Tag: pubmed

MSMR. 2024 Oct 20;31(10):2-10.

ABSTRACT

Summaries of HIV seropositivity for members of the U.S. military have been published with MSMR since 1995. The current report summarizes numbers and trends of newly identified HIV-antibody seropositivity from January 1, 2019 through June 30, 2024 among military members of 5 services under the active and reserve components of the U.S. Armed Forces, in addition to the Army and Air Force National Guard. From January 2023 through June 2024, approximately 1.8 million service members (active component, Guard, and reserve) were tested for antibodies to HIV, and 403 (0.22 per 1,000 tested) were identified as HIV-antibody positive. Of the 403 new HIV infections that were identified during this period, only 10 (2.5%) were among female service members. The HIV-antibody seropositivity rates first reported in MSMR 3 decades ago remain comparable to rates presented in 2023, under scoring a continued value of HIV testing programs. The cost-effectiveness of HIV testing strategies, differentiated by universal or indications-based testing following military accession, may be instructive to further understand the value of current screening efforts in different clinical settings.

PMID:39467267

J Magn Reson Imaging. 2024 Oct 28. doi: 10.1002/jmri.29635. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary hypertension (PH) is a life-threatening. Differentiation pulmonary arterial hypertension (PAH) from pulmonary venous hypertension (PVH) is important due to distinct treatment protocols. Invasive right heart catheterization (RHC) remains the reference standard but noninvasive alternatives are needed.

PURPOSE/HYPOTHESIS: To evaluate 4D Flow MRI-derived 3D vortex energetics in the left pulmonary artery (LPA) for distinguishing PAH from PVH.

STUDY TYPE: Prospective case-control.

POPULATION/SUBJECTS: Fourteen PAH patients (11 female) and 18 PVH patients (9 female) diagnosed from RHC, 23 healthy controls (9 female).

FIELD STRENGTH/SEQUENCE: 1.5 T; gradient recalled echo 4D flow and balanced steady-state free precession (bSSFP) cardiac cine sequences.

ASSESSMENT: LPA 3D vortex cores were identified using the lambda2 method. Peak vortex-contained kinetic energy (vortex-KE) and viscous energy loss (vortex-EL) were computed from 4D flow MRI. Left and right ventricular (LV, RV) stroke volume (LVSV, RVSV) and ejection fraction (LVEF, RVEF) were computed from bSSFP. In PH patients, mean pulmonary artery pressure (mPAP), pulmonary capillary wedge pressure (PCWR) and pulmonary vascular resistance (PVR) were determined from RHC.

STATISTICAL TESTS: Mann-Whitney U test for group comparisons, Spearman’s rho for correlations, logistic regression for identifying predictors of PAH vs. PVH and develop models, area under the receiver operating characteristic curve (AUC) for model performance. Significance was set at P < 0.05.

RESULTS: PAH patients showed significantly lower vortex-KE (37.14 [14.68-78.52] vs. 76.48 [51.07-120.51]) and vortex-EL (9.93 [5.69-25.70] vs. 24.22 [12.20-32.01]) than PVH patients. The combined vortex-KE and LVEF model achieved an AUC of 0.89 for differentiating PAH from PVH. Vortex-EL showed significant negative correlations with mPAP (rho = -0.43), PCWP (rho = 0.37), PVR (rho = -0.64). In the PAH group, PVR was significantly negatively correlated with LPA vortex-KE (rho = -0.73) and vortex-EL (rho = -0.71), and vortex-KE significantly correlated with RVEF (rho = 0.69), RVSV, (rho = 0.70). In the PVH group, vortex-KE (rho = 0.52), vortex-EL significantly correlated with RVSV (rho = 0.58).

DATA CONCLUSION: These preliminary findings suggest that 4D flow MRI-derived LPA vortex energetics have potential to noninvasively differentiate PAH from PVH and correlate with invasive hemodynamic parameters.

EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 3.

PMID:39467263 | DOI:10.1002/jmri.29635

Ter Arkh. 2024 Oct 10;96(9):872-878. doi: 10.26442/00403660.2024.09.202849.

