Bonnie B. Dean

Effectiveness of Proton Pump Inhibitors in Nonerosive Reflux Disease

BACKGROUND & AIMS Little information is available about the efficacy of proton pump inhibitors (PPIs) in patients with nonerosive reflux disease (NERD). We aimed to synthesize available data and determine the effectiveness of PPIs on symptom resolution in patients with NERD. METHODS A systematic review of the literature identified studies reporting the effects of PPIs in patients with NERD. Heartburn resolution data were pooled across studies. The effectiveness of PPI therapy in inducing complete heartburn resolution was compared in patients with NERD vs. erosive esophagitis (EE). RESULTS Seven trials evaluating heartburn resolution in NERD were identified. Higher proportions of patients reported achieving sufficient heartburn resolution compared with complete heartburn resolution. The effect of PPIs on sufficient heartburn resolution was observed sooner than was complete heartburn resolution. Therapeutic gain of PPI therapy over placebo ranged from 30% to 35% for sufficient heartburn control and from 25% to 30% for complete heartburn control. Pooled response rates at 4 weeks were significantly higher for patients with EE compared with NERD (56% vs. 37%, P < 0.0001). CONCLUSIONS PPIs provide a more modest therapeutic gain in patients with NERD as compared with those with EE. A trend in increased therapeutic gain for NERD patients was shown throughout the 4 weeks, suggesting that 4 weeks of follow-up evaluation may be insufficient to show full therapeutic gain in this patient population.

The burden of illness of gastro-oesophageal reflux disease: impact on work productivity.

Background:  The impact of gastro‐oesophageal reflux disease on work productivity has become increasingly important, as the symptoms of gastro‐oesophageal reflux disease affect individuals in their productive years of life.

Review: use of electronic medical records for health outcomes research: a literature review.

This review assessed the use of electronic medical record (EMR) systems in outcomes research. We systematically searched PubMed to identify articles published from January 2000 to January 2007 involving EMR use for outpatient-based outcomes research in the United States. EMR-based outcomes research studies (n = 126) have increased sixfold since 2000. Although chronic conditions were most common, EMRs were also used to study less common diseases, highlighting the EMRs’ flexibility to examine large cohorts as well as identify patients with rare diseases. Traditional multi-variate modeling techniques were the most commonly used technique to address confounding and potential selection bias. Data validation was a component in a quarter of studies, and many evaluated the EMR’s ability to achieve similar results previously achieved using other data sources. Investigators using EMR data should aim for consistent terminology, focus on adequately describing their methods, and consider appropriate statistical methods to control for confounding and treatment-selection bias.

Estimating Direct and Indirect Costs of Premenstrual Syndrome.

Objective:To quantify the economic impact of premenstrual syndrome (PMS) on the employer. Methods:Data were collected from 374 women aged 18–45 with regular menses. Direct costs were quantified using administrative claims of these patients and the Medicare Fee Schedule. Indirect costs were quantified by both self-reported days of work missed and lost productivity at work. Regression analyses were used to develop a model to project PMS-related direct and indirect costs. Results:A total of 29.6% (n = 111) of the participants were diagnosed with PMS. A PMS diagnosis was associated with an average annual increase of

A prospective assessment investigating the relationship between work productivity and impairment with premenstrual syndrome.

59 in direct costs (P < 0.026) and

Erythropoiesis-stimulating protein therapy and the decline of renal function: a retrospective analysis of patients with chronic kidney disease

4333 in indirect costs per patient (P < 0.0001) compared with patients without PMS. Conclusions:A PMS diagnosis correlated with a modest increase in direct medical costs and a large increase in indirect costs.

USING THE DAILY RECORD OF SEVERITY OF PROBLEMS AS A SCREENING INSTRUMENT FOR PREMENSTRUAL SYNDROME

Learning ObjectivesDescribe, in this prospective study of women keeping a symptom diary during two consecutive menstrual cycles, the effects of premenstrual syndrome (PMS) on absence from work and productivity when working.Relate the effects of PMS on self-reported impairment of routine work, school, and household activities.Recall the effects of PMS, if any, on social activities, hobbies, and interpersonal relationships. Abstract Our objective was to assess life domain and work-related impairment in patients experiencing premenstrual syndrome (PMS). A sample of women, 18 to 45 years of age, completed the Daily Rating of Severity of Problems Form to record daily symptoms for two consecutive menstrual cycles. In the workplace, women with PMS reported higher absenteeism rates (2.5 days vs. 1.3 days; P = 0.006) and more workdays with 50% or less of typical productivity per month (7.2 days vs. 4.2 days; P < 0.0001). Women with PMS in one of two menstrual cycles reported a greater number of days with impairment in routine work, school, and household activities in comparison with women without PMS. Results indicate that PMS leads to substantial im in normal daily activities and occupational productivity and significantly increased work absenteeism.

