Search

AIMS To use a database of national essential medicine lists to determine how many include the three tobacco dependence medicines: nicotine replacement therapy, varenicline and bupropion. METHODS Retrospective observational study using national essential medicine lists for 137 countries. RESULTS Of the 137 countries, 34 listed at least one of the three tobacco dependence medicines included in this analysis. Bupropion was listed by 23 countries, nicotine replacement therapy by 17 countries and varenicline by eight countries. CONCLUSIONS Tobacco dependence medicines do not appear on the essential medicines lists of most countries.

Aim Diabetes is the ninth leading cause of death. Improving access to diabetes medicines may decrease mortality. Diabetes medicines on national essential medicines lists (NEMLs) vary considerably. We examine the association between diabetes population health outcomes, relating to mortality, and the listing of diabetes medicines on national essential medicine lists for 127 countries. Materials and methods We conducted a cross-sectional study. We determined the number of diabetes medicines on NEMLs and used multiple linear regression to analyze the association between diabetes health outcomes and the number of medicines on NEMLs. We used linear regression to assess the association between diabetes health outcomes and the listing or not listing of medicines that were listed by 25% to 75% of countries. Diabetes prevalence, gross domestic product (GDP) per capita and mean expenditure per person with diabetes were controlled for in all analyses. Results The total number of diabetes medicines listed on NEMLs ranged from 0 to 16 (median: 4; interquartile range: 3 to 6). Diabetes health outcome scores were associated with the number of diabetes medicines on NEMLs (1·3-point increase [95% Confidence Interval, 95% CI 0·5-2·1] for every additional medicine on NEMLs; p = 0·002) and GDP per capita (19·5-point increase [95% CI 5·4 to 33·6] for every 10-fold increase in GDP; p = 0·003). Diabetes expenditure was not associated with health outcome scores (p = 0·23). Increases in diabetes health outcomes score were associated with the listing of glimepiride (7·9-point increase 95% CI 2·3-13·5, p = 0.006) and glipizide (5·8-point increase 95% CI 0·03-11·6, p = 0·049) on NEMLs. Conclusions Listing of diabetes medicines on NEMLs has the potential to improve population health outcomes related to mortality in countries with diverse incomes and diabetes prevalence without necessarily increasing diabetes health expenditure. This article is protected by copyright. All rights reserved.

Background:Carbapenemase-producing Enterobacteriaceae (CPE) pose a significant global health threat.Objective:To conduct a systematic review of health outcomes and long-term sequelae attributable to CPE infection.Methods:We followed PRISMA reporting guidelines and published our review protocol on PROSPERO (CRD42018097357). We searched Medline, Embase, CINAHL and the Cochrane Library. We included primary studies with a carbapenem-susceptible control group in high-income countries, published in English. Quality appraisal was completed using Joanna Briggs Institute checklists. We qualitatively summarized frequently reported outcomes and conducted a meta-analysis.Results:Our systematic review identified 8,671 studies; 17 met the eligibility criteria for inclusion. All studies reported health outcomes; none reported health-related quality-of-life. Most studies were from Europe (65%), were conducted in teaching or university-affiliated hospitals (76%), and used case-control designs (53%). Mortality was the most commonly reported consequence of CPE-infections; in-hospital mortality was most often reported (62%). Our meta-analysis (n = 5 studies) estimated an absolute risk difference (ARD) for in-hospital bloodstream infection mortality of 0.25 (95% confidence interval [CI], 0.17–0.32). Duration of antibiotic therapy (range, 4–29.7 vs 1–23.6 days) and length of hospital stay (range, 21–87 vs 15–43 days) were relatively higher for CPE-infected patients than for patients infected with carbapenem-susceptible pathogens. Most studies (82%) met >80% of their respective quality appraisal criteria.Conclusions:The risk of in-hospital mortality due to CPE bloodstream infection is considerably greater than carbapenem-susceptible bloodstream infection (ARD, 0.25; 95% CI, 0.17–0.32). Health outcome studies associated with CPE infection are focused on short-term (eg, in-hospital) outcomes; long-term sequelae and quality-of-life are not well studied.Trial Registration:PROSPERO (CRD42018097357).

