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1.
AIDS Behav ; 2022 Jun 10.
Artículo en Inglés | MEDLINE | ID: mdl-35687190

RESUMEN

The study objective was to explore the impact of COVID-19 pandemic restrictions on the clinics' ability to provide continuous healthcare services to youth (15-24 years) living with HIV (YLWH). One focused semi-structured interview was conducted with each HIV clinic site-resulting in ten interviews. Data were analyzed using thematic analysis techniques assisted by NVIVO coding software and themes indicating barriers and facilitators to providing uninterrupted healthcare were elicited. Six themes were identified that affected the care continuum of YLWH: Timeframe of clinic preparation to address COVID-19 restrictions; impact on treatment cascade monitoring data; impact on patient care; impact on staff and services offered; software use and virtual visits; community impact. With careful planning and preparation, clinics were able to successfully implement a process of care that adapted to COVID-19 restrictions. Guidance is provided on how healthcare facilities can effectively incorporate strategies to provide continued services during pandemics and natural disasters.

2.
Telemed J E Health ; 2022 Jun 16.
Artículo en Inglés | MEDLINE | ID: mdl-35708582

RESUMEN

Introduction: The rapid onset of the COVID-19 pandemic increased hospital admissions and shortages for personal protective equipment (PPE) used to slow the spread of infections. In addition, nurses treating COVID-19 patients have time-consuming guidelines to properly don and doff PPE to prevent the spread. Methods: To address these issues, the Medical University of South Carolina repurposed continuous virtual monitoring (CVM) systems to reduce the need for staff to enter patient rooms. The objective of this study was to identify the economic implications associated with using the CVM program for COVID-19 patients. We employed a time-driven activity-based costing approach to determine time and costs saved by implementing CVM. Results: Over the first 52 days of the pandemic, the use of the CVM system helped providers attend to patients needs virtually while averting 19,086 unnecessary in-person interactions. The estimated cost savings for the CVM program for COVID-19 patients in 2020 were $419,319, not including potential savings from avoided COVID-19 transmissions to health care workers. A total of 19,086 PPE changes were avoided, with savings of $186,661. After accounting for cost of the CVM system, the net savings provided an outstanding return on investment of 20.6 for the CVM program for COVID-19 patient care. Conclusion: The successful and cost saving repurposing of CVM systems could be expanded to other infectious disease applications, and be applied to high-risk groups, such as bone marrow and organ transplant patients.

3.
Asian J Androl ; 2022 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-35645045

RESUMEN

The authors performed a comprehensive review of current literature to create a model comparing commonly evaluated variables in male factor infertility, for example, follicle-stimulating hormone (FSH), testicular volume (TV), and testosterone (T), to better predict sperm retrieval rate (SRR). Twenty-nine studies were included, 9 with data on conventional testicular sperm extraction (cTESE) for a total of 1227 patients and 20 studies including data on microdissection testicular sperm extraction (mTESE) for a total of 4760 patients. A weighted-means value of SRR, FSH, T, and TV was created, and a weighted linear regression was then used to describe associations among SRR, type of procedure, FSH, T, and TV. In this study, weighted-means values demonstrated mTESE to be superior to cTESE with an SRR of 51.9% vs 40.1%. Multiple weighted linear regressions were created to describe associations among SRR, procedure type, FSH, T, and TV. The models showed that for every 1.19 mIU ml-1 increase in FSH, there would be a significant decrease in SRR by 1.0%. Seeking to create a more clinically relevant model, FSH values were then divided into normal, moderate elevation, and significant elevation categories (FSH <10 mIU ml-1, 10-19 mIU ml-1, and >20 mIU ml-1, respectively). For an index patient undergoing cTESE, the retrieval rates would be 57.1%, 44.3%, and 31.2% for values normal, moderately elevated, and significantly elevated, respectively. In conclusion, in a large meta-analysis, mTESE was shown to be more successful than cTESE for sperm retrievals. FSH has an inverse relationship to SRR in retrieval techniques and can alone be predictive of cTESE SRR.

