Health Outcomes Of Adult Patients Research Articles

SA69 The Association Between Polypharmacy and Its Adverse Health Outcomes in Adult Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

SA69 The Association Between Polypharmacy and Its Adverse Health Outcomes in Adult Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Regular HbA1c examination and health outcomes in adult patients with type 2 diabetes in South Korea: A retrospective cohort study.

Concerns have been raised about the effectiveness of using process-centered indicators to assess the quality of diabetes care in Korea. This study aims to examine the factors influencing the performance of regular HbA1c testing and to explore its association with health outcomes, including hospitalization and mortality. We utilized a retrospective cohort design with a 4-year follow-up period, involving 159,452 adult patients newly diagnosed with type 2 diabetes (E11 in International Classification of Diseases, 10th Edition) in 2011. We established a national population database by merging the Korea National Health Insurance (KNHI) claims database and the KNHI Qualification Database of South Korea. The proportion of diabetic patients who underwent regular HbA1c testing at least once a year in the first 3 years was determined to be 33.8%. In comparison, patients who did not receive regular tests during the same period exhibited significantly increased odds of hospitalization (diabetes/CVD/renal, OR, 1.23, 95% CI, 1.12-1.34; diabetes, OR, 1.36, 95% CI, 1.17-1.57). Additionally, this nonpatient group experienced a higher risk of mortality (OR: 1.56, 95% CI: 1.36-1.80). This study supports the positive impact of regular HbA1c testing on health outcomes for individuals with type 2 diabetes. To increase the current 33% rate of regular HbA1c testing, developing patient-customized management policies is essential. Priority should be given to diabetic patients aged 65 or older, living in rural areas, and those belonging to low-income families (medical aid).

Enhancing Oral Health via the Sense of Coherence Approach Among Adult Patients at University Dental Hospital.

The purpose of the study was to assess the sense of coherence and its relationship with oral health and other study variables among adult patients at university dental hospital. This cross-sectional study included adult patients visiting the Dental Hospital of the College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam. Sense of coherence was determined by Antonovsky's Sense of Coherence scale (SOC-13), which consists of 13 items on a 7-point Likert. DMFT index, plaque index, gingival index, and simplified oral hygiene index were used to evaluate the oral health of study participants. Bivariate and multivariable analyses were performed, and 0.05 level of significance was used in the study. The study included the data of 558 participants with a mean age of 32.19±10.11 years. The mean score of SOC was 52.77±13.11, which was significantly higher in high-income participants (P <0.001), participants without a medical condition (P=0.021), non-smokers (P <0.001), and those who visited the dentist in less than one year (P=0.028). Bivariate analysis showed statistically significant negative correlations between SOC and DMFT index (P=0.002), SOC and plaque index (P <0.001), SOC and gingival index (P=0.002), and SOC and simplified oral hygiene index (P=0.001). Multivariable analysis also showed that SOC was significantly correlated with DMFT index (P=0.001), plaque index (P <0.001), gingival index (P <0.001), and oral hygiene index (P=0.004) after controlling for age, gender, education, and monthly income. This study found that high-income and healthy participants, non-smokers, and those who visited the dental office during the last one year demonstrated significantly higher SOC. In addition, there was a statistically significant correlation between SOC and oral health. These study findings highlight the importance of raising awareness about SOC to improve oral health outcomes in adult patients.

Embryonic alcohol exposure in zebrafish predisposes adults to cardiomyopathy and diastolic dysfunction.

