Patient-Reported Outcome Measures for Severe Recurrent Bilateral Nasal Polyps: Psychometric Evaluation and Content Validity.

Objective: To date, no patient-reported outcome measures have been specifically developed to assess pharmacological treatment effect in participants with severe chronic rhinosinusitis (CRS) with recurrent bilateral nasal polyps (NP). These studies aimed to assess (1) the psychometric properties and (2) content validity of Visual Analogue Scales (VAS) assessing NP symptom severity.

Study Design: (1) Retrospective psychometric validation study using clinical trial data and (2) cross-sectional qualitative patient interview study.

Understanding the Patient Experience of Severe, Recurrent, Bilateral Nasal Polyps: A Qualitative Interview Study in the United States and Germany.

Objectives: To qualitatively explore patient experiences of severe, recurrent, bilateral nasal polyps (NP).

Methods: A targeted literature review of published qualitative studies and online blogs describing patient experiences of NP was conducted. Semistructured concept elicitation interviews were conducted in the United States and Germany with participants ≥18 years with severe, recurrent, bilateral NP to explore their symptom experience and impacts on health-related quality of life (HRQoL; NCT03221192).

Healthcare costs and utilization associated with muscle weakness diagnosis codes in patients with chronic obstructive pulmonary disease: a United States claims analysis.

Aims: Muscle weakness (MW)-attributable healthcare resource utilization (HCRU) and costs in patients with chronic obstructive pulmonary disease (COPD) have not been well-characterized in US insurance claims databases. The primary objective of this study was to estimate HCRU in patients with evidence of COPD with and without MW diagnosis codes.

Materials And Methods: This retrospective analysis used the MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases.

Patient Preferences for Attributes of Type 2 Diabetes Mellitus Medications in Germany and Spain: An Online Discrete-Choice Experiment Survey.

Introduction: Understanding patient preferences for attributes of type 2 diabetes mellitus (T2DM) medications may help explain how the attributes differentially affect patient perceptions and behaviors. In this survey, we quantified the relative preferences among patients in Germany and Spain in separate analyses.

Methods: A stated-preference, discrete-choice experiment (DCE) survey was designed to elicit preferences for T2DM treatment attributes among patients with self-reported T2DM and who reported being prescribed T2DM medication for > 2 years.

Reasons for discontinuation of GLP1 receptor agonists: data from a real-world cross-sectional survey of physicians and their patients with type 2 diabetes.

Aim: Nonadherence to glucagon-like peptide-1 receptor agonists (GLP1 RAs) is relatively common among patients with type 2 diabetes mellitus (T2DM). This study sought to identify reasons why patients discontinue GLP1 RAs.

Materials And Methods: Retrospective data from the Adelphi Diabetes Disease Specific Programme were used.

Real-world comparison of treatment patterns and effectiveness of albiglutide and liraglutide.

Aim: To compare medication adherence, discontinuation and glycemic control in patients receiving albiglutide versus liraglutide.

Patients & Methods: Administrative claims data and glycated hemoglobin (HbA) results were analyzed from a sample of adult health plan members with Type 2 diabetes.

Results: Patients were matched 1:1 in the albiglutide (n = 2213) and liraglutide (n = 2213) overall cohorts and in 244 patients with HbA results from each treatment group.

Non-Persistence and Non-Adherence of Patients with Type 2 Diabetes Mellitus in Therapy with GLP-1 Receptor Agonists: A Retrospective Analysis.

Introduction: Our main aim was to assess the level of persistence and adherence to therapy with glucagon-like peptide-1 (GLP-1) receptor agonists in type 2 diabetes mellitus (T2DM) patients in the United Kingdom (UK) and Germany, also by comparing once- (OD) with twice-a-day (BID) therapy.

Methods: We used two large retrospective datasets: a German claims dataset and the UK General Practitioner (GP)-based Clinical Practice Research Datalink (CPRD) dataset (2010-2012). All continuously insured T2DM patients with at least one outpatient/inpatient T2DM diagnosis were observed starting with the first prescription of a GLP-1 receptor agonist.

The economic burden of pulmonary arterial hypertension (PAH) in the US on payers and patients.

