scholarly journals Use of olanzapine compared with clozapine for treatment-resistant schizophrenia in a real-world setting: nationwide register-based study

BJPsych Open ◽  
2021 ◽  
Vol 7 (5) ◽  
Author(s):  
Young Tak Jo ◽  
Sung Woo Joo ◽  
Soojin Ahn ◽  
Youngjae Choi ◽  
Jungsun Lee
Keyword(s):  
Real World ◽  
Survival Rates ◽  
Current Status ◽  
Emergency Room Visits ◽  
Treatment Resistant ◽  
Psychiatric Admissions ◽  
Before And After ◽  
Patient Variables ◽  
The Republic ◽  
Incident Cohort

Background Clozapine is generally considered as the treatment of choice for patients with treatment-resistant schizophrenia (TRS). However, its superiority has recently been questioned because olanzapine has been suggested as non-inferior to clozapine in its effectiveness. Aims We aimed to investigate the current status of clozapine prescriptions to identify any disparity between clinical guidelines and real-world practices. Method In this study, we utilised the Health Insurance Review Agency database in the Republic of Korea to investigate the real-world effectiveness of clozapine for patients with TRS. We compared differences in patient variables before and after clozapine administration, and we also performed survival analyses for both psychiatric admissions and emergency room visits among patients who used clozapine or olanzapine. Results This study investigated an incident cohort of 64 442 patients, and 2338 patients have been prescribed clozapine. Of these, 998 patients had TRS. In survival analysis, clozapine showed a worse survival rate for psychiatric admissions than olanzapine (hazard ratio 0.615). We also identified that clinicians tended to try a number of antipsychotics, as recommended, before starting patients on clozapine. Conclusions In conclusion, we found that olanzapine led to higher survival rates for psychiatric admissions than clozapine. Thus, considering the risk of serious adverse effects, clozapine may be used conservatively. Considering several studies advocating superior efficacy of clozapine, further studies with extensive data are recommended.

Only problem gamblers spend less money when loot boxes are removed from a game: A before and after study of Heroes of the Storm

2019 ◽  
Author(s):  
David Zendle
Keyword(s):  
Video Games ◽  
Problem Gambling ◽  
Video Game ◽  
Real World ◽  
Complex Pattern ◽  
Problem Gamblers ◽  
Before And After ◽  
Gambling Severity ◽  
Reliable Correlation ◽  
Before And After Study

Loot boxes are items in video games that may be paid for with real-world money, but which contain randomised contents. There is a reliable correlation between loot box spending and problem gambling severity: The more money gamers spend on loot boxes, the more severe their problem gambling tends to be. However, it is unclear whether this link represents a case in which loot box spending causes problem gambling; a case in which the gambling-like nature of loot boxes cause problem gamblers to spend more money; or whether it simply represents a case in which there is a general dysregulation in in-game spending amongst problem gamblers, nonspecific to loot boxes.The multiplayer video game Heroes of the Storm recently removed loot boxes. In order to better understand links between loot boxes and problem gambling, we conducted an analysis of players of Heroes of the Storm (n=112) both before and after the removal of loot boxes.There were a complex pattern of results. In general, when loot boxes were removed from Heroes of the Storm, problem gamblers appeared to spend significantly less money in-game in contrast to other groups. These results suggest that the presence of loot boxes in a game may lead to problem gamblers spending more money in-game. It therefore seems possible that links between loot box spending and problem gambling are not due to a general dysregulation in in-game spending amongst problem gamblers, but rather are to do with specific features of loot boxes themselves.

scholarly journals POS1121 DEMOGRAPHICS, COMORBIDITIES, AND RENAL FUNCTION OF UNCONTROLLED GOUT PATIENTS WHO RECEIVED PEGLOTICASE: FINDING FROM A LARGE US CLAIMS DATABASE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 839.2-840
Author(s):  
C. Vesel ◽  
A. Morton ◽  
M. Francis-Sedlak ◽  
B. Lamoreaux
Keyword(s):  
Kidney Function ◽  
Real World ◽  
Randomized Clinical Trials ◽  
Small Subset ◽  
Phase 3 ◽  
Claims Database ◽  
Medical Diagnoses ◽  
Ckd Stage ◽  
Before And After ◽  
The Impact

