INTRODUCTION AND OBJECTIVES:Medical treatments for overactive bladder (OAB) have proven efficacy in controlled trials. However, 1-year treatment persistence is reported to be as low as 25% for anticholinergics and 40% for β3 agonists. Real-world data on treatment continuation and treatment sequence is limited. Therefore, we aimed to study treatment persistence trends in women initiated on OAB medications.MATERIALS AND METHODS:We used advanced data-mining techniques to query the largest regional provider's medication purchase database, dispensing for patients, for all women initiating OAB pharmacotherapy between 2010 and 2020. Treatment persistence was measured as days in which the patient was in possession of medication and nonpersistence was defined as prescription nonrefilling for 90 days. We employed a Sankey diagram to explore trends in OAB medication acquisition and treatment sequence. We compared treatment persistence using Kaplan-Meier survival curves and pairwise log-rank analysis.RESULTS:Here, 46 079 women made 791 681 unique claims of OAB medications. Only 39% of the patients tried more than one OAB formulation, including dose change. The overall persistence rate for all drugs was 55% in 30 days, 46% in 90 days, and 37% per year. The persistence rate for Mirabegron at 30 days was 54%, 42% at 90 days, and 17% at 1 year. Overall, persistence rates were unchanged when stratifying by the time Mirabegron insurance acceptance into coverage (p > 0.05).CONCLUSIONS:Real-world OAB pharmacotherapy persistence rates are lower than previously reported. The introduction of Mirabegron did not seem to improve these rates or affect the treatment sequence.

Background Ciprofloxacin is a widely used antibiotic that has lost efficiency due to extensive resistance. We developed machine learning (ML) models that predict the probability of ciprofloxacin resistance in hospitalized patients. Methods Data were collected from electronic records of hospitalized patients with positive bacterial cultures, during 2016-2019. Susceptibility results to ciprofloxacin ( n = 10,053 cultures) were obtained for Escherichia coli, Klebsiella pneumoniae, Morganella morganii, Pseudomonas aeruginosa , Proteus mirabilis and Staphylococcus aureus . An ensemble model, combining several base models, was developed to predict ciprofloxacin resistant cultures, either with (gnostic) or without (agnostic) information on the infecting bacterial species. Results The ensemble models’ predictions are well-calibrated, and yield ROC-AUCs (area under the receiver operating characteristic curve) of 0.737 (95%CI 0.715–0.758) and 0.837 (95%CI 0.821–0.854) on independent test-sets for the agnostic and gnostic datasets, respectively. Shapley additive explanations analysis identifies that influential variables are related to resistance of previous infections, where patients arrived from (hospital, nursing home, etc.), and recent resistance frequencies in the hospital. A decision curve analysis reveals that implementing our models can be beneficial in a wide range of cost-benefits considerations of ciprofloxacin administration. Conclusions This study develops ML models to predict ciprofloxacin resistance in hospitalized patients. The models achieve high predictive ability, are well calibrated, have substantial net-benefit across a wide range of conditions, and rely on predictors consistent with the literature. This is a further step on the way to inclusion of ML decision support systems into clinical practice.

You have accessJournal of UrologyCME1 May 2022MP07-11 REAL WORLD MEDICATION PERSISTENCE IN TREATMENT OF WOMEN WITH OVERACTIVE BLADDER ACCORDING TO LARGE SCALE PRESCRIPTION CLAIMS DATA Chen Shenhar, Karin Lifshitz, Igor Mintz, Yariv Shtabholtz, Ofer Yossepowitch, Jack Baniel, and Shachar Aharony Chen ShenharChen Shenhar More articles by this author , Karin LifshitzKarin Lifshitz More articles by this author , Igor MintzIgor Mintz More articles by this author , Yariv ShtabholtzYariv Shtabholtz More articles by this author , Ofer YossepowitchOfer Yossepowitch More articles by this author , Jack BanielJack Baniel More articles by this author , and Shachar AharonyShachar Aharony More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002529.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Medical treatments for overactive bladder (OAB) have proven efficacy in controlled trials. However, 1-year medication persistence is reported to be as low as 25% for anticholinergics and 40% for β3 agonists. Real world data on treatment continuation and sequence in case of medication replacement is limited. Our aim was to study actual treatment persistence trends in women initiated on OAB medications. METHODS: We used advanced data-mining techniques to explore the largest regional provider’s medication purchase database, dispensing for over 400,000 patients, for all women initiating OAB pharmacotherapy between 2010 and 2020, and cross-referenced them with patient age, BMI, and smoking status. Medication persistence was measured in days for which the patient was issued a medication, and prescription non-refilling for 90 days was defined as non-persistence. We employed a Sankey diagram to map trends in OAB medication claims and treatment sequence. We further compared medication persistence using Kaplan-Meier survival curves and pairwise log-rank analysis. We studied the effects of age and smoking status on medication continuation using logistic regression modelling. RESULTS: Between 2010 and 2020, 46,079 women made 791,681 unique acquisitions of OAB medications. Overall treatment persistence rates were 49% for 30 days, 34% for 90 days, and 9% for a year. The 1-year persistence rate was highest for Mirabegron (10%) and Oxybutynin (11%) compared with all other medications (4%) (p<0.005). Overall persistence rates were unchanged when stratifying by time of Mirabegron acceptance into insurance coverage (p>0.05). Patients persisting with treatment for over 90 days were 5 years older compared to their non-persisting counterparts (mean age 72.8±14.3 vs. 67.5±16.5 years, p<0.05). Non-smokers had an odds ratio of 1.1 [95% CI: 1.04-1.16] of persistence when compared to smokers. CONCLUSIONS: Real-world OAB pharmacotherapy persistence rates are lower than previously reported. The added option of Mirabegron did not seem to improve these rates. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e119 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chen Shenhar More articles by this author Karin Lifshitz More articles by this author Igor Mintz More articles by this author Yariv Shtabholtz More articles by this author Ofer Yossepowitch More articles by this author Jack Baniel More articles by this author Shachar Aharony More articles by this author Expand All Advertisement PDF DownloadLoading ...

