Potentially Inappropriate Medication Prescribing Detected by Computer Algorithm among Older Patients: Results from the MAPT Study

(1) Background: Some medications may be dangerous for older patients. Potentially inappropriate medication prescribing (PIP) among older patients represents a significant cause of morbidity. The aim of this study was to create an algorithm to detect PIP in a geriatric database (Multidomain Alzheimer Preventive Trial (MAPT) study), and then to assess the algorithm construct validity by comparing the prevalence of PIP and associated factors with literature data. (2) Methods: An algorithm was constructed to detect PIP and was based on different explicit criteria among which the European list of potentially inappropriate medications (EU(7)-PIM), the STOPP and START version 2 tools. For construct validity assessment, logistic mixed-effects model repeated measures analyses were used to identify factors associated with PIP. (3) Results: Prevalence of PIP was 59.0% with the EU(7)-PIM list criteria, 43.2% with the STOPP criteria and 51.3% with the START criteria. Age, polypharmacy, and higher Charlson comorbidity index were associated with PIP. (4) Conclusions: Prevalence of PIP and associated factors are consistent with literature data, supporting the construct validity of our algorithm. This algorithm opens up interesting perspectives both in terms of analysis of very large databases and integration into e-prescribing or pharmaceutical validation software.

Effects of different invitation strategies on participation in a cohort study of Iranian public sector employees: a cluster randomized trial

Background Identifying strategies to optimize participation in health studies is one of the major concerns for researchers. The purpose of this study was to evaluate the efficiency of different invitation strategies on participation rate in the Employees’ Health Cohort Study of Iran (EHCSIR). Methods Two cluster-randomized trials were carried out to assess the outcomes of different invitation strategies. In the first phase, 7 units with 1880 employees (3 hospitals, 3 health centers, and 1 office) were assigned to the three parallel modes of invitation: 1) invitation letter, 2) phone call and 3) Short Message Service (SMS). In the second phase, 6 hospitals with 1633 employees were allocated to two invitation methods: 1) invitation letter, 2) invitation letter plus EHCSIR project introduction video. All groups were followed up by phone calls. A logistic mixed-effects model was used to compare the effectiveness of the strategies. The cost-effectiveness of the interventions was also compared. Results In the first phase, the participation rates in the invitation letter, phone call, and SMS groups were 27.04% (182/673), 21.55% (131/608), and 22.54% (135/599), respectively. Using an invitation letter was significantly more successful than SMS (Adjusted Odds Ratio = 1.80, 95% CI =1.14 to 2.85). Average Cost-Effectiveness Ratios (ACER) were $1.37, $1.42, and $1.55 for the invitation letter, phone call, and SMS, respectively. In the second phase, adding a project introduction video to the invitation letter did not significantly influence the participation rate (Adjusted OR = 0.58, 95% CI =0.24 to 1.36). The ACER was $1.21 for the invitation letter only and $2.01 for the invitation letter plus the introduction video. Conclusions In comparison with the phone call and SMS, the invitation letter is the most effective invitation method for public sector employees to participate in a cohort study. Sending an introduction video did not significantly increase the participation rate compared to sending an invitation letter only.

P142 Head flexion has the greatest impact on OSA severity during REM sleep

Introduction Recent work has shown that head flexion has a modest worsening effect and head rotation has a modest protective effect on OSA severity. However, there is substantial variability both within and between individuals. In this analysis we aimed to identify if this variability is explained by sleep-state, BMI, age or sex. Methods 28 participants provided informed consent and were studied using diagnostic polysomnography with the addition of a customised, accelerometry based, head posture measurement device. For each epoch during supine sleep, the sleep state (NREM/REM), average head flexion (degrees) and average head rotation (degrees) were recorded. A logistic mixed effects model was fit across all epochs with the anthropometrics (BMI, sex, age), sleep state, average head flexion and average head rotation as explanatory variables with the absence/presence of one or more respiratory event(s) as the binary outcome variable. Results In total, 2122 of 5369 supine sleep epochs had a respiratory event. Three participants had no supine sleep. There were significant interaction effects for flexion-rotation, BMI-rotation and REM-flexion. The REM-flexion interaction effect was the strongest interaction effect with an odds ratio per 5 degrees of head flexion in REM sleep of 1.47 (95% CI: 1.13 – 1.86). Discussion Head flexion related worsening of OSA severity is greatest during REM sleep. This may be explained by attenuated upper airway neuromuscular activation in REM sleep compared with NREM sleep.

Incidence of delirium in an acute geriatric community hospital: an exploratory analysis of an observational cohort study controlled with a meta-analysis of incidences from literature.

