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Patterns and predictors of treatment initiation and completion in patients with chronic hepatitis C virus infection
Clark BT, Garcia-Tsao G, Fraenkel L
Patient Preference and Adherence , 2012, DOI: http://dx.doi.org/10.2147/PPA.S30111
Abstract: tterns and predictors of treatment initiation and completion in patients with chronic hepatitis C virus infection Original Research (2160) Total Article Views Authors: Clark BT, Garcia-Tsao G, Fraenkel L Published Date April 2012 Volume 2012:6 Pages 285 - 295 DOI: http://dx.doi.org/10.2147/PPA.S30111 Received: 22 January 2012 Accepted: 07 February 2012 Published: 04 April 2012 Brian T Clark1,2, Guadalupe Garcia-Tsao1,2, Liana Fraenkel1,2 1Veterans Administration, Connecticut Healthcare System, West Haven, 2Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA Objectives: Guidelines for hepatitis C (HCV) strongly recommend antiviral treatment for patients with more severe liver disease given their increased risk of developing cirrhosis and other liver-related complications. Despite the proven benefits of therapy, 70%–88% of patients chronically infected with HCV do not undergo treatment. The goal of this paper is to describe patterns of treatment initiation among patients with both mild and severe disease and to assess the factors that are associated with treatment initiation and completion. Methods: Subjects completed previously validated questionnaires to ascertain sociodemographic characteristics, choice predisposition, and clinical characteristics prior to meeting with the hepatologist to discuss treatment initiation and were followed for 12 months. We examined the association between patient characteristics and treatment patterns controlling for liver disease severity. Results: Of the 148 eligible subjects entered into our study, 55 (37%) initiated treatment during the 12-month follow-up period. Of the 86 subjects with severe liver disease, 43 (50%) initiated treatment. Financial barriers and geographic access to care were the most common reasons for treatment deferral. Of the 55 patients initiating treatment, 24 (44%) discontinued treatment, with intolerance of side effects being the most common reason for discontinuation. After adjusting for liver disease severity, patient choice predisposition (prior to discussion with their provider) was strongly associated with initiation of treatment, while sociodemographic characteristics were not. Conclusion: Treatment initiation did align with current recommendations (patients with severe disease were more likely to initiate treatment), however, rates of treatment initiation and completion were low. Patient choice predisposition is the strongest predictor of treatment initiation, independent of disease severity. Improving individualized treatment outcomes for patients with chronic HCV requires efforts at identifying patients’ choice predisposition, and improving access for those wishing to initiate therapy.
Patterns and predictors of treatment initiation and completion in patients with chronic hepatitis C virus infection
Clark BT,Garcia-Tsao G,Fraenkel L
Patient Preference and Adherence , 2012,
Abstract: Brian T Clark1,2, Guadalupe Garcia-Tsao1,2, Liana Fraenkel1,21Veterans Administration, Connecticut Healthcare System, West Haven, 2Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USAObjectives: Guidelines for hepatitis C (HCV) strongly recommend antiviral treatment for patients with more severe liver disease given their increased risk of developing cirrhosis and other liver-related complications. Despite the proven benefits of therapy, 70%–88% of patients chronically infected with HCV do not undergo treatment. The goal of this paper is to describe patterns of treatment initiation among patients with both mild and severe disease and to assess the factors that are associated with treatment initiation and completion.Methods: Subjects completed previously validated questionnaires to ascertain sociodemographic characteristics, choice predisposition, and clinical characteristics prior to meeting with the hepatologist to discuss treatment initiation and were followed for 12 months. We examined the association between patient characteristics and treatment patterns controlling for liver disease severity.Results: Of the 148 eligible subjects entered into our study, 55 (37%) initiated treatment during the 12-month follow-up period. Of the 86 subjects with severe liver disease, 43 (50%) initiated treatment. Financial barriers and geographic access to care were the most common reasons for treatment deferral. Of the 55 patients initiating treatment, 24 (44%) discontinued treatment, with intolerance of side effects being the most common reason for discontinuation. After adjusting for liver disease severity, patient choice predisposition (prior to discussion with their provider) was strongly associated with initiation of treatment, while sociodemographic characteristics were not.Conclusion: Treatment initiation did align with current recommendations (patients with severe disease were more likely to initiate treatment), however, rates of treatment initiation and completion were low. Patient choice predisposition is the strongest predictor of treatment initiation, independent of disease severity. Improving individualized treatment outcomes for patients with chronic HCV requires efforts at identifying patients’ choice predisposition, and improving access for those wishing to initiate therapy.Keywords: barriers, access, preferences, utilization, adverse events
