Monitoring acute care utilization (ACU) during adjuvant chemotherapy for early breast cancer (EBC) as a measure of quality.

220 Background: Serious chemotherapy associated (CA) toxicities resulting in ACU are a concern when administering adjuvant chemotherapy for EBC. Monitoring ACU during adjuvant chemotherapy may serve as a measure of quality of cancer care delivery. We undertook a population based study of ACU in patients undergoing adjuvant chemotherapy for EBC compared with controls. Methods: All EBC patients diagnosed 01/07 – 12/09 in Ontario, Canada were identified from the Ontario Cancer Registry. Patient records were linked deterministically to provincial healthcare databases. All patients received ≥1 cycle of adjuvant chemotherapy. EBC cases (n = 4,718) were matched to non-cancer controls (n = 4,718) on age and geographic location. ACUs (emergency room or hospitalizations) within 30 days of chemotherapy were identified. If the primary reason for visit was a common toxicity of chemotherapy, the visit was considered chemotherapy associated (CA). All cause and CA visits were compared between cases and controls. Logistic regression models were used to identify covariates associated with ACU. Results: ACU was significantly higher in EBC pts compared with controls for both all cause (42.1% vs. 9.1%, p<.001) and CA (30.7% vs. 2.4%, p<.001) visits. Fever was the most common CA toxicity (22.9% vs. 1.2%,p<.001). Taxanes were significantly associated with increased ACU compared with anthracycline only (see Table). Conclusions: Serious chemotherapy associated toxicity resulting in ACU is common among EBC patients receiving chemotherapy. Interventions aimed at mitigating CA toxicity, particularly with the use of taxanes may reduce ACUs and improve quality of care. [Table: see text]

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Acute care utilization (ACU) among women receiving adjuvant chemotherapy for early breast cancer (EBC).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.27_suppl.65 ◽

2012 ◽

Vol 30 (27_suppl) ◽

pp. 65-65 ◽

Cited By ~ 4

Author(s):

Katherine Enright ◽

Eva Grunfeld ◽

Lingsong Yun ◽

Rahim Moineddin ◽

Susan Faye Dent ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Geographic Location ◽

Population Level ◽

Population Based ◽

Care Utilization ◽

Population Based Study ◽

Logistic Regression Models ◽

Ontario Cancer Registry ◽

Acute Care Utilization ◽

The Impact

65 Background: Adjuvant chemotherapy is considered standard care for patients with lymph node (LN) positive and high risk LN negative EBC. While toxicities of chemotherapy are documented in clinical trials, the impact of toxicities on ACU at a population level is unknown. We undertook a population based study of ACU in patients undergoing adjuvant chemotherapy for EBC compared with controls. Methods: All EBC patients diagnosed 01/07 – 12/09 in Ontario, Canada, were identified from the Ontario Cancer Registry. Pt records were linked deterministically to provincial healthcare databases. All patients received ≥1 cycle of adjuvant chemotherapy. EBC cases (n = 4,718) were matched to non-cancer controls (n = 4,718) on age and geographic location. ACUs (emergency room or hospitalizations) within 30 days of chemotherapy were identified. If the primary reason for visit was a common toxicity of chemotherapy, the visit was considered chemotherapy associated (CA). All cause and CA visits were compared between cases and controls. Logistic regression models were used to identify covariates associated with ACU. Results: ACU was significantly higher in EBC pts compared with controls for both all cause (42.1% vs 9.1%, p<.001) and CA (30.7% vs 2.4%, p<.001) visits. Fever was the most common CA toxicity (22.9% vs 1.2%, p<.001). Taxanes were significantly associated with increased ACU compared with anthracycline only. Conclusions: ACU is common among EBC receiving chemotherapy and significantly higher than among controls. Interventions aimed at mitigating CA toxicity, particularly with the use of taxanes may reduce ACUs. [Table: see text]

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The Association of Antibiotic (ATB) exposure prior to immune checkpoint inhibitor (ICI) treatment on early emergency room and hospitalization utilization: A population-based study.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.304 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 304-304

Author(s):

Lawson Eng ◽

Rinku Sutradhar ◽

Yue Niu ◽

Ning Liu ◽

Ying Liu ◽

...

