scholarly journals Prospective Evaluation of Gastric Neurostimulation for Diabetic Gastroparesis in Canada

2015 ◽  
Vol 29 (4) ◽  
pp. 198-202 ◽  
Author(s):  
Himanish Panda ◽  
Philip Mitchell ◽  
Michael Curley ◽  
Michelle Buresi ◽  
Lynn Wilsack ◽  
...  
Keyword(s):  
Health Care ◽  
Short Form ◽  
Real Life ◽  
Diabetic Gastroparesis ◽  
Medication Cost ◽  
Care Utilization ◽  
Medication Costs ◽  
Before And After ◽  
The Mean ◽  
One Year

BACKGROUND: The efficacy of gastric neurostimulation therapy for diabetic gastroparesis (GP) in a ‘real-life’ Canadian setting has not been assessed.AIMS: To assess changes in health-related quality of life (QoL), weekly vomiting frequency (WVF), total symptom score (TSS) and health care utilization 12 months before and after gastric neurostimulator implantation in a diabetic GP cohort.METHODS: Medication-refractory diabetic GP patients (n=7, four female, mean age 42 years) were prospectively recruited from 2008 to 2012. QoL scores were self-administered and obtained at baseline, 24 and 48 weeks postimplantion. WVF and TSS were assessed similarly. Health care usage, measured as hospitalization frequency and medication cost, was obtained six and 12 months before and after implant. Changes from baseline to six and 12 months for all outcomes were compared.RESULTS: The mean (± SD) QoL according to EuroQol was significantly better at 24 weeks after the baseline measurement (baseline 29±5, 24 weeks 52±7; P=0.03). The mean improvement in TSS was significantly better at one year postintervention (baseline score 35±5 versus 12 months 27±3; P=0.03). Changes in Short-Form 36 Health Survey and WVF were not significant. Days of GP-related hospitalization were highly variable but decreased from a median of 71 days (range 0 to 227 days) to 29 days (range two to 334 days) one year before and after surgery, respectively (P=0.735). Outpatient medication costs did not decrease to a significant extent.CONCLUSION: Gastric neurostimulation for diabetic GP appeared to show some beneficial palliative effects overall in the present small open-label series, but the effect is highly variable among patients, and placebo effect cannot be ruled out.

scholarly journals Health Care Utilization Among Texas Veterans Health Administration Enrollees Before and After Hurricane Harvey, 2016-2018

2021 ◽  
Vol 4 (12) ◽  
pp. e2138535
Author(s):  
Margaret Carrel ◽  
Gosia S. Clore ◽  
Seungwon Kim ◽  
Mary Vaughan Sarrazin ◽  
Eric Tate ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Veterans Health Administration ◽  
Care Utilization ◽  
Veterans Health ◽  
Health Administration ◽  
Before And After

scholarly journals PMH43 HEALTH CARE UTILIZATION OF PATIENTS WITH DEPRESSION BEFORE AND AFTER INTIATING DULOXETINE

2010 ◽  
Vol 13 (7) ◽  
pp. A453
Author(s):  
N Shi ◽  
E Durden ◽  
Z Cao ◽  
A Torres ◽  
M Happich
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Before And After

Incremental health care services and expenditures associated with depression among individuals with cutaneous lupus erythematosus (CLE)

Lupus ◽  
2018 ◽  
Vol 27 (7) ◽  
pp. 1107-1115 ◽  
Author(s):  
M E Ogunsanya ◽  
S O Nduaguba ◽  
C M Brown
Keyword(s):  
Health Care ◽  
Prescription Drugs ◽  
Lupus Erythematosus ◽  
Medical Expenditure Panel Survey ◽  
Cutaneous Lupus Erythematosus ◽  
Health Care Expenditures ◽  
Medical Expenditure ◽  
Care Utilization ◽  
Medication Costs ◽  
Cutaneous Lupus

