Adherence to CPAP with a nasal mask combined with mandibular advancement device versus an oronasal mask: a randomized crossover trial

Sleep and Breathing - Evidence for the management of CPAP-treated obstructive sleep apnea suggests that oronasal masks reduce mouth leaks at the expense of higher pressures and poorer adherence....     

Zidovudine Adherence in Persons with AIDS: The Relation of Patient Beliefs About Medication to Self-Termination of Therapy

OBJECTIVE: To examine the relation of patient beliefs about medication usage and adherence to zidovudine (ZDV) therapy in persons with AIDS. DESIGN: Face-to-face interviews were used to determine attitudes of persons with AIDS toward ZDV and other prescribed medications, history of ZDV usage, and sociodemographics. SETTING: A public hospital infectious disease clinic, an AIDS day care program, and an inpatient unit in a voluntary hospital where care was provided cooperatively by staff and an informal-care partner. PATIENTS/PARTICIPANTS: One hundred forty-one people with the acquired immunodeficiency syndrome agreed to be reinterviewed as part of a longitudinal, New York City-based study examining outcomes related to quality of life. Initial recruitment procedures were to approach all active AIDS patients at each of the three sites between January and July of 1992; reinterviews, which were conducted an average of 6 months later, occurred from mid-1992 through May of 1993. MEASUREMENTS AND MAIN RESULTS: The Zidovudine Drug Attitude Inventory was used to assess subjective feelings and attitudes concerning ZDV and prescribed medications in general. Respondents were grouped into five categories on the basis of their ZDV usage history: (1) "short-term" users (i.e., those who had been taking ZDV for 25 months or less); (2) "long-term" users (i.e., those who had been taking ZDV for more than 25 months); (3) self-terminated users; (4) doctor-terminated users; and (5) never users. Long-term users were likely to view ZDV as an illness prophylactic. In contrast, self-terminated users and never users were most likely to believe that ZDV caused adverse side effects and that medicine need not be taken as prescribed. CONCLUSIONS: Patients' beliefs about ZDV were significantly associated with adherence-related behavior. In particular, those who had self-terminated ZDV treatment believed that taking the drug was harmful, were skeptical of its ability to prevent illness, and felt that physicians' directives about medication usage in general could be disregarded. These findings highlight the importance of educating patients about ZDV and of establishing regular patient-clinician exchanges concerning patients' experiences with and beliefs concerning ZDV.     

Exenatide and sitagliptin are not associated with increased risk of acute renal failure: a retrospective claims analysis

Aim: This study evaluated whether the risk of acute renal failure (ARF) increases with exenatide and sitagliptin use. Methods: A retrospective cohort study of a large medical and pharmacy claims database was performed. Data for 4 91 539 patients were analysed. Cox proportional hazard models were used to compare the risk of ARF between diabetic and non‐diabetic subjects and between diabetic patients treated with exenatide, sitagliptin and control medications. Results: Adjusted Cox analyses showed diabetic subjects had a higher risk of ARF [HR 1.51, confidence interval (CI) 1.26–1.81, p < 0.001] than non‐diabetic controls. Compared with diabetic controls, neither exenatide (HR 0.77, CI 0.42–1.41, p = 0.40) nor sitagliptin (HR 1.17, CI 0.82–1.65, p = 0.39) increased the risk of ARF. Conclusion: Our study revealed an increased incidence of ARF in diabetic versus non‐diabetic patients but no association between use of exenatide or sitagliptin and ARF. Because of the limitations of this observational analysis, we cannot exclude the possibility of a very small increased risk.     

Single-port versus multi-port cholecystectomy for patients with acute cholecystitis: a retrospective comparative analysis

BACKGROUND: Trans-umbilical single-port laparoscopic cholecystectomy for chronic gallbladder disease is becoming increasingly accepted worldwide. But so far, no reports exist about the challenging single-port surgery for acute cholecystitis. The objective of this study was to describe our experience with single-port cholecystectomy in comparison to the conventional laparoscopic technique. METHODS: Between August 2008 and March 2010, 73 patients with symptomatic gallbladder disease and histopathological sign...     

