Current Medical Research and Opinion最新文献

The GLP-1 receptor-based agonists (GLP-1RAs) and SGLT2 inhibitors (SGLT2i) are major 21^st century breakthroughs in diabetes and obesity medicine but there are important safety considerations regarding the perioperative and periprocedural management of individuals who are treated with these agents. GLP-1RAs have been linked to an increased risk of retained gastric contents and pulmonary aspiration while SGLT2i can be associated with diabetic ketoacidosis. This manuscript provides a narrative review of the available evidence for perioperative and periprocedural risks in people prescribed GLP-1RAs and SGLT2i. The authors provide expert opinion-driven recommendations and algorithms on how to safely manage GLP-1RAs and SGLT2i under perioperative/periprocedural settings.

Aripiprazole 2-month ready-to-use (Ari 2MRTU) is a long-acting injectable antipsychotic that was approved for use in Europe in March 2024, for the maintenance treatment of schizophrenia in adult patients stabilized with aripiprazole; it is administered via gluteal intramuscular injection once every two months. This review examines population pharmacokinetic model-based simulations relevant to the use of Ari 2MRTU in Europe, accompanied by expert commentary that contextualizes the simulations and highlights the potential implications of the availability of Ari 2MRTU for patients, caregivers, and clinicians. Various simulations conducted across 8 weeks (representing the first dosing interval), or 32 weeks (representing maintenance dosing) demonstrated an aripiprazole exposure profile for Ari 2MRTU that was similar to aripiprazole once-monthly (AOM), but with an extended dosing interval. In treatment initiation scenarios consistent with the European label, therapeutic levels of aripiprazole (i.e., ≥95 ng/mL) were maintained when transitioning from either AOM or oral aripiprazole, including with a two-injection start regimen with no requirement for 14 days of oral aripiprazole supplementation. Therapeutic levels of aripiprazole were also observed for treatment maintenance scenarios, except when dosing of Ari 2MRTU was delayed by 8 weeks. The availability of Ari 2MRTU extends the range of options for the maintenance treatment of schizophrenia in Europe. Ari 2MRTU may provide adherence benefits due to its extended dosing interval and the option to initiate treatment using a two-injection start regimen, which does not require 14 days of overlapping oral supplementation.

This paper reviews the scientific evidence on new anti-amyloid monoclonal antibodies for treating Alzheimer's disease as a case study for improving scientific evidence communication. We introduce five guidelines condensed from the biomedical evidence literature but adapted to the short format of science communication in e.g., journal opinion pieces and newspaper articles. Given the major importance and recent confusion regarding the discussed drugs, with certain disagreements seen e.g., between FDA and EMA, the suggested guidelines may be useful to clinicians discussing with their patients and to scientists communicating the evidence in balance. More generally, we hope that the guidelines may help us to improve communication of scientific evidence on complex topics in opinion pieces in the scientific literature, in advocacy, and in media appearances.

Objective: To explore the risk factors for discontinuation of pericapsular soft tissue and pelvic realignment (PSTP-R) therapy derived from Shiatsu in the candidates with osteoarthritis for total hip replacement (THR) (i.e., candidates for total hip replacement) treated from 2017 to 2020, and to identify the effect modifiers of PSTP-R therapy for patients who continued therapy for 6 months.

Methods: Exploratory analyses of data from the clinical trial for PSTP-R therapy in a prospective observational study in which the PSTR exercises for 6 months improved Harris Hip Score (HHS) in 193 patients with an HHS below 60 points in two study centers, even in 130 patients with complete loss of cartilage on radiography among those 193 ones. The risk factors for the discontinuation of PSTP-R therapy and the effect modifiers for PSTP-R therapy were explored statistically.

Results: The risk of discontinuation of PSTP-R therapy increased as the frequency of buttock pain at baseline increased, and was mitigated as the baseline opening angle of the hip according to the modified Patrick's test increased. Cartilage loss on radiography was not a risk factor for withdrawal from PSPT-R therapy. Among patients who continued PSTP-R therapy for 6 months, a lower Kellgren-Lawrence grade at baseline was associated with an increase in the total score of HHS.

