Introducing an Invention: Puzzle Shaped Cast for Upper Limb Fractures

Upper limb fractures are prevalent injuries. An essential element of fracture healing is to maintain the bones alignment. However there are lots of complications associated with traditional ways of treatment, such as compartment syndrome and stiffness due to immobility for long time. Also evaluation and observation of the limb under the casts for potential infections and skin issues are not possible. By this article an invention of puzzle shaped cast for upper limb is introduced. This novel cast is made up of different parts that they complete each other and join as pieces of a puzzle to shape a cast. By this mean physical examination during the healing process is possible and the complications could be less.</span

Clinical characteristics and outcomes of patients with heart failure with reduced ejection fraction and chronic obstructive pulmonary disease: insights from PARADIGM-HF

Background: Chronic obstructive pulmonary disease (COPD) is a common comorbidity in heart failure with reduced ejection fraction, associated with undertreatment and worse outcomes. New treatments for heart failure with reduced ejection fraction may be particularly important in patients with concomitant COPD. Methods and Results: We examined outcomes in 8399 patients with heart failure with reduced ejection fraction, according to COPD status, in the PARADIGM‐HF (Prospective Comparison of Angiotensin Receptor Blocker–Neprilysin Inhibitor With Angiotensin‐Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial. Cox regression models were used to compare COPD versus non‐COPD subgroups and the effects of sacubitril/valsartan versus enalapril. Patients with COPD (n=1080, 12.9%) were older than patients without COPD (mean 67 versus 63 years; P&lt;0.001), with similar left ventricular ejection fraction (29.9% versus 29.4%), but higher NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide; median, 1741 pg/mL versus 1591 pg/mL; P=0.01), worse functional class (New York Heart Association III/IV 37% versus 23%; P&lt;0.001) and Kansas City Cardiomyopathy Questionnaire–Clinical Summary Score (73 versus 81; P&lt;0.001), and more congestion and comorbidity. Medical therapy was similar in patients with and without COPD except for beta‐blockade (87% versus 94%; P&lt;0.001) and diuretics (85% versus 80%; P&lt;0.001). After multivariable adjustment, COPD was associated with higher risks of heart failure hospitalization (hazard ratio [HR], 1.32; 95% CI, 1.13–1.54), and the composite of cardiovascular death or heart failure hospitalization (HR, 1.18; 95% CI, 1.05–1.34), but not cardiovascular death (HR, 1.10; 95% CI, 0.94–1.30), or all‐cause mortality (HR, 1.14; 95% CI, 0.99–1.31). COPD was also associated with higher risk of all cardiovascular hospitalization (HR, 1.17; 95% CI, 1.05–1.31) and noncardiovascular hospitalization (HR, 1.45; 95% CI, 1.29–1.64). The benefit of sacubitril/valsartan over enalapril was consistent in patients with and without COPD for all end points. Conclusions: In PARADIGM‐HF, COPD was associated with lower use of beta‐blockers and worse health status and was an independent predictor of cardiovascular and noncardiovascular hospitalization. Sacubitril/valsartan was beneficial in this high‐risk subgroup. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01035255

The impact of comorbidities on productivity loss in asthma

Rationale Health-related productivity loss and the impact of comorbidities on the economic burden of asthma are important, yet overlooked, components. I aimed at revising recent estimates of the costs of asthma worldwide. The empirical research involved evaluating the effect of comorbidities on productivity loss among adult asthma patients. Methods A literature review was conducted on studies regarding the costs of asthma (January 2008 to January 2015) and subsequently on the effects of comorbidities on productivity. In parallel data from a prospectively evaluated random sample of employed adults with asthma was used and the prevalence of comorbidities measured using a validated self-administered comorbidity questionnaire (SCQ), range 0 – 39, (the higher the score, the higher the level of comorbidity). Productivity loss, including absenteeism and presenteeism, were also measured using validated instruments in 2010 Canadian dollars ($). I used a two-part regression model to estimate the adjusted difference of productivity loss across levels of comorbidity, controlling for potential confounding variables. Results The review demonstrated that asthma imposes a major economic burden, however there are large discrepancies in the reported estimates. There is also uncertainty about the indirect costs of asthma and the effects of comorbidities on these costs. A random sample of 284 adults with the mean age of 47.8 (SD 11.8) was included (68$317.5 per week (SD $858.8). Comorbidity was significantly associated with productivity loss. One-unit increase in the SCQ score was associated with a 14$1,685 per week more productivity loss than a patient with a SCQ of zero. Conclusion This study demonstrates that comorbidities substantially decrease productivity in working asthma patients. Asthma management strategies must be cognizant of the role of comorbidities and should properly incorporate the effect of comorbidity and productivity loss in estimating the benefit of disease management strategies.Medicine, Faculty ofGraduat

Extent, trends, and determinants of controller/reliever balance in mild asthma: a 14-year population-based study

