Current Medical Research and Opinion最新文献

Objective: This study explored the perspectives of people with HIV (PWH) in the United States regarding barriers and facilitators of engaging with HIV care, focusing on treatment initiation, satisfaction, adherence, and preferences.

Methods: An observational, cross-sectional, quantitative online survey was conducted from 2024 through 2025 among eligible PWH aged ≥18 years. The survey was carried out globally; we report results from PWH who reside in the United States. Survey questions assessed sociodemographic, sociobehavioral, and clinical characteristics; HIV diagnosis and linkage to care; and HIV treatments and treatment success. The survey included the validated HIV Treatment Satisfaction Questionnaire (HIVTSQ). Results were analyzed for subgroups of interest. Data were summarized descriptively; formal statistical comparisons were conducted.

Results: A total of 402 PWH participated in the survey. Rapid antiretroviral therapy (ART) initiation was deemed "important"/"very important" by 93% of participants, yet 73% of PWH ever treated did not start treatment within 7 days of diagnosis and 29% started after >30 days. Common reasons for delayed treatment included fear of side-effects, physician recommendation, and needing time to accept the diagnosis. The median HIVTSQ score for overall treatment satisfaction was 51.0/60.0, with numerically higher satisfaction observed among those aged ≥50 years (57.0), not using drugs (54.0), and on bictegravir/emtricitabine/tenofovir alafenamide (57.0). The most important features to stay on treatment were long-term tolerability and efficacy.

Conclusion: Despite the recognized importance of rapid ART initiation, almost one-third of participants ever treated started treatment >30 days after diagnosis. These findings can support tailored strategies to enhance rapid ART initiation and treatment adherence and satisfaction, thereby improving health outcomes for PWH.

Background/objective: Disordered mineral metabolism is associated with adverse outcomes in dialysis populations, but its prognostic significance in non-dialysis CKD is less well defined. This study evaluated elevated serum alkaline phosphatase (ALP) and hyperphosphatemia as predictors of mortality and renal outcomes in non-dialysis CKD.

Methods: In this prospective cohort study, patients from a tertiary renal clinic were followed for >12 months. Elevated ALP was defined as >105 U/L in females or >130 U/L in males; hyperphosphatemia as phosphate >4.5 mg/dL. The primary outcome was mortality, and the secondary outcome was a composite endpoint (ESKD progression, dialysis initiation, or doubling of serum creatinine). Kaplan-Meier, log-rank, and Cox regression analyses were performed (STATA; p <.05).

Results: Among 360 patients (mean age 53.7 ± 13.9 years; follow-up 14 ± 4.2 months), elevated ALP was present in 31.7% and was associated with higher mortality (24.6% vs 8.9%, p <.001) and composite events (45.6% vs 33.9%, p = .03). Hyperphosphatemia occurred in 38.1% and was associated with increased mortality (21.2% vs 9.4%, p = 0.002) and composite outcomes (57.4% vs 25.6%, p <.001). Elevated ALP independently predicted mortality (HR = 2.37; 95% CI = 1.36-4.15; p = .002) but not composite outcomes. Hyperphosphatemia predicted both mortality (HR = 2.59; 95% CI = 1.47-4.57; p = .001) and composite events (HR = 2.55; 95% CI = 1.80-3.60; p <.001). Subgroup analyses demonstrated the highest mortality risk among patients with concurrent elevations in ALP and serum phosphate.

Conclusions: Elevated ALP independently predicted mortality, while hyperphosphatemia predicted both mortality and CKD progression. Monitoring these biomarkers may improve risk stratification and guide future interventional studies.

Background: As the cornerstone of ablation, cryoballoon Ablation (CBA) still has certain limitations, whereas Pulse Field Ablation (PFA) offers a non-thermal and tissue specific alternative. This review aims to compare the safety and efficacy of PFA and CBA.

Methods: A systematic search for eligible studies was conducted in trial registries and databases until August 31, 2024. A total of 1090 patients from eight studies were included.

Results: Most studies reported higher 1-year free recurrence rate in PFA, but did not yield statistical significance (RR 1.03, 95%CI: 0.94, 1.12, p = 0.55, I2 = 0%). PFA was associated with a significantly lower contrast volume (MD -41.63, 95% CI: -49.19 to -34.06, p < 0.00001, I² = 0%), but showed non-significant differences in procedural time (MD -5.84, 95% CI: -12.35 to 0.66, p = 0.08, I² = 83%) and fluoroscopy time (MD 1.43, 95% CI: -0.09 to 2.95, p = 0.07, I² = 75%). Complications were comparable, except for phrenic nerve palsy (PNP) that occurred exclusively in CBA. PFA and CBA are comparable in the terms of acute success and 1-year free recurrence rates. Repeat procedures were more frequent after PFA. However, organized atrial tachycardia (AT) was more commonly observed in the CBA group, while recurrences in both groups were predominantly Atrial Fibrillation (AF).

Conclusion: PFA offers advantages in procedural time and contrast medium use. Complication rate for PFA and CBA was similar except for PNP which exclusively occurred in CBA.

