Antimicrobial Susceptibility Pattern in Chronic Suppurative Otitis Media Patient in a Tertiary Care Hospital

VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8

A845

Objectives: The success of dental care is highly dependent on an individualized treatment plan with attainable goals and the absence of adverse impacts on individual wellbeing. The most widely used instrument to measure such an influence in an adult patient population is the Oral Health Impact Profile— OHIP (G.D.Slade, A.J.Spencer,1994). Therefore, the present study aimed to evaluate the prosthetic treatment outcomes by means of consistent patient-centered tool.  Methods: Cross-sectional study was conducted over a five-year period on 256 partially edentulous patients, who were treated in the Stomatological Medical Center of Danylo Halytskyi Lviv National Medical University. Among them in 52 persons (37-71,2%-females, 15-28,8%-males), ranged in age 55-80 years, information before and after prosthetic treatment was collected by OHIP-14 structured questionnaire (validated translation) with additional questions relating to the treatment goal attainment (G.D.Slade,2007). Data were analyzed using the paired t-test and Spearman’s rho in SPSS Statistics (p-value for statistical significance was set at< 0,05).  Results: There were statistically significant improvements in patients’ average ratings one-month after treatment—decrease from 4,3 to 1,4 impacts per person(p= 0,023) and increase of perceived treatment goal from an average 4,8 to 6,3 per person (p= 0,014). Consequently, positive correlation (rho= 0,68, p< 0,05) was observed between the mean number of impacts (1,4 per person) and the level of patients’ satisfaction (6,3 per person) as the ranked variables. Nevertheless, threeyears after treatment the number of adverse impacts on daily life increased from an average of 1,4 to 3,7 per person (p= 0,046), and those 3,7 impacts correlated negatively (rho= -0,23, p< 0,05) with average self rating of perceived treatment goal (6,3 per person) one-month after treatment.  Conclusions: Self-reported patients’ satisfaction one-month after treatment is not closely related to the long term OHIP-14 scores. Significant increase of OHIP-14 scores three-years after treatment clearly indicates the need of subsequent prosthetic corrective measures.

Objectives: This study aims to review the impact of traditional medicine treatment on the quality of life (QoL) of the atopic dermatitis (AD) patients.  Methods: We searched the PubMed, Oasis, NDSL, RISS, CNKI and J-Stage for published papers. We included randomized controlled trials on traditional medicine for AD which evaluated the improvement of QoL as outcome measurement and excluded animal studies and review papers. We qualitatively analyzed characteristics of the studies by several categories such as origin of trials, diagnostic method, treatment method, QoL assessment method, evaluation of the impact of treatment on patient’s QoL and the incidence of adverse event.  Results: We reviewed 98 studies, and finally included 2 published papers in this study. Identified studies were both conducted in China region. All the studies recruited the age range of pediatric patients based on the criteria of Hanifin and Rajka that defined as moderate to severe AD. The types of treatment methods were varied. One was multi-arm trial which divided into a single oral administration of Chinese herbal formula (PTQXT) group, combination of PTQXT with Chinese herbal external wash formula group and positive control group. The other was single use of Chinese herbal medicine concoction compared with placebo drug. The studies measured QoL as general outcome by using certified Chinese version of the Children’s Dermatology Life Quality Index. The result showed that patients’ quality of daily life improved almost 30% (p= 0.023, p= 0.008). There were no reported adverse events.  Conclusions: The present study showed that we need to conduct more systematic and analytic researches for supporting clinical evidence of QoL improvement of traditional medicine for AD. We hope these valuable evidences can lead to modernize the health policy on traditional medicine for saving patients’ economic burden of disease as well as maintaining the patients’ QoL in the future.

PSS7 Predicted Demand For A New Injectable Solution For Delivering Glaucoma Medicine

SENSORY SYSTEMS DISORDERS – Health Care Use & Policy Studies

Ozdemir S1, Wong T2, Finkelstein EA3 1Duke-NUS Medical School, Singapore, Singapore, 2Singapore National Eye Centre, Singapore, Singapore, 3Duke NUS Medical School, Singapore, Singapore

