scholarly journals Patients’ aged ≥65 years dispositions during ambulance assignments, including factors associated with non-conveyance to hospital: a longitudinal and comparative study

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038885
Author(s):  
Elin-Sofie Forsgärde ◽  
Carina Elmqvist ◽  
Bengt Fridlund ◽  
Anders Svensson ◽  
Richard Andersson ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Patient Characteristics ◽  
Exclusion Criteria ◽  
Optimal Care ◽  
Care Level ◽  
Patient Transfers ◽  
Factors Associated ◽  
Changes Over Time ◽  
Triage Level ◽  
Over Time

ObjectivesPatients ≥65 years old represent 30%–50% of all ambulance assignments (AAs), and the knowledge of which care level they are disposed to is limited and diverging. The aim of this study was therefore to describe and compare characteristics of patients’ aged ≥65 years dispositions during AA, including determining changes over time and factors associated with non-conveyance to hospitals.DesignA longitudinal and comparative database study.SettingAmbulance service in a Swedish region.Participants32 085 AAs with patients ≥65 years old during the years 2014, 2016 and 2018. Exclusion criteria: AAs with interhospital patient transfers and lack of patients’ dispositions data.Outcome measuresDependent factors: conveyance and non-conveyance to hospitals. Independent factors: age, sex, symptom, triage level, scene, time, day and season.ResultsThe majority (n=29 060; 90.6%) of patients’ dispositions during AA were conveyance to hospitals. In total, the most common symptoms were circulatory (n=4953; 15.5%) and respiratory (n=4529; 14.1%). A significant increase, p<0.01, of non-conveyance to hospitals was shown during 2014 and 2018, from 801 (7.8%) to 1295 (11.4%). Increasing age was associated with decreasing odds of non-conveyance, 85–89 years (OR=0.85, 95 % CI=0.72 to 0.99) and 90 years or older (OR=0.80, 95 % CI=0.68 to 0.93). Several factors were associated with non-conveyance, for example, symptoms of diabetes (OR=8.57, 95 % CI=5.99 to 12.26) and mental disorders (OR=5.71, 95 % CI=3.85 to 8.48) in comparison with infections.ConclusionsThe study demonstrates several patient characteristics, and factors associated with non-conveyance to hospitals, such as age, symptom, triage level, scene, time, day and season. The increasing non-conveyance trend highlights the importance of further studies on optimal care levels for patients ≥65 years old.

Gender representation in authorship in later-phase systemic clinical trials in biliary tract cancer (BTC).

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 348-348
Author(s):  
Mairead Geraldine McNamara ◽  
John A. Bridgewater ◽  
Lipika Goyal ◽  
David Goldstein ◽  
Rachna T. Shroff ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Senior Author ◽  
Industry Funding ◽  
Factors Associated ◽  
End Point ◽  
Female Author ◽  
Changes Over Time ◽  
Google Search ◽  
Later Phase ◽  
Over Time

348 Background: The proportion of females in medicine is increasing (approx. 50% in medical school/workforce), but disparities in female authorship in oncology research publications exist; female corresponding authorship reportedly ranges from 7.2-39.1% in oncology clinical trials (Ludmir et al 2019). This study aimed to describe and assess factors associated with female first and senior authorship in later phase systemic clinical trials in BTC and to identify any changes over time. Methods: Embase/Medline were used to identify final primary trial publications in BTC (2000-2020) (excluding phase I (PI) (expected to move to later phase), mixed tumour site trials, reviews, editorials and trial-in-progress publications). Gender was determined by inspection of names, google search and author communication. Chi-square tests and log regression were used to assess factors associated with female first and senior authorship, including changes over time (STATA16). Results: Of 501 publications, 163 met inclusion criteria; 80% single-arm PII and 15% and 5% randomised PII and PIII respectively; 73% enrolled ≤50 patients. Tumour primary sites were all BTC: 86%, cholangiocarcinoma: 8%, gallbladder cancer: 6%; 80% involved chemotherapy, 13% targeted therapy and 5% localised/systemic combinations; 65% were in first-line (1L) advanced setting, 17% post 1L, 13% advanced non-specified and 5% neo-adjuvant/adjuvant. Forty-eight percent received industry funding and 65% met primary end-point. Sixty-four percent were published post ABC-02 (Valle et al 2010). Publication impact factor (IF) was ≤5 in 50% and >20 in 12%. Median number of authors in all publications was 11. Geographic location of all first and senior authors were Asia (42%/42%), Europe (29%/29%), USA (24%/22%) and other (4%/6%), respectively. Median individual trial female author representation was 25%; there were no female authors in 12% of trials. Overall, female first and senior author representation was 21% and 11%, respectively. Median position of first female author was second. In publications with IF ≤20 and >20, there were 22% and 16% female first and 13% and 0% female senior authors, respectively. The phase of trial, journal IF, industry funding, or whether met primary end-point did not impact female first or senior author representation (all P>.05). There were more female senior authors associated with “other” geographic locations (40% in 10 trials) (P=.016) vs Asia (7%), Europe (8%) and USA (14%). There were no significant changes in female first or senior author representation over time (‘00-05: 21%/18%, ‘06-10: 27%/5%, ‘11-15: 15%/15%, ‘16-20: 22%/9%, P=.738, and P=.508 respectively). Conclusions: Female first and senior author representation in later phase systemic clinical trial publications in BTC is low and has not changed significantly over time. The underlying reasons for this imbalance need to be better understood and addressed.

