This document provides a summary of an upcoming meeting on asthma treatment adherence. The meeting will take place on September 26th in Amsterdam. It will be chaired by Eric van Ganse and focus on a bidirectional adherence study being conducted by an international research team. The study is analyzing the relationship between adherence to asthma treatment and asthma-related health outcomes using data from an electronic health records database. The agenda includes updates on the study design, measures of adherence and health outcomes, and initial analyses. Next steps for the study and opportunities to present preliminary findings are also discussed.
An overview of the work and initial results of the REG-EAACI Taskforce assessing the quality of literature in the field of real-world respiratory medicine.
An overview of the work and initial results of the REG-EAACI Taskforce assessing the quality of literature in the field of real-world respiratory medicine.
Child Health Working Group and Small Airways Study Group Joint MeetingZoe Mitchell
Slides from meeting of Respiratory Effectiveness Group Child Health Working Group and Small Airways Study Group joint meeting, held in London during ERS 2016 Congress
Child Health Working Group and Small Airways Study Group Joint MeetingZoe Mitchell
Slides from meeting of Respiratory Effectiveness Group Child Health Working Group and Small Airways Study Group joint meeting, held in London during ERS 2016 Congress
ATS Symposium: Leukotriene Antagonists As First-line Asthma Controller For St...Zoe Mitchell
ATS Symposium session presented by Prof. David Price:
Leukotriene Antagonists As First-line Asthma Controller For Step 2
Presented May 2015 at ATS 2015, Denver, Colorado, USA
Predictors of MDT review and the impact on lung cancer survival for HNELHD re...Cancer Institute NSW
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Dr. Mary Ann Lansang teaches us how to use the concepts of evidence-based medicine in our daily lives as infection prevention and control practitioners
Objectives:
•Learn about the current of SSI prevention in Canada
•Review the updated SSI-GSK
•Compare CPSI SSI-GSK to national and international literature
Outcome Measures in Cancer: Do disease specific instruments offer greater sen...Office of Health Economics
Paula's slides for her presentation on Outcomes Measures in Cancer given at the C2E2 Rounds Conference at the University of British Columbia on July 5th, 2017.
Using Implementation Science to transform patient care (Knowledge to Action C...NEQOS
Master Class presentation and workshop materials from the NENC AHSN Collaborating for Better Care Partnership's Master Class, led by Professor Jeremy Grimshaw' on 1st September 2014
POINT-of-IMPACT testing. A European perspective - Bert NiestersWAidid
At SoGat meeting 2019 Bert Niesters - Professor in Molecular Diagnostic in Clinical Virology, Medical Molecular Microbiologist at University Medical Center Groningen, Department of Medical Microbiology, Division of Clinical Viroloy, The Netherlands - has talked about the developing trends in molecular diagnostics and the impact on the Laboratory.
To learn more, please visit www.waidid.org!
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
1. DATE: SATURDAY SEPTEMBER 26TH
VENUE: Wyndham Apollo Hotel, Amsterdam
ROOM: Boardroom
TIME: 13.00–14.30PM
CHAIR/WORKING GROUP LEAD:
Eric van Ganse: PharmacoEpidemiology Lyon (PEL)
Respiratory Medicine, Croix Rousse University Hospital, Lyon, France
UMR CNRS 5558, Claude-Bernard University, Lyon, France
ADHERENCE WORKING
GROUP MEETING
3. Alexandra Dima, Faculty of Social and Behavioural Sciences,
University of Amsterdam, Amsterdam, The Netherlands
Bidirectional Adherence Study Update
4. The study
• Title: Exploring the bidirectional relationship between
database markers of asthma treatment adherence and
asthma-related outcomes
• Research team:
REG collaborators RiRL [data extraction]
Gene Colice (Lead Investigator)
David Price
Alexandra Dima
Hilary Pinnock
Iain Small
Cynthia Rand
Michelle Eakin
Janet Holbrook
Miguel Román Rodríguez
Eric van Ganse
Randy Brown
Alison Chisholm
Julie von Ziegenweidt
Utrecht University [Phase I]
Ellen Koster
Patrick Souverein
NIVEL [Phase II]
Marcia Vervloet
6. Inclusion / Exclusion criteria
• Inclusion Criteria:
• 3 years of continuous records (1 prior & 2 after IPD)
• Physician-diagnosed asthma ≥ 1 year prior to IPD
• Aged ≥6 years at IPD (i.e. ≥5 years at time of diagnosis)
• First ICS prescription at IPD via MDI or DPI
• On active asthma therapy (≥ 2 prescriptions for ICS and/or
SABA at different points during each outcome year)
• Exclusion Criteria:
• Any prescriptions for LABA, combination ICS/LABA
therapy, and/or LTRA during the baseline year
• Received maintenance oral steroids during
baseline year
7. Measures
• ICS adherence
• Asthma outcomes:
• Moderate-to-severe exacerbations
• Risk domain asthma control
• Overall asthma control
• Treatment stability
• Prescription-derived mean daily SABA dosage
• Prescription-derived controller to total asthma meds ratio
• Covariates:
• At IPD: age, gender, BMI, smoking status, device type, ICS
dosage, ICS drug, asthma duration, comorbidities, etc.
