National Medical Information Research Articles

Examining the effects of social assistance on suicide-related behaviour among impoverished older adults in Korea using a nationwide cohort study from 2010–2019

Suicide rates among older adults in Korea are one of the highest in the world. Although prior research found that poverty is associated with suicide mortality among older adults in Korea, it is unknown whether being a recipient of social assistance may reduce suicide risk among older adults living in poverty. We examined the impact of the public assistance program on suicide-related behaviour (SRB). Data from a nationwide cohort in the Korean National Health Insurance Database, including demographic and medical treatment information, linked to the vital statistics for 2010–19 was used. The entire Korean population born before 1951 was included (n = 7,889,086). Flexible parametric survival model was performed to assess whether the risk of SRB hospitalisation and death differed across a) different levels of socioeconomic status, and b) social assistance status among the poor, using gender-stratified models. Older age, chronic disease, poverty, and being out of the labour market were associated with higher SRB hospitalisation and death for both genders. Among those living in poverty, social assistance recipients had lower rates for SRB death and hospitalisation, compared to the low-income non-recipients. Men who were non-recipients had 0.21 higher hazards ratio (95%CI 0.20 to 0.22) for SRB deaths compared to recipients, and the difference was 0.11 (95%CI 0.10 to 0.11) in women, with similar patterns for SRB hospitalizations. Poverty was associated with higher SRB death and hospitalisation among older adults in Korea. Social assistance targeting the older population may help reduce SRB.

Bevacizumab-induced proteinuria and its association with antihypertensive drugs: A retrospective cohort study using a Japanese administrative database.

Proteinuria is a major side-effect of the anti-tumor drug bevacizumab, although its incidence and risk factors in the real world are still unclear. Although renin-angiotensin-aldosterone system inhibitors are used clinically to prevent proteinuria, their efficacy remains unclear. The aim of the present study was to reveal the incidence and risk factors of bevacizumab-induced proteinuria and examine the effectiveness of antihypertensive drugs in preventing proteinuria. We conducted a retrospective cohort study using the National Hospital Organization Clinical Data Archives and Medical Information Analysis Databank. Hospitalized patients who received bevacizumab between January 1, 2016, and June 30, 2019, were included. The study outcome was proteinuria within 12 months of bevacizumab administration. Patient characteristics, laboratory tests, and medications were compared between patients with and without proteinuria using multivariable logistic regression analysis. Among the 2,458 patients, 27% developed proteinuria after bevacizumab administration. Nursing dependence (odds ratio [OR], 2.40; 95% confidence interval [CI], 1.89-3.05; P<0.001) and systolic blood pressure ≥140 mmHg (OR, 1.44; 95% CI, 1.17-1.79; P<0.001) were identified as risk factors. Patients with an estimated glomerular filtration rate (eGFR) of 60-89, 45-59, and <45 mL/min/1.73 m2 had 29.7%, 76.8%, and 66.0% higher odds of proteinuria, respectively, than those with an eGFR ≥90 mL/min/1.73 m2. No significant relationship was observed between antihypertensive drugs and the occurrence of proteinuria. More patients may suffer from proteinuria after bevacizumab administration than previously reported. Nursing dependence and systolic blood pressure are predictive risk factors for bevacizumab-induced proteinuria. Patients at risk of proteinuria should be closely monitored.

Changes in Drug Clinical Trials of Thyroid Diseases in China, 2009-2022.

The incidence rate of thyroid diseases increased worldwide. This study aims to overview the changing landscape of drug clinical trials on thyroid disease during 2009-2022. The detailed information of thyroid disease drug trials registered on the National Medical Products Administration (NMPA) Registration and Information Disclosure Platform for Drug Clinical Studies was searched and collected. The thyroid drug clinical trials were analyzed by the characteristics, time trends, indications, and geographical distribution. Sixty-five thyroid disease drug clinical trials were launched from 2009 to 2022 in China, which included 21 trials in nontumorous thyroid disease and 44 trials in thyroid carcinoma. The number of registered trials of thyroid diseases including thyroid carcinoma and nontumorous thyroid disease increased steadily from 2009 to 2020. Bioequivalence studies accounted for the largest proportion (32[49.2%]), while phase I and Phase II studies both only accounted for 18.5% (12/65). A significant difference was observed in the trials phase, and randomization between thyroid carcinoma and nontumorous thyroid disease. In terms of clinical indications and drug mechanisms, the number of trials in multi-target tyrosine kinase inhibitors for thyroid carcinoma (n=35) ranked first, followed by thyroid hormone for hypothyroidism (n=7), thyrotropin for thyroid carcinoma (n=6). Sixty-five trials were led by 36 principal investigator (PI) units, and more than 30% of PI-leading units were located in Shanghai (n=7) and Beijing (n=4). During the past 13 years, the development of thyroid diseases drugs trials has achieved certain progress in thyroid carcinoma, especially the molecular targeted therapy, yet the development of drug trials on nontumorous thyroid disease was very slow.