Background Delirium in hospitalised older adults is associated with negative health outcomes. Admission to an alternative care setting may lower the incidence of delirium. The Acute Geriatric Community Hospital (AGCH) was recently opened in the Netherlands and uses a multi-component non-pharmacological intervention strategy to prevent delirium. Objective To describe the incidence of delirium found in the AGCH and compare this incidence to a hospital control group found in literature. Design Prospective cohort study; exploratory meta-analysis of proportions. Setting The AGCH is an acute geriatric unit in an intermediate care facility. Participants Patients aged >65 years with acute medical conditions admitted to the AGCH. Methods Delirium assessment using the Confusion Assessment Method (CAM) upon admission and on day one, two and three or until delirium had resolved. Patients charts were reviewed if CAM was missing. In an logistic mixed-effects model, the delirium incidence rate in AGCH was compared to pooled delirium incidence rates from six studies found in a high-quality review. Results 214 patients from the AGCH (mean age 81.9 years, 47% male, 12% with a history of dementia) were included in the analysis. Delirium developed in 8% (18/214) (95% CI [confidence interval] 5-13%) of patients during AGCH admission compared to 16% (95% CI 12-21%) in hospitals. Admission to the AGCH was associated with a decreased delirium incidence rate compared to the hospital control group (OR [odds ratio]= 0.49, 95% CI 0.24-0.98, p-value=0.044). Conclusions The delirium incidence in the AGCH was relatively low compared to those incidences found in general hospitals.

Visual attention during seeing for speaking in healthy aging

As we age, we accumulate a wealth of information, but cognitive processing becomes slower and less efficient. There is mixed evidence on whether world knowledge compensates for age-related cognitive decline (Umanath & Marsh, 2014). We investigated whether older adults are more likely to fixate more meaningful scene locations than are young adults. Young (N=30) and older adults (N=30, aged 66-82) described scenes while eye movements and descriptions were recorded. We used a logistic mixed-effects model to determine whether fixated scene locations differed in meaning, salience, and center distance from locations that were not fixated, and whether those properties differed for locations young and older adults fixated. Meaning predicted fixated locations well overall, though the locations older adults fixated were less meaningful than those that young adults fixated. These results suggest that older adults’ visual attention is less sensitive to meaning than young adults, despite extensive experience with scenes.

Built Environment and Self-Rated Health: Comparing Young, Middle-Aged, and Older People in Chengdu, China

Objectives: This article explores how the building-scale built environment is associated with self-rated health, examining differences in this association among younger, middle-aged, and older age groups. Features examined included building type, building condition, and sidewalk presence in front of dwellings. Background: Understanding how the relationships between built environments and health vary across age groups helps to build a healthy environment for all. However, most studies have concentrated on the neighborhood or indoor environment, rather than whole buildings, and few have compared age groups. Methods: This study analyzed survey data from 1,019 adults living in 40 neighborhoods in Chengdu, China, recruited through a clustered random sampling approach. It used a Bayesian logistic mixed-effects model with interaction terms between age-group indicators and other variables. Results: Significant differences exist in the relationships of self-rated health with some environmental and other indicators among age groups. For older people, living in multi-floor buildings, having a household smoker, and undertaking fewer hours of weekly exercise were associated with lower odds of reporting good, very good, or excellent health. These relationships were not identified among middle-aged and younger people. More education was associated with higher odds of reporting better health among older and middle-aged groups. Conclusions: Older people experience more health-related challenges compared to middle-aged and younger people. However, among the examined built environment factors, building type was the only significant factor related to self-rated health among older people. To promote health among older people, this study recommends adding elevators in the multi-floor buildings.

Validation of the Aktibipo SElf-RaTing (ASERT) questionnaire for digital self-assessment of mood and relapse-detection in bipolar disorder: Observational Study (Preprint)

BACKGROUND Self-reported mood is a valuable clinical data source regarding disease state and course in patients with mood disorders. However, validated, quick and scalable digital self-report measures that can also detect relapse are still missing for clinical care. OBJECTIVE We aimed to validate the newly developed Aktibipo SElf-RaTing questionnaire (ASERT), a 10-item mobile app-based self-report mood questionnaire, consisting of 4 depression, 4 mania, and 2 non-specific symptom items, each with 5 possible answers. The validation dataset was a subset of the ongoing observational longitudinal AKTIBIPO400 study, aimed at long-term monitoring of mood and activity (via actigraphy), in bipolar disorder (BD) patients. Included were patients with confirmed BD, monitored with weekly ASERT questionnaires and monthly clinical scales (Montgomery-Åsberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS)). METHODS The content validity of ASERT was assessed with principal component analysis and using Cronbach’s alpha for the assessment of internal consistency of each factor. Convergent validity of the depressive or manic items of the ASERT questionnaire with corresponding clinical scale was assessed using linear mixed effect model and linear correlation analyses. Additionally, we investigated the capability of ASERT to distinguish relapse (YMRS≥15, MADRS≥15) from a non-relapse (inter-episode) state (YMRS<15, MADRS<15) using a logistic mixed-effects model. RESULTS Altogether, 99 BD patients were included in the study (mean follow-up=754 days) and completed 78.1% of the requested ASERT assessments (median completion time=24.0 seconds). The ASERT depression items were highly associated with MADRS total scores (P<.001, bootstrap). Similarly, the ASERT mania items were highly associated with YMRS total scores (P<.001, bootstrap). Furthermore, the logistic mixed-effects regression model for scale-based relapse detection showed high detection accuracy in a repeated holdout validation for both depression (Accuracy=85.0%, Sensitivity=69.9%, Specificity=88.4%, area under the ROC curve AUC=0.880), and mania (Accuracy=87.5%, Sensitivity=64.9%, Specificity=89.9%, AUC=0.844). CONCLUSIONS The ASERT questionnaire is a quick and acceptable mood monitoring tool administered via a smartphone application with good capability to detect worsening of clinical symptoms in a long-term monitoring scenario.

