scholarly journals Assessing the incidence of acidosis in patients receiving metformin with and without risk factors for lactic acidosis

2018 ◽  
Vol 9 (9) ◽  
pp. 179-190 ◽  
Author(s):  
Katy E. Trinkley ◽  
Heather D. Anderson ◽  
Kavita V. Nair ◽  
Daniel C. Malone ◽  
Joseph J. Saseen
Keyword(s):  
Risk Factors ◽  
Lactic Acidosis ◽  
Renal Insufficiency ◽  
Administrative Database ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Medication Group ◽  
First Line Therapy ◽  
Significant Difference ◽  
The Impact

Background: Despite strong recommendations to use metformin as first-line therapy for type 2 diabetes (T2DM), its use has been suboptimal, likely due to concerns of lactic acidosis. This study compared the association of acidosis in patients with T2DM prescribed metformin with those prescribed other antihyperglycemic medications or no medications. Methods: This was a retrospective cohort study of patients with newly diagnosed T2DM utilizing an administrative database, which includes medical and prescription claims. Eligible patients had a diagnosis of T2DM, had continuous health plan enrollment 3 months prior to study enrollment and during the study period, and were at least 18 years of age. Mutually exclusive exposure groups were metformin only, other antihyperglycemic medications, and no medication. Acidosis cases were stratified by exposure group and risk factors for lactic acidosis (chronic obstructive pulmonary disease, hepatic dysfunction, alcohol abuse, heart failure, renal insufficiency, age of 80 years or older, and a history of acidosis). Degree of renal insufficiency was not available. Associations between exposure and acidosis were estimated, and risk factors evaluated. Results: A total of 132,780 patients met inclusion criteria: 24,936 (20%) metformin only group, 15,059 (11%) other antihyperglycemic medication group, and 92,785 (70%) no medication group. Acidosis was observed in 1.45 per 10,000 patient months (0.78 metformin, 1.59 other antihyperglycemic medication, 1.51 no medication). The unadjusted relative risk of acidosis was 0.5 for patients prescribed metformin only compared with the other exposure groups (95% confidence interval = 0.2–1.2). There was no significant difference in risk of acidosis between exposure groups, irrespective of risk factors for lactic acidosis. Conclusions: Risk of acidosis was similar with metformin only compared with those prescribed other antihyperglycemic medications or no medication. These results support expanded use of metformin for T2DM. Additional studies are needed to understand the impact of risk factor severity on risk of lactic acidosis.

scholarly journals Epidemiology of Chronic Obstructive Pulmonary Disease (COPD) Comorbidities in Lithuanian National Database: A Cluster Analysis

2022 ◽  
Vol 19 (2) ◽  
pp. 970
Author(s):  
Elena Jurevičienė ◽  
Greta Burneikaitė ◽  
Laimis Dambrauskas ◽  
Vytautas Kasiulevičius ◽  
Edita Kazėnaitė ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Kidney Diseases ◽  
Screening Tools ◽  
National Database ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Significant Difference ◽  
The Impact

Various comorbidities and multimorbidity frequently occur in chronic obstructive pulmonary disease (COPD), leading to the overload of health care systems and increased mortality. We aimed to assess the impact of COPD on the probability and clustering of comorbidities. The cross-sectional analysis of the nationwide Lithuanian database was performed based on the entries of the codes of chronic diseases. COPD was defined on the code J44.8 entry and six-month consumption of bronchodilators. Descriptive statistics and odds ratios (ORs) for associations and agglomerative hierarchical clustering were carried out. 321,297 patients aged 40–79 years were included; 4834 of them had COPD. A significantly higher prevalence of cardiovascular diseases (CVD), lung cancer, kidney diseases, and the association of COPD with six-fold higher odds of lung cancer (OR 6.66; p < 0.0001), a two-fold of heart failure (OR 2.61; p < 0.0001), and CVD (OR 1.83; p < 0.0001) was found. Six clusters in COPD males and five in females were pointed out, in patients without COPD—five and four clusters accordingly. The most prevalent cardiovascular cluster had no significant difference according to sex or COPD presence, but a different linkage of dyslipidemia was found. The study raises the need to elaborate adjusted multimorbidity case management and screening tools enabling better outcomes.