Outcome measures of phase III anticancer drug trials in China.

Outcome measures of phase III anticancer drug trials in China.

The changing landscape of drug clinical trials on cardiometabolic diseases in China, 2009–2021

BackgroundCardiometabolic disease is a clinical syndrome characterized by multiple metabolic disorders, with atherosclerosis as the core and cardiovascular and cerebrovascular events as the outcome. Drug research and development (R&D) in cardiometabolic diseases has grown rapidly worldwide. However, the development of cardiometabolic drug clinical trials in China remains unclear. This study aims to depict the changing landscape of drug clinical trials for cardiometabolic diseases in China during 2009–2021.MethodsThe detailed information of drug trials on cardiometabolic diseases registered in the National Medical Products Administration (NMPA) Registration and Information Disclosure Platform was collected between January 1, 2009, and July 1, 2021. The landscape of cardiometabolic drug clinical trials was analyzed by the characteristics, time trends, indications, pharmacological mechanisms, and geographical distribution.ResultsA total of 2466 drug clinical trials on cardiometabolic diseases were extracted and analyzed. The annual number of drug trials increased rapidly in the past twelve years. Among all the trials, the bioequivalence trials (1428; 58.3%) accounted for the largest proportion, followed by phase I (555; 22.5%), phase III (278; 11.3%), phase II (169; 6.9%), and phase IV (26; 1.1%). Of 2466 trials, 2133 (86.5%) trials were monomer drugs, only 236 (9.6%) trials were polypills and 97 (3.9%) were traditional Chinese medicine (TCM) compounds. In terms of pharmacological mechanisms, the number of trials in dihydropyridine (DHP) calcium antagonists 321 (11.9%) ranked first, while trials in angiotensin receptor blocker (ARB) 289 (10.7%) and dipeptidyl peptidase-4 (DPP-4) inhibitor 205 (7.6%) ranked second and third place respectively. Of 236 chemical polypills trials, 23 (9.7%) polypills were the combination of DHP calcium antagonists and statins, while others were the combination of two same pharmacological effect agents. As for the geographical distribution of leading units, 36 trials were led by principal investigators (PI) units from Beijing, followed by Jiangsu (n = 29), Shanghai (n = 19), Guangdong (n = 19), and Hunan (n = 19), showing an uneven regional distribution.ConclusionsGreat progress has been made in drug clinical trials on cardiometabolic diseases, especially in antihypertensive agents, hypoglycemic agents, and hypolipidemic agents. However, the insufficient innovation of first-in-class drugs and polypills should be carefully considered by all stakeholders in drug trials.

Characteristics and Trends in Clinical Trials of Cardiovascular Drugs in China from 2009 to 2021.

Cardiovascular disease remains the leading cause of death worldwide and brings a heavy burden. However, the development of cardiovascular drug clinical trials in China remains unclear. The purpose of this study was to identify the status of clinical trials of cardiovascular drugs in China and provide a reference for stakeholders' decisions. Data were collected from the National Medical Products Administration (NMPA) Registration and Information Disclosure Platform for Drug Clinical Trials before July 1, 2021. We collected all information about clinical trials, including study design, and leading unit. The landscape of cardiovascular drug clinical trials was analyzed by the characteristics, time trends, indications, and geographical distribution. A total of 1666 cardiovascular drug clinical trials were launched from 2009 to 2021 in China. Bioequivalence/bioavailability studies accounted for the most significant proportion (1099 [65.97%]), followed by phase I (296 [17.77%]), phase III (135 [8.10%]), phase II (118 [7.08%]), and phase IV trials (18 [1.08%]). Initiated trials increased by 23.45% annually from 2009 to 2020. Trials of hypertension accounted for the most significant number, followed by coronary heart disease, dyslipidemia, and heart failure. Most trials (66.68%) were conducted in eastern China, followed by the central and western regions, showing a regional disparity as leading units. Despite the significant progress of cardiovascular drug clinical trials in China, there is still a long way to innovative drug research and development, requiring persistent policy support and more investment. Innovation, quality, efficiency, and equity need to be carefully considered by all stakeholders in clinical trials.

