Role Of Patient Characteristics Research Articles

Role of patient characteristics in adherence to first-line treatment guidelines in breast, lung and prostate cancer: insights from the Nordic healthcare system

ObjectivesThis study investigates the influence of socioeconomic status, health literacy, and numeracy on treatment decisions and the occurrence of adverse events in patients with breast, lung, and prostate cancer within...

Role of Patient Characteristics and Insurance Type in Newly Diagnosed Multiple Myeloma Care Disparities.

Little is known about the role of social determinants of health (SDOH) in the utilization of novel treatments among patients with newly diagnosed multiple myeloma (NDMM). This retrospective cohort study used Taussig Cancer Center's Myeloma Patient Registry to identify adults with NDMM between January 1, 2017, and December 31, 2021. Electronic health records data captured treatment with (1) triplet or quadruplet regimen and (2) lenalidomide during the first year after NDMM, and (3) stem-cell transplant (SCT) through December 31, 2022. Multivariable logistic regression models examined associations of demographic/clinical characteristics and SDOH with care patterns. We identified 569 patients with median age at diagnosis of 66 years (IQR, 59-73); 55% were male, 76% White, 23% Black, 1.1% other races, insured by Medicare (51%), private payer (38%), Medicaid (8.3%), and self-pay/other (1.8%). In the multivariable models, self-pay/other payers (adjusted odds ratio [AOR], 0.15 [95% CI, 0.03 to 0.54]) was associated with lower odds of triplet or quadruplet regimen, compared with Medicare. Private insurance (AOR, 0.48 [95% CI, 0.27 to 0.86]) and self-pay/other payers (AOR, 0.16 [95% CI, 0.04 to 0.74]) had lower odds of lenalidomide. Black patients (v White; AOR, 0.47 [95% CI, 0.26 to 0.85]) and patients treated at regional hospitals (v Taussig Cancer Center; AOR, 0.27 [95% CI, 0.12 to 0.57]) had lower odds of SCT. The odds of receiving triplet or quadruplet regimen, lenalidomide, and SCT also varied by the year of NDMM. Care for NDMM varied based on race, insurance type, year of diagnosis, and treatment facility. It may be useful to examine the impact of insurance-related characteristics and recent policy initiatives on care disparities.

Trends in all-cause mortality of hospitalized patients due to SARS-CoV-2 infection from a monocentric cohort in Milan (Lombardy, Italy).

BackgroundRobust data on case fatality rate (CFR) among inpatients with COVID-19 are still lacking, and the role of patient characteristics in in-hospital deaths remains under-investigated. This study quantified the overall CFR and described its trend in a cohort of hospitalized patients with SARS-CoV-2 in Italy. Admission to ICU, death, or discharge were the secondary outcomes.MethodsThis retrospective study is based on administrative health data and electronic case records of inpatients consecutively admitted to Niguarda Hospital between 21 February and 8 November 2020.ResultsAn overall CFR of 18% was observed. CFR was significantly reduced during the second wave of contagion (1 June to 30 September, 16%) compared with the first wave (21 February to 31 May, 21% p = 0.015). Such reduction was mainly observed among male inpatients between 40 and 80 years with limited comorbidities. Admission to ICU was associated with a high risk of mortality in both waves. The incidence of severe disease and the need for ICU admission were lower in the second wave.ConclusionCFR in SARS-CoV-2 inpatients was demonstrated to decrease over time. This reduction may partly reflect the changes in hospital strategy and clinical practice. The reasons for this improvement should be further investigated to plan an exit strategy in case of future outbreaks.Key messages What is already known on this topic Before the advent of anti-COVID-19 vaccines, a multi-wave pattern of contagion was observed, and this trend conditioned the inpatient case fatality rate (CFR), which varied over time accordingly to the waves of contagion.Only preliminary results on the in-hospital mortality trend are available, along with a partial analysis of its determinants. Consequently, robust data on CFR among inpatients with SARS-CoV-2 infection are still lacking, and the role of patient characteristics in in-hospital deaths remains under-investigated. What this study adds This study shows that the in-hospital mortality in patients with SARS-CoV-2 infection decreases over time.Such reduction was mainly observed among male inpatients between 40 and 80 years with limited comorbidities. Admission to ICU was invariably associated with a high risk of mortality during the whole study period (21 February to 8 November 2020), but the incidence of severe disease and the need for ICU admission were lower in the second wave of contagions (1 October to 8 November 2020). This reduction may partly reflect the impact of changes in hospital strategy and clinical practice. The reasons for this improvement should be further investigated to inform the response to future outbreaks and to plan exit strategy by prioritizing high-risk populations.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10389-021-01675-y.

