scholarly journals Playing jeopardy by not treating the whole person with arthritis

2018 ◽  
Vol 5 (1) ◽  
Author(s):  
Patricia Lynn Dobkin ◽  
Gilles Boire
Keyword(s):  
Clinical Outcomes ◽  
Joint Damage ◽  
First Year ◽  
Biomedical Model ◽  
Potent Predictor ◽  
Whole Person ◽  
Care Approach ◽  
Using Data ◽  
One Year

Availability of potent medications, earlier diagnosis and use of drug combinations should have made rheumatoid arthritis yesterday’s disease. Unfortunately the majority of patients never reach remission. The focus of treatment has been based on the biomedical model aiming to reduce inflammation, regulate the immune system, and prevent joint damage – all worthy outcomes. A whole person care approach would add to patient care by including attention to the psychosocial aspects of illness that contribute to clinical outcomes. Two studies using data from a longitudinal cohort followed out to four years with early arthritis patients will be highlighted. The first identified predictors of pain one year after baseline in 211 patients. While overall pain decreased over time, emotion-oriented coping contributed to pain intensity and affective pain. The second study examined the link between depression and clinical outcomes four years later using data from 275 patients. It was found that when depression persisted into the first year it was the most potent predictor of disease activity at each follow-up visit. Moreover, the proportion of patients who ever reached remission decreased from 84.3% to 31.3% for patients with depressive symptoms at 12 months. vailability of potent medications, earlier diagnosis and use of drug combinations should have made rheumatoid arthritis yesterday’s disease.   Unfortunately the majority of patients never reach remission. The focus of treatment has been based on the biomedical model aiming to reduce inflammation, regulate the immune system, and prevent joint damage – all worthy outcomes. A whole person care approach would add to patient care by including attention to the psychosocial aspects of illness that contribute to clinical outcomes.   Two studies using data from a longitudinal cohort followed out to four years with early arthritis patients will be highlighted. The first identified predictors of pain one year after baseline in 211 patients. While overall pain decreased over time, emotion-oriented coping contributed to pain intensity and affective pain. The second study examined the link between depression and clinical outcomes four years later using data from 275 patients. It was found that when depression persisted into the first year it was the most potent predictor of disease activity at each follow-up visit. Moreover, the proportion of patients who ever reached remission decreased from 84.3% to 31.3% for patients with depressive symptoms at 12 months.  It is recommended that both curing and healing be considered when treating arthritis patients given the importance of psychosocial factors to the trajectory of the disease. This could be done by screening for and treating depression in arthritis patients. Antidepressant medications and/or psychological interventions such as Mindfulness-Based Stress Reduction or Cognitive Behavioural Therapy are options to be considered.

scholarly journals Cardiovascular risk factors associated with acute myocardial infarction and stroke in the MADIABETES cohort

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
M. A. Salinero-Fort ◽  
F. J. San Andrés-Rebollo ◽  
J. Cárdenas-Valladolid ◽  
M. Méndez-Bailón ◽  
R. M. Chico-Moraleja ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Antihypertensive Drugs ◽  
Hdl Cholesterol ◽  
First Year ◽  
Backward Elimination ◽  
One Year ◽  
Time Varying Covariates

AbstractWe aimed to develop two models to estimate first AMI and stroke/TIA, respectively, in type 2 diabetes mellitus patients, by applying backward elimination to the following variables: age, sex, duration of diabetes, smoking, BMI, and use of antihyperglycemic drugs, statins, and aspirin. As time-varying covariates, we analyzed blood pressure, albuminuria, lipid profile, HbA1c, retinopathy, neuropathy, and atrial fibrillation (only in stroke/TIA model). Both models were stratified by antihypertensive drugs. We evaluated 2980 patients (52.8% women; 67.3 ± 11.2 years) with 24,159 person-years of follow-up. We recorded 114 cases of AMI and 185 cases of stroke/TIA. The factors that were independently associated with first AMI were age (≥ 75 years vs. < 75 years) (p = 0.019), higher HbA1c (> 64 mmol/mol vs. < 53 mmol/mol) (p = 0.003), HDL-cholesterol (0.90–1.81 mmol/L vs. < 0.90 mmol/L) (p = 0.002), and diastolic blood pressure (65–85 mmHg vs. < 65 mmHg) (p < 0.001). The factors that were independently associated with first stroke/TIA were age (≥ 75 years vs. < 60 years) (p < 0.001), atrial fibrillation (first year after the diagnosis vs. more than one year) (p = 0.001), glomerular filtration rate (per each 15 mL/min/1.73 m2 decrease) (p < 0.001), total cholesterol (3.88–6.46 mmol/L vs. < 3.88 mmol/L) (p < 0.001), triglycerides (per each increment of 1.13 mmol/L) (p = 0.031), albuminuria (p < 0.001), neuropathy (p = 0.01), and retinopathy (p = 0.023).

