The changing characteristics of patients with chronic hepatitis C prescribed direct acting antiviral medicines in general practice since listing of the medicines on the Australian Pharmaceutical Benefits Scheme

Background and Aim: The primary objective of this study was to determine whether the characteristics of patients prescribed direct acting antiviral (DAA) medicines have changed since initial listing of the medicines on the Australian Pharmaceutical Benefits Scheme (PBS). Methods: A cross-sectional study was conducted using data from MedicineInsight, an Australian database of general practice electronic health records, from March 2016 to August 2018. We compared sociodemographic, comorbidity, and clinical characteristics of patients aged at least 18 years who were prescribed at least one DAA in the first 4 months of PBS listing in 2016 with those prescribed at least one DAA in 2018. Results: There were 2251 eligible adult patients prescribed a DAA during the study period, 62% were men and 59% were aged 50 years and older. Patients prescribed DAA medicines initially were older (aged ≥50 years: 67.9% vs 49.3%; P 1 (20.4% vs 8.9%; P < 0.001) than those prescribed DAA medicines in 2018. A greater proportion of patients in regional/remote (46.5% vs 35.6%; P < 0.001) and socioeconomically disadvantaged areas (44.4% vs 34.5%; P = 0.003) accessed treatment in 2018 compared with 2016. Conclusions: Despite evidence of decreasing uptake of DAA medicines across Australia, this study indicates broadened uptake among younger age groups and those residing in regional/remote and socioeconomically disadvantaged areas since 2016. While uptake of DAA medicines in some population subgroups appears to have improved, continuous efforts to improve uptake across the Australian population are essential

Development of a graphical user interface for automatic separation of human voice from Doppler ultrasound audio in diving experiments

Doppler ultrasound (DU) is used in decompression research to detect venous gas emboli in the precordium or subclavian vein, as a marker of decompression stress. This is of relevance to scuba divers, compressed air workers and astronauts to prevent decompression sickness (DCS) that can be caused by these bubbles upon or after a sudden reduction in ambient pressure. Doppler ultrasound data is graded by expert raters on the Kisman-Masurel or Spencer scales that are associated to DCS risk. Meta-analyses, as well as efforts to computer-automate DU grading, both necessitate access to large databases of well-curated and graded data. Leveraging previously collected data is especially important due to the difficulty of repeating large-scale extreme military pressure exposures that were conducted in the 70-90s in austere environments. Historically, DU data (Non-speech) were often captured on cassettes in one-channel audio with superimposed human speech describing the experiment (Speech). Digitizing and separating these audio files is currently a lengthy, manual task. In this paper, we develop a graphical user interface (GUI) to perform automatic speech recognition and aid in Non-speech and Speech separation. This constitutes the first study incorporating speech processing technology in the field of diving research. If successful, it has the potential to significantly accelerate the reuse of previously-acquired datasets. The recognition task incorporates the Google speech recognizer to detect the presence of human voice activity together with corresponding timestamps. The detected human speech is then separated from the audio Doppler ultrasound within the developed GUI. Several experiments were conducted on recently digitized audio Doppler recordings to corroborate the effectiveness of the developed GUI in recognition and separations tasks, and these are compared to manual labels for Speech timestamps. The following metrics are used to evaluate performance: the average absolute differences between the reference and detected Speech starting points, as well as the percentage of detected

Pregabalin prescribing patterns in Australian general practice, 2012–2018: a cross-sectional study

Background: In 2013 pregabalin was subsidised by Australia′s Pharmaceutical Benefits Scheme (PBS) for neuropathic pain.Since the subsidy, pregabalin prescribing has been increasing in Australia and so has related harm.There are concerns it is being prescribed for indications other than neuropathic pain, which have little evidence of efficacy.Aim: To describe pregabalin prescribing in Australian general practice.Design & setting: A cross-sectional study of patients attending 445 general practice sites in the national MedicineInsight database from March 2012–February 2018.Method: The following aspects were calculated: the proportion of prescriptions that were for pregabalin per year; the prevalence of pain conditions in patients prescribed pregabalin; and same-day prescribing of pregabalin with opioids or benzodiazepines.Results: Prescribing increased from 13 per 10 000 to 104 per 10 000 prescriptions between 2012– 2013 and 2017–2018.A total of 1 891 623 patients were identified of whom 114 123 (6.0%) were prescribed pregabalin; 49.7% (n = 56 772) had a recorded diagnosis of neuropathic pain.Among people prescribed pregabalin without a recorded diagnosis of neuropathic pain, 43.5% (n = 24 927) had a diagnosis of back problems, 8.8% (n = 5073) chronic pain, and 26.4% (n = 30 146) had no pain diagnosis.Pregabalin was prescribed the same day as an opioid to 38.1% of patients (95% confidence interval [CI] = 37.1% to 39.1%) and a benzodiazepine to 13.1% of patients (95% CI = 12.5% to 13.7%).Patients with a diagnosis of chronic pain had the highest rate of same-day prescribing of pregabalin with an opioid (70.4%, 95% CI = 68.9% to 71.9%) or a benzodiazepine (25.8%, 95% CI = 24.2% to 27.4%) Conclusion: Substantial increases in pregabalin prescribing were identified in Australian general practice, but only half of patients had a neuropathic pain diagnosis recorded, the only approved indication for subsidy.High rates of same-day prescribing with opioids and benzodiazepines may put patients at increased risk of harm

