PubMed İndeksli Yayınlar Koleksiyonu / PubMed Indexed Publications Collection
Permanent URI for this collectionhttps://hdl.handle.net/20.500.11779/1928
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Article Citation - Scopus: 10Patterns of Treatment and Correction of Hyponatremia in Intensive Care Unit Patients(W.B. Saunders, 2015-10-01) Badawi, Omar; Chiodo, Joseph; Waikar, Sushrut S.; Boklage, Susan; Dasta, Joseph; Xie, Lin; Başer, OnurPurpose: The goal of this study was to examine the real-world patterns of care and interventions among intensive care unit (ICU) patients with hypervolemic and euvolemic hyponatremia using a large clinical database. Materials and Methods: The Phillips eICU Research Institute database was used to investigate hyponatremia treatment patterns and trends, mortality, and ICU and hospital length of stay. Demographics, clinical characteristics, and outcome variables were compared in patients corrected for hyponatremia using both a more strict and a less strict definition. Results: At admission, 35%, 55%, and 10% of patients had mild, moderate, and severe hyponatremia, respectively. At the end of an ICU stay, the percentage of patients who did not have corrected serum sodium concentration was 48% (using a more strict definition) and 24% (using a less strict definition). Using either definition of correction, patients with serum sodium correction had lower mortality and longer survival than did patients without corrected serum sodium concentration. Conclusions: A significant proportion of hyponatremia is not corrected during an ICU stay. Critically ill patients with hyponatremia who have their serum sodium corrected have lower mortality and longer survival, highlighting the need for more attention to hyponatremia and its correction in critically ill patients. © 2015 Elsevier Inc.Article Citation - WoS: 25Citation - Scopus: 25Impact of Switching From an Initial Tumor Necrosis Factor Inhibitor on Health Care Resource Utilization and Costs Among Patients With Rheumatoid Arthritis(Elsevier, 2015-07-01) Roy, Sanjoy; Ganguli, Arijit; Xie, Lin; Başer, Onur; Cifaldi, MaryPurpose: Despite improved clinical outcomes for the majority of patients, nearly 30% of patients with rheumatoid arthritis (RA) who initiate tumor necrosis factor antagonist (anti-TNF) biologic agents fail to respond to their first-line anti-TNF and switch to another anti-TNF or a non-TNF biologic. How this change affects health care costs and resource utilization is unknown. We therefore compared RA patients taking first-line anti-TNFs who switched to a second anti-TNF versus those patients who switched to an alternate biologic. Methods: Health care claims data were obtained from a large US database for eligible adults with confirmed RA diagnoses who initiated anti-TNF treatment and switched to another biologic. Health care costs and utilization during the first 12 months' postswitch were compared. Generalized linear models were used to adjust for differences in demographic and clinical characteristics before switching. Findings: Patients who switched to a second anti-TNF rather than a non-TNF biologic were generally younger (53.0 vs. 55.3 years; P < 0.0001) and less likely to be female (79.7% vs. 82.7%; P = 0.0490). Of the 3497 eligible patients who switched from first-line anti-TNFs, 2563 (73.3%) switched to another anti-TNF and 934 (26.7%) switched to a non-TNF. Adalimumab was the most frequently prescribed (43.4%) second-line anti-TNF, and abatacept was the most common non anti-TNF (71.4%). Patients who switched to a second anti-TNF remained on their first medication for a significantly shorter period (342.5 vs 420.6 days; P < 0.0001) and had lower comorbidity indices and higher disease severity at baseline than those who switched to a non anti-TNF. After adjusting for baseline differences, patients who switched to second anti-TNFs versus a non-TNF incurred lower RA-related costs ($20,938.9 vs $22,645.2; P = 0.0010) and total health care costs ($34,894.6 vs $38,437.2; P = 0.0010) 1 year postswitch. These differences were driven by increased physician office visit costs among the non-TNF group. Implications: Among the anti-TNF initiators who switched therapy, more patients switched to a second anti-TNF than to a non-TNF. Switching to a second anti-TNF treatment was associated with lower all-cause and RA-related health care costs and resource utilization than switching to a non-TNF. Because switching therapy may be unavoidable, finding a treatment algorithm mitigating this increase to any extent should be considered. These data are limited by their retrospective design. Additional confounding variables that could not be controlled for may affect results. (C) 2015 The Authors. Published by Elsevier HS journals, Inc.