SARS-CoV-2 Outcomes: The Role of Patient Characteristics and Chronic Disease Comorbidities.

Several patient demographics such as race/ethnicity and comorbid chronic conditions are associated with severity of illness among COVID-19 patients. This study examines national data of COVID-19 patients to estimate the likelihood that these characteristics are associated with a hospital admission, admission to an intensive care unit (ICU), and length of hospital stay. Using logistic regressions, the authors found that minority populations (Black, Asian, and Hispanic) were 21% to 35% more likely to be hospitalized than Whites. Moreover, patients with multiple chronic conditions also were more likely to be hospitalized, admitted to the ICU, and had longer lengths of stay. Results highlight the need to target vaccines to the most vulnerable populations during COVID-19 but also for future outbreaks.

Effects of cognitive-behavioral and psychodynamic-interpersonal treatments for eating disorders: a meta-analytic inquiry into the role of patient characteristics and change in eating disorder-specific and general psychopathology in remission

BackgroundCognitive behavior therapy (CBT) and psychodynamic-interpersonal therapies (PIT) are two widely used and conceptually different outpatient treatments for eating disorders (EDs). To better understand how these treatments works, for whom, and under what circumstances, there is a need for knowledge about how outcomes are affected by diagnosis, comorbidity, changes in psychopathology, and study design.MethodReports on the effects of CBT and PIT for eating disorders were searched. Rates of remission and changes in ED specific- and general psychopathology were computed. Regression models were made to predict event rates by changes in specific- and general psychopathology, as well as ED diagnosis and study design.ResultsThe remission rate of CBT for binge eating disorder was 50%, significantly higher than the effect for other diagnostic groups (anorexia = 33%, bulimia: 28%, mixed samples 30%). The number of studies found for PIT was limited. All effect sizes differed from zero (binge eating disorder = 27%, anorexia = 24%, bulimia = 18%, mixed samples = 15%), but the precision of the estimates was low, with some lower-bound confidence intervals close to zero. For CBT, change in ED specific psychopathology predicted remission only when controlling for ED diagnosis, while change in general psychopathology did not predict remission at all. The predictive value of change in psychopathology for PIT, and the potential impact of comorbid personality disorders could not be analyzed due to a lack of studies. There was no difference in effects between randomized controlled trials and observational studies.ConclusionsCBT showed consistent remission rates for all EDs but left a substantial number of patients not in remission. Extant evidence suggest that PIT is not consistently effective in achieving remission for patients with EDs, although this finding is uncertain due to a small number of eligible studies. A group of patients with eating disorders may, however, require therapy aimed at strengthening deficits in self functions not easily ameliorable by cognitive behavioral techniques alone. Further research should be aimed at identifying treatment interventions that helps patients change behavior, while strengthening self-functions to substitute eating-disordered behavior in the long-term.

Prognosis analysis of thick data: Clustering heart diseases risk groups case study

Analyzing clinical data differs from other machine learning data analysis as most of the clinical data are relatively small requiring more qualitative techniques to bring focus to the context and then to predict important indicators like the patient risk in developing heart disease. The strength of qualitative analytics lies in data thickness as they can work on small samples and corpuses (“small data”). However, working with thick data analytics requires involving patient characteristics (e.g. socioeconomic status, family background, working conditions, social support, psycho-social characteristics, lifestyle risk factors, age group, gender and social capital) and their weights in a particular clinical practice. Therefore, the role of patient characteristics is not only a dominant factor in thick data analytics but it is also linked to predicting the prognosis of patient cases. A Fuzzy C-Means algorithm is presented as technique for prognostic predictions to identify risk groups associated with Cardiovascular Disease (CVD) conditions.

