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The temporal relationship of alcohol use and subsequent self-reported health status among people with HIV 艾滋病毒感染者酒精使用与随后自我报告的健康状况的时间关系
Pub Date : 2023-06-01 DOI: 10.1016/j.ajmo.2022.100020
Jarratt D. Pytell , Ximin Li , Carol Thompson , Catherine R. Lesko , Mary E. McCaul , Heidi Hutton , D. Scott Batey , Edward Cachay , Kenneth H. Mayer , Sonia Napravnik , Katerina Christopoulos , Cui Yang , Heidi M. Crane , Geetanjali Chander , Bryan Lau

Background

Alcohol use among people with HIV is associated with worse HIV treatment outcomes. Its impact on self-reported health status is unclear.

Setting

Longitudinal cohort of people with HIV engaged in care across 7 clinics participating in the Centers for AIDS Research Network of Integrated Care Systems between January 2011 and June 2014.

Methods

A total of 5046 participants were studied. A quantile regression model estimated the association of alcohol use levels with subsequent self-reported health status score, accounting for multiple covariates including depressive symptoms. Women, men who have sex with women, and men who have sex with men were analyzed separately.

Results

Prevalence of heavy alcohol use was 21%, 31%, and 37% among women, men who have sex with women, and men who have sex with men, respectively. Women with heavy alcohol use had a subsequently decreased median self-reported health status score compared to women with no or moderate alcohol use (odds ratio [OR]: 0.76; 95% confidence interval [CI]: 0.58–0.99); this association was not explained by the presence of depressive symptoms. There was no observed association of alcohol use level on subsequent self-reported health status among men who have sex with women. Men who have sex with men reporting no alcohol use had a subsequently decreased median self-reported health status compared to moderate alcohol use (OR: 0.88; 95% CI: 0.80-0.97).

Conclusion

Heavy alcohol use is associated with worsened self-reported health status at subsequent visits among women with HIV and not men with HIV.

背景艾滋病毒感染者饮酒与更差的艾滋病毒治疗结果有关。它对自我报告的健康状况的影响尚不清楚。背景2011年1月至2014年6月,参与艾滋病综合护理系统研究网络的7家诊所的HIV感染者参与护理的纵向队列。方法共研究5046名参与者。一个分位数回归模型估计了酒精使用水平与随后自我报告的健康状况评分的相关性,考虑了包括抑郁症状在内的多个协变量。分别对女性、与女性发生性关系的男性和与男性发生性行为的男性进行分析。结果女性、男男性行为者和男男性行为者重度饮酒的患病率分别为21%、31%和37%。与不饮酒或中度饮酒的女性相比,重度饮酒的女性随后自我报告的健康状况得分中位数下降(比值比[or]:0.76;95%置信区间[CI]:0.58–0.99);抑郁症状的存在并不能解释这种联系。在与女性发生性关系的男性中,没有观察到酒精使用水平与随后自我报告的健康状况之间的关联。与中度饮酒相比,与报告未饮酒的男性发生性关系的男性随后自我报告的健康状况中位数下降(OR:0.88;95%CI:0.80-0.97)。
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引用次数: 0
Patients admitted on weekends have higher in-hospital mortality than those admitted on weekdays: Analysis of national inpatient sample 周末入院患者的住院死亡率高于周末入院患者:全国住院患者样本分析
Pub Date : 2023-06-01 DOI: 10.1016/j.ajmo.2022.100028
Augustine Manadan , Shilpa Arora , Millan Whittier , Ehizogie Edigin , Preeti Kansal

Introduction

Since the 1999 Institute of Medicine report, hospitals have implemented a myriad of measures to protect patients from medical errors. At this point, looking beyond errors may bring additional safety benefits. This study aims to analyze predictors of in-hospital death regardless of underlying diagnoses in an effort to identify additional targets for improvement.

Methods

We performed a retrospective study of hospitalizations from the 2016-2019 National Inpatient Sample (NIS) database. Logistic regression analyses were used to calculate adjusted odds ratios (OR) for variables associated with in-hospital death.