Clinical and economic outcomes after surgical aortic valve replacement in Medicare patients
Clark MA, Duhay FG, Thompson AK, Keyes MJ, Svensson LG, Bonow RO, Stockwell BT, Cohen DJ
Risk Management and Healthcare Policy , 2012, DOI: http://dx.doi.org/10.2147/RMHP.S34587
Abstract: ical and economic outcomes after surgical aortic valve replacement in Medicare patients Original Research (2045) Total Article Views Authors: Clark MA, Duhay FG, Thompson AK, Keyes MJ, Svensson LG, Bonow RO, Stockwell BT, Cohen DJ Published Date October 2012 Volume 2012:5 Pages 117 - 126 DOI: http://dx.doi.org/10.2147/RMHP.S34587 Received: 02 June 2012 Accepted: 06 September 2012 Published: 31 October 2012 Mary Ann Clark,1 Francis G Duhay,2 Ann K Thompson,2 Michelle J Keyes,3 Lars G Svensson,4 Robert O Bonow,5 Benjamin T Stockwell,3 David J Cohen6 1The Neocure Group LLC, Washington, DC, 2Edwards Lifesciences Corporation, Irvine, CA, 3The Burgess Group LLC, Alexandria, VA, 4Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH, 5Center for Cardiovascular Innovation, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 6Saint Luke's Mid America Heart Institute, Kansas City, MO, USA Background: Aortic valve replacement (AVR) is the standard of care for patients with severe, symptomatic aortic stenosis who are suitable surgical candidates, benefiting both non-high-risk and high-risk patients. The purpose of this study was to report long-term medical resource use and costs for patients following AVR and validate our assumption that high-risk patients have worse outcomes and are more costly than non-high-risk patients in this population. Methods: Patients with aortic stenosis who underwent AVR were identified in the 2003 Medicare 5% Standard Analytic Files and tracked over 5 years to measure clinical outcomes, medical resource use, and costs. An approximation to the logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) based on administrative data was used to assess surgical risk, with a computed logistic EuroSCORE > 20% considered high-risk. Results: We identified 1474 patients with aortic stenosis who underwent AVR, of whom 1222 (82.9%) were non-high-risk and 252 (17.1%) were high-risk. Among those who were non-high-risk, the mean age was 73.3 years, 464 (38.2%) were women, and the mean logistic EuroSCORE was 7%, whereas in those who were high-risk, the mean age was 77.6 years, 134 (52.8%) were women, and the mean logistic EuroSCORE was 37%. All-cause mortality was 33.2% for non-high-risk and 66.7% for high-risk patients at 5 years. Over this time period, non-high-risk patients experienced an average of 3.9 inpatient hospitalizations and total costs of $106,277 per patient versus 4.7 hospitalizations and total costs of $144,183 for high-risk patients. Conclusion: Among elderly patients undergoing AVR, long-term mortality and costs are substantially greater for high-risk than for non-high-risk individuals. These findings indicate that further research is needed to understand whether newer approaches to aortic valve replacement such as transcatheter AVR may be a lower cost, clinically valuable alternative.
The Effect of Task Based Language Teaching on Writing Skills of EFL Learners in Malaysia  [PDF]
Rai Zahoor Ahmed, Siti Jamilah Bt Bidin
Open Journal of Modern Linguistics (OJML) , 2016, DOI: 10.4236/ojml.2016.63022
Abstract: This quasi experimental study has validated the effectiveness of Task Based Language Teaching (TBLT) in promoting writing skills of EFL learners enrolled in undergraduate programs at public sector Malaysian universities. TBLT is emerging as an essential part of curricula in language pedagogies in several countries around the globe and advocated by prominent SLA researchers along with ELT practitioners. In current study research participants were divided into an experimental and a control group. The data were collected following a Mixed Method Research paradigm during pretest and posttest. A Paired Samples T-test was used to determine the statistical significance of the learners’ scores in pretest as compared to the posttest. The vast majority of the learners opined in their reflective journal that TBLT was the most interesting and a learner centered approach enabling learners to use their existing linguistic resources. The use of existing linguistic resources is a fundamental principle of TBLT as it leads the EFL learners to be fluent and confident users of English language both inside and outside the classroom in real life situations.
Saving Lives: Timely Flash Flood Warnings in the UK  [PDF]
Colin Clark
Journal of Geoscience and Environment Protection (GEP) , 2017, DOI: 10.4236/gep.2017.52005
Abstract:
Flash floods are a major cause of death and destruction to property on a worldwide scale. In the UK sudden flooding has been the cause of the loss of over 60 lives during the last century. Forecasting these events to give enough warning is a major concern: after the 2004 flood at Boscastle, Cornwall UK the Environment Agency (2004) stated that it was not possible to provide a warning in such a fast reacting and small catchment. This is untrue since the Agency had already implemented a real time non-linear flow model as part of a flood warning system on the upper Brue in Somerset UK. This model is described in this paper as it has been applied to the Lynmouth flood of 1952, and briefly for the Boscastle catchment, both of which have an area of about 20 km2. The model uses locally measured SMD and saturated hydraulic conductivity data. With the addition of further parameters the model has been successfully used nationwide.