Objectives: Non-compliance to eye drops for treating glaucoma is a major concern as it may lead to serious complications. A subconjunctivally injected solution, which is a new method of delivering glaucoma medicine, replaces the daily use of eye drops via a slow release mechanism. The injected solution can last several months and may be attractive to patients for its convenience. The objective of this study is to predict stated demand for a new injectable solution for delivering glaucoma medicine based on product features, patient characteristics and physician recommendation.  Methods: A web-enabled discrete-choice experiment (DCE) survey was administered to 500 glaucoma patients in the US who are part of an internet panel. Patients were asked to choose between an injectable solution and eye drops in a series of questions. The injectable solution was defined in terms of frequency of administration, out-of-pocket cost, percentage of patients who have adopted the new technology and doctor’s recommendation.  Results: The DCE survey results show that cost, frequency of administration, doctor recommendation and percentage of adaption of the technology among patients are all significant factors influencing patient preferences for a new injectable solution. However, patients are most sensitive to the out-of-pocket costs. About 9% are likely to be early adopters and will want the new technology even at fairly high prices, whereas 20% are unlikely to opt for the injectable solution at any price. The remaining 71% may opt for the injectable solution, depending on the price. Patient age was negatively and household income was positively correlated with uptake.  Conclusions: The demand for the injectable solution is likely to be roughly 15% in the early stages of market entry, but will increase over time to 30% or higher as more physicians begin to recommend the injectable solution to their patients, assuming it continues to have a strong safety and efficacy profile. PSS8 Fabrication of Anti-Vitiligo Ointment Containing Psoralia Corylifolia: Invitro and Invivo Characterization Hussain I1, Hussain N2, Manan A1, Ali B3, Rashid A4 1SMBB Medical University, Larkana, Larkana, Pakistan, 2BZU, Multan, Multan, Pakistan, 3Gomal University, Dera Ismail Khan, Pakistan, 4DRAP Pakistan, Islamabad, Pakistan

Objectives: Fabrication of Ointment and to explore the clinical outcome of ointment formulation containing seed powder of Psoralia corylifolia. Methods: 20 patients (Aged 25-65 years) were included in this study. Formulations were applied on effected body part of patients and some effected portion of the same patient was regarded as control (self control study design). The formulation that passed the required tests (pH, the temperature stability tests in 8 ±0.1°C, 25 ±0.1°C, 40 ±0.1°C, and the physical properties like color, bleeding and rheology) was selected. FTIR studies of Psoralia corylifolia seeds powder and formulation were performed. The pigmentation of white spots of Vitiligo was photographically evaluated before,during and after 12 weeks of treatment,  Results: A significant (p ≤  0.05) reduction in the pigmentation of skin was determined in all those 20 patients used ointment containing seed powder of P. corylifolia. Pre and post-treatment difference in the levels of pigmentation was statistically significant (p =  0.05). Hydrophilic ointment prepared with seed powder of P. corylifolia was found effective on Vitiligo as compared to self control.  Conclusions: Fabricated Ointment formulation containing seed powder of P. corylifolia could be an effective monotherapy for Vitiligo: PSS9 The Effect of Traditional Medicine on Quality of Life in Patients with Atopic Dermatitis: A Review of Recent Clinical Trials Ko Y, Cheon C, Jang B, Ko S Kyung Hee University, Seoul, South Korea

PSS10 Drug Utilization Evaluation of Amoxicillin-Clavulanic Acid in Csom Patients in a South Indian Hospital: A Retrospective Analysis Jayachandran L1, Kumar A1, Kumar S1, R B2, A S1 1Manipal University, Manipal, India, 2Manipal University, Udupi, India

Objectives: To calculate the defined daily dosage (DDD) of amoxicillin-clavulanic acid in Chronic Suppurative Otitis Media patients infected with Pseudomonas spp.  Methods: A retrospective study was conducted among CSOM patients treated for three years (2012-2014). The Institutional ethics committee clearance was obtained before collecting the data from medical records. The demographics, antibiotic culture sensitivity data and the antibiotics prescription pattern of CSOM patients were collected by using case report form. The drug utilization was evaluated by calculating the DDD. The DDD/1000 people/day was calculated for amoxicillin-clavulanic acid (for both oral and parenteral preparation), using the formula:- DDD/1000 people/day =  amount of drug (mg) sold in 1 year/[DDD (mg) * 365 days * no.of people]  Results: Among the 66 CSOM patients, 55.5% of the patients were males. CSOM tubotympanic disease was the most common type of CSOM accounting for 61.9% of the patients. Amoxicillin-clavulanic acid was prescribed in 50 patients that comprises of 75.75% of the patients. DDD/1000 people/ day was found to be 25.47 in 2012, 25 in 2013 and 41.32 in 2014 for the parenteral preparation, whereas for oral preparation DDD/1000 people/day was found to be 4.30 in 2012, 15.75 in 2013 and 19.17 in 2014.  Conclusions: This retrospective DUE of amoxicillin-clavulanic acid revealed that DDD has increased from 2012 – 2014 for Pseudomonas spp CSOM in this region (South India). Physicians need to adhere to antibiotic policy based on the susceptibility pattern to decrease the emergence of resistance against amoxicillin-clavulanic acid. Future, large scale studies are required to conclude the antibiotic consumption pattern in CSOM patients.