merlin—A unified modeling framework for data analysis and methods development in Stata

The challenges in statistics and data science are rapidly growing because access to a multitude of data types continues to increase, as well as the sheer quantity of data. Analysts are now presented with multivariate data, sometimes measured repeatedly, and often requiring the ability to model nonlinear relationships and hierarchical structures. In this article, I present the merlin command, which attempts to provide an extremely general framework for data analysis. From simple settings such as fitting a linear regression model or a Weibull survival model to more complex settings such as fitting a three-level logistic mixed-effects model or a multivariate joint model of multiple longitudinal outcomes (of different types) and a recurrent event and survival with nonlinear effects, merlin can fit them all. I will take a single dataset and attempt to show you the full range of capabilities of merlin and discuss some future directions for the implementation in Stata.

Accuracy of continuous glucose monitoring in preterm infants: a systematic review and meta-analysis

Background and objectivesContinuous glucose monitoring (CGM) could be a valuable instrument for measurement of glucose concentration in preterm neonate. We undertook a systematic review and meta-analysis to compare the diagnostic accuracy of CGM devices to intermittent blood glucose evaluation methods for the detection of hypoglycaemic or hypoglycaemic events in preterm infants.Data sourcesA structured electronic database search was performed for studies that assessed the accuracy of CGM against any intermittent blood glucose testing methods in detecting episodes of altered glycaemia in preterm infants. No restrictions were used. Three review authors screened records and included studies.Data extractionRisk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. From individual patient data (IPD), sensitivity and specificity were determined using predefined thresholds. The mean absolute relative difference (MARD) of the studied CGM devices was assessed and if those satisfied the accuracy requirements (EN ISO 15197). IPD datasets were meta-analysed using a logistic mixed-effects model. A bivariate model was used to estimate the summary receiver operating characteristic curve (ROC) curve and extract the area under the curve (AUC). The overall level of certainty of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation.ResultsAmong 4481 records, 11 were included. IPD datasets were obtained for five studies. Only two of the studies showed an MARD lower than 10%, with none of the five CGM devices studied satisfying the European Union (EU) ISO 15197 requirements. Pooled sensitivity and specificity of CGM devices for hypoglycaemia were 0.39 and 0.99, whereas for hyperglycaemia were 0.87 and 0.99, respectively. The AUC was 0.70 and 0.86, respectively. The certainty of the evidence was considered as low to moderate. Limitations primarily related to the lack of representative population, reference standard and CGM device.ConclusionsCGM devices demonstrated low sensitivity for detecting hypoglycaemia in preterm infants, however, provided high accuracy for detection of hyperglycaemia.PROSPERO registration numberCRD42020152248.

QOLP-10. MONITORING TRENDS IN PATIENT DISTRESS IN GLIOBLASTOMA USING THE PHQ4 QUESTIONNAIRE

OBJECTIVE To identify the trend of distress over time and whether palliative care (PC) referral and visit affected distress level in glioblastoma (GBM) patients. BACKGROUND GBM patients experience significant distress due to their prognosis and neurologic involvement. All subjects in the neuro-oncology clinic at our institution routinely receive the Patient Health Questionnaire-4 (PHQ4) which is a validated screening tool that comprises a section for generalized anxiety disorder (GAD2) and a depression screen (PHQ2). DESIGN This prospective study was approved by the institutional review board. GBM patients who started radiation therapy on 1/1/2019 or later were included. Patients with a GAD2 or PHQ2 of 3 or above were categorized as present for anxiety or depression. A logistic mixed-effects model was used to test the trend of anxiety or depression over time and the impact of PC referral and visit. RESULT 131 PHQ4 questionnaires from 39 newly diagnosed GBM patients (mean age: 59.9yrs ± 15.0; 23M/16F) at the pre-radiation, post radiation and at least every 2 months thereafter were reviewed. Before radiation, 54.8% of patients reported anxiety, higher than at 1-month post radiation (23.5%), 2-3 months (41.4%), 4-6 months (20.0%), and after 6 months (25.0%). This temporal trend is significant (P = 0.0385) after adjusting for patient characteristics such as age, gender and performance status. The proportions of anxiety were not different among visits without PC referral (23.7%), with PC referral and no PC visit (42.4%), and with PC visit (32.4%, P = 0.64). We did not identify a similar temporal trend in depression. CONCLUSION Our data suggests that anxiety is more prevalent than depression in this cohort. This study identifies subjects to be at a greatest likelihood of experiencing anxiety at the pre-radiation time point. Focused interventions at this time point may help improve the patient’s overall quality of life.