Pragmatic and Observational Research最新文献

{"title":"Real-life treatment of rhinitis in Australia: a historical cohort study of prescription and over-the-counter therapies for patients with and without additional respiratory disease.","authors":"David B Price,&nbsp;Pete K Smith,&nbsp;Richard John Harvey,&nbsp;A Simon Carney,&nbsp;Vicky Kritikos,&nbsp;Sinthia Z Bosnic-Anticevich,&nbsp;Louise Christian,&nbsp;Derek Skinner,&nbsp;Victoria Carter,&nbsp;Alice Ms Durieux","doi":"10.2147/POR.S153266","DOIUrl":"10.2147/POR.S153266","url":null,"abstract":"<p><strong>Background: </strong>The aim of the study was to explore rhinitis therapy purchases in different Australian regions for patients with and without additional respiratory disease, using both doctor's prescriptions and over-the-counter (OTC) medications.</p><p><strong>Patients and methods: </strong>It was a historical cohort study of pharmacy-related claims that included prescription or OTC rhinitis therapy, with or without asthma/COPD therapy, from January 2013 to December 2014.</p><p><strong>Results: </strong>Overall, 4,247,193 prescription and OTC rhinitis treatments were purchased from 909 pharmacies over a calendar year; the majority were single-therapy purchases for rhinitis only patients. More multiple-therapy was purchased for rhinitis and asthma/COPD patients (4.4%) than for rhinitis only patients (4.0%), with a greater proportion purchased in VIC, SA and TAS (4.7% of rhinitis only patients and 4.5% of rhinitis and asthma/COPD patients) than in other areas. Dual therapy of oral antihistamine (OAH) and intranasal corticosteroid (INS) were the most frequently purchased multiple-therapy, with higher purchasing rates for rhinitis and asthma/COPD patients (2.6%) than for rhinitis only patients (1.6%). The most frequently purchased single therapy was OAH (70.1% of rhinitis only patients and 57.3% of rhinitis and asthma/COPD patients). First-line INS therapy was more likely to be purchased for rhinitis and asthma/COPD patients (15.3% by prescription and 11.7% OTC) than for rhinitis only patients (5.0% by prescription and 9.2% OTC); however, geographical differences in the proportion of therapies purchased OTC were noted, with a lower proportion of OTC OAH and INS purchases in Queensland and the Northern Territory for patients with and without comorbid respiratory disease.</p><p><strong>Conclusion: </strong>Purchases of first-line INS therapy are more likely for patients with comorbid respiratory disease if they have received prescriptions and information/advice from their general practitioner. The study results indicate a need for patient information/education at the point-of-sale of OTC OAHs to enable patients to assess their nasal symptoms and receive treatment support from pharmacists. Greater availability to INSs in pharmacies as well as guidance from current guidelines and instruction in correct intranasal technique may also lead to greater uptake of INSs.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"9 ","pages":"43-54"},"PeriodicalIF":8.9,"publicationDate":"2018-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/POR.S153266","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36431412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of database-derived severe exacerbations and asthma control measures in asthma: responsiveness and predictive utility in a UK primary care database with linked questionnaire data.","authors":"Gene Colice, Alison Chisholm, Alexandra L Dima, Helen K Reddel, Annie Burden, Richard J Martin, Guy Brusselle, Todor A Popov, Julie von Ziegenweidt, David B Price","doi":"10.2147/POR.S151615","DOIUrl":"10.2147/POR.S151615","url":null,"abstract":"<p><strong>Background: </strong>Observational research is essential to evaluate the real-life effectiveness of asthma treatments and can now make use of outcomes derived from electronic medical records.</p><p><strong>Aim: </strong>The aim of this study was to investigate the utility of several database outcome measures in asthma.