Comparative Clinical Outcomes With Scale-up of Dolutegravir as First-Line Antiretroviral Therapy in Ukraine.

Achievement of the UNAIDS 95-95-95 targets requires ARV regimens that are easy to use, well-tolerated, and cost-effective. Dolutegravir (DTG)-based regimens are efficacious and less costly than other common first-line regimens. This study assessed real-world effectiveness of DTG regimens in treatment-naive people living with HIV in Ukraine. We extracted data from the national Medical Information System on all adult patients who initiated antiretroviral therapy (ART) with DTG, lopinavir/ritonavir, or efavirenz (EFV) between October 2017 and June 2018, at 23 large clinics in 12 regions of Ukraine. Viral suppression at 12 ± 3 months and retention at 12 months after treatment initiation were the outcomes of interest. Of total 1057 patients, 721 had a viral load test within the window of interest, and 652 (90%) had viral load of ≤ 200 copies/mL. The proportion with suppression was lower in the EFV group [aOR = 0.4 (95% confidence interval: 0.2 to 0.8)] and not different in the LPV group [aOR = 1.6 (0.5 to 4.9)] compared with the DTG group. A 24-month or longer gap between diagnosis and treatment was associated with lower odds of suppression [aOR = 0.4 (0.2 to 0.8)]. Treatment retention was 90% (957/1057), with no significant difference by regimen group. History of injecting drug use was associated with decreased retention [aOR = 0.5 (0.3 to 0.8)]. DTG-based regimens were comparable with LPV and more effective than EFV in achieving viral suppression among ART-naive patients in a multisite cohort in Ukraine. Treatment retention was equally high in all 3 groups. This evidence from Ukraine supports the ART Optimization Initiative as a strategy to improve efficiency of the ART program without negatively affecting patient clinical outcomes.

Myocardial Infarction after Kidney Transplantation: A Risk and Specific Profile Analysis from a Nationwide French Medical Information Database.

Introduction: Renal transplant recipients have a high peri-operative risk for cardiovascular events. The post-transplantation period also carries a risk of myocardial infarction (MI). Coronary artery disease (CAD) is a leading cause of death in these patients. We aimed to assess the risk of MI, the specific morbidity profile of MI after transplantation as well as the long-term prognosis after MI in renal transplantation (RT) patients regarding cardiovascular (CV) death and all-cause death. Methods: From a French national medical information database, all of the patients seen in French hospitals in 2013 with at least 5-years follow-up were retrospectively identified and patients without transplantation but with previous dialysis at baseline were excluded. There were 17,526 patients with RT and 3,288,857 with no RT. Results: Among these patients, 1020 in the RT group (5.8%), and 93,320 in the non-RT group (2.8%) suffered acute MI during a median follow-up of 5.4 years. After multivariable adjustment, risk of MI was higher in RT patients than in non-RT patients (HR 1.45, IC 95% 1.35–1.55). The mean age was 59.5 years for transplant patients with MI, and 70.6 years for the reference population with MI (p < 0.0001). MI patients with RT (vs. non RT patients) were more likely to have hypertension, diabetes dyslipidemia, and peripheral artery disease (76.0% vs. 48.1%, 38.7% vs. 25.2%, 33.2% vs. 23.2%, and 31.2% vs. 17.3%, respectively, p < 0.0001). Incidence of non ST-elevation MI (NSTEMI) was higher in RT patients while incidence of ST-elevation MI (STEMI) was higher in patients without RT. In unadjusted analysis, risk of all-cause death and CV death within the first month after MI were higher in patients without RT (18% vs. 11.1% p < 0.0001 and 12.3% vs. 7.8%, p < 0.0001, respectively). However, multivariable analysis indicated that risk of all-cause death was higher in patients with RT than in those with no RT (adjusted HR 1.15 IC 95% 1.03–1.28). Conclusions: MI is not an uncommon complication after RT (incidence of around 5.8% after 5 years). RT is independently associated with a 45% higher risk of MI than in patients without RT, with a predominance of NSTEMI. MI in patients with RT is independently associated with a 15% higher risk of all-cause death than that in patients with MI and no RT.

