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Observational Database (observational + database)
Selected AbstractsPatient, consumer, client, or customer: what do people want to be called?HEALTH EXPECTATIONS, Issue 4 2005Raisa B. Deber PhD Abstract Objective, To clarify preferred labels for people receiving health care. Background, The proper label to describe people receiving care has evoked considerable debate among providers and bio-ethicists, but there is little evidence as to the preferences of the people involved. Design, We analysed dictionary definitions as to the derivation and connotations of such potential labels as: patient, client, customer, consumer, partner and survivor. We then surveyed outpatients from four clinical populations in Ontario, Canada about their feelings about these labels. Setting and participants, People from breast cancer (n = 202), prostate disease (n = 202) and fracture (n = 202) clinics in an urban Canadian teaching hospital (Sharpe study), and people with HIV/AIDS at 10 specialty care clinics and three primary care practices affiliated with the HIV Ontario Observational Database (n = 431). Variables and outcome measures, The survey instruments included questions about opinion of label, role in treatment decision-making (the Problem Solving Decision Making scale), trust, use of information and health status. Results, Our respondents moderately liked the label ,patient'. The other alternatives evoked moderate to strong dislike. Conclusions, Many alternatives to ,patient' incorporate assumptions (e.g. a market relationship) which care recipients may also find objectionable. People who are receiving care find the label ,patient' much less objectionable than the alternatives that have been suggested. [source] Predicting short-term disease progression among HIV-infected patients in Asia and the Pacific region: preliminary results from the TREAT Asia HIV Observational Database (TAHOD)HIV MEDICINE, Issue 3 2005J Zhou Objectives HIV disease progression has been well documented in Western populations. This study aimed to estimate the short-term risk of AIDS and death from the TREAT Asia HIV Observational Database (TAHOD), a prospective, multicentre cohort study in Asia and the Pacific region. Methods Prospective data were analysed to estimate short-term disease progression. Endpoints were defined as the time from study entry to diagnosis with AIDS or death. Antiretroviral treatment was fitted as a time-dependent variable. Predictors of disease progression were assessed using Cox proportional hazards models, and prognostic models were developed using Weibull models. Results A total of 1260 patients with prospective follow-up data contributed 477 person-years of follow-up, during which 18 patients died and 34 were diagnosed with AIDS, a combined rate of 10.1 per 100 person-years. Compared with patients receiving antiretroviral treatment, patients not on treatment had a higher rate of disease progression (17.6 vs. 8.1 per 100 person-years, respectively). Baseline CD4 count was the strongest predictor of disease progression. Prognostic models, using either a baseline CD4 count as the sole marker or markers including baseline haemoglobin, AIDS-related symptoms and previous or current antiretroviral treatment, were successful at identifying patients at high risk of short-term disease progression. Conclusions Similar to the situation in Western countries, baseline CD4 count was the strongest predictor of short-term disease progression. Prognostic models based on readily available clinical data and haemoglobin level should be useful in estimating short-term clinical risk in HIV-infected patients in Asia and the Pacific region. [source] Incidence and diagnostic diversity in first-episode psychosisACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2010R. Reay Reay R, Mitford E, McCabe K, Paxton R, Turkington D. Incidence and diagnostic diversity in first-episode psychosis. Objective:, To investigate the incidence and range of diagnostic groups in patients with first-episode psychosis (FEP) in a defined geographical area. Method:, An observational database was set up on all patients aged 16 years and over presenting with FEP living in a county in Northern England between 1998 and 2005. Results:, The incidence of all FEP was 30.95/100 000. The largest diagnostic groups were psychotic depression (19%) and acute and transient psychotic disorder (19%). Fifty-four per cent of patients were aged 36 years and over. Patients with schizophrenia spectrum