Probabilities of ICU admission and hospital discharge according to patient characteristics in the designated COVID-19 hospital of Kuwait

BackgroundSubsequent epidemic waves have already emerged in many countries and in the absence of highly effective preventive and curative options, the role of patient characteristics on the development of outcomes needs to be thoroughly examined, especially in middle-east countries where such epidemiological studies are lacking. There is a huge pressure on the hospital services and in particular, on the Intensive Care Units (ICU). Describing the need for critical care as well as the chance of being discharged from hospital according to patient characteristics, is essential for a more efficient hospital management. The objective of this study is to describe the probabilities of admission to the ICU and the probabilities of hospital discharge among positive COVID-19 patients according to demographics and comorbidities recorded at hospital admission.MethodsA prospective cohort study of all patients with COVID-19 found in the Electronic Medical Records of Jaber Al-Ahmad Al-Sabah Hospital in Kuwait was conducted. The study included 3995 individuals (symptomatic and asymptomatic) of all ages who tested positive from February 24th to May 27th, 2020, out of which 315 were treated in the ICU and 3619 were discharged including those who were transferred to a different healthcare unit without having previously entered the ICU. A competing risk analysis considering two events, namely, ICU admission and hospital discharge using flexible hazard models was performed to describe the association between event-specific probabilities and patient characteristics.ResultsResults showed that being male, increasing age and comorbidities such as chronic kidney disease (CKD), asthma or chronic obstructive pulmonary disease and weakened immune system increased the risk of ICU admission within 10 days of entering the hospital. CKD and weakened immune system decreased the probabilities of discharge in both females and males however, the age-related pattern differed by gender. Diabetes, which was the most prevalent comorbid condition, had only a moderate impact on both probabilities (18% overall) in contrast to CKD which had the largest effect, but presented only in 7% of those admitted to ICU and in 1% of those who got discharged. For instance, within 5 days a 50-year-old male had 19% (95% C.I.: [15,23]) probability of entering the ICU if he had none of these comorbidities, yet this risk jumped to 31% (95% C.I.: [20,46]) if he had also CKD, and to 27% in the presence of asthma/COPD (95% C.I.: [19,36]) or of weakened immune system (95% C.I.: [16,42]).ConclusionsThis study provides useful insight in describing the probabilities of ICU admission and hospital discharge according to age, gender, and comorbidities among confirmed COVID-19 cases in Kuwait. A web-tool is also provided to allow the user to estimate these probabilities for any combination of these covariates. These probabilities enable deeper understanding of the hospital demand according to patient characteristics which is essential to hospital management and useful for developing a vaccination strategy.

Abstract B010: Association of cancer survivors' sociodemographic characteristics with survivorship care patterns

Abstract Cancer survivors may have unique medical care needs due to chronic/late-occurring effects of cancer or cancer treatment. “Shared care,” which involves delivery of components of survivorship care by both oncologists and primary care providers (PCPs), may lead to increased coordination of care and may better address survivors' needs. However, little is known regarding potential disparities in receipt of shared care among cancer survivors. We examined associations between cancer survivors' sociodemographic characteristics and their receipt of shared care. SEER-CAHPS data, linking NCI's Surveillance, Epidemiology, and End Results (SEER) registry data, Medicare claims, and Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey responses, were used. Individuals age >65 years at diagnosis in 2000-2011 SEER-CAHPS with breast, cervical, colorectal, lung, renal, or prostate cancers or hematologic malignancies who responded to a Medicare CAHPS survey >18 months after diagnosis were included. Individuals were classified in four mutually exclusive survivorship care patterns: Shared Care, Oncologist-led, PCP-led, or Other survivorship care, based on the proportions of their oncologist, PCP, and other physician encounters in Medicare claims data. Differences in survivorship care pattern by sex, age, education, race/ethnicity, and dual Medicare-Medicaid status were examined. Among the 10,132 survivors included in the study, 15.1%, 10.0%, 32.7%, and 42.2% received Shared Care, Oncologist-led, PCP-led, and Other care patterns, respectively. Compared with survivors in Shared Care, significantly greater proportions of those in the PCP-led pattern were over age 85 (24% PCP-led vs. 16% Shared Care), female (55% PCP-led vs. 44% Shared Care), and had high school or less educational attainment (52% PCP-led vs. 46% Shared Care). A significantly smaller proportion of survivors in the Oncologist-led pattern were older than age 85 (12% Oncologist-led vs. 16% Shared Care). Significantly more of those in the Other survivorship care pattern compared with Shared Care were older than age 85 (21% Other vs. 16% Shared Care) and non-Hispanic White (87% Other vs. 81% Shared Care), and fewer survivors in the Other care pattern had high school or less educational attainment (42% Other vs. 46% Shared Care). Overall, we found few significant and consistent associations between sociodemographic characteristics and receipt of Shared Care among cancer survivors in the SEER-CAHPS data set. However, these characteristics may influence type of survivorship care pattern received. Further research is needed to examine the role of patient characteristics in receiving different survivorship care patterns. Citation Format: Michael T. Halpern, Julia Cohen, Lisa M. Lines, Michelle A. Mollica, Erin E. Kent. Association of cancer survivors' sociodemographic characteristics with survivorship care patterns [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B010.

