Explore the vast range of titles available.

ABSTRACT Objective: To assess patient preferences across two attributes – effectiveness and convenience – in the selection of an erythropoietic agent to treat chemo­therapy-related anemia. Methods: During 2004, 500 adults with solid tumors and anemia were recruited through 50 oncologists’ offices across the USA. Data were collected through self-administered questionnaires, divided into two parts. The first, completed by the provider, captured clinical information and providers’ perceptions of patient preferences. The second, completed by the patient, recorded knowledge, experiences, and preferences regarding anemia and its treatments. Patient preferences, the relative importance of effectiveness (time to noticeable relief of fatigue) and convenience (number of provider visits required in an 8-week period), were measured using a choice-based conjoint (CBC) analysis. Each attribute was assessed at three levels (4, 6, or 8 weeks/visits). Results: 467 providers (93%) and 438 patients (88%) completed the preference sections. When choosing a medication to treat anemia, 77% of providers viewed effectiveness as more important to patients than convenience. Similarly, patients had a greater preference for effectiveness than convenience. Relative preference weights were significantly higher for 4- versus 6-week effectiveness (0.61 vs. 0.09, p < 0.001) and 6- versus 8-week effectiveness (0.09 vs. –0.70, p = 0.004). Overall, time to effectiveness was twice as important to patients as the number of visits. Limitations: Only two attributes were included in the CBC, which did not control for bias from respondent characteristics or experiences. Conclusion: When evaluating an erythropoietic agent to treat chemotherapy-related anemia, both providers and patients view effectiveness as more important than convenience.

Objective. To examine the relationship of three alternative measures of adherence with seven negative outcomes associated with epilepsy for development of a quality measure in epilepsy. Design. Retrospective cohort analysis. Setting. PharMetrics national claims database. Participants. Patients in the PharMetrics database for the years 2004-08 taking antiepileptic drugs. Intervention. None. Main Outcome Measures. For each definition of adherence, the odds ratios (ORs) comparing non-adherent with adherent groups were assessed for consistency and direction for the number of hospital admissions, emergency room (ER) visits, head injuries including traumatic brain injuries, falls, motor vehicle accidents (MVAs), fractures and a 'seizure' outcome defined as hospital admissions or ER visits with a primary diagnosis of epilepsy or convulsions. Results. The inclusion criteria were met by 31 635 individuals. In the multivariate analysis, the adherent group had lower odds of hospital admissions with ORs for the eight specifications ranging from 0.729 to 0.872 and ER visits where ORs for the eight specifications ranged from 0.750 to 0.893. The eight ORs for head injuries ranged from 0.647 to 0.888. For fractures the ORs ranged from 0.407 to 0.841. Our for seizure was inconsistendy associated with adherence status. Conclusions. All the adherence measures defined non-adherent groups that were associated with negative outcomes in epilepsy.

BackgroundThe Simeprevir ObservatioNal Effectiveness across practice seTtings (SONET) study evaluated the real-world effectiveness of simeprevir-based treatment for hepatitis C virus (HCV) infection.MethodsThe SONET study was a phase 4, prospective, observational, United States–based study enrolling patients ≥18 years of age with chronic genotype 1 HCV infection. The primary endpoint was the proportion of patients who achieved sustained virologic response 12 weeks after the end of treatment (SVR12), defined as HCV ribonucleic acid undetectable ≥12 weeks after the end of all HCV treatments.ResultsOf 315 patients (intent-to-treat [ITT] population), 275 (87.3%) completed the study. Overall, 291 were treated with simeprevir + sofosbuvir, 17 with simeprevir + sofosbuvir + ribavirin, and 7 with simeprevir + peginterferon + ribavirin. The majority of patients were male (63.2%) and white (60.6%); median age was 58 years, 71.7% had genotype/subtype 1a, and 39.4% had cirrhosis. The SVR12 was achieved by 81.2% (255 of 314) of ITT patients (analysis excluded 1 patient who completed the study but was missing SVR12 data); 2 had viral breakthrough and 18 had viral relapse. The SVR12 was achieved by 92.4% (255 of 276) of patients in the modified ITT (mITT) population, which excluded patients who discontinued treatment for nonvirologic reasons before the SVR12 time point or were missing SVR12 assessment data. Among mITT patients, higher SVR12 rates were associated with factors including age ≥65 years, non-Hispanic/Latino ethnicity, and employment status, but not genotype/subtype nor presence of cirrhosis. Simeprevir-based treatment was well tolerated; no serious adverse events were considered related to simeprevir.ConclusionsIn the real-world setting, simeprevir + sofosbuvir treatment was common and 92% of mITT patients achieved SVR12. Simeprevir-based treatment was effective and well tolerated in this cohort, including patients with cirrhosis.