Background:NHANES data indicate that approximately 9.2 million Americans have gout,1 with a small subset having uncontrolled disease.2 Pegloticase is a PEGylated recombinant uricase enzyme indicated for treating uncontrolled gout that markedly reduces serum uric acid levels (sUA)3 and resolves tophi in treatment responders.4 Despite pegloticase availability in the US for many years, real world demographics of pegloticase users in the treatment of uncontrolled gout have not been previously reported in a population-based cohort.Objectives:This study utilized a large US claims database to examine demographics and co-morbidities of uncontrolled gout patients treated with pegloticase. Kidney function before and after pegloticase treatment and concomitant therapy with immunomodulators were also examined.Methods:The TriNetX Diamond database includes de-identified data from 4.3 million US patients with gout (as of September 2019), including demographics, medical diagnoses, laboratory values, procedures (e.g. infusions, surgeries), and pharmacy data. Patients who had received ≥1 pegloticase infusion were included in these analyses. The number of infusions was evaluated for a subgroup of patients who were in the database ≥3 months before and ≥2 years after the first pegloticase infusion (i.e. first infusion prior to September 2017) to ensure only complete courses of therapy were captured. In this subpopulation, kidney function before and after pegloticase therapy was examined, along with the presence of immunomodulation prescriptions (methotrexate, mycophenolate mofetil, azathioprine, leflunomide) within 60 days prior to and 14 days after the first pegloticase infusion.Results:1494 patients treated with pegloticase were identified. Patients were 63.1 ± 14.0 years of age (range: 23–91), mostly male (82%), and white (76%). Mean sUA prior to pegloticase was 8.7 ± 2.4 mg/dL (n=50), indicating uncontrolled gout in the identified population. The most commonly reported comorbidities were chronic kidney disease (CKD, 48%), essential hypertension (71%), type 2 diabetes (39%), and cardiovascular disease (38%), similar to pegloticase pivotal Phase 3 trial populations. In patients with pre-therapy kidney function measures (n=134), pre-treatment eGFR averaged 61.2 ± 25.7 ml/min/1.73 m2, with 44% having Stage 3-5 CKD. In patients with complete therapy course capture and pre- and post-therapy eGFR measures (n=48), kidney function remained stable (change in eGFR: -2.9 ± 18.2 ml/min/1.73 m2) and CKD stage remained the same or improved in 81% of patients. In 791 patients with complete treatment course capture, patients had received 8.7 ± 13.8 infusions (median: 3, IQR: 2-10). Of these, 189 (24%) patients received only 1 pegloticase infusion and 173 (22%) received ≥12 infusions. As the data cut-off for this analysis pre-dated emerging data on the use of immunomodulation as co-therapy, only 19 of 791 (2%) patients received immunomodulation co-therapy with pegloticase.Conclusion:This relatively large group of patients with uncontrolled gout treated with pegloticase had similar patient characteristics of those studied in the phase 3 randomized clinical trials. Patients with uncontrolled gout are significantly burdened with systemic co-morbid diseases. The majority of patients had stable or improved kidney function following pegloticase treatment. As these results reflect patients initiating treatment prior to 2018, before co-treatment with immunomodulation was introduced, this cohort only included a small percentage of patients who were co-treated with an immunomodulator. Future studies using more current datasets are needed to evaluate real world outcomes in patients treated with pegloticase/immunomodulator co-therapy and to evaluate the impact of systemic co-morbid diseases.References:[1]Chen-Xu M, et al. Arthritis Rheumatol 2019 71:991-999.[2]Fels E, Sundy JS. Curr Opin Rheumatol 2008;20:198-202.[3]Sundy J, et al. JAMA 2011;306:711-720.[4]Mandell BF, et al. Arthritis Res Ther 2018;20:286.Disclosure of Interests:Claudia Vesel Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc, Allan Morton Speakers bureau: Sanofi, Amgen, and Horizon, Megan Francis-Sedlak Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc, Brian LaMoreaux Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc.

