Factors associated with appropriate inhaler use in patients with COPD - lessons from the REAL survey

The authors thank Clarice Field (PhD) and Paul McKiernan (PhD) of Novartis for providing medical writing support, which was funded by Novartis AG, Basel, Switzerland, in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3). Pankaj Goyal and Joao Mendes, Novartis Pharma AG, Basel, contributed to the design and conceptualization of study. The survey was designed by PDD, London, United Kingdom, and GfK Switzerland AG, Basel, Switzerland. The survey was conducted by GfK Switzerland AG, Basel, Switzerland, and sponsored by Novartis Pharma AG, Basel, Switzerland.Peer reviewedPublisher PD

Health economic assessment of ferric carboxymaltose in patients with iron deficiency and chronic heart failure based on the FAIR-HF trial: an analysis for the UK

AIMS: The purpose of this study was to evaluate the cost-effectiveness of iron repletion using intravenous (i.v.) ferric carboxymaltose (FCM) in chronic heart failure (CHF) patients with iron deficiency with or without anaemia. Cost-effectiveness was studied from the perspective of the National Health Service in the UK. METHODS AND RESULTS: A model-based cost-effectiveness analysis was used to compare iron repletion with FCM with no iron treatment. Using data from the FAIR-HF trial and publicly available sources and publications, per patient costs and clinical effectiveness of FCM were estimated compared with placebo. Cost assessment was based on study drug and administration costs, cost of CHF treatment, and hospital length of stay. The incremental cost-effectiveness ratio (ICER) of FCM use was expressed as cost per quality-adjusted life year (QALY) gained, and sensitivity analyses were performed on the base case. The time horizon of the analysis was 24 weeks. Mean QALYs were higher in the FCM arm (difference 0.037 QALYs; bootstrap-based 95% confidence interval 0.017-0.060). The ICER of FCM compared with placebo was €4414 per QALY gained for the FAIR-HF dosing regimen. Sensitivity analyses confirmed the base case result to be robust. CONCLUSION: From the UK payers' perspective, managing iron deficiency in CHF patients using i.v. FCM was cost-effective in this analysis. The base case ICER was clearly below the threshold of €22 200-€33 300/QALY gained (£20 000-£30 000) typically used by the UK National Institute for Health and Clinical Excellence and proved to be robust in sensitivity analysis. Improved symptoms and better quality of life contributed to this result

Meta Modeling for Business Process Improvement

Conducting business process improvement (BPI) initiatives is a topic of high priority for today’s companies. However, performing BPI projects has become challenging. This is due to rapidly changing customer requirements and an increase of inter-organizational business processes, which need to be considered from an end-to-end perspective. In addition, traditional BPI approaches are more and more perceived as overly complex and too resource-consuming in practice. Against this background, the paper proposes a BPI roadmap, which is an approach for systematically performing BPI projects and serves practitioners’ needs for manageable BPI methods. Based on this BPI roadmap, a domain-specific conceptual modeling method (DSMM) has been developed. The DSMM supports the efficient documentation and communication of the results that emerge during the application of the roadmap. Thus, conceptual modeling acts as a means for purposefully codifying the outcomes of a BPI project. Furthermore, a corresponding software prototype has been implemented using a meta modeling platform to assess the technical feasibility of the approach. Finally, the usability of the prototype has been empirically evaluated

A questionnaire on treatment satisfaction and disease specific knowledge among patients with acute coronary syndrome. I: Are treatment satisfaction and disease specific knowledge continuous latent traits?

OBJECTIVE: To assess psychometric properties of a questionnaire covering treatment satisfaction and disease-specific knowledge among patients discharged after treatment for acute coronary syndrome. METHODS: Comparative scaling of the questionnaire using latent class analysis (LCA) and exploratory factor analysis (EFA) in a consecutive sample of 2015 patients. RESULTS: LCA revealed four qualitatively differing patterns of patients' knowledge and five distinct patterns of treatment satisfaction. EFA for patients' knowledge identified four uncorrelated "dimensions". Patient satisfaction was scored in a two-factor solution despite proven heterogeneity of persons. CONCLUSIONS: LCA was helpful to identify classes of patients that cannot be scaled according to a latent trait model. PRACTICE IMPLICATIONS: Specific patterns of insufficient disease-specific knowledge and satisfaction requiring specific interventions became visible

A questionnaire on treatment satisfaction and disease specific knowledge among patients with acute coronary syndrome II: Insights for patient education and quality improvement