</p><p><strong>Methods: </strong>This study identified cohorts of patients with active asthma from a UK primary care database - Optimum Patient Care Research Database - approximately 10% of which was prospectively supplemented with questionnaire data. The \"Questionnaire cohort\" included patients aged 18-60 years with valid questionnaire data and 1 year of continuous primary care data. Separate \"ICS initiation\" and \"ICS step-up\" cohorts included patients aged 5-60 years initiated on inhaled corticosteroids (ICSs), who had 1 year of continuous primary care data before, and after, this index visit. Database measures of asthma symptom control and exacerbations were identified in the Optimum Patient Care Research Database and cross-tabulated with corresponding patient-reported (questionnaire) data. Responsiveness of the database outcomes was analyzed, using McNemar's and Wilcoxon's signed rank tests, and Poisson regression was used to estimate the association between database outcomes and future risk of database exacerbations, in the ICS initiation cohort.</p><p><strong>Results: </strong>The final study included 2,366 Questionnaire cohort patients and 51,404 ICS initiation patients. Agreement between patient-reported and database-recorded exacerbations was fair (kappa 0.35). Following the initiation of ICS, database risk domain asthma control (based on exacerbations) improved (proportion of patients with uncontrolled asthma decreased from 24.9% to 18.6%; <i>P</i><0.001) and mean number of database exacerbations decreased from 0.09 to 0.08 per patient per year (<i>P</i>=0.001). However, another measure of asthma control which includes short-acting beta-agonist prescription as part of the definition did not show this improvement. Patients with prior exacerbations had a higher risk of future exacerbation (rate ratio [95% confidence interval], 3.23 [3.03-3.57]).</p><p><strong>Conclusion: </strong>Asthma control and exacerbations derived from primary care databases were responsive, with the exception of short-acting beta-agonist prescriptions, and useful for risk prediction.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"9 ","pages":"29-42"},"PeriodicalIF":8.9,"publicationDate":"2018-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b5/65/por-9-029.PMC6092127.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36414174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with early cardiac complications following transcatheter aortic valve implantation with transapical approach.","authors":"Vasileios Patris,&nbsp;Konstantinos Giakoumidakis,&nbsp;Mihalis Argiriou,&nbsp;Katerina K Naka,&nbsp;Efstratios Apostolakis,&nbsp;Mark Field,&nbsp;Manoj Kuduvalli,&nbsp;Aung Oo,&nbsp;Stavros Siminelakis","doi":"10.2147/POR.S157843","DOIUrl":"https://doi.org/10.2147/POR.S157843","url":null,"abstract":"<p><strong>Purpose: </strong>To estimate the incidence of postprocedural early cardiac complications among patients undergoing transcatheter aortic valve implantation, through transapical approach (TA-TAVI), and to identify factors independently associated with the occurrence of them.</p><p><strong>Patients and methods: </strong>A retrospective cohort study of 90 patients, who had undergone TA-TAVI in a tertiary hospital of Liverpool, UK, during a 5-year period (September 2008-October 2013), was conducted. Data on patient demographics, periprocedural characteristics and cardiac complications presented within 30-day post TA-TAVI were collected, retrospectively, using the hospital's electronic database.</p><p><strong>Results: </strong>The overall 30-day incidence of cardiac complications was estimated at 18.9% (n=17/90). The rate of new onset of atrial fibrillation (AF), atrioventricular block requiring permanent pacemaker implantation, shockable cardiac arrest rhythm and cardiac tamponade was 11.1%, 3.3%, 2.2% and 2.2%, respectively. Bivariate analysis found that absence of preoperative AF (<i>p</i>=0.01), receiving of oral inotropes preprocedurally (<i>p</i>=0.01), intravenous inotropic support postprocedurally (<i>p</i>=0.01) and requirement for postprocedural tracheal intubation (<i>p</i>=0.001) were the main factors associated with increased probability for patient cardiac morbidity.</p><p><strong>Conclusion: </strong>It seems that patients with absence of AF and oral inotropic support preprocedurally and those with post TA-TAVI mechanical ventilatory and intravenous inotropic support have greater probability to develop cardiac complications. This knowledge allows the early identification of high-risk patients and supports clinicians to apply both preventive and therapeutic interventions for the optimum patient management and care. In addition, administrators could allocate the health care system resources effectively.