scholarly journals Network robustness improvement via long-range links

2019 ◽  
Vol 6 (1) ◽  
Author(s):  
Vincenza Carchiolo ◽  
Marco Grassia ◽  
Alessandro Longheu ◽  
Michele Malgeri ◽  
Giuseppe Mangioni
Keyword(s):  
Complex Networks ◽  
Long Range ◽  
Real World ◽  
Network Robustness ◽  
Scale Free ◽  
Area Of Interest ◽  
Before And After ◽  
Significant Area ◽  
Better Than

AbstractMany systems are today modelled as complex networks, since this representation has been proven being an effective approach for understanding and controlling many real-world phenomena. A significant area of interest and research is that of networks robustness, which aims to explore to what extent a network keeps working when failures occur in its structure and how disruptions can be avoided. In this paper, we introduce the idea of exploiting long-range links to improve the robustness of Scale-Free (SF) networks. Several experiments are carried out by attacking the networks before and after the addition of links between the farthest nodes, and the results show that this approach effectively improves the SF network correct functionalities better than other commonly used strategies.

The Iterative Development and Testing of an Interactive Mobile Application for Skill Retention of Cardiopulmonary Resuscitation Among High School Students: A Pilot Study

2021 ◽  
pp. 104687812110326
Author(s):  
Adeel Arif ◽  
Amber Arif ◽  
Kimberly Anne Fasciglione ◽  
Farrukh Nadeem Jafri
Keyword(s):  
High School ◽  
High School Students ◽  
Cardiopulmonary Resuscitation ◽  
Mobile Apps ◽  
Low Cost ◽  
Survival Rates ◽  
Compression Rate ◽  
School Students ◽  
Skill Retention ◽  
Before And After

Abstract: Background Locations concentrated with High School (HS) students tend to have lower out-of-hospital cardiac arrest (OHCA) survival rates. Mobile applications (apps) have the capability to augment cardiopulmonary resuscitation (CPR) skill retention as a low-cost, accessible training method. Methods An iterative process to develop an app to reinforce CPR skills emphasizing hand placement, compression rate, real-time feedback, and recurring tips is described. The app was tested on HS students to measure its impact on quality and comfort of CPR using Likert surveys and skills assessments before and after one month of usage. CPR Score and compression rate were measured using the Laerdal™ Little Anne Manikin QCPR software. Results Fourteen HS students participated in a prospective observational study. It was found that the use of the developed app was associated with improved CPR performance (80.43% v. 87.86%, p=0.01-0.02, 95% CI=2.20-12.66) after one month. Additionally, improvements were demonstrated in compression rate accuracy (21.43% v. 64.29%, p=0.041, 95% CI=0.132-0.725), increased comfort performing CPR (3.86 v. 4.79, p<0.001, 95% CI =0.99-1.00) and comfort performing CPR on strangers (2.71 v. 4.42, p<0.001, 95% CI=1.24-2.19). In addition, for every time the app was used, CPR performance increased by 0.5668% (p=0.0182). Conclusion Findings suggest that mobile apps may have promising implications as augmentative tools for CPR curriculums.

scholarly journals Real-World Experience of the One-Year Efficacy of Rifaximin Add-On to Lactulose Is Superior to Lactulose Alone in Patients with Cirrhosis Complicated with Recurrent Hepatic Encephalopathy in Taiwan

2021 ◽  
Vol 11 (6) ◽  
pp. 478
Author(s):  
Ching Chang ◽  
Chien-Hao Huang ◽  
Hsiao-Jung Tseng ◽  
Fang-Chen Yang ◽  
Rong-Nan Chien
Keyword(s):  
Hepatic Encephalopathy ◽  
Real World ◽  
Ammonia Level ◽  
Decompensated Cirrhosis ◽  
Control Group ◽  
Multivariable Logistic Regression Model ◽  
Before And After ◽  
One Year ◽  
The One ◽  
Serum Ammonia