scholarly journals Impact Prognostic of Delayed Reperfusion Time in Patients With Stemi of ≤24 Hours Treated in the Emergency Department of a General Hospital

2020 ◽  
Author(s):  
Lorenzo Socias ◽  
Guillem Frontera ◽  
Catalina Rubert ◽  
Joan Torres ◽  
Tomas Ripoll ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Reperfusion Therapy ◽  
Cardiovascular Complications ◽  
Primary Angioplasty ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Killip Class ◽  
Coronary Syndrome ◽  
The Impact

Abstract Background. The patients who attend a hospital without a hemodynamic laboratory may have differences in health outcomes, treatment, reperfusion times, the rate of cardiovascular complications, hospital stay, mortality or costs may be affected. The study aimed to analyze the prognostic of patients with STEMI treated in the Emergency Department (ED) and the impact prognostic of the delayed reperfusion time in a Hospital General without hemodynamic laboratory. Methods. After ethics review board approval, this retrospective observational cohort study of patients included acute coronary syndrome with ST elevation of ≤ 24 h in the Illes Balears infarction code registry (CI-IB) between May 2008 and December 2018. The information recorded were age, sex, cardiovascular risk factors, site of AMI, time delays, reperfusion therapy with fibrinolysis and primary angioplasty (PA). Cardiovascular Event (CE) was defined the combined variable: Killip class progression, malignant arrhythmias, Re-infarction, cerebrovascular disease and mortality. Results.605 patients were analyzed. The reperfusion treatment was 83,1% (80,8% with PA). 19% presented some CE. Hospital and monthly mortality was 6.8% and 7.8% respectively. The main differences between patients with and without CE were: age (66 vs 59 years); Chronic obstructive pulmonary disease (COPD); previous infarction; anterior location; Door-To-Needle Time and FPC-PA time. The risk factors of CE were: age, COPD, anterior location, fibrinolysis and patients without reperfusion treatment. In the group with PA, the risk of mortality was higher in COPD (p=0.012), Symptom start –FPC time with (p = 0,084) and FPC-PA time > 90 minutes (p= 0.107). FCM-AP> 90 minutes had a higher mortality (10 vs 4.4%;HR 1,79; IC 95% 1,15-2,78; log-rank:p=0,013)Conclussions. In our cohort, most patients received reperfusion treatment and were performed within the recommended time. In ED, the pacients with a FCM-PA time longer than recommended in the guidelines and COPD had higher CE y mortality.

scholarly journals Comparing the impact of different exercise interventions on fatigue in individuals with COPD: A systematic review and meta-analysis

2019 ◽  
Vol 16 ◽  
pp. 147997311989485 ◽  
Author(s):  
Lok Sze Katrina Li ◽  
Stacey Butler ◽  
Roger Goldstein ◽  
Dina Brooks
Keyword(s):  
Meta Analysis ◽  
Interval Training ◽  
Cochrane Library ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Exercise Interventions ◽  
Significant Difference ◽  
Related Quality ◽  
Type Of Exercise ◽  
The Impact

To systematically review randomized controlled trials that compared the effectiveness of different types of exercise on the symptom of fatigue in individuals with chronic obstructive pulmonary disease (COPD). MEDLINE, EMBASE, EMcare, PsychINFO, and Cochrane library were searched from inception to October 2018. Studies were included if individuals with COPD were randomized into two or more physical exercise interventions that reported fatigue. Of the 395 full-texts reviewed, 17 studies were included. Fifteen studies reported the impact of exercise on health-related quality of life with fatigue as a subdomain. Reduction in fatigue was observed following endurance, resistance, or a combination of both exercises. There was no significant difference between continuous and interval training ( n = 3 studies, pooled standardized mean difference (SMD) = −0.17, 95% CI = −0.47, 0.12, p = 0.25) or between endurance and resistance training ( n = 3 studies, SMD = −0.35, 95% CI = −0.72, 0.01, p = 0.07) on fatigue in people with COPD. Fatigue reduction is not usually a primary outcome of exercise interventions, but it is frequently a secondary domain. The type of exercise did not influence the impact of exercise on fatigue, which was reduced in endurance, resistance, or a combination of both exercises, enabling clinicians to personalize training to match targeted outcomes.