• Prior to baseline: any ICS prescription
16. Asthma control
• Moderate-to-severe exacerbations
o Asthma-related hospitalizations / ED attendance
– Asthma A&E or hospits
– COPD/respiratory-related/generic hospits +
Lower_respiratory_consultation (excl: lung function
test)
Lower Respiratory read codes (incl. asthma, COPD, LRTI)
Asthma/COPD review codes (excl: monitoring letter codes)
Lung function, asthma monitoring
o OCS prescriptions
! If within 1 week – 1 event
17. Asthma control
• Risk domain asthma control
o No moderate-to-severe exacerbations
o No AB + evidence of respiratory review (± 7days)
– Lower_respiratory_consultation
– Any additional respiratory examinations, referrals, chest
x-rays or events
o Asthma-related outpatient attendance
• Overall asthma control
o + SABA dose ≤200mcg salbutamol / ≤500mcg terbutaline
• Treatment stability
o + no add-on therapy / 50% dose increase
18. Asthma control
• Individual elements
Number of patients per 1 yr (N=13922)
Baseline yr FU yr 1 FU yr 2 All FU
Asthma hospit 46 (0.4%) 101 (0.7%) 85 (0.6%) 164 (1.2%)
COPD hospit 5 (<0.1%) 12 (<0.1%) 10 (<0.1%) 22(0.16%)
Resp hospit 39 (0.3%) 106 (0.8%) 91 (0.7%) 175(1.26%)
≥ 1 OCS Rx event 1207 (8.7%) 2392 (17.2%) 1969 (14.1%) 3473(25%)
≥ 1 rAB Rx event 1272 (9.1%) 1913 (13.7%) 1699 (12.2%) 2982(21.4%)
Any of the above 5229(37.6%)
Max per person per year – 10 OCS & 7 rAB events
Max per person per 2yrs – 19 OCS & 11 rAB events
19. Next steps for AC markers
• Read codes & computation procedure for each
marker – to clarify details?
• Are hospitalizations less recorded in OPCRD?
• To merge different types of events OR consider
outcomes individually (e.g. OCs)?
20. Next steps
• Phase I – finish report & paper (end October)
o + ICPE & ERS posters; ESPACOMP oral presentation
• Phase II – 6 months planned after end of Phase I
21. Alexandra Dima, Faculty of Social and Behavioural Sciences,
University of Amsterdam, Amsterdam, The Netherlands
ASTRO-LAB Model of Asthma
Adherence Determinants
24. Meeting Rational: develop a roadmap for
Respiratory Adherence Research*
Rationale:
• To promote consistency and
comparability of results across
studies and improve the efficiency
and value of adherence research
findings, there is a need to consider
the:
o Current priorities in adherence
research
o Methods used to measure
adherence
o Taxonomy employed in
conceptualizing adherence
behaviours and determinants.