Results

There were 121,026,484 adult hospital discharges in the database. Multivariable analysis showed the following variables were associated with higher in-hospital death: Age (OR, 1.04), Charlson Comorbidity Index (OR, 1.23), male (OR, 1.16), income Q1 (OR, 1.12), income Q2 (OR, 1.07), west region (OR, 1.07), non-elective admission (OR, 2.01), urban hospital location (OR, 1.17), and weekend admission (OR, 1.14). Percentage of deaths for weekend versus weekday admissions was 2.7% versus 2.1%. Fewer procedures (ICD-10-PCS) were done in first 24 hours of weekend admissions when compared to weekday admissions (34.8% vs 46.8%; p<0.001). Only 524,295 in-hospital deaths were expected for weekend admissions but 673,085 were observed.

Conclusion

Weekend hospital admissions were associated with higher adjusted mortality and a lower rate of procedures when compared to weekday admissions. Further studies should be done to further clarify and confirm if additional staffing and procedural availability on weekends could improve hospital outcomes.

自1999年医学研究所的报告以来,医院已经实施了无数的措施来保护病人免受医疗事故的伤害。在这一点上,超越错误可能会带来额外的安全好处。本研究旨在分析院内死亡的预测因素,而不考虑潜在的诊断,以确定进一步的改善目标。方法对2016-2019年国家住院患者样本(NIS)数据库中的住院情况进行回顾性研究。采用Logistic回归分析计算与院内死亡相关变量的校正优势比(OR)。结果数据库中有成人出院病例121,026,484例。多变量分析显示,以下变量与较高的院内死亡率相关:年龄(OR, 1.04)、Charlson合并症指数(OR, 1.23)、男性(OR, 1.16)、收入Q1 (OR, 1.12)、收入Q2 (OR, 1.07)、西部地区(OR, 1.07)、非选择性住院(OR, 2.01)、城市医院位置(OR, 1.17)和周末住院(OR, 1.14)。周末和工作日入院的死亡率分别为2.7%和2.1%。与工作日入院相比,周末入院前24小时内完成的程序(ICD-10-PCS)较少(34.8% vs 46.8%;术中,0.001)。预计周末入院的住院死亡人数只有524,295人,但实际观察到673,085人。结论与工作日住院相比,周末住院的调整死亡率较高,手术率较低。应该进行进一步的研究,以进一步澄清和确认周末额外的人员配置和程序可用性是否可以改善医院的结果。
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引用次数: 0
Behavioral approaches to nutrition and eating patterns for managing type 2 diabetes: A review 行为方法的营养和饮食模式管理2型糖尿病:综述
Pub Date : 2023-06-01 DOI: 10.1016/j.ajmo.2023.100034
Meg G. Salvia , Paula A. Quatromoni

Nutritional interventions are a key component of type 2 diabetes management; making health-supporting changes in eating patterns can improve postprandial glycemic excursions and lower HbA1c to reduce diabetes-related morbidity and mortality. Research around implementing calorie-restricted and/or low-carbohydrate diets is plentiful, though the ability to sustain physiologic and behavioral changes for longer than 12 months is a concern. An understanding of intervention goals and adherence is needed to apply this research to patient care and translate expectations to real-world living contexts. Diverse dietary patterns including a Mediterranean eating pattern, vegetarian or plant-based eating pattern, or others that emphasize high-quality carbohydrates (e.g., whole grains), vegetables, whole fruits, legumes, and fish can support achievement of glycemic targets. Counseling strategies like motivational interviewing can be used to build eating competence. These approaches prioritize collaborative decision-making with the goal of increasing patient empowerment and self-efficacy. Strategies for incorporating these tools and frameworks in a clinical setting are highlighted. Providing ongoing diabetes and nutrition education, paired with appropriate support to address the challenges in implementing and sustaining behavior changes, is warranted. Further, social determinants of health including environmental context, education, socioeconomic status, access to healthcare, and experiences of systemic stigma (e.g., racism or weight bias) can interfere with individuals’ diabetes self-care and nutrition behaviors. Providing medical nutrition therapy and tailoring nutrition interventions to individual needs and circumstances can be an important way physicians, dietitians, and diabetes providers can support individuals with type 2 diabetes.

