scholarly journals Factors Associated with Decisions for Initial Dosing, Up-Titration of Propiverine and Treatment Outcomes in Overactive Bladder Syndrome Patients in a Non-Interventional Setting

2021 ◽  
Vol 10 (2) ◽  
pp. 311
Author(s):  
Marjan Amiri ◽  
Tim Schneider ◽  
Matthias Oelke ◽  
Sandra Murgas ◽  
Martin C. Michel

Two doses of propiverine ER (30 and 45 mg/d) are available for the treatment of overactive bladder (OAB) syndrome. We have explored factors associated with the initial dosing choice (allocation bias), the decision to adapt dosing (escalation bias) and how dosing relative to other factors affects treatment outcomes. Data from two non-interventional studies of 1335 and 745 OAB patients, respectively, receiving treatment with propiverine, were analyzed post-hoc. Multivariate analysis was applied to identify factors associated with dosing decisions and treatment outcomes. Several parameters were associated with dose choice, escalation to higher dose or treatment outcomes, but only few exhibited a consistent association across both studies. These were younger age for initial dose choice and basal number of urgency and change in incontinence episodes for up-titration. Treatment outcome (difference between values at 12 weeks vs. baseline) for each OAB system was strongly driven by the respective baseline value, whereas no other parameter exhibited a consistent association. Patients starting on the 30 mg dose and escalating to 45 mg after 4 weeks had outcomes comparable with those staying on a starting dose of 30 or 45 mg. We conclude that dose escalation after 4 weeks brings OAB patients with an initially limited improvement to a level seen in initially good responders. Analysis of underlying factors yielded surprisingly little consistent insight.

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Zafirah Amalina binti Zulkipli ◽  
Muhammad Amir Hafiz bin Mohd Salleh ◽  
Musaab Nassereldeen Ahmed

Introduction: Tuberculosis (TB) remains a formidable public health concern in Malaysia. Malaysia’s national treatment success rate is still below the ideal 90% positive outcome recommended by the End TB Strategy (2015-2035). In this study, we evaluated the treatment outcomes and associated predictors of smear or culture positive pulmonary tuberculosis (PTB) patients. Materials and Methods: This is a retrospective cohort study conducted in chest clinic of Hospital Tengku Ampuan Afzan (HTAA), Pahang from January 2012 to December 2016. PTB cases in HTAA were crosschecked with TB registry and patients who fulfilled the inclusion criteria were selected. Data was collected using a standardized clinical report form and analyzed using multiple logistic regression. Results: There were a total of 342 patients recruited. Majority were Malaysian (94.2%), male (67.8%) and Malay (80.0%). The treatment success rate was 55.26%, with a cure rate of 42.98%. The high portion of defaulters (21.05%) in our study population was amongst the most striking findings. Multiple logistic regression analysis revealed that the factors associated with unfavourable treatment outcome were time in treatment, case after treatment interruption or failure and poor compliance. Univariate analysis revealed that male, hepatitis, smoking and intravenous drug user were found to be significant factors associated with poorer treatment outcomes. Conclusion: Achieving a higher patient retention rate is a significant factor in increasing effectiveness of treatment services. Thus, our study recommends stricter Directly Observed Treatment, Short Course (DOTS) and an enhanced understanding of the real barriers to patients’ treatment regimen adherence in order to overcome them.


2019 ◽  
Author(s):  
Mahmud Abdulkader ◽  
Ischa van Aken ◽  
Selam Sahle Niguse ◽  
Haftamu Hailekiros ◽  
Mark Spigt

Abstract Objective Evidence on treatment outcomes and identifying factors facilitating treatment success through a register based retrospective study have significant contribution in the improvement of a National Tuberculosis Program. However there is a scarcity of data from peripheral health settings in Ethiopia. Therefore this study was aimed at determining treatment outcomes and factors associated with “successful treatment” outcomes among tuberculosis patients.Results A total of 3445 patient records were included. More than half, (58%) were males and the mean age was 33.88 ± 16.91 (range: 0-90). Majority, 1471 (42.7%) had extra-pulmonary TB. From the total TB patients, 18.8% were HIV co infected. The overall treatment success rate was 89.5%. The treatment outcome of TB patients were 371 (10.8%) cured, 2234 (64.8) treatment completed, died 119 (3.5%) died, 9 (0.3%) failed, 178 (5.1%) defaulted and 534 (15.5%) were transferred out. A successful treatment outcome was achieved in 2605 (89.3%). Multinomial regression analysis revealed that being new treatment case (AOR 1.76; 95% CI: 1.19 to 2.60, p=0.005) and age less than 17 years old (AOR 1.65; 95% CI: 1.01 to 2.68, p=0.045) to be statistically associated with favorable treatment outcome.


