Systematic assessment of factors influencing preferences of crohn's disease patients in selecting an anti-tumor necrosis factor agent (CHOOSE TNF TRIAL).

BACKGROUND: Infliximab (IFX), adalimumab (ADA), and certolizumab pegol (CZP) have similar efficacy in induction and maintenance of clinical remission in Crohn's disease (CD). Given the comparable nature of these drugs, patient preferences may influence the choice of the product. We aimed to identify factors that may contribute to CD patients' decision in selecting one anti-tumor necrosis factor (TNF) agent over the others. METHODS: A prospective survey was performed among anti-TNF-naïve CD patients. Prior to completion of a questionnaire, patients were provided with a written description of the three anti-TNF agents, focusing on indications, mode of administration, side effects, and scientific evidence of efficacy and safety for each drug. RESULTS: One hundred patients (47 females, mean age 45 ± 16 years, range 19-81) with an ileal, colonic, or ileocolonic (33%, 40%, and 27%, respectively) disease location completed the questionnaire. Based on the information provided, 36% of patients preferred ADA, 28% CZP, and 25% IFX, whereas 11% were undecided. The patients' decision in selecting a specific anti-TNF drug was influenced by the following factors: ease of use (69%), time required for therapy (34%), time interval between application of the drug (31%), scientific evidence for efficacy (19%), and fear of syringes (10%). CONCLUSIONS: The majority of patients preferred anti-TNF medications that were administered by subcutaneous injection rather than by intravenous infusion. Ease of use and time required for therapy were two major factors influencing the patients' selection of a specific anti-TNF drug. Patients' individual preferences should be taken into account when prescribing anti-TNF drugs. (Inflamm Bowel Dis 2012).

An Assessment of Traffic Safety in Urban Deer Herd Management Zones in Iowa, 2010

Many states are striving to keep their deer population to a sustainable and controllable level while maximizing public safety. In Iowa, measures to control the deer population include annual deer hunts and special deer herd management plans in urban areas. While these plans may reduce the deer population, traffic safety in these areas has not been fully assessed. Using deer population data from the Iowa Department of Natural Resources and data on deer-vehicle crashes and deer carcass removals from the Iowa Department of Transportation, the authors examined the relationship between deer-vehicle collisions, deer density, and land use in three urban areas in Iowa that have deer management plans in place (Cedar Rapids, Dubuque, and Iowa City) over the period 2002 to 2007. First, a comparison of deer-vehicle crash counts and deer carcass removal counts was conducted at the county level. Further, the authors estimated econometric models to investigate the factors that influence the frequency and severity of deer-vehicle crashes in these zones. Overall, the number of deer carcasses removed on the primary roads in these counties was greater than the number of reported deervehicle crashes on those roads. These differences can be attributed to a number of reasons, including variability in data reporting and data collection practices. In addition, high rates of underreporting of crashes were found on major routes that carry high volumes of traffic. This study also showed that multiple factors affect deer-vehicle crashes and corresponding injury outcomes in urban management zones. The identified roadway and non-roadway factors could be useful for identifying locations on the transportation system that significantly impact deer species and safety and for determining appropriate countermeasures for mitigation. Efforts to reduce deer density adjacent to roads and developed land and to provide wider shoulders on undivided roads are recommended. Improving the consistency and accuracy of deer carcass and deer-vehicle collision data collection methods and practices is also desirable.

A Survey of Traffic Safety Culture Among Iowa Adults, TS-1101, 2012

Iowa’s traffic safety culture is influenced by laws and policies, enforcement methods, driver education, roadway engineering, and drivers’ behaviors. The Center for Social and Behavioral Research at the University of Northern Iowa was contracted by the Iowa Department of Transportation to conduct a general population survey of adult Iowans. Telephone interviews were conducted with 1,088 adult Iowans from October to December 2011. A dual-frame (cell phone and landline) sampling design was used. The interview covered a wide range of traffic safety topics (e.g., traffic safety policies, enforcement techniques, and distracted driving). Most Iowans said driving in Iowa is about as safe now as it was 5 years ago; however, one-fourth said driving in Iowa is less safe now. There are a number of driving-related behaviors many adult Iowans consider serious threats to traffic safety and never acceptable to do while driving. Yet, many Iowans report often seeing other drivers engaging in these behaviors and admit engaging in some themselves. For example, nearly 1 in 5 adult Iowa drivers said they have sent or read a text message or email while driving in the past 30 days despite this being prohibited since July of 2011. A slight majority said they support using cameras on highways, interstates, and city streets to automatically ticket drivers for speeding, with even stronger support for red light cameras. A comprehensive approach to traffic safety in Iowa is required to encourage protective factors that enhance traffic safety and reduce the impact of detrimental factors.

