Use Of Retrospective Data Research Articles

Suicidal Ideation and Behaviors Among Irish Travellers Presenting for Emergency Care.

Background: Suicide is a serious problem in the Traveller community, with rates estimated at 11%: over 6 times that of the general population. Aims: We aimed to establish the prevalence and correlates of suicidal ideation (SI) and self-harm (SH) among Irish Travellers. Method: This was an observational cross-sectional cohort study of patients presenting with SH and SI to a tertiary hospital in Ireland, in an area with a large local Traveller population. Data were analyzed from the anonymized database (n=2,016), comparing characteristics of Travellers and the general population. Results: This study found that Travellers (1.6% of the local population) represent 4.3% of the population seen in hospital with SH and SI, and 14.8% of episodes. There was a significant difference in SH methods used: Travellers were significantly more likely to present following attempted hanging (OR = 21.8; p = .004). Travellers were more commonly diagnosed with depression or substance abuse, referred from critical care, and transferred for inpatient psychiatric treatment. Limitations: Limitations include the use of retrospective data from a service activity database rather than clinical information collected prospectively. Conclusion: There are significant differences in patterns of suicidal behaviors between Irish Travellers and the general population. Further research is required to understand and address the high rates of suicidal behaviors in this population.

Assessing the Progression of Alzheimer’s Disease in Real-World Settings in Three European Countries

Background:There exists considerable variation in disease progression rates among patients with Alzheimer’s disease (AD).Objective:The primary objective of this observational study is to assess the progression of AD by characterizing cognitive, functional, and behavioral changes during the follow-up period between 6 and 24 months.Methods:A longitudinal prospective study with community-dwelling patients with an established clinical diagnosis of AD of mild to moderate severity was conducted in Germany, Spain and the UK. A sample of 616 patients from 69 sites was included.Results:Patients had a mean of 1.9 years (SD = 1.9) since AD diagnosis at study inclusion. Cognitive symptoms were reported to have first occurred a mean of 1.1 years (SD = 1.7) prior to AD diagnosis and 1.4 (SD = 1.8) years prior to AD treatment. Patients initially diagnosed with mild and moderate AD spent a median (95%CI) of 3.7 (2.8; 4.4) and 11.1 (6.1, ‘not reached’) years until progression to moderate and severe AD, respectively, according to the Mini-Mental State Examination (MMSE) scores. A mixed model developed for cognitive, functional, and neuropsychiatric scores, obtained from study patients at baseline and during follow-up period, showed progressive deterioration of AD patients over time.Conclusion:The study showed a deterioration of cognitive, functional, and neuropsychiatric functions during the follow-up period. Cognitive deterioration was slightly faster in patients with moderate AD compared to mild AD. The duration of moderate AD can be overestimated due to the use of retrospective data, lack of availability of MMSE scores in clinical charts and exclusion of patients at time of institutionalization.

The Prognostic Significance of the Neutrophil-to-Lymphocyte Ratio in Patients with Multiple Myeloma: A Pilot Study

Objective: The neutrophil-to-lymphocyte ratio(NLR) is a biomarker for systematic inflammation. It is also thought that the NLR can be used as a new biomarker by clinicians in predicting the prognosis of patients with multiple myeloma(MM). This study, aimed to retrospectively investigate the prognostic significance of pretreatment NLR in patients with MM, based on the hypothesis that elevated pretreatment NLR is a biomarker indicating worse survival in patients with MM. Materials and Methods: Patients aged >18 years with MM diagnosed, follow-up, and treated between January 2011 and December 2017 in the department of internal and geriatric medicine at Istanbul Faculty of Medicine were enrolled into this study. We retrospectively collected the data of 40 patients from the medical records. The relationship between NLR and baseline characteristics, laboratory parameters, prognosis, and survival outcome was analyzed. Results: The study showed that the mean NLR was 2.84±2.62 (0.1-14.8) in the whole blood count. No significant correlation was found between NLR and mortality (p=0.965). A significant relationship was found between higher stage and mortality (p=0.035). In addition, anemia, low albumin level, and elevated lactate dehydrogenas (LDH) level indicated poor survival time in patients with MM (p=0.022; p=0.031; p=0.023). Conclusion: Our study showed no relationship between NLR and both mortality and overall survival (OS). The above result can be explained by the fact that our study had some limitations such as the use of retrospective data from a single-center and the small sample size.

