scholarly journals Gender differences in COPD management in a Sicilian general practice setting: a cohort study evaluating the impact of educational interventions

2020 ◽  
Vol 6 (3) ◽  
pp. 00279-2020
Author(s):  
Valentina Isgrò ◽  
Janet Sultana ◽  
Andrea Fontana ◽  
Valentina Ientile ◽  
Umberto Alecci ◽  
...  
Keyword(s):  
Gender Differences ◽  
Cohort Study ◽  
Best Practice ◽  
Linear Models ◽  
Reference Group ◽  
Educational Interventions ◽  
Gender Disparity ◽  
Educational Programme ◽  
Copd Patients ◽  
The Impact

AimThe aim of this study was to measure gender differences among COPD patients' quality of care (QOC) before and after two educational interventions in Southern Italy.MethodsIn this prospective cohort study, COPD patients were identified from primary care electronic medical records (EMRs). Twelve process indicators concerning diagnosis, preventative measures and therapeutic processes were developed as a measure of QOC. Educational interventions consisted of clinical seminars and audits on COPD QOC at baseline, and at 12 and 24 months. QOC indicators were stratified by gender: odds ratios (ORs) (males as reference group) of having a good QOC indicator were calculated at baseline, 12 and 24 months, with 95% confidence intervals (CIs) using hierarchical generalised linear models.ResultsOf 46 326 people registered in the EMRs, 1463 COPD patients (3.1%) were identified, of which 37% were women. QOC indicators reflecting best practice 24 months after the educational programme were generally not different to baseline, often favouring men. On the other hand, the composite global QOC indicator suggested that while a good overall QOC at baseline was significantly higher in men than women (OR: 0.74; 95% CI: 0.57–0.96), it became nonsignificant at 24 months (OR: 0.96; 95% CI: 0.72–1.29).ConclusionsSpecific QOC indicators among COPD patients often favoured men. However, several gender disparities seen at baseline disappeared at 24 months, suggesting that even general educational interventions which do not target gender can improve the gender disparity in QOC.

Reducing the number of unnecessary laboratory tests within hospital through the use of educational interventions

2021 ◽  
pp. 000456322110406
Author(s):  
Michael Thurm ◽  
Helen Craggs ◽  
Merlin Watts ◽  
Anthony Brooks
Keyword(s):  
Cohort Study ◽  
Cost Saving ◽  
General Hospital ◽  
Laboratory Tests ◽  
Patient Management ◽  
District General Hospital ◽  
Educational Interventions ◽  
Blood Tests ◽  
Medical Teams ◽  
The Impact

Background The growing number of laboratory investigation requests is placing an increased burden upon NHS resources. Around a quarter of all tests are unnecessary repeats, and almost a third have no impact on patient management. Doctors recognise that tests should only be performed when clinically indicated, but a culture persists of undertaking unnecessary repeat investigations. Methods A cohort study was undertaken at a district general hospital to observe the impact of introducing educational interventions in the form of a poster and a series of educational lectures, encouraging clinicians to consider whether an investigation was clinically indicated. Data was collected from nine different sites across the hospital run by different medical teams regarding the number of tests undertaken and the impact on patient care. Results Data from over 13,000 tests and over 2000 patients was analysed from nine different sites across the hospital. There was a significant reduction (33%, p = 0.0001) in the number of blood tests performed. This reduction in testing saved £7006 over the course of 1 month, in addition to other benefits. There was a reduction in testing in eight out of the nine sites in which the study was undertaken, demonstrating good generalisability of results. There was no significant increase in length of admission or mortality. Conclusion Educational interventions to doctors have a significant and safe impact in reducing the number of unnecessary investigations, providing cost saving benefits to the NHS.

scholarly journals Gender differences among Swedish COPD patients: results from the ARCTIC, a real-world retrospective cohort study

2019 ◽  
Vol 29 (1) ◽  
Author(s):  
Karin Lisspers ◽  
Kjell Larsson ◽  
Christer Janson ◽  
Björn Ställberg ◽  
Ioanna Tsiligianni ◽  
...  
Keyword(s):  
Primary Care ◽  
Gender Differences ◽  
Cohort Study ◽  
Mortality Rate ◽  
Real World ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Healthcare Resource ◽  
Drug Prescriptions ◽  
Copd Patients

