scholarly journals Surgical management of benign prostatic obstruction: 20-year population-level trends

2019 ◽  
Vol 14 (8) ◽  
Author(s):  
Joseph LaBossiere ◽  
Christopher Wallis ◽  
Sender Herschorn ◽  
Lesley Carr ◽  
Refik Saskin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Management ◽  
Primary Outcome ◽  
Population Level ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Benign Prostatic Obstruction ◽  
Laser Prostatectomy ◽  
Endoscopic Laser ◽  
Adjusted Rate

Introduction: Benign prostatic obstruction (BPO) due to histologic benign prostatic hyperplasia is highly prevalent among older men. Despite widespread use of medical therapy, surgical treatment remains a mainstay in the management of BPO. We sought to characterize trends in the surgical management of BPO in Ontario, Canada. Methods: We performed an interrupted time-series analysis using segmented regression among men aged 18 years and older undergoing surgical treatment for BPO between January 1, 1994 and December 31, 2014 in Ontario, Canada. The passage of time was considered the primary exposure. The primary outcome was the proportion of all BPO surgeries performed using each of the following modalities: transurethral resection of the prostate (TURP), endoscopic laser prostatectomy, open/laparoscopic prostatectomy, and others. Results: We identified 136 459 men who underwent BPO surgery between 1994 and 2014. The annual age-adjusted rate of BPO surgery declined significantly over time (24 to 10 per 10 000 population in 1994 and 2014, respectively). From 1994 to 2001, there were no significant changes in the distribution of BPO surgical modalities with TURP, the most common throughout (97.2% and 97% in 1994 and 2001, respectively). From 2002 to 2014, there was a significant decline in the use of TURP (92.1% to 76.9%; p=0.027) with a corresponding increase in the use of endoscopic laser prostatectomy (3.5% to 21.9%; p=0.0008). Conclusions: This study demonstrates a shift in the management of BPO, with increasing use of endoscopic laser prostatectomy, beginning in 2002. However, TURP remains the most common treatment modality.

scholarly journals Changes in the dollar value of per capita alcohol, essential, and non-essential retail sales in Canada during COVID-19

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel T. Myran ◽  
Brendan T. Smith ◽  
Nathan Cantor ◽  
Lennon Li ◽  
Sudipta Saha ◽  
...  
Keyword(s):  
Time Series ◽  
Alcohol Use ◽  
Population Level ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Retail Sales ◽  
Ongoing Research ◽  
Per Capita ◽  
Statistics Canada ◽  
Alcohol Sales

Abstract Background Multiple survey reports suggest that alcohol use has increased in Canada during the COVID-19 pandemic. However, less is known about how per capita alcohol sales, which predict population-level alcohol use, have changed and whether changes in alcohol sales differ from changes in sales of other products due to pandemic factors. Methods We obtained monthly retail sales data by industry from Statistics Canada, for the six largest provinces in Canada (containing 93% of the national population), between January 2010 and November 2020, representing time before and 9 months after the start of the pandemic in Canada. We used an interrupted time series analysis to estimate pandemic impacts on the dollar value of monthly per capita (per individuals 15+ years) alcohol, essential and non-essential retail sales. We adjusted our analyses for pre-pandemic sales trends, inflation, seasonality and changing population demographics over time. Results During the first 9 months of the pandemic, the values of per capita alcohol, essential and non-essential sales were, respectively, 13.2% higher, 3.6% higher and 13.1% lower than the average values during the same period in the prior 3 years. Interrupted time series models showed significant level change for the value of monthly per capita alcohol sales (+$4.86, 95% CIs: 2.88, 6.83), essential sales (−$59.80, 95% CIs: − 78.47, − 41.03) and non-essential sales (−$308.70, 95% CIs: − $326.60, − 290.79) during the pandemic. Alcohol sales were consistently elevated during the pandemic, and the pre- and post-pandemic slopes were comparable. In contrast, essential and non-essential retail sales declined in the early months of the pandemic before returning to regular spending levels. Conclusion During the first 9 months of the pandemic, per capita alcohol sales were moderately elevated in Canada. In contrast, non-essential sales were lower than prior years, driven by large decreases during the initial months of the pandemic. These findings suggest that the pandemic was associated with increased population-level alcohol consumption, which may lead to increased alcohol-related harms. Ongoing research is needed to examine how factors, including pandemic-related stressors and specific alcohol sales-related policies, may have influenced changes in alcohol use and harms.

