When Effects Cannot be Estimated: Redefining Estimands to Understand the Effects of Naloxone Access Laws

alexandrossfakianakis shared this article with you from Inoreader When Effects Cannot be Estimated: Redefining Estimands to Understand the Effects of Naloxone Access Laws via Epidemiology - Published Ahead-of-Print Violations of the positivity assumption (also called the common support condition) challenge health policy research and can result in significant bias, large variance, and invalid inference. We define positivity in the single- and multiple-timepoint (i.e., longitudinal) health policy evaluation setting, and discuss real-world thr eats to positivity. We show empirical evidence of the practical positivity violations that can result when attempting to estimate the effects of health policies (in this case, Naloxone Access Laws). In such scenarios, an alternative is to estimate the effect of a shift in law enactment (e.g., the effect if enactment had been delayed by some number of years). Such an effect corresponds to what is called a modified treatment policy, and dramatically weakens the required positivity assumption, thereby offering a means to estimate policy effects even in scenarios with serious positivity problems. We apply the approach to define and estimate the longitudinal effects of Naloxone Access Laws on opioid overdose rates. Violations of the positivity assumption (also called the common support condition) challenge health policy research and can result in significant bias, large variance, and invalid inference. We define positivity in the single- and multiple-timepoint (i.e., longitudinal) health policy evaluation setting, and discuss real-world threats to positivity. We show empirical evidence of the practical positivity violations that can result when attempting to estimate the effects of health policies (in this case, Naloxone Access Laws). In such scenarios, an alternative is to estimate the effect of a shift in law enactment (e.g., the effect if enactment had been delayed by some number of years). Such an effect corresponds to what is called a modified treatment policy, and dramatically weakens the required positivity assumption, thereby offering a means to estimate policy effects even in scenarios with serious positivity problems. We apply the approach to define and estimate the longitudinal effec ts of Naloxone Access Laws on opioid overdose rates. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Efficacy of platelet‐rich fibrin and connective tissue graft in papilla reconstruction

alexandrossfakianakis shared this article with you from Inoreader Efficacy of platelet‐rich fibrin and connective tissue graft in papilla reconstruction via Journal of Esthetic and Restorative Dentistry Abstract Purpose To evaluate efficacy of platelet-rich fibrin (PRF) or connective tissue graft (CTG) in papilla reconstruction (PR) with the semilunar incision (SI) technique. Materials and Methods The analysis consisted of 55 sites (27 CTG and 28 PRF) from 20 patients who underwent PR with either PRF or CTG placed in the maxillary anterior region with SI technique. Baseline (BL) and follow-up (T1, first month, T3, third month, T6, sixth month) clinical data including periodontal evaluations (gingival index (GI), plaque index (PI), pocket depth (PD), keratinized tissue width (KTW), gingival recession), papilla-associated recordings (alveolar crest-interdental contact point [AC-IC], alveolar crest-papilla tip [AC-PT], papilla tip-interdental contact point [PT-IC], papilla height loss [PHL], interdental tissue stroke [ITS] and papilla presence index [PPI]) and patient satisfaction were analyzed. Results CTG provided better PR outcomes. GI, PI, and PD showed a slight increase at T1 and then, turned to their BL levels. The other periodontal parameters showed significant improvement after both treatment modalities. No inter-group difference was found except for KTW, which was in favor of CTG. Conclusion Based on the results, CTG is recommended over PRF in PR treatment due to its superior outcomes with less recurrence risk. Clinical Significance Connective tissue graft provides superior results than platelet-rich fibrin in papilla reconstruction with the semilunar incision technique. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Dose of deferasirox correlates with its effects, which differ between low‐risk myelodysplastic syndrome and aplastic anaemia