Hospital- versus community-based syringe exchange: a randomized controlled trial.

This study examined the effect of syringe exchange program setting on the injection practices, health status, and health service utilization patterns of injection drug users (IDUs) recruited from a public urban hospital. One hundred sixty-six participants were randomized to either community- or hospital-based syringe exchange services. Poisson regression models were used to compare service utilization between groups. In both conditions, risky drug use practices decreased, and physical health functioning improved over time. Hospital-based syringe exchange program (SEP) attendees had 83% more inpatient admissions (p < .0001) and 22% more ambulatory care visits (p < .0001) than those assigned to the community-based SEP condition. Syringe exchange services that are integrated into public hospital settings may serve as a valuable strategy to engage hard to reach IDU populations in behavioral interventions designed to reduce HIV risk transmission behaviors and increase access to, or engagement in, the use of secondary and tertiary preventive medical care.     

Urinary pathogens' resistance to common antibiotics: a retrospective analysis

The susceptibility of urinary pathogens to common antibiotics was investigated and the results analysed retrospectively using the WHONET computer program. Of 1776 urine samples (44 catheterized) processed, 510 (28.7%) urinary pathogens were isolated. Of these 510 positive cultures, 455 (89.2%) were gram-negative bacilli, 45 (8.8%) Candida species and 10 (1.9%) gram-positive cocci. Of the 44 catheterized samples, 32 (72.7%) yielded significant bacteriuria and these were mainly gram-negative bacteria (24/32). The commonest pathogen isolated was Escherichia coli (47.3%) followed by Klebsiella species (10.3%), non-fermenters other than Pseudomonas species (9%), Candida species (8.8%), Providentia species (7%), Pseudomonas species (5.6%), Citrobacter species (3.7%), Enterobacter species (3.3%) and Proteus species (2.5%). The isolation of gram-negative bacteria among inpatients and outpatients was 71.6% and 28.3%, respectively. The critical care unit, nephrourology, obstetric and gynaecology, medical and surgical wards were found to be high-risk areas constituting 58.7% of the major isolates. The highest and lowest mean resistance among gram-negative bacteria to common antibiotics was 93.5% to ampicillin and to 61% gentamicin. The mean resistance to norfloxacin, amoxy-clavulanic acid, nitrofurantoin, trimethoprim-sulfamethoxazole and cefazolin was 65%, 67%, 75.5%, 76% and 77.5%, respectively. The most resistant pathogen to common antibiotics was found to be Proteus species (resistance 80% and above). Overall susceptibility testing demonstrated decreased usefulness of common antibiotics and demonstrates a need for a re-evaluation of common antibiotics used in the therapy for urinary tract infection.     

Esophageal adenocarcinoma versus squamous cell carcinoma: retrospective hospital-based analysis of a 12-year temporal trend

There is a paucity of literature from the Indian subcontinent looking at the prevalence of esophageal cancer by histological type. In our study, we ascertained the relative proportion and location of adenocarcinoma (AC) and squamous cell carcinoma (SCC) of the esophagus at a referral hospital in Mumbai, India over a 12-year period to assess whether a time-trend existed. A retrospective analysis was carried out on patients who were diagnosed with and/or treated for esophageal cancer at the P D Hinduja Hospital and Research Centre in Mumbai between January 1, 2000 and December 31, 2011. Data were procured from histopathology and oncology registers of the institute, the database of the Gastroenterology consultants, the Endoscopy Department records and from the Medical Records Department. Of the 445 cases of esophageal cancer with known histology, 104 (23?%) were AC and 314 (71?%) were SCC. Over the 12-year period, the proportions of AC compared to SCC did not show a statistically significant temporal change (p?=?0.145). AC comprised nearly a quarter of esophageal carcinoma in Mumbai. There has been no significant change in the number and proportion of AC and SCC in the 12-year period.     

