scholarly journals Effectiveness of behavioural medical rehabilitation under real-life conditions in germany: a propensity-score matched analysis

2021 ◽  
Author(s):  
Miriam Markus ◽  
Annemarie Euhus ◽  
Matthias Bethge
Keyword(s):  
Propensity Score ◽  
Work Ability ◽  
Relative Effectiveness ◽  
Real Life ◽  
Rehabilitation Programme ◽  
Medical Rehabilitation ◽  
Management Skills ◽  
Fear Avoidance Beliefs ◽  
Life Conditions ◽  
Number Of Patients

Objectives: In Germany, behavioural medical rehabilitation programmes have been implemented for patients with musculoskeletal disorders and additional mental health comorbidity. The aim of this cohort study is to assess the relative effectiveness of behavioural medical rehabilitation under real-life conditions. Design: Participants received either a common or behavioural medical rehabilitation programme. Propensity score matching was used to provide balanced samples of both groups (German Clinical Trials Register: DRKS00016404). Participants: A total of 360 patients treated in behavioural medical rehabilitation were compared with 360 matched controls. The mean age of study participants was approximately 53.5 years (standard deviation (SD)=7.0 years) and 74.0% were women. Results: No significant and clinical meaningful differences were found in return to work, applications for disability pension, and the number of patients receiving social security benefits in the year after rehabilitation. However, participants in behavioural medical rehabilitation reported better self-rated work ability, physical functioning and self-management skills, and decreased pain disability and fear-avoidance beliefs 10 months after rehabilitation. Standardized effect sizes were between 0.13 and 0.22. Conclusion: Behavioural medical rehabilitation had no clinical meaningful effect on maintaining and restoring work ability. However, behavioural medical rehabilitation affected pain and disease management skills 10 months after completing the rehabilitation programme.

Effects of nationwide implementation of work-related medical rehabilitation in Germany: propensity score matched analysis

2019 ◽  
Vol 76 (12) ◽  
pp. 913-919 ◽  
Author(s):  
Matthias Bethge ◽  
Miriam Markus ◽  
Marco Streibelt ◽  
Christian Gerlich ◽  
Michael Schuler
Keyword(s):  
Propensity Score ◽  
Real Life ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Rehabilitation Programme ◽  
Medical Rehabilitation ◽  
Risk Scores ◽  
Pension Insurance ◽  
Work Related ◽  
Patient Reported

ObjectivesSince 2014, the Federal German Pension Insurance has approved several departments to implement work-related medical rehabilitation programmes across Germany. Our cohort study was launched to assess the effects of work-related medical rehabilitation under real-life conditions.MethodsParticipants received either a common or a work-related medical rehabilitation programme. Propensity score matching was used to identify controls that were comparable to work-related medical rehabilitation patients. The effects were assessed by patient-reported outcome measures 10 months after completing the rehabilitation programme.ResultsWe compared 641 patients who were treated in work-related medical rehabilitation with 641 matched controls. Only half of the treated patients had high initial work disability risk scores and were intended to be reached by the new programmes. The dose of work-related components was on average in accordance with the guideline; however, the heterogeneity was high. Work-related medical rehabilitation increased the proportion of patients returning to work by 5.8 percentage points (95% CI 0.005 to 0.110), decreased the median time to return to work by 9.46 days (95% CI -18.14 to -0.79), and improved self-rated work ability by 0.38 points (95% CI 0.05 to 0.72) compared with common medical rehabilitation. A per-protocol analysis revealed that work-related medical rehabilitation was more effective if patients were assigned according to the guideline and the minimal mandatory treatment dose was actually delivered.ConclusionsThe implementation of work-related medical rehabilitation in German rehabilitation centres affected work participation outcomes. Improving guideline fidelity (reach and dose delivered) will probably improve the outcomes in real-world care.Trial Registration NumberDRKS00009780

scholarly journals Impact of polyclonal antithymocyte globulins on kidney transplant outcomes in real-life: a propensity score analysis