alexandrossfakianakis shared this article with you from Inoreader Dose of deferasirox correlates with its effects, which differ between low‐risk myelodysplastic syndrome and aplastic anaemia via Journal of Clinical Pharmacy and Therapeutics This study retrospectively evaluated the efficacy, safety and dose–effect relationships of deferasirox (DFX) in patients with low-risk myelodysplastic syndrome (MDS) and aplastic anaemia (AA) who were refractory to regular treatment in a real-world setting. We found that a significant decrease in serum ferritin (SF) and an improvement in haematologic parameters, organ function and even overall survival (OS) can be achieved if the accumulated DFX dose reaches a certain level. Patients with low-risk MDS need a higher dose than those with AA. Abstract What is known and objective Patients with low-risk myelodysplastic syndrome (MDS) and aplastic anaemia (AA) often need transfusions, which may accelerate iron overload. The aim of this study was to evaluate the efficacy, safety and dose–effect relationships of deferasirox (DFX) in patients with low-risk MDS and AA who were refractory to regular treatment in a real-world setting. Methods Patient data were recorded, and dose–effect relationships of DFX were calculated after the first 6 months. Total annual exposure to DFX was calculated after 12 months and expressed as the accumulated exposure time at a dosage of 20 mg/kg/day. Results and discussion Sixty-one patients with low-risk MDS and 51 with AA were enrolled. The minimum dosage of DFX needed for a significant serum ferritin (SF) decrease was 20 mg/kg/day at 6 months, and the minimum accumulation of DFX had to reach 9 months at 20 mg/kg/day by 12 months for patients with low-risk MDS. For patients with AA, the minimum dosage was 10 mg/kg/day at 6 months, and the minimum accumulation had to reach 3 months at 20 mg/kg/day by 12 months. With the same exposure, significant improvements in haematological parameters were also observed in AA. Lower liver enzymes compared with baseline were observed. Gastrointestinal disorders and elevated serum creatinine were the most common side effects. Higher exposure to DFX correlated with longer overall survival (OS). What is new and conclusion A significant decrease in SF and an improvement in haematologic parameters, organ function and even OS can be achieved if the accumulated DFX dose reaches a certain level. Patients with low-risk MDS need a higher dose than those with AA. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effect of body weight on bleeding events of aspirin in ischemic stroke or transient ischemic attack patients

alexandrossfakianakis shared this article with you from Inoreader Effect of body weight on bleeding events of aspirin in ischemic stroke or transient ischemic attack patients via Journal of Clinical Pharmacy and Therapeutics Bodyweight and combination with SSRIs are related to bleeding adverse reaction of aspirin. Patients weighted less than 60 kg will be at a higher risk of adverse bleeding events. Abstract What is Known and Objectives Bleeding is the most common adverse reaction to aspirin and can lead to drug discontinuation or even be life-threatening in the secondary prevention of stroke or transient ischemic attack. The aim of this study was to evaluate risk factors for bleeding adverse reaction of aspirin in ischemic stroke or transient ischemic attack. Methods This retrospective analysis included patients treated with aspirin (100 mg) as a secondary prevention for ischemic stroke or transient ischemic attack. The bleeding events that occurred during the first year were collected, including gastrointestinal, skin, nasal cavity, gum, and urinary tract bleeding events. Then, univariate and multivariate logistic regression analyses were used to identify independent factors associated with bleeding events of aspirin. Results and Discussion A total of 578 patients were enrolled in this study, and 58 patients developed bleeding during the first year of secondary prevention. Body weight and combination with selective serotonin reuptake inhibitors were found to be significant risk factors for overall bleeding (p = 0.025 and 0.012). Body weight below 60 kg was a risk factor for overall bleeding and gastrointestinal bleeding events. What is new and conclusion Patients weighing less than 60 kg were at increased risk of bleeding with 100 mg aspirin for secondary prevention of cerebral infarction transient ischemic attack. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The role of gastrointestinal pathogen PCR testing in liver transplant recipients hospitalized with diarrhea

alexandrossfakianakis shared this article with you from Inoreader The role of gastrointestinal pathogen PCR testing in liver transplant recipients hospitalized with diarrhea via Transplant Infectious Disease Abstract Background Diarrhea is a common symptom among liver transplant (LT) recipients and can result in significant morbidity. The utility of PCR-based multiplex gastrointestinal (GI) pathogen panels in this population is unknown. Methods We assessed incidence, predictors, and outcomes of GI PCR positivity among inpatients who underwent stool pathogen testing with the FilmArray multiplex GI PCR panel at our institution within 1 year following LT from April 2015 to December 2019. Results 112 patients were identified. 14 (12.5%) had a positive PCR for any pathogen. Escherichia coli (n = 9) and Norovirus (n = 5) were the most common pathogens detected. Recipients with a positive PCR were significantly further from LT (median 74.5 vs 15.5 days, p < 0.01) and tested earlier during hospitalization (median 1.0 vs 9.0 days, p < 0.01). C. difficile was positive in 20.0% of patients with a positive PCR and 11.4% with a negative PCR. CMV viremia was observed in 11.6% of patients, all in the negative PCR group. Following a positive PCR, patients were more likely to have a change in antimicrobial regimen (71.4% vs 28.6%, p = 0.02), a shorter length of stay (median 7.5 vs. 17.5 days, p < 0.01), and a trend toward lower rates of readmission and colonoscopy within 30 days. Conclusions In hospitalized LT recipients with diarrhea, GI PCR pathogen identification was associated with the use of targeted antimicrobial therapy and a shorter length of stay. GI PCR testing should be considered early during admission and later in the post-LT period. This article is protected by copyright. All rights reserved View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Impact of gastroplasty on salivary characteristics, dental health status and oral sensory aspects: a controlled clinical study