scholarly journals A Systematic Review of Risk Factors Associated with Near-Fatal and Fatal Asthma

2005 ◽  
Vol 12 (5) ◽  
pp. 265-270 ◽  
Author(s):  
GG Alvarez ◽  
M Schulzer ◽  
D Jung ◽  
JM FitzGerald
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Inhaled Corticosteroids ◽  
Respiratory Arrest ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Mortality And Morbidity ◽  
Factors Associated ◽  
Fatal Asthma ◽  
The Impact

BACKGROUND: Asthma mortality and morbidity continue to be a serious global problem. Systematic reviews provide an opportunity to review risk factors in detail.OBJECTIVE: To review all of the literature for risk factors associated with near-fatal asthma (NFA) and fatal asthma (FA).METHODS: A literature search from 1960 to January 2004 in MEDLINE and EMBASE was conducted. Studies were included based on the following criteria: NFA was defined as an asthma exacerbation resulting in respiratory arrest requiring mechanical ventilation or a partial pressure of CO2of at least 45 mmHg or asthma resulting in death (FA); the study reported the number of cases (NFA and/or FA) and asthmatic controls; there was explicit reporting of risk factors; cases that were adult and pediatric in nature; and all study types. Studies that included patients with chronic obstructive pulmonary disease were excluded.RESULTS: Four hundred and three articles were identified, of which 27 met the inclusion criteria. Increased use of medications such as beta-agonists via metered dose inhalers (OR=1.67, 95% CI 0.99 to 2.84, P=0.057) and nebulizers (OR=2.45, 95% CI 1.52 to 3.93, P=0.0002), oral steroids (OR=2.71, 95% CI 1.34 to 5.51, P=0.006) and oral theophylline (OR=2.02, 95% CI 1.03 to 3.98, P=0.04) and a history of hospital (OR=2.62, 95% CI 1.04 to 6.58, P=0.04) and/or intensive care unit (OR=5.14, 95% CI 1.91 to 13.86, P=0.001) admissions and mechanical ventilation (OR=6.69, 95% CI 2.80 to 15.97, P=0.0001) due to asthma were predictors of NFA and FA. Prior emergency department assessment did not confer a greater risk of NFA and FA (OR=1.13, 95% CI 0.43 to 2.92, P=0.810).The use of inhaled corticosteroids (ICS) measured in a dose-independent fashion (did the patient take ICS previously; yes or no) inferred equivocal risk of NFA and FA (OR=1.31, 95% CI 0.83 to 2.05, P=0.25). However, two studies measured the use of ICS in a dose-dependent fashion (ie, measured the number of prescriptions filled within the previous six to 12 months). Both studies showed a trend toward a protective effect against FA. One study showed that the premature cessation of ICS can hasten death.CONCLUSIONS: In the present study, risk factors of NFA and FA have been more accurately defined. Clinicians should identify patients with these characteristics to reduce their risk of NFA and FA. Further research should focus on quantifying the impact of risk factors on asthma deaths.

scholarly journals Awareness of Risk Factors among Persons at Risk for Lung Cancer, Chronic Obstructive Pulmonary Disease and Sleep Apnea: A Canadian Population-Based Study

2010 ◽  
Vol 17 (6) ◽  
pp. 287-294 ◽  
Author(s):  
Shannon L Walker ◽  
David L Saltman ◽  
Rosemary Colucci ◽  
Lesli Martin
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
At Risk ◽  
Sleep Apnea ◽  
First Nations ◽  
Lung Diseases ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Lifestyle Choices ◽  
The Impact