Keyword(s):

Emergency Room ◽

Acute Care ◽

Therapeutic Option ◽

Population Based ◽

Dose Effect ◽

Care Utilization ◽

Comorbidity Score ◽

Logistic Regression Models ◽

Acute Care Utilization ◽

The Impact

304 Background: ICIs are becoming a common therapeutic option for many solid tumors. Prior studies have shown that ATB exposure can negatively impact ICI outcomes through gut microbiome changes leading to poorer overall survival; however, less is known about the potential impact of ATB exposure on toxicities from ICI. We undertook a population-based retrospective cohort study in patients receiving ICIs to evaluate the impact of ATB exposure on early acute care use, defined as emergency department visit or hospitalization, within 30 days of initiation of ICI therapy. Methods: Administrative data was utilized to identify a cohort of cancer patients > 65 years of age receiving ICIs from June 2012 to October 2018 in Ontario, Canada. We linked databases deterministically to obtain socio-demographic and clinical co-variates, ATB prescription claims and acute care utilization. Patients were censored if they died within 30 days of initiating ICI therapy. The impact of ATB exposure within 60 days prior to starting ICI on early acute care use was evaluated using multi-variable logistic regression models, adjusted for age, gender, rurality, recent hospitalization within 60 days prior to starting ICI and comorbidity score. Results: Among 2737 patients (median age 73 years), 43% received Nivolumab, 41% Pembrolizumab and 13% Ipilimumab, most commonly for lung cancer (53%) or melanoma (34%). Of these patients, 19% had ATB within 60 days prior to ICI with a median ATB treatment duration of 9 days (SD = 13). 647 (25%) patients had an acute care episode within 30 days of starting ICIs; 182 (7%) patients passed away within 30 days without acute care use and were censored from further analyses. Any ATB exposure within 60 days prior to ICI was associated with greater likelihood of acute care use (aOR = 1.34 95% CI [1.07-1.67] p = 0.01). A dose effect was seen based on weeks of ATB exposure within 60 days prior to ICI (aOR = 1.12 per week [1.04-1.21] p = 0.004) and early acute care use. ATB class analysis identified that exposure to penicillins (aOR = 1.54 [1.11-2.15] p = 0.01) and fluoroquinolones (aOR = 1.55 [1.11-2.17] p = 0.01) within 60 days of starting ICIs were associated with a greater likelihood of acute care use, while there was no significant association between cephalosporin exposure and early acute care use (p > 0.05). Conclusions: Exposure to ATBs, specifically fluoroquinolones and penicillins, prior to ICI therapy is associated with greater likelihood of hospitalization or emergency room visits within 30 days after initiation of ICIs, even after adjustment for relevant co-variates including age, comorbidity score and recent hospitalization prior to ICI initiation. Further studies are required to better understand the mechanisms of recent ATB exposure on early acute care use among patients receiving ICIs.

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Are depressive symptoms associated with quality of care in diabetes? Findings from a nationwide population-based study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001804 ◽

2021 ◽

Vol 9 (1) ◽

pp. e001804

Author(s):

Andreas Jung ◽

Yong Du ◽

Julia Nübel ◽

Markus A Busch ◽

Christin Heidemann ◽

...

Keyword(s):

Depressive Symptoms ◽

Sex Education ◽

Population Based ◽

National Health Survey ◽

Future Research ◽

Population Based Study ◽

Logistic Regression Models ◽

The Past ◽

Diagnosed Diabetes

IntroductionWe investigated whether the presence of depressive symptoms among adults with diagnosed diabetes is associated with adverse quality of diabetes care.Research design and methodsThe study population was drawn from the German national health survey ‘German Health Update’ 2014/2015-European Health Interview Survey and included 1712 participants aged ≥18 years with self-reported diabetes during the past 12 months. Depressive symptoms in the past 2 weeks were assessed by the eight-item depression module of the Patient Health Questionnaire (PHQ-8), with PHQ-8 sum score values ≥10 indicating current depressive symptoms. We selected 12 care indicators in diabetes based on self-reported information on care processes and outcomes. Associations of depressive symptoms with those indicators were examined in multivariable logistic regression models with stepwise adjustments.ResultsOverall, 15.6% of adults with diagnosed diabetes reported depressive symptoms, which were higher in women than in men (18.7% vs 12.9%). Adjusted for age, sex, education, social support, health-related behaviors, and diabetes duration, adults with depressive symptoms were more likely to report acute hypoglycemia (OR 1.81, 95% CI 1.13 to 2.88) or hyperglycemia (OR 2.10, 95% CI 1.30 to 3.37) in the past 12 months, long-term diabetes complications (OR 2.30, 95% CI 1.55 to 3.39) as well as currently having a diet plan (OR 2.14, 95% CI 1.39 to 3.29) than adults without depressive symptoms. Significant associations between depressive symptoms and other care indicators were not observed.ConclusionsThe present population-based study of adults with diagnosed diabetes indicates an association between depressive symptoms and adverse diabetes-specific care with respect to outcome but largely not to process indicators. Our findings underline the need for intensified care for persons with diabetes and depressive symptoms. Future research needs to identify underlying mechanisms with a focus on the inter-relationship between diabetes, depression and diabetes-related distress.