How Parental Love Received in Childhood Affects Consumers’ Future Financial Discipline

The quantity and quality of nurturance that a child receives from her parents has a significant effect on the child’s future psychological health. However, it is unclear whether early nurturance similarly impacts future financial well-being—an issue of growing global importance. This article examines the effects of “parental love” on the future financial well-being of children, using measures of financial discipline and income. We analyze longitudinal data involving 1,428 children through the National Longitudinal Survey of Children and Youth and document that the children in our sample who received higher levels of parental love during childhood are subsequently financially more disciplined and report earning higher incomes. Furthermore, we find that this association between early parental love and future financial well-being is mediated by the child’s emotional quotient. These findings are robust to the use of retrospective data from 398 consumers in the United States.

Agreement between current status and retrospective data for prevalence and duration of exclusive breast feeding from low- and middle-income countries surveys.

Indicators to assess exclusive breast feeding (EBF) status are based on current status data according to World Health Organization (WHO), specially to avoid recall bias or imprecise reporting. To analyse the agreement between current status and retrospective data for prevalence and duration of EBF in low- and middle-income countries. Cross-sectional study using Demographic and Health Surveys (DHS) datasets of infants under six months from 10 low- and middle-income countries. It was applied two kinds of data about EBF: (1) current status data: variables about breast milk and foods offered in the previous day (yes or no) and (2) retrospective data: variables about age at which foods were offered the first time. The prevalence of EBF was estimated the same way for current status and for retrospective data. The median duration for current status data was calculated according to WHO recommendation, and retrospective data were calculated using survival analysis. The Kappa coefficient was applied to assess the agreement of prevalence using both kinds of data. Prevalence of EBF was higher using current status data and differences between both data ranged from 0.5 to 6.4 percentage points. Kappa coefficient ranged from 0.74 (substantial) to 0.94 (almost perfect) in nine countries. Medians were higher using retrospective than current status data for two countries and lower for another two; however, differences were small (from 0.08 to 0.44month). For six countries, breast-feeding practice was so low that it was not possible to calculate the median using either data. The difference between prevalence and median estimated using current status and retrospective data is little and the agreement ranged to substantial and almost perfect. We suggest the use of retrospective data to estimate duration of EBF in cross-sectional surveys.

(116) Pain Assessment in the Pediatric Intensive Care Unit: FLACC in Action

Pain assessment in the pediatric intensive care unit (PICU) is complex, as the patient population is diverse in age, cognitive development, and acuity. Appropriate use of pain assessment instruments is vital for clinicians to identify patients experiencing pain and to evaluate the effectiveness of interventions provided. The Face, Legs, Activity, Cry, and Consolability (FLACC) pain scale is commonly used in North American PICUs to assess pain in patients who are unable to provide self-report. However, clinical application of the FLACC has not been studied in this setting. The purpose of this study was to examine use of the FLACC in a cohort of PICU patients. Data was extracted from electronic health records between September 1, 2013 and August 31, 2014. In that time, nurses assessed 708 patients 7,972 times using the FLACC scale. Assessments were complete (a value entered for all five components) for 2,703 (34%) of the assessments in 540 (76%) children. The Cry component was most often missing (3,456 assessments, 43%), followed by Legs (2,714 assessments, 34%) and Activity (2,703 assessments, 34%). Of the completed scores (range 0-10), a total score of 0 was most frequent (1,413 assessments, 52%), followed by scores of 5 (581 assessments, 21%) and 10 (167 assessments, 6%). All components had similar mean scores. A high proportion of incomplete components and patterns in scoring (all 0, all 1, all 2) brings to question the clinical utility of the FLACC in PICU. However, the use of retrospective data limits our ability to interpret findings. Nurses may use FLACC to guide pain assessment, but fail to complete documentation, or they may be systematically avoiding completion of components that cannot be assessed in some patients. More research is needed to determine how PICU nurses score and use FLACC scores to inform pain management.