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"9 ","pages":"21-27"},"PeriodicalIF":8.9,"publicationDate":"2018-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/POR.S157843","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36323948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative predictors of delirium and incidence factors in adult patients post cardiac surgery.","authors":"Stavros Theologou, Konstantinos Giakoumidakis, Christos Charitos","doi":"10.2147/POR.S157909","DOIUrl":"10.2147/POR.S157909","url":null,"abstract":"<p><strong>Background: </strong>Delirium is a quite common complication in adult patients post-cardiac surgery. The purpose of our study was to identify perioperative characteristics and also focus on incidence factors that could predict delirium in the cardiac surgery intensive care unit (CICU) postoperatively.</p><p><strong>Methods: </strong>We conducted a prospective study of 179 consecutive patients, who underwent open-heart surgical operation and were admitted to the CICU of a general tertiary hospital in Athens, Greece. The patients were screened for delirium by using the diagnostic tools of Rich-mond Agitation Sedation Scale (RASS score) and the Confusion Assessment Method - ICU (CAM-ICU). The delirium assessment was carried out on the 1st and the 2nd postoperative day, and was conducted twice every nursing shift. A short questionnaire on sociodemographics and clinical patient characteristics was used for data collection purposes.</p><p><strong>Results: </strong>A total of 179 patients who underwent open-heart surgical operation with cardiopulmonary bypass (CPB) were enrolled in our study. The 2-day incidence of postoperative delirium in ICU was 11.2% (n=20/179). The main independent predictors of delirium on the 2nd postoperative day were neutrophil-to-lymphocyte ratio (<i>p</i>=0.001) and urea levels (<i>p</i>=0.016). Additionally, increased perioperative creatinine (<i>p</i>=0.006) and sodium (<i>p</i>=0.039) levels were significantly associated with delirium occurrence. Furthermore, elevated EuroSCORE (<i>p</i>=0.001), extended length of stay (LOS) in ICU (<i>p</i><0.001), and extended LOS with endotracheal tube (<i>p</i>=0.001) were also statistically significant indicators.</p><p><strong>Conclusion: </strong>Patients with extended LOS with endotracheal tube and prolonged stay in ICU in accordance with peaked urea, neutrophil-to-lymphocyte ratio, creatinine, and sodium levels seem to have a significantly greater probability of developing delirium in the ICU. Further research is needed in the field of postoperative cardiac patients in order to determine the causality and etiology of certain risk factors for delirium.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"9 ","pages":"11-19"},"PeriodicalIF":8.9,"publicationDate":"2018-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/02/c2/por-9-011.PMC5947574.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36109704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world effectiveness and safety of oral anticoagulation strategies in atrial fibrillation: a cohort study based on a German claims dataset.","authors":"Sabrina Mueller,&nbsp;Antje Groth,&nbsp;Stefan G Spitzer,&nbsp;Anja Schramm,&nbsp;Andreas Pfaff,&nbsp;Ulf Maywald","doi":"10.2147/POR.S156521","DOIUrl":"https://doi.org/10.2147/POR.S156521","url":null,"abstract":"<p><strong>Objective: </strong>To compare the real-world effectiveness and safety of non-vitamin-K-antagonist oral anticoagulant (NOAC) treatment in atrial fibrillation (AF) patients with a vitamin-K-antagonist (VKA)-based treatment.</p><p><strong>Methods: </strong>This was a retrospective analysis of an anonymized claims dataset from 3 German health insurance funds covering the period from January 01, 2010 to June 30, 2014, with a minimum observation time of 12 months. All continuously insured patients with at least 2 outpatient AF diagnoses and/or 1 inpatient respective diagnosis who received at least 1 outpatient prescription of a NOAC or VKA were included.</p><p><strong>Outcomes and measures: </strong>Death, ischemic strokes (IS), non-specified strokes, transient ischemic attacks (TIAs), myocardial infarctions (MIs), arterial embolism (AE), hemorrhagic strokes, severe bleedings, and composite outcomes. Main comparisons were done based on propensity score-matched (PSM) cohorts. Results were reported as incidence rate ratios and hazard ratios (HRs).