Use of Trained Mothers to Teach Interviewing Skills to First-Year Medical Students: A Follow-up Study

PEDIATRICS ◽  
1977 ◽  
Vol 60 (2) ◽  
pp. 165-169 ◽  
Author(s):  
Paula L. Stillman ◽  
Darrell L. Sabers ◽  
Doris L. Redfield
Keyword(s):  
Medical Students ◽  
School Curriculum ◽  
Control Group ◽  
First Year ◽  
Feedback Session ◽  
Optimal Learning ◽  
Interviewing Skills ◽  
One Year ◽  
First Year Medical Students

This report describes an attempt to evaluate the effectiveness of "trained mother" interviews early in the medical school curriculum. As an adjunct to a first-year course that teaches interviewing techniques, half of the students were exposed to an interview with one of three trained mothers early in the course. This treatment interview was immediately followed by a feedback session which concentrated on the content and process of interviewing. At the end of the course, all students had an evaluative interview. Those students who had an initial interview and feedback session with a trained mother scored significantly higher on both the content and process of their interviews than the control group. This technique is an effective and efficient way to teach interviewing skills to medical students prior to entering any of their clinical clerkships. A follow-up assessment conducted one year later indicated that one interview with a trained mother is sufficient for optimal learning and that the skills learned are retained over at least that period of time.

Combined hormonal contraception and risk of venous thromboembolism within the first year following pregnancy

2014 ◽  
Vol 112 (07) ◽  
pp. 73-78 ◽  
Author(s):  
Thomas Bergholt ◽  
Anne Nielsen ◽  
Michael J. Paidas ◽  
Ellen Christine L. Løkkegaard ◽  
Jesper Petersen
Keyword(s):  
Venous Thromboembolism ◽  
Hormonal Contraception ◽  
Hormonal Contraceptives ◽  
First Year ◽  
The Difference ◽  
Combined Hormonal Contraception ◽  
One Year ◽  
First Time ◽  
Combined Hormonal Contraceptives

SummaryEstimating the risk of venous thromboembolism (VTE) associated with combined hormonal contraceptives following early terminated pregnancies or birth, a Danish nationwide retrospective cohort observing a one-year follow-up was defined using three unique registries. All Danish women with confirmed pregnancies aged 15–49 during the period of 1995–2009 were included. The main outcomes were relative and absolute risks of first time venous thromboembolism in users as well as non-users of combined hormonal contraceptives. In 985,569 person-years, 598 venous thromboembolisms were recorded. After early terminated pregnancies and births, respectively, 113 and 485 events occurred in 212,552 and 773,017 person-years. After early terminated pregnancies, the crude VTE incidence ratios were similar, and the numbers needed to harm were equal between groups that did or did not use combined hormonal contraceptives throughout the follow-up year. After childbirth, individuals that used combined hormonal contraceptives were more likely than non-users to experience VTE depicted by crude incidence ratios; however, the difference was only significant after 14 weeks. This implied that the numbers needed to harm were lower for those that used compared to those that did not use combined oral contraceptives in the initial 14 weeks postpartum. In conclusion, the use of combined hormonal contraceptives after early terminated pregnancies was not detrimental, but during the puerperal period, they should be used with caution.

Subspinal impingement: clinical outcomes of arthroscopic decompression with one year minimum follow up

2018 ◽  
Vol 28 (9) ◽  
pp. 2756-2762 ◽  
Author(s):  
Frankl Michal ◽  
Eyal Amar ◽  
Ran Atzmon ◽  
Zachary Sharfman ◽  
Barak Haviv ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
One Year

Nonfocal Symptoms in Patients with Transient Ischemic Attack and Association with Stroke Risk

2021 ◽  
Vol 19 ◽  
Author(s):  
Shuxiang Yang ◽  
Lu Zhao ◽  
Lulu Pei ◽  
Shuang Cao ◽  
Yuan Gao ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Stroke Risk ◽  
First Year ◽  
Kaplan Meier ◽  
Predictive Outcome ◽  
One Year ◽  
Ischemic Attack ◽  
Cumulative Risks