4.
Health Informatics J ; 28(2): 14604582221107808, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35726687

RESUMEN

Background: Using the International Classification of Diseases (ICD) codes alone to record opioid use disorder (OUD) may not completely document OUD in the electronic health record (EHR). We developed and evaluated natural language processing (NLP) approaches to identify OUD from the clinal note. We explored the concordance between ICD-coded and NLP-identified OUD.Methods: We studied EHRs from 13,654 (female: 8223; male: 5431) adult non-cancer patients who received chronic opioid therapy (COT) and had at least one clinical note between 2013 and 2018. Of eligible patients, we randomly selected 10,218 (75%) patients as the training set and the remaining 3436 patients (25%) as the test dataset for NLP approaches.Results: We generated 539 terms representing OUD mentions in clinical notes (e.g., "opioid use disorder," "opioid abuse," "opioid dependence," "opioid overdose") and 73 terms representing OUD medication treatments. By domain expert manual review for the test dataset, our NLP approach yielded high performance: 98.5% for precision, 100% for recall, and 99.2% for F-measure. The concordance of these NLP and ICD identified OUD was modest (Kappa = 0.63).Conclusions: Our NLP approach can accurately identify OUD patients from clinical notes. The combined use of ICD diagnostic code and NLP approach can improve OUD identification.


Asunto(s)
Analgésicos Opioides , Trastornos Relacionados con Opioides , Adulto , Analgésicos Opioides/efectos adversos , Registros Electrónicos de Salud , Femenino , Humanos , Masculino , Procesamiento de Lenguaje Natural , Trastornos Relacionados con Opioides/diagnóstico
5.
JMIR Form Res ; 6(4): e25483, 2022 Apr 25.
Artículo en Inglés | MEDLINE | ID: mdl-35468087

RESUMEN

BACKGROUND: One of the most difficult areas in the fight against HIV/AIDS is reaching out to youth aged 13 to 24 years. The proportion of youth living with HIV/AIDS on antiretroviral therapy (ART) and who are virally undetectable is low, highlighting significant challenges for reaching the Joint United Nations Program on HIV targets. OBJECTIVE: This study aimed to assess the feasibility of obtaining key clinical indicators and monitoring treatment, viral suppression, and retention components of the youth HIV treatment cascade in Adolescent Trials Network for HIV/AIDS Interventions clinics using electronic health record (EHR) downloads and to provide baseline characteristics for the study participants. METHODS: EHR data were systematically obtained from multiple clinical sites and used to meaningfully capture clinical characteristics, initiation of antiretrovirals, and retention in care, which are part of the Centers for Disease Control and Prevention's 4 continuum of care measures. In addition, this study used standard cost values attached to Current Procedural Terminology codes to estimate the cost per visit. RESULTS: Only 2 of the 4 Centers for Disease Control and Prevention treatment cascade measures were assessed using routine EHR data. EHR data are not adequate for monitoring HIV testing or linkage to care because denominator data are not available. However, the data work well for measuring ART initiation and adequately for retention in care. The sites were broadly able to provide information for the required data. However, in most cases, these data are insufficient for identifying patterns of missed appointments because such misses are not captured in the EHR system. Sites with good access to data management resources can operate more efficiently for cascade monitoring study purposes. CONCLUSIONS: Data other than EHRs are needed to measure HIV testing and linkage to youth care. EHR data are useful for measuring ART initiation and work moderately well for measuring retention in care. Site data management resources should be part of the selection process when looking for site partners for clinical studies that plan to use EHR data. Study planners should determine the feasibility of additional funding for organizations in need of additional information technology or data management resources.