scholarly journals Assessment of the Impact of COVID-19 pandemic on population level interest in Skincare: Evidence from a google trends-based Infodemiology study

2020 ◽  
Author(s):  
Hasan Symum ◽  
Md. F. Islam ◽  
Habsa K. Hiya ◽  
Kh M. Ali Sagor
Keyword(s):  
Time Series ◽  
Moving Average ◽  
Arima Model ◽  
Population Level ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Search Volume ◽  
Quasi Experimental ◽  
Relative Search Volume ◽  
The Impact

AbstractBackgroundCOVID-19 pandemic created an unprecedented disruption of daily life including the pattern of skin related treatments in healthcare settings by issuing stay-at-home orders and newly coronaphobia around the world.ObjectiveThis study aimed to evaluate whether there are any significant changes in population interest for skincare during the COVID-19 pandemic.MethodsFor the skincare, weekly RSV data were extracted for worldwide and 23 counties between August 1, 2016, and August 31, 2020. Interrupted time-series analysis was conducted as the quasi-experimental approach to evaluate the longitudinal effects of COVID-19 skincare related search queries. For each country, autoregressive integrated moving average (ARIMA) model relative search volume (RSV) time series and then testing multiple periods simultaneously to examine the magnitude of the interruption. Multivariate linear regression was used to estimate the correlation between countries’ relative changes in RSV with COVID-19 confirmed cases/ per 10000 patients and lockdown measures.ResultsOut of 23 included countries in our study, 17 showed significantly increased (p<0.01) RSVs during the lockdown period compared with the ARIMA forecasted data. The highest percentage of increments occurs in May and June 2020 in most countries. There was also a significant correlation between lockdown measures and the number of COVID-19 cases with relatives changes in population interests for skincare.ConclusionUnderstanding the trend and changes in skincare public interest during COVID-19 may assist health authorities to promote accessible educational information and preventive initiatives regarding skin problems.

The Impact of the Affordable Care Act on Burn Outcomes

2020 ◽  
Author(s):  
Justin E Dvorak ◽  
Erica L W Lester ◽  
Patrick J Maluso ◽  
Leah C Tatebe ◽  
Faran Bokhari
Keyword(s):  
Time Series ◽  
Low Socioeconomic Status ◽  
Affordable Care Act ◽  
Population Level ◽  
Interrupted Time Series ◽  
Home Health ◽  
Interrupted Time Series Analysis ◽  
Post Discharge ◽  
The Affordable Care Act ◽  
The Impact

Abstract Uninsured and low socioeconomic status patients who suffer burn injuries have disproportionately worse morbidity and mortality. The Affordable Care Act was signed into law with the goal of increasing access to insurance, with Medicaid expansion in January 2014 having the largest impact. To analyze the population-level impact of the Affordable Care Act on burn outcomes, and investigate its impact on identified at-risk subgroups, a retrospective time series of patients was created using data from the Healthcare Cost and Utilization Project National Inpatient Sample database between 2011 and 2016. An interrupted time series analysis was conducted to examine mortality, length of stay, and the probabilities of discharge home, home with home health, and to another facility before and after January 2014. There were no changes in burn mortality detected. There was a statistically significant reduction in the probability of being discharged home (−0.000967, P &lt; .01; 95% confidence interval [CI] −0.0015379 to −0.0003962) or discharged home with home health (−0.000709, P &lt; .01; 95% CI −0.00110 to 0.000317) after 2014. There was an increase in the probability of being discharged to another facility (0.00108, P = .01; 95% CI 0.000282–0.00188). While the enactment of the major provisions of the Affordable Care Act in 2014 was not associated with a change in mortality for burn patients, it was associated with more patients being discharged to a facility: This may represent a significant improvement in access to care and rehabilitation. Future studies will assess the societal and economic impact of improved access to post-discharge facilities and rehabilitation.