Over the past few decades, patient centricity has evolved from an idea to a clearly defined component of cancer care, integrated into clinical practice: patients with cancer are now more involved in their care. The aim of this opinion article is to highlight the urgent need to involve them in preclinical and clinical research stages, across cancer types, ensuring their voices are heard, and their care needs are addressed as new and evolving cancer therapies are developed. The current oncology landscape makes patient integration particularly pertinent, as it is becoming more complex and technical, therefore creating a need for patient-level translation. This is combined with the rise of the patient voice and patients' increasing willingness to be involved in shaping research. Additionally, this article presents preliminary ideas, approaches, and current real-world initiatives to encourage greater patient integration in drug development. This article is based on the authors' experiences and is supported by a review of current literature, but it is not aiming to replicate existing comprehensive literature reviews on the subject of patient integration.

Objectives: Several indices are available to predict poor outcomes in older patients admitted to the emergency department (ED); however, there remains a need for more practical, sensitive, and easily applicable tools. This study aimed to develop a novel prognostic index to predict the risk of disability, hospitalization, and mortality in older patients presenting to the ED.

Methods: This study included 356 patients aged 65 and older presenting to the ED. Exclusion criteria were: poor general condition preventing response to questions, low level of consciousness (GCS <15), inability to provide informed consent, and lack of prospective follow-up. The G8 scale, PRISMA-7 questionnaire, Katz Activities of Daily Living Questionnaire (ADL) scale, and Charlson Comorbidity Index were administered. Follow-up assessments were conducted via telephone on the 30th and 180th days post-application, using the Katz ADL scale. Patients or their relatives were also queried about repeated outpatient clinic visits, emergency admissions, hospitalizations, nursing home admissions, and survival status.

Results: Parameters significantly associated with adverse outcomes in univariate analysis were further analyzed using multivariate regression, resulting in the development of the GAZI Index. This new index includes six simple parameters independently associated with adverse outcomes. The predictive performance of the GAZI Index was compared to that of the PRISMA-7, a validated tool in the ED. The GAZI Index demonstrated significantly superior predictive ability for poor outcomes compared to the PRISMA-7 (p = 0.008).

Conclusion: The GAZI Index is a novel, valid, and practical tool for predicting adverse outcomes in older patients presenting to the ED.

Objective: Although agitation is a common neuropsychiatric symptom in Alzheimer's dementia, it can be challenging to recognize and diagnose. Caregivers of individuals with Alzheimer's dementia are often the first to encounter agitation behaviors but may struggle to recognize and communicate symptoms to healthcare professionals (HCPs). Here, we describe the development and evaluation of the Agitation in Alzheimer's Screener for Caregivers (AASC), a practical screening tool to identify agitation symptoms and facilitate caregiver-HCP communication.

Methods: The AASC was developed based on the International Psychogeriatric Association (IPA) criteria for agitation in cognitive disorders, input from multidisciplinary experts, and qualitative interviews with caregivers of patients with Alzheimer's dementia. Thereafter, a 2-phase quantitative evaluation study was conducted to refine the AASC and assess the predictive validity of the final tool against IPA criteria. Data were collected from caregiver-HCP dyads, where caregivers completed the AASC and HCPs used IPA criteria to inform their assessment of agitation.

Results: A total of 226 caregiver-HCP dyads were quantitatively evaluated. The mean age of caregivers was 61 years; many were spouses/partners (46%), White (60%), and female (62%), providing an average of 60 h of care weekly (range: 9-168 h). Following initial assessment and refinement, the final AASC, evaluated in a subset of 105 dyads, showed a 73.3% agreement with IPA criteria, with sensitivity of 0.77, specificity of 0.70, and kappa and F1 scores of 0.47 and 0.71, respectively. Most patients were classified as having mild (41%) to moderate (37%) Alzheimer's dementia, while 22% had severe disease.

Conclusion: The AASC is a reliable, easy-to-use, 2-item screener for the presence and impact of agitation, in agreement with IPA criteria. The AASC supports caregivers and HCPs by providing an accessible framework for recognizing agitation throughout all stages of Alzheimer's dementia and prompting comprehensive assessment for diagnosis and appropriate treatment planning.

Retinal artery occlusions (RAO) are sentinel markers of systemic vascular disease. Beyond well-established risk factors (hypertension, diabetes, dyslipidemia), accumulating evidence links RAO with atrial fibrillation (AF). This manuscript narratively synthesizes observational cohorts, case-control studies, and registry analyses evaluating the bidirectional association between RAO and AF. We appraise the diagnostic yield of AF screening strategies after ocular events and outline clinical implications for thrombo-embolic risk reduction. Across studies, the prevalence of AF is consistently higher after RAO, although effect sizes vary with study design and ascertainment methods. Brief, single-time-point ECG screening frequently misses paroxysmal AF, whereas prolonged monitoring (e.g. 7-14-day patches and implantable loop recorders) increases detection in selected high-risk patients. Currently, no guidelines recommend routine AF screening after retinal artery occlusion; however, risk-stratified pathways grounded in age, vascular comorbidity, and ocular phenotype appear pragmatic. We propose a practical algorithm for AF detection after RAO and summarize ophthalmology-centered management considerations (timely cardiology referral, antithrombotic therapy, and secondary prevention). Key evidence gaps include standardized AF ascertainment, prospective screening trials, and health-economic evaluation. Addressing these could inform future recommendations and reduce preventable stroke and vision loss.