Adaptation and application of the Agency for Healthcare Research and Quality's asthma admission rate pediatric quality indicator to Ohio Medicaid claims data

BackgroundThe U.S. Agency for Healthcare Research and Quality (AHRQ) developed, in the context of a national pediatric discharge database, 18 pediatric quality indicators (PDIs) for assessing pediatric care. These measures have not yet been adapted for and applied to claims databases.ObjectivesThe objectives of this study were to (1) adapt the asthma admission rate (AAR) PDI methodology for claims data; (2) calculate AARs for Ohio Medicaid beneficiaries for 2007-2009, overall as well as by patient and regional characteristics; (3) determine the cost and length of stay associated with these hospitalizations; (4) describe medication use for 90 days before the hospitalizations; and (5) estimate the effect of asthma prevalence rates on AARs across Ohio counties.MethodsA retrospective study was performed using Ohio Medicaid claims data. After adapting the AHRQ methodology for a claims database, AARs were computed for the pediatric asthma population (aged 2-17 years). Total and mean costs and days spent in the hospital were calculated. A Poisson regression model was developed to estimate the effect of asthma prevalence on the AAR.ResultsBetween 2007 and 2009, the Ohio Medicaid AAR rose from 182 to 258 per 100,000 children. Costs (in 2009$) rose from $1,069,783 to $1,470,918, whereas hospital days increased from 672 to 815. Close to 70% of patients had no claims for a maintenance medication for 90 days before their hospitalization. The asthma prevalence rate was significantly associated with the AAR.ConclusionsThe remaining 17 PDIs could also be adapted for claims data to assess the quality of pediatric care.     

An orally bioavailable parthenolide analog selectively eradicates acute myelogenous leukemia stem and progenitor cells

Leukemia stem cells (LSCs) are thought to play a central role in the pathogenesis of acute leukemia and likely contribute to both disease initiation and relapse. Therefore, identification of agents that target LSCs is an important consideration for the development of new therapies. To this end, we have previously demonstrated that the naturally occurring compound parthenolide (PTL) can induce death of human LSCs in vitro while sparing normal hematopoietic cells. However, PTL has relatively poor pharmacologic properties that limit its potential clinical use. Consequently, we generated a family of PTL analogs designed to improve solubility and bioavailability. These studies identified an analog, dimethylamino-parthenolide (DMAPT), which induces rapid death of primary human LSCs from both myeloid and lymphoid leukemias, and is also highly cytotoxic to bulk leukemic cell populations. Molecular studies indicate the prevalent activities of DMAPT include induction of oxidative stress responses, inhibition of NF-kappaB, and activation of p53. The compound has approximately 70% oral bioavailability, and pharmacologic studies using both mouse xenograft models and spontaneous acute canine leukemias demonstrate in vivo bioactivity as determined by functional assays and multiple biomarkers. Therefore, based on the collective preclinical data, we propose that the novel compound DMAPT has the potential to target human LSCs in vivo.     

Prescribing and monitoring hemodialysis dose

Small patients require higher Kt/V, the ratio of dialysis dose (the product of small-molecule clearance (K) and dialysis session length (t) to body water volume (V), than large patients. The errors implicit in Kt/V for judging hemodialysis dose are reviewed; methods for prescribing hemodialysis based on new technology are discussed; and thoughts about future development are suggested.     

Gender and Age Differences in Cardiac Size Parameters of Ghanaian Adults: Can One Parameter Fit All? Part Two

BackgroundThe cardiothoracic ratio (CTR) is a radiographic parameter commonly used in assessing the size of the heart. This study evaluated the gender and age-based differences in the average cardiothoracic ratios, and transverse cardiac diameters (TCD) of adults in Ghana.MethodPlain chest radiography reports of 2004 patients (without known chest related diseases) generated by two radiologists with at least 15 years'' experience from July 2016 to June 2020 were retrospectively analyzed for this study. The CTR for each radiograph was calculated using the formula CTR=(TCD÷TTD)×100, where TCD and TTD represent transverse cardiac diameters and transverse thoracic diameters, respectively. Data were analyzed with the statistical package for social sciences version 23. The independent t-test and One-way Analysis of Variance tests were used in the analyses.ResultsA total of 2004 patients'' chest x-rays were used in the analyses. The ages of the patients ranged from 20–86 years old with a mean of 39.4±14.04 years. The mean CTR for males was 46.6 ± 3.7% while that of females was 47.7±3.7%. The difference in the overall CTR among the gender groupings was statistically significant (p = 0.001). There were statistically significant differences between the gender categories among patients in the following age groups: 30–39 (p=0.046), 40–49 (p=0.001), 50–59 (p=0.001) and 60–69 (p=0.001).ConclusionThe study reveals there are significant gender and age-related differences in cardiac size parameters obtained from routine, frontal chest radiographs. These differences, if considered, may result in early and appropriate treatment of cardiac pathology in some age groups.