Objectives The objective of this paper is to describe the annual direct medical expenditures for cutaneous lupus erythematosus (CLE) patients, and to estimate the incremental health care expenditures and utilization associated with depression among adults with CLE, while controlling for covariates. Methods Using the 2014 Medical Expenditure Panel Survey (MEPS), we compared CLE patients with and without depression to determine differences in: (a) health care utilization—inpatient, outpatient, office-based and emergency room (ER) visits, and prescriptions filled; and (b) expenditures—total costs, inpatient, outpatient, office-based, ER, and prescription medication costs, and other costs using demography-adjusted and comorbidity-adjusted multivariate models (age, gender, race/ethnicity, marital status, education, perception of health status, poverty category, smoking status, and Charlson Comorbidity Index). Results The total direct medical expenditure associated with CLE is estimated at approximately $29.7 billion in 2014 US dollars. After adjusting for covariates, adults with CLE and depression had more hospital discharges (utilization ratio (UR) = 1.13, 95% confidence interval (CI) (1.00–1.28)), ER visits (UR = 1.17, 95% CI (1.09–1.37)), and prescribed medicines (UR = 2.15, 95% CI (1.51–3.05)) than those without depression. Adults with CLE and depression had significantly higher average annual total expenditure that those without depression ($19,854 vs. $9735). Conclusions High health care expenditures are significant for patients with CLE, especially among those with depression. Prescription drugs, inpatient visits, and ER visits contributed most to the total expenditures in CLE patients with depression. Early diagnosis and treatment of depression in CLE patients may reduce total health care expenditures and utilization in this population.

Help-Seeking for Psychiatric Disorders

1997 ◽  
Vol 42 (9) ◽  
pp. 935-942 ◽  
Author(s):  
Roger C Bland ◽  
Stephen C Newman ◽  
Helene Orn
Keyword(s):  
Health Care ◽  
Random Sample ◽  
Help Seeking ◽  
Emotional Problem ◽  
Diagnostic Interview ◽  
Completion Rate ◽  
Care Utilization ◽  
Seeking Help ◽  
One Year ◽  
First Interview

Objective: To examine demographic and clinical determinants of seeking help for mental or emotional problems. To determine the proportion of those people with a disorder who sought help. To determine what categories of professionals are sought by those who get care. Method: A 2-stage random sample of 3956 adult residents of Edmonton, Alberta, Canada was interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS) (73% completion rate). An average of 2.8 years later, a systematic random sample of 1964 subjects was reinterviewed (an 86% completion rate) using the DIS and a health care utilization questionnaire. After adjusting for age and sex, the reinterview sample was representative of those with and without a diagnosis at the first interview. Results: Of the 1964 subjects, 570 (31%) met criteria for a DIS/DSM-III diagnosis in the year preceding the interview (one-year prevalence rate). These diagnoses included generalized anxiety disorder (GAD) and posttraumatic stress disorder (PTSD). For those with a diagnosis, sex, age, marital status, education, employment, and income were examined as determinants of help-seeking. Only sex (female) and age (under 45) were significant predictors. Comorbidity was highly significant: the help-seeking rate for those with one diagnosis was 20.3%; for those with more than one diagnosis, the rate was 42.8% (OR = 2.94, χ2 = 31.4, df = 1, P < 0.001). Just over 28% of those with a diagnosis saw any health care professional, and 7.7% of those without a diagnosis sought help for a mental or emotional problem. A specific diagnosis made a difference: 46.7% of those with a major depressive episode sought help, but only 16.0% of those with alcohol abuse or dependence sought care. Conclusion: Major determinants of help-seeking are sex (female), age (under 45), severity of the illness, and comorbidity. A surprisingly high proportion of those with a disorder (72%) do not seek help, and over one-third of those seeking help do not have a current DIS/DSM-III disorder.

scholarly journals The association between pain catastrophizing, physical function and pain in a cohort of patients undergoing knee arthroplasty

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Sara Birch ◽  
Maiken Stilling ◽  
Inger Mechlenburg ◽  
Torben Bæk Hansen
Keyword(s):  
Physical Function ◽  
Knee Arthroplasty ◽  
General Health ◽  
Pain Catastrophizing ◽  
Short Form ◽  
Oxford Knee Score ◽  
Preoperative Pain ◽  
Sf 36 ◽  
Before And After ◽  
One Year

Abstract Background Pain catastrophizing contributes to acute and long-term pain after knee arthroplasty (KA), but the association between pain catastrophizing and physical function is not clear. We examined the association between preoperative pain catastrophizing and physical function one year after surgery, as well as differences in physical function, pain and general health in two groups of patients with high and low preoperative pain catastrophizing score. Methods We included 615 patients scheduled for KA between March 2011 and December 2013. Patients completed The Pain Catastrophizing Scale (PCS) prior to surgery. The Oxford Knee Score (OKS), Short Form-36 (SF-36) and the EuroQol-5D (EQ-5D) were completed prior to surgery, and 4 and 12 months after the surgery. Results Of the 615 patients, 442 underwent total knee arthroplasty (TKA) and 173 unicompartmental knee arthroplasty (UKA). Mean age was 67.3 (SD: 9.7) and 53.2% were females. Patients with PCS > 21 had statistically significantly larger improvement in mean OKS for both TKA and UKA than patients with PCS < 11; 3.2 (95% CI: 1.0, 5.4) and 5.4 (95% CI: 2.2, 8.6), respectively. Furthermore, patients with preoperative PCS > 21 had statistically significantly lower OKS, SF-36 and EQ-5D and higher pain score than patients with PCS < 11 both preoperatively and 4 and 12 months postoperatively. Conclusions Patients with high levels of preoperative pain catastrophizing have lower physical function, more pain and poorer general health both before and after KA than patients without elevated pain catastrophizing.