PSS11 Antimicrobial Susceptibility Pattern in Chronic Suppurative Otitis Media Patient in a Tertiary Care Hospital Kumar A1, Jayachandran L1, Kumar S2, R B3, A S2 1Manipal university, Manipal,udipi, India, 2Manipal University, Manipal, India, 3Manipal university, Manipal, India

Objectives: To assess the antimicrobial susceptibility pattern in chronic suppurative otitis media (CSOM) patients  Methods: A retrospective observational study was conducted for six months in CSOM patients after obtaining the ethical clearance. Patients treated in our hospital during 2012-2014 were included in the study. Demographic details and prescribing pattern of antibiotics were collected from case records. All adult patients who were given antibiotics after the culture sensitivity report were included. The sensitivity and resistance pattern of antibiotics was represented using antibiogram. Data were analysed using spss 20.0  Results: A total of 155 CSOM patients were recruited in the study. The most frequent causative organism was found to be Pseudomonas followed by MSSA, MRSA, Ecoli ,Acinetobactor, Proteus, Staphylococcus etc. Among the causative organisms, Amoxicillin/ Ampicillin was 100 % resistance to MRSA, Acinetobactor, Staphylococcus, E.coli , Citrobactor ,Klebsiella. In Psuedomonas Piperacillin/Tazobactum was found to be 100 % sensitive in 2012 but was reduced to 96 % in 2013-2014 whereas Cefaperazone/ Sulbactum was found to be 0 % sensitive in 2012 but increased to 85 % in 2013 -2014.  Conclusions: Interpretation of the antibiogram have shown that the antimicrobial pattern in the due course of three years have changed. This development has led to change in the way the antibiotics are prescribed among the CSOM patients in a tertiary care hospitals. Rational use of antibiotics may help in reducing the emergence of resistance among CSOM patients in developing countries and this may prevent chance of reoccurrence. Continous surveillance of susceptibility testing is necessary for customization of empiric antibiotic therapy.

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VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8

URINARY/KIDNEY DISORDERS – Clinical Outcomes Studies PUK1 Burden of Childhood Onset Chronic Kidney Disease Hsu C1, Tain Y2 1Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, 2Kaohsiung Chnag Gung Memorial Hospital, Kaohsiung, Taiwan

Objectives: Chronic kidney disease (CKD) is the focus of national policy efforts worldwide. Children and adolescents with CKD are at very high risk for developing end-stage renal disease (ESRD), and of cardiovascular related mortality during young adulthood. Decision makers should account for multiple interventions to manage modifiable risk of ESRD and delay deterioration of renal dysfunction. The aims of this study were to predict the renal failure timeframe of childhood onset CKD and its clinical burden to the health care system using population-based national health insurance claims database in Taiwan.  Methods: This study used 14-year claims data of newly-diagnosed CKD in the national pediatric cohort (< 20 years). ESRD defined as need for chronic dialysis or kidney transplantation (renal replacement therapies, RRT). Development and validation of prediction model used to predict ESRD included demographic, baseline risks, CKD complications with or without medication therapy, and congenital anomalies of kidney and urinary tract (CAKUT) or non-CAKUT of CKD. Models were developed using Cox models and evaluated using C statistics and Akaike Information Criteria for goodness of fit.  Results: The study cohort included 51,846 pedistric patients (CAKUT:28.9%, non-CAKUT: 71.1%). Incidence of RRT was 2.26% and 0.95% for mortality. The most accurate model for RRT: age, CAKUT/non-CAKUT, prior diabetes, cancer, nutritional deficiency, mineral and metabolic disorders, anemia, hypertension-related cardiovascular disease, growth failure (C statistic, 0.917; 95% CI, 0.901-0.933 in the development cohort and 0.841; 95% CI, 0.825-0.857 in the validation cohort). In the validation cohort, model was more accurate than a simpler model that included age, development of CKD-related complications.  Conclusions: Taiwan’s ESRD incidence in young adulhood compared to world rates is high. Despite uncertainty of CKD stage, this model projects a comparative risk of indivudial complication to increasing ESRD. Our example provides valid childhood CKD model to inform clinical and policy decisions improving pediatric CKD care. PUK2 Clinical Effectiveness of Carbapenem Versus Alternative Antibiotics For Urinary Tract Infection Due to Enterobacteriaceae Producing Esbl: A Systmatic Review Park JJ1, Rhee J2, Park D2 1National Evidence-based Collaborating Agency, Seoul, South Korea, 2National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea

Objectives: To evaluate the clinical safety and effectiveness of carbapenems and other alternative antibiotics in urinary tract infection due to Enterobacteriaceae producing extended-spectrum β -lactamase (ESBL).  Methods: We searched 3 international electronic database including Ovid-Medline, Ovid-EMBASE and Cochrane library and 7 domestic electronic database from its inception to April 2015. Two reviewers independently conducted the data extraction and quality assessment using the Risk of Bias Assessment tool for Non-randomized Studies (RoBANS).  Results: A total of 6 articles with 499 patients were finally selected for this study and there were no randomized controlled trials. The diseases included urinary tract infection, complicated lower urinary tract infection and nephropyelitis. Three studies had a comparative study design for carbapenems and non-carbapenems. The risk of selection bias and confounding bias assessed to be high or unclear. Analysis of four studies reporting the microbiological success rate showed that there was no statistically significant difference between the carbapenem group and the non-carbapenem group (OR= 1.56, 95% CI 0.44-5.56, I2= 59%). In the subgroup analysis, both empirical therapy and definitive therapy showed no significant differences in microbiological success (Respectively, OR= 6.00, 95% CI 0.42-85.25, OR= 1.05 95% CI 0.17-6.52). There was also no statistically significant differences in the clinical success rate between the groups (OR= 1.86, 95% CI 0.51-6.84, I2= 51%).  Conclusions: There was no clear evidence that superiority of carbapenem and other alternative antibiotics. In patients urinary tract infection with ESBL-positive Enterobacteriaceae, the role of carbapenem and other antibiotics should be further evaluated for empirical and definitive treatment. PUK3 Etiology and Outcome of Acute Kidney Injury in South Indian Population Zabiuddin Ahad M1, Suresh AA1, Kumar P1, Attur RP2 1Manipal College of Pharmaceutical Sciences, Manipal, India, 2Department of Nephrology, Kasturba Medical College, Manipal University, Manipal, India

Objectives: To investigate the common etiology and assess prognosis of Acute Kidney Injury (AKI) in south Indian population.  Methods: A retrospective observational study was conducted at tertiary care hospital in south India. Institutional ethics committee approval was obtained prior to the study. As per study criteria, data of patients with age ≥ 18 year admitted during January-June 2012 was collected from the Medical Records using the ICD 10 coding for AKI (N17.9). Patients who had undergone renal transplantation and chronic dialysis were excluded. Pre designed case report form (CRF) was used for data collection. Data was analysed using appropriate statistical tool.  Results: A total of 302 patients were diagnosed to have AKI, out of which 9 patients were excluded. A Male predominance of 74.1% (N= 217) was observed. The mean age was identified as 54.66±16.3 (SD) years. Among the study population (N= 293), 58.7% (N=  172) were Community Acquired - AKI (CA-AKI) whereas 41.3% (N= 121) were Hospital Acquired - AKI (HA-AKI). The most common etiology predisposing to CA-AKI was AKI on CKD 24.4% (N= 42) followed by Sepsis 17% (N= 29), Urinary Tract Infection (UTI) 14.5% (N= 25), Glomerulonephritis 5.8% (N=  10), Acute Gastroenteritis (GE) 4.7% (N= 8) and others causes 31.2% (N=  54) Whereas among the HA-AKI the leading cause

was found to be Sepsis 47.1% (N= 57), Acute GE 12% (N= 14), AKI on CKD 10% (N=  12), UTI 5% (N= 6) and other causes 26.4% (32). It was observed that Fluid replenishment was the main stay of therapy in 68.2% (N= 184) of the patients. Haemodialysis was performed in 37.2% (N= 109) of patients. Complete recovery obtained in 64.7% (N= 188) whereas 15.7% (N= 46) of patients died.  Conclusions: From our study, Sepsis and UTI were found to be the leading etiologies. GE was found as an additional aetiology for AKI. Complete recovery obtained in 64.7% (N= 188) whereas 15.7% (N= 46) of patients died.