6.
Crit Care Explor ; 4(3): e0642, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35261978

RESUMEN

Approximately one in 30 patients with acute respiratory failure (ARF) undergoes an inter-ICU transfer. Our objectives are to describe inter-ICU transfer patterns and evaluate the impact of timing of transfer on patient-centered outcomes. DESIGN: Retrospective, quasi-experimental study. SETTING: We used the Healthcare Cost and Utilization Project State Inpatient Databases in five states (Florida, Maryland, Mississippi, New York, and Washington) during 2015-2017. PARTICIPANTS: We selected patients with International Classification of Diseases, 9th and 10th Revision codes of respiratory failure and mechanical ventilation who underwent an inter-ICU transfer (n = 6,718), grouping as early (≤ 2 d) and later transfers (3+ d). To control for potential selection bias, we propensity score matched patients (1:1) to model propensity for early transfer using a priori defined patient demographic, clinical, and hospital variables. MAIN OUTCOMES: Inhospital mortality, hospital length of stay (HLOS), and cumulative charges related to inter-ICU transfer. RESULTS: Six-thousand seven-hundred eighteen patients with ARF underwent inter-ICU transfer, 68% of whom (n = 4,552) were transferred early (≤ 2 d). Propensity score matching yielded 3,774 well-matched patients for this study. Unadjusted outcomes were all superior in the early versus later transfer cohort: inhospital mortality (24.4% vs 36.1%; p < 0.0001), length of stay (8 vs 22 d; p < 0.0001), and cumulative charges ($118,686 vs $308,977; p < 0.0001). Through doubly robust multivariable modeling with random effects at the state level, we found patients who were transferred early had a 55.8% reduction in risk of inhospital mortality than those whose transfer was later (relative risk, 0.442; 95% CI, 0.403-0.497). Additionally, the early transfer cohort had lower HLOS (20.7 fewer days [13.0 vs 33.7; p < 0.0001]), and lower cumulative charges ($66,201 less [$192,182 vs $258,383; p < 0.0001]). CONCLUSIONS AND RELEVANCE: Our study is the first to use a large, multistate sample to evaluate the practice of inter-ICU transfers in ARF and also define early and later transfers. Our findings of favorable outcomes with early transfer are vital in designing future prospective studies evaluating evidence-based transfer procedures and policies.

7.
Telemed J E Health ; 2022 Mar 08.
Artículo en Inglés | MEDLINE | ID: mdl-35263178

RESUMEN

Introduction: Cost studies of telehealth (TH) and virtual visits are few and report mixed results of the economic impact of virtual care and TH. Largely missing from the literature are studies that identify the cost of delivering TH versus in-person care. The objective was to demonstrate a modified time-driven activity-based costing (TDABC) approach to compare weighted labor cost of an in-person pediatric clinic sick visit before COVID-19 to the same virtual and in-person sick-visit during COVID-19. Methods: We examined visits before and during COVID-19 using: (1) recorded structured interviews with providers; (2) iterative workflow mapping; (3) electronic health records time stamps for validation; (4) standard cost weights for wages; and (5) clinic CPT billing code mix for complexity weighs. We examined the variability in estimated time using a decision tree model and Monte Carlo simulations. Results: Workflow charts were created for the clinic before COVID-19 and during COVID-19. Using TDABC and simulations for varying time, the weighted cost of clinic labor for sick visit before COVID-19 was $54.47 versus $51.55 during COVID-19. Discussion: The estimated mean labor cost for care during the pandemic has not changed from the pre-COVID period; however, this lack of a difference is largely because of the increased use of TH. Conclusions: Our TDABC approach is feasible to use under virtual working conditions; requires minimal provider time for execution; and generates detailed cost estimates that have "face validity" with providers and are relevant for economic evaluation.

8.
Expert Rev Pharmacoecon Outcomes Res ; 22(4): 671-681, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35129031

RESUMEN

BACKGROUND: Oliceridine, a new class of µ-opioid receptor agonist, may be associated with fewer opioid-related adverse events (ORAEs) due to its unique mechanism of action. Thus, it may provide a cost-effective alternative to conventional opioids such as morphine. PATIENTS AND METHODS: Using a decision tree with a 24-hour time horizon, we calculated costs for medication and management of the three most common AEs (oxygen saturation <90%, vomiting, somnolence) following postoperative oliceridine or morphine in high-risk patients. Costs were enumerated as differences in cost of analgesics and resource utilization in the first 24 hours post-surgery. An economic model compared expected AEs and costs in a blended cohort where elderly/obese patients at higher risk for ORAEs received oliceridine while those presumed to be at lower risk received morphine with a cohort that received morphine alone. RESULTS: In high-risk patients, use of oliceridine resulted in overall savings of $363,944 (in 1,000 patients). Implementing a targeted approach of oliceridine utilization in patients with high risk for ORAEs can save a typical hospital system $122,296 in total cost of care. CONCLUSION: Use of oliceridine in postoperative care among patients at high risk provides a favorable health economic benefit compared to the use of morphine.