scholarly journals Impact of COVID-19 Pandemic on Population-Level Interest in Skincare: Evidence from a Google Trends

2021 ◽  
pp. 147-160
Keyword(s):  
Time Series ◽  
Public Interest ◽  
Moving Average ◽  
Arima Model ◽  
Population Level ◽  
Interrupted Time Series ◽  
Limited Information ◽  
Interrupted Time Series Analysis ◽  
Search Volume ◽  
The World

COVID-19 pandemic created an unprecedented disruption of daily life including the pattern of skincare in healthcare settings by issuing stay-at-home orders around the world. There has been limited information about trends of skincare-related public interest during CVOID-19 and whether any substantial disruption in population-level behavior. The objective of this study is to evaluate the change in skincare-related population interest around the world during the COVID-19 pandemic time. Weekly RSV data were extracted worldwide and in 25 counties between August 1, 2016, and August 31, 2020. Interrupted time-series analysis was conducted as the quasi-experimental approach to evaluate the longitudinal effects of COVID-19 skincare-related search queries. For each country, autoregressive integrated moving average (ARIMA) model relative search volume (RSV) time series and then testing multiple periods simultaneously to examine the magnitude of the interruption. Multivariate linear regression was used to estimate the correlation between the relative changes in RSV with COVID-19 confirmed cases/ per million population and lockdown measures. Of 25 included countries in our study, 17 showed significantly increased (p<0.01) RSVs during the lockdown period compared with ARIMA forecasted data. The highest percentage of increments occurs in May and June in most countries. There was also a significant correlation between lockdown measures and the number of COVID-19 cases with relative changes in population interests for skincare. Understanding the trend and changes in skincare public interest during COVID-19 may assist health authorities to promote accessible educational information and preventive initiatives regarding skin problems.

scholarly journals Population-level impact of infant 10-valent pneumococcal conjugate vaccination on adult pneumonia hospitalisations in Finland

Thorax ◽  
2017 ◽  
Vol 73 (3) ◽  
pp. 262-269 ◽  
Author(s):  
Omar Okasha ◽  
Hanna Rinta-Kokko ◽  
Arto A Palmu ◽  
Esa Ruokokoski ◽  
Jukka Jokinen ◽  
...  
Keyword(s):  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Population Level ◽  
Interrupted Time Series ◽  
The Elderly ◽  
Negative Binomial Regression Model ◽  
Interrupted Time Series Analysis ◽  
Entire Study ◽  
Before And After ◽  
International Statistical Classification

IntroductionLimited data are available on population-level herd effects of infant 10-valent pneumococcal conjugate vaccine (PCV10) programmes on pneumonia. We assessed national trends in pneumococcal and all-cause pneumonia hospitalisations in adults aged ≥18 years, before and after infant PCV10 introduction in 2010.MethodsMonthly hospitalisation rates of International Statistical Classification of Diseases, 10th revision (ICD-10)-coded primary discharge diagnoses compatible with pneumonia from 2004–2005 to 2014–2015 were calculated with population denominators from the population register. Trends in pneumonia before and after PCV10 introduction were assessed with interrupted time-series analysis. Rates during the PCV10 period were estimated from adjusted negative binomial regression model and compared with those projected as continuation of the pre-PCV10 trend. All-cause hospitalisations were assessed for control purposes.ResultsBefore PCV10, the all-cause pneumonia rate in adults aged ≥18 years increased annually by 2.4%, followed by a 4.7% annual decline during the PCV10 period. In 2014–2015, the overall all-cause pneumonia hospitalisation rate was 109.3/100 000 (95% CI 96.5 to 121.9) or 15.4% lower than the expected rate. A significant 6.7% decline was seen in persons aged ≥65 years (131.5/100 000), which translates to 1456 fewer pneumonia hospitalisations annually. In comparison, hospitalisations other than pneumonia decreased by 3.5% annually throughout the entire study period.ConclusionThese national data suggest that herd protection from infant PCV10 programme has reversed the increasing trend and substantially decreased all-cause pneumonia hospitalisations in adults, particularly the elderly.

