Proposed framework for a national set of reporting measures in Canada in response to the COVID-19 pandemic.

An effective strategy to control the ongoing coronavirus disease 2019 (COVID-19) pandemic takes into account inputs from many domains, including community epidemiology, surveillance and testing, contact tracing capacity, support for vulnerable populations, and health care system strain. Provincial and federal governments currently lack a universal approach to presenting relevant pandemic data from these domains to the general public in a way that engages them in decision making and promotes adherence to policies. We propose a framework to analyze COVID-19 pandemic data on an ongoing basis using inputs from these five domains, which can be scaled to the local public health unit, provincial, or national level. Data analysis was qualitative and semi-quantitative because there was a paucity of publicly available data on surveillance and testing, contact tracing, and health care system strain, which limited our ability to perform internal and external validation of our model. We urge the federal government to mandate a core set of reporting items across local, provincial, and federal jurisdictions that may then be used to perform validation and implementation of our proposed framework.

Une stratégie efficace pour contrôler la pandémie continue de maladie à coronavirus 2019 (COVID-19) tient compte de l'apport de divers domaines, soit l'épidémiologie communautaire, la surveillance et le dépistage, la capacité de traçage des contacts, le soutien de populations vulnérables et la souche du système de santé. À l'heure actuelle, les gouvernements provinciaux et fédéral ne proposent pas de démarche universelle pour présenter des données pertinentes sur ces domaines de la pandémie au grand public, de manière à le faire participer aux prises de décision et à promouvoir l'adhésion aux politiques. Les auteurs proposent un outil pour procéder à l'analyse des données sur la pandémie de COVID-19 à partir des données de ces cinq domaines, qui peut être adapté pour les unités sanitaires locales, provinciales ou nationale. L'analyse des données était qualitative et semi-quantitative en raison du peu de données publiques sur la surveillance et le dépistage, le traçage des contacts et la souche du système de santé, qui ont limité notre capacité de procéder à une validation interne et externe de notre modèle par l'analyse quantitative. Les auteurs exhortent le gouvernement fédéral à mandater un ensemble d'éléments à signaler dans les régions sociosanitaires locales, provinciales et fédérale qui peuvent ensuite utilisés pour valider mettre en œuvre le cadre proposé.

Harmonization of the ICHOM Quality Measures to Enable Health Outcomes Measurement in Multimorbid Patients.

Objectives: To update the sets of patient-centric outcomes measures ("standard-sets") developed by the not-for-profit organization ICHOM to become more readily applicable in patients with multimorbidity and to facilitate their implementation in health information systems. To that end we set out to (i) harmonize measures previously defined separately for different conditions, (ii) create clinical information models from the measures, and (iii) restructure the annotation to make the sets machine-readable. Materials and Methods: First, we harmonized the semantic meaning of individual measures across all the 28 standard-sets published to date, in a harmonized measure repository. Second, measures corresponding to four conditions (Breast cancer, Cataracts, Inflammatory bowel disease and Heart failure) were expressed as logical models and mapped to reference terminologies in a pilot study. Results: The harmonization of semantic meaning resulted in a consolidation of measures used across the standard-sets by 15%, from 3,178 to 2,712. These were all converted into a machine-readable format. 61% of the measures in the 4 pilot sets were bound to existing concepts in either SNOMED CT or LOINC. Discussion: The harmonization of ICHOM measures across conditions is expected to increase the applicability of ICHOM standard-sets to multi-morbid patients, as well as facilitate their implementation in health information systems. Conclusion: Harmonizing the ICHOM measures and making them machine-readable is expected to expedite the global adoption of systematic and interoperable outcomes measurement. In turn, we hope that the improved transparency on health outcomes that follows will let health systems across the globe learn from each other to the ultimate benefit of patients.

Respiratory Tract Infections in Patients With Inflammatory Bowel Disease: Safety Analyses From Vedolizumab Clinical Trials.

BACKGROUND AND AIMS: Vedolizumab, a humanised monoclonal antibody for the treatment of inflammatory bowel disease, selectively blocks gut lymphocyte trafficking. This may reduce the risk of respiratory tract infections [RTIs] compared with systemic immunosuppressive therapies. To assess this possibility, we evaluated the rates of RTIs in clinical trials of vedolizumab. METHODS: Patient-level data from Phase 3 randomised controlled trials [RCTs] of vedolizumab in ulcerative colitis [UC; GEMINI 1] and Crohn's disease [CD; GEMINI 2], and a long-term safety study [UC and CD] were pooled. Cox proportional hazards models were used to estimate the incidence of upper RTIs [URTIs] and lower RTIs [LRTIs] with adjustment for significant covariates. RESULTS: In the RCTs [n = 1731 patients], the incidence of URTIs was numerically higher in patients receiving vedolizumab compared with those receiving placebo, although this difference was not statistically significant (38.7 vs 33.0 patients per 100 patient-years; hazard ratio [HR] 1.12; 95% confidence interval [CI]: 0.83-1.51; p = 0.463). The rate of LRTIs, including pneumonia, was numerically lower in the vedolizumab versus the placebo group: this difference was not statistically significant (7.7 vs 8.5 per 100 patient-years [HR 0.85; 95% CI: 0.48-1.52; p = 0.585]). Both URTIs and LRTIs were more frequent in patients with CD compared with UC. Most RTIs in patients receiving vedolizumab were not serious and did not require treatment discontinuation. CONCLUSIONS: Vedolizumab therapy was not associated with an increased incidence of respiratory tract infection compared with placebo.