ABSTRACT

AIM: Evaluation of genes polymorphisms frequencies of angiotensinogen (AGT), angiotensin converting enzyme type 1 (ACE1) and angiotensin II receptors type 1 (AGTR1) and type 2 (AGTR2) in patients admitted with coronavirus disease (COVID-19) and its association the severity of severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2).

MATERIALS AND METHODS: The study included 100 patients admitted to the hospital with a laboratory-confirmed diagnosis of COVID-19. All patients were identified with alleles and genotypes of polymorphic markers rs4762 of the AGT gene, rs1799752 of the ACE1 gene, rs5186 of the AGTR1 gene and rs1403543 of the AGTR2 gene. The frequencies of each polymorphisms were compared with population. Statistical processing was performed using the Statistica 8.0 software package.

RESULTS: In evaluated cohort there was higher frequency of D-allele ACE1 rs1799752 compared to population. Depending on the availability of criteria for the severity of coronavirus infection, 44 (44%) patients were diagnosed with severe, 56 (56%) with moderate course. The groups did not significantly differ in age, gender, cardiovascular risk factors and comorbid pathology. In the groups with severe and moderate course, the same distribution of genotypes and alleles of AGT rs4762, AGTR2 rs1403543 and ACE1 rs1799752 was revealed. For the I/D alleles of the ACE1 rs1799752 gene, a significant deviation from the papulation was found in both the group of severe and moderate COVID-19. In the group with a severe course of the disease, a higher frequency of the mutant C-allele of the AGTR1 rs5186 gene was detected. In the same group, a deviation in the frequency ratio of A and C of the AGTR1 rs5186 alleles from Hardy-Weinberg Equilibrium was found. When calculating the risk of severe COVID-19 in the presence of the C-allele compared with the A-allele, an odds ratio 2.092 (95% confidence interval 1.066-4.108) was obtained.

CONCLUSION: The data obtained suggest that the genes polymorphisms of the components of renin-angiotensin-aldosterone system, namely D-allele of ACE1 rs1799752 and C-allele of AGTR1 rs5186, may make it possible to identify groups of patients predisposed to the development of more severe COVID-19.

PMID:39467241 | DOI:10.26442/00403660.2024.09.202849

Ter Arkh. 2024 Oct 10;96(9):860-871. doi: 10.26442/00403660.2024.09.202848.

ABSTRACT

BACKGROUND: Arterial hypertension (AH) remains the leading risk factor associated with cardiovascular diseases (CVDs), cerebrovascular disease and chronic kidney disease. About 70% of patients with AH who are on monotherapy cannot achieve blood pressure (BP) targets, and therefore all quidelines for the management of AH have recently recommended prescribing combination therapy (PCT). In real clinical practice (RCP), there remains significant uncertainty in the effectiveness and rationality of therapy, despite the wide availability of antihypertensive drugs (AHD) and the presence of recommendations for a stepwise approach to prescribing combinations of specific groups of AHD in different clinical situations.

AIM: Analyze the real ongoing antihypertensive therapy, including the PCT; international nonproprietary names of drugs and their dosages in RCP; compliance of therapy with clinical recommendations; changing trends in the PCT.

MATERIALS AND METHODS: An analysis was carried out of the data from the register of AH, the compliance of treatment in different clinical groups of patients and the achievement of BP and low-density lipoprotein cholesterol targets in the sample of 2019-2022 (n=5012). The prescription of AHD and achievement of targets values were assessed in accordance with current clinical guidelines for the management of AH and hypercholesterolemia. Data from 2010 (n=7782) and 2020 (n=3061) were analyzed to assess the dynamics of prescription of monotherapy and PCT.

RESULTS: The greatest increase in the number of AHD was observed in patients with hypertension in combination with coronary heart disease, heart failure, and atrial fibrillation. In a small group of patients with hypertension without other CVDs, the recommended combinations of AHD were not prescribed; preference was given to angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and β-adrenoblocker (β-AB). PCT mainly differed from the recommended combinations by the wider use of drugs from the β-AB group. The PCT of recommended drugs was highest in patients with hypertension and coronary artery disease – more than 90%, hypertension and heart failure in 56.2%, hypertension and atrial fibrillation – 33.3%, hypertension and chronic kidney desease – 19.6%. Achievement of BP and low-density lipoprotein cholesterol targets was insufficient in all analyzed groups. Among the international nonproprietary names of drugs, the most frequently prescribed are the following: bisoprolol, metoprolol, lisinopril, perindopril, losartan, spironolactone, amlodipine, torasemide, indapamide, hypochlorothiazide, moxonidine. The prescribed daily dosages were closer to the initial recommended ones. By 2020, the prescription of PCT with β-AB and a more uniform prescription of various combinations will come to the fore, while PCT in 2010 is characterized by the presence of one or two leaders combinations.