THEORETICAL BASIS OF INFORMATION AND COMMUNICATION SUPPORT OF HEALTHCARE ACTIVITIES

The article investigates the theoretical essence of information and communication support of health care institutions, analyzes its components such as information and communication. The main approaches to the interpretation of the concept of “information” from the point of view of different branches of science are revealed. The paper identifies that health care facilities are in continuous communicative interaction with the target audience – government agencies, the public, the population, and schematically presents its process. It is determined that the health care sector is characterized by the presence of internal and external information environments, within which internal and external communication links are distinguished and implemented. It is noted that the management of information and communication support of health care institutions provides for the functioning of a single information system of the institution, which is part of the national medical information system. The article analyzes the functional components of information and communication support of medical institutions and presents their brief characteristics. The functional components of the work include: information support, communication, organizational, legal, financial, software, mathematical, technological and documentary support. It was found that the management of information and communication support of the health care institution involves the allocation of two subsystems: information and communication. Management of the information subsystem offers the organization of work from information arrays, management of the communicative system of connection to establishment of communicative communication with target auditors. The article establishes generalized principles of functioning and development of the system of information and communication support of health care institutions. It is determined that the management of health care facilities directly depends on the development and use of modern technologies, which contributes to the improvement of the management process.

Quality indicators for clinical care of patients with hypertension: scoping review protocol

IntroductionCardiovascular diseases impose significant financial impact on countries implementing universal health coverage (UHC). Hypertension is a primary disease that will lead to more severe conditions without adequate clinical care. The...

ЭПИДЕМИОЛОГИЧЕСКИЙ АНАЛИЗ УРОВНЯ РАСПРОСТРАНЁННОСТИ И ЗАБОЛЕВАЕМОСТИ НАСЕЛЕНИЯ ЦЕРЕБРОВАСКУЛЯРНЫМИ БОЛЕЗНЯМИ В КЫРГЫЗСКОЙ РЕСПУБЛИКЕ

Objective: Assessing the dynamics of the long-term trend of prevalence and primary incidence of cerebrovascular diseases (CVD) among different populations of the Kyrgyz Republic (KR). Methods: The main source of information for assessing the incidence of the population of CVD was data from the National Medical Information Center (NMIC) of the Ministry of Healthcare. Retrospective epidemiological study of the prevalence and primary incidence of CVD in the long-term dynamics of 2002-2017 was conducted. Calculated the growth rate (reduction) using the method of the smallest squares to align the dynamic series; a comparative analysis of morbidity rates in groups of age groups and in the context of nine administrative and territorial units of the KR with the calculation of the average multi-year incidence levels (AMIL). Results: In the long-term dynamics (from 2002 to 2017) there is a moderate trend towards an increase in prevalence rates (the rate of growth compared to 2002 was 1.3%) and AMIL 843.9. Among strokes that determine the incidence of CVD, ischemic stroke (60.8%) has the highest proportion. In the long-term dynamics, there is a pronounced tendency to increase unspecified strokes (the growth rate was 10.3%), AMIL incidence – 23.0±2,80/0000. There is a marked upward trend in the incidence of the disease of the studied pathology among children (the rate of increase was 47%). In the 9 administrative territories of the KR there is a fairly strong difference between the AMIL and the CVD among the child population, ranging from 1.00/0000 to 20.90/0000 cases, i.e. territorial differences reach up to 20.9 times; adults and adolescents – from 211.10/0000 to 3127.80/0000 (differences up to 14.8 times). Of the nine administrative territories of the KR, the largest proportion of AMIL morbidity among adults and adolescents is observed in Bishkek, and among children – in the Osh region. AMIL prevalence and primary incidence of strokes in men are statistically, significantly higher than in women. In the long-term dynamics, there is an increase in mortality rates from ischemic strokes with a rate of increase compared to 2002 year – 37.5%, along with a decrease in mortality from hemorrhagic and unspecified strokes. The largest proportion of CVD cases over the past year (2017) is over the age of 70 (32%). Conclusion: The actuality of the problem of CVD in the KR is due to a moderate trend of growth rates of prevalence with the highest proportion of ischemic stroke. The expressed growth trend is caused by unspecified strokes. The largest proportion of AMIL morbidity of adult and adolescent CVD is observed in Bishkek, and among children – in the Osh region. Strokes are more common in males. Keywords: Cerebrovascular diseases, epidemiological analysis, stroke, long-term dynamics.

