Objective To review the literature on the association between antidiabetic agents and morbidity and mortality in people with heart failure and diabetes. Design Systematic review and meta-analysis of controlled studies (randomised trials or cohort studies) evaluating antidiabetic agents and outcomes (death and admission to hospital) in patients with heart failure and diabetes. Data sources Electronic databases, manual reference search, and contact with investigators. Review methods Two reviewers independently extracted data. Risk estimates for specific treatments were abstracted and pooled estimates derived by metaanalysis where appropriate. Results Eight studies were included. Three of four studies found that insulin use was associated with increased risk for all cause mortality (odds ratio 1.25, 95% confidence interval 1.03 to 1.51; 3.42, 1.40 to 8.37 in studies that did not adjust for diet and antidiabetic drugs; hazard ratio 1.66, 1.20 to 2.31; 0.96, 0.88 to 1.05 in the studies that did). Metformin was associated with significantly reduced all cause mortality in two studies (hazard ratio 0.86, 0.78 to 0.97) compared with other antidiabetic drugs and insulin; 0.70, 0.54 to 0.91 compared with sulfonylureas); a similar trend was seen in a third. Metformin was not associated with increased hospital admission for any cause or for heart failure specifically. In four studies, use of thiazolidinediones was associated with reduced all cause mortality (pooled odds ratio 0.83, 0.71 to 0.97, I 2 =52%, P=0.02). Thiazolidinediones were associated with increased risk of hospital admission for heart failure (pooled odds ratio 1.13 (1.04 to 1.22), I 2 =0%, P=0.004). The two studies of sulfonylureas had conflicting results, probably because of differences in comparator treatments. Important limitations were noted in all studies. Conclusion Metformin was the only antidiabetic agent not associated with harm in patients with heart failure and diabetes. It was associated with reduced all cause mortality in two of the three studies. INTRODUCTIONWorldwide, more than 171 million people have diabetes, and its prevalence is expected to double by 2030.1 People with diabetes are at increased risk of developing heart failure, 2 3 with the relative risk increasing by 10-15% per unit increase in glycated haemoglobin. [4][5][6][7] Conversely, heart failure is present in 25-40% of all adults with diabetes.2 8-12 Moreover, people with heart failure have worse outcomes if they also have diabetes, [13][14][15] and it has been suggested that any level of hyperglycaemia is associated with increased rates of hospital admission, even in patients without manifest diabetes. 16How best to achieve glycaemic control in patients with diabetes and heart failure is therefore an important clinical question. Many antidiabetic drugs are now available to control hyperglycaemia. However, their role in managing diabetes in patients with heart failure is uncertain, 17 and considerable controversy exists about the overall effect of antidiabetic agents on ou...

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We conducted a population-based cohort study using administrative databases to quantify the association between oral and inhaled corticosteroid use and onset of diabetes mellitus in the elderly. Proton pump inhibitor (PPI) users were used as a control group. Relative to PPI users (N = 53,845), oral corticosteroid users (N = 31,864) were more likely to develop diabetes (adjusted rate ratio [aRR], 2.31; 95% confidence interval [95% CI], 2.11 to 2.54); however, inhaled corticosteroid users (N = 38,441) were not (aRR, 1.03; 95% CI, 0.93 to 1.14). The estimated number needed to harm for continuous use of oral corticosteroids relative to PPIs over 1, 2, and 3 years of use were 41, 23, and 16, respectively.