AbstractThe present study aimed to generate real-world evidence regarding gender differences among chronic obstructive pulmonary disease (COPD) patients, especially as regards the diagnosis and outcomes in order to identify areas for improvement and management and optimize the associated healthcare resource allocation. ARCTIC is a large, real-world, retrospective cohort study conducted in Swedish COPD patients and a matched reference population from 52 primary care centers in 2000–2014. The incidence of COPD, prevalence of asthma and other comorbidities, risk of exacerbations, mortality rate, COPD drug prescriptions, and healthcare resource utilization were analyzed. In total, 17,479 patients with COPD were included in the study. During the study period, COPD was more frequent among women (53.8%) and women with COPD experienced more exacerbations vs. men (6.66 vs. 4.66). However, the overall mortality rate was higher in men compared with women (45% vs. 38%), but no difference for mortality due to COPD was seen between genders over the study period. Women seemed to have a greater susceptibility to asthma, fractures, osteoporosis, rheumatoid arthritis, rhinitis, depression, and anxiety, but appeared less likely to have diabetes, kidney diseases, and cardiovascular diseases. Furthermore, women had a greater risk of COPD-related hospitalization and were likely to receive a significantly higher number of COPD drug prescriptions compared with men. These results support the need to reduce disease burden among women with COPD and highlight the role of healthcare professionals in primary care who should consider all these parameters in order to properly diagnose and treat women with COPD.

scholarly journals Recognizing, reporting and reducing the data curation debt of cohort studies

2020 ◽  
Vol 49 (4) ◽  
pp. 1067-1074 ◽  
Author(s):  
Oliver W Butters ◽  
Rebecca C Wilson ◽  
Paul R Burton
Keyword(s):  
Cohort Study ◽  
Cohort Studies ◽  
Best Practice ◽  
Study Data ◽  
Data Curation ◽  
Cross Domain ◽  
Existential Risk ◽  
The Uk ◽  
Skills Shortages ◽  
The Impact

Abstract Good data curation is integral to cohort studies, but it is not always done to a level necessary to ensure the longevity of the data a study holds. In this opinion paper, we introduce the concept of data curation debt—the data curation equivalent to the software engineering principle of technical debt. Using the context of UK cohort studies, we define data curation debt—describing examples and their potential impact. We highlight that accruing this debt can make it more difficult to use the data in the future. Additionally, the long-running nature of cohort studies means that interest is accrued on this debt and compounded over time—increasing the impact a debt could have on a study and its stakeholders. Primary causes of data curation debt are discussed across three categories: longevity of hardware, software and data formats; funding; and skills shortages. Based on cross-domain best practice, strategies to reduce the debt and preventive measures are proposed—with importance given to the recognition and transparent reporting of data curation debt. Describing the debt in this way, we encapsulate a multi-faceted issue in simple terms understandable by all cohort study stakeholders. Data curation debt is not only confined to the UK, but is an issue the international community must be aware of and address. This paper aims to stimulate a discussion between cohort studies and their stakeholders on how to address the issue of data curation debt. If data curation debt is left unchecked it could become impossible to use highly valued cohort study data, and ultimately represents an existential risk to studies themselves.

Microscopic Colitis and Risk Of Cancer—AA Population-Based Cohort Study

2020 ◽  
Author(s):  
David Bergman ◽  
Hamed Khalili ◽  
Bjorn Roelstraete ◽  
Jonas F Ludvigsson
Keyword(s):  
Cohort Study ◽  
Reference Group ◽  
Large Population ◽  
Population Based ◽  
Microscopic Colitis ◽  
First Year ◽  
Increased Risk ◽  
Risk Of Cancer ◽  
The Impact

Abstract Background and Aims The association between microscopic colitis [MC] and cancer risk is unclear. Large, population-based studies are lacking. Methods We conducted a nationwide cohort study of 11 758 patients with incident MC [diagnosed 1990–2016 in Sweden], 50 828 matched reference individuals, and 11 614 siblings to MC patients. Data were obtained through Sweden´s pathology departments and from the Swedish Cancer Register. Adjusted hazard ratios [aHRs] were calculated using Cox proportional hazards models. Results At the end of follow-up [mean: 6.7 years], 1239 [10.5%] of MC patients had received a cancer diagnosis, compared with 4815 [9.5%] of reference individuals (aHR 1.08 [95% confidence interval1.02–1.16]). The risk of cancer was highest during the first year of follow up. The absolute excess risks for cancer at 5, 10, and 20 years after MC diagnosis were + 1.0% (95% confidence interval [CI] 0.4%-1.6%), +1.5% [0.4%-2.6%], and + 3.7% [-2.3–9.6%], respectively, equivalent to one extra cancer event in every 55 individuals with MC followed for 10 years. MC was associated with an increased risk of lymphoma (aHR 1.43 [1.06–1.92]) and lung cancer (aHR 1.32 [1.04–1.68]) but with decreased risks of colorectal (aHR 0.52 [0.40–0.66]) and gastrointestinal cancers (aHR 0.72 [0.60–0.85]). We found no association with breast or bladder cancer. Using siblings as reference group to minimise the impact of shared genetic and early environmental factors, patients with MC were still at an increased risk of cancer (HR 1.20 [1.06–1.36]). Conclusions This nationwide cohort study demonstrated an 8% increased risk of cancer in MC patients. The risk was highest during the first year of follow-up.

scholarly journals The Role of Sleep Disturbance, Depression and Anxiety in Frail Patients with AF–Gender Differences

