Daniel Aguilar

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.

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

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.

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

Objective. To evaluate asthma symptom frequency, severity, and control among children with asthma and to evaluate the impact on social functioning and sleep impairment. Patients and Methods. Using a cross-sectional design, adult caregivers of children aged 6–12 years with moderate to severe asthma (severity based on National Asthma Education and Prevention Program guidelines) were surveyed about the childs symptoms, treatment, activity limitation, and sleep impairment. Asthma was categorized as uncontrolled if the caregiver reported any of the following of the child: experienced >2 days/week with symptoms, were awakened at night by symptoms during the preceding 4 weeks, had activity limited by a health problem, or used short-acting beta-agonist for rescue >5 times/week. Asthma not meeting any of these criteria was categorized as controlled. Social functioning and sleep impairment were assessed using questions adapted from the SleepLearnPlay instrument. Children with uncontrolled and controlled asthma were compared using t tests for continuous variables and Fishers exact test for categorical variables. Multiple comparison adjustment using the Bonferroni procedure was made for social functioning and sleep impairment measures. Results. A total of 473 caregivers completed the survey; 360 were caregivers of children with uncontrolled asthma and 113 of children with controlled asthma. Compared with controlled asthma, a greater proportion of children with uncontrolled asthma showed avoidance across all nine social activities assessed. Children with uncontrolled asthma were significantly more likely to wake up at night with symptoms (p <.0001) and use a rescue inhaler at night (p <.0001), experience difficulty waking up in the morning (p = .0001) and getting out of bed (p = .0039), and be overly tired all day (p <.0001). Conclusions. Uncontrolled asthma impacted functioning and sleep of children to a significantly greater degree than well-controlled asthma. Proper treatment and disease management to improve symptom control can reduce this impact on the lives of children.

Impairments in worker productivity and health-related quality of life among employees with irritable bowel syndrome: does bowel habit predominance make a difference?

Impairments in worker productivity and health-related quality of life among employees with irritable bowel syndrome: does bowel habit predominance make a difference?

Disease-specific cost savings of treating nighttime versus daytime gastroesophageal reflux disease in an employed population

Summary Objective: The extent to which proton pump inhibitors (PPIs) can offset direct medical costs by reducing symptoms related to gastroesophageal reflux disease (GERD) in order to improve work productivity is not well understood. This study aimed to evaluate the economic impact of treating GERD with PPIs versus no treatment, from an employers perspective. Study design: An economic model was developed to simulate symptom reduction and breakthrough symptoms as well as associated costs over 1 year among a population of 100,000 with a 20% GERD prevalence rate. Medical costs, including GERD-related office visits, hospitalisations and procedures, were delineated by symptom severity. Indirect costs represented the monetised work productivity loss. PPI treatment costs

PGI1 HETEROGENEITY ACROSS RANDOMIZED CONTROLLED TRIALS OF PROTON-PUMP INHIBITORS IN NIGHTTIME GERD: A SYSTEMATIC REVIEW

2/day (standard dose). Results: The GERD burden was substantial (

PRS31 IMPACT OF UNCONTROLLED PEDIATRIC ASTHMA ON CHILD AND CAREGIVER PRODUCTIVITY

62,500,000). Treatment yielded

Identifying IBS patients using Rome II symptom criteria: 3- or 12-month reporting?

32,600,000 in savings (

IMPAIRMENT IN WORK PRODUCTIVITY AND HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH IBS

1,630 saved/patient/year), mostly from reducing indirect costs. Treatment produced greater savings among nighttime GERD patients throughout the PPI cost range (

Uncontrolled asthma: assessing quality of life and productivity of children and their caregivers using a cross-sectional Internet-based survey

1–