scholarly journals Using Syndromic Surveillance to Quantify ED Visits for Coagulopathy Cases

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Kelly Walblay ◽  
Megan Patel ◽  
Stacey Hoferka
Keyword(s):  
Data Quality ◽  
Medical Record ◽  
Syndromic Surveillance ◽  
Medical Record Number ◽  
Medical Evaluation ◽  
Prescription Refill ◽  
Ed Visits ◽  
The Mean ◽  
Repeat Visits

ObjectiveTo determine whether emergency department (ED) visits were captured in syndromic surveillance for coagulopathy cases associated with an outbreak linked to synthetic cannabinoid (SC) use and to quantify the number of ED visits and reasons for repeat visits.IntroductionIn March 2018, the Illinois Department of Public Health (IDPH) was informed of a cluster of coagulopathy cases linked to SC use. By June 30, 2018, 172 cases were reported, including five deaths, where 74% were male and the mean age was 35.3 years (range: 18–65 years). All cases presented to an emergency department (ED) at least once for this illness. Ninety-four cases provided clinical specimens and all tested positive for brodifacoum, a long-acting anticoagulant used in rodenticide. Cases were reported to the health department by the Illinois Poison Control Center and direct reporting from hospitals. REDCap was the primary database for tracking cases and collecting demographic information, risk factor data and healthcare facility utilization, including number of ED visits. Syndromic surveillance was utilized to monitor ED visits related to the cluster, assist with case finding and provide situational awareness of the burden on the EDs and geographic spread. In this study, we retrospectively used syndromic surveillance along with the data in REDCap to quantify the number of ED visits per coagulopathy case, understand the reasons for repeat visits, and determine whether visits were captured in syndromic surveillance.MethodsIllinois hospital ED data submitted to the National Syndromic Surveillance Platform instance of ESSENCE (ESSENCE), was compared to data present in our primary REDCap database. A subset of the cases, males 18-44 years of age (n=105; 61% of cases), were included in this analysis. Illinois ESSENCE data in males aged 18-44 years from March 10, 2018–June 30, 2018 were matched to cases in the REDCap database by age, zip code, initial visit date, facility, and reason for visit including: chief complaint, discharge diagnosis, and triage note. If the initial visit was found, the matching criteria and medical record number were used to search for additional related visits. The number of visits in ESSENCE and reasons for visits were totaled for each patient. Reasons for repeat visits were categorized into four categories: continued gross bleeding or symptoms associated with coagulopathy, medical evaluation or follow-up, laboratory work and prescription refill. Repeat visits may fall into more than one category. The number and dates of ED visits captured in ESSENCE per case were compared to that reported in REDCap. An epidemic curve was constructed to display the number of ED visits and type (i.e. primary visit or repeat visit) captured by REDCap only, ESSENCE only or both by visit date.ResultsOf the 105 cases in REDCap, 89 (85%) were matched to at least one ED visit in ESSENCE from March 10, 2018–June 30, 2018. The mean number of ESSENCE ED visits per case was 1.9 visits and the median was one visit (range: 1–11 visits). The main chief complaints for the primary visit included hematuria (n=31), abdominal pain (n=20), back pain/flank pain (n=13), K2 (n=11), bleeding from multiple sites (n=8), vomiting blood (n=7), and urinary tract infection or kidney stones (n=7). Of the 89 cases matched to a visit in ESSENCE, 84 (94%) cases, representing 142 (79%) of ED visits, were captured by syndrome definitions that were being utilized to monitor the cluster. Forty-three cases (48%) had at least two visits in ESSENCE. The reasons for return visits captured in ESSENCE (n=84) were continued gross bleeding or symptoms associated with coagulopathy (n=53), medical evaluation or follow-up (n=14), laboratory work (n=13), prescription refill (n=7) or unknown (n=2). Of the 105 cases, the number of ED visits reported in REDCap matched the number of visits found in ESSENCE for 49 cases (47%). For 24 cases (23%), ESSENCE identified more visits than REDCap and for 16 cases (15%), REDCap had more ED visits reported than captured in ESSENCE. Sixteen cases (15%) in REDCap were not found in ESSENCE. All of the unmatched visits were due to ESSENCE data quality, including a lack of reporting hospital admissions, lack of submitting data to ESSENCE, and missing data including: date of birth, medical record number, and triage notes.ConclusionsSyndromic surveillance was a useful tool in describing the burden of ED visits for patients in the Illinois coagulopathy outbreak linked to SC use. ESSENCE data helped to quantify the number of ED visits per patient and identify patients that re-presented for the same illness. The most common reason for repeat ED visits was continued symptoms, which may be attributed to misdiagnosis at the initial healthcare visit. ED visits that were not picked up by ESSENCE were a result of data quality issues from select facilities that were not reporting hospitalizations or key information such as date of birth, medical record number or triage notes. Engagement with healthcare facilities to provide this information will improve the data quality of syndromic surveillance. 