2020 ◽  
Vol 10 (1) ◽  
pp. 11
Author(s):  
Beata Jankowska-Polańska ◽  
Jacek Polański ◽  
Krzysztof Dudek ◽  
Agnieszka Sławuta ◽  
Grzegorz Mazur ◽  
...  
Keyword(s):  
Gender Differences ◽  
Sleep Disturbance ◽  
Sleep Disturbances ◽  
Depressive Disorders ◽  
Reference Group ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
Frail Patients ◽  
Anxiety Depression ◽  
The Impact

The aim of the study was to assess the link between anxiety and depression and frailty syndrome (FS) in patients with atrial fibrillation (AF) with regard to gender differences. Material and methods. The study was conducted on 158 patients with AF (mean age 70.4 ± 7.6). The study used the hospital anxiety and depression scale (HADS-M), the Athens insomnia scale (AIS) and the Edmonton frailty scale to assess and compare anxiety, depression, and sleep disturbance between frail and non-frail patients with AF. Results. FS was diagnosed in 53.2% of patients. A comparative analysis showed a statistically significantly higher severity level of anxiety (12.0 ± 2.6 vs. 8.4 ± 2.5, p < 0.001) and depression (12.5 ± 2.5 vs. 7.2 ± 3.3, p < 0.001) in frail patients compared to non-frail patients. The analysis of the level of anxiety, depression and FS did not show any significant differences between the studied women and men. However, statistically, significant differences were observed when FS occurred, regardless of gender. Anxiety disorders were observed in 75.5% of patients with FS and in 16.7% without frailty, whereas depressive disorders were observed in 73.6% of frail patients and in 4.2% without frailty. In an analysis of the impact of cumulative variables on the level of frailty, the risk of FS in patients with anxiety/depression and sleep disturbance is almost 500 times higher compared to patients without anxiety/depression and sleep disturbance. The risk of frailty in patients with sleep disturbance only is thirteen times higher than in the reference group, i.e., in patients without depression/anxiety and sleep disturbances. Conclusions: Patients with AF and FS show deeper anxiety, depression and sleep disturbances. Gender does not influence the risk of frailty in AF patients. Frailty in patients with AF is associated with a higher risk of depression, sleep disturbances and anxiety.

scholarly journals Analysis of Acute Drug Usage From a Retrospective Cohort Study on the Impact of an OPEP Device in COPD Patients With Chronic Bronchitis

CHEST Journal ◽  
2016 ◽  
Vol 150 (4) ◽  
pp. 837A
Author(s):  
Jason Suggett ◽  
Brian Carlin ◽  
Patrick Dunne ◽  
Gary Kauffman ◽  
Dominic Coppolo
Keyword(s):  
Cohort Study ◽  
Chronic Bronchitis ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Drug Usage ◽  
Copd Patients ◽  
The Impact

scholarly journals Association between serum phosphate and mortality in critically ill patients: a large retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e044473
Author(s):  
Yang Chen ◽  
Mengdi Luo ◽  
Huange Xu ◽  
Weiwei Zhao ◽  
Qing He
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Reference Group ◽  
Normal Serum ◽  
Serum Phosphate ◽  
Secondary Outcomes ◽  
The Impact ◽  
Very High

ObjectivesThis research aims to explore the impact of serum phosphate on the mortality of critically ill patients.DesignA retrospective large cohort study.SettingOur data were extracted from a publicly accessible database named ‘Multiparameter Intelligent Monitoring in Intensive Care Database III’.Participants27 131 patients were included by clear definitions of selection and exclusion criteria.InterventionsWe used initial phosphate at admission as a design variable. Patients were divided into six groups with different serum phosphate levels and five groups at different intensive care unit (ICU) departments.Primary and secondary outcomes28-day and 90-day mortality were primary outcomes. All-cause mortality and length of stay ICU were secondary outcomes.ResultsPatients with very-high-normal serum phosphate, hypophosphataemia and hyperphosphataemia had worse outcomes. And the relationship between serum phosphate and the probability of 28-day or 90-day mortality had a linear relationship. After adjustment for potential confounders, hypophosphataemia and hyperphosphataemia were not significantly associated with 28-day or 90-day mortality. Nevertheless, at the medical ICU, hyperphosphataemia was associated with increased 28-day or 90-day mortality (HR=0.64, 95% CI 0.48 to 0.84, p=0.0017; HR=0.72, 95% CI 0.57 to 0.91, p=0.0067, respectively), using group 2 (≥2.5 mg/dL and <3.0 mg/dL) as the reference group.ConclusionsPatients with very-high-normal serum phosphate also had worse outcomes, it might be necessary to re-evaluate the definitions of the normal reference range for serum phosphate. Hypophosphataemia and hyperphosphataemia are not the independent risk factors of 28-day or 90-day ICU mortality, which leads us to consider whether phosphate monitoring is not a necessary measure in critically ill patients. But hyperphosphataemia was associated with increased 28-day or 90-day mortality at the medical ICU, which emphasises the potential importance of early diagnosis and treatment of hyperphosphataemia for the patients who were admitted to the medical ICU.

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