The Role of Patient Characteristics in the Success of Nonoperative Treatment of Anterior Cruciate Ligament Injuries

Background: Anterior cruciate ligament (ACL) tears can either be treated nonoperatively with physical therapy and then treated operatively if persistent instability is present, or be directly treated operatively. Advantages of early ACL reconstruction surgery include shorter time from injury to surgery and potentially fewer meniscal injuries, but performing early ACL reconstruction in all patients results in surgery in patients who might not need ACL reconstruction. It is important to assess in which patients nonoperative treatment is successful and which patients will require ACL reconstruction and thus might be better treated surgically in an earlier phase. Purpose: To identify patient characteristics that predict the success of nonoperative treatment. Study Design: Cohort study (Prognosis); Level of evidence, 2. Methods: All patients with complete ACL injuries who were evaluated between 2014 and 2017 at our clinic were included. The minimum follow-up was 2 years. The initial treatment and ultimate ACL reconstruction were reviewed. Univariate analysis was performed using Mann-Whitney U tests and chi-square tests and multivariate analysis using binary logistic regression. Results: A total of 448 patients were included with a median age of 26 years and median Tegner level of 7 and mean Tegner level of 6.4. At initial consultation, 210 patients (47%) were treated nonoperatively with physical therapy and 126 of these patients (60%) ultimately required ACL reconstruction. Nonoperative treatment failed in 88.9% of patients <25 years of age, 56.0% of patients 25 to 40 years, and 32.9% of patients >40 years (P < .001); and 41.9% of patients with Tegner level 3 to 6, and 82.8% of patients with Tegner level 7 to 10. Age <25 years (odds ratio [OR], 7.4; P < .001) and higher Tegner levels (OR, 4.2; P < .001) were predictive of failing nonoperative treatment in multivariate analysis. Patients in the failed nonoperative group had longer time from diagnosis to surgery than the direct reconstruction group (6.2 vs 2.2 months; P < .001), and more frequently had new meniscal injuries (17.4% vs 3.1%; P < .001) at surgery. Conclusion: Nonoperative treatment of ACL injuries failed in 60% of patients and was highly correlated with age and activity level. In patients aged 25 years or younger or participating in higher-impact sports, early ACL reconstruction should be considered to prevent longer delay between injury and surgery, as well as new meniscal injuries.