营养干预是2型糖尿病管理的关键组成部分;在饮食模式上做出有利于健康的改变,可以改善餐后血糖波动,降低糖化血红蛋白,从而降低糖尿病相关的发病率和死亡率。关于实施卡路里限制和/或低碳水化合物饮食的研究很多,尽管维持生理和行为变化超过12个月的能力是一个问题。需要了解干预目标和依从性,将本研究应用于患者护理并将期望转化为现实生活环境。多种多样的饮食模式,包括地中海饮食模式、素食或植物性饮食模式,或其他强调高质量碳水化合物(如全谷物)、蔬菜、全水果、豆类和鱼类的饮食模式,都可以帮助实现血糖目标。像动机性访谈这样的咨询策略可以用来建立饮食能力。这些方法优先考虑协作决策,目标是提高患者的能力和自我效能。强调了将这些工具和框架纳入临床环境的策略。提供持续的糖尿病和营养教育,配合适当的支持,以应对实施和维持行为改变的挑战,是有必要的。此外,健康的社会决定因素,包括环境背景、教育、社会经济地位、获得医疗保健的机会以及系统性耻辱的经历(如种族主义或体重偏见),都可能干扰个人的糖尿病自我保健和营养行为。根据个人需要和情况提供医疗营养治疗和量身定制营养干预可能是医生、营养师和糖尿病提供者为2型糖尿病患者提供支持的重要途径。
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引用次数: 2
Oral anticoagulation use in non-valvular atrial fibrillation patients in rural setting 口服抗凝剂在农村非瓣膜性房颤患者中的应用
Pub Date : 2023-06-01 DOI: 10.1016/j.ajmo.2022.100026
Camille Brod , Nicole Groth , Macaela Rudeck , Ramin Artang , Matthew Rioux , Catherine Benziger

Background

The 2019 ACC/AHA/HRS guidelines established direct oral anticoagulants (DOACs) as first line therapy over warfarin for non-valvular atrial fibrillation (AF).

Methods

Ambulatory clinic patients with non-valvular AF or atrial flutter seen between 10/1/2019-7/12/2020 included. High-risk AF defined as males CHA2DS2-VASc score ≥2 and females ≥3. Patients were separated into: warfarin, DOAC, or no oral anticoagulation (OAC). ATRIA bleed score calculated. A provider survey assessing knowledge and barriers to anticoagulation completed via REDCap between 3/5-4/16/2020.

Results

Of 12,014 subjects with AF, 8,032 were high risk (mean age 75.9 ± 9.8 years; 57.5% male). There were 4,619 (57.1%) ≥ 75 years and 63.4% were rural dwelling. There was no significant difference between the number of subjects on anticoagulation before and after the guideline publication (75.6% vs. 75.7%, p = 0.79). Warfarin use decreased 2.3% over 1 year (39.3% to 37.0%), while DOACs increased 2.4% (36.2% to 38.7%, p < 0.001 for both). At 1-year, age, male gender, CHA2DS2-VASc score 4-6, hypertension, stroke and cardiology consult increased prescription of OAC (p<0.05). Vascular disease, high risk ATRIA bleed, renal disease, prior hemorrhage, and left atrial appendage occlusion were associated with decreased OAC use (p < 0.05). Left atrial appendage occlusion device use was low (<1%). In a survey, majority of providers noted bleeding risk (35.1%) and cost (25.0%) to be the biggest barriers to DOAC use.

Conclusions

The new guidelines caused a slight increase in DOACs over time. Significant barriers to DOAC use exist in rural areas; one in four high risk AF patient remains without OAC therapy.