Fetal alcohol spectrum disorders (FASDs) impact up to 0.8% of the global population. However, cardiovascular health outcomes in adult patients, along with predictive biomarkers for cardiac risk stratification, remain unknown. Our aim was to utilize a longitudinal cohort study in an animal model to evaluate the impact of embryonic alcohol exposure (EAE) on cardiac structure, function, and transcriptional profile across the lifespan. Using zebrafish, we characterized the aftereffects of EAE in adults binned by congenital heart defect (CHD) severity. Chamber sizes were quantified on dissected adult hearts to identify structural changes indicative of cardiomyopathy. Using echocardiography, we quantified systolic function based on ejection fraction and longitudinal strain, and diastolic function based on ventricular filling dynamics, ventricular wall movement, and estimated atrial pressures. Finally, we performed RNA-sequencing on EAE ventricles and assessed how differentially expressed genes (DEGs) correlated with cardiac function. Here, we demonstrate that EAE causes cardiomyopathy and diastolic dysfunction through persistent alterations to ventricular wall structure and gene expression. Following abnormal ventricular morphogenesis, >30% of all EAE adults developed increased atrial-to-ventricular size ratios, abnormal ventricular filling dynamics, and reduced myocardial wall relaxation during early diastole despite preserved systolic function. RNA-sequencing of the EAE ventricle revealed novel and heart failure-associated genes (slc25a33, ankrd9, dusp2, dusp4, spry4, eya4, and edn1) whose expression levels were altered across the animal's lifespan or correlated with the degree of diastolic dysfunction detected in adulthood. Our study identifies EAE as a risk factor for adult-onset cardiomyopathy and diastolic dysfunction, regardless of CHD status, and suggests novel molecular indicators of adult EAE-induced heart disease.

Evaluating Mental Health Outcomes in COVID-19 ICU Survivors: A Scoping Review of Measurement Tools.

Objective: The objective of this scoping review was to map the range of measurement tools used to study the prevalence of common mental health conditions in COVID-19 ICU survivors. Introduction: Increased rates of admission to and survivorship from intensive care units (ICUs) have been observed in recent years, particularly during the global pandemic. ICU patients are at a higher risk of developing depressive, anxiety, and PTSD symptoms. Due to the high burden of disease, an accurate understanding of long-term mental health challenges for this population is key. Unfortunately, there is significant variability in reported prevalence rates. Heterogeneity in measurement tools potentially contribute to this. Inclusion criteria: Studies were eligible if they (a) reported mental health outcomes of adult patients diagnosed with COVID-19 and admitted to an ICU, (b) used standardised mental health outcome measures, and (3) were peer-reviewed. Methods: Searches were conducted in PubMed, PsycInfo, and Scopus. The initial search retrieved 1234 publications. After de-duplication and title and abstract screening, 72 full-text articles were examined for eligibility and 44 articles were excluded, leaving 28 eligible studies. Reference lists of the eligible studies were screened, and four other studies were added. 32 studies were ultimately included in this review. Results: Significant heterogeneity of measurement tools and clinical thresholds were observed. Only 6.25% of the studies compared changes in mental health outcomes to baseline measurements. Between five and nine unique measurement tools were used to study depression, anxiety, and PTSD, respectively. Studies were also observed to use up to 19 different thresholds to establish the prevalence of PTSD. Conclusions: The heterogeneity of measurement tools and thresholds continues to confound prevalence rate estimations of mental health complications post-ICU admission. Future research will benefit from consistency in the use of recommended outcome measures and the use of psychometrically comparable cut-off points between key measures.

Prevalence of attention deficit hyperactivity disorder and health outcomes in adult patients with psychiatric disorders: a multi-country, two-part, observational study

Prevalence of attention deficit hyperactivity disorder and health outcomes in adult patients with psychiatric disorders: a multi-country, two-part, observational study

Treatment options in primary mediastinal B cell lymphoma patients, retrospective multicentric analysis; a Turkısh oncology group study.