European and Russian physician awareness of best management approaches for infections due to antibiotic-resistant Gram-negative bacteria.

OBJECTIVES: The rapid spread of infections due to antibiotic-resistant, Gram-negative bacteria in Europe and surrounding regions requires a heightened level of awareness among physicians within their practice settings. METHODS: We surveyed 800 physicians who treat these infections across France, Germany, Spain, Italy, and Russia to assess their awareness of best management approaches. RESULTS: We found that more than two-thirds do not consider themselves highly aware of best management practices. The respondents are facing these resistant infections as evidenced by the antibiotics they report using and their stated interest in newer agents. Respondents indicated that precious time is lost waiting for culture results, but also said they will need more information about accuracy, use, and costs for adopting rapid molecular testing. CONCLUSIONS: The survey further identified the need for treatment guidelines and clinical decision support tools that can be applied at the bedside.

Patient preferences for change in symptoms associated with opioid-induced constipation.

INTRODUCTION: While opioids have become a standard treatment option for those experiencing moderate to severe chronic pain, side effects of constipation and related symptoms have interfered with their usage in as many as 40-50% of treated patients. Prior research has elucidated the range of these symptoms, but no study has determined which of these symptoms patients most desire improving or whether improving constipation itself by as little as one more bowel movement per week is deemed an important change. METHODS: We conducted an online patient survey of 513 participants residing in one of six countries who reported having chronic pain, were taking opioids, and experiencing opioid-induced constipation (OIC) to address these questions. RESULTS: Respondents rank ordered their preferences and the following eight symptoms generated >80% endorsement as important to improve: improvement in having bowel movements without rectal pain, soft stools that are not loose or watery, regular bowel movements, a reduction in rectal straining, relief from feeling bloated, feeling less fear about having OIC when following their opioid medication regime, a desire to worry less overall about having a bowel movement, and with less 'stomach' area pain. When asked 'how important is it you to have 1 more bowel movement per week", over 90% endorsed it was 'somewhat', 'very', or 'extremely important' with nearly 70% (n = 354) endorsing the 'extremely' or 'very important' response options. In multivariate models, being in more overall pain or reporting fewer than 3 bowel movements per week were found to be independent predictors of the importance. CONCLUSIONS: These results highlight the notable range of OIC symptoms most desired by patients to improve and demonstrate that bowel movements of only one more per week were important to register a meaningful improvement. The latter is particularly helpful for those assessing the minimal clinically important difference in treating this condition.

Effect of concurrent prescription antiarthralgia pharmacotherapy on persistence to aromatase inhibitors in treatment-naive postmenopausal females.

BACKGROUND: Aromatase inhibitors function by suppressing estrogen biosynthesis in peripheral tissues. The resulting estrogen deprivation is considered the underlying cause for aromatase inhibitor-induced arthralgia, which affects patients' quality of life and may affect their persistence to aromatase inhibitor therapy. The effect of concurrent treatment with aromatase inhibitors and prescription antiarthralgia pharmacotherapy on improving persistence to aromatase inhibitor therapy is unknown. OBJECTIVE: To evaluate the effect of concurrent prescription antiarthralgia pharmacotherapy on persistence to aromatase inhibitor therapy in treatment-naïve postmenopausal women. METHODS: This retrospective cohort pharmacy claims study examined the drug utilization pattern between July 2008 and October 2009 of postmenopausal females, naïve to aromatase inhibitor therapy, with 18 months of continuous prescription benefit eligibility. Patients were divided into 2 groups: group A (control) included patients who did not have a claim for a prescription antiarthralgia medication in a 1-year follow-up period, while group B (active) included patients with prescription antiarthralgia medications started within the 1-year follow-up period after starting treatment with an aromatase inhibitor. Persistence to aromatase inhibitor therapy was compared between the 2 groups. RESULTS: The study population comprised 29,967 patients: 24,804 (82.8%) in group A, and 5163 (17.2%) in group B. Aromatase inhibitor discontinuation rates within the first year of therapy were not statistically significantly different between groups: 40.9% in group A (10,145/24,804) and 34.5% in group B (1781/5163) (HR 1.127; 95% CI 0.900-1.411; p = 0.297). Persistence for the 2 groups did not differ statistically significantly for any of the 3 aromatase inhibitors measured separately. CONCLUSIONS: Postmenopausal females treatment-naïve to aromatase inhibitor therapy who also received treatment with a prescription antiarthralgia medication did not have significantly higher persistence with aromatase inhibitor therapy. Further research should focus on other possible causes of poor persistence in patients using aromatase inhibitor therapy.

Trends in medication treatment for ADHD.

OBJECTIVE: This study examines demographic trends in the use of medications to treat ADHD in adult and pediatric populations. METHOD: Using pharmacy claims data for a large population of commercially insured Americans, the study measures ADHD treatment prevalence and drug use from 2000 to 2005. RESULTS: In 2005, 4.4% of children (ages 0 to 19) and 0.8% of adults (ages 20 and older) used ADHD medications. Treatment rates were higher in boys (6.1%) than in girls (2.6%), but the rates for men and women were approximately equal (0.8%). During the period of the study, treatment prevalence increased rapidly (11.8% per year) for the population as a whole. Treatment rates grew more rapidly for adults than for children, more rapidly for women than for men, and more rapidly for girls than for boys. CONCLUSION: Improved identification of ADHD in adult and female patients has contributed to rapid growth in ADHD medication use.