Impaired Health Status, Daily Functioning, and Work Productivity in Adults With Excessive Sleepiness

ABSTRACT Background/Aims: Previous studies have hinted at possible associations between anemia and progression of renal disease. The study objective was to determine whether treatment with erythropoiesis-stimulating proteins (ESPs) can curb the rate of decline in renal function in pre-dialysis patients with chronic kidney disease (CKD). Methods: Observational, before/after analysis using electronic medical records from the Veterans Administration (VA). Included patients had at least two measurements of serum creatinine levels before and after ESP treatment initiation. The Cockcroft–Gault formula was used to derive estimates of glomerular filtration rate (GFR). Rate of renal function decline prior to and following initiation of therapy were compared. Results: One hundred and twenty two patients with renal impairment levels of Stage 3 (moderate) or Stage 4 (severe) at ESP treatment initiation were identified. Over 80% of patients initiated therapy with either Grade 1 or Grade 2 anemia. The rate of renal function decline was calculated as the slope of the least-squares linear regression line of the inverse serum creatinine over time during the pre-treatment initiation and post-treatment initiation time periods. Overall, patients experienced a slowing in the rate of renal function decline after treatment was initiated (mean pre-treatment initiation rate of –0.094 dL/mg/yr versus mean post-treatment initiation rate of –0.057 dL/mg/yr). Conclusion: Renal function declined at a slower rate following ESP initiation. Results are consistent with prior studies indicating delayed dialysis initiation in patients treated with ESPs. Analyses were limited by the observational study design and lack of information regarding some potential confounders. Longer-term, prospective trials are needed to determine whether ESPs slow progression of renal disease and the potential magnitude of such an effect.

Night‐time and daytime atypical manifestations of gastro‐oesophageal reflux disease: frequency, severity and impact on health‐related quality of life

OBJECTIVE: To assess symptom ratings on the first day of menses to identify women at high risk of clinically significant premenstrual syndrome (PMS) who should undergo further evaluation. METHODS: A cohort of 697 women kept daily symptom ratings using the Daily Record of Severity of Problems (DRSP). The DRSP includes 21 symptom items grouped within 11 domains. DRSP scores on the first day of menses were calculated using the sum of all 21 items (standard method), the sum of the highest rated items within each domain (alternative method), and the sum of seven items derived from modeling. Seventy percent of the study sample was randomly assigned into a model-building set to identify optimal cutoff scores for PMS screening. The remaining 30% comprised a testing set used to compare PMS screening results to a PMS diagnosis based on two cycles of daily DRSP ratings. RESULTS: Of the initial study sample, 388 participants (55.7%) completed two cycles of daily ratings. The prevalence of PMS was 30.4%. In the model-building set, the positive and negative predictive values of the 21-item DRSP scores were 53.8% and 83.4% using the standard method and 52.7% and 84.0% using the alternative method. Corresponding values were 55.0% and 84.9% for an abbreviated seven-item DRSP version. These results were confirmed in the testing set. CONCLUSION: The DRSP administered on the first day of menses is an acceptable screening instrument to identify women who may have PMS. LEVEL OF EVIDENCE: II

Uncontrolled asthma among children: impairment in social functioning and sleep.

Objective: This study evaluated the effects of excessive sleepiness (ES) on health status, daily functioning, and work productivity. Methods: From a survey performed in June to July 2006, people with or without ES in two groups (1758 with obstructive sleep apnea, depression, narcolepsy, multiple sclerosis, or shift work; 1977 without these conditions) were assessed on the Work Productivity and the Activity Impairment Scale, Short Form-12, Medical Outcomes study 6-item Cognitive Function Scale, and the Toronto Hospital Alertness Test. Results: ES in both groups was associated with highly significant impairments in health status, daily activities, and work productivity for all measures (P < 0.0001), except for absenteeism (P = 0.0400 for group A, P = 0.8360 for group B). Conclusions: ES may have an incremental negative impact measurable above that of obstructive sleep apnea, multiple sclerosis, narcolepsy, depression, or shift work.