</p><p><strong>Results: </strong>We assigned 37,439 AF patients to each PSM cohort (NOAC cohort: mean age 78.2 years, mean CHA₂DS₂VASc score 2.96, mean follow-up 348.5 days; VKA cohort: mean age 78.2 years, mean CHA₂DS₂VASc 2.95, mean follow-up 365.5 days). NOAC exposure was associated with significantly higher incidence rate ratios; 95% CI/HRs; 95% CI for the following outcomes: death (1.22; 1.17-1.28/1.22; 1.17-1.28), IS (1.90; 1.69-2.15/1.92; 1.69-2.19), non-specified strokes (2.04; 1.16-3.70/1.93; 1.13-3.32), TIAs (1.52; 1.29-1.79/1.44; 1.21-1.70), MIs (1.26; 1.10-1.15/1.31; 1.13-1.52), AE (1.75; 1.32-2.32/1.81; 1.36-2.34) and severe bleeding (1.92; 1.71-2.15/1.95; 1.74-2.20). Multivariable Cox regression analyses and additional sensitivity analysis, including analysis of PSM-matched NOAC/VKA treatment-naive patients, only confirmed the above results. The study was documented under clinicaltrials.gov (NCT02657616).</p><p><strong>Conclusion and relevance: </strong>A VKA therapy seems to be more effective and safer than a NOAC therapy in a real-world cohort of German AF patients.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"9 ","pages":"1-10"},"PeriodicalIF":8.9,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/POR.S156521","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36088605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of DPP-4 inhibitors on asthma control: an administrative database study to evaluate a potential pathophysiological relationship.","authors":"Gene Colice,&nbsp;David Price,&nbsp;Maria Gerhardsson de Verdier,&nbsp;Karma Rabon-Stith,&nbsp;Christopher Ambrose,&nbsp;Katherine Cappell,&nbsp;Debra E Irwin,&nbsp;Paul Juneau,&nbsp;Anna Vlahiotis","doi":"10.2147/POR.S144018","DOIUrl":"https://doi.org/10.2147/POR.S144018","url":null,"abstract":"<p><strong>Rationale: </strong>DPP-4 may regulate immunological pathways implicated in asthma. Assessing whether DPP-4 inhibitor (DPP-4i) use might affect asthma control is clinically important because DPP-4i use in type 2 diabetes mellitus management (T2DM) is increasing. This study evaluated associations between DPP-4i use and asthma control.</p><p><strong>Methods: </strong>This was a retrospective, observational, matched cohort study using administrative claims in the MarketScan^® Commercial Claims and Encounters (Commercial) and Medicare Supplemental and Coordination of Benefits (Medicare Supplemental) databases. Adult asthma patients initiating an oral DPP-4i or a non-DPP-4i between November 1, 2006 and March 31, 2014 were included. Patients were followed for asthma-related outcomes for 12 months after initiation of the antidiabetes medication. Outcomes included risk-domain asthma control (RDAC), defined as no asthma hospitalizations, no lower respiratory tract infections, and no oral corticosteroid (OCS) prescriptions; overall asthma control (RDAC criteria plus limited short-acting beta agonist use); treatment stability (RDAC criteria plus no increase of ≥50% in inhaled corticosteroid dose or addition of other asthma therapy); and severe asthma exacerbation rates (asthma-related hospitalizations, emergency room visits, or acute treatments with OCS). Comparisons were made between two matched cohorts (DPP-4i vs. non-DPP-4i initiators) using multivariable logistic regression and generalized linear modeling. Covariates included baseline demographic and clinical characteristics related to asthma and T2DM.</p><p><strong>Results: </strong>The adjusted odds of achieving RDAC (odds ratio [OR]: 1.05; 95% CI: 0.964 to 1.147), overall asthma control (OR: 1.04; 95% CI: 0.956 to 1.135), and treatment stability (OR: 1.04; 95% CI: 0.949 to 1.115) did not differ between the DPP-4i and non-DPP-4i cohorts. A difference was not found between cohorts in severe asthma exacerbation rates during the 12 months following initiation of antidiabetes treatment (mean = 0.32 vs. 0.34 exacerbations per subject-year, respectively; <i>p</i>=0.064).</p><p><strong>Conclusion: </strong>Asthma control was similar between patients initiating DPP-4i and non-DPP-4i antidiabetes medications, suggesting no association between DPP-4i use and asthma control.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"8 ","pages":"231-240"},"PeriodicalIF":8.9,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/POR.S144018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35653840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with late ANC initiation among pregnant women in select public health centers of Addis Ababa, Ethiopia: unmatched case-control study design.","authors":"Kahasse Gebrekidan,&nbsp;Alemayehu Worku","doi":"10.2147/POR.S140733","DOIUrl":"https://doi.org/10.2147/POR.S140733","url":null,"abstract":"<p><strong>Background: </strong>Although Ethiopia has shown remarkable achievements in reducing maternal mortality in the last 10 years, the prevalence of late antenatal care (ANC) initiation is still high in the country.