Comparison of intermittent audit vs daily documentation of pharmacist interventions

2020 ◽  
Author(s):  
Hannah Turton ◽  
Ceridwen Jones ◽  
Russell Levy ◽  
Asad E Patanwala
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Primary Outcome ◽  
Hospital Setting ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Pharmacist Interventions ◽  
Unpaired Student ◽  
The Mean

Abstract Purpose To compare an intermittent audit method vs a daily documentation method with regard to the number of interventions documented by clinical pharmacists in the hospital setting. Methods A 2-phase pre-post cohort study was conducted at an academic hospital to compare numbers and types of pharmacist interventions documented over an 18-month period before implementation of a daily documentation method (the “pre-phase” period) and during the 6 months after implementation (the “post-phase” period). During the pre-phase period (January 2018 to July 2019), pharmacists prospectively documented interventions on specific audit days. The audit days occurred at approximately monthly intervals. During the post-phase period (July 2019 to March 2020) pharmacists used electronic medical record tools to document interventions daily. The primary outcome was the total number of interventions per day. Values for the pre- and post-phase periods were compared using an unpaired Student t test and through interrupted time series analysis. Results There were a total of 3,628 interventions (on 14 intermittent audit days) during the pre-phase period and 9,300 interventions (on 163 continuous days) in the post-phase period. The mean (SD) number of reported interventions per day decreased from 259 (82) in the pre-phase period to 57 (33) in the post-phase period (P &lt; 0.001). The mean (SD) number of daily reported interventions per pharmacist decreased from 24 (5) in the pre-phase period to 6 (2) in the post-phase period (P &lt; 0.001). This decrease was consistent with results of the interrupted time series analysis. There was a decrease in reported interventions at the time of implementation (change from most recent audit day, –125 interventions; 95% confidence interval [CI], –187 to –62 interventions; P &lt; 0.001). Similarly, there was a decrease in reported interventions per pharmacist at the time of implementation (change from most recent audit day, –22 [95% CI, –26 to –18] interventions; P &lt; 0.001). Conclusion A change from intermittent audits to daily documentation of interventions resulted in an approximately 5-fold decrease in the number of interventions recorded by pharmacists.

scholarly journals MP13-10 SURGICAL MANAGEMENT OF BENIGN PROSTATIC OBSTRUCTION: 20-YEAR POPULATION-LEVEL TRENDS

2017 ◽  
Vol 197 (4S) ◽  
Author(s):  
Christopher Wallis ◽  
Lesley Carr ◽  
Sender Herschorn ◽  
Refik Saskin ◽  
Sidney Radomski ◽  
...  
Keyword(s):  
Surgical Management ◽  
Population Level ◽  
Benign Prostatic Obstruction

scholarly journals 77. Out of Sight, Out of Mind: Impact of an Antimicrobial Stewardship Bundle on Fluoroquinolone Utilization

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S56-S56
Author(s):  
Blade W Black ◽  
Stephanie Harding ◽  
Kathy Beadle
Keyword(s):  
Antimicrobial Stewardship ◽  
Primary Outcome ◽  
Control Variable ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
E Coli ◽  
Antimicrobial Usage ◽  
Days Of Therapy ◽  
The Mean ◽  
The Impact