The Impact of Senior Early Assessment Model of Care on The Emergency Department’s Improvement Index in a General Teaching Hospital in Southern Iran

Background: Emergency departments (EDs) play a crucial role in healthcare systems that are currently inflicted by countless problems. A high level of mismatch between supply and demand in EDs entail crowding and weak performance. Objectives: To compare the senior early assessment model of care in the ED of main referral medical center in southern Iran. Methods: The present study evaluated ED performance measures over a six month period prior to (Sep. 2013 - Feb. 2014) and following (Sep. 2014 - Feb. 2015) the development of the senior early assessment model of care, through the use of retrospective data. All admission records were collected and calculated via Iranian national ED performance measures and further analyzed (α = 0.05). Results: A total of 48 194 patients were visited over a six month period prior to the senior early assessment model of care; in addition, 49,133 patients were analyzed during a six month period after. The percentage of patients disposed within six hours was different before and after the intervention (79.48% vs. 88.05%, P = 0.025). Although the percentage of discharge with personal responsibility and the mean ± SD of duration of triage time were reduced, no statistical significant changes were observed before and after the intervention (P = 0.127, P = 0.132). Moreover, the percentage of unsuccessful CPR was increased, however, it was not significant (P = 0.347). Conclusions: It seems that applying new models of care, such as senior early assessment, can solve ED overcrowding. In the present research, the patients’ disposition within six hours was reduced. On the other hand, no recognizable difference was found as far as reducing unsuccessful CPR, duration of triage time, and discharge with personal responsibility. It is recommended that future studies assess the efficacy of models of care.

The association between bullying victimization in childhood and fibromyalgia. Data from the nationwide Finnish health and social support (HeSSup) study based on a sample of 64,797 individuals

BackgroundFibromyalgia is a functional pain syndrome presenting with various psychological symptoms. Several studies have shown that adverse life events are associated with fibromyalgia. The aim of the current study is to explore the association between self-reported bullying victimization in childhood and self-reported fibromyalgia in adulthood. MethodsThe basic study setting is cross-sectional - with focused use of retrospective data - derived from a large on-going postal follow up survey (sample N = 64,797) initiated in Finland in 1998. Only respondents having answered the questions on fibromyalgia in both follow ups in 2003 and 2012 were included (N = 11,924). Severity of bullying was divided into three groups starting from no bullying followed by minor and severe bullying. Covariates having shown statistically significant associations with fibromyalgia in cross tabulation using Pearson's chi-squared test were included in the final multiple logistic regression analyses. ResultsIn our study, 50.6% of the respondents reported victimization of minor and 19.6% of severe bullying in childhood. Participants reporting fibromyalgia in adulthood reported more bullying, and in females alone this association was statistically significant (p = .027). In multiple logistic regression analysis statistically significant associations between bullying victimization in childhood (reference: no bullying) and fibromyalgia were found: adjusted odds ratio (OR) for minor bullying was 1.35 (95% CI 1.09–1.67) and for severe bullying 1.58 (95% CI 1.21–2.06). However, in log-linear and logistic regression interaction models the association between bullying and fibromyalgia was not statistically significant when depression was included in the models. ConclusionsOur results suggest that peer bullying victimization might be associated with fibromyalgia. However, in logistic log linear and logistic interaction models there was no statistically significant association when depression was included. As a result, there is need for further, preferably prospective cohort studies. The findings also emphasize the importance of actions to prevent childhood bullying.

Hypoglossal schwannomas: A systematic review of the literature

BackgroundSchwannomas of the hypoglossal nerve are rare and account for a very small percentage of non-vestibular schwannomas. ObjectivesIn this systematic review of the literature, we examined the epidemiology, symptomatology, management, and outcomes of patients with hypoglossal schwannomas. MethodsThe electronic database Pubmed was searched for all reports of hypoglossal schwannomas with descriptions of symptoms, management, and outcome characteristics. Data was extracted from each study and compiled in a spreadsheet. Continuous variables were reported as means and medians. Categorical variables were reported as proportions. Additional analysis was not done due to inconsistent reporting of outcomes and small sample sizes. ResultsA total of 59 studies (94 total individual cases) were included. 64% of patients were female with mean age of 44.6 years. The majority were intracranial/extracranial (50%). The most common symptoms were tongue deviation or speech disturbance (38%) and headaches (33%). Hypoglossal nerve dysfunction was present in 80% of patients. Surgical excision was performed in 93%, with a 15% complication rate. Evidence of residual mass after surgery was noted in 29%. Permanent hypoglossal nerve deficits occurred in 67%. Recurrence of tumor burden was reported in 6 studies, with median time to recurrence of 16.5 months. ConclusionCurrent evidence suggests overall favorable outcomes with surgical resection of hypoglossal schwannomas, with a large percentage of patients experiencing mild and usually well-tolerated neurologic deficit. Limitations of this study include the use of retrospective data taken from case reports/series with highly selected patients, selective reporting, and absence of control groups.

