scholarly journals FRI0527 THE EFFECT OF A NURSE-LED PREDNISOLONE TAPERING REGIME IN POLYMYALGIA RHEUMATICA: A RETROSPECTIVE COHORT STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 863.2-863
Author(s):  
C. Mork ◽  
M. Yde Matthiesen ◽  
M. Callsen ◽  
K. Keller
Keyword(s):  
Cohort Study ◽  
Usual Care ◽  
Retrospective Cohort Study ◽  
Polymyalgia Rheumatica ◽  
Retrospective Cohort ◽  
Standard Care ◽  
Care Group ◽  
Standard Care Group ◽  
Prednisolone Dose ◽  
Prednisolone Treatment

Background:The cornerstone treatment of polymyalgia rheumatic (PMR) is prednisolone, which has several side effects such as osteoporosis and type 2 diabetes [1]. Therefore, the duration of prednisolone treatment should be as short as possible. Previous studies indicate that only 10-30% has discontinued prednisolone after 1 year and approximately 50% after 2 years [2].Objectives:To investigate the efficacy of a nurse-led prednisolone tapering regime in patients with PMR compared to usual care.Methods:The study is a single center retrospective cohort study with a 2-year follow-up. Prednisolone dose was evaluated after 1 and 2 years.A nurse-led PMR clinic was introduced June 1st, 2015 and patients diagnosed until June 7th, 2017 were included. Patients were diagnosed by a physician, and subsequently managed by nurses according to a specific protocol, with prednisolone tapering from 15 mg to discontinuation after 52 weeks. Regularly blood tests and telephone interviews were performed and a rheumatologist was involved if deemed necessary.Patients diagnosed with PMR between June 1st, 2012 and June 1st, 2015 served as controls. They received standard care by a rheumatologist.The Danish guidelines for managing PMR remained unchanged throughout the study period.The study population was identified by searching the electronic patient journal for the PMR diagnosis. Data collection was performed by four experienced reumatologists. Data were obtained from the Electronic Patient Journal of Central Denmark Region and recorded in the RedCap database.Results:Five hundred and seventy patients were screened. Patients not diagnosed with PMR, with simultaneously giant cell arteritis, with relapse of known PMR, or prednisolone treatment for more than 4 weeks prior to the diagnosis were excluded. Sixty eight patients received standard care and 107 nurse-led care. There was no statistical difference between groups regarding reason for exclusion.At baseline there was no difference between patients receiving standard care and nurse-led care regarding gender, mean age (70.7 years vs. 72.2 years), clinical findings, symptoms, level of C-reactive protein (43.4 mg/L vs. 39.7 mg/L), anti-citrullinated protein antibody and reumatoid factor status. Median (IQR) prednisolone starting dose in the standard care group was 15 mg (15-25) vs. 15 mg (15-15) in the nurse-led care group (p=0.008).After 1 year 29.4% of patients receiving standard care had discontinued prednisolone vs. 35.5% receiving nurse-led care (p=0.403). Median (IQR) prednisolone dose after 1 year was 3.75 mg (0-5) in the standard care group and 1.25 mg (0-3.75) in nurse-led care group (p=0.004). After 2 years 60.3% of patients receiving standard had discontinued prednisolone vs. 82.2% receiving nurse-led care (p=0.001). Median (IQR) prednisolone dose after 2 years was 0 mg (0-2.5) in the standard care group and 0 mg (0-0) in the nurse-led care group (p=0.004). There was no difference between groups regarding relapse of PMR and initiation of MTX treatment in either year 1 or 2.Conclusion:A tight and systematic approach to prednisolone tapering in PMR is more effective than usual care. The results should be confirmed in a prospective setting.References:[1] Gabriel SE, Sunku J, Salvarani C, O’Fallon WM, Hunder GG. Adverse outcomes of antiinflammatory therapy among patients with polymyalgia rheumatica. Arthritis Rheum 1997; 40(10):1873-8.[2] Muratore F, Pipitone N, Hunder GG, Salvarani C. Discontinuation of therapies in polymyalgia rheumatica and giant cell arteritis. Clin Exp Rheumatol 2013; 31(4 Suppl 78):S86-92.Disclosure of Interests:None declared

scholarly journals ASSESSMENT OF TIME IN THERAPEUTIC RANGE WITH WARFARIN THERAPY IN PHARMACIST VERSUS USUAL CARE GROUP: A RETROSPECTIVE COHORT STUDY