Health outcomes and medicaid costs for frail older individuals: a case study of a MCO versus fee-for-service care

Older individuals receiving both Medicare and Medicaid benefits are known to have a disproportionate burden of illness and high medical care costs. Elder Health, Inc., a private, for-profit managed care organization operating in Maryland under capitation rates from both Medicare and Medicaid, has tailored a medical practice to these individuals, with the stated objective of providing integrated care. This study compared 200 Elder Health patients with a closely matched group of dually eligible older individuals receiving care in fee-for-service practices. There was a baseline in-home structured interview with the patient, followed 1 year later with a telephone interview. Other data sources were Medicaid claims data and Elder Health's utilization records. The outcomes of interest were the patients' health and functional status, their satisfaction with care, rates of use of medical services, and costs to Medicaid.Elder Health patients had similar general health status, better functional status, and greater satisfaction with access to care but less satisfaction with information giving than the fee-for-service group. They received more primary care and preventive services and had less than half the number of hospital days. Costs to Medicaid were nearly identical. Institutional and community-based long-term care costs were not included in the analysis.As pressures mount for the Health Care Financing Administration to expand its prepaid contracts with private health plans and the need for integrated programs increase, quantitative assessment of innovative delivery models such as Elder Health, Inc. will be essential to ensure that patients' and the publics' interests are well served.     

Prevalence of combined fecal and urinary incontinence: a community-based study.

OBJECTIVE: To assess the prevalence of combined fecal and urinary incontinence. DESIGN: A cross-sectional, community-based study. SETTING: Olmsted County, Minnesota. PARTICIPANTS: Men (n = 778) and women (n = 762), aged 50 years or older, selected randomly from the population. MEASUREMENTS: Participants completed a previously validated self-administered questionnaire that assessed the occurrence of fecal and urinary incontinence in the previous year. RESULTS: The age-adjusted prevalence of incontinence was 11.1% (95% Confidence Interval (CI), 8.8-13.5) in men and 15.2% (95% CI, 12.5-17.9) in women for fecal incontinence; 25.6% (95% CI, 22.5-28.8) in men and 48.4% (95% CI, 44.7-52.2) in women for urinary incontinence; and 5.9% (95% CI, 4.1-7.6) in men and 9.4% (95% CI, 7.1-11.6) in women for combined urinary and fecal incontinence. The prevalence of fecal incontinence increased with age in men but not in women, from 8.4% among men in their fifties to 18.2% among men in their eighties (P for trend = .001). For women, the prevalence increased from 13.1% among 50-year-old women to 20.7% among women 80 years or older (P for trend = .5). Among persons with fecal incontinence, the prevalence of concurrent urinary incontinence was 51.1% among men and 59.6% among women (P = .001 and P = .003, respectively). Cross-sectionally, the age-adjusted, relative odds of fecal incontinence among persons with urinary incontinence was greater in men than in women (Odds Ratio (OR) = 3.0; 95% CI, 1.9-4.8 in men and OR = 1.8; 95% CI, 1.2-2.7 in women, P = .04). CONCLUSIONS: These findings suggest that persons with one form of incontinence are likely to have the other form as well. Despite the higher prevalence of urinary and fecal incontinence among women, the association between fecal incontinence and urinary incontinence was stronger among men than women. This finding, and the significant association between fecal incontinence and age observed in men but not in women, suggest that the etiologies may be more closely linked in men than in women.     