BACKGROUND:The use of online medical forums is on the rise globally. Data scraping is a method of extracting website content using an automated computer program. We scraped users' questions regarding back and neck pain (BNP) from popular Israeli online medical forums. We aimed to identify the sort of questions being asked about BNP, and to analyse explicit themes that characterize their questions.METHODS:Six leading Israeli BNP forums were identified. In phase 1, Python scripts scraped 12,418 questions into a data set. In phase 2 - five themes were identified: Surgery (n = 2,957); health care professions (n = 2,361); Sports (n = 2,304); drugs (n = 1,419) and interpretation of imaging (n = 845). Phase 3 - included the categorization of explicit fear-related words by the authors. Phase 4 - analysis of explicit fear-related themes yielded 402 questions.RESULTS:Gender was identified for 394 users, and age was identified for 181 users. A total of 248 users (61.6%) were women and 146 men (36.3%). Mean age 36.3 ± 16.15 for women and 35.5 ± 16.1 for men. The most commonly expressed fears were related to: invasive procedures, 30.9% (131 questions); fear of serious condition or misdiagnosis, 17.0% (72 questions); General concerns, 13.7% (58 questions); fear of worsening or relapse, 12.3% (52 questions); adverse effects of oral drugs or radiation, 10.8% (46 questions) and concerns related to lifestyle, 9.7% (41 questions).CONCLUSIONS:Web scraping is a feasible strategy with which to explore medical forums and the above-mentioned themes, all of which are of potential clinical significance.SIGNIFICANCE:Using automated algorithms, a total of 12,369 questions from online back and neck medical forums were scraped and analysed. Secondary analysis categorized fear-related themes that were mentioned by users. Identifying and addressing patients' fear has potential to improve communication and therapeutic outcome. For example, questions regarding surgery were typically asked after the option was mentioned by a physician. This insight should encourage physicians to devote extra time explaining the possible implications of surgery, should they consider it as an option.

Age-related decline in physiological, physical and cognitive functions as well as disabilities resulting from pathological conditions may interfere with the ability to adapt to the environmental and social demands. It is important to understand and characterize the ways in which these age-related is to present a multi-dimensional approach to assess performance of a simulated complex daily activity of older adults compared to young adults. Six young adults aged 28.2 ± 4.3 years and seven community dwelling older adults aged 74.3 ±5.8 years were tested during a single session. After training on a self-paced treadmill a non-functional simulation to learn how to navigate within the virtual environment (VE), they perform the Virtual Multiple Errands Test (VMET) in a mall simulation. The young adults performed the VMET significantly better than the older group. In contrast, the older group made significantly more stops while performing the VMET, they walked for a greater distance and wandered about more in the VE. The results of this study provide support for the need to use more realistic virtual environments that truly simulate the challenges experienced by people when engaging in functional tasks.

The purpose of this paper was to demonstrate a proof of concept concerning the design and implementation of a simulation that replicates a real world environment in order to evaluate a complex task of shopping within a mall while measuring cognitive, motor and metabolic aspects of the task. The paper presents the experimental protocol and results from four young healthy and two elderly adults who performed the Multiple Errands Test in both simulated and real world settings. These initial findings show the feasibility of the protocol in both environments.