Background: The majority of patients with asthma have the mild form of the disease. Whether mild asthma patients receive appropriate asthma medications has not received much attention in the literature. We examined the trends in indicators of controller/reliever balance. Methods: Using administrative health databases of British Columbia, Canada (2000 to 2013), we created a population-based cohort of adolescents/adults with mild asthma using validated case definition algorithms. Each patient-year of follow-up was assessed based on two markers of inappropriate medication prescription: whether the ratio of controller medications (inhaled corticosteroids [ICS] and leukotriene receptor antagonists [LTRA]) to total asthma-related prescriptions was low (cut-off 0.5 according to previous validation studies), and whether short-acting beta agonists (SABA) were prescribed inappropriately according to previously published criteria that considers SABA in relation to ICS prescriptions. Generalized linear models were used to evaluate trends and to examine the association between patient-, disease-, and healthcare-related factors and medication use. Results: The final cohort consisted of 195,941 mild asthma patients (59.5% female; mean age at entry 29.6 years) contributing 1.83 million patient-years. In 48.8% of patient-years, controller medications were suboptimally prescribed, while in 7.2%, SABAs were inappropriately prescribed. There was a modest year-over-year decline in inappropriate SABA prescription (relative change − 1.3%/year, P < 0.001) and controller-to-total-medications (relative change − 0.5%/year, P < 0.001). Among the studied factors, the indices of type and quality of healthcare (namely respirologist consultation and receiving pulmonary function test) had the strongest associations with improvement in controller/reliever balance. Conclusions: Large number of mild asthma patients continue to be exposed to suboptimal combinations of asthma medications, and it appears there are modifiable factors associated with such phenomenon.Medicine, Faculty ofPharmaceutical Sciences, Faculty ofOther UBCMedicine, Department ofRespiratory Medicine, Division ofReviewedFacult

Trends in oral corticosteroids use in severe asthma: a 14-year population-based study

Background: Oral corticosteroids are important components of pharmacotherapy in severe asthma. Our objective was to describe the extent, trends, and factors associated with exposure to oral corticosteroids (OCS) in a severe asthma cohort. Methods: We used administrative health databases of British Columbia, Canada (2000–2014) and validated algorithms to retrospectively create a cohort of severe asthma patients. Exposure to OCS within each year of follow-up was measured in two ways: maintenance use as receiving on average ≥ 2.5 mg/day (prednisone-equivalent) OCS, and episodic use as the number of distinct episodes of OCS exposure for up to 14 days. Trends and factors associated with exposure on three time axes (calendar year, age, and time since diagnosis) were evaluated using Poisson regression. Results: 21,144 patients (55.4% female; mean entry age 28.7) contributed 40,803 follow-up years, in 8.2% of which OCS was used as maintenance therapy. Maintenance OCS use declined by 3.8%/calendar year (p < 0.001). The average number of episodes of OCS use was 0.89/year, which increased by 1.1%/calendar year (p < 0.001). Trends remained significant for both exposure types in adjusted analyses. Both maintenance and episodic use increased by age and time since diagnosis. Conclusions: This population-based study documented a secular downward trend in maintenance OCS use in a period before widespread use of biologics. This might have been responsible for a higher rate of exacerbations that required episodic OCS therapy. Such trends in OCS use might be due to changes in the epidemiology of severe asthma, or changes in patient and provider preferences over time.Medicine, Faculty ofPharmaceutical Sciences, Faculty ofOther UBCMedicine, Department ofRespiratory Medicine, Division ofReviewedFacult

The impact of comorbidities on productivity loss in asthma patients

Background: Health-related productivity loss is an important, yet overlooked, component of the economic burden of disease in asthma patients of a working age. We aimed at evaluating the effect of comorbidities on productivity loss among adult asthma patients. Methods: In a random sample of employed adults with asthma, we measured comorbidities using a validated self-administered comorbidity questionnaire (SCQ), as well as productivity loss, including absenteeism and presenteeism, using validated instruments. Productivity loss was measured in 2010 Canadian dollars ($). We used a two-part regression model to estimate the adjusted difference of productivity loss across levels of comorbidity, controlling for potential confounding variables. Results: 284 adults with the mean age of 47.8 (SD 11.8) were included (68$317.5 per week (SD $858.8). One-unit increase in the SCQ score was associated with 14$1000 per week more productivity loss than a patient with a SCQ of zero. Conclusions: Our study deepens the evidence-base on the burden of asthma, by demonstrating that comorbidities substantially decrease productivity in working asthma patients. Asthma management strategies must be cognizant of the role of comorbidities to properly incorporate the effect of comorbidity and productivity loss in estimating the benefit of disease management strategies.Medicine, Faculty ofOther UBCNon UBCExperimental Medicine, Division ofMedicine, Department ofRespiratory Medicine, Division ofReviewedFacult