Performance of creatinine-based equations for estimating glomerular filtration rate changes over time

2018 ◽  
Vol 35 (5) ◽  
pp. 819-827 ◽  
Author(s):  
Marieke H C van Rijn ◽  
Marie Metzger ◽  
Martin Flamant ◽  
Pascal Houillier ◽  
Jean-Philippe Haymann ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Patient Characteristics ◽  
Estimated Gfr ◽  
Changes Over Time ◽  
Over Time ◽  
Measured Gfr

Abstract Background Glomerular filtration rate (GFR) is commonly used to monitor chronic kidney disease (CKD) progression, but its validity for evaluating kidney function changes over time has not been comprehensively evaluated. We assessed the performance of creatinine-based equations for estimating GFR slope according to patient characteristics and specific CKD diagnosis. Methods In the NephroTest cohort study, we measured GFR 5324 times by chromium 51–labeled ethylenediamine tetraacetic acid renal clearance in 1955 adult patients with CKD Stages 1–4 referred to nephrologists (Stages 1–2, 19%) and simultaneously estimated GFR with both the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations for isotope dilution mass spectrometry traceable creatinine; absolute and relative GFR slopes were calculated using a linear mixed model. Results Over a median follow-up of 3.4 [interquartile range (IQR) 2.0–5.6] years, the decline in mean absolute and relative measured GFR (mGFR) and CKD-EPI and MDRD estimated GFR (eGFR) was 1.6 ± 1.2, 1.5 ± 1.4 and 1.3 ± 1.3 mL/min/1.73 m2/year and 5.9 ± 5.3, 5.3 ± 5.3 and 4.8 ± 5.2%/year, respectively; 52% and 55% of the patients had MDRD and CKD-EPI eGFR slopes within 30% of mGFR slopes. Both equations tended to overestimate the GFR slope in the youngest patients and underestimate it in the oldest, thus producing inverse associations between age and mGFR versus eGFR slope. Other patient characteristics and specific CKD diagnoses had little effect on the performance of the equations in estimating associations. Conclusions This study shows little bias, but poor precision in GFR slope estimation for both MDRD and CKD-EPI equations. Importantly, bias strongly varied with age, possibly due to variations in muscle mass over time, with implications for clinical care and research.

scholarly journals Trends and Efficacy of Interferon-Free Anti–hepatitis C Virus Therapy in the Region of High Prevalence of Elderly Patients, Cirrhosis, and Hepatocellular Carcinoma: A Real-World, Nationwide, Multicenter Study of 10 688 Patients in Japan

2019 ◽  
Vol 6 (5) ◽  
Author(s):  
Hidenori Toyoda ◽  
Masanori Atsukawa ◽  
Haruki Uojima ◽  
Akito Nozaki ◽  
Hideyuki Tamai ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatitis C ◽  
Real World ◽  
Odds Ratio ◽  
Patient Characteristics ◽  
Exact Matching ◽  
Factors Associated ◽  
High Prevalence ◽  
History Of ◽  
Over Time