Oliceridine, a new class of opioid analgesics, administered directly into a vein, is a unique medication in that it provides pain relief equivalent to morphine and may have less costly side effects. It is given in a hospital/clinic or surgery center for the treatment of postoperative pain and can reduce costs compared to other opioid analgesics, possibly due to less side effects. An economic model was developed that compares morphine to oliceridine in patients more likely to experience sides effects due to traditional pain medications, comparing common side effects and pain relief following surgery. Although oliceridine costs more than morphine, in our economic model, the use of oliceridine resulted in cost savings ($363,944 US 2020 Dollars in 1,000 patients), and a positive return of investment of over 7 times, when compared to morphine.


Asunto(s)
Analgésicos Opioides , Farmacia , Anciano , Analgésicos Opioides/efectos adversos , Humanos , Morfina/efectos adversos , Dolor Postoperatorio/inducido químicamente , Dolor Postoperatorio/tratamiento farmacológico , Compuestos de Espiro , Tiofenos
9.
Am J Occup Ther ; 76(1)2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-35019968

RESUMEN

Stroke rehabilitation is expensive, and recent changes to Medicare reimbursement demand more efficient interventions. The use of cost-effectiveness analysis (CEA) can help occupational therapy practitioners, rehabilitation directors, and payers better understand the value of occupational therapy and decide whether or not to implement new treatments. The objective of this article is to illustrate the contribution of CEA to stroke rehabilitation using a hypothetical new intervention as an example. What This Article Adds: This article facilitates an understanding of the importance of CEA to occupational therapy. It also explains how CEA improves consistency with reporting standards for cost-effectiveness studies.


Asunto(s)
Terapia Ocupacional , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Anciano , Análisis Costo-Beneficio , Humanos , Medicare , Estados Unidos
10.
Pharmacoepidemiol Drug Saf ; 31(3): 353-360, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-34859532

RESUMEN

PURPOSE: To evaluate "high-risk" opioid dispensing to adolescents, including daily morphine milligram equivalents (MME) above recommended amounts, the percentage of extended-release opioid prescriptions dispensed to opioid-naïve adolescents, and concurrent use of opioids and benzodiazepines, and to evaluate changes in those rates over time. METHODS: Retrospective cohort study of one state's prescription drug monitoring program data (2010-2017), evaluating adolescents 12-18 years old dispensed opioid analgesic prescriptions. Outcomes of interest were the quarterly frequencies of the high-risk measures. We utilized generalized linear regression to determine whether the rate of the outcomes changed over time. RESULTS: The quarterly percentage of adolescents ages 12-18 years old dispensed an opioid who received ≥90 daily MME declined from 4.1% in the first quarter (Q1) of 2010 to 3.4% in the final quarter (Q4) of 2017 (p < 0.0001). The frequency of adolescents dispensed ≥50 daily MME changed little over time. In 2010, the percentage of adolescents receiving an extended-release opioid who were opioid naïve was 60.7%, declining to 50.6% by Q4 of 2017 (p > 0.10 overall change 2010-2017). The percentage of adolescent opioid days overlapping with benzodiazepine days was 1.6% in Q1 of 2010, declining to 1.1% by Q4 of 2017 (p < 0.001). CONCLUSIONS: Among persons 12-18 years old dispensed an opioid analgesic, receipt of ≥90 daily MME declined during the years 2010-2017, as did the percentage of adolescent opioid days that overlapped with benzodiazepines. More than half of the individuals who received extended-release opioid analgesics were identified as opioid naïve and, counter to guidelines, received products intended for opioid-tolerant individuals.


Asunto(s)
Analgésicos Opioides , Programas de Monitoreo de Medicamentos Recetados , Adolescente , Analgésicos Opioides/uso terapéutico , Niño , Prescripciones de Medicamentos , Humanos , Pautas de la Práctica en Medicina , Estudios Retrospectivos , South Carolina
11.
J Comp Eff Res ; 11(1): 47-56, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34726477

RESUMEN

Aim: Missing data cause problems through decreasing sample size and the potential for introducing bias. We tested four missing data methods on the Sequential Organ Failure Assessment (SOFA) score, an intensive care research severity adjuster. Methods: Simulation study using 2015-2017 electronic health record data, where the complete dataset was sampled, missing SOFA score elements imposed and performance examined of four missing data methods - complete case analysis, median imputation, zero imputation (recommended by SOFA score creators) and multiple imputation (MI) - on the outcome of in-hospital mortality. Results: MI performed well, whereas other methods introduced varying amounts of bias or decreased sample size. Conclusion: We recommend using MI in analyses where SOFA score component values are missing in administrative data research.