2019年ACC/AHA/HRS指南将直接口服抗凝剂(DOACs)作为治疗非瓣膜性心房颤动(AF)的一线治疗方法,而不是华法林。方法纳入2019年10月1日至2020年7月12日期间门诊非瓣膜性房颤或心房扑动患者。高危房颤定义为男性CHA2DS2-VASc评分≥2,女性≥3。患者被分为:华法林,DOAC,或无口服抗凝(OAC)。计算心房出血评分。在2020年3月5日至4月16日期间通过REDCap完成了一项评估抗凝知识和障碍的提供者调查。结果12014例房颤患者中,8032例为高危人群(平均年龄75.9±9.8岁;57.5%的男性)。≥75岁的4619例(57.1%),63.4%为农村居民。指南发表前后接受抗凝治疗的受试者人数无显著差异(75.6% vs. 75.7%, p = 0.79)。华法林的使用在1年内下降了2.3%(39.3%至37.0%),而DOACs增加了2.4%(36.2%至38.7%),p <两者均为0.001)。1岁时,年龄、男性、CHA2DS2-VASc评分4-6、高血压、脑卒中、心内科会诊OAC处方增加(p < 0.05)。血管疾病、高危心房出血、肾脏疾病、既往出血和左心耳闭塞与OAC使用减少相关(p <0.05)。左心耳闭塞器使用率低(1%)。在一项调查中,大多数提供者指出出血风险(35.1%)和费用(25.0%)是使用DOAC的最大障碍。随着时间的推移,新指南导致DOACs略有增加。农村地区使用DOAC存在重大障碍;四分之一的高危房颤患者仍未接受OAC治疗。
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引用次数: 0
Differential impact of systolic and diastolic heart failure on in-hospital treatment, outcomes, and cost of patients admitted for pneumonia 收缩期和舒张期心力衰竭对住院治疗、结果和住院肺炎患者费用的不同影响
Pub Date : 2023-06-01 DOI: 10.1016/j.ajmo.2022.100025
Jessica El Halabi , Essa Hariri , Quinn R. Pack , Ning Guo , Pei-Chun Yu , Niti G. Patel , Peter B. Imrey , Michael B. Rothberg

Background

Patients admitted with pneumonia and heart failure (HF) have increased mortality and cost compared to those without HF, but it is not known whether outcomes differ between systolic and diastolic HF. Management of concomitant pneumonia and HF is complicated because HF treatments can worsen complications of pneumonia.

Methods

This is a retrospective cohort study from the Premier Database among patients admitted with pneumonia between 2010 and 2015. Patients were categorized based on systolic, diastolic, and combined HF using ICD-9 codes. The primary outcome was in-hospital mortality. Secondary outcomes included use of HF medications, length of stay, cost, intensive care unit (ICU) admission, as well as use of invasive mechanical ventilation (IMV), vasopressors and inotropes. Multivariable logistic regression was used to describe associations of these outcomes with type of HF.

Results

Of 123,211 patients with pneumonia and HF, 41,196 (33.4%) had systolic HF, 69,982 (56.8%) diastolic HF, and 12,033 (9.8%) had combined HF. Compared to patients with diastolic HF, after multivariable adjustment systolic HF was associated with higher in-hospital mortality (OR 1.15; 95% CI:1.11–1.20), ICU admission, and use of IMV and vasoactive agents, but not with increased length of stay or cost. Among patients with systolic HF, 80% received a loop diuretic, 72% a beta blocker, 48% angiotensin converting enzyme inhibitor or angiotensin receptor blocker, and 12.5% a mineralocorticoid receptor antagonist.

Conclusion

Systolic HF is associated with added risk in pneumonia compared to diastolic HF. There may also be an opportunity to optimize medications in systolic HF prior to discharge.

背景:入院的肺炎合并心力衰竭(HF)患者与非HF患者相比,死亡率和费用增加,但尚不清楚收缩期和舒张期HF的结局是否有差异。合并肺炎和心衰的治疗是复杂的,因为心衰治疗会加重肺炎的并发症。方法:本研究是一项来自Premier数据库的回顾性队列研究,研究对象为2010年至2015年住院的肺炎患者。使用ICD-9编码根据收缩期、舒张期和合并心衰对患者进行分类。主要终点是住院死亡率。次要结局包括HF药物的使用、住院时间、费用、重症监护病房(ICU)入住情况,以及有创机械通气(IMV)、血管加压药和收缩性药物的使用情况。使用多变量逻辑回归来描述这些结果与心衰类型的关联。结果123,211例肺炎合并心衰患者中,收缩期心衰41,196例(33.4%),舒张期心衰69,982例(56.8%),合并心衰12033例(9.8%)。与舒张期心衰患者相比,多变量调整后,收缩期心衰与更高的住院死亡率相关(OR 1.15;95% CI: 1.11-1.20)、ICU入院、使用IMV和血管活性药物,但与住院时间或费用的增加无关。在收缩期心力衰竭患者中,80%接受利尿剂治疗,72%接受受体阻滞剂治疗,48%接受血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂治疗,12.5%接受矿皮质激素受体拮抗剂治疗。结论与舒张期心衰相比,收缩期心衰与肺炎风险增加相关。在收缩期心衰出院前,也可能有机会优化药物治疗。
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引用次数: 0
Comparing clinical outcomes between two continuous glucose monitors: similar diabetes-related events, all-cause hospitalizations and HbA1c reductions in type 1 and type 2 diabetes 两种连续血糖监测仪的临床结果比较:1型和2型糖尿病的类似糖尿病相关事件、全因住院和HbA1c降低
Pub Date : 2023-06-01 DOI: 10.1016/j.ajmo.2022.100008
Eden Miller , Gregory J. Roberts , Jennifer M. Joseph , Yelena Nabutovsky , Ignacio J. Reyes , Diana Souto , Naunihal Virdi , Irl B. Hirsch