OBJECTIVE: To assess awareness among persons at risk for lung cancer, chronic obstructive pulmonary disease (COPD) and sleep apnea regarding symptoms and risk factors of the disease, and their attitudes regarding the disease and toward those who are affected.METHODS: A quantitative hybrid telephone and Internet survey of a representative population of Canadian adults at risk for at least one of the three diseases was conducted. To measure the awareness and attitudes of First Nations, Inuit and Métis people to these diseases, a proportionate number were also surveyed.RESULTS: A total of 3626 individuals were contacted. Of these, 3036 (84%) were eligible to participate. Of those at risk for lung cancer and COPD, 65% and 69%, respectively, were due to tobacco smoke exposure. Among those at risk, 72% believed that they were informed about lung cancer compared with 36% for COPD and 56% for sleep apnea. Most respondents were knowledgeable about the common symptoms of lung cancer, COPD and sleep apnea, but were less aware of the impact lifestyle choices could have on the development of these disorders and the availability of treatment. Most of the participants (77%) believed that smoking was an addiction rather than a habit (19%). There were no significant differences in the awareness of risk factors, symptoms and attitudes toward all three lung diseases between First Nations, Inuit and Métis people and the general population.CONCLUSIONS: Canadians are reasonably aware of risk factors and symptoms for lung cancer and sleep apnea. However, there is poor awareness of COPD as a disease entity. There is a lack of appreciation for the impact lifestyle choices and changes can have on lung diseases.

scholarly journals Hospital-Based Clinical Pharmacy Services to Improve Ambulatory Management of Chronic Obstructive Pulmonary Disease

2016 ◽  
Vol 33 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Amber Lanae Smith ◽  
Valerie Palmer ◽  
Nada Farhat ◽  
James S. Kalus ◽  
Krishna Thavarajah ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Ambulatory Care ◽  
Pulmonary Disease ◽  
Clinical Pharmacy ◽  
Chronic Obstructive ◽  
Pharmacy Services ◽  
Obstructive Pulmonary Disease ◽  
Clinical Pharmacy Services ◽  
Significant Difference ◽  
The Impact

Background: No systematic evaluations of a comprehensive clinical pharmacy process measures currently exist to determine an optimal ambulatory care collaboration model for chronic obstructive pulmonary disease (COPD) patients. Objective: Describe the impact of a pharmacist-provided clinical COPD bundle on the management of COPD in a hospital-based ambulatory care clinic. Methods: This retrospective cohort analysis evaluated patients with COPD managed in an outpatient pulmonary clinic. The primary objective of this study was to assess the completion of 4 metrics known to improve the management of COPD: (1) medication therapy management, (2) quality measures including smoking cessation and vaccines, (3) patient adherence, and (4) patient education. The secondary objective was to evaluate the impact of the clinical COPD bundle on clinical and economic outcomes at 30 and 90 days post–initial visit. Results: A total of 138 patients were included in the study; 70 patients served as controls and 68 patients received the COPD bundle from the clinical pharmacist. No patients from the control group had all 4 metrics completed as documented, compared to 66 of the COPD bundle group ( P < .0001). Additionally, a statistically significant difference was found in all 4 metrics when evaluated individually. Clinical pharmacy services reduced the number of phone call consults at 90 days ( P = .04) but did not have a statistically significant impact on any additional pre-identified clinical outcomes. Conclusion: A pharmacist-driven clinical COPD bundle was associated with significant increases in the completion and documentation of 4 metrics known to improve the outpatient management of COPD.

scholarly journals The Impact of COVID-19 on Hospitalised COPD Exacerbations in Malta

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Yvette Farrugia ◽  
Bernard Paul Spiteri Meilak ◽  
Neil Grech ◽  
Rachelle Asciak ◽  
Liberato Camilleri ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Chronic Obstructive ◽  
Inpatient Mortality ◽  
Obstructive Pulmonary Disease ◽  
Predictors Of Mortality ◽  
Copd Exacerbations ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Difference ◽  
The Impact