*International Expert Panel Meeting organised by the Respiratory Effectiveness Group with the
support of Teva Pharmaceutical Industries Ltd
The Challenge:
• There is no single determinant of non-
adherence to respiratory therapies
• There is no ‘one-size-fits-all’ intervention to
improve adherence in the eyes of healthcare
professionals and payors.
• Interventions need to be tailored to the
individual needs of each patient.
25. Barcelona Meeting Panel Members
Chair:
David Price: REG Chairman, Academic Centre of Primary Care, University of Aberdeen, UK
Panel Members:
• Aji Barot: Patient Connect Service Limited,
Surrey, UK
• Richard Costello: Royal College of
Surgeons, Ireland and Beaumont Hospital,
Dublin, Ireland
• Alex Dima: Amsterdam School of
Communication Research ASCoR, University of
Amsterdam, Amsterdam, The Netherlands
• Michelle Eakin: Division of Pulmonary and
Critical Care Medicine, Department of Medicine,
Johns Hopkins School of Medicine, Baltimore,
Maryland
• Juliet Foster: Clinical Management Group,
Woolcock Institute of Medical Research,
University of Sydney, Sydney, Australia
• Jonathan Grigg: Asthma UK Centre for
Applied Research, Centre for Paediatrics,
Blizard Institute, Queen Mary, University of
London, London, UK
• Job van Boven: Department of Pharmacy,
Unit of Pharmaco-Epidemiology &
PharmacoEconomics University of Groningen,
Groningen, The Netherlands
• Thys van der Molen: Primary Care
Respiratory Medicine, University of Groningen,
Groningen, The Netherlands
• Dermot Ryan: Clinical Strategic Advisor at
Optimum Patient Care; EAACI Primary Care
Lead and Research Fellow at University of
Edinburgh, UK
• Bernard Vrijens: Department of Biostatistics
and Medical Informatics, University of Liège,
Liège, Belgium
26. Agenda: presentations
Session I: “Adherence – What Is It?”
Taxonomy – how do we currently describe adherence in chronic diseases Bernard Vrijens
Understanding adherence within the process of asthma care: the Astrolab model Alexandra Dima
Implications of delivery (mode of delivery) on adherence Thys van der Molen
Adherence challenges in children and the effect on outcomes Jonathan Grigg
Adherence challenges in older populations and the effect on outcomes Richard Costello
Inherent adherence challenges within health system Michelle Eakin
Implications of adherence on health economic outcomes Job van Boven
Session II: “Adherence – How Do We Measure It?”
Measurement of adherence within respiratory RCTs and observational studies Bernard Vrijens
Patient-reported adherence: how to optimize data quality Alexandra Dima
Technology-based approaches to adherence monitoring
Michelle Eakin &
Richard Costello
Session III: “Adherence – How Can We Improve It?”
Role of the clinician in optimizing adherence Dermot Ryan
Role of the pharmacist in optimizing adherence Aji Barot
Interventions with proven effect and potential for scaling up to real-life clinical settings Juliet Foster
System & Payer-driven solutions Michelle Eakin
27. Meeting Output
Adherence-themed Special Issue of JACI:
In Practice
• Editorial
• 5 papers
1. Terminology / Taxonomy
2. Determinants of Adherence – the
ASTRO-LAB Model
Focus on patient determinants
3. Delivery route & implementation
4. Age & cognition
Focus on HCP- and Payer
determinants
5. The role of the health system, cost-
effectiveness & scalability & health
care professionals
Publication dates:
• Online early Q1 2016
• Special Issue September
2016
28. Special Issue Overview (I)
Paper Working Title Co-authors
Status & approx.
submission date
Editorial
Introduction to main themes of the
special issue
David Price & ?
• Alison Chisholm to draft
• Additional authors TBC
• Draft to be informed by
content of Papers 1-5
Paper 1
What we mean when we talk about
adherence in respiratory medicine
Bernard Vrijens; David Price; Alex
Dima; Michell Eakin; Juliet Foster;
Job van Boven; Marjin de Bruin;
Eric van Ganse
• Alison Chisholm to draft;
• Vrijens et al
• Full author order TBA.