2020 ◽  
pp. 68-71
Author(s):  
DANIEL MAJERCZYK ◽  
KIMBERLY RUSCHE ◽  
PRASHANT SAKHARKAR
Keyword(s):  
Cohort Study ◽  
Usual Care ◽  
Therapeutic Range ◽  
Retrospective Cohort Study ◽  
Usual Care Group ◽  
Retrospective Cohort ◽  
Warfarin Therapy ◽  
Care Group ◽  
Chads2 Score ◽  
Pharmacist Care

Objective: Anticoagulation management with warfarin is a familiar challenge seen in primary care settings. A greater time in the therapeutic range (TTR) has shown improved health benefits in patients treated with warfarin for atrial fibrillation. The aim of this study was to assess the level of anticoagulation control achieved with warfarin therapy measured by TTR. Methods: Patients attending anticoagulation service at a medical center were included in this retrospective cohort study. Patients with at least two international normalized ratio (INR) values not more than 4 weeks apart were included and placed in a usual care group or a pharmacist care group based on the care received. Anticoagulation control was measured by calculating TTR according to Roosendaal’s linear interpolation method. A TTR of >70% was considered high-quality and >60% was considered moderate coagulation control. The data were analyzed for descriptive statistics, associations, and for identifying predictors of TTR. A p value of <0.05 was considered statistically significant. Results: Mean age of patients was 58±9 years; 57% were male; 48% were White Caucasian, and 43% had a CHADS2 score of ≥3. Patients in the pharmacist group had a high TTR (67.6% vs. 43.4%, p<0.0001) and an INR in a significantly lower sub-therapeutic range than the usual care group (5.6% vs. 14.8%; p<0.0001). Half of the patients in the pharmacist group were able to achieve a TTR threshold of 60% and greater compared to less than one-third among the usual care group. Age and pharmacist care were found to be great predictors of TTR after adjusting for gender, ethnicity, and CHADS2 score (p<0.001). Conclusion: Our findings confirmed that pharmacist led anticoagulation care positively improved patients’ TTR with warfarin.

scholarly journals Readmission and mortality in patients treated by interprofessional student teams at a training ward compared with patients receiving usual care: a retrospective cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e022251 ◽  
Author(s):  
Karin Hallin ◽  
Max Gordon ◽  
Olof Sköldenberg ◽  
Peter Henriksson ◽  
Anna Kiessling
Keyword(s):  
Cohort Study ◽  
Usual Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Trauma Centre ◽  
University Teaching ◽  
Student Teams ◽  
Level Ii ◽  
Interprofessional Training ◽  
Patient Readmissions

ObjectiveThis study aimed to compare the rate of patient readmissions and mortality between care provided at an orthopaedic interprofessional training ward (IPTW) and usual care.DesignRetrospective cohort study.SettingOrthopaedic wards at a level II trauma centre at a Swedish university teaching hospital between 2006 and 2011.ParticipantsTwo cohorts were identified: (1) a control cohort that had not received care at the IPTW, and (2) patients who had been treated for at least 1 day at the IPTW.Main outcome measuresReadmission at 90 days and 1-year mortality.ResultsWe included 4652 controls and 1109 in the IPTW group. The mean age was 63 years, and 58% were women. The groups did not differ in any of the outcomes: the readmission rate in the control and IPTW groups was 13.5% and 14.0%, respectively, while mortality was 5.2% and 5.3%, respectively. This lack of difference remained after adjusting for confounders.ConclusionInterprofessional undergraduate training in patient-based settings can be performed in a level II trauma hospital with satisfactory patient safety.

scholarly journals Impact of age at diagnosis in polymyalgia rheumatica: A retrospective cohort study of 218 patients

2020 ◽  
Vol 19 (12) ◽  
pp. 102692
Author(s):  
Maarten Van Hemelen ◽  
Albrecht Betrains ◽  
Steven Vanderschueren ◽  
Daniel Blockmans
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Polymyalgia Rheumatica ◽  
Retrospective Cohort ◽  
Age At Diagnosis

Using a chatbot to reduce emergency department visits and unscheduled hospitalizations among patients with gynecologic malignancies during chemotherapy: a retrospective cohort study (Preprint)

2021 ◽  
Author(s):  
Ming-Yuan Huang ◽  
Chia-Sui Weng ◽  
Hsiao-Li Kuo ◽  
Yung-Cheng Su
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Usual Care ◽  
Cancer Patients ◽  
Retrospective Cohort Study ◽  
Text Messaging ◽  
Retrospective Cohort ◽  
Emergency Department Visits ◽  
Gynecologic Malignancies ◽  
Ed Visits