Introduction and Aims. The first COVID-19 case in Malta was confirmed on the 7th of March 2020. This study is aimed at investigating a significant difference between the number of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) admissions and their inpatient outcome at Mater Dei Hospital during the COVID-19 pandemic when compared to the same period in 2019. Furthermore, we aim to determine predictors of mortality in AECOPD inpatients. Method. Data was collected retrospectively from electronic hospital records during the periods 1st March until 10th May in 2019 and 2020. Results. There was a marked decrease in AECOPD admissions in 2020, with a 54.2% drop in admissions ( n = 119 in 2020 vs. n = 259 in 2019). There was no significant difference in patient demographics or medical comorbidities. In 2020, there was a significantly lower number of patients with AECOPD who received nebulised medications during admission (60.4% in 2020 vs. 84.9% in 2019; p ≤ 0.001 ). There were also significantly lower numbers of AECOPD patients admitted in 2020 who received controlled oxygen via venturi masks (69.0% in 2020 vs. 84.5% in 2019; p = 0.006 ). There was a significant increase in inpatient mortality in 2020 (19.3% [ n = 23 ] and 8.4% [ n = 22 ] for 2020 and 2019, respectively, p = 0.003 ). Year was found to be the best predictor of mortality outcome ( p = 0.001 ). The lack of use of SABA pre-admission treatment ( p = 0.002 ), active malignancy ( p = 0.003 ), and increased length of hospital stay ( p = 0.046 ) were also found to be predictors of mortality for AECOPD patients; however, these parameters were unchanged between 2019 and 2020 and therefore could not account for the increase in mortality. Conclusions. There was a decrease in the number of admissions with AECOPD in 2020 during the COVID-19 pandemic, when compared to 2019. The year 2020 proved to be a significant predictor for inpatient mortality, with a significant increase in mortality in 2020. The decrease in nebuliser and controlled oxygen treatment noted in the study period did not prove to be a significant predictor of mortality when corrected for other variables. Therefore, the difference in mortality cannot be explained with certainty in this retrospective cohort study.

scholarly journals The problems and limitations of cohort studies

Breathe ◽  
2014 ◽  
Vol 10 (4) ◽  
pp. 306-311 ◽  
Author(s):  
Warren Lenney ◽  
Francis J. Gilchrist ◽  
Aphrodite Kouzouna ◽  
Anand D. Pandyan ◽  
Val Ball
Keyword(s):  
Risk Factors ◽  
Lung Function ◽  
Cohort Studies ◽  
Chronic Obstructive ◽  
European Respiratory Society ◽  
Raw Data ◽  
Obstructive Pulmonary Disease ◽  
Chronic Respiratory Diseases ◽  
Using Data ◽  
The Impact

SummaryChronic obstructive pulmonary disease (COPD) is the third most common cause of mortality worldwide and it is important to discover whether risk factors can be identified from studies undertaken in childhood.Numerous longitudinal cohort studies have been developed in many parts of the world to better understand the long-term outcomes of chronic respiratory diseases. Using data they have generated, it should be possible to identify specific risk factors in children and develop a model to prioritise their importance when found, in order to consider ways to reduce the prevalence and/or severity of disease in adults. However, this does require the sharing of data within the field, as is happening in other related fields, such as the Virtual International Stroke Trial Archive (www.vista.gla.ac.uk). Pooling of the raw data could be very informative and an organisation such as the European Respiratory Society could play an important role in ensuring this happens.Unfortunately, cohort studies vary widely in their inclusion criteria, their methodology and the format in which lung function data are presented. The raw data required to develop a model to assess the impact of childhood risk factors on future lung function have not been made available from many of the published articles.Our initial belief that recognised risk factors are independent variables was naïve and a different approach is required to better understand their interdependence.