Determination of Examination-Specific Diagnostic Reference Level in Computed Tomography by A New Quality Control-Based Dose Survey Method.

A new "quality-control-based (QC-based) dose survey method" has been developed for determination of diagnostic reference levels (DRL) in Computed Tomography (CT) examinations. The "QC-based dose survey method" is based on the use of retrospective data in the QC documents and reports, which are typically available from the National Regulatory Authority database. The method was applied to 70 CT scanners in Tehran, Iran, by using the available QC reports from the database. The commonly used "data collection method" was also applied by filling each questionnaire on-site to validate the new method. Using the new QC-based and data collection methods, the DRLs of four common CT examinations: head, sinus, chest, and abdomen/pelvis were determined and compared. The DRLs determined by the "QC-based method" for head, sinus, chest, and abdomen/pelvis are 59, 29, 10, and 13 mGy, respectively, for the volume computed tomography dose index (CTDIVol) and 834, 235, 233, and 522 mGy-cm for the dose length product (DLP), respectively. The difference between the DRLs obtained by the two methods is on the average 6.7 ± 5.7%, which is within the acceptance tolerance level of the IAEA for QC dosimetry tests. The "QC-based dose survey method" is believed to be an effective alternative method to the other commonly used "data collection" and "direct dose measurement method" for determination of CT examination DRLs. This new method has unique characteristics such as simplicity, time and cost effectiveness, highly reduced clinical interruptions and collaborations, and potential for large-scale surveys with capability for more frequent review of national DRL values.

Healthcare resource utilization among patients with relapsed multiple myeloma in the UK, France, and Italy

Aims: To assess the real-world healthcare resource utilization (HRU) and costs associated with different treatment regimens used in the management of patients with relapsed multiple myeloma in the UK, France, and Italy.Methods: Retrospective medical chart review of characteristics, time to progression, level of response, HRU during treatment, and adverse events (AEs). Data collection started on June 1, 2015 and was completed on July 15, 2015. In the 3 months before record abstraction, eligible patients had either disease progression after receiving one of their country’s most commonly prescribed regimens or had received the best supportive care and died. Costs were calculated based on HRU and country-specific diagnosis-related group and/or unit reference costs, amongst other standard resources.Results: Physicians provided data for 1,282 patients (387 in the UK, 502 in France, 393 in Italy) who met the inclusion criteria. Mean [median] total healthcare costs associated with a single line of treatment were €51,717 [35,951] in the UK, €37,009 [32,538] for France, and €34,496 [42,342] for Italy, driven largely by anti-myeloma medications costs (contributing 95.0%, 90.0%, and 94.2% of total cost, respectively). During active treatment, the highest costs were associated with lenalidomide- and pomalidomide-based regimens. Mean cost per month was lowest for patients achieving a very good partial response or better. Unscheduled events (i.e. not considered part of routine management, whether or not related to multiple myeloma, such as unscheduled hospitalization, AEs, fractures) accounted for 1–9% of total costs and were highest for bendamustine.Limitations: The use of retrospective data means that clinical practice (e.g. use of medical procedures, evaluation of treatment response) is not standardized across participating countries/centers, and some data (e.g. low-grade AEs) may be incomplete or differently adjudicated/reported. The centers involved may not be fully representative of national practice.Conclusions: Drug costs are the main contributor to total HRU costs associated with multiple myeloma. The duration of active treatment may influence the average total costs, as well as response, associated with a single line of therapy. Improved treatment outcomes, and reductions in unscheduled events and concomitant medication use may, therefore, reduce the overall HRU and related costs of care in multiple myeloma.