2020 ◽  
Author(s):  
Jamal Bamoulid ◽  
Thomas Crepin ◽  
Emilie Gaiffe ◽  
Bruno Moulin ◽  
Luc Frimat ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Propensity Score ◽  
Acute Rejection ◽  
Propensity Score Analysis ◽  
Graft Loss ◽  
Real Life ◽  
Area Under The Curve ◽  
Life Conditions ◽  
Score Analysis ◽  
The Impact

Abstract Background: Randomized studies reported a marginal superiority of polyclonal antithymocyte globulins (ATG, Thymoglobulin®, Sanofi, Gentilly, France, or Fresenius®, Bad Homburg, Germany) to prevent acute rejection compared to monoclonal anti-CD25 antibodies (IL2Ra). Nevertheless, the representativeness and the generalizability of these studies are questionable. Methods: We studied the impact of ATG use in real-life conditions in a multicenter study. Propensity score analysis was performed to address potential confounding by indication. Results: 817 patients were included. Logistic regression revealed that age, male gender, a pre-transplant history of cancer, presence of anti-HLA antibodies, previous kidney transplantation, and transplant center were associated with ATG use. The area under the curve of the propensity score was 0.84 + 0.02. ATG use was not associated with a lower rate of acute rejection (18.2% in ATG-treated patients vs 15.8% in non-ATG-treated patients, p =0.356). Adjustment for propensity score slightly modified the relationship between ATG and acute rejection towards a more neutral effect ( p =0.913). Score match analysis recapitulated the previous result. ATG use was associated with the occurrence of opportunistic infection ( p =0.034). There was no difference in graft loss or death between the two groups. Conclusions: In real-life conditions, ATG does not substantially reduce the risk of acute rejection after kidney transplantation. A better discrimination of patients who may benefit from ATG is required.

scholarly journals Impact of polyclonal antithymocyte globulins on kidney transplant outcomes in real-life: a propensity score analysis

2019 ◽  
Author(s):  
Jamal Bamoulid ◽  
Thomas Crepin ◽  
Emilie Gaiffe ◽  
Bruno Moulin ◽  
Luc Frimat ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Propensity Score ◽  
Acute Rejection ◽  
Propensity Score Analysis ◽  
Graft Loss ◽  
Real Life ◽  
Area Under The Curve ◽  
Life Conditions ◽  
Score Analysis ◽  
The Impact

Abstract Background Randomized studies reported a marginal superiority of polyclonal antithymocyte globulins (ATG) to prevent acute rejection compared to monoclonal anti-CD25 antibodies (IL2Ra). Nevertheless, the representativeness and the generalizability of these studies are questionable. Methods We studied the impact of ATG use in real-life conditions in a multicenter study. Propensity score analysis was performed to address potential confounding by indication. Results 817 patients were included. Logistic regression revealed that age, male gender, a pre-transplant history of cancer, presence of anti-HLA antibodies, previous kidney transplantation, and transplant center were associated with ATG use. The area under the curve of the propensity score was 0.84+0.02. ATG use was not associated with a lower rate of acute rejection (18.2% in ATG-treated patients vs 15.8% in non-ATG-treated patients, p=0.356). Adjustment for propensity score slightly modified the relationship between ATG and acute rejection towards a more neutral effect (p=0.913). Score match analysis recapitulated the previous result. ATG use was associated with the occurrence of opportunistic infection (p=0.034). There was no difference in graft loss or death between the two groups. Conclusions In real-life conditions, ATG does not substantially reduce the risk of acute rejection after kidney transplantation. A better discrimination of patients who may benefit of ATG is required.

scholarly journals Diabetes mellitus was not associated with lower amputation-free survival after open revascularization for chronic limb-threatening ischemia – A nationwide propensity score adjusted analysis