Primary mediastinal B-cell lymphomas (PMBL) are aggressive B- cell lymphomas. Although the initial treatment models vary in PMBL, appropriate treatment methods are not known. We aim to show real-life data on health outcomes in adult patients with PMBL who received various type of chemoimmunotherapies in Turkey. We analyzed the data of 61 patients who received treatments for PMBL from 2010 to 2020. The overall response rate (ORR), overall survival (OS) and progression-free survival (PFS) of the patients were evaluated. 61 patients were observed in this study. The mean age of the study group was 38.4 ± 13.5 years. From among them, 49.2% of the patients were female (n = 30). For first-line therapy, 33 of them had received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) regimen (54%). Twenty-five patients had received rituximab, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (DA-EPOCH-R) regimen. The ORR was 77%. The median OS and PFS were as follows: 25 months (95% CI: 20.4-29.4) and 13 months (95% CI: 8.6-17.3), respectively. The OS and PFS at 12 months were 91.3% and 50%, respectively. The OS and PFS at five years were 64.9% and 36.7%, respectively. Median follow-up time period was 20 months (IQR 8.5-38.5). R-CHOP and DA-EPOCH-R showed good results in PMBL. These remain one of the best determined systemic treatment options for first-line therapy. Also, the treatment was associated with good efficacy and tolerability.

Psychosocial interventions and mental health in patients with cardiovascular diseases living in low and middle-income countries: A systematic review protocol.

ObjectiveThe objective of this review is to evaluate the effectiveness of psychosocial interventions on mental health outcomes in adult patients with Cardiovascular Diseases (CVDs) living in low- and middle-income countries (LMICs).IntroductionMental health issues are highly prevalent among patients with CVDs leading to poor disease prognosis, self-care/ management, and Quality of Life (QOL). In the context of LMICs, where the disease burden and treatment gap are high and resources are inadequate for accessing essential care, effective psychosocial interventions can make significant contributions for improving mental health and reducing mental health problems among patients who live with cardiovascular diseases.Inclusion criteriaThis review will include studies published between 2010 and 2021 that evaluated the effect of psychosocial interventions on mental health outcomes (resilience, self-efficacy, QOL, depression and anxiety) on adult patients (aged ≥18 years) with any cardiovascular diseases using experimental and quasi experimental designs.MethodsThe search will be conducted from the following databases: MEDLINE via OVID (1946—Present), EMBASE via OVID (1974 –Present), Cumulative Index for Nursing and Allied Health Literature (CINAHL) via EBSCOhost (1936—Present), PsycINFO via OVID (1806—Present), Scopus via Elsevier (1976—Present), and Cochrane Library via Wiley (1992—Present). Data will be critically appraised using standard tools and extracted by two reviewers and disagreement will be solved by the third reviewer. Meta-analysis will be performed, if possible, otherwise, data will be synthesized in narrative and tabular forms.DiscussionThe findings of this review will provide a key insight into contextually relevant psychosocial interventions for promoting mental health of patients with CVDs living in LMICs. The review findings will be potentially useful for health care providers and researchers to implement such interventions not only for reducing the burden of mental health issues but also for improving the overall well-being among patients with chronic illnesses.Systematic review registration numberProspero-CRD42020200773.

Prevalence of polypharmacy and associated adverse health outcomes in adult patients with chronic kidney disease: protocol for a systematic review and meta-analysis

BackgroundPolypharmacy, often defined as the concomitant use of ≥ 5 medications, has been identified as a significant global public health threat. Aging and multimorbidity are key drivers of polypharmacy and have been linked to a broad range of adverse health outcomes and mortality. Patients with chronic kidney disease (CKD) are particularly at high risk of polypharmacy and use of potentially inappropriate medications given the numerous risk factors and complications associated with CKD. The aim of this systematic review will be to assess the prevalence of polypharmacy among adult patients with CKD, and the potential association between polypharmacy and adverse health outcomes within this population.Methods/designWe will search empirical databases such as MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, and PsycINFO and grey literature from inception onwards (with no language restrictions) for observational studies (e.g., cross-sectional or cohort studies) reporting the prevalence of polypharmacy in adult patients with CKD (all stages including dialysis). Two reviewers will independently screen all citations, full-text articles, and extract data. Potential conflicts will be resolved through discussion. The study methodological quality will be appraised using an appropriate tool. The primary outcome will be the prevalence of polypharmacy. Secondary outcomes will include any adverse health outcomes (e.g., worsening kidney function) in association with polypharmacy. If appropriate, we will conduct random effects meta-analysis of observational data to summarize the pooled prevalence of polypharmacy and the associations between polypharmacy and adverse outcomes. Statistical heterogeneity will be estimated using Cochran’s Q and I2 index. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., sex, kidney replacement therapy, multimorbidity).DiscussionGiven that polypharmacy is a major and a growing public health issue, our findings will highlight the prevalence of polypharmacy, hazards associated with it, and medication thresholds associated with adverse outcomes in patients with CKD. Our study will also draw attention to the prognostic importance of improving medication practices as a key priority area to help minimize the use of inappropriate medications in patients with CKD.Systematic review registrationPROSPERO registration number: [CRD42020206514].