CONCLUSION: The described features of prescribing AHD partially reproduce clinical recommendations for the management of AH. Differences in therapy provided in RCP may be associated with an attempt to intensify the treatment of hypertension in patients with other concomitant CVDs. At the same time, analysis of combinations and dosages of prescribed drugs suggests the presence of wide opportunities for further escalation of therapy. The presented data can provide insight into current patterns of antihypertensive therapy prescription in patients in RCP and lay the foundation for optimizing therapy in different categories hypertensive patients.

PMID:39467240 | DOI:10.26442/00403660.2024.09.202848

J Clin Oncol. 2024 Oct 28:JCO2401476. doi: 10.1200/JCO-24-01476. Online ahead of print.

ABSTRACT

Phase III trials that randomly assign patients to a control treatment (C), an experimental treatment (A), or a combination treatment (AB) should be designed with the goal to recommend the best treatment: AB (if it is better than A and C), A (if it is better than C, and AB is not better than A), or C (if neither AB nor A is better than C). However, this goal can be challenging to achieve with statistical confidence. We performed a survey of cancer trials published in five journals from January 2018 to May 2024 to assess the trial designs being used in this setting and found that three quarters of them did not have a provision for a formal comparison of the AB treatment arm with the A treatment arm, a possible shortcoming. A limited simulation evaluates two analysis strategies that incorporate an AB versus A comparison and is used to formulate some recommendations for designing these types of trials.

PMID:39467219 | DOI:10.1200/JCO-24-01476

R I Med J (2013). 2024 Nov 1;107(11):10-13.

ABSTRACT

Functional neurological disorder (FND) is a common diagnosis of varied neuropsychiatric symptoms presenting to pediatric healthcare settings, including primary, urgent and subspecialty care. A key diagnostic shift appearing in the DSM-V is that FND is no longer a diagnosis of exclusion; rather, a rule-in diagnosis based on suggestive elements of symptom presentation. This article reviews diagnostic criteria, clarifying features, risks, and prognostic factors. This is the first in a series of six articles on FND and will introduce an FND case that will be examined in each subsequent article in the context of their more specific subject matter.

PMID:39467190

AORN J. 2024 Nov;120(5):e1-e9. doi: 10.1002/aorn.14236.

ABSTRACT

The use of a surgical safety checklist can help prevent sentinel events; however, a lack of adherence to the checklist can result in inadequate preoperative patient readiness and negative outcomes. The purpose of this quality improvement project was to address preoperative concerns that prevent patient readiness in a military hospital. To change practice, the project involved the use of an evidence-based practice model and Kurt Lewin’s change theory. The primary investigator provided an educational initiative on the required checklist for perioperative personnel and collected data on key elements (ie, consent completion, laboratory test results, antibiotic availability, checklist completion) for 30 days after the initiative. Consent completion rates were 100% both before and after the intervention. Statistical analysis (chi-square [χ²]) showed significant improvement for the remaining three elements. The results were the most significant for laboratory test results (χ² ₁ = 33.496, P < .00001).

PMID:39467188 | DOI:10.1002/aorn.14236

Am J Manag Care. 2024 Oct;30(10):504-509. doi: 10.37765/ajmc.2024.89619.

ABSTRACT

OBJECTIVE: To describe the results of a program developed to manage institutional postacute care (IPAC) (postacute skilled nursing, inpatient rehabilitation facility, and long-term acute care) in a CMS Bundled Payments for Care Improvement (BPCI) project for coronary artery bypass graft (CABG) surgery.

STUDY DESIGN: We compared pre- and postutilization patterns during a 3-year period by evaluating risk-adjusted national, state, and other BPCI participant comparisons using a difference-in-differences (DID) analysis in a large urban community tertiary center with a CABG surgery program. Included in the analysis were all Medicare patients receiving CABG surgery at the institution (n = 504), across the nation (n = 213,423), and at other BPCI institutions (n = 4939).

