Thomas A. Burke

The Work Limitations Questionnaire's validity and reliability among patients with osteoarthritis

The 25-item Work Limitations Questionnaire (WLQ) was recently developed to measure health-related decrements in ability to perform job roles among employed individuals. Research has demonstrated its validity and reliability in several populations. We assessed the WLQs performance when administered to patients with osteoarthritis (OA), which is a leading cause of work disability and productivity loss. We recruited a representative sample of 230 employed, confirmed OA patients and a comparison group of 37 healthy employed controls. Subjects completed a mail survey. In tests of the WLQs scale internal reliability, the questionnaire met all established criteria. Additionally, in construct validity tests, the WLQ correctly detected OA vs. control group differences, and correlated significantly with arthritis pain, stiffness, and functional limitation, and self-reported work productivity. The WLQ is an accurate and reliable source of information for assessing the work impact of OA.

Discontinuation of antihypertensive drugs among newly diagnosed hypertensive patients in UK general practice.

Objectives To evaluate antihypertensive drug discontinuation among newly diagnosed hypertensive patients. Methods This was a population-based cohort study using the UK General Practice Research Database (GPRD). Patients newly diagnosed with hypertension between 1991 and 2001 and subsequently treated with antihypertensive drugs were included. Overall antihypertensive drug discontinuation was evaluated from a patients first-ever antihypertensive prescription. Class-specific discontinuations were evaluated from a patients first-ever prescriptions of angiotensin-converting enzyme (ACE) inhibitors (ACE-I), alpha antagonists, angiotensin-2 antagonists (AIIA), β blockers, calcium-channel blockers (CCB), miscellaneous, potassium-sparing diuretics, and thiazides. Discontinuation occurred when no antihypertensive prescription was issued within 90 days following the most recent prescription expiration. Results The study population comprised 109 454 patients, with 223 228 antihypertensive drug-class episodes contributing to the class-specific analysis. Overall antihypertensive drug discontinuation was 20.3% [95% confidence interval (CI): 20.0, 20.5%] at 6 months and 28.5% (95% CI: 28.2, 28.7%) at 1 year, with a median time to discontinuation of 3.07 years. The median time to antihypertensive class discontinuation was longest for AIIAs (2.90 years) followed by ACE-I (2.24), CCB (1.86), β blockers (1.50), thiazides (1.50), alpha antagonists (1.35), potassium-sparing diuretics (0.40), and miscellaneous (0.39). One-year discontinuation ranged from 29.4% (95% CI: 28.0, 30.7) for AIIAs to 64.1% (95% CI: 62.1, 66.3) for potassium-sparing diuretics. Forty-four percent who discontinue their first-ever antihypertensive drug class failed to switch to a different drug class within 90 days of discontinuation. Conclusion It is important that general practitioners (GPs) monitor patients closely in the first year following antihypertensive drug initiation, due to the high early risk of discontinuation, and the low percentage of patients who switch to a different antihypertensive drug class after a drug-class discontinuation. AIIA, followed by ACE-I and CCB, had the lowest risk of discontinuation among antihypertensive drug classes.

Adherence to proton pump inhibitors or H2-receptor antagonists during the use of non-steroidal anti-inflammatory drugs

Background : The efficacy of proton pump inhibitors (PPIs) or histamine‐2 receptor antagonists (H2RAs) prescribed as prophylaxis for NSAID‐related upper gastrointestinal (UGI) toxicity is dependent upon patient adherence.

Antiemetic Guideline Consistency and Incidence of Chemotherapy-Induced Nausea and Vomiting in US Community Oncology Practice: INSPIRE Study

PURPOSE Consensus guidelines for preventing chemotherapy-induced nausea and vomiting (CINV) are variably implemented in practice. The purpose of this study was to evaluate the impact of guideline-consistent/guideline-inconsistent CINV prophylaxis (GCCP/GICP) on the incidence of no CINV after cycle 1 of highly or moderately emetogenic chemotherapy (HEC or MEC). PATIENTS AND METHODS This prospective observational study enrolled chemotherapy-naive adult outpatients who received single-day HEC or MEC at four oncology practice networks, all using electronic health record (EHR) systems, in Georgia, Tennessee, and Florida. Results from the Multinational Association of Supportive Care in Cancer Antiemesis Tool, a validated tool to measure CINV, administered 5 to 8 days postchemotherapy, were merged with EHR data. The primary end point, no CINV, defined as no emesis and no clinically significant nausea (score < 3 on 0-10 scale), was compared between cohorts using logistic regression. RESULTS A total of 1,295 patients were enrolled (mean age, 59.3 years; 70.0% female; 35.5% HEC). The overall prevalence of GCCP was 57.3%. When corticosteroids were prescribed on days 2 to 4 after all HEC, GCCP for HEC increased from 28.7% to 89.8%; when NK1-receptor antagonists were prescribed after all MEC, GCCP for MEC increased from 73.1% to 97.8%. Over 5 days postchemotherapy, the incidence of no CINV was significantly higher in the GCCP cohort than the GICP cohort (53.4% v 43.8%; P < .001). The adjusted odds of no CINV with GCCP was 1.31 (95% CI, 1.07 to 1.69; P = .037). CONCLUSION Increased adherence to antiemetic guidelines could significantly reduce the incidence of CINV after HEC and MEC.

An Economic Model for Determining the Costs and Consequences of Using Various Treatment Alternatives for the Management of Arthritis in Canada

AbstractObjective:To construct a decision analytical model to compare the costs and clinical consequences of treating patients with celecoxib or various nonsteroidal anti-inflammatory drug (NSAID)/gastrointestinal (GI) co-therapy regimens for the management of osteoarthritis and rheumatoid arthritis. The model quantified the number of patients expected to experience any GI complication commonly associated with NSAID therapy. Design: Resource use for the treatment of each GI complication in the model was estimated after consulting Canadian experts. Standard unit costs from Ontario were applied to resources to calculate the cost of each complication. Main outcome measures and results: The model revealed that the NSAID-alone regimen was associated with the lowest cost [

A Framework for Evaluating the Clinical Consequences of Initial Therapy with NSAIDs, NSAIDs plus Gastroprotective Agents, or Celecoxib in the Treatment of Arthritis

262 Canadian dollars (

Dyspepsia tolerability from the patients' perspective: a comparison of celecoxib with diclofenac

Can) per patient per 6 months] followed by the celecoxib regimen (

Reliability, validity, and responsiveness of severity of dyspepsia assessment (SODA) in a randomized clinical trial of a COX-2-specific inhibitor and traditional NSAID therapy.

Can273), diclofenac/misoprostol (

Incidence of outpatient physician claims for upper gastrointestinal symptoms among new users of celecoxib, ibuprofen, and naproxen in an insured population in the United States

Can365), NSAID + histamine H2 receptor antagonist (

Physician-reported management of edema and destabilized blood pressure in cyclooxygenase-2-specific inhibitor users with osteoarthritis and treated hypertension

Can413), NSAID + misoprostol (