ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

Proceedings of the 3rd Biennial Conference of the Society for Implementation Research Collaboration (SIRC) 2015: advancing efficient methodologies through community partnerships and team science

It is well documented that the majority of adults, children and families in need of evidence-based behavioral health interventionsi do not receive them [1, 2] and that few robust empirically supported methods for implementing evidence-based practices (EBPs) exist. The Society for Implementation Research Collaboration (SIRC) represents a burgeoning effort to advance the innovation and rigor of implementation research and is uniquely focused on bringing together researchers and stakeholders committed to evaluating the implementation of complex evidence-based behavioral health interventions. Through its diverse activities and membership, SIRC aims to foster the promise of implementation research to better serve the behavioral health needs of the population by identifying rigorous, relevant, and efficient strategies that successfully transfer scientific evidence to clinical knowledge for use in real world settings [3]. SIRC began as a National Institute of Mental Health (NIMH)-funded conference series in 2010 (previously titled the “Seattle Implementation Research Conference”; $150,000 USD for 3 conferences in 2011, 2013, and 2015) with the recognition that there were multiple researchers and stakeholdersi working in parallel on innovative implementation science projects in behavioral health, but that formal channels for communicating and collaborating with one another were relatively unavailable. There was a significant need for a forum within which implementation researchers and stakeholders could learn from one another, refine approaches to science and practice, and develop an implementation research agenda using common measures, methods, and research principles to improve both the frequency and quality with which behavioral health treatment implementation is evaluated. SIRC’s membership growth is a testament to this identified need with more than 1000 members from 2011 to the present.ii SIRC’s primary objectives are to: (1) foster communication and collaboration across diverse groups, including implementation researchers, intermediariesi, as well as community stakeholders (SIRC uses the term “EBP champions” for these groups) – and to do so across multiple career levels (e.g., students, early career faculty, established investigators); and (2) enhance and disseminate rigorous measures and methodologies for implementing EBPs and evaluating EBP implementation efforts. These objectives are well aligned with Glasgow and colleagues’ [4] five core tenets deemed critical for advancing implementation science: collaboration, efficiency and speed, rigor and relevance, improved capacity, and cumulative knowledge. SIRC advances these objectives and tenets through in-person conferences, which bring together multidisciplinary implementation researchers and those implementing evidence-based behavioral health interventions in the community to share their work and create professional connections and collaborations

Psoriasis Treatment Patterns: A Retrospective Claims Study

Thesis (Master's)--University of Washington, 2018BACKGROUND: Psoriasis (PsO) is a chronic, autoimmune, dermatologic disease affecting 7.5 million adults in the United States. Treatment options for psoriasis include topical therapy, phototherapy, oral systemic therapies, and biologics. Currently, there is a gap in the evidence in the evaluation of treatment patterns for psoriasis. With emerging options in managing psoriasis, it has become increasingly important to investigate current utilization patterns. METHODS: This observational, retrospective cohort study utilized the MarketScan® Commercial Claims and Medicare Supplemental Databases from January 1st, 2014 to December 31st, 2016. The target population was psoriasis patients over 18 years old who were new users of oral or biologic psoriasis medications. Descriptive statistics including proportions of patients on each treatment type were presented. Outcomes of interest were persistence, switching, and restarting. We investigated within-class persistence, between-class switching and between-class restarting. Additionally, we compared orals and biologics with respect to persistence and switching. Lines of therapy and temporal patterns of switching and restarting after loss of persistence were also characterized. Furthermore, a Cox regression model was used to compare persistence on orals and biologics as overall classes. RESULTS: A total of 5933 patients were identified. 2600 patients lost persistence on their index medication class. Patients whose index drug was a Vitamin A derivative or other biologic had highest proportions of loss of persistence. Treatment type (oral versus biologic) had no bearing on persistence (HR: 1.00, 95%CI: 0.93, 1.09). Of the 2600 patients who lost persistence, 546 switched classes at least once during the study period. The most common switch from an oral index therapy was to a TNF-α inhibitor. The most common switch from a biologic was to a PDE4 inhibitor. A second switch was fairly uncommon, with 93 of 546 patients undergoing a second switch. Of 2600 patients who lost persistence, 1853 patients restarted their index medication class. The most commonly restarted oral medication class was PDE4 inhibitors (27.5% of all restarts), followed by folic acid antagonists (19.9%). TNF-α inhibitors were more frequently restarted than other biologics (32.2% versus 18.1% of all restarts). CONCLUSION: Approximately half of all patients lost persistence, after which the majority restarted their index drug. More switches from orals to biologics were made than vice versa, with larger proportions of biologics constituting 2nd line treatment compared to 1st line treatment. More studies are needed to identify characteristics of patients that differentiate patterns of treatment utilization in US adult psoriasis patients

More than just tracking time: Complex measures of user engagement with an internet-based health promotion intervention

BACKGROUND: There has been a rise in internet-based health interventions without a concomitant focus on new methods to measure user engagement and its effect on outcomes. We describe current user tracking methods for internet-based health interventions and offer suggestions for improvement based on the design and pilot testing of healthMpowerment.org (HMP). METHODS: HMP is a multi-component online intervention for young Black men and transgender women who have sex with men (YBMSM/TW) to reduce risky sexual behaviors, promote healthy living and build social support. The intervention is non-directive, incorporates interactive features, and utilizes a point-based reward system. Fifteen YBMSM/TW (age 20 to 30) participated in a one-month pilot study to test the usability and efficacy of HMP. Engagement with the intervention was tracked using a customized data capture system and validated with Google Analytics. Usage was measured in time spent (total and across sections) and points earned. RESULTS: Average total time spent on HMP was five hours per person (range 0-13). Total time spent was correlated with total points earned and overall site satisfaction. CONCLUSION: Measuring engagement in internet-based interventions is crucial to determining efficacy. Multiple methods of tracking helped derive more comprehensive user profiles. Results highlighted the limitations of measures to capture user activity and the elusiveness of the concept of engagement