disorder only accounted for 55% of cases. Conclusion:, This clinical database revealed marked diversity in age and diagnostic groups in FEP with implications for services and guidelines. These common presentations of psychoses are grossly under researched, and no treatment guidelines currently exist for them. [source] Long-term follow-up of nevirapine-treated patients in a single-centre cohortHIV MEDICINE, Issue 8 2009M Colafigli Objectives We reviewed the safety and efficacy of nevirapine (NVP)-based therapy in all patients initiating NVP-containing combined antiretroviral therapy [cART (,3 drugs)] in our clinic since 1994. Methods Patient characteristics and laboratory values from the start of the NVP-based cART regimen to the last available follow-up or to NVP discontinuation were retrieved from an observational database. Results Five hundred and seventy-three patients were treated with NVP-based cART for a median of 18.4 (range 0.1,128.8) months. The 1-year cumulative estimated probability of discontinuing NVP-containing regimens for toxicity was 0.203. Only 1.9% developed a grade 3 alanine aminotransferase (ALT) elevation. Significant increases in high-density lipoprotein cholesterol were observed up to month 12 except in treatment-naďve patients, where the increase was limited to 3 months. Discontinuation because of cutaneous reaction was predicted independently by female gender [Hazard Ratio (HR) 3.21, P<0.001] and Centers for Disease Control class C (HR 0.50, P=0.012). Discontinuation because of liver toxicity was predicted independently by anti-hepatitis C virus positivity (HR 3.84, P<0.001). In patients starting NVP-containing cART with undetectable viral loads, the 5-year estimated probability of viral load >400 HIV-1 RNA copies/mL was 0.34. Conclusions Long-term follow-up with an NVP-containing cART showed a low rate of discontinuation caused by liver toxicity and the maintenance of virological suppression in patients switched with undetectable viral loads. [source] Anticholinergics and Ketamine Sedation in Children: A Secondary Analysis of Atropine Versus GlycopyrrolateACADEMIC EMERGENCY MEDICINE, Issue 2 2010Steven M. Green MD Abstract Objectives:, Adjunctive anticholinergics are commonly administered during emergency department (ED) ketamine sedation in children under the presumption that drying oral secretions should decrease the likelihood of airway and respiratory adverse events. Pharmacologic considerations suggest that glycopyrrolate might exhibit a superior adverse effect profile to atropine. The authors contrasted the adverse events noted with use of each of these anticholinergics in a large multicenter observational database of ketamine sedations. Methods:, This was a secondary analysis of an observational database of 8,282 ED ketamine sedations assembled from 32 prior series. The authors compared the relative incidence of six adverse events (airway and respiratory adverse events, laryngospasm, apnea, emesis, recovery agitation, and clinically important recovery agitation) between children who received coadministered atropine, glycopyrrolate, or no anticholinergic. Multivariable analysis using the specific anticholinergic as a covariate was performed, while controlling for other known predictors. Results:, Atropine was associated with less vomiting (5.3%) than either glycopyrrolate (10.7%) or no anticholinergic (11.4%) in both unadjusted and multivariable analyses. Glycopyrrolate was associated with significantly more airway and respiratory adverse events (6.4%) than either atropine (3.3%) or no anticholinergic (3.0%) and similarly more clinically important recovery agitation (2.1% vs. 1.2 and 1.3%). There were, however, no differences noted in odds of laryngospasm and apnea. Conclusions:, This secondary analysis unexpectedly found that the coadministered anticholinergic atropine exhibited a superior adverse event profile to glycopyrrolate during ketamine sedation. Any such advantage requires confirmation in a separate trial; however, our data cast doubt on the traditional premise that glycopyrrolate might be superior. Further, neither anticholinergic showed efficacy in decreasing airway and respiratory adverse events. ACADEMIC EMERGENCY MEDICINE 2010; 17:157,162 © 2010 by the Society for Academic Emergency Medicine [source] Outcomes research in amyotrophic lateral sclerosis: Lessons learned from the amyotrophic lateral sclerosis clinical assessment, research, and education database,ANNALS OF NEUROLOGY, Issue S1 2009FAAN, Robert G. Miller MD Objective To