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Journal of Medical Economics 2023Despite migraine being one of the most common neurological diseases, affected patients are often not effectively treated. This analysis describes the burden of migraine...
AIMS
Despite migraine being one of the most common neurological diseases, affected patients are often not effectively treated. This analysis describes the burden of migraine in Germany and assesses real-world treatment patterns and healthcare resource utilization (HCRU) of preventive-treated migraine patients from the perspective of Statutory Health Insurance.
METHODS
A retrospective analysis was conducted using InGef Research Database claims data from 2018-2019. Migraine patients were stratified into cohorts by acute and preventive treatment status. Patients on preventive treatment were further stratified according to the type of prophylaxis received. Disease burden in preventively treated migraine patients was reported treatment patterns, pathways, and comorbidities. HCRU was assessed through outpatient provider visits, hospitalizations, and sick leave.
RESULTS
160,164 adult migraine patients were identified, of which 55,378 (34.6%) were prescribed preventive treatment with conventional ( = 25,984, 46.9%), calcitonin gene-related peptide monoclonal antibody (CGRP mAb) ( = 613, 1.1%), or off-label therapies ( = 28,781, 52.0%). 936 (1.7%) patients received Botulinum Neurotoxin Type A (BoNTA). CGRP mAb-treated patients had a high rate of triptan prescriptions (2018: 95.5%; 2019: 88.9%), migraine-related hospitalizations (2018: 33.0%; 2019: 21.0%), and sick leave (2018: 26.8%; 2019: 22.5%). A high proportion of CGRP mAb- and BoNTA-treated patients was diagnosed with abdominal and pelvic pain (34.3% and 36.2%) and low back pain (34.1% and 35.3%). These patients also showed a high prevalence of depressive episodes (49.1% and 50.1%) and chronic pain disorders (37.5% and 32.9%).
LIMITATIONS
This study focused on descriptive analyses which do not allow for assessment of causality when comparing treatment groups.
CONCLUSIONS
Disease burden was high in patients receiving CGRP mAbs suggesting that patients treated preventively with CGRP mAbs shortly after product launch in Germany were severely affected, chronic migraine patients. The same may be true for patients receiving BoNTA who also showed an increased disease burden.
Topics: Adult; Humans; Calcitonin Gene-Related Peptide; Retrospective Studies; Migraine Disorders; Delivery of Health Care; Patient Acceptance of Health Care; Botulinum Toxins, Type A; Antibodies, Monoclonal
PubMed: 37126606
DOI: 10.1080/13696998.2023.2207413 -
Clinical Oral Investigations Jun 2023Studies have shown that mouth and respiratory tract microorganisms can be transported in aerosol and spatter. Due to aerosol-generating procedures, there are potentially... (Review)
Review
Studies have shown that mouth and respiratory tract microorganisms can be transported in aerosol and spatter. Due to aerosol-generating procedures, there are potentially various infection risks for patients and those working in health care, especially in oral health care. Dental aerosol can contaminate not only the mucous membranes of the oral health-care professional's mouth, respiratory passages, and eyes but also exposed surfaces and materials in the environment. As such, preventing disease transmission within oral health-care offices is important issue. Since the start of the COVID-19 pandemic, an innumerable amount of (mis)information and advice on how to stay safe and prevent the spread of coronavirus has been published. What preventive measures can and have been taken to counteract this, and what have we learned during the pandemic? This review summarizes relevant literature that has addressed the presence and dispersal of aerosol and spatter as a concern in health care. It includes the sources of dental aerosol, their potential health threats, and strategies for controlling and mitigating their impact. It shows that further research is needed to better understand the potential health risks of dental aerosol and to develop effective strategies for mitigating them. CLINICAL RELEVANCE: Using personal protective equipment, high-volume evacuation systems and pre-procedural antimicrobial agents can help to reduce the potential for infection in oral health-care settings and protect the well-being of oral health-care workers and their patients.