2021 ◽  
pp. 1358863X2110082
Author(s):  
Erika Lilja ◽  
Anders Gottsäter ◽  
Mervete Miftaraj ◽  
Jan Ekelund ◽  
Björn Eliasson ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Propensity Score ◽  
Vascular Surgery ◽  
Incidence Rate ◽  
Cox Regression ◽  
Major Amputation ◽  
Incidence Rates ◽  
Major Adverse Cardiovascular Events ◽  
Cox Regression Analysis ◽  
Number Of Patients

The risk of major amputation is higher after urgently planned endovascular therapy for chronic limb-threatening ischemia (CLTI) in patients with diabetes mellitus (DM). The aim of this nationwide cohort study was to compare outcomes between patients with and without DM following urgently planned open revascularization for CLTI from 2010 to 2014. Out of 1537 individuals registered in the Swedish Vascular Registry, 569 were registered in the National Diabetes Register. A propensity score adjusted Cox regression analysis was conducted to compare outcome between the groups with and without DM. Median follow-up was 4.3 years and 4.5 years for patients with and without DM, respectively. Patients with DM more often had foot ulcers ( p = 0.034) and had undergone more previous amputations ( p = 0.001) at baseline. No differences in mortality, cardiovascular death, major adverse cardiovascular events (MACE), or major amputation were observed between groups. The incidence rate of stroke was 70% higher (95% CI: 1.11–2.59; p = 0.0137) and the incidence rate of acute myocardial infarction (AMI) 39% higher (95% CI: 1.00–1.92; p = 0.0472) among patients with DM in comparison to those without. Open vascular surgery remains a first-line option for a substantial number of patients with CLTI, especially for limb salvage in patients with DM. The higher incidence rates of stroke and AMI among patients with DM following open vascular surgery for infrainguinal CLTI require specific consideration preoperatively with the aim of optimizing medical treatment to improve cardiovascular outcome postoperatively.

scholarly journals Management of Patients with Pancreatic Ductal Adenocarcinoma in the Real-Life Setting: Lessons from the French National Hospital Database

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3515
Author(s):  
Christelle de la Fouchardière ◽  
Mustapha Adham ◽  
Anne-Marie Marion-Audibert ◽  
Antoine Duclos ◽  
Claude Darcha ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Real Life ◽  
Ductal Adenocarcinoma ◽  
University Hospitals ◽  
National Hospital ◽  
Curative Intent ◽  
The Real ◽  
Oncological Treatment ◽  
Real Life Setting ◽  
Number Of Patients

Pancreatic ductal adenocarcinoma (PDAC) remains a major public health challenge, and faces disparities and delays in the diagnosis and access to care. Our purposes were to describe the medical path of PDAC patients in the real-life setting and evaluate the overall survival at 1 year. We used the national hospital discharge summaries database system to analyze the management of patients with newly diagnosed PDAC over the year 2016 in Auvergne-Rhône-Alpes region (AuRA) (France). A total of 1872 patients met inclusion criteria corresponding to an incidence of 22.6 per 100,000 person-year. Within the follow-up period, 353 (18.9%) were operated with a curative intent, 743 (39.7%) underwent chemo- and/or radiotherapy, and 776 (41.4%) did not receive any of these treatments. Less than half of patients were operated in a high-volume center, defined by more than 20 PDAC resections performed annually, mainly university hospitals. The 1-year survival rate was 47% in the overall population. This study highlights that a significant number of patients with PDAC are still operated in low-volume centers or do not receive any specific oncological treatment. A detailed analysis of the medical pathways is necessary in order to identify the medical and territorial determinants and their impact on the patient’s outcome.

scholarly journals An expandable approach for design and personalization of digital, just-in-time adaptive interventions