Accurate SARS-CoV-2 diagnosis is essential to guide prevention and control of COVID-19. Here we examine SARS-CoV-2 molecular-based test performance characteristics and summarize case-level data related to COVID-19 diagnosis. From January 11 through April 22, 2020, Public Health Ontario conducted SARS-CoV-2 testing of 86,942 specimens collected from 80,354 individuals, primarily using real-time reverse-transcription polymerase chain reaction (rRT-PCR) methods. We analyzed test results across specimen types and for individuals with multiple same-day and multi-day collected specimens. Nasopharyngeal compared to throat swabs had a higher positivity (8.8% vs. 4.8%) and an adjusted estimate 2.9 Ct lower (SE = 0.5, pt of multi-day specimens increased over time. Symptomatic cases had rRT-PCR results with an adjusted estimate 3.0 Ct (SE = 0.5, p

Left atrial enlargement (LAE) is a marker for diastolic cardiac dysfunction. Echocardiograms are considered the gold-standard for diagnosis, but given their wider access and lower economic cost, electrocardiograms (ECGs) may be useful in identifying patients who would benefit from further investigation. This study investigates the utility of ECG criteria to diagnose LAE in pediatric patients. A retrospective chart review (n = 492) was conducted in patients whose echocardiograms demonstrated LAE by left atrial indexed diameter z-score ≥2.0 and/or increased left atrial to aortic root ratio at various cutoffs (≥1.4, ≥1.6, ≥1.8). ECG criteria studied included: (1) P wave ≥110 msec, (2) P mitrale ≥40 msec, in LII (3) terminal negative P wave deflection in lead V1 > 40 msec, and (4) P/PR segment >1.6 in lead II. Sensitivity, specificity, Cohen’s Kappa coefficient (κ), and ROC curves were calculated. A combination of P mitrale ≥40 msec and terminal negative P wave deflection in lead V1 > 40 msec yielded the greatest agreement (κ = 0.221, 95%CI 0.060–0.382), but all ECG criteria used to diagnose LAE had poor diagnostic value (AUC

BACKGROUND: Left atrial enlargement (LAE) has been established as a marker for diastolic dysfunction in left-sided cardiac disease. The gold-standard for diagnosis is the echocardiogram. In clinical practice pediatric patients who are suspicious for LAE often receive echocardiograms with concurrent electrocardiograms (ECGs) to exclude other diagnoses. Given the wider access and lower economic cost of ECGs compared to echocardiograms, ECGs have great potential to be used as a screening test to identify patients who would benefit from further investigation by echocardiography. However, the use of ECG criteria for the diagnosis of LAE has not been validated in the pediatric population. OBJECTIVES: To identify the diagnostic utility of independent or combinations of ECG criteria to diagnose LAE in the pediatric population. DESIGN/METHODS: A large retrospective case-control study (n=492) was conducted at a pediatric hospital in patients identified by echocardiography as meeting ≥1 of the following LAE criteria: 1) left atrial indexed diameter z-score ≥2.0, or 2) increased left atrial to aortic root ratio at various cutoffs (≥1.4, ≥1.6, ≥1.8). ECG criteria included: 1) a P wave ≥110 msec, 2) P mitrale ≥40 msec, and 3) a terminal negative portion of P wave in lead V1 >40 msec, 4) P/PR segment >1.4, 1.6, or 1.8 in lead II. Sensitivity, specificity, Cohen’s Kappa coefficient (κ), and receiver operating characteristic curves (ROC) were constructed to investigate the diagnostic utility of single and combination criteria. RESULTS: Diagnostic performance of ECG criteria had low to moderate sensitivity (20.8–55.0%) and moderate to high specificity (73.6–96.1%). The greatest agreement occurred when using two ECG criteria: P mitrale ≥40 msec and a terminal negative portion of the P wave in lead V1 >40 msec (κ = 0.221, 95% CI 0.060–0.382). ROC curve analysis further demonstrated that terminal negative P wave in V1 is the most strongly correlated with the echocardiographic criteria (AUC:0.580–0.581). CONCLUSION: The presence of positive ECG criteria indicates a probable diagnosis of LAE, however the absence of ECG criteria cannot be used to exclude this diagnosis. It should be noted that the presence of these criteria should not be used in isolation. Further research is required to determine correlation with clinical presentation and implications for clinical management.