Quality of life of survivors of paediatric intensive care

Objective: The mortality rate in paediatric intensive care units (PICU) has fallen over the last two decades. More advanced treatment is offered to children with life-threatening disease and there is substantial interest in knowing whether long term outcome and quality of life after intensive care are acceptable

Health Outcomes and Cost of Care Among Older Adults with Schizophrenia: A 10-Year Study Using Medical Records across the Continuum of Care

Objectives The population of older patients with schizophrenia is increasing. This study describes health outcomes, utilization, and costs over 10 years in a sample of older patients with schizophrenia compared to older patients without schizophrenia. Design, Setting, Participants An observational cohort study of 31,588 older adults (mean age 70.44 years) receiving care from an urban public health system, including a community mental health center, during 1999–2008. 1635 (5.2%) were diagnosed with schizophrenia and 757 (2.4%) had this diagnosis confirmed in the community mental health center. Patients’ electronic medical records were merged with Medicare claims, Medicaid claims, the Minimum Dataset, and the Outcome and Assessment Information Set. Information on medication use was not available. Measurements Rates of comorbid conditions, health care utilization, costs, and mortality. Results Patients with schizophrenia had significantly higher rates of congestive heart failure (45.05% v. 38.84%), chronic obstructive pulmonary disease (52.71% v. 41.41%), and hypothyroidism (36.72% v. 26.73%) than the patients without schizophrenia (p<0.001). They had significantly lower rates of cancer (30.78% v. 43.18%) and significantly higher rates of dementia (64.46% v. 32.13%). The patients with schizophrenia had significantly higher mortality risk (HR: 1.25, CI: 1.07–1.47) than the patients without schizophrenia. They also had significantly higher rates of health care utilization. The mean costs for Medicare and Medicaid were significantly higher for the patients with schizophrenia than for the patients without schizophrenia. Conclusions The management of older adult patients with schizophrenia is creating a serious burden for our health care system, requiring the development of integrated models of health care

Risk of Adverse Gastrointestinal Events from Inhaled Corticosteroids

Previous studies suggest a risk of gastrointestinal events in patients prescribed oral corticosteroids, but gastrointestinal events have not commonly been documented in patients prescribed inhaled corticosteroids. We explored whether patients prescribed inhaled corticosteroids are at risk of adverse gastrointestinal effects

Safety of intravenous ferric carboxymaltose versus oral iron in patients with nondialysis-dependent CKD: an analysis of the 1-year FIND-CKD trial.

Background: The evidence base regarding the safety of intravenous (IV) iron therapy in patients with chronic kidney disease (CKD) is incomplete and largely based on small studies of relatively short duration. Methods: FIND-CKD (ClinicalTrials.gov number NCT00994318) was a 1-year, open-label, multicenter, prospective study of patients with nondialysis-dependent CKD, anemia and iron deficiency randomized (1:1:2) to IV ferric carboxymaltose (FCM), targeting higher (400-600 µg/L) or lower (100-200 µg/L) ferritin, or oral iron. A post hoc analysis of adverse event rates per 100 patient-years was performed to assess the safety of FCM versus oral iron over an extended period. Results: The safety population included 616 patients. The incidence of one or more adverse events was 91.0, 100.0 and 105.0 per 100 patient-years in the high ferritin FCM, low ferritin FCM and oral iron groups, respectively. The incidence of adverse events with a suspected relation to study drug was 15.9, 17.8 and 36.7 per 100 patient-years in the three groups; for serious adverse events, the incidence was 28.2, 27.9 and 24.3 per 100 patient-years. The incidence of cardiac disorders and infections was similar between groups. At least one ferritin level ≥800 µg/L occurred in 26.6% of high ferritin FCM patients, with no associated increase in adverse events. No patient with ferritin ≥800 µg/L discontinued the study drug due to adverse events. Estimated glomerular filtration rate remained the stable in all groups. Conclusions: These results further support the conclusion that correction of iron deficiency anemia with IV FCM is safe in patients with nondialysis-dependent CKD

Model reduction for initial value ODEs

Many physical phenomena in biology and physiology are described by mathematical models that comprise a system of initial value ordinary differential equations. Each differential equation may often be written as the sum of several terms, where each term represents a different physical entity. A wide range of techniques, ranging from heuristic observation to mathematically rigorous asymptotic analysis, may be used to simplify these equations allowing the identification of the key phenomena responsible for a given observed behaviour. In this study we extend an algorithm for automatically simplifying systems of initial value ordinary differential equations (Whiteley, Mathematical Biosciences, vol. 225, pp. 44-52, 2010) that is based on a posteriori analysis of the full system of equations. Our extensions to the algorithm make the following contributions: (i) each equation in a system of differential equations may be written as a finite sum of contributions (including the derivative term), and any one of these terms may be neglected (if it is appropriate to do so) in the simplified model; and (ii) a simplified model is generated that allows accurate prediction of one or more components of the solution at all times. These extensions are illustrated using examples drawn from enzyme kinetics and cardiac electrophysiology

Can participation promote psychological ownership of a shared resource? An intervention study of community-based safe water infrastructure

Previous research suggests that community-based participation, a process through which beneficiaries can actively influence and define the direction and execution of development programs, can promote long-term uptake, use, and management of shared resources, such as community-based safe water infrastructure. However, results are heterogeneous. Psychological ownership theory and initial evidence suggests that participation promotes positive outcomes for shared resources by fostering sense of ownership through three routes: having control, intimate knowledge, and investing the self. This study used community-based safe water infrastructure as an example to investigate how various forms of participation affect acceptance, use, and functionality of a shared resource and whether this effect is mediated by psychological ownership. We conducted a nonrandomized cluster-based controlled trial with pre–post intervention assessment (N = 369) in 33 villages in rural Nepal, where safe water infrastructure is shared. Participatory intervention activities (e.g., influence in decisionmaking, contributing materials and labour) favourably affected self-reported outcomes and use of the water supply infrastructure but not observed functionality or drinking water quality. In conclusion, this study supports the assumption that participation can foster psychological ownership, which in turn can support successful management of a shared resource