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- Andreasson, Anna, 1980-, et al.
(författare)
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Effect of on-demand vs continuous prescription of proton pump inhibitors on symptom burden and quality of life : results of a real-world randomized controlled trial in primary care patients with gastroesophageal reflux disease
- 2024
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Ingår i: Annals of Medicine. - 0785-3890 .- 1365-2060. ; 56:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: This study aimed to assess the impact of on-demand versus continuous prescribing of proton pump inhibitors (PPIs) on symptom burden and health-related quality of life in patients with gastroesophageal reflux disease (GERD) presenting to primary care.Methods: Thirty-six primary care centres across Europe enrolled adult GERD patients from electronic health records. Participants were randomised to on-demand or continuous PPI prescriptions and were followed for 8 weeks. PPI intake, symptom burden, and quality of life were compared between the two groups using mixed-effect regression analyses. Spearman’s correlation was used to assess the association between changes in PPI dose and patient-reported outcomes.Results: A total of 488 patients (median age 51 years, 58% women) completed the initial visit, with 360 attending the follow-up visit. There was no significant difference in PPI use between the continuous and on-demand prescription groups (b=.57, 95%CI:0.40-1.53), although PPI use increased in both groups (b = 1.33, 95%CI:0.65 − 2.01). Advice on prescribing strategy did not significantly affect patient-reported outcomes. Both symptom burden (Reflux Disease Questionnaire, b=-0.61, 95%CI:-0.73 − -0.49) and quality of life (12-item Short Form Survey physical score b = 3.31, 95%CI:2.17 − 4.45) improved from baseline to follow-up in both groups. Increased PPI intake correlated with reduced reflux symptoms (n = 347, ρ=-0.12, p = 0.02) and improved quality of life (n = 217, ρ = 0.16, p = 0.02).Conclusion: In real-world settings, both continuous and on-demand PPI prescriptions resulted in similar increases in PPI consumption with no difference in treatment effects. Achieving an adequate PPI dose to alleviate reflux symptom burden improves quality of life in GERD patients. EudraCT number 2014-001314-25.
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| 2. |
- Knoche, Hendrik, et al.
(författare)
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Identifying Challenges and Opportunities for Intelligent Data-Driven Health Interfaces to Support Ongoing Care
- 2023
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Ingår i: CHI EA '23: Extended Abstracts of the 2023 CHI Conference on Human Factors in Computing Systems. - : Association for Computing Machinery (ACM). - 9781450394222 ; , s. 1-7
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Konferensbidrag (refereegranskat)abstract
- This workshop will explore future work in the area of intelligent, conversational, data-driven health interfaces both from patients’ and health care professionals’ perspectives. We aim to bring together a diverse set of experts and stakeholders to jointly discuss the opportunities and challenges at the intersection of public health care provisioning, patient and caretaker empowerment, monitoring provisioning of health care and its quality. This will require AI-supported, conversational decision-making interfaces that adhere to ethical and privacy standards and address issues around agency, control, engagement, motivation, and accessibility. The goal of the workshop is to create a community around intelligent data-driven interfaces and create a road map for their future research.
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| 3. |
- Wang, Wenjuan, et al.
(författare)
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Developing and externally validating a machine learning risk prediction model for 30-day mortality after stroke using national stroke registers in the UK and Sweden.
- 2023
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:11
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: We aimed to develop and externally validate a generalisable risk prediction model for 30-day stroke mortality suitable for supporting quality improvement analytics in stroke care using large nationwide stroke registers in the UK and Sweden.DESIGN: Registry-based cohort study.SETTING: Stroke registries including the Sentinel Stroke National Audit Programme (SSNAP) in England, Wales and Northern Ireland (2013-2019) and the national Swedish stroke register (Riksstroke 2015-2020).PARTICIPANTS AND METHODS: Data from SSNAP were used for developing and temporally validating the model, and data from Riksstroke were used for external validation. Models were developed with the variables available in both registries using logistic regression (LR), LR with elastic net and interaction terms and eXtreme Gradient Boosting (XGBoost). Performances were evaluated with discrimination, calibration and decision curves.OUTCOME MEASURES: The primary outcome was all-cause 30-day in-hospital mortality after stroke.RESULTS: In total, 488 497 patients who had a stroke with 12.4% 30-day in-hospital mortality were used for developing and temporally validating the model in the UK. A total of 128 360 patients who had a stroke with 10.8% 30-day in-hospital mortality and 13.1% all mortality were used for external validation in Sweden. In the SSNAP temporal validation set, the final XGBoost model achieved the highest area under the receiver operating characteristic curve (AUC) (0.852 (95% CI 0.848 to 0.855)) and was well calibrated. The performances on the external validation in Riksstroke were as good and achieved AUC at 0.861 (95% CI 0.858 to 0.865) for in-hospital mortality. For Riksstroke, the models slightly overestimated the risk for in-hospital mortality, while they were better calibrated at the risk for all mortality.CONCLUSION: The risk prediction model was accurate and externally validated using high quality registry data. This is potentially suitable to be deployed as part of quality improvement analytics in stroke care to enable the fair comparison of stroke mortality outcomes across hospitals and health systems across countries.
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