Objective: To validate a case definition of multiple sclerosis (MS) using health administrative data and to provide the first province-wide estimates of MS incidence and prevalence for Saskatchewan, Canada. Methods: We used population-based health administrative data between January 1, 1996 and December 31, 2015 to identify individuals with MS using two potential case definitions: (1) ≥3 hospital, physician, or prescription claims (Marrie definition); (2) ≥1 hospitalization or ≥5 physician claims within 2 years (Canadian Chronic Disease Surveillance System [CCDSS] definition). We validated the case definitions using diagnoses from medical records (n = 400) as the gold standard. Results: The Marrie definition had a sensitivity of 99.5% (95% confidence interval [CI] 92.3-99.2), specificity of 98.5% (95% CI 97.3-100.0), positive predictive value (PPV) of 99.5% (95% CI 97.2-100.0), and negative predictive value (NPV) of 97.5% (95% CI 94.4-99.2). The CCDSS definition had a sensitivity of 91.0% (95% CI 81.2-94.6), specificity of 99.0% (95% CI 96.4-99.9), PPV of 98.9% (95% CI 96.1-99.9), and NPV of 91.7% (95% CI 87.2-95.0). Using the more sensitive Marrie definition, the average annual adjusted incidence per 100,000 between 2001 and 2013 was 16.5 (95% CI 15.8-17.2), and the age-and sex-standardized prevalence of MS in Saskatchewan in 2013 was 313.6 per 100,000 (95% CI 303.0-324.3). Over the study period, incidence remained stable while prevalence increased slightly. Conclusion: We confirm Saskatchewan has one of the highest rates of MS in the world. Similar to other regions in Canada, incidence has remained stable while prevalence has gradually increased. RÉSUMÉ: Établir l'incidence et la prévalence de la sclérose en plaques en Saskatchewan. Objectif: Au moyen de données administratives relatives à la santé, valider une définition des cas de sclérose en plaques (SP) et fournir les premières estimations de l'incidence et de la prévalence de la SP en Saskatchewan. Méthodes: Les données administratives que nous avons utilisées se rapportaient à la période allant du 1 er janvier 1996 au 31 décembre 2015 et étaient relatives à la population de la Saskatchewan. Nous avons ainsi cherché à identifier des individus atteints de SP au moyen de deux définitions de cas potentielles : (1) ≥3 demandes de remboursement d'un hôpital, actes facturés par un médecin ou demandes de règlement relatives à un médicament sur ordonnance (définition de Marrie); (2) ≥1 hospitalisation ou ≥5 actes facturés par un médecin au cours de deux ans (définition du Système canadien de surveillance des maladies chroniques [SCSMC]). À titre de norme de référence, nous avons ensuite validé ces définitions de cas en nous référant à des diagnostics établis dans des dossiers médicaux (n = 400). IC 95 %, 96,9), une VPP de 98,9 % (IC 95 %, 96,9) et une VPN de 91,7 % (IC 95 %, 87,0). À l'aide de la définition de Marrie, plus sensible, il appert que l'incidence moyenne annuelle ajustée de SP par 100 000 habitants était, entre 2001. En ce qui regarde la ...

Published studies have not found a strong association between low SES and nonadherence to antihypertensive medications. However, important limitations in the assessment of SES can be identified in virtually all studies. Future studies are required to ascertain whether a stronger association is observed when SES is determined by comprehensive measures.

A detectable excess of cardiovascular morbidity appears to be associated with nonadherence to statin therapy. Our analysis suggests that many occurrences of myocardial infarction could be prevented with improvements in adherence. Larger studies are necessary to determine the association between adherence and other cardiovascular end points.

Motion-induced vibration can be greatly reduced by properly shaping the reference command. Input shaping is one type of reference shaping method that is based largely on linear superposition. In this paper we document the impact of nonlinear crane dynamics on the effectiveness of input shaping. As typical bridge cranes are driven using Cartesian motions, they behave nearly linearly for low- and moderate-velocity motions. On the other hand, the natural rotational motions of tower cranes make them more nonlinear. The nonlinear equations of motion for both bridge and tower cranes are presented and experimentally verified using two portable cranes. The effectiveness of input shaping on the near-linear bridge crane is explained. Then, a command-shaping algorithm is developed to improve vibration reduction during the more nonlinear slewing motions of the tower crane. Experimental results demonstrate the effectiveness of the proposed approach over a wide range of operating conditions.

BackgroundSeveral educational interventions have been designed to improve patient knowledge before and after kidney transplantation. However, evaluation of such interventions has been difficult because validated instruments to measure knowledge-based outcomes in this population have not been developed.ObjectiveTo create a tool to measure patient knowledge of kidney transplantation and to evaluate its validity.MethodsThe Kidney Transplant Understanding Tool (K-TUT) was created using a stepwise iterative process. Experts in the field and transplant recipients were consulted to establish content validity. The K-TUT consists of 9 true/false and 13 multiple-choice questions, and scores are based on the number correct answers [YES/NO format] of 69 items. The questionnaire was piloted in a study that also measured health literacy (via the Short Test of Functional Health Literacy) in transplant candidates, whereas the main survey was mailed to transplant recipients. Test-retest was performed, and completed surveys were analyzed for internal consistency, construct validity, floor and ceiling effects, and reproducibility.ResultsSurveys were offered to 106 pretransplant patients and 235 in the posttransplant period, and response rates were 38.7% (41/106) and 63.4% (149/235), respectively. The mean corrected scores were 53.1 ± 8.5 (77%) and 56.2 ± 6.3 (81%), respectively. Test-retest was performed over 20% of both cohorts and percent agreement ranged between 70% and 100% in the pretransplant group and 66% and 100% in the posttransplant group. Cronbach α ranged from 0.794 to 0.875 in all cohorts indicating favorable internal consistency. Increased health literacy in the pretransplant group was significantly associated with increased knowledge (r = 0.52; P < 0.001), suggestive of construct validity, and the absence of floor and ceiling effects was positive. The majority of transplant recipients (98/148, 67%) believed the questionnaire adequately assessed transplant knowledge, about a quarter (36/148, 24.3%) were “unsure,” and 85% (126/148) agreed that no questions should be removed.ConclusionsAlthough more study is warranted to further assess psychometric properties, the K-TUT appears to be a promising tool to measure transplant knowledge.