Gemcitabine, Oxaliplatin and Paclitaxel (GemPOx) in Patients with Relapsed or Refractory Germ Cell Tumors After High Dose Chemotherapy, A Retrospective Single-Center Experience

Germ cell tumors are chemosensitive tumors, and patients with metastatic germ cell tumors can be cured even in the metastatic setting. There are limited treatment options for the patients who have refractory or recurrent disease after high dose chemotherapy (HDCT) with autologous stem cell transplantation. We aimed to show real-life data on health outcomes in adult patients with recurrent or refractory germ cell tumor who received the gemcitabine, oxaliplatin, and paclitaxel (GemPOx) combination regimen.We analyzed the data of 33 patients receiving GemPOx regimen after HDCT in our department between January 2016 and January 2020. Primary objectives were overall response rate (ORR), overall survival (OS), and progression-free survival (PFS). The mean age of the study group was 31.5 ± 8.2 years. Of the 33 patients, 27 (81.8%) were men. The median OS and PFS were 16 months (95% CI: 7.33-24.7) and 10 months (95% CI: 5.1-14.9), respectively. The one-year OS and PFS were 65.7% and 40%, respectively. ORR was 42.4%. Toxicity was managable.Our study demonstrates acceptable safety and efficacy of GemPOx regimen for relapsed refractory patients with germ cell tumors. GemPOx remains one of the best determined systemic treatment options for progressive germ cell tumors patients after HDCT. Keywords: Gemcitabine, Oxaliplatin, Paclitaxel, Germ cell tumors, High dose chemotherapy

Evaluation of an integrated HIV and hypertension management model in rural South Africa: a mixed methods approach

ABSTRACT Background: A summary of Soter Ameh’s PhD thesis titled, ‘An integrated HIV and hypertension management model in rural South Africa: A mixed methods approach’ is presented here. In responding to the dual high burden of non-communicable diseases (NCDs) and HIV in South Africa, the national government initiated an integrated chronic disease management (ICDM) model in health facilities as a pilot programme. The aim of the ICDM model is to leverage the successes of the innovative HIV treatment programme for NCDs to improve the quality of care and health outcomes of adult patients. Objectives: The specific objectives of this study were to: (1) determine the quality of care provided in the integrated model in 2013, (2) describe patients’ and operational managers’ perceptions of quality of care in the integrated model in 2013, and (3) assess effectiveness of the integrated model in controlling CD4 counts (>350 cells/mm3) and blood pressure (<140/90 mmHg) of patients from 2011 to 2013. Methods: A combination of quantitative and qualitative methods was used to assess and describe the quality of care in the model. Effectiveness of the model in controlling patients’ blood pressure (BP) and CD4 counts was assessed in selected PHC facilities in the Bushbuckridge municipality in Mpumalanga province, South Africa. Results: The findings showed the suboptimal quality of care in five of the eight priority dimensions of care used as leverage for the NCD programme. The ICDM model had a small but significant effect on BP control for hypertension patients receiving treatment. Conclusions: The HIV programme needs to be more extensively leveraged for hypertension treatment to achieve an optimal BP control in the study area. These findings could have policy relevance for low- and middle-income countries currently undertaking proof of concept studies to demonstrate the feasibility of implementing an integrated chronic disease care model.