The Effect of Clinical and Demographic Factors on Quality of Life in End-Stage Renal Disease. A Multicenter Cross-Sectional Study

The aim of this study was to assess the quality of life (QoL) in end-stage renal disease (ESRD) patients undergoing hemodialysis and to examine the clinical and demographic attributes associated with it.This is a multicenter, cross-sectional study, conducted in 2018, in which 367 patients with ESRD undergoing hemodialysis were recruited. Data were collected through a two-part anon-ymous, self-completed questionnaire. The first part contained questions regarding demographic, social, and clinical information, and the Greek version of Missoula–Vitas Quality of Life Index-15 (MVQoL-15) scale was used to assess QoL. Descriptive and inferential statistical methods were applied. All reported p-values were two-tailed, and the statistical significance level was set at 0.05. Of the study participants, 62.1% were male, with a mean age of 61.80 ±15.11. Of the participants, 67.3% were living in urban areas and 59.1% were married. The majority of the Hemodialysis (HD) patients evaluated possessively all the domains of MVQoL except the wellbeing Domain. QoL was found to be influenced, among others, by age (0.001), occupation (0.002), education (0.003), and additional health problems (&lt;0.001). The role of patient characteristics in QoL is an area of interest, and early and proper intervention is important to enhance QoL.

Association of Gender with Survival in Melanoma In Situ of the Head and Neck: A National Database Study.

IntroductionWhile prior studies have addressed the gender-specific survival of malignant melanoma, such investigation is lacking for melanoma in situ (MIS) and for the sun-exposed head and neck areas. Understanding the role of patient characteristics on disease prognosis is essential in determining optimal patient treatment and follow-up. We conducted a retrospective cohort study of patients diagnosed with MIS of the head and neck to assess the association of gender with long-term survival.MethodsFirst primary cases of MIS diagnosed between 1998 and 2015 were extracted from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database. Cox regression analysis adjusting for demographic, tumor, and treatment characteristics was used to evaluate all-cause and cancer-specific mortality risks.ResultsAfter adjusting for demographic, tumor, and treatment data, males demonstrated significantly poorer overall survival (hazard ratio [HR] 1.484; 95% confidence interval [CI] 1.332, 1.653; P<0.001) and cancer-specific survival (HR 1.571; 95% CI 1.056, 2.338; P=0.026) compared to their female counterparts.ConclusionProposed reasons for these findings include gender-based hormonal influence on cancer growth and development, gender-specific health utilization behaviors, and gender-based cosmetic impact of cutaneous malignancies. These findings do have limitations, including its retrospective nature, possible upgrading of MIS diagnoses during the study period, miscoding, and inability to account of lifestyle/modifiable/environmental risk factors. Nevertheless, it suggests a gender-specific survival difference, which may be further investigated and considered as part of clinician awareness, influence patient counseling, and screening for such patients.

Early recovery trajectories after fast-track primary total hip arthroplasty: the role of patient characteristics

Early recovery trajectories after fast-track primary total hip arthroplasty: the role of patient characteristics

Early recovery trajectories after fast-track primary total hip arthroplasty: the role of patient characteristics

Background and purpose — Little is known about heterogeneity in early recovery after primary total hip arthroplasty (THA). Therefore, we characterized subgroups of patients according to their hip function trajectory during the first 6 weeks after THA in a fast-track setting.Patients and methods — 94 patients (median age 65 years [41–82], 56 women) from a single hospital participated in a diary study. Patients recorded their severity of hip problems (Oxford Hip Score, OHS) weekly for 6 weeks after THA. Latent class growth modelling (LCGM) was used to identify patients with the same hip function trajectory and to compare these subgroups on patient characteristics.Results — LCGM revealed a fast (n = 17), an average (n = 53), and a slow (n = 24) recovery subgroup. Subgroups differed on the estimated weekly growth rate during the first 2 weeks (fast: 9.5; average: 5.3; slow: 2.7), with fewer differences between groups in the last 4 weeks (fast: 0.90; average: 2.0; slow: 1.7). Patients in the slow recovery group could be characterized as women of older age (mean age =69) who rated their health as lower preoperatively, needed more assistance during recovery, and were less satisfied with the outcomes of the surgery.Interpretation — We identified distinct recovery trajectories in the first 6 weeks after fast-track primary THA which were associated with patient characteristics.