Topics: Humans; COVID-19; SARS-CoV-2; Oral Health; Pandemics; Respiratory Aerosols and Droplets
PubMed: 37162570
DOI: 10.1007/s00784-023-05034-x -
Annali Di Igiene : Medicina Preventiva... 2022The literature claims that an increased risk of complications from pertussis and influenza exists for pregnant women and infants. Maternal tetanus, diphtheria, and...
BACKGROUND
The literature claims that an increased risk of complications from pertussis and influenza exists for pregnant women and infants. Maternal tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines seem to decrease this risk so that several countries are committed to increase vaccination uptake, but not all of them know their own vaccination coverage and factors that motivate this population to vaccination.
STUDY DESIGN
A cross-sectional survey was conducted.
METHODS
We conducted this survey to estimate among pregnant women: 1) the vaccine coverage, 2) the availability of information, 3) the knowledge about maternal Tdap and influenza vaccination, 4) the factors that could have driven unvaccinated pregnant women to have themselves vaccinated. In addition, determinants of Tdap and influenza vaccine uptake and correct knowledge about vaccine-preventable diseases and vaccination in pregnancy were assessed using univariate and multivariate analyses.
RESULTS
Of the 250 women included in the present study, only 58 (23.2%, 95% Confidence Interval (CI): 18-28.4%) and 21 (8.1%, 95% CI: 5-11.8%) reported that they had been vaccinated with Tdap and influenza vaccine, respectively, during their current pregnancy. The most common reasons cited for getting themselves vaccinated was having background knowledge of the health problems due to the diseases prevented by Tdap and influenza vaccines, awareness regarding these vaccines being recommended in pregnancy, knowledge of their effectiveness and/or side effects, and having been informed about vaccination by a healthcare professional.
CONCLUSIONS
Influenza and Tdap vaccine uptake among pregnant women in Italy is low, however, the present study showed that women are available to get vaccinated during pregnancy when adequately informed about the vaccines recommended.
Topics: Cross-Sectional Studies; Diphtheria; Diphtheria-Tetanus-acellular Pertussis Vaccines; Female; Humans; Infant; Influenza Vaccines; Influenza, Human; Pregnancy; Tetanus; Vaccination; Whooping Cough
PubMed: 35195239
DOI: 10.7416/ai.2022.2503 -
Drug Safety Mar 2022Medication-related problems often lead to patient harm. This paper aims to review the Australian literature to determine the overall incidence, severity and... (Review)
Review
INTRODUCTION
Medication-related problems often lead to patient harm. This paper aims to review the Australian literature to determine the overall incidence, severity and preventability of medication-related hospital admissions, as well as providing a national estimate on their extent and cost.
METHODS
The first part of the paper includes a literature search to identify studies that provided estimates of medication-related problems that caused hospital admissions. Incidence of medication-related hospital admissions, type of medication-related problem contributing to admission (e.g. adverse medicine reaction) and method used to estimate incidence (e.g. chart review) were extracted. Data on severity and preventability of the admissions were extracted where available. The second part of the paper involves use of methodological triangulation to estimate the extent and cost of medication-related hospital admission. Median estimates used to assess medication-related hospital admissions and the 2019-2020 national hospital admissions data were used to calculate the national estimate on the extent of medication-related hospital admission. Costs were also estimated.
RESULTS
Seventeen studies provided estimates on the extent of medication-related hospital admissions as assessed using medication chart review. The median incidence of 2.5% (interquartile range [IQR] 0.6%) as a proportion of all hospital admissions suggests 275,000 hospital admissions annually in Australia are medication related. The median incidence of 9% (IQR 3.9%) of emergency admissions suggests that 270,000 admissions annually are medication related. Eight studies provided estimates of the extent of medication-related hospital admissions identified from administrative health data; the median incidence of 1.7% with an under-reporting rate of 82% suggests 280,000 hospital admissions annually are medication related. Triangulation of results suggests that at least 250,000 hospital admissions annually in Australia are medication related, with an estimated cost of 1.4 billion Australian dollars (AUD$). Five studies assessed severity, and nine studies assessed preventability. Preventability estimates suggest two-thirds of medication-related hospital admissions are potentially preventable.