OBJECTIVE: Secondary prevention for coronary heart disease is achieved by pharmaceutical control of risk factors and patients' own self management behaviour. To comply with longterm treatment patients need sufficient knowledge of their condition and should be satisfied with acute care. Therefore a questionnaire measuring both issues was constructed. METHODS AND RESULTS: Latent class analysis applied in a sample of over 2000 patients suffering from acute coronary syndrome revealed 4 configurative patterns of knowledge and 5 distinct patterns of (dis-)satisfaction. Nearly 50% of all patients displayed insufficient knowledge upon discharge. Deficits clustered around misinformation on necessary lifestyle changes versus dysfunctional strategies for future emergency situations. Satisfaction and disease specific knowledge were interrelated in complex patterns. CONCLUSIONS: Disease specific knowledge and satisfaction with treatment proved to be psychometrically valid indicators of the quality of the treatment process that might also have an impact on outcome. PRACTICE IMPLICATIONS: A validated questionnaire is ready for routine administration after discharge of patients with acute coronary syndrome from acute hospital care. Patient education efforts and quality improvement in treatment centres might be effectively monitored using this questionnaire

Botulismus: Prävention, Diagnostik, Therapie und mögliche Bedrohungslagen

In Zeiten mit erhöhter Terrorismus-Bedrohung müssen sich auch Ärzte mit bioterroristischen Szenarien auseinandersetzen. Die Arbeit möchte Ärzten einen aktuellen Überblick zu Botulinumtoxin und zur möglichen Bedrohungslage geben. Dazu wurde die Literatur systematisch aufgearbeitet und für spezielle Fragestellungen Experten kontaktiert. Resultate: Die Toxizität von Botulinumtoxin liegt um ein Vielfaches höher als für jedes andere natürliche Toxin. In der Klinik des Botulismus zeigt sich das charakteristische Bild einer akuten, afebrilen symmetrischen und absteigenden Lähmung unabhängig von der Art der Exposition, mit Normalbefunden bezüglich Mentalstatus, Sensorik und Elektrolyt-Haushalt. Im Einzelfall wird Botulismus trotzdem oft primär falsch diagnostiziert, Cluster mit zutreffenden Symptomen und ≥ 2 Fällen sind pathognonomisch. Die aktuelle Therapie beinhaltet supportive Pflege, respiratorische Unterstützung und Verabreichung eines Antitoxins. Die frühe Verabreichung eines Antitoxins vermag das Ausmaß der Lähmung zu limitieren aber nicht zu vermindern. Während für adulte Patienten nur equine Präparate verfügbar sind, gibt es für Säuglinge und Kinder in den USA ein humanes Antitoxin. Personen mit erhöhtem Expositions-Risiko können mit einem pentavalenten Botulinumtoxoid-Impfstoff geimpft werden. Botulinumtoxin ist einfach zu gewinnen. Durch die praktisch ubiquitäre Verfügbarkeit und hohe Toxizität, eignet sich Botulinumtoxin zur Verwendung bei bioterroristischen Anschlägen. Wie bereits in der Vergangenheit geschehen, muss auch in Zukunft mit einer missbräuchlichen Verwendung gerechnet werden. Schlussfolgerung: Obwohl Botulismus in Westeuropa selten vorkommt, sollte er bei Patienten mit Lähmungssymptomatik in der Differenzialdiagnose mitberücksichtigt werden. Auch ist mit einer absichtlichen Freisetzung von Botulinumtoxin zu rechnen. Deshalb sollte jeder Botulismus-Fall sowohl auf eine Verbindung mit anderen Fällen wie auch auf einen allfälligen terroristischen Hintergrund überprüft werden. = In times of increased terrorist threat health professionals need to be prepared for bioterrorist events. The goal must be to give doctors an overview over the current state of knowledge and risk assessment of botulinum toxin. This review is based on Information gathered by a systematic analysis of the literature and by contacting experts. The toxicity of botulinum toxin exceeds any other known natural toxin. Clinical features of botulism consist of an acute, afebrile symmetrical and descending paralysis, regardless of the route of exposure, with normal mental status, sensory functions and electrolyte values. The initial diagnosis is often wrong in individual cases of botulism, but clusters with typical symptoms and two or more cases usually provide the diagnosis. Current treatment is primarily supportive care, respiratory support and antitoxin administration. Early application of antitoxin can limit the extent of the paralysis, but will not reverse it. Antitoxin for adult patients is of equine origin, while children in the USA can be treated with a recently developed human antitoxin. A pentavalent toxoid vaccine is available for persons at high risk of exposure. Botulinum toxin is easily extracted and ubiquitously available. These two features, together with the high toxicity, makes misuse easy. Misuse will continue to occur. Although a rare disease in Western Europe, botulism should be included in the differential diagnosis in patients with specific symptoms of paralysis. There is the potential threat of deliberate release of botulinum toxin. For this reason every outbreak of botulism must be assessed for any possible links to terrorism

In-hospital delay increases the risk of perforation in adults with appendicitis

The influence of in-hospital delay (time between admission and operation) on outcome after appendectomy is controversial

Clinical impact and healthcare resource utilization associated with early versus late COPD diagnosis in patients from UK CPRD database

Funding The study was funded by Novartis AG, Basel, Switzerland. Acknowledgments Editorial and writing support was provided by Santanu Bhadra and Harneet Kaur (Novartis), funded by Novartis AG, Basel, Switzerland, in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3). Data analysis was conducted by Pharmatelligence.Peer reviewedPublisher PD