The Role of Patient Characteristics in the Concordance of Daily and Retrospective Reports of PTSD

Research has documented discrepancies between daily and retrospective reports of psychological symptoms in a variety of conditions. A limited number of studies have assessed these discrepancies in samples of individuals with posttraumatic stress disorder (PTSD), with even less research addressing potential covariates that may influence such discrepancies. In the current study, 65 individuals with co-occurring PTSD and alcohol use disorder (AUD) completed daily assessments of their PTSD symptoms for 1 month, followed by a standard retrospective report of PTSD over the same month. Initial analyses explored the mean levels of daily and retrospective PTSD symptoms, while multilevel models assessed the level of agreement between daily and retrospective reports and the role of demographic variables and comorbid psychopathology (e.g., depression) or substance use (e.g., alcohol use) in moderating the association of daily and retrospective reports. Results showed that retrospective reports of arousal and avoidance symptoms were weakly related to daily reports of these symptoms, while reports of reexperiencing and numbing symptoms showed better agreement. Intra-individual alcohol consumption also moderated associations of reexperiencing and avoidance symptoms, such that on days individuals drank more, their daily reports resembled their retrospective reports less well. Future research should explore the degree to which these results generalize to nondually diagnosed samples, as well as the role such reporting discrepancies may play in PTSD treatment.

The Role of Patient Characteristics on the Choice of Unicompartmental versus Total Knee Arthroplasty in Patients With Medial Osteoarthritis

BackgroundMedial unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) are both viable treatment options for medial osteoarthritis (OA). However, it remains unclear when to choose for which arthroplasty treatment. Goals of this study were therefore to (1) compare outcomes after both treatments and (2) assess which treatment has superior outcomes in different patient subgroups. MethodsIn this retrospective cohort study, 166 patients received the RESTORIS MCK Medial UKA and 63 patients the Vanguard TKA and were radiographically matched on isolated medial OA. Western Ontario and McMaster Universities Arthritis Index scores were collected preoperatively and postoperatively (mean: 3.0 years, range: 2.0-5.0 years). ResultsPreoperatively, no differences were observed, but medial UKA patients reported better functional outcomes than TKA (89.7 ± 13.6 vs 81.2 ± 18.0, P = .001) at follow-up.Better functional outcomes were noted after medial UKA in patients younger than age 70 years (89.5 ± 14.2 vs 78.6 ± 20.0, P = .001), with body mass index below 30 (90.3 ± 11.4 vs 83.6 ± 14.9, P = .005), with body mass index above 30 (88.3 ± 17.5 vs 78.8 ± 21.0, P = .034) and in females (90.6 ± 11.0 vs 78.1 ± 19.4, P = .001) when compared with TKA. No differences were found in males and older patients between both arthroplasties. ConclusionSuperior functional outcomes were noted after medial UKA over TKA in patients presenting with medial OA with these prostheses. Subgroup analyses suggest that medial UKA is the preferred treatment in younger patients and females while no differences were noted in older patients and males after medial UKA and TKA. This might help the orthopedic surgeon in individualizing arthroplasty treatment for patients with medial OA.

Ward Climate Within a High Secure Forensic Psychiatric Hospital: Perceptions of Patients and Nursing Staff and the Role of Patient Characteristics

Within this study the relationship between patient characteristics (age, length of stay, risk, psychopathy) and individual perceived ward climate (n=83), and differences between staff's and patient perceptions of climate (n=185) was investigated within a high secure forensic hospital. Results show that therapeutic hold was rated higher among staff compared to patients, while patients held a more favorable view on patient cohesion and experienced safety. Furthermore, patient characteristics (age, risk and psychopathy) were found to be related with individual ratings of ward climate. The findings underline the importance of assessing ward climate among both patients and staff in clinical practice.

In-hospital fatality following hip fracture care in Portugal: understand the role of patient characteristics and compare providers

Background The increase number of elderly is aggravating the demand on health systems caused by hip fractures treatment. Fatality can be used an indicator for quality of treatment. The aims are: assessing determinants of death during hospitalization for hip fracture and compare providers. Methods We used a multilevel (patient/hospital/area) Bayesian approach. The outcome measure was in-hospital fatality; patient level factors were collected from the National …

Global differences in dialysis modality mix: the role of patient characteristics, macroeconomics and renal service indicators