Real-Life Anemia Management Among Patients with Non-Dialysis-Dependent Chronic Kidney Disease in Three European Countries

Danilo Fliser,1 Maria Mata Lorenzo,2 Katherine Houghton,3 Claire Ainsworth,3 Martin Blogg,2 Elena González de Antona Sánchez,4 Jose Portoles5 1Saarland University Medical Center, Homburg, Germany; 2Astellas Pharma Europe Ltd., Addlestone, UK; 3RTI Health Solutions, Manchester, UK; 4Astellas Pharma España S.A., Madrid, Spain; 5Hospital Universitario Puerta de Hierro, Madrid, SpainCorrespondence: Danilo Fliser, Saarland University Medical Center, Homburg, Germany, Tel +49 – 6841 – 16 15040, Fax +49 – 6841 – 16 15454, Email [email protected]: Anemia is prevalent among patients with chronic kidney disease (CKD), yet current evidence indicates that treatment may not adhere to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. We aimed to document the management of patients with non-dialysis-dependent (NDD)-CKD receiving erythropoiesis-stimulating agent (ESA) therapy in Europe.Methods: This retrospective, observational study extracted information from medical records in Germany, Spain, and the UK. Eligible patients were adults with NDD-CKD stages 3b– 5 who initiated ESA therapy for anemia between January and December 2015. Anemia was defined as hemoglobin (Hb) < 13.0 g/dL (males) or < 12.0 g/dL (females). Data regarding ESA treatment, treatment response, concomitant iron therapy and blood transfusions were extracted up to 24 months post-ESA initiation, and data on CKD progression until abstraction date.Results: Eight hundred and forty-eight medical records were abstracted. Approximately 40% received no iron therapy prior to ESA initiation. At ESA initiation, mean ± standard deviation Hb level was 9.8 ± 1.0 g/dL. Most patients received darbepoetin alfa, and switching between ESAs was rare (8.5% of patients). Concomitant intravenous and oral iron therapy was prescribed for 36% and 42% of patients, respectively, during initial ESA therapy. Mean Hb levels reached the target level (10– 12 g/dL) within 3– 6 months of ESA initiation. Hb, transferrin saturation, and ferritin levels were infrequently monitored from 3 months post-ESA initiation. Rates of blood transfusion, dialysis, and diagnosis of end-stage renal disease were 16.4%, 19.3%, and 24.6%, respectively. Rates of kidney transplant and death were 4.8% and 8.8%, respectively.Conclusion: Among ESA-treated patients, ESA initiation was in accordance with KDIGO guidelines, but subsequent monitoring of Hb and iron deficiency were suboptimal.Graphical Abstract: Keywords: anemia, chronic kidney disease, clinical care process, erythropoiesis-stimulating agents, iron therapy, real-life managemen

The effect of treatment with omalizumab, an anti-IgE antibody, on asthma exacerbations and emergency medical visits in patients with severe persistent asthma

Background: Patients with severe persistent asthma who are inadequately controlled despite treatment according to current asthma management guidelines have a significant unmet medical need. Such patients are at high risk of serious exacerbations and asthma-related mortality.Methods: Here, we pooled data from seven studies to determine the effect of omalizumab, an anti-immunoglobulin E (IgE) monoclonal antibody, on asthma exacerbations in patients with severe persistent asthma. Omalizumab was added to current asthma therapy and compared with placebo (in five double-blind studies) or with current asthma therapy alone (in two open-label studies). The studies included 4308 patients (2511 treated with omalizumab), 93% of whom had severe persistent asthma according to the Global Initiative for Asthma (GINA) 2002 classification. Using the Poisson regression model, results were calculated as the ratio of treatment effect (omalizumab : control) on the standardized exacerbation rate per year.Results: Omalizumab significantly reduced the rate of asthma exacerbations by 38% (P &lt; 0.0001 vs control) and the rate of total emergency visits by 47% (P &lt; 0.0001 vs control). Analysis of demographic subgroups showed that the efficacy of omalizumab on asthma exacerbations was unaffected by patient age, gender, baseline serum IgE (split by median) or by 2- or 4-weekly dosing schedule, although benefit in absolute terms appeared to be greatest in patients with more severe asthma, defined by a lower value of percentage predicted forced expiratory volume in 1 s (FEV?) at baseline.Conclusions: These results suggest that omalizumab may fulfil an important need in patients with severe persistent asthma, many of whom are not adequately controlled on current therapy