scholarly journals Identification and Assessment of Repeat Drug Overdose Visits at EDs in Virginia

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Inderbir Sohi ◽  
Erin E Austin ◽  
Jonathan Falk
Keyword(s):  
Medical Record ◽  
Drug Overdose ◽  
Syndromic Surveillance ◽  
Age Groups ◽  
Opioid Overdose ◽  
Medical Record Number ◽  
Significant Difference ◽  
Repeat Visit ◽  
Ed Visits ◽  
Repeat Visits

ObjectiveTo identify and assess the characteristics of individuals with repeated emergency department (ED) visits for unintentional opioid overdose, including heroin, and how they differ from individuals with a single overdose ED visit.IntroductionThe Virginia Department of Health (VDH) utilizes syndromic surveillance ED data to measure morbidity associated with opioid and heroin overdoses among Virginia residents. Understanding which individuals within a population use ED services for repeated drug overdose events may help guide the use of limited resources towards the most effective treatment and prevention efforts.MethodsVDH classified syndromic surveillance visits received from 98 EDs (82 hospitals and 16 emergency care centers) between January 2015 and July 2018. An unintentional opioid overdose, which included heroin, was classified based on the chief complaint and/or discharge diagnosis (ICD-9 and ICD-10) using Microsoft SQL Server Management Studio. ED visits were categorized as either a single or a repeat visit, where a repeat visit was defined as two or more separate ED visit records from the same individual. ED visit records were matched to individuals using medical record number. Each match represented a repeat visit for one person. RStudio was used to conduct Pearson’s chi-square tests for sex, race, and 10-year age groups among both visit groups and to assess visit frequency among the repeat visit group.ResultsBetween January 2015 and July 2018, 9,869 ED visits for opioid overdose were identified, of which 734 (7.4%) were repeat visits among 597 individuals occurring among 57 EDs. The proportion of individuals with repeated opioid overdose visits was significantly different compared to the proportion of individuals with a single opioid overdose visit by sex (male 66% vs. 61%) and age group (20-29 years 34% vs 30%) (p < 0.05). No significant difference was found by race. EDs had an average of 10 individuals who had repeated opioid overdose visits, with a range from 1 to 62 individuals. Individuals with repeated opioid overdose visits made on average 2.2 visits to EDs, with a range of 2 to 6 visits. The overdose visit rate among EDs ranged from 0.6 to 51.3 opioid overdoses per 100,000 ED visits, with four EDs having a rate greater than 40 opioid overdose visits per 100,000 ED visits.ConclusionsApproximately 7% of ED visits during the study period for opioid overdose were identified as repeat visits using the medical record number. Individuals with repeated opioid overdose visits differed from those with a single opioid overdose visit with respect to sex and age. Repeated opioid overdose visits were disproportionately higher for males and individuals aged 20-29. Hospital utilization by individuals with repeated opioid overdose visits can provide information on which EDs or communities that may require further attention. Some limitations of this study are that the method utilized to identify individuals may result in an underestimation of repeat visits because limited personally identifying information was used to match visit records, and repeat visits that occurred before and after the study period would not be captured. 