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A population based study of surgeon characteristics associated with the uptake of contemporary techniques in renal surgery

Canadian Urological Association Journal ◽

10.5489/cuaj.182 ◽

2013 ◽

Vol 7 (9-10) ◽

pp. 576 ◽

Cited By ~ 5

Author(s):

Stanley A Yap ◽

Shabbir M.H. Alibhai ◽

David Margel ◽

Robert Abouassaly ◽

Narhari Timilshina ◽

...

Keyword(s):

Regression Models ◽

Surgical Techniques ◽

Population Based ◽

Academic Status ◽

Renal Surgery ◽

Population Based Study ◽

Logistic Regression Models ◽

Ontario Cancer Registry ◽

Renal Tumours ◽

Underlying Mechanisms

Introduction: We have witnessed the slow uptake of many contemporary techniques in the surgical management of renal tumours. We sought to evaluate surgeon-level characteristics associated with the uptake of laparoscopy, partial nephrectomy (PN) and adrenal-sparing approaches in surgically managing these tumours.Methods: Using the Ontario Cancer Registry, we identified surgeons treating renal cell carcinoma (RCC) in the province of Ontario, Canada between 2002 and 2004. We then classified individuals within this cohort as either high or low utilizers of laparoscopy, PN or adrenal-sparing approaches. Further variables analyzed included academic status, surgeon graduation year and surgical volume status. We then used univariable and multivariable logistic regression models to assess predictors of uptake.Results: We evaluated a total of 108 surgeons for their uptake of both laparoscopy and adrenal-sparing approaches and 94 surgeonsfor their uptake of PN. We identified 32 surgeons (30%) as high users of laparoscopy. Predictors of uptake of laparoscopy included graduation year after 1990 (odds ratio [OR] 4.81, confidence interval [CI] 1.57-14.8) and high-surgeon volume (OR 4.33, CI1.60-10.4). We identified 41 surgeons (44%) as high users of PN. The only predictor of uptake of PN was academic status (OR 5.83,CI 1.96-17.3). We identified 69 surgeons (65%) as high users of adrenal-sparing approaches, but did not identify any significant predictors for uptake in this group.Discussion: We identify unique factors contributing to the uptake of distinct surgical techniques in the management of RCC. This information sheds lights on the underlying mechanisms and helps us understand how to further encourage the dissemination of these practices.

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A population-based study comparing patterns of care delivery on the quality of care for persons living with HIV in Ontario

BMJ Open ◽

10.1136/bmjopen-2014-007428 ◽

2015 ◽

Vol 5 (5) ◽

pp. e007428-e007428 ◽

Cited By ~ 15

Author(s):

C. E. Kendall ◽

M. Taljaard ◽

J. Younger ◽

W. Hogg ◽

R. H. Glazier ◽

...

Keyword(s):

Quality Of Care ◽

Care Delivery ◽

Population Based ◽

Patterns Of Care ◽

Population Based Study ◽

Persons Living With Hiv ◽

Living With Hiv

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Faculty Opinions recommendation of Nocturia frequency, bother, and quality of life: how often is too often? A population-based study in Finland.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.2274980.1895082 ◽

2010 ◽

Author(s):

Alexis Te ◽

Doreen E Chung

Keyword(s):

Quality Of Life ◽

Population Based ◽

Population Based Study

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Quality of life among people living with HIV in England and the Netherlands: a population-based study

The Lancet Regional Health - Europe ◽

10.1016/j.lanepe.2021.100177 ◽

2021 ◽

Vol 8 ◽

pp. 100177

Author(s):

Stephanie Popping ◽

Meaghan Kall ◽

Brooke E. Nichols ◽

Evelien Stempher ◽

Lisbeth Versteegh ◽

...

