3,902 research outputs found
Patent foramen ovale closure vs. medical therapy for recurrent stroke prevention: Evolution of treatment effect during follow-up
No full textBACKGROUND
Little is known regarding changes in treatment effect over time associated with patent foramen ovale (PFO) closure among patients with embolic stroke of unknown origin.
METHODS
We reconstructed Kaplan-Meier curves for stroke from individual randomized trials comparing PFO closure vs. medical therapy among patients with embolic stroke. Random effects Cox-regression analyses were performed in order to estimate hazard ratios (HRs) with 95% confidence intervals (95%CIs).
RESULTS
A total of 2531 patients enrolled across 4 randomized trials were included. PFO closure was associated with a significant reduction in the risk of stroke at longest available follow-up (HR 0.18, 95%CI 0.06 to 0.59, P=0.005). However, recurrent stroke was already significantly reduced among patients randomized to PFO closure at 1-year (HR 0.40, 95%CI 0.20 to 0.80, P=0.010), with the treatment effect remaining consistent (P-for-interaction=0.356) between 1- and 5-year (HR 0.14, 95%CI 0.05 to 0.55, P=0.005) and beyond 5-year (HR 0.20, 95%CI 0.03 to 1.19, P=0.077).
CONCLUSIONS
Among patients with embolic stroke of unknown origin, PFO closure reduces the risk of stroke compared with medical therapy, with a significant reduction in recurrences starting already within 1-year after percutaneous PFO closure
Replication data for: Macroeconomic Conditions When Young Shape Job Preferences for Life
No full textCotofan, Maria, Cassar, Lea, Dur, Robert, and Meier, Stephan, (2023) “Macroeconomic Conditions When Young Shape Job Preferences for Life.” Review of Economics and Statistics 105:2, 467–473
Incentives and group identity
No full textThis paper investigates in a principal-agent environment whether and how group membership influences the effectiveness of incentives and when incentives can have "hidden costs", i.e., a detrimental effect. We show experimentally that in all interactions control mechanisms can have hidden costs for reasons specific to group membership. In within-group interactions control has detrimental effects because the agent does not expect to be controlled and reacts negatively when being controlled. In between-group interactions, agents perceive control more hostile once we condition on their beliefs about principals' behavior. Our finding contributes to the micro-foundation of psychological effects of incentives. © 2014 Elsevier Inc
Drug-related problems and dosage adjustment in patients with liver disease
No full textThe liver is essential for the metabolism of medicinal substances. Liver disease, especially liver cirrhosis, may lead to various pharmacokinetic and pharmacodynamic changes, predisposing patients with liver cirrhosis to adverse drug events (ADEs). In contrast to patients with renal failure, where dose adjustment can be performed by means of creatinine clearance, no such surrogate parameter exists for patients with liver disease. Specific dosage recommendations for patients with liver cirrhosis are often not available in the product information.
We contributed to the development of a database that categorizes drugs according to their pharmacokinetic characteristics and allows for specific dosage recommendations for patients with liver disease.
In the first study, we summarized this database for all anti-infective drugs on the Swiss market in 2012. Forty-seven % (N = 49) and 44% (N = 46) of the 104 anti-infectives on the market were primarily eliminated by the liver and the kidney, respectively. For 9 drugs, the elimination pathway could not be elucidated. One fifth of all drugs was eliminated ≥50% by bile. CYP P450 enzymes were involved in the metabolism of 27% of the drugs. For 48% of the anti-infectives, studies on pharmacokinetic alterations in liver disease were found. The Swiss product information provides specific recommendations for patients with liver disease for only 50% of anti-infective drugs.