scholarly journals The First Retrospective Commercial Claims-Based Analysis of CAR T Treated Patients with Relapsed or Refractory Large B-Cell Lymphoma (R/R LBCL)

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 31-31
Author(s):  
Anna Purdum ◽  
Jonathan Johnson ◽  
Anthony Bonagura ◽  
Liliosa Nyamutswa ◽  
Caitlin Elliott ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Characteristics ◽  
B Cell Lymphoma ◽  
P Value ◽  
Publicly Traded ◽  
Index Event ◽  
Car T ◽  
Ed Visits ◽  
The Mean

Introduction: Approximately 74,000 Americans are diagnosed with Non-Hodgkin Lymphoma (NHL) each year, of whom 30% are identified as having LBCL. In recent years, two autologous anti-CD19 chimeric antigen receptor T-Cell (CAR T) therapies were approved for the treatment of patients with R/R LBCL with ≥ 2 prior systemic therapies. Objectives: To describe the demographic and clinical characteristics of the CAR T patients and to compare healthcare resource utilization (HCRU) and costs pre- and post-CAR T therapy. Methods: This pre/post-index comparison evaluated in the Optum Research Database included adult (age ≥ 18 years) commercial and Medicare Advantage (MA) enrollees, with medical benefits and evidence of medical/procedure codes indicative of CAR T therapy between 01/01/2017 and 03/31/2019. Patients must have been continuously enrolled in their commercial healthcare plan for at least 3 months prior to and 6 months after the infusion (index) unless death occurred. Patients with evidence of pre-index leukemia were excluded. Baseline demographic and clinical characteristics included age, gender, insurance type, geographic region, and comorbidities. Measures of pre/post HCRU and standardized cost (scaled as per patient per month (PPPM) values to account for variable follow-up durations) included ambulatory visits, emergency department (ED) visits, and inpatient admissions (both Intensive Care Unit (ICU) and non-ICU visits). Information on the CAR T administration index visit and length of stay (LOS) for inpatient admissions were also captured. Data analysis (descriptive statistics) was conducted using Statistical Analysis System (SAS) Version 9.4. Results: 109 patients met all inclusion criteria. The patient mean age was 59.31 (SD = 12.60), 59% were male, 70% were commercially insured, 30% MA, and the mean Quan-Charlson Comorbidity score was 3.60.Thirty patients received CAR T administration through clinical trials. Seventeen percent received CAR T therapy in a Prospective Payment System (PPS) Exempt Cancer Hospital and 83% received treatment in Inpatient PPS hospitals. The CAR T therapy index event was administered inpatient for 82% of patients and twenty patients (18%) received CAR T in the outpatient setting. The median LOS during CAR T administration was 16 days which included 52% ICU admissions. During the pre-index period, all patients experienced an ambulatory visit with an average of 15.09 visits PPPM, whereas 41% had an ED encounter for an average rate of 0.39 visits PPPM, and 44% had an inpatient stay with 0.28 PPPM. The total medical and pharmacy costs were $128K PPPM. With a median follow-up of 8.4 months, patients experienced 46% fewer ambulatory visits (average 8.14 PPPM, p-value &lt; 0.001), 49% fewer ED visits (average 0.20 PPPM, p-value &lt; 0.037), and 18% fewer inpatient visit rates (average 0.23 PPPM, p-value = 0.415) in the post index period (excluding the index event) than pre-index period. The mean total medical and pharmacy costs were also 49% lower at $66K PPPM (p-value &lt; 0.008). Conclusions:Post-CAR T care was associated with lower health care utilization including fewer ambulatory visits, and ED visits and lower overall total health care costs compared to pre-CAR T care. Disclosures Purdum: Kite: Current Employment, Current equity holder in publicly-traded company. Johnson:Optum: Current Employment, Current equity holder in publicly-traded company. Bonagura:Optum: Current Employment, Current equity holder in publicly-traded company. Nyamutswa:Kite: Current Employment, Current equity holder in publicly-traded company. Elliott:Optum: Current Employment. Lal:Optum: Current Employment.