Treatment of gastrointestinal stromal tumours in paediatric and young adult patients with sunitinib: a multicentre case series

BackgroundGastrointestinal stromal tumours (GIST) are rarely encountered mesenchymal tumours of the gastrointestinal tract (1.5 people per 100,000/year) that are even more rarely seen in paediatric patients (1–2% of all cases). The standard treatment for advanced adult GIST is imatinib with sunitinib as a second-line option. Although the efficacy and tolerability of sunitinib in adults with GIST has been established, little is known of the profile of sunitinib in paediatric/young adult patients with GIST given the rarity of this disease.MethodsPaediatric/young adult patients aged up to 21 years with diagnosis of GIST who were treated with sunitinib were identified from retrospective records from three centres in Europe and the US. Most patients commenced sunitinib in a 6-week cycle, however, dosing could be reduced, delayed, changed to (or initiated with) a continuous schedule. Objective response (Response Evaluation Criteria In Solid Tumours [RECIST]) and adverse events were recorded.ResultsWe identified 9 paediatric/young adult patients (aged 11–21 years) with GIST who were treated with sunitinib de novo (n = 1) or following failure of imatinib (n = 8). Progressive disease was previously documented for all patients including 7 patients during imatinib therapy. Baseline patient and tumour profile characteristics showed a distinct profile (notably all were wild-type KIT/PDGFR) compared to that established for adults. Sunitinib treatment was associated with a best response of stable disease for 7 patients, with disease stabilisation lasting from 1 month to >73 months and a median progression free survival time of 15 months. There was some evidence of better disease control for sunitinib when compared to prior imatinib. Most adverse events with sunitinib were manageable and all were consistent with the known profile of the agent.ConclusionThe ability to draw firm conclusions from this case series is limited by the small number of patients and the use of retrospective data which is largely reflective of the rarity of this condition. However, our findings provide initial evidence of clinical benefit and a generally manageable toxicity profile for sunitinib when administered to paediatric/young adult patients with GIST, most of whom had documented progressive disease during prior imatinib treatment.

Making sense of organizational change: Is hindsight really 20/20?

SummaryThis qualitative study explores the conceptual links between 2 different approaches to managerial cognition, sensemaking and cognitive bias, in the context of organizational change. A longitudinal case study utilizing both real‐time assessments and retrospective sensemaking data from interviews with 26 hospital employees at 3 points in time was undertaken. Patterns related to individuals' retrospective accounts and real‐time assessments were identified and used to construct 4 prototypical narratives. Data analysis revealed that organizational change was not a markedly negative experience for most informants, which is contrary to the prevailing theme in the literature. This and other findings are discussed in terms of sensemaking and cognitive bias. This study makes 2 contributions to our understanding of how individual's experience and make sense of organizational change over time as (a) little is known about how the process of change unfolds over time at the individual level and (b) extant research has not investigated the extent to which individuals' retrospective sensemaking about organizational change reflects or diverges from their real‐time assessments over the course of the change. More broadly, the study provides insights and focused advice for management researchers regarding the use of retrospective data to understand individuals' perceptions of situations that have already occurred.

Developing an Ethical and Legal Interoperability Assessment Process for Retrospective Studies.

The past decade has witnessed the creation of major international research consortia, aiming to facilitate the sharing of data from different studies to maximize health benefits. However, combining heterogeneous data across existing studies requires addressing issues related to both data harmonization and ethical and legal interoperability. This article proposes a rigorous interoperability assessment process to assess whether different data sets are sufficiently ethically and legally interoperable to allow for a given proposed research use. The methodology used to develop this process is based on a comprehensive analysis of the international ethical and legal framework governing the use of retrospective data in research, and includes the following steps: (I) finding existing processes; (II) comparing processes to identify similarities and differences and determining the limits of the "consistent whole"; (III) establishing common principles and procedures; and, (IV) changing or removing processes that do not contribute to the consistent whole. Each of these four steps were examined using step-specific methodologies, including (a) literature and policy reviews; (b) consultations with international ethical, legal and social implications (ELSI) experts; and (c) a case study piloting the proposed framework in an actual international research consortium. This assessment process takes into account key legal and ethical components such as consent, recontact, and waiver of consent. As a result, this analysis allows the development of a comprehensive filter used to verify the legal and ethical restrictions pertaining to a data set. This in turns helps in determining whether the given data set can to be used for a proposed research project, or is ethically and legally interoperable for use in research collaborations. By integrating this filter to the regular data access processes used by cohorts, not only will researchers be able to create virtual "mega-cohorts" of research participants, but it will also ensure that these cohorts respect basic legal and ethical precepts.

Incentive Domestic Gas Price Regulation in Russia: Comparative Analysis of Alternative “Price Cap” Indicators

Introduction of the price regulatory mechanism based on the principle of equal profitability of domestic and export gas sales is announced in Russia. In this article the “price cap” mechanism is considered as a form of incentive regulation; the experience of using the external market price as an indicator of the “fair” price level in antitrust enforcement is presented. Analyzing the existing wholesale gas price formation mechanisms around the world we identify alternative indicators of the external market price for gas and compare levels and volatilities of the “base” internal gas prices calculated on their basis with the use of retrospective data.