Background: Pulmonary arterial hypertension (PAH) is a rare condition that can ultimately lead to right heart failure and death. In this study we estimated the health care costs and resource utilization associated with PAH in a large US managed care health plan.

Methods: Subjects with claims-based evidence of PAH from 1/1/2004 to 6/30/2010 (identification period) were selected.

Demographics, clinical characteristics, health resource utilization and cost of chronic thromboembolic pulmonary hypertension patients: retrospective results from six European countries.

Background: Chronic Thromboembolic Pulmonary Hypertension (CTEPH) results from incomplete resolution of a pulmonary embolus, leading to pulmonary hypertension and progressive right heart failure and death. We aimed to describe the demographics, treatment patterns, health resource utilization and related costs of patients with CTEPH.

Methods: In specialized PH centres across six European countries, medical charts of CTEPH patients on PH medication were retrospectively extracted (chart review between 2006 and 2009).

Development and validation of the living with pulmonary hypertension questionnaire in pulmonary arterial hypertension patients.

Background: The Living with Pulmonary Hypertension questionnaire (LPH) was adapted from the Minnesota Living with Heart Failure Questionnaire for use in patients with pulmonary arterial hypertension (PAH). Study objectives were to confirm the face and content validity, to assess the structure and psychometric properties, and provide guidance for the interpretation of the LPH.

Methods: A qualitative interview study was conducted with PAH patients in the US (n=12), Germany (n=14) and France (n=12) to evaluate the face and content validity of the LPH.

Risk factors for early readmission to acute care for persons with schizophrenia taking antipsychotic medications.

OBJECTIVE The study examined risk factors for readmission to acute care among Florida Medicaid enrollees with schizophrenia treated with antipsychotics. METHODS Medicaid and service use data for 2004 to 2008 were used to identify adults with schizophrenia discharged from hospitals and crisis units who were taking antipsychotics. Data were extracted on demographic characteristics, service use before admission, psychopharmacologic treatment after discharge, and readmission to acute behavioral health care.

Prevalence of liver disease in veterans with bipolar disorder or schizophrenia.

Objective: To assess the prevalence of three liver diseases [hepatitis C virus (HCV), nonalcoholic fatty liver disease and alcohol-induced cirrhosis] in patients (veterans) with/without schizophrenia/schizoaffective disorder and bipolar disorder.

Methods: A retrospective electronic chart review of Veterans Integrated Services Network 20 facilities from January 1, 2001 to December 21, 2006 selected patients to one of two groups: schizophrenia/schizoaffective disorder or bipolar disorder. Patients in both groups were compared with veterans in an equal-sized random sample from the same data set of veterans without psychiatric diagnoses.

Medication adherence and hospitalization among patients with schizophrenia treated with antipsychotics.

Objective: This analysis assessed rates of medication adherence and predictors of nonadherence and hospitalization among patients treated with long-acting injectable and oral antipsychotic therapies.

Methods: Data were from a retrospective analysis of Florida Medicaid recipients with schizophrenic disorder (ICD-9-CM code 295.XX) who received a prescription for an antipsychotic between July 1, 2004, and June 30, 2005.

Evaluation of health services use following the initiation of risperidone long-acting therapy among schizophrenia patients in the veterans health administration.

What Is Known And Objective: The introduction of long-acting injection antipsychotic agents has been associated with better treatment persistence and better subsequent patient outcomes. However, limited empirical data are available on patient outcomes resulting from the initiation of long-acting injectable antipsychotic agents. In this study, we assessed patterns of health-care utilization following the initiation of risperidone long-acting therapy (RLAT), the first and only second generation long-acting injectable antipsychotic agent, in schizophrenia patients within the Veterans Health Administration.

Accreditation of medical laboratories in Croatia--experiences of the Institute of Clinical Chemistry, University Hospital "Merkur", Zagreb.

Since 2003 when the international norm for implementation of quality management in medical laboratories (EN ISO 15189, Medical laboratories--Particular requirements for quality and competence) was established and accepted, accreditation has become practical, generally accepted method of quality management and confirmation of technical competence of medical laboratories in the whole world. This norm has been translated into Croatian and accepted by the Croatian Institute for Norms as Croatian norm. Accreditation is carried out on voluntary basis by the Croatian Accreditation Agency that has up to now accredited two clinical medical biochemical laboratories in the Republic of Croatia.