URINARY/KIDNEY DISORDERS – Cost Studies PUK4 Estimating The Cost of End-Stage Renal Disease to The Hospital System in Singapore Sidharta SD1, Yang F2, Yoong JS1 1National

University of Singapore, Singapore, Singapore, 2University of Manchester, Manchester, UK

Objectives: The aim of this study is to estimate the direct hospital-related costs of newly diagnosed End-Stage Renal Disease (ESRD) patients in Singapore.  Methods: Data from 2004 to 2013 were retrieved from a tertiary hospital in Singapore, which included the cost of all services received by individual patients in the hospital. Records of all adult patients (≥  21-years old) with ESRD in year 2013 were extracted. For our analysis, we only included those whose time after the first diagnosis exceeded 90 days and were followed-up to their death or 31 Dec 2013. Total hospital-related costs after diagnosis were generated for each patient. We performed a Generalized Linear Model using gamma family distribution and log link with total cost as the response variable and patients’ demographics, such as age group, gender, race, death status (binary), and the time after diagnosis as the explanatory variables. Cost estimates were established from the predictions of this regression model.  Results: In total, 445 ESRD patients were analyzed in the model. Time after diagnosis was statistically significant in predicting the costs. We recoded the age variable (mean =  64.19, SD =  15.95) into three groups that correspond to age 21-50 (N =  68), 51-65 (N =  159), and 66-102 (N =  218). Predicted direct hospital-related costs for the first 6 months after diagnosis were (Singapore Dollar) S$24410, S$23523, and S$17654 in the respective groups. During the first 12 months, direct costs were S$32401, S$31223, and S$23433 respectively. The total burden of ESRD hospitalrelated direct costs were S$9.98 million. In comparison, the total hospital costs for all patients admitted in 2013 were S$830 million.  Conclusions: The hospital costs of ESRD patients are considerable. In addition, costs for such patients are highest in the first six months after they were diagnosed than those in the next six months. PUK5 Comparative Analysis on The Out-Of-Pocket Expenditure Among Patients Suffering From Chronic Kidney Disease between Medical Insurance Covered And Uncovered Areas in China Wu J, Liu J, Zhu B, Mao Y Xi’an Jiaotong University, Xi’an, China

Objectives: Since the health and economic costs of chronic diseases have created an impending disaster, it is critical to get the patients suffering from chronic kidney disease (CKD) covered by basic medical insurance. This paper takes two cities, Qingdao, which has brought CKD into basic medical insurance, and Shenyang, which hasn’t, in China as example, and aims at comparing the out-of-pocket (OOP) expenditure among patients suffering from CKD between the two cities.  Methods: Data on outpatient and inpatient expenditure of CKD sufferers from 2008 to 2010 of the two sample cities has been collected and descriptive statistical analysis has been adopted to find out whether there is a difference between the two.  Results: On the aspect of outpatient expenditure, the OOP ratios of kidney dialyzed patients are 18.1%, 17.12% and 17.27% and those of kidney transplant recipients are 29.42%, 29.01% and 28.44 % from 2008 to 2010 in Shenyang respectively. While those ratios in Qingdao are 10.47%, 8.89%, 8.87% and 20.89%, 19.86%, 19.42% respectively. On the aspect of inpatient expenditure, the OOP ratios of kidney dialyzed patients are 29.31%, 28.57% and 26.85% from 2008 to 2010 in Shenyang, and the OOP ratios of kidney transplant recipients are 35.13%, 40.02% and 44.2%. Meanwhile, those ratios in Qingdao are 20.89%, 23.02%, 22.59%, and 33.69%, 29.65%, 24.06% respectively.  Conclusions: The OOP ratio of CKD sufferers in medical insurance covered cities is significantly lower than those uncovered, which indicate the progress basic health insurance has made to get citizens out of the risk of poverty caused by chronic disease to a large extent. And it is suggested to invest more money on the health security system focusing on chronic disease prevention and bring more people suffering from the diseases into the system. PUK6 Pharmacoeconomic Evaluation of Patients Undergoing Hemodialysis At a Tertiary Care Centre Prasad S, Kaza S, Prasad N S, Prabhu RA, Rangaswamy D, Shenoy S, Saraf K Kasturba Medical College Manipal, Manipal University, Manipal, Udupi, Karnataka, India

Objectives: To analyze the direct and indirect medical and non-medical costs in hemodialysis patients.  Methods: This is a cross-sectional, observational study carried out in a tertiary care hospital in South India. Patients undergoing twice weekly maintenance hemodialysis were included in the study. The data pertaining to the pharmacoeconomic- related direct medical and non-medical costs were collected from patient interviews, records, medical bills and other relevant sources. 85 patients were included in the study.  Results: The mean age was 53 years with 73.1% males. Majority of them belonged to the middle class as assessed by the Kuppuswamy’s socioeconomic scale with 34% being currently employed. Most (90%) of them were married and 70% had atleast 1 person accompany them to the dialysis centre. Public transport was used as the means of travel to the dialysis centre by