Pain prevalence and its determinants after spinal cord injury: a systematic review.

Pain prevalence studies are important as they illustrate the magnitude of pain problems in a certain patient population, such as patients living with a spinal cord injury (SCI). Strikingly, reported pain prevalence rates in SCI patients are found to vary greatly, while determinants for the differences between pain prevalence reports remain unclear. We here aim to identify determinants for the differences (heterogeneity) in pain prevalence reports through a systematic review of all SCI pain prevalence reporting studies. Literature search was done using Medline, Cumulative Index to Nursing and Allied Health Literature, ISI Web of Knowledge and Embase. Data abstraction was performed while blinded and was followed by meta-(regression)-analyses. We identified 82 studies. Study design-related determinants of SCI pain prevalence reports were pain definition strictness (mild, moderate or high), primary study goal (pain study or not), data source (retrospective or not), and in a limited number of cases response/attrition rates. While correcting for these items, population characteristics correlating with pain prevalence rates were both proportion of patients with a depression and average time after injury (positive correlations). Between-study heterogeneity may remain even after the identification/correction of above-mentioned causes of heterogeneity.Pain after SCI does seem to relate to the duration of the injury and depression, yet major causes of bias in reported pain prevalence are found to be related to the primary study goal (pain study or not), choice of pain definition and the use of retrospective data.

Intervention for optimal outcome in children and adolescents with a history of autism.

Autism spectrum disorders (ASDs) were once considered lifelong disorders, but recent findings indicate that some children with ASDs no longer meet diagnostic criteria for any ASD and reach normal cognitive function. These children are considered to have achieved "optimal outcomes" (OO). The present study aimed to retrospectively examine group differences in the intervention history of children and adolescents with OO and those with high-functioning autism (HFA). The current study examined intervention histories in 25 individuals with OO and 34 individuals with HFA (current age, 8-21 years), who did not differ on age, sex, nonverbal intelligence, or family income. Intervention history was collected through detailed parent questionnaires. Children in the OO group had earlier parental concern, received earlier referrals to specialists, and had earlier and more intensive intervention than those in the HFA group. Substantially more children with OO than HFA received applied behavior analysis (ABA) therapy, although for children who received ABA, the intensity did not differ between the groups. Children in the HFA group were more likely to have received medication, especially antipsychotics and antidepressants. There were no group differences in the percent of children receiving special diets or supplements. These data suggest that OO individuals generally receive earlier, more intense interventions, and more ABA, whereas HFA individuals receive more pharmacologic treatments. Although the use of retrospective data is a clear limitation to the current study, the substantial differences in the reported provision of early intervention, and ABA in particular, is highly suggestive and should be replicated in prospective studies.

Clinical correlates of perinatal bipolar disorder in an interdisciplinary obstetrical hospital setting

BackgroundPregnancy and the postpartum period can be destabilizing for women with bipolar disorder (BD), and treatment decisions particularly complex. Yet, to date, relatively little research has focused on perinatal BD. MethodFollowing IRB approval, trained raters reviewed clinical records of 334 women who had sought treatment at a specialized partial hospitalization program serving perinatal women, including demographic, clinical, and treatment history information as noted in each patient׳s chart by treating providers. ResultsSlightly over 10% of the perinatal sample was diagnosed with Bipolar I, Bipolar II, or Bipolar NOS Disorder. In addition, 26% of the sample, regardless of diagnostic status, reported recent, abnormally elevated mood persisting 4 or more days. Compared to women with other Axis I disorders, women with a BD diagnosis were more likely to report a substance abuse history, prior suicide attempts, and more extensive psychiatric histories, including greater use of pharmacotherapy. Pregnant women with BD were more likely to take psychotropic medications prenatally, and postpartum women with BD reported higher rates of birth complications and difficulty breastfeeding. LimitationsThis research is limited by use of retrospective data, and utilization of self-report and clinician diagnosis, rather than structured interviews. ConclusionEven in the context of a partial hospital sample with high levels of symptoms and impairment, the clinical features of perinatal women with BD stand out as markedly more severe in comparison to those of women seeking care for other perinatal psychiatric conditions. Risk for suicide, substance abuse, and difficulties in the mother–child relationship are concerns.