BACKGROUND A chatbot is an automatic text-messaging tool that creates a dynamic interaction and simulates a human conversation through text or voice via smartphones or computers. A chatbot could be an effective solution for cancer patients’ follow-up during treatment, and could save time for healthcare providers. OBJECTIVE We conducted a retrospective cohort study to evaluate whether a chatbot-based collection of patient-reported symptoms during chemotherapy, with automated alerts to clinicians, could decrease emergency department (ED) visits and hospitalizations. A control group received usual care. METHODS Self-reporting symptoms were communicated via the chatbot, a Facebook Messenger-based interface for patients with gynecologic malignancies. The chatbot included questions about common symptoms experienced during chemotherapy. Patients could also use the text-messaging feature to speak directly to the chatbot, and all reported outcomes were monitored by a cancer manager. The primary and secondary outcomes of the study were emergency department visits and unscheduled hospitalizations after initiation of chemotherapy after diagnosis of gynecologic malignancies. Multivariate Poisson regression models were applied to assess the adjusted incidence rate ratios (aIRRs) for chatbot use for ED visits and unscheduled hospitalizations after controlling for age, cancer stage, type of malignancy, diabetes, hypertension, chronic renal insufficiency, and coronary heart disease. RESULTS Twenty patients were included in the chatbot group, and 43 in the usual-care group. Significantly lower aIRRs for chatbot use for ED visits (0.27; 95% CI 0.11–0.65; p=0.003) and unscheduled hospitalizations (0.31; 95% CI 0.11–0.88; p=0.028) were noted. Patients using the chatbot approach had lower aIRRs of ED visits and unscheduled hospitalizations compared to usual-care patients. CONCLUSIONS The chatbot was helpful for reducing ED visits and unscheduled hospitalizations in patients with gynecologic malignancies who were receiving chemotherapy. These findings are valuable for inspiring the future design of digital health interventions for cancer patients.

scholarly journals Rapid corticosteroid taper versus standard of care for immune checkpoint inhibitor induced nephritis: a single-center retrospective cohort study

2021 ◽  
Vol 9 (4) ◽  
pp. e002292
Author(s):  
Meghan D Lee ◽  
Harish Seethapathy ◽  
Ian A Strohbehn ◽  
Sophia H Zhao ◽  
Genevieve M Boland ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Immune Checkpoint ◽  
Retrospective Cohort ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Standard Of Care ◽  
Renal Recovery ◽  
Care Group ◽  
Significant Difference

BackgroundCurrent guidelines for treatment of immune checkpoint inhibitor (ICI)-induced nephritis are not evidence based and may lead to excess corticosteroid exposure. We aimed to compare a rapid corticosteroid taper to standard of care.MethodsRetrospective cohort study in patients with ICI-induced nephritis comparing a rapid taper beginning with 60 mg/day prednisone and tapered to 10 mg within 3 weeks to a historical control group that began 60 mg/day tapered to 10 mg within 6 weeks (standard of care). Renal recovery was defined as creatinine returning to within 1.5-fold baseline. The log-rank test compared the differences in time to renal recovery between the groups. We report rates of renal recovery at 30, 60 and 90 days, and timing and outcomes of ICI rechallenge.ResultsThirteen patients received rapid corticosteroid taper and 14 patients received standard of care. Baseline characteristics were similar between groups. The median time to ≤10 mg/day prednisone was 20 days (IQR 15–25) in the rapid-taper group compared with 38 days (IQR 30–58) in the standard-of-care group. There was no significant difference in the time to renal recovery between the groups, though numerically higher numbers of patients recovered by 30 days, 11 (85%) in the rapid-taper arm versus 6 (46%) in the standard of care arm. Exposure to other nephritis-causing medications (proton pump inhibitor or trimethoprim-sulfamethoxazole) during the corticosteroid taper was more common in the standard of care group, 9 (64%) versus rapid-taper group, 2 (15%), and was associated with longer time to renal recovery, 20 days (IQR 14–101) versus 13 days (IQR 7–34) in those that discontinued nephritis-causing medications. Fifteen (56%) of patients were rechallenged with ICIs, and only two (13%) developed recurrent nephritis.ConclusionsPatients with ICI-induced nephritis have excellent kidney outcomes when treated with corticosteroids that are tapered over 3 weeks.

scholarly journals Mortality among patients with polymyalgia rheumatica: A retrospective cohort study

2020 ◽  
Author(s):  
Richard Partington ◽  
Sara Muller ◽  
Christian D Mallen ◽  
Alyshah Abdul Sultan ◽  
Toby Helliwell
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Polymyalgia Rheumatica ◽  
Retrospective Cohort
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