The Value of Using Unofficial Measurements of Rainfall: The Dublin Storm and Flood of June 1963  [PDF]
Colin Clark
Journal of Geoscience and Environment Protection (GEP) , 2019, DOI: 10.4236/gep.2019.72006
Abstract: Rainfall measurements are vital for the design of hydraulic structures, climate change studies, irrigation and land drainage works. The most important source of design rainfall data comes from convective storms. Accurate assessment of the storm rainfall requires a fairly dense network of raingauges. In 1963, such a storm took place over Dublin in Ireland. However, the existing raingauge network was insufficient to identify both the depth and pattern of rainfall. An appeal was made by Met Eireann for additional unofficial rainfall data. The result was remarkable in that the estimated maximum rainfall depth was found to be more than double the official value and that the resulting depth area analysis suggested a rainfall volume over a large area much bigger than the original isohyet map indicated. This result has huge implications for the estimation of maximum rainfall and dam safety assessment, especially in countries where the raingauge network has a low density. This paper first provides a description of the synoptic conditions that led to the storm, second an analysis of the rainfall data and how the unofficial measurements produced a very different depth area relationship; third, the social consequences of the resulting flood are described. Fourth, the storm is then placed in the context of other storms in the British Isles Finally the implications for rainfall measurement, gauge density and an example of how revised estimates of probable maximum precipitation (PMP) have been used to improve the safety and design standard of a flood detention dam are discussed.
The association of psychological stress and health related quality of life among patients with stroke and hypertension in Gaza Strip
BT Baune, Y Aljeesh
Annals of General Psychiatry , 2006, DOI: 10.1186/1744-859x-5-6
Abstract: The WHOQOL-BREF questionnaire was applied to 112 hypertensive patients with hypertension plus stroke and 224 hypertensive patients without stroke. Psychological stress was assessed with SCL-90. Means scale scores were compared using student-t-test and predictors of QOL were calculated with covariance analysis.Patients with stroke had a significant lower QOL than patients without stroke and a significantly higher level of stress (p < 0.01). In analyses of covariance psychological stress was significantly correlated to all domains of QOL among non-stroke patients. The same psychological and sociodemographic factors showed little impact on the stroke patients in these multivariable analyses. In these models psychological stress had a significant impact on the global domain of QOL among stroke patients. Income and gender were the only sociodemographic factors being significantly associated with the physical (education) and social (gender) domains of QOL in stroke patients.Psychological stress was strongly correlated with all domains of QOL in patients without stroke and was only partly associated with QOL among patients with stroke. Future studies should investigate if psychological stress is a factor suitable for educational and psychological interventions aiming at stress reduction in CVD patients which might substantially contribute to better health related quality of life in these patients.Quality of life (QOL) is a phrase often used in health care settings at policy and administration levels, in clinical assessments of therapies, and in clinical management of individual cases. While QOL is a broad concept that covers such areas as social, environmental, economic, and health satisfaction, health-related quality of life (HRQL) is less wide ranging, including mental and physical health and their consequences. Health-related quality of life (HRQL) is considered as one of the key concepts in contemporary practice of medicine and delivery of health care [1-4]. Quality of
The effect of seed size on yield and yield components of chickpea and lentil
BT Bi er
African Journal of Biotechnology , 2009,
Abstract: This study was carried out in order to determine the effect of seed size on the yield and yield components of chickpea and lentil. Two field experiments, composed of three chickpea (Cicer arietinum L.) varieties, four lentil (Lens culinaris Medik.) and two seed sizes, were conducted in southeastern Anatolia, Turkey in 2005 and 2006 in randomized complete block designs. The seeds of the three grading sizes used in this study were evaluated for yield and its components in chickpea and lentil. For chickpea, effect of seed size on yield and 100 seed weight were significant, but no difference in seed size affects other yield components, and correlations between seed size and seed yield and 100 seed weight were positive. For lentil, effect of seed size on yield and yield components was not significant.
Potential of Moringa oleifera (Lam.) fresh root-bark extract as an organic piscicide in aquaculture pond management
BT Adesina, BO Omitoyin
Egyptian Journal of Biology , 2011,
Abstract: This study examined the effectiveness of Moringa oleifera fresh root-bark extract as an organic piscicide to control predatory fish in ponds. Acute-lethal toxicity (LC50) of Moringa oleifera extract for 96-h exposure for Oreochromis niloticus fingerlings was determined at 26.45 mg l-1. The extract was more toxic on at higher concentrations of 100 mg l-1, with fingerlings showing abnormal swimming, restlessness and uncoordinated behaviour before death. Moringa oleifera extract could be used as an organic piscicide in aquaculture pond management. Baseline information on its toxicity to fish could serve as a tool in fisheries management to wipe out predatory fish in ponds prior to stocking.
Awareness and attitude of women towards their spouse's use of vasectomy as a fertility control method in Jos, North-Central Nigeria
BT Utoo, PM Utoo
Jos Journal of Medicine , 2010,
Abstract: No abstract supplied
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