Asunto(s)
Registros Electrónicos de Salud , Puntuaciones en la Disfunción de Órganos , Humanos , Unidades de Cuidados Intensivos , Método de Montecarlo , Estudios Retrospectivos
12.
J Comp Eff Res ; 10(15): 1107-1119, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34240625

RESUMEN

Aim: Oliceridine, a new class of µ-opioid receptor agonist, is selective for G-protein signaling (analgesia) with limited recruitment of ß-arrestin (associated with adverse outcomes) and may provide a cost-effective alternative versus conventional opioid morphine for postoperative pain. Patients & methods: Using a decision tree with a 24-h time horizon, we calculated costs for medication and management of three most common adverse events (AEs; oxygen saturation <90%, vomiting and somnolence) following postoperative oliceridine or morphine use. Results: Using oliceridine, the cost for managing AEs was US$528,424 versus $852,429 for morphine, with a net cost savings of $324,005. Conclusion: Oliceridine has a favorable overall impact on the total cost of postoperative care compared with the use of the conventional opioid morphine.


Lay abstract Oliceridine, a new class of opioid pain medication, given in a vein, is a unique medication in that it provides pain relief comparable to morphine and may have less costly side effects. It is given in a hospital or surgery center for the treatment of postoperative pain and can save money compared with other opioid pain medicines due to fewer side effects. An economic model was developed to compare morphine to oliceridine for common side effects and pain relief following surgery. Oliceridine use resulted in a cost saving (US$324,005; 2020 US dollars) when compared with morphine.


Asunto(s)
Dolor Agudo , Compuestos de Espiro , Dolor Agudo/tratamiento farmacológico , Análisis Costo-Beneficio , Humanos , Tiofenos
13.
Artículo en Inglés | MEDLINE | ID: mdl-34143736

RESUMEN

Rehabilitation device efficacy alone does not lead to clinical practice adoption. Previous literature identifies drivers for device adoption by therapists but does not identify the best settings to introduce devices, the roles of different stakeholders including rehabilitation directors, or specific criteria to be met during device development. The objective of this work was to provide insights into these areas to increase clinical adoption of post-stroke restorative rehabilitation devices. We interviewed 107 persons including physical/occupational therapists, rehabilitation directors, and stroke survivors and performed content analysis. Unique to this work, care settings in which therapy goals are best aligned for restorative devices were found to be outpatient rehabilitation, followed by inpatient rehabilitation. Therapists are the major influencers for adoption because they typically introduce new rehabilitation devices to patients for both clinic and home use. We also learned therapists' utilization rate of a rehabilitation device influences a rehabilitation director's decision to acquire the device for facility use. Main drivers for each stakeholder are identified, along with specific criteria to add details to findings from previous literature. In addition, drivers for home adoption of rehabilitation devices by patients are identified. Rehabilitation device development should consider the best settings to first introduce the device, roles of each stakeholder, and drivers that influence each stakeholder, to accelerate successful adoption of the developed device.


Asunto(s)
Fisioterapeutas , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Sobrevivientes , Estados Unidos
15.
Health Res Policy Syst ; 19(1): 77, 2021 May 06.
Artículo en Inglés | MEDLINE | ID: mdl-33957934

RESUMEN

BACKGROUND: The Patient Protection and Affordable Care Act of 2010, commonly referred to as the Affordable Care Act (ACA), was created to increase access to primary care, improve quality of care, and decrease healthcare costs. A key provision in the law that mandated expansion of state Medicaid programme changed when states were given the option to voluntarily expand Medicaid. Our study sought to measure the impact of ACA Medicaid expansion on preventable hospitalization (PH) rates, a measure of access to primary care. METHODS: We performed an interrupted time series analysis of quarterly hospitalization rates across eight states from 2012 to 2015. Segmented regression analysis was utilized to determine the impact of policy reform on PH rates. RESULTS: The Affordable Care Act's Medicaid expansion led to decreased rates of PH (improved access to care); however, the finding was not significant (coefficient estimate: -0.0059, CI -0.0225, 0.0107, p = 0.4856). Healthcare system characteristics, such as Medicaid spending per enrollee and Medicaid income eligibility, were associated with a significant decrease in rates of PH (improved access to care). However, the Medicaid-to-Medicare fee index (physician reimbursement) and states with a Democratic state legislature had a significant increase in rates of PH (poor access to care). CONCLUSION: Health policy reform and healthcare delivery characteristics impact access to care. Researchers should continue evaluating such policy changes across more states over longer periods of time. Researchers should translate these findings into cost analysis for state policy-makers to make better-informed decisions for their constituents. CONTRIBUTION TO KNOWLEDGE: Ambulatory care-sensitive conditions are a feasible method for evaluating policy and measuring access to primary care. Policy alone cannot improve access to care. Other factors (trust, communication, policy-makers' motivations and objectives, etc.) must be addressed to improve access.