Conclusion: Buttock pain at baseline was most associated with discontinuation of PSPT-R therapy. The patients that can improve with PSPT-R therapy should be selected to avoid inappropriate surgery by the detailed analysis of relevant clinical factors influencing the response for this program as well as image findings such as cartilage loss on radiography at baseline.

Trial registration: Registered in the Clinical Trials Registry on 20^th July 2017 (UMIN000028277).

Objective: To identify factors that may influence health-seeking behaviors and health system interactions from the perspective of Black patients with lung cancer (LC) or peripheral artery disease (PAD).

Methods: Semi-structured interviews were conducted virtually with Black patients in the United States. Thematic analysis of interview transcripts was performed. The Sense-Think-ACT-Relate (STAR) behavioral framework was used to map emerging themes of drivers and barriers to health-seeking behaviors and health system interactions.

Results: Thirty Black patients with LC (n = 15) and PAD (n = 15) participated in this study. The mean age of participants was 53.4 years, 22 were female, and half lived in an urban area or large city. Factors that shape health-seeking behaviors spanned several framework domains including Trust, Rational and Emotional Associations, Cultural, and Situational. Having a provider who was friendly, knowledgeable, and understood the patient's lived experience was a key driver to seeking care. Barriers to care included patients not recognizing disease symptoms, reservations about seeking care, having previous negative interactions with healthcare systems, and feeling stigmatized or excluded. Situational influences, such as financial cost of accessing and receiving healthcare, also acted as barriers. Similar themes emerged for the LC versus PAD cohorts.

Conclusion: Multiple drivers and barriers to health-seeking behaviors exist for Black patients with LC versus PAD, including patients' perceptions of previous health system interactions. Because of known inequities experienced by Black patients, these results highlight the need for interventions that address more than just medical needs but that also encourage patients to seek care when they experience early symptoms and prioritize establishing patient-provider relationships built on trust, respect, and cultural understanding.

Objective: To describe the demographic/clinical characteristics, treatment patterns, and mortality among patients hospitalized with COVID-19 during Omicron predominance by immunocompromised and high-risk status.

Methods: Retrospective observational study of patients hospitalized with COVID-19 between January 1, 2022 and November 30, 2022, using data from the Optum de-identified Clinformatics Data Mart Database. Patient demographic/clinical characteristics, treatments, mortality and costs, were assessed, during the emergence of BA.1 BA.4, BA.5, BA.2.12.1, BA.2.75, BQ.1, XBB Omicron viral subvariants.

Results: Overall, 43,123 patients were included, with a mean (standard deviation [SD]) age of 75.5 (12.4) years, 51.8% were female. Immunocompromised patients accounted for 36% of hospitalized patients while only 5.8% received any outpatient COVID-19 treatment within 30 days of hospital admission. The mean (SD) hospital length of stay was 7.9 (7.5) days with 15.5% mortality within 30 days of admission. Mean (SD) hospital costs were $33,975 ($26,392), and 30-day all-cause readmission was 15.1%. Patients with immunocompromised status and those with a higher number of high-risk conditions proceeded to have an elevated proportion of hospital readmissions and mortality within 30 days. Moreover, a higher proportion of mortality was observed during the BA.1 period (20.1%) relative to other variant periods (11.0%).

Conclusion: COVID-19 imposed a large healthcare burden, particularly among immunocompromised patients and those with underlying high-risk conditions during Omicron period. Low utilization of outpatient COVID-19 treatments was observed in these high-risk populations eligible for treatment. Continued surveillance and research regarding COVID-19 variants and the impact of outpatient treatment options on high-risk patients is crucial to inform and guide public health action.

Objective: Chronic cough (CC) symptoms can persist as refractory or unexplained CC (RCC). We sought to characterize the clinical and economic burden of RCC.