scholarly journals High Healthcare Utilization and Costs in Patients with Higher-Risk MDS/Low Blast Count AML Treated with Azacitidine in Ontario, Canada

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 834-834 ◽  
Author(s):  
Lee Mozessohn ◽  
Matthew Cheung ◽  
Nicole Mittmann ◽  
Craig C. Earle ◽  
Ning Liu ◽  
...  
Keyword(s):  
Economic Impact ◽  
Resource Utilization ◽  
Real World ◽  
Drug Costs ◽  
Real World Data ◽  
World Data ◽  
Blast Count ◽  
Ed Visits ◽  
The Mean

Abstract Background: Azacitidine (AZA) use in higher-risk MDS has been adopted because it improves survival. Despite this, "real-world" data on the economic impact and resource utilization remains unknown. We used the Ontario provincial AZA MDS registry, which captures all AZA-treated patients in the province, to analyze "real-world" data on healthcare use, associated costs and their predictors in AZA treated higher-risk patients. Methods: We linked the provincial MDS AZA registry (single-payer/universal access), which captures baseline characteristics and treatment response for all AZA-treated patients in Ontario, to population-based health system administrative databases. Only higher-risk MDS patients (IPSS intermediate-2, high) and low blast count AML (21-30% blasts) treated from May 30, 2010 to March 16, 2015 were included. Patients were followed for 24 months following first AZA treatment and censored at the earliest of 90 days after last AZA treatment, date of death, time of acute leukemia induction/allogeneic stem cell transplant or March 31, 2016. We estimated healthcare resource utilization and the mean (and overall) standardized 28-day healthcare cost in Canadian dollars ($1 CDN = 0.76 USD$). Quantile regression was used to explore predictors of cost. Negative binomial regression models were used to explore predictors for higher rate of emergency department (ED) visits, and for longer length of stay, with the natural logarithm of length of follow-up as an offset variable in each model. Results: The registry had 652 higher-risk MDS and 225 low blast count AML patients (n = 877) with median follow up of 8 months (IQR 4-13). Median age was 73 years (IQR 66-79), 66.0% were male, 17.8% were secondary MDS and IPSS scores of those calculable were intermediate-2 (64.9%) and high-risk (35.1%). At the time of AZA initiation, 587 patients (66.9%) were transfusion dependent. The median number of cycles received was 6 (range 3 to 11) and median overall survival was 16.1 months (95% CI 13.9 to 18.3). Overall, 705 patients (80.4%) had at least 1 ED visit and 290 (33.1%) had an ED visit during their first cycle of AZA. In addition, 680 patients (77.5%) had at least 1 hospital admission with a mean hospital stay of 17.7 days (95% CI 16.3 to 19.1) over the entire study period. 141 patients (16.1%) required admission to an intensive care unit. Older age (Rate ratio [RR] = 1.33, 95% CI 1.09-1.62), rurality (RR=1.75, 95% CI 1.42-2.15), high IPSS score (RR=1.31, 95% CI 1.06-1.62), and increased comorbidity level were each independent predictors of increased ED visits; while higher comorbidity level (RR=1.51, 95% CI 1.08-2.11), high IPSS score (RR=1.39, 95% CI 1.01-1.92), and transfusion dependence (RR=1.51, 95% CI 1.13-2.01) were associated with longer hospital stays. The overall mean cost was $146,675 per patient (95% CI $139,537 to $153,812) including AZA and $103,580 (95% CI 98,675 to 108,486) excluding AZA drug costs. The mean standardized cost per 28-day period per patient was $17,638 (95% CI $16, 870 to $18,407) with AZA and $13,450 (95% CI $12,730 to $14,170) without AZA drug costs. Inpatient admissions ($4,631, 95% CI $4,010 to $5,251) and non-physician outpatient cancer clinic costs ($6,092, 95% CI $5,851 to $6,333) were the major cost drivers. Excluding AZA costs, the mean standardized 28-day costs were higher in those receiving less than 4 cycles of AZA (n= 295) at $19,408 (95% CI $17,568 to $21,248), compared with those receiving 4 or more cycles (n= 582) at $10,430 (95% CI $10,069 to $10,790) with inpatient admissions as the major driver (mean $10,192, 95% CI $8,594 to $ 10,192 vs. $1,812, 95% CI $1,558 to $2,065). On multivariable analysis, only greater comorbid disease burden (β = $2,074, 95% CI $665 to $3,483) and transfusion dependence (β = $2,402, 95% CI $1,190 to $3,613) were associated with higher median standardized 28-day cost. Conclusions: In our analysis of "real-world" patients with uniformly higher-risk MDS treated with AZA we demonstrate a significant economic impact above and beyond the cost of AZA alone. The costs are higher in patients who are transfusion dependent and have greater comorbidity and appear to be driven by inpatient care and outpatient non-physician ambulatory care. This group of patients are high users of healthcare resources with the majority having ED visits and inpatient admissions. These results will inform patients and providers about the "real-world" anticipated toxicities of AZA. Disclosures Buckstein: Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.

