Persisting disparities between sexes in outcomes of ruptured abdominal aortic aneurysm hospitalizations

We sought to describe and analyze discrepancies between sexes in the outcomes of patients hospitalized for ruptured abdominal aortic aneurysms (rAAA) by conducting a retrospective analysis of the Nationwide Inpatient Sample. The review included all adult patients (≥18 years old) hospitalized with a primary diagnosis of rAAA between January 2002 and December 2014. In-hospital mortality differences between females and males were analyzed overall and separately among those receiving endovascular AAA repair (EVAR) or open AAA repair (OAR). In-hospital mortality for females declined from 61.0% in 2002 to 49.0% in 2014 (P for trend <0.001), while mortality for males declined from 48.6% in 2002 to 32.2% in 2014 (P for trend <0.001). Among those receiving EVAR, females were significantly more likely to die in the hospital than males (adjusted odds ratio [OR], 1.44; 95% CI, 1.12–1.84). In addition, the odds of mortality among those receiving OAR were higher for females than males (adjusted OR, 1.14; 95% CI: 1.00–1.31). These data provide evidence that despite overall decreasing trends in mortality for both sexes, females remain at higher risk of death compared with males regardless of surgical repair procedure.

Variability in the therapeutic management of advanced ovarian cancer patients: a five-country survey of oncologists

Background

Advanced ovarian cancer patients have a poor prognosis, mainly because the disease is diagnosed at a late stage. A number of therapeutic approaches, such as neoadjuvant and maintenance therapies, have been developed to try to improve treatment outcome. In parallel, the targeted therapies bevacizumab and olaparib have recently been approved for ovarian cancer treatment. The goal of our survey was to provide a comprehensive, global depiction of advanced ovarian cancer treatments across different regions.

Patients and methods

Oncologists from France, Italy, Germany, the UK, and the USA were invited to participate in an online survey. Participants were eligible if they personally managed at least 15 ovarian cancer patients. Quantitative questions addressed the proportion of patients in neoadjuvant, treatment, and maintenance settings; proportion of BRCA-positive patients; and the type of treatment prescribed per setting and per line of therapy, depending on the patient’s BRCA status.

Results

A total of 138 respondents completed our survey in Europe and 132 in the USA. The proportions of patients in treatment, maintenance, and remission were identical across each country and line of treatment at 60%, 20%, and 20%, respectively. The proportion of BRCA-tested patients ranged from 45% in Italy to 73% in the USA, with 10% (UK)–21% (Italy) of tested patients having a positive status. Levels of bevacizumab and olaparib prescriptions differed based on the country, line of treatment, and setting, with a significant share of patients receiving both drugs outside of their approved indications for ovarian cancer treatment.

Conclusion

This survey provides real-world data on how advanced ovarian cancer patients are currently treated: 1) BRCA testing was not performed systematically, which raises concerns regarding access to treatment and 2) absence of consensus regarding which chemotherapeutic regimens or targeted therapy to use in different stages of the disease.

Treatment sequencing in advanced BRAF-mutant melanoma patients: Current practice in the United States

Background

Treatment of advanced BRAF-mutant melanoma has changed dramatically in the past 3 years thanks to the approval of new immunotherapy and targeted therapy agents.

Objectives

The goal of our survey was to investigate when immunotherapy and targeted therapy are used in the management of advanced melanoma patients and whether differences exist between the types of setting.

Methods

Oncologists from academic centers, community-based centers, and private clinics were invited to participate in an online survey. Survey questions addressed the proportion of BRAF-mutant patients per treatment line, proportion of patients on targeted therapy and immunotherapy available in the United States, and reasons for prescribing each drug class.

Results

A total of 101 physicians completed the survey, of which 47 worked in a private clinic, 33 in an academic center, and 21 in a community-based center. Academic center participants tended to see more severe patients (P < .001) and had more patients in second-line treatment than participants from other setting types. In addition, academic center physicians had more patients in clinical trials (P < .001), and they prescribed the ipilimumab and nivolumab combination more frequently. In terms of sequencing, all participants used targeted therapy for severe or rapidly progressing patients and immunotherapy for those who were less severe or slowly progressing.

Conclusions

The findings illustrate the differences in treatment approach per type of setting, with patients in academic centers more likely to receive recently approved products or to be enrolled in clinical trials than those in community-based settings.