Abstract Background We investigated changes in patient characteristics, rate of sustained virologic response (SVR), and factors associated with SVR after anti-hepatitis C virus (HCV) therapy with direct-acting antiviral (DAA) regimens in real-world practice in Japan, where patients with HCV are characterized by older age and high prevalence of cirrhosis and hepatocellular carcinoma (HCC). Methods Changes in patient characteristics and SVR rates were evaluated from medical records among 10 688 patients who started interferon (IFN)-free DAA therapy between September 2014 and June 2018 in a nationwide, multicenter study. Factors associated with failure of SVR were analyzed. In particular, effects of cirrhosis or history of HCC on SVR were assessed by exact matching. Results Patient age was becoming younger and baseline liver fibrosis was becoming milder over time. Overall SVR rate was 95.4%. The SVR rates increased over time in patients without a history of IFN-free DAA therapy. Multivariate analysis revealed that cirrhosis was unfavorably associated with achievement of SVR in both patients with genotype 1 (odds ratio, 1.68; 95% confidence interval [CI], 1.27–2.21) and genotype 2 (odds ratio, 1.69; 95% CI, 1.01–2.78). Comparisons after exact matching showed that the SVR rate was significantly lower in patients with cirrhosis than without it, whereas patients with and without a history of HCC had similar SVR rates. Conclusions Background characteristics of patients who undergo IFN-free DAA therapy are changing in Japan. Patients without a history of IFN-free DAA therapy have high SVR rates. Exact matching confirmed that cirrhosis significantly influences the achievement of SVR in real-world settings.

Antibiotic resistance of uropathogenic Escherichia coli and ESBL prevalence in general practice patients over 10 years

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711533
Author(s):  
Antoinette van Driel
Keyword(s):  
Antibiotic Susceptibility ◽  
Treatment Guidelines ◽  
Patient Characteristics ◽  
Antibiotic Use ◽  
E Coli ◽  
The North ◽  
General Practices ◽  
Changes Over Time ◽  
Care Database ◽  
Over Time

BackgroundBacterial susceptibility to antibiotics changes over time. Knowledge of the susceptibility is important for antibiotic treatment guidelines in general practices.AimTo determine the antibiotic-susceptibility of E. coli from uncomplicated UTI among women in general practices in the Netherlands and to compare the results with those collected in 2004 and 2009.MethodUrine samples were collected from women with symptoms of uncomplicated UTI, in 30 sentinel GP practices of the Nivel Primary Care database. Patient characteristics, E. coli susceptibility and ESBL prevalence were analysed.ResultsIn total, 689 samples were collected. E. coli was the most isolated uropathogen (83%). Antibiotic susceptibility was stable over time except for ciprofloxacin (96%, 97% and 94% in 2004, 2009 and 2014, respectively; P<0.05). The susceptibility to co-amoxiclav was 88%, 87% and 92% in 2004, 2009 and 2014, respectively. The prevalence of ESBL producing E. coli increased from 0.1% in 2004, to 2.2% in 2014 (P<0.05). Susceptibility for co-trimoxazole was the highest in the West (88%) and the lowest in the North (72%, P = 0.021). Ciprofloxacin susceptibility was related to antibiotic use in the past 3 months (97% no use versus 90% use, P = 0.002) and those aged >70 years (P = 0.005). In 2014, prescription of fosfomycin increased compared to 2009 (14.3% versus 5.6%) at the expense of co-amoxiclav, co-trimoxazole and ciprofloxacin (P<0.05).ConclusionThe antibiotic susceptibility percentages to the agents tested were stable over the 10-year period, except for ciprofloxacin as was the prevalence of ESBL producing E. coli. Surveillance with regular intervals is warranted.

scholarly journals Changes Over Time in the Differential Mortality Gap in Individuals With Mental Disorders

2020 ◽  
Vol 77 (6) ◽  
pp. 648 ◽  
Author(s):  
Oleguer Plana-Ripoll ◽  
Nanna Weye ◽  
Natalie C. Momen ◽  
Maria K. Christensen ◽  
Kim M. Iburg ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Differential Mortality ◽  
Changes Over Time ◽  
Over Time

Inequality and Punishment

2015 ◽  
Vol 663 (1) ◽  
pp. 185-203 ◽  
Author(s):  
Michelle S. Phelps ◽  
Devah Pager
Keyword(s):  
State Level ◽  
The United States ◽  
State Prison ◽  
Factors Associated ◽  
Political Dominance ◽  
Prison Populations ◽  
Changes Over Time ◽  
First Time ◽  
Over Time

After decades of steady expansion, state prison populations declined in recent years for the first time since 1972. Though the size of the decrease was small, it masks substantial state heterogeneity. This article investigates variation in state-level incarceration rates from 1980 through 2013, examining the factors associated with the rise and decline in prison populations. We find evidence for four key stories in explaining the prison decline: crime, budgets, politics, and inequality. Many of these relationships are consistent across decades, including the role of racial composition, violent crime, and Republican political dominance. In contrast, states’ fiscal capacity and economic inequality became more important after 2000. This research emphasizes the importance of examining changes over time in the correlates of incarceration growth and decline and represents the first effort to systematically understand the recent reversal in the trajectory of incarceration practices in the United States.

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