scholarly journals An R Script for Assessment of Data Quality in the BioSense Locker Database

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Serena Rezny ◽  
Stacey Hoferka
Keyword(s):  
Data Quality ◽  
Quality Assessment ◽  
Syndromic Surveillance ◽  
Quality Metrics ◽  
Quality Improvements ◽  
Aggregated Data ◽  
Ed Visits ◽  
Facility Level ◽  
Data Quality Metrics

Syndromic surveillance requires reliable, accurate, and complete healthcare encounter data. To address the need for quality assessment of ED data, we developed an R script to assess and produce reports on data quality in the BioSense locker database. The script examines identifying variables in the HL7 messages from the locker, aggregates messages into ED visits based on these identifiers, processes the aggregated data to calculate metadata for each visit, and computes various data quality metrics. Facility-level reports are written to HTML files, which can then be shared with hospitals and vendors to support ongoing data quality improvements.

scholarly journals Management of Severe Chronic Pain with Methadone in Pediatric Patients with Sickle Cell Disease

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3663-3663
Author(s):  
Zachary LeBlanc ◽  
Chris Vance ◽  
Jie Zhang ◽  
Sabrina R Macksoud ◽  
Steffane Battle ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Research Funding ◽  
Pediatric Patients ◽  
Baseline Period ◽  
Chronic Pain Management ◽  
Cell Disease ◽  
Severe Chronic Pain ◽  
Ed Visits ◽  
The Mean