Objectives

We compared clinical outcomes after acquiring a FreeStyle Libre© Flash Continuous Glucose Monitoring System (FSL) or Dexcom (DEX) continuous glucose monitoring (CGM) device in individuals with type 1 diabetes (T1D) and type 2 diabetes (T2D) treated with intensive insulin therapy.

Design and Methods

This retrospective analysis of the IBM® MarketScan® Research Databases and IBM® Explorys® Electronic Health Records Database assessed differences in acute diabetes-related events (ADE), all-cause hospitalizations (ACH) and glycated hemoglobin (HbA1c) in T1D and T2D populations 6 months post CGM acquisition. Analyses were conducted in two study cohorts (Cohort 1, n = 7,494; Cohort 2, n = 678). Participants were T1D or T2D, age ≥ 18 years, treated with short or rapid-acting insulin and naïve to CGM, who acquired a CGM system. Users were propensity score matched on demographics and clinical factors.

Results

Cohort 1: Post-CGM ADE-free rates at 6 months ranged from 94.8 to 96.7% and ACH-free rates ranged from 90.4 to 95.4%, for both T1D and T2D groups, with no significant differences between CGM systems. Cohort 2: Significant HbA1c reductions were associated with use of the DEX and FSL devices in the T1D (-0.35% and -0.37%, respectively) and T2D (-0.73% and -0.79%, respectively) cohorts, both p < 0.001, with no significant differences in the magnitude of reduction between systems (T1D p = 0.99 and T2D p = 0.84).

Conclusions

Acquisition of the FSL and DEX systems was associated with similar rates of acute diabetes-related events and all-cause hospitalizations and similar HbA1c reductions in adults with T1D and T2D.

目的:比较使用FreeStyle Libre©Flash连续血糖监测系统(FSL)或Dexcom (DEX)连续血糖监测(CGM)设备对接受胰岛素强化治疗的1型糖尿病(T1D)和2型糖尿病(T2D)患者的临床结果。设计和方法对IBM®MarketScan®研究数据库和IBM®Explorys®电子健康记录数据库进行回顾性分析,评估T1D和T2D人群在CGM获得6个月后急性糖尿病相关事件(ADE)、全因住院(ACH)和糖化血红蛋白(HbA1c)的差异。对两个研究队列进行分析(队列1,n = 7,494;队列2,n = 678)。参与者为T1D或T2D,年龄≥18岁,接受短效或速效胰岛素治疗,naïve to CGM,获得CGM系统。使用者的倾向评分与人口统计学和临床因素相匹配。结果结果1:CGM后6个月,T1D组和T2D组的ade无症状率为94.8 - 96.7%,ach无症状率为90.4 - 95.4%,CGM系统之间无显著差异。队列2:在T1D(分别为-0.35%和-0.37%)和T2D(分别为-0.73%和-0.79%)队列中,使用DEX和FSL装置可显著降低HbA1c, p <0.001,系统之间的减少幅度无显著差异(T1D p = 0.99, T2D p = 0.84)。结论:获得FSL和DEX系统与T1D和T2D成人急性糖尿病相关事件和全因住院发生率相似,HbA1c降低相似。
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引用次数: 0
Epidemiological and clinical perspectives of long COVID syndrome 长冠状病毒综合征的流行病学和临床研究
Pub Date : 2023-06-01 DOI: 10.1016/j.ajmo.2023.100033
Katherine Huerne , Kristian B. Filion , Roland Grad , Pierre Ernst , Andrea S. Gershon , Mark J. Eisenberg