Effect Of Prednisone On Platelet Function In Patients With Bleeding Disorders

1981 ◽  
Author(s):  
R McKenna ◽  
F Bachmann ◽  
O Pichairut ◽  
B Whittaker
Keyword(s):  
Platelet Count ◽  
Platelet Function ◽  
Bleeding Time ◽  
Platelet Factor ◽  
Von Willebrand's Disease ◽  
Von Willebrand’S Disease ◽  
Before And After ◽  
History Of ◽  
The Mean ◽  
One Year

There is considerable controversy regarding the effect of Prednisone on the hemostatic mechanism of normal people versus patients with bleeding diatheses. We administered Prednisone 15 mg TID to patients with a positive history of a bleeding disorder, and evaluated the bleeding time and other in-vitrc tests of platelet function prior to and between the 5th and 7th day after Prednisone.Eleven patients were admitted into this study over a one year period. All patients had a history of excessive bruising, epistaxis, bleeding after dental extractions, and gastrointestinal or other bleeding in various combinations. Two out of the eleven had template bleeding times of greater than 15 minutes both before and after the Prednisone. These two patients were subsequently proven to have von Willebrand’s disease by the washed platelet ristocetin assay. In the remaining 9 patients, the pre-Prednisone bleeding time was 9.3 ±3.7 minutes (x ± 1 S.D.) whereas the post-Prednisone bleeding time was 5.8 ±3.6 minutes (x ±1 S.D.). These results were significant(td=3.83;df:7;p=0.007).Platelet aggregation in response to exogenous ADP (1 μM, 3 μM) Sigma bovine tendon collagen (1.8 mg/ml F) and epinephrine (5.5 × 104M), platelet retention in a glass bead column or platelet factor 3 availability did not improve or worsen after Prednisone therapy. The mean platelet count of 328,000±94,000 (x ±1 S.D.) was significantly (p=0.05) higher than the mean pre-Prednisone platelet count of 268,000±77,000 (x ±1 S.D.).In conclusion, we have shown that large doses of Prednisone appear to shorten the bleeding time in patients with significant defects in the primary hemostatic mechanism. However the bleeding time improvement is not evident in patients with von Willebrand’s disease.

scholarly journals Characterization Of Health Care Utilization And Cost Of Hemophilia A And B In Real-Life: A 4-Year Follow-UP Study In Finland

2017 ◽  
Vol 20 (9) ◽  
pp. A500
Author(s):  
H Ventola ◽  
J Jokelainen ◽  
M Linna ◽  
A Lepäntalo ◽  
T Ylisaukko-oja ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Hemophilia A ◽  
Real Life ◽  
Care Utilization ◽  
Follow Up Study

Orthodontic Treatment in the General Dental Service Assessed by the Occlusal Index

1983 ◽  
Vol 10 (4) ◽  
pp. 178-186 ◽  
Author(s):  
R. J. Elderton ◽  
J. D. Clark
Keyword(s):  
Health Care ◽  
Measurement Errors ◽  
Orthodontic Treatment ◽  
Dental Service ◽  
Index Score ◽  
End Of Treatment ◽  
Before And After ◽  
The Mean

As with all other aspects of health care, orthodontic treatment should be evaluated in as objective a manner as possible. In this study, the models of a sample of 256 patients treated by appliance therapy in the General Dental Service were examined. The Occlusal Index was first refined and variability in its use due to articulation and measurement errors was assessed. It was then used to quantify occlusal status both before and after treatment, and thereby monitor changes brought about by treatment. The mean Occlusal Index score at the beginning of treatment was 9·9. At the end of treatment, the mean score had dropped to 5·5. There was wide variation among individual cases, but some reduction was found in 88 per cent of instances. In 56 per cent of cases the reduction ranged up to 6 units, while in 29 per cent of cases the reduction was 6–12 units. However, in cases which started with a marked malocclusion, only about one-third showed a sizeable improvement. In about one-third of all cases there was little improvement in the malocclusion. While there is room for further refinement of the Occlusal Index to increase its usefulness in quantifying occlusal status brought about during orthodontic treatment, the present findings provide a basis for future comparisons.

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