Background and Objective: Patients with transient ischemic attack（TIA）occasionally showed nonfocal symptoms, such as decreased consciousness, amnesia and non-rotatory dizziness. This study intended to evaluate the effect of nonfocal symptoms on the prognosis of patients with TIA. Methods: Data from the prospective hospital-based TIA database of the First Affiliated Hospital of Zhengzhou University were analyzed. The predictive outcome was stroke occurrence at 1 year. Cumulative risks of stroke in patients with and without nonfocal symptoms were estimated with Kaplan-Meier models. Results: We studied 1384 patients with TIA (842 men; mean age, 56±13 years), including 450 (32.5%) with nonfocal symptoms. In the first year after TIA, stroke occurred in 168（12.1%） patients. There was no difference in the risk of stroke between patients with both focal and nonfocal symptoms and patients with focal symptoms alone (11.8% vs 12.4%, log-rank; P=0.691). Conclusions: The occurrence of nonfocal symptoms did not increase the risk of stroke at one-year follow-up compared to the occurrence of focal symptoms alone.

Persistence with Antihypertensives Related to Formulation: The Case of Nifedipine

2005 ◽  
Vol 39 (2) ◽  
pp. 237-242 ◽  
Author(s):  
Nancy S Breekveldt-Postma ◽  
Ron MC Herings
Keyword(s):  
Cardiovascular Diseases ◽  
Antihypertensive Drugs ◽  
First Year ◽  
Proportional Hazard ◽  
Once Daily ◽  
Gastrointestinal Therapeutic System ◽  
Dosing Frequency ◽  
Nifedipine Gastrointestinal Therapeutic System ◽  
One Year

BACKGROUND: Controlled-release dosage forms may enhance persistence with therapy because of reduced dosing frequency and fewer adverse effects. OBJECTIVE: To assess the differences in persistent use of nifedipine between once-daily nifedipine gastrointestinal therapeutic system (GITS) and twice-daily nifedipine retard formulations. METHODS: Incident nifedipine users were selected from January 1992 to December 2001 from the PHARMO database, including drug-dispensing records and hospital records of more than one million subjects in the Netherlands. Patients with unaltered formulation and dosing frequency of nifedipine in the first year of follow-up with at least 2 prescriptions were included in the cohort. Persistence with different formulations was assessed using Cox's proportional hazard analyses. Covariates included in the analysis were, among others, hospitalizations and comedication for cardiovascular diseases. RESULTS: In total, 5889 incident users of nifedipine were included. The median duration of the first treatment episode was 133 days for nifedipine retard and 262 days for nifedipine GITS. One-year persistence with nifedipine increased from 32% in patients using retard formulations to 44% in patients using nifedipine GITS. Multivariate analyses showed that patients using nifedipine GITS were 1.3 times (RR 1.33; 95% CI 1.22 to 1.46) more persistent than those using retard formulations of nifedipine. Persistent patients more often used other antihypertensive drugs and were more often hospitalized for cardiovascular diseases. CONCLUSIONS: Patients using once-daily nifedipine GITS are more persistent with therapy than patients using twice-daily retard formulations.

085 Clinical outcomes were better for relapsing-remitting multiple sclerosis (RRMS) patients who remained on natalizumab compared to those who switched to oral or injectable therapies after 2 years in the tysabri® observational program (TOP)

2018 ◽  
Vol 89 (6) ◽  
pp. A34.2-A34
Author(s):  
Helmut Butzkueven ◽  
Ludwig Kappos ◽  
Tim Spelman ◽  
Maria Trojano ◽  
Heinz Wiendl ◽  
...  
Keyword(s):  
Disease Activity ◽  
Clinical Outcomes ◽  
Cox Models ◽  
Relapse Risk ◽  
Lower Baseline ◽  
Relapsing Remitting ◽  
Study Support ◽  
Using Data ◽  
Relapsing Remitting Multiple Sclerosis