2018 ◽  
Vol 26 (3) ◽  
pp. 198-210 ◽  
Author(s):  
Suat Gonul ◽  
Tuncay Namli ◽  
Sasja Huisman ◽  
Gokce Banu Laleci Erturkmen ◽  
Ismail Hakki Toroslu ◽  
...  
Keyword(s):  
Real Life ◽  
Personal Data ◽  
Just In Time ◽  
Intervention Design ◽  
Intervention Delivery ◽  
Life Conditions ◽  
Triggering Conditions ◽  
Delivery Strategies ◽  
Design Mechanism ◽  
Personalized Intervention

AbstractObjectiveWe aim to deliver a framework with 2 main objectives: 1) facilitating the design of theory-driven, adaptive, digital interventions addressing chronic illnesses or health problems and 2) producing personalized intervention delivery strategies to support self-management by optimizing various intervention components tailored to people’s individual needs, momentary contexts, and psychosocial variables.Materials and MethodsWe propose a template-based digital intervention design mechanism enabling the configuration of evidence-based, just-in-time, adaptive intervention components. The design mechanism incorporates a rule definition language enabling experts to specify triggering conditions for interventions based on momentary and historical contextual/personal data. The framework continuously monitors and processes personal data space and evaluates intervention-triggering conditions. We benefit from reinforcement learning methods to develop personalized intervention delivery strategies with respect to timing, frequency, and type (content) of interventions. To validate the personalization algorithm, we lay out a simulation testbed with 2 personas, differing in their various simulated real-life conditions.ResultsWe evaluate the design mechanism by presenting example intervention definitions based on behavior change taxonomies and clinical guidelines. Furthermore, we provide intervention definitions for a real-world care program targeting diabetes patients. Finally, we validate the personalized delivery mechanism through a set of hypotheses, asserting certain ways of adaptation in the delivery strategy, according to the differences in simulation related to personal preferences, traits, and lifestyle patterns.ConclusionWhile the design mechanism is sufficiently expandable to meet the theoretical and clinical intervention design requirements, the personalization algorithm is capable of adapting intervention delivery strategies for simulated real-life conditions.

scholarly journals A Multi-Objective Optimization Method for Hospital Admission Problem—A Case Study on Covid-19 Patients

Algorithms ◽  
2021 ◽  
Vol 14 (2) ◽  
pp. 38
Author(s):  
Amr Mohamed AbdelAziz ◽  
Louai Alarabi ◽  
Saleh Basalamah ◽  
Abdeltawab Hendawi
Keyword(s):  
Medical Care ◽  
Real Life ◽  
Optimization Method ◽  
Multi Objective Optimization ◽  
Admission Process ◽  
Multi Objective ◽  
Admission Time ◽  
King Faisal Specialist Hospital ◽  
Number Of Patients ◽  
Massive Number

The wide spread of Covid-19 has led to infecting a huge number of patients, simultaneously. This resulted in a massive number of requests for medical care, at the same time. During the first wave of Covid-19, many people were not able to get admitted to appropriate hospitals because of the immense number of patients. Admitting patients to suitable hospitals can decrease the in-bed time of patients, which can lead to saving many lives. Also, optimizing the admission process can minimize the waiting time for medical care, which can save the lives of severe cases. The admission process needs to consider two main criteria: the admission time and the readiness of the hospital that will accept the patients. These two objectives convert the admission problem into a Multi-Objective Problem (MOP). Pareto Optimization (PO) is a common multi-objective optimization method that has been applied to different MOPs and showed its ability to solve them. In this paper, a PO-based algorithm is proposed to deal with admitting Covid-19 patients to hospitals. The method uses PO to vary among hospitals to choose the most suitable hospital for the patient with the least admission time. The method also considers patients with severe cases by admitting them to hospitals with the least admission time regardless of their readiness. The method has been tested over a real-life dataset that consisted of 254 patients obtained from King Faisal specialist hospital in Saudi Arabia. The method was compared with the lexicographic multi-objective optimization method regarding admission time and accuracy. The proposed method showed its superiority over the lexicographic method regarding the two criteria, which makes it a good candidate for real-life admission systems.

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