Abstract Introduction Patients with sickle cell disease (SCD) experience acute painful events; some patients develop chronic pain requiring daily short acting opioids, and frequent emergency department (ED) visits, and inpatient hospitalization. From the Cooperative Study of Sickle Disease (Platt, NEJM 1991), only 1% of patients with SCD experience more than 6 pain events per year. Methadone is a synthetic opioid used in chronic pain, but there is a paucity of data on its use and effectiveness in the pediatric SCD population. We hypothesized that methadone can be used safely in pediatric patients with SCD with severe chronic pain and would reduce ED visits and hospitalizations. Methods We conducted a retrospective cohort study (IRB approved) of 16 pediatric patients with SCD who received methadone for chronic pain management, indicating having more than 5 pain events per year. These patients were among 1100 total patients with SCD at our center. Primary SCD providers escalated doses to maximal effect and when clinically stable, doses were weaned. Follow-up started at time of methadone initiation and ended when a patient was weaned or transitioned to adult care; the 1 year period before treatment initiation was defined as the baseline period. We calculated descriptive statistics to characterize the study population. We compared clinical outcomes (ED visits or hospitalization for pain) for the baseline period and 1 year post methadone initiation using paired T test. To evaluate methadone dosing and dependency, we identified the mean dose, percentage of time at highest dose, and wean of methadone. We assessed withdrawal and safety by reviewing outpatient encounters, EKG screening for QTc > 450, eGFR by cystatin C to determine either a decrease in eGFR by 20% or an eGFR <80, and microalbumin/creatinine urinary excretion. Results Among the 16 participants, 10 (62.5%) were male and the genotypes of each patient were: 14 SS, 1 S/β0-thalassemia, 1 SC. The mean age was 15.5 (±2.8) years at time of methadone initiation and there was a medium follow-up of 2.1 years. Clinically, 13 (81.3%) had previous cholecystectomy, 6 (37.5%) had previous splenectomy, 7 (43.8%) had radiographic evidence of infarction of a long bone within the year prior to initiation of methadone, 10 (62.5%) were receiving chronic transfusion during methadone, and 10 (62.5%) received psychosocial counseling for depression and/or anxiety. The average number of ED visits per month was 0.31 (±0.27) in the baseline period and were 0.28 (±0.28, p=0.658) and 0.31 (±0.25, p=0.921) in the 1 year post and entire follow-up periods. The rate of hospitalizations per month decreased from 0.35 (±0.19) in the baseline period to 0.19 (±0.17, p=0.016) and 0.22 (±0.21, p=0.05) in the 1 year post and entire follow-up periods. The average initial starting dose was 12.5 mg and the mean highest dose was 26.6 mg. In 14 (87.5%) patients the final dose was less than the highest dose and 4 (25.0%) patients were weaned completely off of methadone. For the entire cohort, each patient spent a median of 183 days at their highest dose, a mean of 34% of the total time treated with methadone. No patients experienced signs consistent with opioid withdrawal during the follow-up period. The most common subjective complaints were sedation (12%), nausea and/or vomiting (24%) and constipation (6%). We found no documented new abnormal QTc intervals, changes in eGFR, or new onset proteinuria during the follow up period. Conclusion Methadone use in pediatric patients with SCD is well-tolerated and may lead to improved pain control as evidence by significant reduction in hospitalizations. Additionally, when followed closely, methadone can be used safely without concern for physiologic dependency; this is supported by our ability to wean patients off methadone entirely or weaning to a lower dose than their highest dose in the majority of the cohort. Hematologists should consider methadone as a part of chronic pain management in patients with SCD and severe chronic pain. Disclosures Lebensburger: ASH: Research Funding; NHLBI K23: Research Funding.

scholarly journals Real-World Treatment Patterns, Healthcare Resource Utilization and Associated Costs Among Patients with Chronic Myeloid Leukemia in Later Lines of Therapy

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 8-9
Author(s):  
Ehab L. Atallah ◽  
Rodrigo Maegawa ◽  
Dominick Latremouille-Viau ◽  
Carmine Rossi ◽  
Annie Guerin ◽  
...  
Keyword(s):  
Medical Costs ◽  
Healthcare Resource Utilization ◽  
Treatment Patterns ◽  
Publicly Traded ◽  
Pharmaceutical Corporation ◽  
Analysis Group ◽  
Ed Visits ◽  
The Mean ◽  
Line Of Therapy