2021 ◽  
Vol 91 (1) ◽  
Author(s):  
Lilit Khachatryan ◽  
Ruzanna Grigoryan ◽  
Andrei Dadu ◽  
Ajay M.V. Kumar ◽  
Kristina Akopyan ◽  
...  

Rifampicin-Resistant/Multidrug-Resistant Tuberculosis (RR/MDR-TB) is recognized as a major public health concern globally. In Armenia, the proportion of RR/MDR-TB is increasing among all people affected with TB. We conducted a nationwide cohort study involving analysis of programmatic data to investigate the rates of and factors associated with unfavourable treatment outcomes among patients with RR/MDR-TB registered by the national TB programme from 2014 to 2017 in Armenia. We used Cox regression to identify factors associated with the outcome. Among 451 RR/MDR-TB patients, 80% were men and median age was 46 years. Of them, 53 (11.8%) had Extensively Drug-Resistant Tuberculosis (XDR-TB) and 132 (29.3%) had pre-XDR-TB. Almost half (224, 49.7%) of the patients had unfavourable treatment outcome, which included 26.8% Loss To Follow-Up (LTFU), 13.3% failures and 9.5% deaths. In multivariable analysis, people with pre-XDR-TB [adjusted Hazard Ratio [aHR] 3.13, 95% confidence intervals [CI] 2.16-4.55] and XDR-TB (aHR 4.08, 95% CI 2.45-6.79) had a higher risk of unfavourable outcomes. Patients receiving home-based treatment (71/451, 15.7%) and treatment with new drugs (172/451, 38.1%) had significantly lower risk (aHR 0.45, 95% CI 0.28-0.72 and aHR 0.26, 95% CI 0.18-0.39) of unfavourable treatment outcome.  The proportion of MDR-TB patients reaching favourable treatment outcome in Armenia was substantially lower than the recommended level (75%). The most common treatment outcome was LTFU indicating the need for further assessment of underlying determinants. Home-based treatment looks promising and future studies are required to see if expanding it to all RR/MDR-TB patients is feasible and cost-effective.


PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244581
Author(s):  
Olanrewaju Oladimeji ◽  
Victor Adepoju ◽  
Felix Emeka Anyiam ◽  
James Emmanuel San ◽  
Babatunde A. Odugbemi ◽  
...  

Background The Lagos State Tuberculosis, Buruli Ulcer, and Leprosy Control Program (LSTBLCP) started engaging private hospitals under the Public-Private Mix (PPM) Program in 2008. The study aimed to evaluate the trend and predictors of successful Tuberculosis (TB) treatment outcomes of patients managed across these private health facilities between 2010–2016 in Lagos, Nigeria. Methods Retrospective review of TB treatment register and treatment cards of patients commenced on TB treatment between January 2010 and December 2016 in 36 private health facilities engaged by the LSTBLCP. Between December 2016 and February 2017, data were collected and entered into Microsoft Excel by trained data entry clerks. The analysis was done using SPSS software. Independent predictors of successful treatment outcomes were determined using multivariate analysis at the statistical significance of p<0.05 and 95% confidence interval. Results A total of 1660 records of TB patients were reviewed. 1535 (92.47%) commenced treatment, while 1337 (87.10%) of all records had documented treatment outcomes. Of the 1337 patients with outcomes, 1044 (78.09%) had a successful treatment outcome, and 293 (21.91%) had an unsuccessful outcome. Majority were male, 980 (59.04%), Human Immunodeficiency Virus (HIV) negative status, 1295 (80.24%), diagnosed with smear, 1141 (73.14%), treated in private not-for-profit (PNFP) hospital, 1097 (66.08%), treated for TB between 2014–2016 (18.96%-19.52%). In multivariate analysis, age>20years (aOR = 0.26, p = 0.001), receiving TB treatment in 2013 (aOR = 0.39, p = 0.001), having genexpert for TB diagnosis (aOR = 0.26, p = 0.031) and being HIV positive (aOR = 0.37, p = 0.001) significantly reduced likelihood of successful treatment outcome. The site of TB, being on ART or CPT, were confounding determinants of successful treatment outcomes as they became non-significant at the multivariate analysis level. Conclusion Treatment outcome among Lagos private hospitals was low compared with NTBLCP and World Health Organization (WHO) target. We urge the government and TB stakeholders to strengthen the PPM interventions to improve adherence, particularly among People Living with HIV (PLHIV) and older TB patients. Hence, promotion of early care-seeking, improving diagnostic and case holding efficiencies of health facilities, and TB/HIV collaborative interventions can reduce the risk of an unsuccessful outcome.