Évolutions du nombre de tentatives de suicide dans le Nord-PasdeCalais depuis l’implantation de VigilanS : premières estimations

BackgroundThe implementation of a surveillance program after a suicide attempt (SA) is a very innovative step in the evolution of our system of care. It was interesting to know if we observe a decline in suicide attempts in the region, in particular of recurrences of SA. MethodWe measured the evolution of the number of suicide attempts before and after implantation of VigilanS, using two types of analysis: a first from the national medical information systems in Medicine-Surgery-Obstetrics (PMSI-MCO) and a second from the collection of the ER stays for SA in the hospitals involved in the VigilanS program. ResultsIn 2014 (year before start of VigilanS), a total of 10 119 ER stays for SA was observed (5626 women and4463 men); in 2017, the total was 9.230 stays for SA (5047 women and 3 839 men), representing a decrease of 13.5%. The reduction was balanced between men (−14%) and women (−10%). Based on the figures of PMSI, we see an acceleration of the reduction of stay for SA in the Nord-Pas-de-Calais after 2014 (−16% instead of −6%), instead of the two Picardy departments the most comparable which show a degradation of the phenomenon (+13%), and opposed to the Department of the Oise which shows a stable maintenance of the current decline (−12%). ConclusionThese two indicators are imperfect, but evolution over three years since the implementation of VigilanS goes in the same direction. We find a uncoupling of a hospital stay in connection with a SA. The intensity of this decline seems correlated to the penetrance of the program.

PIN32 - What Is The Hospital Economic Burden Of Hiv In France? Results from an analysis of the national french medical information system database

PIN32 - What Is The Hospital Economic Burden Of Hiv In France? Results from an analysis of the national french medical information system database

One year of anaesthesia in France: A comprehensive survey based on the national medical information (PMSI) database. Part 2: Out-hospital patients

IntroductionEpidemiological data on French ambulatory anaesthesias are restricted. The aim of this study was to perform an epidemiological analysis of this activity for the year 2010. MethodsUsing the national database program for medical information systems (the PMSI), we have listed all institutions in France and her overseas territories performing ambulatory anaesthesia. We have assessed the number and nature of anaesthetic procedures, in terms of type of institution, age and surgeries. These results were correlated with French general demographics. ResultsAmbulatory anaesthetic procedures represented 44.4% of all anaesthesias, excluding childbirth, (n=4644,791 ambulatory acts), among which 88% were performed on adults and 12% on minors. The “65–74 years” age group had the highest annual relative rate of ambulatory anaesthesia. Rate of ambulatory anaesthesia was higher in children compared to adults (60% versus 42.8%, respectively). Outpatient surgery was mainly developed in Private Clinics as compared to public institutions. ConclusionAmbulatory anaesthesia has dramatically increased over fourteen years. It represents almost half of all anaesthetic acts, and its development is promising, especially in University Hospitals and adult populations.

One year of anaesthesia in France: A comprehensive survey based on the national medical information (PMSI) database. Part 1: In-hospital patients