Introduction: Despite advances in tyrosine kinase inhibitor (TKI) therapy for chronic myeloid leukemia (CML), there remains a sizeable proportion of patients (pts) with CML in chronic phase who are refractory or intolerant to these agents. A good understanding of the most recent real-world patterns of care in these pts is necessary in order to provide context for assessing the potential benefits of new treatments undergoing clinical development. The aim of this study was to evaluate treatment patterns in CML pts cycling through TKI therapies achieving later lines of therapy, and to estimate their healthcare resource utilization (HRU) and costs. Methods: Adult pts with CML in the United States who received at least 3 lines of TKI therapy were identified in the IBM MarketScan Commercial and Medicare Supplement databases (Q1/2001-Q2/2019). Treatment patterns were observed from CML diagnosis. Pt characteristics were measured during the 6 months prior to third line (3L) initiation (baseline period). All-cause HRU (inpatient [IP] admissions and days, days with outpatient [OP] services, and emergency department [ED] visits) and costs (medical and pharmacy) were measured 1) during the course of 3L therapy (from 3L initiation to termination) and 2) between 3L initiation and end of follow-up (stem cell transplant [SCT], or end of data availability/health plan coverage). HRU was reported using monthly incidence rates per 100 pts (IR/100pts); costs (2019 USD) were evaluated per-pt-per-month (PPPM) from a payer's perspective. Results: Of the 48,168 pts identified with CML, a total of 296 CML pts initiated 3L therapy; median age was 58.5 years (30% were aged ≥65 years) and 50% were female. The mean follow-up period from CML diagnosis was 57.8 months and from 3L initiation was 24.5 months. Most pts had their first CML diagnosis in or after 2010 (71%) and achieved 3L in or after 2014 (50%). At baseline, the mean modified Charlson Comorbidity Index score (excluding CML) was 1.6 with 24% of pts with a score ≥3, 64% of pts had a moderate or severe Darkow Disease Complexity Index, and the most prevalent comorbidities were hypertension (45%) and diabetes (25%); 21% of pts (i.e., ≥1 indicator of congestive heart failure, cirrhosis, or end-stage renal disease, or ≥75 years old). The most common sequences of TKIs from first line (1L) to 3L were imatinib → dasatinib → nilotinib (28%), imatinib → nilotinib → dasatinib (16%), imatinib → dasatinib → imatinib (9%), and dasatinib → imatinib → nilotinib (5%). The mean duration of 1L, second line (2L), and 3L therapy was 14.9, 10.4, and 15.6 months, respectively; 62% of pts were still in 3L at the end of follow-up. Only one patient received SCT after 3L. The most common TKIs received at each line were imatinib in 1L (65%), dasatinib in 2L (49%), and nilotinib in 3L (36%). The mean treatment-free period (time between line of therapy termination and next line initiation) between 1L and 2L was 1.3 months, 2.6 months between 2L and 3L, and 1.5 months between 3L and 4L. During 3L therapy, pts had a monthly IR/100pts of 3.4 IP admissions, 21.2 IP days, 248.8 OP days, and 10.2 ED visits (Figure 1A). Pharmacy costs accounted for 69% of the mean total costs of $15,192 PPPM, with medical costs accounting for the remainder (Figure 1B). In 3L therapy and later, pts had a monthly IR/100pts of 3.5 IP admissions, 28.7 IP days, 252.2 OP days, and 10.0 ED visits (Figure 1A). Pharmacy costs accounted for 49% of the mean total costs of $18,767 PPPM, with medical costs mainly driven by IP costs (Figure 1B). Conclusions: This study characterized CML pts receiving later lines of therapy, a clinical population which has not been previously well studied with important unmet treatment needs as they repetitively fail TKI therapy. Although the majority of pts were likely fit for SCT, SCT was rare. In addition, pts quickly switched to the subsequent line of therapy, both facts suggesting that an important proportion of pts were intolerant to previous TKIs. While pharmacy costs accounted for nearly half of the total cost burden during 3L, the proportion of medical costs PPPM took more importance following 3L therapy, with IP costs being the primary cost drivers for this increase. These findings support the need for better treatment options in pts with CML undergoing later lines of therapy. Disclosures Atallah: Novartis Pharmaceutical Corporation: Consultancy; Jazz: Consultancy; Pfizer: Consultancy; Takeda: Consultancy, Research Funding; Abbvie: Consultancy; Genentech: Consultancy. Maegawa:Novartis Pharmaceutical Corporation: Current Employment, Current equity holder in publicly-traded company. Latremouille-Viau:Novartis Pharmaceutical Corporation: Consultancy, Other: Dominique Latremouille-Viau is an employee of Analysis Group, Inc. which received consultancy fees from Novartis.; Sanofi Genzyme: Consultancy, Other: Dominique Latremouille-Viau is an employee of Analysis Group, Inc. which received consultancy fees from Sanofi Genzyme.. Rossi:Novartis Pharmaceutical Corporation: Consultancy, Other: Carmine Rossi is an employee of Analysis Group, Inc. which received consultancy fees from Novartis.. Guerin:Abbvie: Consultancy, Other; Sanofi Genzyme: Consultancy, Other: Annie Guerin is an employee of Analysis Group, Inc. which received consultancy fees from Sanofi Genzyme.; Novartis Pharmaceuticals Corporation: Consultancy, Other: Annie Guerin is an employee of Analysis Group, Inc. which received consultancy fees from Novartis.. Patwardhan:Novartis Pharmaceutical Corporation: Current Employment, Current equity holder in publicly-traded company.