Colonoscopy Following Nonoperative Management of Uncomplicated Diverticulitis May Not Be Warranted

Following the nonoperative management of acute diverticulitis, guidelines recommend routine follow-up colonoscopy; however, evidence to support this recommendation are lacking. This study aims to determine the diagnostic yield of endoscopy for clinically significant neoplasia following the successful nonoperative management of acute diverticulitis. This study is a retrospective review. This study was conducted in a large urban health region. Adult patients who were admitted with a diagnosis of acute diverticulitis confirmed by CT and who were successfully managed nonoperatively to hospital discharge were included. Patients who underwent colonoscopy within 2 years of presentation were excluded. The primary outcome measured was the incidence of clinically significant neoplasia (invasive malignancy or advanced adenoma) on follow-up endoscopy within 1 year of admission. Four hundred fifty-eight patients were selected for analysis, of which 249 patients (54%) underwent endoscopy within 1 year of admission. Seventy-seven (30.9%) patients were found to have polyps, 19 (7.6%) patients had advanced adenomas, and 4 (1.6%) patients had an invasive malignancy; 23 patients (9.2%) were found to have clinically significant neoplasia. On subgroup analysis, patients presenting with complicated diverticulitis (n = 74) had a significantly higher incidence of advanced adenoma (18.9% vs 5%, p = 0.001) and invasive malignancy (5.4% vs 0%, p = 0.007) in comparison with patients who presented with uncomplicated diverticulitis (n = 175). On multivariate analysis, patient age (OR 1.04 (1.01-1.08), p = 0.02) and the presence of abscess (OR 4.15 (1.68-10.3), p = 0.002) were identified as significant risk factors for clinically significant neoplasia. The use of retrospective data was a limitation of this study; 54% of selected patients underwent endoscopic follow-up. The incidence of clinically significant neoplasia on endoscopic follow-up after the nonoperative management of acute diverticulitis is 9.2%. Those with complicated diverticulitis are at higher risk, whereas the incidence of clinically significant neoplasia in those with uncomplicated diverticulitis is equal to the incidence in average-risk individuals. Routine diagnostic colonoscopy following the nonoperative management of acute uncomplicated diverticulitis may not be warranted.

Real-world rates, predictors, and associated costs of hypoglycemia among patients with type 2 diabetes mellitus treated with insulin glargine: results of a pooled analysis of six retrospective observational studies

Objective:To evaluate the real-world rates of hypoglycemia and related costs among patients with type 2 diabetes mellitus (T2DM) who initiated insulin glargine with either a disposable pen or vial-and-syringe.Methods:Pooled data were evaluated from six previously published, retrospective, observational studies using US health plan insurance claims databases to investigate adults with T2DM who initiated insulin glargine. The current study evaluated baseline characteristics, hypoglycemic events, and costs during the 6 months prior to and 12 months following insulin glargine initiation. Comparisons were made between patients initiating treatment with a disposable pen (GLA-P) and vial-and-syringe (GLA-V). Multivariate analyses using baseline characteristics as covariates determined predictors of hypoglycemia after initiating insulin glargine.Results:This study included 23,098 patients (GLA-P: 14,911; GLA-V: 8187). Overall annual prevalence of hypoglycemia was low (6.3% overall, 2.2% related to hospital admission or emergency department visit). Prevalence was significantly lower with GLA-P (5.5% vs 7.7%; p < 0.0001). Furthermore, average glycated hemoglobin HbA1c reduction was higher with GLA-P (−1.22% vs −0.86%; p = 0.0012). The average annual hypoglycemia-related cost associated with initiating insulin glargine was $293, with GLA-P being 46% lower than GLA-V ($225 vs $417; p = 0.001). Patients who had already developed microvascular complications at the time of initiating insulin therapy were at higher risk for developing hypoglycemia.Limitations:This study is limited by the use of retrospective data and ICD-9-CM codes, which are subject to coding error. In addition, this pooled analysis used unmatched cohorts, with multivariate regression analyses employed to adjust for between-group differences. Finally, results describe a managed care sample and cannot be generalized to all patients with T2DM.Conclusions:Patients with T2DM initiating insulin glargine treatment showed low rates of hypoglycemia, especially when using a disposable pen device. Hypoglycemia-related costs were low, contributing a very small proportion to overall diabetes-related healthcare costs.