The aim of the second study was the assessment of diagnoses, medication patterns, adverse drug reactions (ADRs), and potential drug-drug interactions (pDDIs) in cirrhotic patients at hospital admission. For this purpose, we performed a cross-sectional retrospective study including 400 patients with liver cirrhosis. At hospital admission, the 400 patients had 2415 diagnoses (median 6 per patient) and 1999 drugs (median 5 per patient), whereof 68% were predominantly eliminated by the liver. In total, 200 ADRs and 132 pDDIs were detected in 112 (28%) and 86 (21.5%) patients, respectively. Fifteen ADRs were directly caused by 17 DDIs, whereof three resulted in hospital admission. Patients with ADRs were older, had more comorbidities, were treated with more drugs, and had a worse renal function and more pDDIs than patients without ADRs.
In the third study, the medication at hospital admission of the same population described in the second study was analyzed in greater detail with the goal to determine the prevalence of incorrectly dosed drugs (IDDs) and their association with ADRs. The adequacy of the drugs with respect to dosing or prescribing was investigated retrospectively by means of previous publications or the above-mentioned database. Additionally, we calculated potential cost savings associated with IDDs and additional hospital stay due to IDD-induced ADRs. In contrast to the second study, we excluded vitamins and minerals for the analyses. Of the remaining 1653 drugs prescribed (median 4 per patient), 336 (20%) were IDDs in 184 patients. Overall, 198 ADRs (83% preventable) occurred in 110 patients. Sixty-one (31% of all ADRs) were associated with IDDs in 40 patients, whereof 77% were considered to be preventable. Especially non-steroidal anti-inflammatory drugs and psycholeptics were a frequent cause of preventable ADRs. Overall, IDDs were more frequently associated with ADRs than correctly dosed drugs and patients with IDDs were more frequently admitted to the hospital due to ADRs. Hospitalizations due to IDD-induced ADRs resulted in 94 additional hospital days. Potential drug-cost savings as a result of mere dose adjustment in patients with liver cirrhosis was minor, but considerable when taking into account hospitalizations due to preventable ADRs caused by IDDs.
Pharmacotherapy in patients with liver cirrhosis is complex and specific recommendations for dosage adjustment frequently not available. Prescribing physicians should be aware of problematic drugs and the principles of dosage adjustment in patients with liver cirrhosis. Prevention of IDDs and associated ADRs potentially leading to hospital admission can contribute to the reduction of healthcare costs.
By developing a database allowing for specific dosage recommendations in patients with liver disease, we are contributing to a safer drug treatment in patients with liver cirrhosis
Replication data for: Macroeconomic Conditions When Young Shape Job Preferences for Life
No full textCotofan, Maria, Cassar, Lea, Dur, Robert, and Meier, Stephan, (2023) “Macroeconomic Conditions When Young Shape Job Preferences for Life.” Review of Economics and Statistics 105:2, 467–473
Uncoupling of Behavioral and Metabolic Twenty-Four-Hour Rhythms in Reindeer (Current Biology, Meier et al. 2024): Actigraphy data
No full text<p>Raw reindeer actigraphy data collected and analysed in the course of the study "Uncoupling of Behavioral and Metabolic Twenty-Four-Hour Rhythms in Reindeer" (Current Biology, Meier et al. 2024). Details on data processing and plotting can be found in the published article. Further information and codes can be requested from the first author Sara A. Meier.</p>
Beef quality labels: A combination of sensory acceptance test, stated willingness to pay, and choice-based conjoint analysis
No full textBenefits trickling away: The health impact of extending access to piped water and sanitation in urban Yemen
No full textThis article investigates the impact of piped water supply and sanitation on health outcomes in urban Yemen using a combination of quasi-experimental methods and results from microbiological water tests. Variations in project roll-out allow separate identification of water and sanitation impacts. Results indicate that access to piped water supply worsens health outcomes when water rationing is frequent, which appears to be linked to a build-up of pollution in the network. When water supply is continuous no clear health benefits are found compared to traditional urban water supply through water vendors. Connections to piped sewers can lead to health improvements, conditional on regular water supply. The findings suggest that investments in piped water supply should not be made when availability and reliability of water cannot be guaranteed
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