Asunto(s)
Medicaid , Patient Protection and Affordable Care Act , Anciano , Accesibilidad a los Servicios de Salud , Humanos , Análisis de Series de Tiempo Interrumpido , Medicare , Atención Primaria de Salud , Estados Unidos
16.
Telemed J E Health ; 27(12): 1440-1442, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-33891500

RESUMEN

Background: Health care is experiencing significant disruptive innovation with the use of technology, including telemedicine and virtual modalities to deliver care. These new models can dramatically improve access to care and reduce health care disparities for patients, especially in underserved and vulnerable populations like children. Problem: To assure diffusions and retention of new approaches they must be assessed for economic value. However, measuring telehealth programs using only an institutional financial viewpoint fails to convey all the societal value of such interventions, so economic studies of telehealth are needed but complex to design. Methods: We reviewed economic study guidelines, details from telehealth study research protocols, IRB submission questions, and telehealth study design literature. We then used an iterative consensus process to develop a framework for measuring value of virtual care at the societal level. Results: The work produced a set of tools that are useful for designing studies for measuring value of virtual care at the societal level. The framework and tools are presented in this report. Conclusions: The conceptual framework for economic evaluation was feasible for use when applied to measure pediatric telehealth value.


Asunto(s)
Telemedicina , Niño , Instituciones de Salud , Humanos , Poblaciones Vulnerables
17.
Int J Pediatr Otorhinolaryngol ; 143: 110636, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33548590

RESUMEN

OBJECTIVES: Tonsillectomy (with or without adenoidectomy) is a common pediatric surgical procedure requiring post-operative analgesia. Because of the respiratory depression effects of opioids, clinicians strive to limit the use of these drugs for analgesia post-tonsillectomy. The objective of this study was to identify demographic and medication use patterns predictive of persistent opioid dispensing (as a proxy for opioid use) to pediatric patients post-tonsillectomy. PATIENTS AND METHODS: Retrospective cohort of South Carolina (USA) Medicaid-insured children and adolescents 0-18 years old without malignancy who had tonsillectomy in 2014-2017. We evaluated opioid dispensing pre-surgery and in the 30 days exposure period after hospital discharge. The main outcome, persistent opioid dispensing, was defined as any subject dispensed ≥1 opioid prescription 90-270 days after discharge. Group-based trajectory analyses described post-procedure opioid dispensing trajectories. RESULTS: There were 11,578 subjects representing 12,063 tonsillectomy procedures. Few (3.5%) procedures were followed by persistent opioid dispensing. Any opioid dispensing during the exposure period was associated with an increased odds of persistent opioid dispensing status during the follow up period (OR 1.51 for 1-6 days of exposure and OR 1.65 for 7-30 days of opioid exposure), as was pre-procedure opioid dispensing, having >1 tonsillectomy procedure, and having complex chronic medical conditions. Group-based trajectory analyses identified 4 distinct patterns of post-discharge opioid dispensing. CONCLUSIONS: Any opioid dispensing during the 30 days after tonsillectomy increased the odds of persistent opioid dispensing by > 50%. Multivariable and group-based trajectory analyses identified patient and procedure variables that correlate with persistent opioid dispensing, primarily driven by groups receiving pre-tonsillectomy opioids and a second group who experienced multiple episodes of tonsillectomy.