Patterns of Care in Patients with Chemotherapy Receiving Erythropoiesis Stimulating Agents (ESAs).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 964-964 ◽  
Author(s):  
Arash Naeim ◽  
Lyssa Friedman ◽  
Eric Elkin ◽  
Sara Adams ◽  
Hema Viswanathan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Initiation ◽  
Retrospective Chart Review ◽  
Patterns Of Care ◽  
Chronic Obstructive ◽  
Policy Debate ◽  
National Guidelines ◽  
Obstructive Pulmonary Disease ◽  
Recommended Treatment ◽  
The Impact

Abstract Background: Hemoglobin (Hb) levels at ESA treatment initiation have undergone recent policy debate. This retrospective chart review used baseline data prior to an educational intervention on anemia guidelines in community-based oncology practices to understand ESA patterns of care among cancer patients receiving chemotherapy. National guidelines at the time of data collection recommended treatment when Hb was <11 g/dL or when Hb was 11–12 g/dL in the presence of anemia symptoms or risk factors for development of symptomatic anemia. The objectives of this analysis were to examine Hb levels and presence of symptoms or risk factors at ESA treatment initiation and proportion of patients receiving at least one transfusion after initial ESA treatment. Methods: Medical charts of patients ≥18 years receiving chemotherapy (June 2005 – August 2006) for lung, ovarian, multiple myeloma, Hodgkin’s and non-Hodgkin’s lymphoma, colorectal, breast, head and neck, bladder or testicular cancer from 47 sites were abstracted. Hb level at initial ESA administration was defined as the value recorded within 7 days prior to or on the day of treatment initiation. Anemia symptoms (chest pain, peripheral edema, sustained tachycardia, severe fatigue, dizziness) and risk factors for the development of symptomatic anemia (prior transfusion, radiation or chemotherapy; chronic obstructive pulmonary disease, cerebrovascular disease or cardiac disease; age ≥ 65 years) were identified using national guidelines. Results: Of 2844 patients on chemotherapy, mean age was 62 years; 66% were female; most common malignancies were breast (36%), non-small cell lung cancer (19%) and colorectal (18%). A total of 1268 patients (44%) received at least one administration of an ESA and of these 1165 (92%) had Hb levels recorded at treatment initiation. A total of 238 patients (20%) had Hb levels ≤10g/dL at ESA initiation, 419 (36%) had Hb levels from 10.1–11.0 g/dL, 358 (31%) had Hb levels from 11.1–12.0 g/dL and 150 (13%) had Hb levels >12g/dL at treatment initiation. Of the 1268 patients who received initial treatment with an ESA, 102 (8%) required at least one transfusion during chemotherapy. Anemia symptoms or risk factors were present in 206 patients (87%) with Hb ≤10g/dL, 335 (80%) with Hb 10.1–11.0 g/dL and 287 (80%) with Hb 11.1–12.0 g/dL at ESA treatment initiation. Of the 1616 patients (56%) who did not receive an ESA during chemotherapy, the majority had a lowest recorded Hb level >12g/dL (647 patients, 40%) and 68% of such patients had anemia symptoms or risk factors. In comparison, 83% of patients receiving an initial ESA administration at Hb >12 g/dL had anemia symptoms or risk factors. Conclusions: Initiation of ESAs occurred most commonly between Hb levels of 10.1–11.0 g/dL. A majority of patients had symptoms or risk factors at ESA treatment initiation across Hb levels. Evaluation of specific symptoms and the role of ESAs in symptom alleviation is needed. Future studies should investigate the impact of new polices for ESA use on utilization patterns. Hb Levels at ESA Treatment Initiation and Presence of Symptoms or Risk Factors (N=1165)* ESA Treatment Presence of Symptoms or Risk Factors Hb at ESA Treatment Initiation N % N % *n=102 with no Hb in week prior to initial ESA treatment ≤10 238 20.4 206 86.6 >10–11 419 36.0 335 80.0 >11–12 358 30.7 287 80.2 >12 150 12.9 125 83.3

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