examine the care of patients with ALS following the publication of the standardized recommendations for the management of patients with amyotrophic lateral sclerosis (ALS) published in 1999 by the American Academy of Neurology. Methods Specific aspects of ALS patient management have been evaluated serially using a national Amyotrophic Lateral Sclerosis Clinical Assessment, Research, and Education (ALS CARE) database to encourage compliance with these recommendations and to assure continuing quality improvement. Results The most recent analysis of 5,600 patients shows interesting epidemiological observations and treatment trends. Proper management of many ALS symptoms has increased substantially since the first publication of the guidelines, and awareness of pseudobulbar affect has increased. Other recommendations are underutilized: Only 9% undergo percutaneous endoscopic gastrostomy, although this procedure was recommended in 22% of patients; and noninvasive positive pressure ventilation was used by only 21% of patients despite being associated with improved 5-year survival rates. Interpretation This observational database has been a useful tool in monitoring compliance with the standard of care for patients with ALS and may have resulted in greater adherence to guidelines. Ann Neurol 2009;65 (suppl):S24,S28 [source] A weighting proposal for an ensemble of regional climate models over Europe driven by 1961,2000 ERA40 based on monthly precipitation probability density functionsATMOSPHERIC SCIENCE LETTERS, Issue 4 2009E. Sánchez Present climate over Europe is simulated by 12 regional climate models (RCMs), forced by ERA40 reanalysis. A method is proposed to score models from the 1961,1990 monthly precipitation cumulative density functions (CDFs) for each season and eight chosen subregions, compared with the CRU observational database. Ensemble CDF curves compare well against observations for all the subregions and seasons. Higher percentiles (heavy precipitation amounts) show a larger spread among results. Important differences in scores are obtained among models, regions and seasons. Applying the scores to compute 1991,2000 weighted ensemble precipitation, results are slightly closer to observations than the direct (unweighted) ensemble, and some cases show a larger improvement. Copyright © 2009 Royal Meteorological Society [source] Procedural Sedation in the Community Emergency Department: Initial Results of the ProSCED RegistryACADEMIC EMERGENCY MEDICINE, Issue 1 2007Alfred Sacchetti MD Abstract Objectives Procedural sedation and analgesia (PSA) has been well profiled in experimental studies in university emergency departments. Extrapolation of these practices into the community hospital setting is not well established. This report describes community hospital practices and outcomes in a multicenter PSA registry. Methods The Procedural Sedation in the Community Emergency Department (ProSCED) registry is a prospective observational database composed of consecutive emergency physician,directed procedural sedation cases in community hospitals. Registered procedures described by 15 categorical data fields are collected at the time of the patient encounter and entered into a secure Internet-housed database. Results A total of 1,028 procedural sedations were performed on 980 patients at 14 study sites. The most common specified procedures performed included shoulder relocation (392), hip relocation (102), elbow relocation (70), upper extremity fracture care (69), lower extremity fracture care (66), and facial laceration repair (67). Complications of any description occurred in 42 cases (4.1%), with no patient's disposition changed secondary to a complication. Patients' ages ranged from 1 month to 95 years, with a median age of 31 years. Of procedures attempted, 982 (95.5%) were successfully completed, 21 cases (2.0%) were adequately sedated but unable to have their procedure completed, and 21 cases (2.0%) were believed to be inadequately sedated. Medication use included midazolam in 423 cases (41.1%), propofol in 253 (24.6%), fentanyl in 253 (24.6%), etomidate in 241 (23.4%), and ketamine in 145 (14.1%), as well as several others. Cases using either ketamine or propofol exhibited the fewest complications, while those using fentanyl, hydromorphone, or midazolam demonstrated the highest complication rates. Conclusions Community emergency physicians deliver safe and effective PSA over a wide variety of ages and procedures while using a broad selection of agents. [source] | ||||||||||