IntroductionNatalizumab is a high-efficacy RRMS therapy. Data on post-natalizumab disease activity may be important for physician consideration. We compared outcomes in patients who switched to an oral or injectable therapy or remained on natalizumab and analysed post-natalizumab relapse predictors using data from TOP, an ongoing 10 year observational study of natalizumab-treated RRMS patients.MethodsData from November 2016 were analysed for patients who stayed on natalizumab (≥3 years natalizumab and only natalizumab during follow-up; n=2466; mean time on natalizumab: 5.5 years) or switched to oral (n=660) or injectable (n=95) therapies for ≥1 year after ≥2 years on natalizumab (mean post-natalizumab follow-up 2.5 vs 2.4 years). Annualised relapse rates (ARRs) and Expanded Disability Status Scale (EDSS) worsening risks were evaluated. Disease activity predictors were compared using adjusted Cox models.ResultsRelapse risk was higher for oral switchers (hazard ratio [HR]=2.18; p<0.001) or injectable switchers (HR=3.02; p<0.001) than for patients who stayed on natalizumab >2 years. EDSS worsening risk was similar for oral (HR=1.19; p=0.266) and higher for injectable (HR=2.52; p<0.001) switchers compared with stayed-on-natalizumab patients. ARRs decreased after 2 years by 20.2% for stayed-on-natalizumab patients but increased from on-natalizumab rates by 17.8% in oral switchers (p<0.001) and 108.1% in injectable switchers (p<0.001). In oral switchers, lower relapse risk was predicted by shorter washout time (>12 weeks vs ≤4 weeks; HR=2.03; p<0.001), fewer pre-natalizumab relapses (HR=1.24/relapse in the prior year; p<0.001), lower baseline EDSS (>3.5 vs≤3.5; HR=1.44; p=0.007), and longer natalizumab duration (>3 years vs ≤3 years; HR=0.76; p=0.040).ConclusionStaying on natalizumab >2 years yields better clinical outcomes than switching to oral or injectable therapies. For those discontinuing natalizumab, switching to an oral versus an injectable yields better outcomes. Disease activity risk in oral switchers is predicted by washout time, pre-natalizumab relapses and EDSS, and time on natalizumab.Study supportBiogen.

Therapy persistence in newly diagnosed non-valvular atrial fibrillation treated with warfarin or NOAC

2016 ◽  
Vol 115 (01) ◽  
pp. 31-39 ◽  
Author(s):  
Anja Katholing ◽  
Christopher Wallenhorst ◽  
Saul Benedict Freedman ◽  
Carlos Martinez
Keyword(s):  
Atrial Fibrillation ◽  
Guideline Adherence ◽  
Practice Research ◽  
First Year ◽  
Clinical Practice Research Datalink ◽  
Supplementary Material ◽  
One Year ◽  
The Uk ◽  
Physician Adherence

SummaryEfforts to reduce stroke in atrial fibrillation (AF) have focused on increasing physician adherence to oral anticoagulant (OAC) guidelines, but high early vitamin K antagonist (VKA) discontinuation is a limitation. We compared persistence of non-VKA OAC (NOAC) with VKA treatment in the first year after OAC inception for incident AF in real-world practice. We studied 27,514 anticoagulant-naïve patients with incident non-valvular AF between January 2011 and May 2014 in the UK primary care Clinical Practice Research Datalink, with full medication use linkage: mean age 74.2 ± 12.4, 45.7 % female, mean follow-up 1.9 ± 1.1 years. After treatment initiation and follow-up until 1/2015, the proportion remaining on OAC at one year (persistence) was estimated using competing risk survival analyses. OAC was commenced ≤90 days after incident AF in 13,221 patients (48.1 %): 12,307 VKA and 914 NOAC (apixaban, dabigatran, rivaroxaban). Amongst those treated with OAC, the proportion commencing NOAC increased from zero in 1/2011 to 27.0 % in 5/2014, and OAC prescriptions for CHA2DS2VASc score ≥2 (guideline adherence) increased from 41.2 % to 65.5 %. Persistence with OAC declined over 12 months to 63.6 % for VKA and 79.2 % for NOAC (p< 0.0001). Persistence for those with CHA2DS2VASc ≥2 was significantly greater for NOAC (83.0 %) than VKA (65.3 %, p< 0.0001) at one year and all earlier time points. Comparison of VKA and NOAC cohorts matched on individual CHA2DS2VASc components showed consistent results. In conclusion, persistence was significantly higher with NOAC than VKA, and could alone lead to fewer cardioembolic strokes. Increased guideline adherence following NOAC introduction could further decrease AF stroke burden.Supplementary Material to this article is available online at www.thrombosis-online.com.

