is a lack of convincing evidence to support any specific physiotherapy treatment approach.3,6 This systematic review aims to assess the effects of physiotherapy treatment if it is based on orthopaedic, motor learning, or neurophysiological principles, or on a mixture of these treatment principles. We searched the Cochrane Stroke Group Trials Register …

Hospital care of patients with ST-elevation myocardial infarction in four different European regions

National surveys as well as European comparative studies suggest that differences in treatment of patients with ST-elevation myocardial infarction (STEMI) exist. The extent to which these variations influence the outcome of hospital care delivered to STE-MI patients in everyday routine is mostly unknown. In this study data representative of hospital care received by STEMI patients in four European regions (Berlin, Dijon, Florence and Tartu) were compared. The four registries are population based. The percentage of women and the mean age of the patients differed among the registries. Risk factors such as hypertension and hypercholesterolaemia also differed among the different regions, whereas a history of diabetes mellitus was similar among the registries. The percentage of patients receiving reperfusion therapy ranged from 47 to 81%. An appreciable difference also resulted after breaking down reperfusion therapy into thrombolysis and primary percutaneous coronary intervention (PCI). Hospital mortality as an outcome measure was very similar among the regions. After adjustment for age, the comparative magnitude of hospital mortality proportion was also very similar among three registries. Only the patients from Florence demonstrated a comparatively lower death rate, with a ratio of 0.81. In summary, there are important differences among baseline characteristics and hospital care of STE-Ml patients in the four study regions. Nevertheless, it was interesting to ascertain that the outcome measured in hospital mortality was very similar among the four registries compared.

Searching for relief: racial differences in treatment of patients with back pain

The purpose of the study was to investigate the impact of race/ethnicity on analgesic prescriptions for back pain. Using 1995–1998 data from the U.S. National Hospital Ambulatory Medical Care Survey, significant racial disparities were observed in the odds of prescriptions. African American (OR=0.67, CI=0.55, 0.83) and Hispanic patients (OR=0.70, CI=0.52, 0.93) were significantly less likely to be given prescriptions for back pain treatment than their White counterparts. These two groups also received fewer medications on average than Whites. When the sample was stratified by sex, the racial differences were even more startling. African American men (OR=0.49, CI=0.35, 0.68) and Hispanic men (OR=0.51, CI=0.33, 0.79) were considerably less likely than White men to be given prescriptions for back pain. In addition, African American male patients were less likely to receive any medications (prescribed or non-prescribed) for pain. The above findings remained even after controlling for pain severity and payment source. The authors concluded that prejudice and racial stereotyping among physicians are the most plausible explanations for the racial/ethnic differences in pain treatment.

Searching for relief: racial differences in treatment of patients with back pain

The purpose of the study was to investigate the impact of race/ethnicity on analgesic prescriptions for back pain. Using 1995–1998 data from the U.S. National Hospital Ambulatory Medical Care Survey, significant racial disparities were observed in the odds of prescriptions. African American (OR=0.67, CI=0.55, 0.83) and Hispanic patients (OR=0.70, CI=0.52, 0.93) were significantly less likely to be given prescriptions for back pain treatment than their White counterparts. These two groups also received fewer medications on average than Whites. When the sample was stratified by sex, the racial differences were even more startling. African American men (OR=0.49, CI=0.35, 0.68) and Hispanic men (OR=0.51, CI=0.33, 0.79) were considerably less likely than White men to be given prescriptions for back pain. In addition, African American male patients were less likely to receive any medications (prescribed or non-prescribed) for pain. The above findings remained even after controlling for pain severity and payment source. The authors concluded that prejudice and racial stereotyping among physicians are the most plausible explanations for the racial/ethnic differences in pain treatment.