Abstract Background Fluoroquinolones are broad spectrum antimicrobials associated with a growing list of adverse effects, such as Clostridioides difficile infection, arrhythmias, central nervous system effects, tendon rupture and aortic aneurysm. Due to increasing concerns regarding adverse events and growing resistance, the antimicrobial stewardship team at Wesley Healthcare implemented a bundle aimed at reducing fluoroquinolone usage beginning in June 2017. The components of this bundle included suppression of fluoroquinolone susceptibility in Enterobacteriaceae isolates, removal of fluoroquinolones as first line options on order sets, and introduction of a respiratory specific antibiogram. Methods The objective was to evaluate the impact of the stewardship bundle on fluoroquinolone utilization. The primary outcome was ciprofloxacin and levofloxacin usage in days of therapy per 1000 inpatient days (DOT) collected at monthly intervals for 24 months before and after intervention. Overall antimicrobial usage in DOT served as a control variable. The secondary outcomes were E. coli and P. aeruginosa susceptibility to ciprofloxacin measured at the same time points as the primary outcome. An interrupted time-series analysis using segmented regression was performed for all variables. Results The mean monthly levofloxacin usage was reduced from 14.1 (95% CI, 12.7 - 15.4) to 8.4 (95% CI, 7.6 - 9.3) DOT. The mean monthly ciprofloxacin usage was reduced from 26.9 (95% CI, 24.6 - 29.4) to 15.8 (95% CI, 14.0 - 17.5) DOT. The trend in levofloxacin usage was reduced (p=0.035), while a pre-existing downward trend in ciprofloxacin usage was unchanged (p=NS). Overall antimicrobial usage increased, likely due to increasing hematology/oncology populations during the study period. There were no differences in E. coli or P. aeruginosa susceptibilities observed. Conclusion This antimicrobial stewardship bundle may be a useful intervention to reduce fluoroquinolone usage. The bundle may be of particular utility in reducing levofloxacin usage, as our results demonstrated a change in both its usage and trend in usage. Disclosures All Authors: No reported disclosures

scholarly journals The impact of COVID-19 on outpatient antibiotic prescriptions in Ontario, Canada; An interrupted time series analysis

2021 ◽  
Author(s):  
Taito Kitano ◽  
Kevin A Brown ◽  
Nick Daneman ◽  
Derek R MacFadden ◽  
Bradley J Langford ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Respiratory Infections ◽  
Population Level ◽  
Interrupted Time Series ◽  
Relative Reduction ◽  
Antibiotic Prescribing ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
The Impact

Abstract Background The COVID-19 pandemic has potentially impacted outpatient antibiotic prescribing. Investigating this impact may identify stewardship opportunities in the ongoing COVID-19 period and beyond. Methods We conducted an interrupted time series analysis on outpatient antibiotic prescriptions and antibiotic prescriptions/patient visits in Ontario, Canada between January 2017 and December 2020 to evaluate the impact of the COVID-19 pandemic on population-level antibiotic prescribing by prescriber’s specialty, patient demographics and conditions. Results In the evaluated COVID-19 period (March-December 2020), there was a 31.2% [95% CI: 27.0%–35.1%] relative reduction in total antibiotic prescriptions. Total outpatient antibiotic prescriptions decreased during the COVID-19 period by 37.1% [32.5%–41.3%] among family physicians, 30.7% [25.8%–35.2%] among sub-specialist physicians, 12.1% [4.4%–19.2%] among dentists and 25.7% [21.4%–29.8%] among other prescribers. Antibiotics indicated for respiratory infections decreased by 43.7% [38.4–48.6%]. Total patient visits and visits for respiratory infections decreased by 10.7% [5.4%–15.6%] and 49.9% [43.1%%–55.9%]). Total antibiotic prescriptions/1,000 visits decreased by 27.5% [21.5%–33.0%], while antibiotics indicated for respiratory infections/1,000 visits with respiratory infections only decreased by 6.8% [2.7%–10.8%]. Conclusion The reduction in outpatient antibiotic prescribing during the COVID-19 pandemic was driven by less antibiotic prescribing for respiratory indications and largely explained by decreased visits for respiratory infections.

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