Long COVID, or post-acute COVID-19 syndrome, is characterized by multi-organ symptoms lasting 2+ months after initial COVID-19 virus infection. This review presents the current state of evidence for long COVID syndrome, including the global public health context, incidence, prevalence, cardiopulmonary sequelae, physical and mental symptoms, recovery time, prognosis, risk factors, rehospitalization rates, and the impact of vaccination on long COVID outcomes. Results are presented by clinically relevant subgroups. Overall, 10–35% of COVID survivors develop long COVID, with common symptoms including fatigue, dyspnea, chest pain, cough, depression, anxiety, post-traumatic stress disorder, memory loss, and difficulty concentrating. Delineating these issues will be crucial to inform appropriate post-pandemic health policy and protect the health of COVID-19 survivors, including potentially vulnerable or underrepresented groups. Directed to policymakers, health practitioners, and the general public, we provide recommendations and suggest avenues for future research with the larger goal of reducing harms associated with long COVID syndrome.

长期新冠肺炎,或急性后新冠肺炎综合征,其特征是在最初感染新冠肺炎病毒后持续2个多月的多器官症状。这篇综述介绍了长期新冠肺炎综合征的证据现状,包括全球公共卫生背景、发病率、流行率、心肺后遗症、身心症状、恢复时间、预后、风险因素、再住院率以及疫苗接种对长期新冠结果的影响。结果由临床相关的亚组表示。总体而言,10-35%的新冠肺炎幸存者出现长期新冠肺炎,常见症状包括疲劳、呼吸困难、胸痛、咳嗽、抑郁、焦虑、创伤后应激障碍、记忆力丧失和注意力难以集中。界定这些问题对于制定适当的疫情后卫生政策和保护新冠肺炎幸存者的健康至关重要,包括潜在的弱势群体或代表性不足的群体。针对政策制定者、卫生从业者和公众,我们为未来的研究提供建议和建议,以减少与长期新冠肺炎综合征相关的危害为更大的目标。
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引用次数: 5
PCSK9 Inhibitor Use and Outcomes Using Concomitant Lipid-Lowering Therapies in the Veterans Health Administration 退伍军人健康管理局PCSK9抑制剂的使用和伴随降脂治疗的结果
Pub Date : 2023-06-01 DOI: 10.1016/j.ajmo.2023.100035
Jessica Eloso , Asma Awad , Xinhua Zhao , Francesca E. Cunningham , Rongping Zhang , Diane Dong , Cathy Kelley , Peter A. Glassman , Sherrie L. Aspinall

Background

Real-world data on use of PCSK9 inhibitors (PCSK9-Is), with or without statins and/or ezetimibe, and associated outcomes, can inform more effective prescribing. The objective was to evaluate clinical effectiveness and safety of PCSK9-Is within the Veterans Health Administration (VHA).

Methods

In this retrospective cohort study, we included Veterans who had at least one outpatient prescription for alirocumab and/or evolocumab filled within VHA between August 21, 2015, and September 30, 2020. Analyses included 4 mutually exclusive subgroups: PCSK9-I alone, PCSK9-I+statin, PCSK9-I+ezetimibe, and PCSK9-I+statin+ezetimibe subgroups. Primary outcomes included medication possession ratio, persistence, and low-density lipoprotein (LDL).

Results

Among Veterans in the analytical cohort (n = 2428), 36.2% were on PCSK9-I monotherapy; 24.0% received a PCSK9-I+statin; 27.4% were on a PCSK9-I+ezetimibe; and 12.4% received triple therapy, that is, PCSK9-I+statin+ezetimibe. The mean medication possession ratio (standard deviation [SD]) for PCSK9-I monotherapy was 83.8% (13.3) compared to 84.3% (11.2) with PCSK9-I+statin therapy, 87.1% (10.1) with PCSK9-I+ezetimibe therapy, and 85.8% (11.7) with triple therapy. The percentage of patients who discontinued PCSK9-I in the monotherapy subgroup was 12.3% vs 9.5%, 6.6%, and 7.4% in the concomitant statin, ezetimibe, and triple-therapy subgroups, respectively (p = .002 among the groups). Mean LDL level was greater in the PCSK9-I monotherapy subgroup (85.6 mg/dL) compared with the concomitant statin (66.5 mg/dL), ezetimibe (65.7 mg/dL), and triple-therapy subgroups (68.1 mg/dL).