CONCLUSIONS
We estimated that 250,000 hospital admissions in Australia are medication related, with an annual cost of AUD$1.4 billion to the healthcare system. Two-thirds of medication-related hospital admissions are potentially preventable.
Topics: Australia; Drug-Related Side Effects and Adverse Reactions; Hospitalization; Hospitals; Humans; Incidence
PubMed: 35089582
DOI: 10.1007/s40264-021-01144-1 -
Antimicrobial Resistance and Infection... Nov 2020Central line-associated bloodstream infections (CLABSI) are largely preventable when evidence-based guidelines are followed. However, it is not clear how well these... (Review)
Review
BACKGROUND
Central line-associated bloodstream infections (CLABSI) are largely preventable when evidence-based guidelines are followed. However, it is not clear how well these guidelines are followed in intensive care units (ICUs) in China. This study aimed to evaluate Chinese ICU nurses' knowledge and practice of evidence-based guidelines for prevention of CLABSIs issued by the Centers for Disease Control and Prevention, US and the Department of Health UK.
METHOD
Nurses completed online questionnaires regarding their knowledge and practice of evidence-based guidelines for the prevention of CLABSIs from June to July 2019. The questionnaire consisted of 11 questions, and a score of 1 was given for a correct answer (total score = 0-11).
RESULTS
A total of 835 ICU nurses from at least 104 hospitals completed the questionnaires, and 777 were from hospitals in Guangdong Province. The mean score of 11 questions related to evidence-based guidelines for preventing CLABSIs was 4.02. Individual total scores were significantly associated with sex, length of time as an ICU nurse, educational level, professional title, establishment, hospital grade, and incidence of CLABSIs at the participant's ICU. Importantly, only 43% of nurses reported always using maximum barrier precautions, 14% of nurses reported never using 2% chlorhexidine gluconate for antisepsis at the insertion site, only 40% reported prompt removal of the catheter when it was no longer necessary, and 33% reported frequently and routinely changing catheters even if there was no suspicion of a CLABSI.
CONCLUSION
Chinese ICU nurses in Guangdong Province lack of knowledge and practice of evidence-based guidelines for the prevention of CLABSIs. National health administrations should adopt policies to train ICU nurses to prevent CLABSIs.
Topics: Adolescent; Adult; Aged; Bacteremia; Catheter-Related Infections; Central Venous Catheters; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Intensive Care Units; Male; Middle Aged; Nurses; Practice Guidelines as Topic; Surveys and Questionnaires; Young Adult
PubMed: 33198796
DOI: 10.1186/s13756-020-00833-3 -
Frontiers in Endocrinology 2022Falls occur frequently among older individuals, leading to high morbidity and mortality. This study was to assess the efficacy of vitamin D in preventing older... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Falls occur frequently among older individuals, leading to high morbidity and mortality. This study was to assess the efficacy of vitamin D in preventing older individuals from falling.
METHODS
We searched the PubMed, Cochrane Library, and EMBASE databases systematically using the keywords "vitamin D" and "fall" for randomized controlled trials (RCTs) comparing the effects of vitamin D with or without calcium supplements with those of a placebo or no treatment on fall incidence in adults older than 50 years. A meta-analysis was performed to calculate risk ratios (RRs), absolute risk differences (ARDs) and 95% CIs with random-effects models.
RESULTS
A total of 38 RCTs involving 61 350 participants fulfilled the inclusion criteria. Compared with placebo, high-dose vitamin D (≥ 700 IU) can prevent falls [RR, 0.87 (95% CI 0.79 to 0.96); ARD, -0.06 (95% CI, -0.10 to -0.02)]. Low-dose vitamin D (<700 IU) was not significantly associated with falls. Subgroup analysis showed that supplemental calcium, 25(OH) D concentration and frequency influenced the effect of vitamin D in preventing falls. Sensitivity analysis showed that vitamin D prevented falls, which was consistent with the primary analysis. In addition, the active form of vitamin D also prevented falls.