Background: Hepatic encephalopathy (HE), a neuropsychiatric complication of decompensated cirrhosis, is associated with high mortality and high risk of recurrence. Rifaximin add-on to lactulose for 3 to 6 months is recommended for the prevention of recurrent episodes of HE after the second episode. However, whether the combination for more than 6 months is superior to lactulose alone in the maintenance of HE remission is less evident. Therefore, the aim of this study is to evaluate the one-year efficacy of rifaximin add-on to lactulose for the maintenance of HE remission in Taiwan. Methods: We conducted a real-world single-center retrospective cohort study to compare the long-term efficacy of rifaximin add-on to lactulose (group R + L) versus lactulose alone (group L, control group). Furthermore, the treatment efficacy before and after rifaximin add-on to lactulose was also analyzed. The primary endpoint of our study was time to first HE recurrence (Conn score ≥ 2). All patients were followed up every three months until death, and censored at one year if still alive. Results and Conclusions: 12 patients were enrolled in group R + L. Another 31 patients were stratified into group L. Sex, comorbidity, ammonia level, and ascites grade were matched while age, HE grade, and model for end-stage liver disease (MELD) score were adjusted in the multivariable logistic regression model. Compared with group L, significant improvement in the maintenance of HE remission and decreased episodes and days of HE-related hospitalizations were demonstrated in group R + L. The serum ammonia levels were significantly lower at the 3rd and 6th month in group 1. Concerning changes before and after rifaximin add-on in group R + L, mini-mental status examination (MMSE), episodes of hospitalization, and variceal bleeding also improved at 6 and 12 months. Days of hospitalization, serum ammonia levels also improved at 6th month. Except for concern over price, no patients discontinued rifaximin due to adverse events or complications. The above results provide evidence for the one-year use of rifaximin add-on to lactulose in reducing HE recurrence and HE-related hospitalization for patients with decompensated cirrhosis.

scholarly journals Effect of Integrated Neuromuscular Exercise in Physical Education Class on Health-Related Fitness in Female Children

Healthcare ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 312
Author(s):  
Marijana Sinđić ◽  
Draženka Mačak ◽  
Nikola Todorović ◽  
Bianka Purda ◽  
Maja Batez
Keyword(s):  
Physical Education ◽  
Muscular Fitness ◽  
Female Children ◽  
Before And After ◽  
Health Related ◽  
The Republic ◽  
Almost All ◽  
And Control ◽  
Cardiorespiratory Endurance ◽  
Health Related Fitness

Integrated neuromuscular training (INT) showed benefits for improving fundamental movement skills (FMS). However, the INT health-related fitness (HRF) effects are lacking. The current study aimed to determine the effects of INT implemented during physical education (PE) in a primary school in the Republic of Serbia on HRF in female children. The sample consisted of 72 healthy girls who were divided into the intervention (EG: n = 37; mean ± SD: age = 8.17 ± 0.31) and control (CG: n = 35; age = 8.11 ± 0.31) groups. The EG and CG performed the INT program and traditional PE activities two times per week within the first ~15 min of PE class, respectively. The Fitnessgram battery tests assessed the HRF (body composition, cardiorespiratory endurance, muscular fitness, and flexibility) before and after the program. After eight weeks, the EG significantly reduced all fat measures, while the CG decreased only triceps skinfold but to a smaller extent (F = 5.92, p < 0.02, ŋ2 = 0.09). Both groups significantly improved the performance of almost all muscular fitness tests (curl-ups, trunk lift, push-ups); however, the EG increased the push-ups more than the CG (F = 9.01, p < 0.01, ŋ2 = 0.14). The EG additionally improved the modified pull-ups (F = 14.09, p < 0.01, ŋ2 = 0.19) and flexed arm hang (F = 28.82, p < 0.01, ŋ2 = 0.33) tests. The flexibility and cardiorespiratory endurance of both groups did not significantly change after eight weeks. This approach of exercise showed positive acceptance and relatively good results after only eight weeks.

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