Analysis of Safety Benefits for Shielding of Bridge Piers, 2009

The highway system in the State of Iowa includes many grade separation structures constructed to provide maximum safety and mobility to road users on intersecting roadways. However, these structures can present possible safety concerns for traffic passing underneath due to close proximity of piers and abutments. Shielding of these potential hazards has been a design consideration for many years. This study examines historical crash experience in the State of Iowa to address the advisability of shielding bridge piers and abutments as well as other structure support elements considering the offset from the traveled way. A survey of nine Midwestern states showed that six states had bridge pier shielding practices consistent with those in Iowa. Data used for the analyses include crash data (2001 to 2007) from the Iowa Department of Transportation (Iowa DOT), the Iowa DOT’s Geographic Information Management System (GIMS) structure and roadway data (2006) obtained from the Office of Transportation Data, and shielding and offset data for the bridges of interest. Additionally, original crash reports and the Iowa DOT video log were also utilized as needed. Grade-separated structures over high-speed, multilane divided Interstate and primary highways were selected for analysis, including 566 bridges over roadways with a speed limit of at least 45 mph. Bridges that met the criteria for inclusion in the study were identified for further analysis using crash data. The study also included economic analysis for possible shielding improvement.

Iowa Department of Public Safety Strategic Plan, revised January 2014

This report outlines the strategic plan for Iowa Department of Public Safety, goals and mission.

Iowa Department of Public Safety Performance Plan, FY2014, December 2014

Agency Performance Plan, Iowa Department of Public Safety

Synthesis of Iowa Research to Address Rural Safety, RB04-013, 2014

Information about roadway departures, rural intersections, and rural speed management countermeasures relevant to Iowa was summarized on webpages (www.ctre.iastate.edu/research-synthesis/) to allow agencies to more effectively target specific types of crashes in Iowa. More information about each of the countermeasures described in this tech transfer summary, as well as speed impacts, reported crash modification factors, costs, usage within Iowa, and Iowa-specific guidance, is available on the Synthesis of Safety-Related Research web pages at www.ctre.iastate.edu/research-synthesis/. The project provides Iowa agencies with a resource (both web pages and relevant publications) to address rural safety. The team is coordinating with the Iowa Local Technical Assistance Program (LTAP), the Iowa Highway Research Board, the Iowa Association of Counties, and other groups to explore additional ways to distribute the information to local and county agencies.

Lane-Departure Safety Countermeasures: Strategic Action Plan for the Iowa Department of Transportation, 2011

Lane departure crashes are the single largest category of fatal and major injury crashes in Iowa. The Iowa Department of Transportation (DOT) estimates that 60 percent of roadway-related fatal crashes are lane departures and that 39 percent of Iowa’s fatal crashes are single-vehicle run-off-road (SVROR) crashes. Addressing roadway departure was identified as one of the top eight program strategies for the Iowa DOT in their Comprehensive Highway Safety Plan (CHSP). The goal is to reduce lane departure crashes and their consequences through lane departure-related design standards and policies including paved shoulders, centerline and shoulder rumble strips, pavement markings, signs, and median barriers. Lane-Departure Safety Countermeasures: Strategic Action Plan for the Iowa Department of Transportation outlines roadway countermeasures that can be used to address lane departure crashes. This guidance report was prepared by the Institute for Transportation (InTrans) at Iowa State University for the Iowa DOT. The content reflects input from and multiple reviews by both a technical advisory committee and other knowledgeable individuals with the Iowa DOT.

Iowa Department of Public Safety Agency Performance Plan, FY2015

Agency Performance Plan, Iowa Department of Public Safety

Best Practices for Low-Cost Safety Improvements on Iowa’s Local Roads, 2008

Many good maintenance practices are done routinely to ensure safe travel on low-volume local roads. In addition, there are many specific treatments that may go beyond the point of routine maintenance and in fact provide additional safety benefits with a relatively low price tag. The purpose of this publication is to try to assemble many of these treatments that are currently practiced in Iowa by local agencies into one, easy-to-reference handbook that not only provides some clarity to each treatment with photos and narrative, but also features references to agencies currently using that technique. Some strategies that are utilized by Iowa, other states, and are topics of research have also been included to allow the user more information about possible options. Even though some areas overlap, the strategies presented have been grouped together in the following areas: Signing and Delineation, Traffic "Calming," Pavement Marking and Rumble Strips/Stripes, Roadside and Clear Zone, Guardrail and Barriers, Lighting, Pavements and Shoulders, Intersections, Railroad Crossings, Bridges and Culverts, and Miscellaneous. The intention is to make this a “living” document, which will continue to be updated and expanded periodically as other existing practices are recognized or new practices come into being.

Traffic Safety Analysis for Local Agencies, 2012

Although many larger Iowa cities have staff traffic engineers who have a dedicated interest in safety, smaller jurisdictions do not. Rural agencies and small communities must rely on consultants, if available, or local staff to identify locations with a high number of crashes and to devise mitigating measures. However, smaller agencies in Iowa have other available options to receive assistance in obtaining and interpreting crash data. These options are addressed in this manual. Many proposed road improvements or alternatives can be evaluated using methods that do not require in-depth engineering analysis. The Iowa Department of Transportation (DOT) supported developing this manual to provide a tool that assists communities and rural agencies in identifying and analyzing local roadway-related traffic safety concerns. In the past, a limited number of traffic safety professionals had access to adequate tools and training to evaluate potential safety problems quickly and efficiently and select possible solutions. Present-day programs and information are much more conducive to the widespread dissemination of crash data, mapping, data comparison, and alternative selections and comparisons. Information is available and in formats that do not require specialized training to understand and use. This manual describes several methods for reviewing crash data at a given location, identifying possible contributing causes, selecting countermeasures, and conducting economic analyses for the proposed mitigation. The Federal Highway Administration (FHWA) has also developed other analysis tools, which are described in the manual. This manual can also serve as a reference for traffic engineers and other analysts.