</p><p><strong>Objective: </strong>The primary purpose of this study was to identify the factors related to late ANC initiation among pregnant women in selected public health centers in Addis Ababa, Ethiopia.</p><p><strong>Subjects and methods: </strong>A total of 402 pregnant women (cases=134, controls=268) were recruited using multistage sampling. The design selected for the study was unmatched case-control. EpiData version 3.02 and SPSS version 20.0 were used for data entry and statistical analysis, respectively. Binary logistic regression model was used to model the odds of late ANC initiation.</p><p><strong>Results: </strong>The odds of attending ANC late were significantly higher for mothers with a monthly household income of <US$45.5 (AOR=6.67; 95% CI: 2.40, 18.60), who were educated up to eighth grade or below (AOR=2.17; 95% CI: 1.03, 4.60), who had unplanned pregnancy (AOR=2.73; 95% CI: 1.03, 7.23), who did not receive advice from health extension workers or TV/radio (AOR=5.21; 95% CI: 2.49, 10.88), who stayed for <5 years in Addis Ababa (AOR=3.93; 95% CI: 1.89, 8.12), and who was charged >$8.50 to start the ANC service (AOR=3.04; 95% CI: 1.98, 4.67).</p><p><strong>Conclusion: </strong>Low educational level, low income of the household, unplanned pregnancy, stay for <5 years in Addis Ababa, not getting advice from health extension workers or local TV/radio and higher cost associated with initiation of the first ANC service were the main predictors of late ANC initiation. Therefore, any intervention which would need to improve early ANC initiation should focus on economic empowerment of women, and tailored health education for migrant women should be strengthened.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"8 ","pages":"223-230"},"PeriodicalIF":8.9,"publicationDate":"2017-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/POR.S140733","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35607387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of neuro-musculoskeletal pain and dysfunction in open-heart surgical patients preoperatively and at 6 and 12 weeks postoperatively: a prospective longitudinal observation study.","authors":"R Nicole Bellet, Rhonda L Lamb, Tonya D Gould, Harold J Bartlett","doi":"10.2147/POR.S131060","DOIUrl":"10.2147/POR.S131060","url":null,"abstract":"<p><p>Chronic neuro-musculoskeletal pain is an important complication of open-heart surgery (OHS). To better understand the development and natural course of neuro-musculoskeletal pain in the immediate post-OHS period, this prospective longitudinal study assessed the prevalence and degree of pain and shoulder disability, and areas of pain pre- and post-OHS. Usual medical, nursing, and physiotherapy care was provided including early extubation, education, walking, sitting out of bed, and upper, lower limb, and trunk exercises from day 1 post-operation. Of 114 elective patients who provided consent, 98 subjects were surveyed preoperatively, and at week 6 and week 12 post-OHS. Open and closed questions encompassed numerical rating of pain scales for various body areas summed as a total pain score (TPS), the shoulder disability score (SDS), exercise compliance, and sternal clicking. Usual care comprised mobility exercises, walking program, and cardiac rehabilitation referral. Survey return rates were 100%, 88%, and 82%, respectively. Of the 76 (78%) subjects with complete data sets, 68% subjects reported a history of previous neuro-musculoskeletal injuries/conditions preoperatively while prevalence for neuro-musculoskeletal pain was 64%, 88%, and 67% and 38%, 63%, and 42% for shoulder disability, at the three assessments. In all, 11% subjects reported sternal clicking at week 6 and 7% at week 12. Pain commonly occurred in the lower back and neck preoperatively, and in front of the chest, neck, rib cage, upper back, and left shoulder at week 6. Rib cage pain alone remained significantly greater than preoperative levels by week 12 post-OHS. Preoperative SDS was positively correlated with post-OHS length of stay; women had higher SDSs than men at week 6 and week 12 and week 12 SDS was negatively correlated with height. Surgical risk score was negatively correlated with change in SDS and TPS from pre-operation to week 12. In conclusion, neuro-musculoskeletal pain and shoulder disability were common preoperatively and while prevalence increased at week 6 post-OHS, overall preoperative levels were restored by week 12.