2017 ◽  
Vol 20 (4) ◽  
pp. 474-483
Author(s):  
Albênica Paulino dos Santos Bontempo ◽  
Aline Teixeira Alves ◽  
Gabriela de Sousa Martins ◽  
Raquel Henriques Jácomo ◽  
Danieli Coeli Malschik ◽  
...  

Abstract Objective: to identify risk factors related to overactive bladder syndrome. Method: a cross-sectional study was performed with elderly women (>60 years) from the community of Ceilândia, in the Distrito Federal, Brazil, with or without symptoms of OBS, who were evaluated through interviews and questionnaires. The clinical and sociodemographic variables analyzed were: age; body mass index (BMI); parity, schooling, previous abdominal and urogynecologic surgeries, physical activity, smoking, constipation, systemic arterial hypertension (SAH), diabetes mellitus; depression and anxiety. The questionnaires applied were the Overactive Bladder Awareness Tool (OAB-V8), the Geriatric Depression Scale and the Beck Anxiety Scale. Data were analyzed descriptively. Binary logistic regression was used to evaluate the significant associations between the independent variables and the outcome of interest. Risk ratios were calculated for each independent variable with 95% confidence intervals. Result: A total of 372 volunteers were recruited, 292 of whom were eligible. Of these, 172 were allocated to the case group (58.9%) and 120 (41.1%) were control subjects. The two groups were homogeneous between one another. There was a high prevalence of OBS in the study population and significant differences for the variables presence of SAH, abdominal surgery and pelvic surgery, with the case group presenting a higher frequency of these events. In multivariate analysis, it was observed that an active sexual life reduces the chance of having OBS by 70.8%, while urogynecologic surgeries increase this risk 3.098 times. Conclusion: In univariate logistic regression analysis, BMI, SAH, a previous history of abdominal and urogynecologic surgery, number of abortions and the presence of symptoms of depression and anxiety, were found to be factors associated with OBS.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Gebremeskel Mirutse ◽  
Mingwang Fang ◽  
Alemayehu Bayray Kahsay ◽  
Xiao Ma

Abstract Background Childhood TB is an indicator of a recent transmission of the disease in a community and it is estimated to constitute 15–20% of all TB cases in many of developing countries. However, only few studies which dominated by industrial countries were engaged to assess the situation. Therefore, this study was aimed to see epidemiology of childhood TB and factors associated with poor treatment outcome in developing country. Method Using retrospective cross-sectional study design; Socio-demographic and clinical data of children aged less than 15 years old, treated for all forms of TB in the past 10 years (2007–2016) was collected from randomly selected eight public hospitals of Tigray. Then, Univariate logistic regression and adjusted multivariate logistic regressions was done to identify variables which had association with unsuccessful treatment outcomes at P-value less than 0.05. Result In the past 10 years, a total of 13,345 Tuberculosis cases were observed. Of these, 1086 (8.1%) cases were children aged less than 15 years old. Sixty seven (6.2%) cases were smear positive. Among those that tested for HIV, 69 (8.3%) cases were TB/HIV co-infected. Of those with treatment outcome record 746 (88.7%) were successfully treated. Factors like being female (AOR, 1.79; 95% CI, 1.07–3.00), Age 0–5 years (AOR, 3.35; 95% CI, 2.11–5.33), Unknown HIV status (AOR, 2.44; 95% CI, 1.51–3.95) and pulmonary positive case (AOR, 2.56; 95% CI, 1.13–5.77), were more likely to have unsuccessful treatment outcome than their counterparts. Conclusion In Tigray 8.1% all TB cases were children age less than 15 years old. Childhood TB treatment outcome varied with sex, age and HIV status.


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