Research progress on the influence of resilience on health outcomes in adults with chronic diseases

This study reviewed the definition of resilience, evaluation tools, protective factors and its effect on health outcomes of adult patients with chronic diseases, in order to provide theoretical guidance for the intervention of resilience of adult chronic disease patients. Key words: Resilience; Adult; Chronic disease; Health outcomes; Review

Clinical Pearls

Advanced technology has made prolonged life support possible, yet approximately 22% of deaths of adult patients in the United States occur in intensive care units (ICUs). Successful transition from active treatment to end-of-life (EOL) care requires good communication and shared decision-making. However, conflict and poor interdisciplinary collaboration among health care professionals reduces the quality of EOL care and contributes to family distress.Brooks and colleagues conducted focus group interviews with ICU nurses and physicians to discuss their experiences and perceptions of EOL care. They found the following:The authors recommend staff support and education from senior clinicians to improve interdisciplinary EOL care. Clear organizational processes with a collaborative decision-making framework can assist staff in leadership roles.See Article, pp 336–341Sleep disruption is a well-known problem for patients in intensive care units (ICUs). Poor-quality sleep that is short contributes to poor outcomes such as delirium and posthospital syndrome. Little is known about the perceptions of patients and clinical staff regarding environmental and nonenvironmental factors affecting patients’ sleep.Ding and colleagues explored the perceptions of adult patients in a medical ICU, patients’ surrogates, and night-shift clinical staff, including nurses, physicians, patient-care assistants, and respiratory therapists. They identified 4 themes:The authors recommend interventions to include an assessment of patients’ psychological stress and perceptions of stress-reduction strategies.See Article, pp 278–286Sedative medications are used to reduce anxiety and increase relaxation in ICU patients receiving mechanical ventilation (MV). Patient-controlled analgesia has been used successfully to manage pain in MV patients, but whether the same principles can be applied to sedative therapy is unknown.Chlan and colleagues conducted a small study in 2010 that showed that MV patients were willing and able to manage their anxiety through self-administered sedatives in a 24-hour period. In this randomized study, they evaluated the use of self-administered dexmedetomidine for up to 5 days with adult MV patients. They found the following:The results show that self-administered sedation therapy was a safe intervention with select patients.See Article, pp 288–296Extracorporeal membrane oxygenation (ECMO) is often used to treat cardiogenic shock and lung failure and as a bridge to lung transplant. Evidence suggests that outcomes after hospital discharge include cognitive impairment, depression, and anxiety, but long-term implications are unknown.Tramm and colleagues examined physical and mental health outcomes in adult patients during the year after ECMO therapy. They found the following:Given the number of patients with lower-extremity issues, the authors suggest including the EuroQol-5-Dimensions-5-Levels tool as a core outcome measure of mobility to detect neurological problems during hospitalization.See Article, pp 311–319

Determining clinical and biological indicators for health outcomes in adult patients with childhood onset of congenital adrenal hyperplasia

Adverse outcomes in adult congenital adrenal hyperplasia (CAH) patients are frequent. The determinants of them have not yet been established. To establish the prevalence of adverse outcomes and to find determining factors for each of them. Cross-sectional monocentric study of 104 patients with childhood onset of CAH (71 women, 33 men). Analysis established first the determinants of clinical, hormonal, genetic variables and second a composite criterion for some of the outcomes and determinants. BMI was above 25 kg/m(2) in 44% of the cohort, adrenal hyperplasia and/or nodules were present in 45% of the patients, and irregular menstrual cycles and hyperandrogenism were found in 50 and 35% of the women respectively. In univariate analysis, the determinants of these outcomes were all linked to disease control, especially 17-hydroxyprogesterone (17OHP) and androstenedione concentrations. Low weight was a determinant of abnormal bone mineral density (BMD) (60% of the cohort). Multivariate analysis confirmed these data. A classic form (CF) of CAH was a determinant of testicular adrenal rest tumors (TARTs) (36% of the men). Total cumulative glucocorticoid dose was a determinant of BMI and TART, whereas fludrocortisone dose was a determinant of TART (P=0.03). In men, the composite criterion was associated with androstenedione concentration and CF. In women, the composite criterion was associated with total testosterone concentration. The present study confirms the high prevalence of adverse outcomes in CAH patients. These are, most often, related to disease control. The impaired health status of adults with CAH could therefore be improved through the modification of treatment.