A Prospective Study on the Feasibility of Related and Unrelated Donor Search and Hematopoietic Cell Transplantation for Adults with Acute Leukemia at 31 European Transplant Centers

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2385-2385
Author(s):  
Vanderson Rocha ◽  
Mutlu Arat ◽  
Vladimir Koza ◽  
Norbet C Gorin ◽  
Augustin Ferrant ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Cord Blood ◽  
Hla Typing ◽  
First Year ◽  
Unrelated Donor ◽  
Alternative Donor ◽  
Family Donor ◽  
Unrelated Cord Blood ◽  
One Year

Abstract Currently, a donor can be virtually found for all patients with an indication for allo-transplantation due to the increased number of hematopoietic stem cell (HSC) donors and increasing use of umbilical cord blood and haplo-transplants. In this study, we have addressed the question of the feasibility of searching HSC donors grafts [HLA-matched sibling donor (MSD), and alternative donors] and performing such transplants or other treatments (such as autologous HSC transplant or chemotherapy) for adults with acute leukemia for whom an indication of allo-HSCT could be planned during the course of their disease. The second objective was to compare in an “intent to treat” analysis, LFS according to planned strategy treatment. Patients were included at HLA typing test. A specific questionnaire was completed specifying the initial strategies planned for each patient and their changes over the period: at HLA typing, after 3, 6, 9, 12 months after the registration, and twice a year for the following 2 years. From 2003 to 2006, 702 adults were enrolled by 31 EBMT centres, 490 had AML, 212 ALL. HLA typing was performed for 443 patients at diagnosis, 172 after first CR, 11 after CR2, and 64 in more advanced phase. Median follow-up was 31 months, median age was 42-years (18–75); 207 patients were aged more than 50 years. A MSD was found for 309 patients (44%). Of 309 patients, 290 patients had 1 MSD, 17 patients 2 MSD and only 2 patients more than 2 donors. In 40 cases where the MDS was found the transplant centres did not planned to perform the transplant. A transplant using a haploidentical donor was planned in 4 cases. At the end, 273 patients were planned to be transplanted from a family donor (269 from a MSD and 4 from an haplo). For the remaining 429 patients, the indication of an auto-HCT was made in 85 (20%) patients, use of chemotherapy as post-remission therapy in 142 (33%) and indication of an allo-HSCT with an alternative donor in 202 (47%). Of those 202 patients, the transplant centres were keen to search for a cord blood donor in 72 cases and for a haplo donor in 11 cases. Analysing the treatment received at the last follow-up and comparing with the strategy planned at the registration, 215 of 270 (80%) patients were transplanted with a family donor, 112 of 142 (79%) patients were still receiving chemotherapy, 53 of 85 (62%) received an autograft and 118 of 202 (58%) received an unrelated transplant. At last follow-up, 448 patients of 702 patients included received an HSCT (64%). Probability of survival at 2 years for 702 patients was 55%. Interval from HLA typing and HSCT was 125 days for MSD, 148 days for unrelated donor, 167 days for unrelated cord blood and 149 days for autologous transplantation. Cumulative incidence function at one year (CIF; using death as a competing event) for receiving an allograft was 81% if the strategy planned was an allograft with a MSD, 57% for those patients for whom an alternative donor was searched and 6% for those patients for whom an allo-transplant was not planed at inclusion. However, CIF at 1-year for really receiving an allograft was 74% in case of MSD, and only 30% for those patients not having an HLA identical siblingAt 2-years, LFS by initial planned strategy at HLA typing was 43% for those patients in whom a donor search was planned, 47% for those with a planned autologous HSCT, 46% for those with planned chemotherapy and 49% for those with a family transplant. In conclusion, the majority of patients (80%) with AL in European centres are HLA typed at diagnosis or CR1. The majority of patients received a MSD as planned treatment in the first year after HLA typing, in the absence of MSD an alternative donor was searched only for 51% of patients and CIF at one year for performing an allotransplant was 30% however in case of searching for alternative donor, transplantation could be performed in 57% of the cases in the first year. Surprisingly, searching for other alternative donors such as unrelated cord blood or haplo-identical donors, was only done for a small proportion of patients, in spite of encouraging results with both strategies. Therefore, in retrospective studies comparing outcomes of HLA identical sibling, and other alternative donor transplants there is a potential bias linked to the decision to search or not in half of the cases, that is probably linked to patients-, disease- and centre-related factors.

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