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"8 ","pages":"211-222"},"PeriodicalIF":8.9,"publicationDate":"2017-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/POR.S131060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35480999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of sedentary status in overweight and obese patients with multiple chronic conditions: a cohort study.","authors":"Mark H Joven,&nbsp;Ivana T Croghan,&nbsp;Stephanie M Quigg,&nbsp;Jon O Ebbert,&nbsp;Paul Y Takahashi","doi":"10.2147/POR.S139097","DOIUrl":"https://doi.org/10.2147/POR.S139097","url":null,"abstract":"<p><strong>Purpose: </strong>Walking may improve health in obese patients with multimorbidity. We aimed to identify predictors associated with achieving <5000 steps per day after 4 months.</p><p><strong>Patients and methods: </strong>We conducted a cohort study of 125 adult patients with a body mass index >25 kg/m² and ≥7 comorbidities. We evaluated potential predictors for <5000 steps per day using logistic regression and adjusting for age >65 years and sex.</p><p><strong>Results: </strong>The mean (range) age was 63.6 (20.3-89.8) years. Daily step counts <5000 at baseline showed the highest risk of <5000 daily steps at 4 months (odds ratio [OR] 31.82, 95% confidence interval [CI]: 12.14-95.50). Other significant characteristics were physical quality of life (OR 6.21, 95% CI: 2.32-18.54), gait speed <1 m/s (OR 2.57, 95% CI: 1.18-5.71), age ≥65 years (OR 2.21, 95% CI: 1.05-4.77), waist circumference ≥102 cm (OR 2.48, 95% CI: 1.05-6.06), and body mass index ≥30 kg/m² (OR 2.69, 95% CI: 1.20-6.26).</p><p><strong>Conclusion: </strong>New models to increase walking may be required for higher-risk patients.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"8 ","pages":"203-209"},"PeriodicalIF":8.9,"publicationDate":"2017-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/POR.S139097","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35617446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of primary care exercise referral schemes on the health of patients with obesity.","authors":"Helen M Parretti,&nbsp;Suzanne E Bartington,&nbsp;Tim Badcock,&nbsp;Lucy Hughes,&nbsp;Joan L Duda,&nbsp;Kate Jolly","doi":"10.2147/POR.S118648","DOIUrl":"https://doi.org/10.2147/POR.S118648","url":null,"abstract":"<p><p>Primary care exercise referral schemes (ERSs) are a potentially useful setting to promote physical activity (PA). It is not established, however, whether interventions to increase PA, such as ERSs, have differing health outcomes according to the participants' body mass index (BMI). This paper summarizes evidence for the impact of primary care ERSs on the health of people with obesity and reports findings of a reanalysis of the EMPOWER study, providing the first data to report differential outcomes of ERSs by BMI category. Our literature review revealed a paucity of published data. A 2011 Health Technology Assessment review and 2015 update were identified, but normal-weight participants were neither excluded nor were results stratified by weight in the included studies. A study of the effect of exercise referral in overweight women reported a significantly greater increase in PA levels in the ERS group than the control group at 3 months. Reanalysis of the EMPOWER study data showed a significant improvement in PA at 3 months in both obese and overweight/normal BMI groups, with the effect size attenuated to 6 months. There was no significant difference from baseline to 6 months in blood pressure for either BMI category. At 6 months, there was a significant decrease in weight from baseline for the obese category. Comparison of crude mean differences between BMI groups revealed a significant mean difference in PA at 3 months favoring the overweight/normal BMI group, but not at 6 months. There were no further significant differences in unadjusted or adjusted mean differences for other outcomes at follow-up. We report some evidence of a differential impact of ERS on PA by BMI category. However, the effect of ERSs in primary care for patients with obesity remains unclear due to the small number of published studies that have reported outcomes by BMI category. Further research is needed.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"8 ","pages":"189-201"},"PeriodicalIF":8.9,"publicationDate":"2017-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/POR.S118648","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35510486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}