Continuity of ambulatory care and health outcomes in adult patients with type 2 diabetes in Korea

ObjectivesContinuity of ambulatory care in chronic disease affects the quality of care and the efficiency of healthcare spending. We assessed the relationship between initial continuity of ambulatory care and subsequent health outcomes (hospitalization, mortality and healthcare costs). MethodsThis was a retrospective cohort study of 68,469 patients enrolled in the Korean National Health Insurance Program, who were 20years of age or older and first diagnosed with type 2 diabetes in 2004. Patients were followed for 4years using claims data to measure continuity of ambulatory care for the initial 3years after first diagnosis and to investigate hospitalization, mortality, and healthcare costs in the fourth year of follow-up. ResultsIn the group of patients with COCI<0.4, the risk of hospitalization for all causes was higher (odds ratio: 1.37, 95% CI: 1.28–1.47) and healthcare costs increased (β=0.037, P<0.001) compared with the reference group (COCI=1.0), after adjusting for patient risk factors, such as age, gender, and comorbidity index. ConclusionsPolicies that promote a continuing relationship with the same physician seem to enhance the quality of care and the efficiency of spending in the treatment of diabetic patients.

Systematic care for asthma in Australian general practice: a randomised controlled trial

To evaluate whether systematic asthma care involving a register-recall system, postcard prompts for review, and education for general practitioners and staff in Australian general practice improves the quality of care and health outcomes for adult patients with moderate to severe asthma. Cluster randomised controlled trial in 40general practices in urban and rural South Australia and New South Wales over the 2years 2004and 2005; practices were randomly allocated to the intervention or control group. 565adult patients of these randomly allocated practices who had doctor-diagnosed moderate to severe asthma and were taking inhaled corticosteroids. Clinical asthma indicators, quality of care, acceptability of the intervention to patients, quality of life, and asthma self-management skills at baseline, 6months and 12months. Although 46% of patients in the intervention group practices responded to the postcard prompts, only 32% actually attended for their asthma review. At 12months, there was a statistically significant difference in provision of written asthma action plans (rate ratio, 1.9; 95% CI, 1.0-3.5; P = 0.04) for intervention group patients compared with control group patients; there was no significant difference in other indicators. We found little objective evidence of improvement in patient management and outcomes resulting from a systematic model of asthma care. Australian New Zealand Clinical Trials Registry ACTRN12605000091606.

XII. Nutrition

XII. Nutrition

Impairment of GH responsiveness to combined GH‐releasing hormone and arginine administration in adult patients with Prader‐Willi syndrome

It is unclear if poor health outcomes of adult patients with Prader-Willi syndrome (PWS) are influenced by GH deficiency (GHD). Few studies have been focused on PWS adults, but further information on the concomitant role of obesity on GH/IGF-I axis function is needed. The aim of our study was to investigate the prevalence of GHD in a large group of adult subjects with genetically confirmed PWS. We studied the GH response to a combined administration of GHRH (1 microg/kg i.v. at 0 minutes) and arginine (ARG) (30 g i.v., infused from 0 to 30 minutes) as well as the baseline IGF-I levels, in a group of 44 PWS adults (18 males, 26 females) aged 18-41.1 years. The same protocol was carried out in a control group of 17 obese subjects (7 males, 10 females) aged 21.8-45.8 years. Blood samples were taken at -15 and 0 minutes and then 30, 45, 60, 90 and 120 minutes after GHRH administration. Serum GH and total IGF-I concentrations were measured by chemioluminescence. Statistical analysis was performed by Student's t-test for unpaired data, and using analysis of variance for parametric and nonparametric (Mann-Whitney test) data, where appropriate. The relationship between pairs of variables was assessed by Pearson's correlation. Independent variables influencing GH secretion were tested by multiple linear regression analysis. The GH response to GHRH + ARG was significantly lower in PWS patients (GH peak (mean +/- SE) 8.4 +/- 1.2 microg/l; AUC: 471.4 +/- 77.8 microg/l/h) than obese subjects (GH peak 15.7 +/- 2.9 microg/l, P < 0.02; AUC 956 +/- 182.9 microg/l/h, P < 0.005). When considered individually, 17 of 44 PWS individuals (38.6%) were severely GHD, according to the cut-off limit of 4.1 microg/l for obese individuals, and low IGF-I-values were present in 33 PWS patients. Moreover, impaired GH response was combined with subnormal IGF-I levels in all PWS patients with GHD. Adult subjects with PWS had a reduced responsiveness to GHRH + ARG administration associated with reduced IGF-I levels. In addition, a severe GHD for age was demonstrated in a significant percentage of PWS subjects. These findings are in agreement with the hypothesis that a complex derangement of hypothalamus-pituitary axis occurred in PWS, and suggested that impaired GH secretion is not an artefact of obesity.