Ethylene glycol and glycolic acid in postmortem blood from fatal poisonings.

Ethylene glycol (EG), a relatively infrequent cause of fatal intoxication, presents an analytical challenge for forensic confirmation in postmortem toxicology. We report EG and glycolic acid (GA) quantification in postmortem blood by gas chromatography coupled with ion trap mass spectrometry (GC-MS) analysis using a modification of a previously reported clinical method. The method is linear from 50 to 4000 mg/L with a limit of detection of 25 mg/L for both EG and GA.

Monitoring anticoagulation in atrial fibrillation.

Background: Randomized control trials and observational studies show high-quality warfarin therapy leads to safe and effective stroke prophylaxis. In usual community practice, patient, physician and health care system factors are barriers to optimal anticoagulation. We examined the predictive relationship between inpatient and outpatient INR values in chronic non-valvular atrial fibrillation (AF) patients hospitalized for ischemic stroke (S), bleed (B) and control events (C) in usual community practice.

Comparisons of hypertension-related costs from multinational clinical studies.

Background: This study identifies and compares the individual cost components of hospital and ambulatory services that manage the care of hypertensive patients in eight countries: the US, the UK, France, Spain, Germany, Italy, Canada and Australia.

Methods: Hypertension-related costs are classified according to four major cardiovascular events: (i) acute myocardial infarction; (ii) congestive heart failure; (iii) stroke; and (iv) renal failure, which was subdivided into renal failure treated by dialysis and renal failure treated by kidney transplantation. To make cross-country costs comparisons, we used the DRG codes used in the US and DRG-like codes from each country.

Impact of appropriate pharmaceutical therapy for chronic conditions on direct medical costs and workplace productivity: a review of the literature.

This paper presents the findings of a literature review investigating the economic impact of appropriate pharmaceutical therapy in treating four prevalent chronic conditions - asthma, diabetes, heart failure, and migraine. The goal of the review was to identify high-quality studies examining the extent to which appropriate pharmaceutical therapy impacts overall medical expenditure (direct costs) and workplace productivity (indirect costs). The working hypothesis in conducting the review was that the costs of pharmaceuticals for the selected chronic conditions are offset by savings in direct and indirect costs in other areas.

Sudden death due to undetected mediastinal germ cell tumor.

A 32-year old man, apparently asymptomatic, was found dead in his apartment. Autopsy revealed a large necrotic mediastinal mass with liver and occipital brain metastases, the latter having produced acute intraparenchymal and intraventricular hemorrhage with cerebellar tonsillar herniation. Histologically, the mediastinal mass and metastases were consistent with immature extragonadal teratoma, with malignant transformation of the intestinal-type epithelium.

Adult-onset MELAS. Evidence for involvement of neurons as well as cerebral vasculature in strokelike episodes.

Background: We report a 46-year-old woman with implications regarding pathogenesis of strokelike episodes in MELAS (mitochondrial encephalomyopathy, lactic acidosis, and strokelike episodes). She had a 10-month history of episodic seizures, strokes, cognitive decline, vomiting, and ileus. She also had sensorineural hearing loss, insulin-dependent diabetes mellitus of several years' duration, and persistent lactic acidosis.

Anatomy of the palmar cutaneous branch of the median nerve: clinical significance.

A detailed anatomic, histologic, and immunohistochemical study of the palmar cutaneous branch of the median nerve (PCBMN) and its distal arborization was undertaken on 12 fresh human cadaveric hands. Small unmyelinated fibers terminated in the superficial loose connective tissue of the transverse carpal ligament. There were no nerve fibers detected in the deep, dense collagen aspect of the ligament.

A case of external beveling with an entrance gunshot wound to the skull made by a small caliber rifle bullet.

The external beveling caused by an entrance gunshot wound to the skull has not been completely explained, but the mechanism is probably a combination of several factors including the angle of shot, twisting force of a rotating bullet, blow-back effect, velocity, shape and size of the bullet, outspread of the kinetic energy from the bullet, and resistance of the skull.