Anaesthesia has evolved in France since the last epidemiologic survey in 1996. The national database program for medical information systems (the PMSI) can be used to track specific knowledge concerning anaesthesia for a selected period of time. The goal of this study was to perform a contemporary epidemiological description of anaesthesia in France for the year 2010. MethodsThe data concerning private or public hospital stays were collected from the national PMSI database. All surgical/medical institutions performing anaesthesia in France and French Overseas Departments and Territories were queried concerning the number of anaesthesias, patient age, sex ratios, institution characteristics, hospitalization types, the duration of hospital stays, and the surgical procedures performed. ResultsIn 2010, the number of anaesthesia procedures performed was 11,323,630 during 8,568,630 hospital stays. We found that 9,544,326 (84.3%) anaesthetic procedures were performed in adults (> 18 years of age; excluding childbirth), 845,568 (7.5%) were related to childbirth and 933,736 (8.2%) were acts in children (up to 18 years of age). The mean duration of hospital stay was 5.7±8.2 days. 56.5% of adults and 39.5% of children were managed as inpatient hospital stays. The male/female sex ratio and mean age were 42/58 and 54±19 years, respectively. In adults, anaesthesia was predominantly performed for abdominal surgery (24.5%), orthopaedics (16.7%), gynaecology (10.3%), ophthalmology (9.7%) and vascular surgeries (7.1%). For paediatric populations, the main surgical activities were Ear-Nose-Throat surgery (43.1%), orthopaedic surgery (15.1%) and urological surgeries (12.8%). DiscussionThe number of anaesthesias performed in France has dramatically increased (42.7%) since the last major epidemiological survey. Anaesthesia in the 21th century has been adapted to associated demographic changes: an older population with more comorbidities and fewer in-hospital procedures.

Economic impact of rheumatoid arthritis (RA) biotherapies in France

Objective Determining the economic impact of rheumatoid arthritis (RA) biotherapies in France. Method The number of patients on RA biotherapy in France was estimated from the French national medical information system program (PMSI) database using the 2007 hospital data. The cost of each biotherapy was calculated on a theoretical basis (French national health authority (HAS) recommendations) and on real-life setting, using ‘real-life’ setting data. In order to calculate the economic impact of the biotherapies, the cost of management with each biotherapy was applied to the RA patient population taking into account the market share of each biotherapy. Results The number of patients with RA estimated was 15,873. Management costs ranged from 11,576 to 21,128 € for the theoretical management scenario and from 6,451 to 19,618 € for the real-life scenario. The overall cost was 222 million € (real-life setting). TNF antagonists (adalimumab, etanercept, infliximab) were prescribed for 82% of the patient population and accounted for 80% of the annual overall cost of theoretical management and 84% of the cost of the real-life setting, respectively. Other biotherapies (abatacept, rituximab) were prescribed for 18% of the patients and accounted for 20 and 16% of the annual overall cost of the theoretical setting and real-life setting. Outpatient biotherapy was prescribed for 61% of the patient population and generated 68 and 71% of the total costs. Conclusion The data constitutes an initial inventory of the economic impact of RA biotherapies in France.

Surveying Medical Information Across Europe: The Present and the Future

Managers from 163 European medical information departments in 30 countries completed a web-based 23-question survey. They were asked about demographics (country, company, team size, name, and reporting lines), responsibilities, training needs, and communication channels for requests. The survey included questions on their challenges, successes, and future trends. National medical information departments were compared with regional or global departments. Besides handling product requests, many departments are responsible for standard response production, safety reporting, promotional review, training, and other proactive services. Personnel are generally well trained. Some regional medical information managers identified competency gaps in copyright knowledge and professional skills. Major challenges were managing limited resources, demonstrating value, and supplying copyright-protected material across borders. Business successes included sharing information via regional databases, web-based services, and congress support. They believe the future will bring greater regulation, web technology usage, communication with patients, and organizational changes (enhanced regional or global operations and outsourcing).

Towards a National Patient Card System in Japan

Patient Card Systems (PCS) have been applied on a regional level to improve access to patient information. However, current projects lack a vision of future integration on a national level. In addition, Integrated Circuit cards and optical cards were introduced without considering that their cost and capacity limits impose significant constraints for future integration. The major arguments against PCS are the huge costs incurred by such a system and the limitations of the card capacities. In addition, standards and legislation have not been sufficiently developed. In this study, we propose a new model of PCS that employs recent communication and card technologies as a key to access a national medical information center. We demonstrate that PCS are feasible if implemented in several distinct phases and if the acceptance and cooperation of physicians and patients are achieved. However, political consensus about the necessity of reform in the health care sector must be established so that the necessary legislation can be enacted.

Health Information in the Year 2000 — Towards the Millennium in Inter national Medical Information: The 7th International Congress on Medical Librarianship, Washington DC, 10-12 May 1995

Health Information in the Year 2000 — Towards the Millennium in Inter national Medical Information: The 7th International Congress on Medical Librarianship, Washington DC, 10-12 May 1995

Second Annual National Medical Information Networking Conference

Second Annual National Medical Information Networking Conference