alexandrossfakianakis shared this article with you from Inoreader Impact of gastroplasty on salivary characteristics, dental health status and oral sensory aspects: a controlled clinical study via Journal of Oral Rehabilitation Abstract Background Saliva is a non-invasive source of biomarkers useful in the study of different pathophysiological conditions. The qualitative and quantitative study of saliva, as well as the assessment of oral health, can be particularly useful for a better understanding of obesity due to its importance in the food oral perception and ingestion. Objectives To evaluate the effect of treatment of morbid obesity (dietary counselling versus gastroplasty) on salivary characteristics, oral sensory perception and dental health in a controlled study. Methods 73 adults (60 females; 19-59 years) with morbid obesity were divided in: Control group (CG; n=34) followed-up during a 6-months dietary program, and Gastroplasty group (GG; n=39) evaluated immediately before, 3, and 6 months after gastroplasty. Dietary habits, Oral Health Impact Profile and xerostomia complaints were investigated by interview. The clinical examination included anthropometric and caries experience evaluation. Salivary flow rate, buffering capacity, total protein and alpha-amylase levels, and sensitivity for the 4 basic tastes were assessed. Two-way mixed model and sign test were applied. Results Physical and clinical aspects did not differ between groups in the beginning of the study, and GG showed a rapid weight loss after surgery (p<0.001). An improvement in most of the dietary aspects was observed, especially in the GG. A worsening in the dental health status was observed over time in both groups, with an increase in the number of filled and decayed teeth. CG showed a better oral health-related quality of life, while xerostomia complains increased in GG after gastroplasty. Salivary flow rate remained stable in both groups, but a decrease in buffering capacity, total protein, and alpha-amylase activity was observed in GG after 6-months; taste sensitivity increased from baseline to 6-months in GG (p<0.05). Conclusion After 6-months of follow-up, patients undergoing gastroplasty presented an improvement in dietary habits and taste sensitivity. However, changes in saliva composition and a worsening in dental health status and xerostomia complaints were also observed. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparative effectiveness and stage‐shift effect of endoscopic exam among newly diagnosed oral cancer patients with different stages in Taiwan

alexandrossfakianakis shared this article with you from Inoreader Comparative effectiveness and stage‐shift effect of endoscopic exam among newly diagnosed oral cancer patients with different stages in Taiwan via Head & Neck Abstract Background Patients with oral cancer are at higher risk of developing second primary esophageal cancer (SPEC) and the consensus for screening strategies remains unclear. This study aimed to examine comparative effectiveness and the stage-shift effect of endoscopic exam among patients with oral cancer. Method A population-based longitudinal retrospective observational matched case and control cohort study with at least 5 years follow-up was conducted. We identified 45 457 newly diagnosed patients with oral cancer, 2004–2013, and the eligible patient with oral cancer was 39 401. Propensity score matching was used to match comparable groups, and the two groups (screening vs. nonscreening) was 5941, individually. The study primary endpoints were to compare detection of incident SPEC and the stage-shift effect of endoscopic screening between screened and nonscreened incident oral cancer patients. Cox proportional hazard and competing risk models were analyzed. Statistical analyses were conducted in 2020–2021. Result Detection of incident SPEC in the screened group was significantly higher than in the nonscreened group (hazard ratio: 2.92, 95% confidence interval [CI]: 2.29–3.72). The stage-shift effect from endoscopic screening was found overall in patients with oral cancer (odds ratio [OR]: 0.39, 95%CI: 0.21–0.70), in particular in advanced-stage patients (OR: 0.25, 95%CI: 0.11–0.61), but not in early-stage patients (OR: 0.60, 95%CI: 0.26–1.40). Conclusion This study confirmed that endoscopic screening achieved early detection of SPEC among patients with oral cancer. To improve the screening stage-shift effect, patients with oral cancer are encouraged to undergo routine endoscopic screening. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.