Nationwide trends of clinical characteristics and economic burden of emergency department visits due to acute ischemic stroke

We aimed to provide estimates of the volume and associated charges of acute ischemic stroke (AIS) visits in the US, as well as to assess predictors of patient disposition following an emergency department (ED) visit for AIS. Our study was conducted using the 2010–2013 data from the Nationwide Emergency Department Sample. We identified adult visits with AIS as the primary diagnosis. A generalized linear model was used to calculate mean charges per visit after adjusting for covariates. Multinomial logistic regression was used to assess predictors of patient disposition following an ED visit for AIS. The national incidence did not appreciably change over time, increasing from 26.4 to 27.0 visits per 10,000 adults. Adjusted mean charges per event were highest in the West, increasing from $3,761 in 2010 to $4,575 in 2013. Multinomial logistic regression showed that older age was associated with increased likelihood of both hospital admission and mortality in the ED, while male sex was associated with lower odds of mortality in the ED. Despite improvements in primary and secondary prevention of cardiovascular disease, AIS remains a significant burden on the health care system with a high volume of ED visits and increasing charges for care.

Reducing waiting time and raising outpatient satisfaction – an interrupted time series study

Background

It is globally agreed that a well-designed health system deliver timely and convenient access to health services for all patients. Many interventions aiming to reduce waiting times have been implemented in Chinese public tertiary hospitals to improve patients’ satisfaction. However, few were well-documented, and the effects were rarely measured with robust methods.

Methods

We conducted a longitudinal study of the length of waiting times in a public tertiary hospital in Southern China which developed comprehensive data collection systems. Around an average of 60,000 outpatients and 70,000 prescribed outpatients per month were targeted for the study during Oct 2014-February 2017. We analyzed longitudinal time series data using a segmented linear regression model to assess changes in levels and trends of waiting times before and after the introduction of waiting time reduction interventions. Pearson correlation analysis was conducted to indicatethe strength of association between waiting times and patient satisfactions. The statistical significance level was set at 0.05.

Results

The monthly average length of waiting time decreased 3.49 min (P=0.003) for consultations and 8.70 min (P=0.02) for filling prescriptions in the corresponding month when respective interventions were introduced. The trend shifted from baseline slight increasing to afterwards significant decreasing for filling prescriptions (P=0.003). There was asignificant negative correlation between waiting time of filling prescriptions and outpatient satisfaction towardspharmacy services (r=−0.71,P=0.004).

Conclusions

The interventions aimed at reducing waiting time and raising patient satisfaction in Fujian Provincial Hospital are effective. A long-lasting reduction effect on waiting time for filling prescriptions was observed because of carefully designed continuous efforts, rather than a one-time campaign, and with appropriate incentives implemented by a task force authorized by the hospital managers. This case provides a model of carrying out continuous quality improvement and optimizing management process with the support of relevant evidence.

Global perspective on colonoscopy use for colorectal cancer screening: a multi-country survey of practicing colonoscopists

Objectives

To examine colorectal cancer screening practices among colonoscopy specialists from 5 countries and inform public health needs in improvement of the ongoing global crisis in colorectal cancer.

Methods

An online survey among colonoscopy specialists was conducted in France, Germany, the United Kingdom, Japan, and the United States. The survey covered topics on colonoscopy practices in the screening as well as in the treatment setting, as well as expected trends.

Results

Participating colonoscopy specialists included 114 physicians from the United States, 81 from France, 80 from Germany, 80 from the United Kingdom, and 156 from Japan. Survey results revealed that 59%–73% of colonoscopies were performed in patients aged 50–75 years old, with 15%–23% performed in patients <50 years old. The proportion of patients with age-based versus symptom-based first colorectal cancer screening varied by country and age. Sedation protocols varied by country; however, rate of incomplete colonoscopy was low in all countries. The proportion of negative first colonoscopies decreased with age in all countries.

Conclusions

This multi-country survey of real-world clinical practices suggests a need for improved participation in population age-based colorectal cancer screening and possibly younger age of screening initiation than currently recommended by guidelines. The variation among countries in the proportion of patients who received their first colonoscopy due to age-based colorectal cancer screening versus symptom-based initial colonoscopy indicates that population-based screening initiatives and improved health outcomes will benefit from public health awareness programs.

Adverse drug reaction early warning using user search data

Purpose

This research proposes a framework to detect adverse drug reactions using Internet user search data, so that adverse drug reaction events can be identified early. Empirical investigation of Avandia, a type II diabetes treatment, is con-ducted to illustrate how to implement the proposed framework.