Keyword(s):

Quality Of Life ◽

The Netherlands ◽

Population Based ◽

People Living With Hiv ◽

Population Based Study ◽

Living With Hiv

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Dietary and lifestyle inflammatory scores are associated with increased risk of metabolic syndrome in Iranian adults

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-021-00648-1 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Hossein Farhadnejad ◽

Karim Parastouei ◽

Hosein Rostami ◽

Parvin Mirmiran ◽

Fereidoun Azizi

Keyword(s):

Metabolic Syndrome ◽

Positive Association ◽

Population Based ◽

Population Based Study ◽

Logistic Regression Models ◽

Increased Risk ◽

Confounding Variables ◽

Adjusted Model ◽

Diet And Lifestyle

Abstract Background In the current study, we aimed to investigate the association of dietary inflammation scores (DIS) and lifestyle inflammation scores (LIS) with the risk of metabolic syndrome (MetS) in a prospective population-based study. Methods A total of 1625 participants without MetS were recruited from among participants of the Tehran Lipid and Glucose Study(2006–2008) and followed a mean of 6.1 years. Dietary data of subjects were collected using a food frequency questionnaire at baseline to determine LIS and DIS. Multivariable logistic regression models, were used to calculate the odds ratio (ORs) and 95 % confidence interval (CI) of MetS across tertiles of DIS and LIS. Results Mean ± SD age of individuals (45.8 % men) was 37.5 ± 13.4 years. Median (25–75 interquartile range) DIS and LIS for all participants was 0.80 (− 2.94, 3.64) and 0.48 (− 0.18, − 0.89), respectively. During the study follow-up, 291 (17.9 %) new cases of MetS were identified. Based on the age and sex-adjusted model, a positive association was found between LIS (OR = 7.56; 95% CI 5.10–11.22, P for trend < 0.001) and risk of MetS, however, the association of DIS and risk of MetS development was not statistically significant (OR = 1.30;95% CI 0.93–1.80, P for trend = 0.127). In the multivariable model, after adjustment for confounding variables, including age, sex, body mass index, physical activity, smoking, and energy intake, the risk of MetS is increased across tertiles of DIS (OR = 1.59; 95% CI 1.09–2.33, P for trend = 0.015) and LIS(OR = 8.38; 95% CI 5.51–12.7, P for trend < 0.001). Conclusions The findings of the current study showed that greater adherence to LIS and DIS, determined to indicate the inflammatory potential of diet and lifestyle, are associated with increased the risk of MetS.

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Prevalence of nocturia among community-dwelling adults: a population-based study in Malaysia

BMC Urology ◽

10.1186/s12894-021-00860-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hui-Yin Yow ◽

John Jeh Lung Tiong ◽

Chun-Wai Mai ◽

Esther van der Werf ◽

Zulkifli Md Zainuddin ◽

...

Keyword(s):

Medical Condition ◽

Population Based ◽

Community Dwelling ◽

Medical Attention ◽

Night Time ◽

Cross Sectional ◽

Population Based Study ◽

Waking Up ◽

The Impact

Abstract Background Nocturia is widely prevalent condition with detrimental effects on quality of life and general health. In Malaysia, there is a lack of up-to-date prevalence study on nocturia. This study aimed to investigate the prevalence of nocturia and awareness pertaining to nocturia among Malaysian adults. Methods A cross-sectional population-based study was conducted among Malaysian adults aged ≥ 18 years old. The data was collected by mixed mode self-administered questionnaire from May 2019 to September 2019. Nocturia was defined as one or more voids at night. Results There were a total of 4616 respondents with 74.5% of response rate. The overall prevalence of nocturia among Malaysian adults was found to be 57.3%. In multivariate analysis, respondents aged 31–40 (1.91 [1.52–2.40]) or > 60 years old (2.03 [1.48–2.71]), and those who presented with hypertension (2.84 [2.28–3.53]), diabetes mellitus (1.78 [1.42–2.25]), renal disease (3.58 [1.93–6.63]) or overactive bladder (1.61 [1.10–2.35]) were associated with higher prevalence of nocturia. A significantly lower disease prevalence (p < 0.05) was noted among those aged 41–50 (0.73 [0.59–0.91]), male (0.78 [0.69–0.88]) and Chinese (0.47 [0.30–0.74]) or Indian (0.34 [0.21–0.54]) ethnicities. A total of 37.3% of respondents with nocturia reported that they faced sleeping difficulty about half the time or more after waking up in the middle of night. Those who had ≥ 2 voids per night experienced significantly higher mean bother score than those who had 1 void per night (p < 0.001). Approximately half (56.7%) of all respondents were not aware that night time urination is a medical condition. Only 25.2% of respondents with nocturia had sought medical attention for their nocturia. Conclusions The prevalence of nocturia among Malaysian adults is high and strongly influenced by age, sex, race and comorbidities. However, the general awareness pertaining to nocturia being a health issue remains low among Malaysians. The findings also highlighted the impact of nocturia on sleep and the need for nocturia education to better address this disease.

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