Highlights • There is a growing need for payment models that enable closer alignment between reimbursement and best practice care. • New integrated payment models may give payers powerful mechanisms ...to reduce unwarranted variations through incentivizing care re-design across systems of providers. • Translating clinician-defined best practice standards to administrative data finds significant potentially avoidable utilization. • Potentially avoidable utilization occurs in all regions, with no single region uniformly achieving either optimal or worst care in all areas.
OBJECTIVE:To estimate the incidence of anemia in pregnancy and compare the maternal and perinatal outcomes of women with and without anemia.
METHODS:We conducted a population-based retrospective ...cohort study on all pregnant women in British Columbia who had a live birth or stillbirth at or after 20 weeks of gestation between 2004 and 2016. Women were diagnosed with anemia based on two criteriathird-trimester hemoglobin value or a delivery admission diagnosis of anemia (made before delivery). Anemia was categorized into no anemia (hemoglobin 11 g/dL or greater), mild (9–10.9 g/dL), moderate (7–8.9 g/dL), severe (less than 7 g/dL), or anemia of unspecified severity (with diagnosis made before delivery). Logistic regression was used to estimate adjusted odds ratios (aOR) and 95% CIs expressing the association between anemia and maternal and perinatal outcomes.
RESULTS:Of 515,270 women in the study population, 65,906 (12.8%) had anemia11.8%, 0.43%, and 0.02% had mild, moderate, and severe anemia, respectively, and 0.58% had anemia of unspecified severity. Anemic women had longer hospitalization duration and more antenatal admissions, and rates of preeclampsia, placenta previa and cesarean delivery were higher among women with anemia. The intrapartum–postpartum blood transfusion rate was 5.1 per 1,000 among women without anemia, and higher among women with anemia (aOR 2.45, 95% CI 1.74–3.45 for mild anemia; 21.3, 95% CI 12.2–37.3 for moderate anemia; not analyzable for severe anemia; and 48.3, 95% CI 6.60–353.9 for anemia of unspecified severity). Anemia was associated with preterm birth (mild anemia, aOR 1.09, 95% CI 1.05–1.12; moderate anemia, aOR 2.26, 95% CI 2.02–2.54; anemia of unspecified severity, aOR 2.27, 95% CI 2.06–2.50), small-for-gestational-age live birth, low 5-minute Apgar score, neonatal death, and perinatal death.
CONCLUSION:Maternal anemia in pregnancy represents a common and potentially reversible risk factor associated with antepartum, intrapartum, and postpartum maternal morbidity and perinatal morbidity and mortality.
Response to Letter Smith, Catherine; Teng, Flora; Branch, Emma ...
Obstetrics and gynecology (New York. 1953),
2020-March, 2020-03-00, 20200301, Letnik:
135, Številka:
3
Journal Article
OBJECTIVE:To estimate the incidence of anemia in pregnancy and compare the maternal and perinatal outcomes of women with and without anemia.
METHODS:We conducted a population-based retrospective ...cohort study on all pregnant women in British Columbia who had a live birth or stillbirth at or after 20 weeks of gestation between 2004 and 2016. Women were diagnosed with anemia based on two criteriathird-trimester hemoglobin value or a delivery admission diagnosis of anemia (made before delivery). Anemia was categorized into no anemia (hemoglobin 11 g/dL or greater), mild (9–10.9 g/dL), moderate (7–8.9 g/dL), severe (less than 7 g/dL), or anemia of unspecified severity (with diagnosis made before delivery). Logistic regression was used to estimate adjusted odds ratios (aOR) and 95% CIs expressing the association between anemia and maternal and perinatal outcomes.
RESULTS:Of 515,270 women in the study population, 65,906 (12.8%) had anemia11.8%, 0.43%, and 0.02% had mild, moderate, and severe anemia, respectively, and 0.58% had anemia of unspecified severity. Anemic women had longer hospitalization duration and more antenatal admissions, and rates of preeclampsia, placenta previa and cesarean delivery were higher among women with anemia. The intrapartum–postpartum blood transfusion rate was 5.1 per 1,000 among women without anemia, and higher among women with anemia (aOR 2.45, 95% CI 1.74–3.45 for mild anemia; 21.3, 95% CI 12.2–37.3 for moderate anemia; not analyzable for severe anemia; and 48.3, 95% CI 6.60–353.9 for anemia of unspecified severity). Anemia was associated with preterm birth (mild anemia, aOR 1.09, 95% CI 1.05–1.12; moderate anemia, aOR 2.26, 95% CI 2.02–2.54; anemia of unspecified severity, aOR 2.27, 95% CI 2.06–2.50), small-for-gestational-age live birth, low 5-minute Apgar score, neonatal death, and perinatal death.
CONCLUSION:Maternal anemia in pregnancy represents a common and potentially reversible risk factor associated with antepartum, intrapartum, and postpartum maternal morbidity and perinatal morbidity and mortality.
Based on the demonstrated clinical activity of immune-checkpoint blockade (ICB) in advanced dedifferentiated liposarcoma (DDLPS) and undifferentiated pleomorphic sarcoma (UPS), we conducted a ...randomized, non-comparative phase 2 trial ( NCT03307616 ) of neoadjuvant nivolumab or nivolumab/ipilimumab in patients with resectable retroperitoneal DDLPS (n = 17) and extremity/truncal UPS (+ concurrent nivolumab/radiation therapy; n = 10). The primary end point of pathologic response (percent hyalinization) was a median of 8.8% in DDLPS and 89% in UPS. Secondary end points were the changes in immune infiltrate, radiographic response, 12- and 24-month relapse-free survival and overall survival. Lower densities of regulatory T cells before treatment were associated with a major pathologic response (hyalinization > 30%). Tumor infiltration by B cells was increased following neoadjuvant treatment and was associated with overall survival in DDLPS. B cell infiltration was associated with higher densities of regulatory T cells before treatment, which was lost upon ICB treatment. Our data demonstrate that neoadjuvant ICB is associated with complex immune changes within the tumor microenvironment in DDLPS and UPS and that neoadjuvant ICB with concurrent radiotherapy has significant efficacy in UPS.
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