• Submission mid November
Paper 2
Moving towards a complete map of
medication adherence determinants
within asthma – the ASTRO-LAB Model
Alex Dima; Marjin de Bruin; Eric
van Ganse + ASTRO-LAB
colleagues
• Alexandra Dima to draft
• Draft underway.
• ASTRO-LAB to agree
author order
• Submission mid November
Paper 3
Patient-level adherence determinants –
Wanting, but unable – the role of inhaler
technique and mode of delivery
David Price; Thys van der Molen;
Victoria Carter & iHARP
Collaborators
• Alison Chisholm to draft
• Victoria Carter liaising with
iHARP collaborators
• Full iHARP author list TBC.
• Submission mid November
Paper 4
Patient-level adherence determinants –
7 stages of man – the role of age and
cognition on medication adherence
Richard Costello; Michell Eakin;
Jonathan Grigg; Juliet Foster;
Dermot Ryan
• Richard Costello to draft
• Costello et al?
• Full author order TBA.
• Submission mid November
Paper 5
Freedom within a framework – the role
of the healthcare system on medication
adherence
Job van Boven; Juliet Foster;
Michell Eakin; Aji Barot; Dermot
Ryan
• Job van Boven to draft
• van Boven et al?
• Full author order TBA.
• Submission mid November
29. Special Issue Overview (I)
Paper Working Title Co-authors
Status & approx.
submission date
Editorial
Introduction to main themes of the
special issue
David Price & ?
• Alison Chisholm to draft
• Additional authors TBC
• Draft to be informed by
content of Papers 1-5
Paper 1
What we mean when we talk about
adherence in respiratory medicine
Bernard Vrijens; David Price; Alex
Dima; Michell Eakin; Juliet Foster;
Job van Boven; Marjin de Bruin;
Eric van Ganse
• Alison Chisholm to draft;
• Vrijens et al
• Full author order TBA.
• Submission mid November
Paper 2
Moving towards a complete map of
medication adherence determinants
within asthma – the ASTRO-LAB Model
Alex Dima; Marjin de Bruin; Eric
van Ganse + ASTRO-LAB
colleagues
• Alexandra Dima to draft
• Draft underway.
• ASTRO-LAB to agree
author order
• Submission mid November
Paper 3
Patient-level adherence determinants –
Wanting, but unable – the role of inhaler
technique and mode of delivery
David Price; Thys van der Molen;
Victoria Carter & iHARP
Collaborators
• Alison Chisholm to draft
• Victoria Carter liaising with
iHARP collaborators
• Full iHARP author list TBC.
• Submission mid November
Paper 4
Patient-level adherence determinants –
7 stages of man – the role of age and
cognition on medication adherence
Richard Costello; Michell Eakin;
Jonathan Grigg; Juliet Foster;
Dermot Ryan
• Richard Costello to draft
• Costello et al?
• Full author order TBA.
• Submission mid November
Paper 5
Freedom within a framework – the role
of the healthcare system on medication
adherence
Job van Boven; Juliet Foster;
Michell Eakin; Aji Barot; Dermot
Ryan
• Job van Boven to draft
• van Boven et al?
• Full author order TBA.
• Submission mid November
Selected by the Journal Editors as CME papers within the Issue.