CONCLUSION
In this meta-analysis of RCTs, doses of 700 IU to 2000 IU of supplemental vitamin D per day were associated with a lower risk of falling among ambulatory and institutionalized older adults. However, this conclusion should be cautiously interpreted, given the small differences in outcomes.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42020179390.
Topics: Accidental Falls; Aged; Calcium; Dietary Supplements; Humans; Vitamin D; Vitamins
PubMed: 36034418
DOI: 10.3389/fendo.2022.919839 -
Journal of Preventive Medicine and... Dec 2023Nurses have good opportunities to communicate with osteoporotic patients and the public as well as convey osteoporosis prevention education to them. Therefore, nurses...
BACKGROUND
Nurses have good opportunities to communicate with osteoporotic patients and the public as well as convey osteoporosis prevention education to them. Therefore, nurses require specific knowledge, attitude, practice (KAP), and desirable nutritional behaviors for osteoporosis prevention and treatment strategies. Little is known about the KAP for osteoporosis prevention and nutritional behaviors among nurses in Iran.
PURPOSE
The present study was conducted to evaluate nurses' KAP and nutritional behaviors for osteoporosis prevention.
METHODS
This cross-sectional study included 195 nurses working in three hospitals in southeastern Iran. Nurses were selected using a stratified random sampling method between April and June 2020. The data collection tools included questionnaires of KAP and nutritional behaviors to prevent osteoporosis.
FINDINGS
According to the findings, nurses' knowledge regarding osteoporosis prevention was high level (20.23 ± 3.79) and their attitude (72.71 ± 6.97), practice (48.25 ± 6.38), and nutritional behavior scores (110.12 ± 13.68) were desirable. In addition, nurses' KAP regarding osteoporosis prevention was correlated with their nutritional behaviors (p = 0.001).
CONCLUSIONS
Given the high levels of knowledge, desirable practices, and in Iranian nurses regarding the prevention of osteoporosis, they can play a significant role in changing KAP and nutritional behaviors of people to prevent this disease. To this end, educational and support programs should be implemented in clinical and community settings to develop a healthy lifestyle in the community.
Topics: Humans; Cross-Sectional Studies; Iran; Health Knowledge, Attitudes, Practice; Clinical Competence; Surveys and Questionnaires; Osteoporosis; Nurses
PubMed: 38379736
DOI: 10.15167/2421-4248/jpmh2023.64.4.2709 -
World Journal of Urology Jan 2022Urinary stone disease is a common disease with a prevalence of 4.7% in Germany. The incidence increased over the last decades, and recurrence rates are up to 50% in the...
PURPOSE
Urinary stone disease is a common disease with a prevalence of 4.7% in Germany. The incidence increased over the last decades, and recurrence rates are up to 50% in the first 5 years after diagnosis. Adequate preventive measures can avoid up to 46% of stone recurrences. These numbers outline the importance of prevention. Especially among high-risk stone formers, specific diagnostics and measures are required. Published data indicate the divergence between the importance of prevention and its implementation in everyday clinical practice. This is the first survey among German urological departments highlighting medical care concerning the prevention of recurrent urinary stone disease, identifying challenges and providing recommendations for improvements.
METHODS
Two hundred and seventy urological hospital departments in Germany were anonymously surveyed about measurements to prevent recurrent stone disease. The questionnaire comprised 23 items dealing with diagnostics, counselling, knowledge among doctors concerning preventive measures and difficulties in preventing recurrent urinary stone disease.
RESULTS
Sixty-three urological departments (23.8%) answered the survey. The majority perform stone analysis at first and repeat events. Most patients with urinary stone disease receive general advice on preventive measures during their hospitalization. General recommendations focus on fluid intake and lifestyle changes. However, specific diets are infrequently recommended by inpatient urologists. Diagnostics to identify high-risk stone formers are mostly insufficient, and guideline-compliant urine tests are uncommon.