An increase in the dialysis programme expenditure is expected in most countries given the continued rise in the number of people with end-stage renal disease (ESRD) globally. Since chronic peritoneal dialysis (PD) therapy is relatively less expensive compared with haemodialysis (HD) and because there is no survival difference between PD and HD, identifying factors associated with PD use is important. Incidence counts for the years 2003-05 were available from 36 countries worldwide. We studied associations of population characteristics, macroeconomic factors and renal service indicators with the percentage of patients on PD at Day 91 after starting dialysis. With linear regression models, we obtained relative risks (RRs) with 95% confidence intervals (CIs). The median percentage of incident patients on PD was 12% (interquartile range: 7-26%). Determinants independently associated with lower percentages of patients on PD were as follows: patients with diabetic kidney disease (per 5% increase) (RR 0.93; 95% CI 0.89-0.97), health expenditure as % gross domestic product (per 1% increase) (RR 0.93; 95% CI 0.87-0.98), private-for-profit share of HD facilities (per 1% increase) (RR 0.996; 95% CI 0.99-1.00; P = 0.04), costs of PD consumables relative to staffing (per 0.1 increase) (RR 0.97; 95% CI 0.95-0.99). The factors associated with a lower percentage of patients on PD include higher diabetes prevalence, higher healthcare expenditures, larger share of private-for-profit centres and higher costs of PD consumables relative to staffing. Whether dialysis modality mix can be influenced by changing healthcare organization and funding requires additional studies.

Hiv-1 Control after Transient Antiretroviral Treatment Initiated in Primary Infection: Role of Patient Characteristics and Effect of Therapy

The occurrence of viral control after interruption of an antiretroviral treatment (ART) initiated during primary HIV-1 infection (PHI) is rare and the frequency and predictive factors of such a control are unknown. Within the French ANRS PRIMO Cohort, 164 patients interrupted ART initiated during PHI. We compared patients whose viral load (VL) remained undetectable (<50 copies/ml) or low (50-500 copies/ml) 1 year after ART interruption to those who evidenced a rapid viral rebound. After ART interruption, VL remained undetectable for a median time of 4.5 years in 14 patients ('post-ART controllers') and low in another 14 patients for a median time of 1.5 years. Post-ART controllers also maintained higher CD4(+) T-cell counts compared to other patients. Female gender, a high CD4(+) T-cell count and low VL during PHI, and a high CD4(+) T-cell count and low HIV DNA levels at interruption, were associated with post-ART HIV control. Treatment characteristics did not differ between controllers and non-controllers. Post-ART controllers had lower specific CD8(+) T-cell frequencies and CD8(+) T-cell activation on ART and after ART interruption than non-controllers. Few patients maintain very low VL after interruption of treatment initiated during PHI. Early patient characteristics were the main factors of viral control, although early initiation of ART and the effect of ART on reservoir might contribute to control.

The cognitive impact of antiepileptic drugs

Effective treatment of epilepsy depends on medication compliance across a lifetime, and studies indicate that drug tolerability is a significant limiting factor in medication maintenance. Available antiepileptic drugs (AEDs) have the potential to exert detrimental effects on cognitive function and therefore compromise patient wellbeing. On the other hand, some agents may serve to enhance cognitive function. In this review paper, we highlight the range of effects on cognition linked to a variety of newer and older AEDs, encompassing key alterations in both specific executive abilities and broader neuropsychological functions. Importantly, the data reviewed suggest that the effects exerted by an AED could vary depending on both patient characteristics and drug-related variables. However, there are considerable difficulties in evaluating the available evidence. Many studies have failed to investigate the influence of patient and treatment variables on cognitive functioning. Other difficulties include variation across studies in relation to design, treatment group and assessment tools, poor reporting of methodology and poor specification of the cognitive abilities assessed. Focused and rigorous experimental designs including a range of cognitive measures assessing more precisely defined abilities are needed to fill the gaps in our knowledge and follow up reported patterns in the literature. Longitudinal studies are needed to improve our understanding of the influence of factors such as age, tolerance and the stability of cognitive effects. Future trials comparing the effects of commonly prescribed agents across patient subgroups will offer critical insight into the role of patient characteristics in determining the cognitive impact of particular AEDs.