ABSTRACT
OBJECTIVES: To determine the initial distribution of medication in patients with de novo Parkinson's disease (PD), to estimate the share of patients who not receive a recommended initial therapy according to current German guidelines, and to compare the time-to-levodopa. METHODS: We used the Disease Analyzer database (IMS HEALTH), containing basic medical data from ~20 million patients in Germany. The primary outcome was the therapy change rate from initial treatment to levodopa estimated by Kaplan-Meier analyses. A Cox proportional hazards model was used to estimate the relationship between time-to-levodopa and confounders for a maximum follow-up of 10 years (between January 2002 and December 2011). Adjusted hazard ratios (HR) and 95% confidence intervals (CI) are presented for change-to-levodopa rate. RESULTS: A representative sample of de-novo patients diagnosed with PD was drawn (n=108,885). 71.8% of patients received levodopa as a first line treatment. 29,708 patients started with other anti-PD substances: 13.3% with dopamine agonists (DA), 3.6% with amantadine, 5.9% with anticholinergics, and 0.8% with monoamine oxidase B (MAO-B) inhibitors. Therefore, the proportion of patients who not receive a recommended initial therapy according to current German guidelines was ~10%. 29.0% of patients not starting with levodopa switched to levodopa within 5 years. After 5 years, more than 80% of PD patients using anticholinergics as their initial treatment remained levodopa-free. MAOB- inhibitors and DAs showed significantly lower proportions of levodopa-free patients after 5 years (35% and 55%, respectively). Compared to MAO-B inhibitors, the HR for switching to levodopa was 0.38 (CI 0.34-0.43; p<0.001) for anticholinergics and 0.85 (CI 0.75-0.97; p=0.017) for nonergot DA. CONCLUSIONS: Surprisingly, initial treatment with anticholinergics is correlated with the longest delay of levodopa treatment among all monotherapies. Our results suggest re-evaluating the comparative effectiveness of all initial PD treatments in head-tohead comparisons.
Subject(s)
Antiparkinson Agents/therapeutic use , Levodopa/therapeutic use , Parkinson Disease/drug therapy , Aged , Cohort Studies , Female , Humans , Male , Middle Aged , Monoamine Oxidase Inhibitors/therapeutic use , Retrospective Studies , Time FactorsABSTRACT
OBJECTIVE: A case study at the department for heart surgery of an Austrian University Hospital in 2001, examined the outcome of improved communication aimed at empowering patients to be more effective co-producers of recuperation after surgery. METHODS: Evaluated were the effects of a training program for developing communication skills of health professionals (physicians, physiotherapists, and nurses) along with a reorganization of patient information schemes. The clinical outcomes after four types of surgery (bypass, stent, artificial valve insertion and combination of these) were observed in 100 patients without (control group) and 99 with the intervention administered (intervention group). Two objective and two subjective health outcome parameters were selected for analysis: care level adjusted length of stay in hospital, frequency of post-surgery complications, subjective health, subjective satisfaction with care received. Self-administered breathing exercises were measured as an intermediary outcome parameter. RESULTS: In the intervention group length of hospital stay was shorter (by 1 day), incidence of post-surgery tachyarrhythmia was reduced (by 15%), transfer to less intensive care levels was faster and patient ratings for communicative quality of care by doctors and nurses were improved. CONCLUSION: Professional communication aimed at empowering patients to act as co producers can indeed have an effect on clinical outcome. PRACTICE IMPLICATIONS: Staff training and reorganization of communication schemes can be an effective intervention in hospital care.
Subject(s)
Cardiac Surgical Procedures/psychology , Communication , Patient Education as Topic/organization & administration , Patient Participation , Physician-Patient Relations , Power, Psychological , Adult , Aged , Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/etiology , Austria/epidemiology , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/education , Clinical Competence/standards , Female , Humans , Incidence , Inservice Training/organization & administration , Length of Stay/statistics & numerical data , Male , Medical Staff, Hospital/education , Medical Staff, Hospital/psychology , Middle Aged , Outcome Assessment, Health Care , Patient Participation/methods , Patient Participation/psychology , Patient Satisfaction , Patient Transfer/statistics & numerical data , Postoperative Care/education , Postoperative Care/psychology , Program EvaluationSubject(s)
Behavior , Fertility , Marriage , Men , Mortality , Sex Characteristics , Behavior/physiology , Fathers/psychology , Humans , Male , Population Dynamics , Social Sciences , Testosterone/physiologyABSTRACT
A lost less is known about the morbidity and mortality consequences of male infertility. It was the aim of our study to analyse the association between sperm concentration and individual lifetime mortality in men. The data sources included medical records of 601 men who attended the andrological service at the Marburg University Hospital between 1949 and 1985, and vital data gathered from public registration offices and a statutory health insurance. A Cox regression model estimated a two-fold higher mortality risk for oligozoospermic men as compared to the normozoospermic group for cohorts born between 1892 and 1931. Since a selection bias could not be found, we assume there to be a connection between poor fertility status and a shorter lifespan in men. Possible explanations for the variation in mortality risk are: (i) Lifestyle and health behaviour in adulthood, (ii) conditions in utero, and (iii) genetic dispositions.
Subject(s)
Longevity , Oligospermia , Adult , Aged , Aged, 80 and over , Humans , Infertility, Male , Male , Middle Aged , Sperm CountABSTRACT
PURPOSE: Extracorporeal shock wave therapy (ESWT) for the treatment of Peyronie's disease is still controversial. This exploratory meta-analysis of published studies in the international literature investigates its therapeutic effects. MATERIALS AND METHODS: The treatment outcomes from 17 study groups identified by a computerized literature search were compared with natural history outcomes and data from control groups from 2 controlled ESWT studies. An exploratory meta-analysis was performed because a methodologically sound meta-analysis lege artis did not appear appropriate, since treated groups differ considerably in structure, the selection of outcome measures is inconsistent and measurement is not standardized. RESULTS: ESWT seems to have an effect on penile pain during erection and on the improvement of sexual function. Pain seems to resolve faster after ESWT than during the course of the natural history. The effect on plaque size and penile curvature is less impressive. CONCLUSIONS: ESWT in Peyronie's disease at least seems to be effective in regard to penile pain and sexual function compared to natural history. Deducing from these data the effect on plaque size and curvature remains questionable. However, ESWT is not an evidence based therapy at present. A controlled (preferably pairwise matched), single blind, multicenter study with careful, detailed documentation of disease symptoms before intervention and of outcomes is required to evaluate the real effect of ESWT.