CONCLUSION
The quality of secondary prevention needs to improve considerably. The focus should be put on identifying high-risk stone formers and offering those patients specific counselling. Furthermore, general advice on dietary recommendations should be extended.
Topics: Germany; Hospitalization; Humans; Recurrence; Urinary Calculi
PubMed: 34406436
DOI: 10.1007/s00345-021-03813-3 -
Current Opinion in Anaesthesiology Feb 2023Delirium is a marker of acute brain insufficiency and a harbinger of poor outcomes and increased healthcare costs. Despite success preventing delirium by... (Review)
Review
PURPOSE OF REVIEW
Delirium is a marker of acute brain insufficiency and a harbinger of poor outcomes and increased healthcare costs. Despite success preventing delirium by nonpharmacologic measures, the incidence in the postcardiac surgical ICU population remains high. Dexmedetomidine, a selective alpha-2 agonist, is a plausible preventive agent with sedative, anxiolytic, analgesic, sympatholytic and anti-inflammatory properties, and is the subject of very active study in cardiac surgery populations.
RECENT FINDINGS
Recent trials, including DEXACET (2019), DECADE (2020), LOWDEXDEL (2021), and DIRECT (2022) individually, failed to show a benefit for dexmedetomidine and highlighted associated risks. Meta-analyses have offered conflicting results, highlighting the complexity of delirium, and likely interaction of multiple etiological pathways; those that concluded benefit often were driven by trials at high risk of bias. Meta-analyses excluding biased trials currently suggest no benefit for dexmedetomidine over control in unselected cardiac surgical populations.
SUMMARY
Although using dexmedetomidine to prevent delirium in unselected cardiac surgical patients is not supported by current evidence, there remains hope that it may offer benefits in highly selected populations, and further trials are ongoing.
Topics: Humans; Dexmedetomidine; Delirium; Hypnotics and Sedatives; Cardiac Surgical Procedures; Intensive Care Units
PubMed: 36342329
DOI: 10.1097/ACO.0000000000001207 -
World Neurosurgery Dec 2023Meningiomas are one of the most common benign primary brain tumors; however, there is a paucity of literature on potential preventability. This comprehensive review... (Review)
Review
BACKGROUND
Meningiomas are one of the most common benign primary brain tumors; however, there is a paucity of literature on potential preventability. This comprehensive review aimed to explore the existing evidence for the potential risk factors that may contribute to meningioma development and to discuss early prevention strategies.
METHODS
Literature search was conducted via MEDLINE, Embase, Web of Science, and Cochrane Database to retrieve existing literature on various environmental exposures and lifestyle behaviors that are potential risk factors for the development of meningiomas.
RESULTS
Significant risk factors included exposure to ionizing radiation and certain environmental chemicals. Notably, this study also identified that cigarette smoking and obesity are associated with the development of meningiomas. To date, wireless phone usage, hormonal exposures, dietary factors, and traumatic brain injury remain inconclusive. Early prevention strategies should primarily be family-driven, community-based, and public health-endorsed strategies. Targeting unhealthy behaviors through healthcare organizations could execute a pivotal role in the maintenance of an optimum lifestyle, reducing the development of risk factors pertinent to meningiomas.
CONCLUSIONS
To our knowledge, this is the first study that offers a perspective on prevention of meningiomas. A causal relationship of risk factors in developing meningiomas cannot be directly established with the current evidence. We are aware of the limitations of the hypothesis, but we believe that this study will raise more awareness and our findings could potentially be endorsed by organizations promoting health across the globe. Further prospective and retrospective studies will shed more light on this topic and help establish a definitive relationship.
Topics: Humans; Meningioma; Retrospective Studies; Brain Neoplasms; Risk Factors; Meningeal Neoplasms
PubMed: 37774783
DOI: 10.1016/j.wneu.2023.09.075