Design/methodology/approach

Typical adverse drug reaction identification measures and time series processing techniques are used in the proposed framework. Google Trends Data is employed to represent user searches. The baseline model is a disproportionality anal-ysis using official drug reaction reporting data from the U.S. Food and Drug Administration’s (FDA) Adverse Event Re-porting System (FAERS).

Findings

Results show that Google Trends series of Avandia side effects search reveal a significant early warning signal for the side effect emergence of Avandia. The proposed approach of using user search data to detect adverse drug reactions is proved to have a longer leading time than traditional drug reaction discovery methods. Three more drugs with known adverse reactions are investigated using the selected approach, and two are successfully identified.

Research limitations/implications

Validation of Google Trends data’s representativeness of user search is yet to be explored. In future research, user search in other search engines and in healthcare web forums can be incorporated to obtain a more comprehensive adverse drug reaction early warning mechanism.

Practical implications

Using Internet data in drug safety management with a proper early warning mechanism may serve as an earlier signal than traditional drug adverse reaction. This has great potential in public health emergency management.

Originality/value

Our research work proposes a novel framework of using user search data in adverse drug reaction identification. User search is a voluntary drug adverse reaction exploration behavior. Further, user search data series are more concise and accurate than text mining in forums. The proposed methods as well as the empirical results will shed some light on incor-porating user search data as a new source in pharmacovigilance.

Investment and incentives in 21st Century pharmaceutical research in Europe: the cost of opportunity

We could say that a financial reward to a successful R&D project is an investment and an investment in healthcare R&D is an opportunity. However, not all investments are successful and opportunities can be missed. And sometimes, one stakeholder’s success is another’s failure.

Considerations on bringing warehoused HCV patients into active care following interferon-free, direct-acting antiviral drug approval

Objectives

Until recently, lack of efficacious and tolerable hepatitis C virus (HCV) treatments prompted patient warehousing until better treatment options became available. We investigated whether the introduction of ledipasvir/sofosbuvir precipitated patient return to clinics, thereby changing HCV clinic dynamics.

Methods

Online questionnaire responses indicated the volume of HCV patients followed, the proportion of warehoused patients and those who were proactively offered new options, methods for identifying and contacting patients, and insurance authorization/reimbursement-related information.

Results

Of 168 practices surveyed, 19% indicated no patient warehousing in the previous 3 years; 81% had warehoused 40% of patients; 92% were able to handle their patient load; and 82% had not changed practices to accommodate more HCV patients in the previous 12 months. Of the 35% of patients who were ledipasvir/sofosbuvir-eligible, 50% already completed/are completing therapy, 21% were not treated due to insurance denial, and 19% were awaiting responses from insurance companies.

Conclusions

Launch of a new treatment did not overburden HCV practices. Patients eligible to receive new treatments were being treated, but pre-authorization processes and reimbursement denials reduced the numbers of treated patients.

Consumer satisfaction with tertiary healthcare in China: findings from the 2015 China National Patient Survey

Objective

This study aims to develop understanding of Chinese patient satisfaction with tertiary hospitals.

Design

The study draws on data collected from the 2015 China National Patient Survey. A Likert five-point scale was used to formulate the questionnaires. Descriptive analysis and logistic regression analysis were conducted.

Setting

A structured questionnaire was used by 1432 interviewers to interview 27 475 outpatients and 19 938 inpatients in 136 tertiary hospitals from 31 provinces.

Participants

Outpatients in the dispensing area and inpatients in the discharging area were randomly interviewed.

Main Outcome Measure(s)

Key domains of the questionnaire include the layout of service functions, environment maintenance, process management, quality of care, humane care and the patient–doctor relationship. Within each domain, several indicators were set, and each indicator was given a statement.

Results

The overall satisfaction scores are 4.42 ± 0.68 and 4.67 ± 0.62 for outpatient and inpatient, respectively. The domains with highest satisfaction are ‘diagnosis and treatment’ for outpatient and ‘nursing care’ for inpatient. Outpatients were least satisfied with long waiting time, while inpatients were least satisfied with the food. The strongest predictor of overall satisfaction appears to be ‘patient–doctor relationship’ for both outpatients (OR = 3.53, 95% CI: 3.17–3.92) and inpatients (OR = 7.34, 95% CI: 5.55–9.70).

Conclusions

Chinese hospitals need to pay more attention to offering more humane care to patients, hospital environment and process management improvement, reducing waiting times for seeing doctors and outpatient testing, and improving amenity services such as better food in the wards.