To determine the association between dietary intake and risk of non-severe hypoglycemia in adolescents with type 1 diabetes. Type 1 adolescents from a randomized trial wore a blinded continuous glucose monitoring (CGM) system at baseline for one week in free-living conditions. Dietary intake was calculated as the average from two 24-h dietary recalls. Non-severe hypoglycemia was defined as having blood glucose <70mg/dL for ≥10min but not requiring external assistance, categorized as daytime and nocturnal (11PM–7AM). Data were analyzed using logistic regression models. Among 98 participants with 14,277h of CGM data, 70 had daytime hypoglycemia, 66 had nocturnal hypoglycemia, 55 had both, and 17 had neither. Soluble fiber and protein intake were positively associated with both daytime and nocturnal hypoglycemia. Glycemic index, monounsaturated fat, and polyunsaturated fat were negatively associated with daytime hypoglycemia only. Adjusting for total daily insulin dose per kilogram eliminated all associations. Dietary intake was differentially associated with daytime and nocturnal hypoglycemia. Over 80% of type 1 adolescents had hypoglycemia in a week, which may be attributed to the mismatch between optimal insulin dose needed for each meal and actually delivered insulin dose without considering quality of carbohydrate and nutrients beyond carbohydrate. ClinicalTrials.gov identifier: NCT01286350.

Objectives: Previous studies have shown racial disparities in the utilization and perioperative metrics of orthopedic procedures. However, it remains unclear if similar disparities exist in rotator cuff repair (RCR). The purpose of this study was to examine trends in racial disparities between white and black patients with inpatient RCR in the United States (US). Methods: Admissions for inpatient RCR in 2008-2012 were queried from the Healthcare Cost and Utilization Project National Inpatient Sample. The primary outcome was utilization rate, defined by the number of RCRs normalized to the US population per race and year. The effect of race on utilization and perioperative metrics was assessed using a regression model correcting for race and year, with a race- year interaction term to approximate temporal trends in disparities (alpha=0.05, 1-beta>0.90). Results: Overall, 20,363 patients were included in the final analysis, 18,602 identifying as white (91%) and 1,761 (8.6%) as black. On average, white patients undergoing RCR were older (white median=67 [IQR=58-75] years; black median=60 [IQR=52-68] years, P<0.0001) and more likely on Medicare (white: 59%; black: 44%, P<0.0001). Black race was associated with a 6.6/1,000,000 lower utilization rate compared to white race (P<0.0001). Although the utilization gap narrowed over time, this trend was not significant (Ptrend=0.06). Black patients were 4% less likely to be discharged to a facility (P< 0.0001, Ptrend=0.07) and had a 0.23-day longer average length of stay (P=0.047, Ptrend=0.81). When correcting for baseline age and comorbidities, postoperative complications were not significantly different between white and black patients (beta=-2.4%, 95%CI=-13.0%-+8.3%, P=0.60). Conclusions: There is a discrepancy in inpatient RCR utilization between white and black patients. Although this disparity appears to be decreasing over time, this trend was not significant. Further studies are warranted to understand causal factors for these differences, that may serve as targets for future public health interventions.