Efficacy and safety of a phospholipid emulsion (GR270773) in Gram-negative severe sepsis: results of a phase II multicenter, randomized, placebo-controlled, dose-finding clinical trial.

OBJECTIVE: To assess the survival benefit and safety profile of low-dose (850 mg/kg) and high-dose (1350 mg/kg) phospholipid emulsion vs. placebo administered as a continuous 3-day infusion in patients with confirmed or suspected Gram-negative severe sepsis. Preclinical and ex vivo studies show that lipoproteins bind and neutralize endotoxin, and experimental animal studies demonstrate protection from septic death when lipoproteins are administered. Endotoxin neutralization correlates with the amount of phospholipid in the lipoprotein particles. DESIGN: A three-arm, randomized, blinded, placebo-controlled trial. SETTING: Conducted at 235 centers worldwide between September 2004 and April 2006. PATIENTS: A total of 1379 patients participated in the study, 598 patients received low-dose phospholipid emulsion, and 599 patients received placebo. The high-dose phospholipid emulsion arm was stopped, on the recommendation of the Independent Data Monitoring Committee, due to an increase in life-threatening serious adverse events at the fourth interim analysis and included 182 patients. MEASUREMENTS AND MAIN RESULTS: A 28-day all-cause mortality and new-onset organ failure. There was no significant treatment benefit for low- or high-dose phospholipid emulsion vs. placebo for 28-day all-cause mortality, with rates of 25.8% (p = .329), 31.3% (p = .879), and 26.9%, respectively. The rate of new-onset organ failure was not statistically different among groups at 26.3%, 31.3%, 20.4% with low- and high-dose phospholipid emulsion, and placebo, respectively (one-sided p = .992, low vs. placebo; p = .999, high vs. placebo). Of the subjects treated, 45% had microbiologically confirmed Gram-negative infections. Maximal changes in mean hemoglobin levels were reached on day 10 (-1.04 g/dL) and day 5 (-1.36 g/dL) with low- and high-dose phospholipid emulsion, respectively, and on day 14 (-0.82 g/dL) with placebo. CONCLUSIONS: Treatment with phospholipid emulsion did not reduce 28-day all-cause mortality, or reduce the onset of new organ failure in patients with suspected or confirmed Gram-negative severe sepsis.

Besoins, prescriptions et sécurité des produits sanguins labiles ; autosuffisance en produits sanguins labiles [Roundtables of SFTS Congress 2013: Needs, indications and safety of blood products; self-sufficiency in blood products].

The current issues debate brings together experts around the themes of self-sufficiency (in its national and European aspects) and of needs in cellular blood products. The point of view of the manufacturer and prescribers of blood products are confronted.

The nine-year sustained cost-containment impact of swiss pilot physicians-pharmacists quality circles.

BACKGROUND: Six pioneer physicians-pharmacists quality circles (PPQCs) located in the Swiss canton of Fribourg (administratively corresponding to a state in the US) were under the responsibility of 6 trained community pharmacists moderating the prescribing process of 24 general practitioners (GPs). PPQCs are based on a multifaceted collaborative process mediated by community pharmacists for improving compliance with clinical guidelines within GPs' prescribing practices. OBJECTIVE: To assess, over a 9-year period (1999-2007), the cost-containment impact of the PPQCs. METHODS: The key elements of PPQCs are a structured continuous quality improvement and education process; local networking; feedback of comparative and detailed data regarding costs, drug choice, and frequency of prescribed drugs; and structured independent literature review for interdisciplinary continuing education. The data are issued from the community pharmacy invoices to the health insurance companies. The study analyzed the cost-containment impact of the PPQCs in comparison with GPs working in similar conditions of care without particular collaboration with pharmacists, the percentage of generic prescriptions for specific cardiovascular drug classes, and the percentage of drug costs or units prescribed for specific cardiovascular drugs. RESULTS: For the 9-year period, there was a 42% decrease in the drug costs in the PPQC group as compared to the control group, representing a $225,000 (USD) savings per GP only in 2007. These results are explained by better compliance with clinical and pharmacovigilance guidelines, larger distribution of generic drugs, a more balanced attitude toward marketing strategies, and interdisciplinary continuing education on the rational use of drugs. CONCLUSIONS: The PPQC work process has yielded sustainable results, such as significant cost savings, higher penetration of generics and reflection on patient safety, and the place of "new" drugs in therapy. The PPQCs may also constitute a solid basis for implementing more comprehensive collaborative programs, such as medication reviews, adherence-enhancing interventions, or disease management approaches.