Asunto(s)
Tonsilectomía , Adolescente , Cuidados Posteriores , Analgésicos Opioides/uso terapéutico , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Alta del Paciente , Estudios Retrospectivos , South Carolina/epidemiología , Tonsilectomía/efectos adversos , Estados Unidos
18.
Pediatrics ; 147(3)2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33526605

RESUMEN

BACKGROUND AND OBJECTIVES: Despite published declines in opioid prescribing and dispensing to children in the past decade, in few studies have researchers evaluated all children in 1 state or examined changes in mean daily opioid dispensed. In this study, we evaluated changes in the rate of dispensed opioid analgesics and the mean daily opioid dispensed to persons 0 to 18 years old in 1 state over an 8-year period. METHODS: We identified opioid analgesics dispensed to children 0 to 18 years old between 2010 and 2017 using South Carolina prescription drug monitoring program data. We used generalized linear regression analyses to examine changes over time in the following: (1) rate of dispensed opioid prescriptions and (2) mean daily morphine milligram equivalents (MMEs) per prescription. RESULTS: From the first quarter of 2010 to the end of the fourth quarter of 2017, the quarterly rate of opioids dispensed decreased from 18.68 prescriptions per 1000 state residents to 12.03 per 1000 residents (P < .0001). The largest declines were among the oldest individuals, such as the 41.2% decline among 18-year-olds. From 2010 through 2017, the mean daily MME dispensed declined by 7.6%, from 40.7 MMEs per day in 2010 to 37.6 MMEs per day in 2017 (P < .0001), but the decrease was limited to children 0 to 9 years old. CONCLUSIONS: The rate of opioid analgesic prescriptions dispensed to children 0 to 18 years old in South Carolina declined by 35.6% over the years 2010-2017; however, the MME dispensed per day declined minimally, suggesting that more can be done to improve opioid prescribing and dispensing.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Prescripciones de Medicamentos/estadística & datos numéricos , Adolescente , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Pautas de la Práctica en Medicina , Mal Uso de Medicamentos de Venta con Receta/estadística & datos numéricos , South Carolina
19.
Artículo en Inglés | MEDLINE | ID: mdl-33437174

RESUMEN

As healthcare costs continue to increase, studies assessing costs are becoming increasingly common, but researchers planning for studies that measure costs differences (savings) encounter a lack of literature or consensus among researchers on what constitutes "small" or "large" cost savings for common measures of resource use.  Other fields of research have developed approaches to solve this type of problem. Researchers measuring improvement in quality of life or clinical assessments have defined minimally important differences (MID) which are then used to define magnitudes when planning studies. Also, studies that measure cost effectiveness use benchmarks, such as cost/QALY, but do not provide benchmarks for cost differences. In a review of the literature, we found no publications identifying indicators of magnitude for costs. However, the literature describes three approaches used to identify minimally important outcome differences: (1) anchor-based, (2) distribution-based, and (3) a consensus-based Delphi methods. In this exploratory study, we used these three approaches to derive MID for two types of resource measures common in costing studies for: (1) hospital admissions (high cost); and (2) clinic visits (low cost). We used data from two (unpublished) studies to implement the MID estimation. Because the distributional characteristics of cost measures may require substantial samples, we performed power analyses on all our estimates to illustrate the effect that the definitions of "small" and "large" costs may be expected to have on power and sample size requirements for studies. The anchor-based method, while logical and simple to implement, may be of limited value in cases where it is difficult to identify appropriate anchors. We observed some commonalities and differences for the distribution and consensus-based approaches, which require further examination. We recommend that in cases where acceptable anchors are not available, both the Delphi and the distribution-method of MID for costs be explored for convergence.

20.
Ther Innov Regul Sci ; 55(1): 212-227, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32959207

RESUMEN

BACKGROUND: Global, randomized clinical trials are extremely complex. Trial start-up is a critical phase and has many opportunities for delay which adversely impact the study timelines and budget. Understanding factors that contribute to delay may help clinical trial managers and other stakeholders to work more efficiently, hastening patient access to potential new therapies. METHODS: We reviewed the available literature related to start-up of global, Phase III clinical trials and then created a fishbone diagram detailing drivers contributing to start-up delays. The issues identified were used to craft a checklist to assist clinical trial managers in more efficient trial start-up. RESULTS: We identified key drivers for start-up delays in the following categories: regulatory, contracts and budgets, insurance, clinical supplies, site identification and selection, site activation, and inefficient processes/pitfalls. CONCLUSION: Initiating global randomized clinical trials is a complex endeavor, and reasons for delay are well documented in the literature. By using a checklist, clinical trial managers may mitigate some delays and get clinical studies initiated as soon as possible.


Asunto(s)
Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos
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