Conclusions

Veterans showed good adherence and/or persistence with PCSK9-I regimens. On average, those receiving concomitant therapy with a statin and/or ezetimibe achieved significantly lower LDL levels.

背景关于PCSK9抑制剂(PCSK9-Is)的使用,无论是否使用他汀类药物和/或依折麦布,以及相关结果的真实世界数据,都可以为更有效的处方提供信息。目的是在退伍军人健康管理局(VHA)内评估PCSK9-Is的临床有效性和安全性。方法在这项回顾性队列研究中,我们纳入了2015年8月21日至2020年9月30日期间在VHA内至少开了一张阿利罗库单抗和/或埃沃洛单抗门诊处方的退伍军人。分析包括4个相互排斥的亚组:PCSK9-I单独、PCSK9-I+他汀类、PCSK9-I+依折麦布和PCSK9-I+他汀类+依折麦布亚组。主要结果包括药物持有率、持续性和低密度脂蛋白(LDL)。结果在分析队列中的退伍军人(n=2428)中,36.2%接受PCSK9-I单药治疗;24.0%接受PCSK9-I+他汀类药物治疗;27.4%在PCSK9-I+依折麦布上;12.4%的患者接受PCSK9-I+他汀+依折麦布三联治疗。PCSK9-I单药治疗的平均药物拥有率(标准差[SD])为83.8%(13.3),而PCSK9-I+他汀类药物治疗为84.3%(11.2),PCSK9-I+依折麦布治疗为87.1%(10.1),三药治疗为85.8%(11.7)。单药治疗亚组中停用PCSK9-I的患者比例分别为12.3%和9.5%,同时使用他汀类药物、依折麦布和三联治疗亚组分别为6.6%和7.4%(各组间p=.002)。PCSK9-I单药治疗亚组(85.6 mg/dL)的平均LDL水平高于同时使用他汀类药物(66.5 mg/dL、依折麦布(65.7 mg/dL和三重治疗亚组)(68.1 mg/dL。结论退伍军人对PCSK9-I方案表现出良好的依从性和/或持久性。平均而言,那些同时接受他汀类药物和/或依折麦布治疗的患者的LDL水平显著降低。
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引用次数: 0
Concerns with the Usage of ChatGPT in Academia and Medicine: A Viewpoint 对ChatGPT在学术和医学中使用的关注:一种观点
Pub Date : 2023-06-01 DOI: 10.1016/j.ajmo.2023.100036
Muath Alser , Ethan Waisberg
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引用次数: 24
Beyond the EHR: How Digital Health Tools Foster Participatory Health and Self-Care for Patients with Diabetes 超越EHR:数字健康工具如何促进糖尿病患者的参与式健康和自我护理
Pub Date : 2023-05-06 DOI: 10.1016/j.ajmo.2023.100043
Daniel Z. Sands

Just as physicians managing patients with diabetes find that it is a data-driven process, for patients living with diabetes, it is even more so, as physicians see them every few months, but patients need to live with diabetes all the time. Fortunately, the advent of the web has allowed patients to connect with information, medical care, and other patients, while mobile and connected technologies such as smartphones have provided the flexibility to do this—and to manage and share their health information—from anywhere. Healthcare professionals who care for patients with diabetes should be aware of the digital health technologies that enable patients to better care for themselves, be more active participants in their healthcare, and improve the quality of their lives.

正如管理糖尿病患者的医生发现,这是一个数据驱动的过程,对于糖尿病患者来说,更是如此,因为医生每隔几个月就会看到他们,但患者需要一直与糖尿病生活在一起。幸运的是,网络的出现使患者能够与信息、医疗保健和其他患者联系起来,而移动和连接技术(如智能手机)提供了这样做的灵活性,并且可以从任何地方管理和共享他们的健康信息。照顾糖尿病患者的医疗保健专业人员应该了解数字健康技术,这些技术使患者能够更好地照顾自己,更积极地参与他们的医疗保健,并提高他们的生活质量。
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引用次数: 0
期刊
American journal of medicine open
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