Requirements:
• Authors write a short (5 question) multiple-choice exam to accompany
their article
• Complete a AAAAI Information Document for each CME activity
30. Manon Belhassen & Eric Van Ganse, PharmacoEpidemiology Lyon (PEL)
Respiratory Medicine, Croix Rousse University Hospital, Lyon, France
UMR CNRS 5558, Claude-Bernard University, Lyon, France
“Lyon Adherence Projects”
31. ADHERENCE IN ASTHMA :
OVER 20 YEARS, FROM FIELD
STUDIES TO COMPUTERIZED
DATA
35. A. Measurement of adherence proxies to anti-
asthma inhaled steroids in French Claims Data
o Primary objective : The main objective was to provide, in
patients treated by given ICs packagings, reference values for
the proportion of days covered during a 12-month period for the
corresponding ICs packagings
o Secondary objective: The secondary objective was to provide
in newly-treated patients reference values for 12-month
persistence to ICs molecules
o Study design:
– An initial historical cohort of ICS-treated asthma patients
– Specific cohorts were then specifically identified from this initial
cohort for each studied dimensions of adherence (CMA,
persistence)
o Data source: EGB (French claims data)
36. A. Measurement of adherence proxies to anti-
asthma inhaled steroids in French Claims Data
o Inclusion criteria: “new treatment episodes”
o ≥ 3 canisters of the same molecule of ICs consecutively
dispensed between 2007 and 2013 according to the following
rules:
– Dispensed at 2 or 3 different dates
– The time-interval between the first and the third dispensed
canisters will not exceed 120 days (for this computation a
canister was assumed to last 60 days)
– Age 6-40 years at the date of the first dispensed ICs canister
(older patients were excluded)
37. A. Measurement of adherence proxies to anti-
asthma inhaled steroids in French Claims Data
o CMA
Children
Teenagers
Children&
Teenagers
Women
Men
Adults
Total
N 1,606 538 2,144 1,667 1,285 2,952 5,096
Mean CMA in
% (σ)
58.3
(28.5)
56.1 (28.7) 57.7 (28.6) 51.4 (28.4)
52.7
(28.5)
52.0
(28.4)
54.4
(28.6)
24% of patients had a CMA ≥ 80%
Mean CMA=54.4%
38. A. Measurement of adherence proxies to anti-
asthma inhaled steroids in French Claims Data
o 12 months non-persistence
Drug classes Children
Teenager
s
Children
&
Teenagers
Women Men Adults TOTAL
Any ICs molecule
314/404
(77.7%)
95/115
(82.6%)
409/519
(78.8%)
379/462
(82.0%)
237/302
(78.5%)
616/764
(80.6%)
1,025/1283
(79.9%)
39. B. TYPOLOGIES OF TREATMENT
BEFORE HOSPITALIZATION
• Subjects:
o >=3 dispensations of asthma-related medications
during any 12-month window from 2006 to 2013
o Aged between 6 years and 45 years
o Within this cohort, we selected patients who
experienced asthma-related hospitalization defined as
a hospital discharge with asthma (J45 and J46 ICD-
10 codes)
40. B. TYPOLOGIES OF TREATMENT
BEFORE HOSPITALIZATION
• Typologies:
o Based on recorded drug dispensations, subjects were
categorized on exposure to ICS alone, LABA alone or FDC of
LABA+ICS, in the 12 months before asthma-related
hospitalization
o Cluster and discriminant analyses. Ward’s minimum-variance
hierarchical clustering method was performed using an
agglomerative (bottomup) approach and Ward’s linkage
o At each generation of clusters, samples were merged into larger
clusters to minimize the within-cluster sum of squares or to
maximize the between-cluster sum of squares.
42. B. TYPOLOGIES OF TREATMENT
BEFORE HOSPITALIZATION
• 20,633 asthma patients : 301(0,45%) with
hospitalization for asthma
• 3 typologies:
o Cluster 1 : 176 patients (58,5%):
– Few treatments!
o Cluster 2 : 108 patients (35,9%) :
– Regular FDC therapy
o Cluster 3: 17 patients (5,7%) :
– Free Combinations IC + LABA (unbalanced)
43. CONCLUSIONS
• Hospitalization is “the” outcome of interest, if
power allows it
• Interest to “view” (Dutch method, ie graphs)
patterns of use of therapy
• Clustering?
• Determinants?... Answer = PROs + linkage with
computerized datasets
• Interventions? … close/quick/effective
interaction with asthma patients is needed…
45. Adherence-related questions in
respiratory research
• Dose management – real-time data transfer (IT),
and effective self-care (patient empowerment)
• Health care professionals – their role in adherence
in respiratory care (and alternatives?)
• Continuity of regular ICS use – changing beliefs of
patients and practitioners (paradigm shift)
• Technology in adherence – how can we optimize
data use for research and clinical purposes