ABS13: Systematic practice-based asthma care in the Australian setting

Asthma is a major health priority in Australia. Many patients are not being adequately managed in primary care, despite the introduction of incentives encouraging a more comprehensive and systematic approach to care. To evaluate whether systematic asthma care (especially the use of recall for an asthma review) improves the quality of care and health outcomes for adult patients, and whether this is cost effective. Subjects and method: We recruited 565 patients aged 18 or over who had been diagnosed with moderate or severe asthma. They were from 40 general practices in urban and rural settings in two Australian states. We conducted a cluster randomised controlled trial, with the practice as the unit of randomisation. The intervention included: - setting up an asthma register-recall system incorporating postcard prompts; - education of GPs and staff about their roles in systematic care, use of spirometry and the Asthma 3+ Plan. Data was collected through patient questionnaires, spirometry, case note review, and interviews with practice staff. Preliminary analysis revealed that 47% of patients responded to the postcard prompts and made appointments for an asthma review. Final results will be presented showing whether this resulted in any significant differences between intervention and control patients in - quality of care – including use of spirometry, asthma action plans, education; - clinical outcomes – including lung function, asthma on waking, days off work; - acceptability of systematic care; - quality of life. The trial will determine whether changes in delivery of asthma care are acceptable, feasible and effective in improving patient outcomes — and provide an evidence base for future policy initiatives. Conflict of interest and funding No conflicts of interest. Funded by National Health and Medical Research Council of Australia.

Comparison of the Quality of Well-Being Scale and the SF-36 Results Among Two Samples of Ill Adults: AIDS and Other Illnesses

Purpose. To compare results of using the SF-36 Short Form 36 (SF-36) and the Quality of Well-being Scale (QWB) in characterizing health outcomes over time in patients having serious illnesses, including cancer and AIDS. Background. The SF-36 and the QWB are alternative measures of health-related quality of life. The SF-36 is a morbidity measure that features a profile of nine dimensions. The QWB is a preference-based measure that combines morbidity and mortality into a single number. However, the QWB can also be scored and used as a profile. We compare SF-36 and QWB scores with different scoring methods to assess validity and sensitivity to change over time in health outcomes for adult patients with HIV infection, cancer, and other serious illnesses. Subjects. 201 adults with serious illnesses, including 99 with AIDS and 102 with cancer or other illnesses. Procedure. All subjects received both measures at baseline and at 6-month intervals thereafter, over a period of 21/2 years. Results. In the profile mode, the QWB captured outcomes that characterize the AIDS syndrome. The SF-36 differentiated between the AIDS and other illnesses patients on some scales, but without consistent direction. However, the overall QWB showed a decrease in quality of life over time for both the AIDS and other illnesses patients while the SF-36 did not. This is because many patients died and these were counted as outcomes by the QWB and as missing data by the SF-36. Conclusions. The QWB appears to be better able to capture outcomes of serious illness over time than does the SF-36.