METHODS: The intervention included (1) use of a standardized tool for evaluation and prognostication of patient placement, (2) programmatic changes to manage patient functional recovery, and (3) patient and family engagement in postacute placement and functional recovery plan.

RESULTS: Physical therapist/occupational therapist time with patients who had undergone CABG surgery increased by more than 179% between the pre- and postintervention periods. This was associated with a 41.2% and 51.6% decline in IPAC use at the institution on an observed basis and adjusted basis, respectively. DID comparison demonstrated a 14.40% (95% CI, -19.30% to -9.60%) greater reduction at the target hospital than at other participating BPCI hospitals.

CONCLUSIONS: A strong association exists between a focused patient functional recovery program and IPAC use reduction after CABG surgery. Using a structured approach to clinical analytics and hypothesis testing of redesign efforts when managing postacute care populations removes waste from care delivery.

PMID:39467180 | DOI:10.37765/ajmc.2024.89619

Am J Manag Care. 2024 Oct;30(10):494-499. doi: 10.37765/ajmc.2024.89618.

ABSTRACT

OBJECTIVE: Prior authorization is used to ensure providers treat patients with medically accepted treatments. Our objective was to evaluate prior authorization decisions in cancer care by race/ethnicity for commercially insured patients.

STUDY DESIGN: Retrospective study of 18,041 patients diagnosed with cancer between January 1, 2017, and April 1, 2020.

METHODS: Using commercial longitudinal data from a large national insurer, we described the racial and ethnic composition in terms of prior authorization process outcomes for individuals diagnosed with cancer. We then used linear regression models to evaluate whether disparities by race or ethnicity emerged in prior authorization process outcomes.

RESULTS: The self-identified composition of the sample was 85% White, 3% Asian, 10% Black, and 1% Hispanic; 64% were female, and the mean age was 53 years. The average prior authorization denial rate was 10%, and the denial rate specifically due to no medical necessity was 5%. Hispanic patients had the highest prior authorization denial rate (12%), and Black patients had the lowest prior authorization denial rate (8%). Regressions results did not identify racial or ethnic disparities in prior authorization outcomes for Black and Hispanic patients compared with White patients. We observed that Asian patients had lower rates of prior authorization denials compared with White patients.

CONCLUSIONS: We observed no differences in the prior authorization process for Black and Hispanic patients with cancer and higher rates of prior authorization approvals for Asian patients compared with White patients.

PMID:39467179 | DOI:10.37765/ajmc.2024.89618

Am J Manag Care. 2024 Oct;30(10):482-487. doi: 10.37765/ajmc.2024.89617.

ABSTRACT

OBJECTIVES: To assess the congruence between patient assignment and established patients as well as their association with Healthcare Effectiveness Data and Information Set (HEDIS) quality performance.

STUDY DESIGN: A retrospective cross-sectional analysis from January 2020 to February 2022.

METHODS: The study setting is a fully integrated health care delivery system in Phoenix, Arizona. The study population includes Medicaid patients who received primary care services or were assigned to a primary care physician (PCP) at the study setting by 5 Medicaid managed care organizations (MCOs). We identified 4 possible relationships between the established patients (2 primary care visits) and the assigned patients (assigned by the MCO to the study setting): true-positive, false-positive, true-negative, and false-negative classifications. Precision and recall measures were used to assess congruence (or incongruence). Outcome measures were HEDIS quality metrics.

RESULTS: A total of 100,030 Medicaid enrollees (adults and children) were established and/or assigned to the study setting from 5 separate payers. Only 15% were congruently established and assigned to the physician (true-positive). The overall precision was 21%, and the overall recall was 37%. The HEDIS quality performance was significantly higher (P < .05) for established patients for 5 of 6 metrics compared with patients who were not established.

CONCLUSIONS: The vast majority of assigned patients were not treated by the assigned PCP, yet better patient outcomes were seen with an established patient. As the health system rapidly adopts value-based payments, more rigorous methodologies are essential to identify physician-patient relationships.

PMID:39467178 | DOI:10.37765/ajmc.2024.89617