Methods: In this retrospective US cohort study using data from Optum's de-identified CDM Database (01/2015-03/2022), CC was identified as ≥1 CC diagnosis or ≥3 cough events (with ≥8 weeks and ≤120 days between the first and third events and ≥3 weeks between any two events). The index date was set as the earliest date of meeting the CC definition. The baseline period was defined as the 364 days prior to and including the index date. Adults with CC at baseline who met CC requirements (≥1 CC diagnosis, or ≥2 cough events occurring ≥8 weeks but ≤120 days apart) in both follow-up year 2 and follow-up year 3 were defined as having "3-year chronic cough" (3YCC), a proxy measure of RCC, and compared to adults with CC at baseline who did not meet CC requirements in follow-up years 2 and 3 (non-3YCC). A propensity score weighting approach was used to adjust for baseline differences between the 3YCC and non-3YCC groups to compare clinical characteristics and healthcare resource use and costs in the two groups during the follow-up period.

Results: At baseline, the 3YCC group (N = 3,338) had significantly more comorbidities and higher all-cause healthcare resource use and costs than the non-3YCC group (N = 43,122) in unweighted analyses. After weighting, the groups (N = 3,338 with 3YCC and N = 3,145 without) were compared during a 3-year follow-up period. The 3YCC group had significantly more comorbidities, higher levels of all-cause healthcare resource use, and higher all-cause healthcare costs during the follow-up period compared to the non-3YCC group, after adjusting for baseline differences. For example, the mean total healthcare costs (in 2022 US dollars) were significantly higher among the 3YCC group than the non-3YCC group in each follow-up year, at $49,454 versus $42,144 in follow-up year 1, $49,339 versus $36,939 in follow-up year 2, and $51,737 versus $36,503 in follow-up year 3 (p <.001 for each comparison).

Conclusions: After adjusting for baseline differences, persistent symptoms of CC were associated with significantly higher comorbidity, healthcare resource use, and healthcare costs compared to CC that resolved. Effective treatments for RCC would thus be expected to result in improved health as well as substantial healthcare cost offsets.

Objective: The symptom burden associated with allergic rhinitis (AR) negatively impacts the life of people living with the condition. Although the impact of AR on educational outcomes and the effect of AR-relieving medication have been investigated, the availability of up-to-date, population-based, real-world evidence is limited. Therefore, the aim was to investigate the impact of AR and AR-relieving medication on educational outcomes.

Methods: A register-based study was conducted using Danish registers. Educational outcomes were defined as the average 9th-grade final grade. Individuals diagnosed with AR before the age of 13, born between 1986 and 2006, and with observed final examination grades were included as cases. To investigate the impact of AR-relieving medication, cases were stratified by medication use. The impact of AR was estimated through a comparison of individuals with AR to their sibling with no history of AR.

Results: 52,808 cases were included (33,035 with siblings). Cases with no filled prescriptions of AR-relieving medication in their final examination year had an average grade of 7.09. Cases with a minimum of one collection had a higher average. Cases initiated on AIT had an average test score that was 0.60 points higher than cases with no filled prescriptions of aH or INCs in the final examination year. The average grade among cases with paired siblings was 7.29 whilst their siblings had an average grade that was -0.04 lower.

Conclusion: In the Danish context, AR does not affect educational outcomes; however, more frequent use of AR-relieving medications is associated with better educational outcomes.

Breast cancer is a significant health challenge, with accurate and timely diagnosis being critical to effective treatment. Immunohistochemistry (IHC) staining is a widely used technique for the evaluation of breast cancer markers, but manual scoring is time-consuming and can be subject to variability. With the rise of Artificial Intelligence (AI), there is an increasing interest in using machine learning and deep learning approaches to automate the scoring of ER, PR, and HER2 biomarkers in IHC-stained images for effective treatment. This narrative literature review focuses on AI-based techniques for the automated scoring of breast cancer markers in IHC-stained images, specifically Allred, Histochemical (H-Score) and HER2 scoring. We aim to identify the current state-of-the-art approaches, challenges, and potential future research prospects for this area of study. By conducting a comprehensive review of the existing literature, we aim to contribute to the ultimate goal of improving the accuracy and efficiency of breast cancer diagnosis and treatment.