Aim: To assess real-world treatment profiles, including the time to and reasons for discontinuation or drug switching, treatment reinitiation, and postdiscontinuation follow-up in patients receiving antimuscarinics or ß3-agonists for overactive bladder (OAB) through a retrospective chart review. Methods: We retrospectively reviewed medical charts of 777 patients, aged ≥18 years, who underwent antimuscarinic or ß3-agonist therapy at our hospital. Data on patient's age, sex, chief complaint, and OAB symptom score at therapy initiation were collected. Treatment persistence was assessed with respect to the median time to discontinuation and the persistence rate at 12 months. Results: Older patients, male patients, and those with more severe urgency symptoms were more likely to show treatment persistence with OAB medications. Treatment persistence with mirabegron was significantly longer than that with antimuscarinics when administered as either the first-or second-line medication. Multivariate analyses showed that urgency severity and use of mirabegron were independently associated with better persistence (p = .026 and p = .018, respectively). Out of 583 patients who discontinued medication, 344 continued with the visit schedule, and the reinitiation rate of the OAB medication was 19% at a median follow-up of 24 months. Conclusion: Although the persistence rates for OAB medications improved with the introduction of mirabegron, most patients still discontinued the medication therapy within 1 year. The treatment strategies for patients with mild symptoms and those who are resistant to medication can still be improved. Tailored individualized treatments that avoid excessive reliance on pharmacotherapy would be key to further improve treatment outcomes in OAB patients.
Recently, spoken keyword detection (SKD) systems that listen live audio and tries to capture user's utterances with specific keywords has been extensively studied, in order to realize a truly usable hands-free speech interface in our life: “Okay google” in Google products, “Hey, Siri” on Apple products and “Alexa” on Amazon Alexa / Amazon echo. Since the keyword detectors are typically built from large number of actually spoken keywords, they are irreplaceable and the users of such systems are forced to speak only the keyword they defined. On the other hand, a SKD method based on keyword-filler model using generic phoneme model and garbage filler sequence model is promising in that, since the acoustic pattern of the keyword will can be given as phoneme sequence, it is task-dependent and anyone can use his own keyword. In this study, an improvement of the latter method is studied. Recurrent neural network language model (RNNLM) is introduced as linguistic constraint for both filler-filler and filler-keyword instead of N-gram, and experimental result on actual spoken data for a spoken dialogue system showed that our method can improve the keyword detection performance.
To assess real-world treatment profiles, including utilization rate, time to and reasons for discontinuation of combination pharmacotherapy with β 3 -agonists and antimuscarinics for refractory overactive bladder (OAB) through a retrospective chart review. Methods:We retrospectively reviewed the records of OAB patients who received β 3 -agonists or antimuscarinics at our hospital between 2012 and 2020 and analyzed the clinical course of patients who progressed to combination therapy. Data on age, sex, major complaints, OAB symptom score at the initiation of combination therapy, treatment persistence, and reasons for discontinuation were collected. Treatment persistence was assessed with respect to the median time to discontinuation and persistence rate at 12 months. Results: Of the 2163 patients receiving β 3 -agonists or antimuscarinics, only 84 (3.8%) progressed to combination therapy with both drug classes. At therapy initiation, most (98%) of these patients had moderate to severe OAB symptoms. Median treatment duration and 12-month persistence rate for combination therapy were 595 days and 64.0%, respectively. The reasons for discontinuation were insufficient treatment efficacy followed by adverse effects including voiding impairment in nearly 10% of the patients. None of the baseline parameters was independently associated with persistence in the multivariate analysis. Conclusion: While underutilized among OAB patients refractory to monotherapy, combination pharmacotherapy showed a greater persistence rate than published mirabegron or antimuscarinic monotherapy when applied to patients with moderate to severe symptoms. Treatment-emergent voiding impairment is a concern associated with this mode of therapy. A small sample size at a single institution is the limitation of this study.
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