Pulmonary endarterectomy combined with cardiac surgery: A 7-year retrospective analysis

BackgroundPulmonary artery endarterectomy (PEA) is established as a successful method for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). A significant fraction of patients indicated for the pulmonary endarterectomy has other severe comorbidities that generally increase the risk of cardiac surgery. The aim of our study is to analyze the process of indications and therapeutic procedures at our Cardio-Centre, as well as comparing hemodynamic parameters and long-term results in order to determine the continuation of the treatment.MethodFrom September 2004 to August 2012, 192 patients underwent PEA for CTEPH. We carried out a retrospective analysis of patients’ data. Patients were divided into two groups: A and B. The group A included patients with PEA only (128 patients), group B consisted of patients with PEA and other cardiac procedure (64 patients, i.e. 33.3% of which 72 cardiac procedures were carried out). Group B was further subdivided into group B1-patients with PEA + CABG, which included 25 patients, and group B2-PEA + suture of PFO, which consisted of 29 patients for more detailed analysis.ResultsFive-year survival rate is 83% in group A, 79.3% in group B, and 63.1% in group B1. Group B1 is statistically significantly different from group A (P = 0.031). The cumulative survival rate is comparable for groups A and B2. Cumulative survival rate is very good with annual survival in group A – 94%, group B2 – 90% and group B1 – 82.6%.ConclusionResults of combined interventions are comparable with isolated pulmonary endarterectomy. We did not find any differences in hemodynamic effects. All patients indicated for the PEA should be screened for the most common comorbidities regardless of their age. We recommend implementation CryoMAZE for the treatment of atrial fibrillation or atrial flutter.     

阿司匹林哮喘:回顾性分析

目的了解我国阿司匹林哮喘(aspirin induced asthma,AIA)流行情况、发病机制及诊治特点。方法对近5年发表在国内的24篇AIA相关文献进行回顾性分析。结果我国AIA发病率为3.85%～6.50%。病情多较为严重,中、重度为80.00%～81.37%,常合并有鼻部疾病,一般为50%～100%。结论我国AIA发病率较高,且存在诊断不足。对于非处方药物患者和医生认识不足,随意使用增加了AIA的发生,AIA相关机制及防治研究甚少。预防AIA发生最重要的就是避免使用解热镇痛抗炎药,如临床必须用非甾体类抗炎药且无禁忌证,建议使用扑热息痛。     

Nutritional interventions to reduce cardiovascular disease: individual versus population perspectives

Conclusions The search for the ideal diet to prevent CVD advances, with important developments in the definition of metabolic effects of individual fatty acids, carbohydrates, and proteins. The translation of these results to health messages for physicians, nutritionists, and their patients is up-to-date, with the National Cholesterol Education Program Adult Treatment Panel III incorporating new information. Less clear is the message to the population at large, in terms of translating the results to alter eating patterns in a healthful direction. Further consensus building and research may be necessary to assure that both high-risk and population approaches to the nutritional prevention of CVD are consistent and complementary.     

Symptomatic versus asymptomatic papillary thyroid microcarcinoma: a retrospective analysis of surgical outcome and prognostic factors.

Although the mortality rate associated with papillary microcarcinoma (PMC) of the thyroid generally is very low, some patients present with bulky nodal metastasis or distant metastasis and have an unfavorable prognosis. We retrospectively reviewed clinical aspects, surgical treatment and outcome of 178 patients with PMC in an attempt to determine the prognostic factors. The cause-specific 10-year survival rate was 96%. Three of four patients who showed signs of distant metastasis during the postsurgical period died of the disease, and another died of local recurrence. The most significant prognostic factors were the presence of clinically apparent lymph-node metastasis and hoarseness due to recurrent nerve palsy at the time of diagnosis. All distant metastases and cancer-specific deaths occurred in the 30 patients with symptomatic PMC who had either cervical lymphadenopathy, recurrent laryngeal nerve palsy or both. The 148 patients who had neither symptom had a distinctly favorable outcome. Total thyroidectomy followed by radioactive iodine treatment did not improve the final outcome in patients with symptomatic PMC. We conclude that patients with asymptomatic PMC can expect a truly favorable outcome, but some of those with symptomatic PMC may fall within a high-risk group of patients who do not benefit from aggressive treatment.