Sound Production Treatment for Acquired Apraxia of Speech: An Examination of Dosage in Relation to Probe Performance

2020 ◽  
pp. 1-16
Author(s):  
Julie L. Wambaugh ◽  
Lydia Kallhoff ◽  
Christina Nessler
Keyword(s):  
Retrospective Analysis ◽  
Sound Production ◽  
Apraxia Of Speech ◽  
Practice Schedule ◽  
Practice Schedules ◽  
Baseline Performance ◽  
The Mean ◽  
Number Of Treatment ◽  
The Impact

Purpose This study was designed to examine the association of dosage and effects of Sound Production Treatment (SPT) for acquired apraxia of speech. Method Treatment logs and probe data from 20 speakers with apraxia of speech and aphasia were submitted to a retrospective analysis. The number of treatment sessions and teaching episodes was examined relative to (a) change in articulation accuracy above baseline performance, (b) mastery of production, and (c) maintenance. The impact of practice schedule (SPT-Blocked vs. SPT-Random) was also examined. Results The average number of treatment sessions conducted prior to change was 5.4 for SPT-Blocked and 3.9 for SPT-Random. The mean number of teaching episodes preceding change was 334 for SPT-Blocked and 179 for SPT-Random. Mastery occurred within an average of 13.7 sessions (1,252 teaching episodes) and 12.4 sessions (1,082 teaching episodes) for SPT-Blocked and SPT-Random, respectively. Comparisons of dosage metric values across practice schedules did not reveal substantial differences. Significant negative correlations were found between follow-up probe performance and the dosage metrics. Conclusions Only a few treatment sessions were needed to achieve initial positive changes in articulation, with mastery occurring within 12–14 sessions for the majority of participants. Earlier occurrence of change or mastery was associated with better follow-up performance. Supplemental Material https://doi.org/10.23641/asha.12592190

Drug-eluting stents for treatment of focal infrapopliteal lesions

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 90-95 ◽  
Author(s):  
Rastan ◽  
Noory ◽  
Zeller
Keyword(s):  
Limb Salvage ◽  
Bare Metal Stents ◽  
Target Lesion ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Target Lesion Revascularisation ◽  
Randomized Studies ◽  
Drug Eluting ◽  
The Mean

We have investigated the role of drug-eluting stents on patency rates after treatment of focal infrapopliteal lesions in patients with intermittent claudication and critical limb ischemia. Reports indicate that drug-eluting stents reduce the risk of restenosis after percutaneous infrapopliteal artery revascularization. A Pub Med, EMBASE, Cochrane database review search of non-randomized studies investigating patency rates, target lesion revascularisation rates, limb salvage rates and mortality rates in an up to 3-year follow-up period after drug-eluting stent placement was conducted. In addition, preliminary results of randomized studies comparing drug-eluting stents with bare-metal stents and plain balloon angioplasty in treatment of focal infrapopliteal lesions were included in this review. A total of 1039 patients from 10 non-randomized and randomized studies were included. Most commonly used drug-eluting stents were sirolimus-eluting. The mean follow-up period was 12.6 (range 8 - 24). The mean 1-year primary patency rate was 86 ± 5 %. The mean target lesion revascularization rate and limb salvage rate was 9.9 ± 5 % and 96.6 %±4 %, respectively. Results from non-randomized and preliminary results from prospective, randomized trials show a significant advantage for drug-eluting stents in comparison to plain balloon angioplasty and bare-metal stents concerning target lesion patency and in parts target lesion revascularisation. No trial reveals an advantage for drug-eluting stents with regard to limb salvage and mortality.

Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 255-258 ◽  
Author(s):  
Perruchoud ◽  
Vuilleumier ◽  
Givel
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Healing Time ◽  
Incision And Drainage ◽  
The Mean ◽  
Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

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