Kansas journal of medicine最新文献

Introduction: Aspirin and an oral P2Y12 inhibitor are recommended for one year after percutaneous coronary intervention (PCI) in patients with acute coronary syndromes. While ticagrelor or prasugrel, more potent P2Y12 inhibitors, are preferred over clopidogrel, de-escalation often is based on provider judgment. This study compared cardiovascular outcomes and bleeding risks between patients who remained on ticagrelor or prasugrel (unchanged group) and those de-escalated to clopidogrel within 30 days of PCI.

Methods: The authors analyzed data from patients admitted between June 2014 and December 2022 for acute coronary syndromes requiring PCI who received an oral P2Y12 inhibitor within 72 hours of admission. The primary outcome was a composite of all-cause mortality, urgent revascularization, stent thrombosis, stroke, and major bleeding at one year. Secondary outcomes included the individual components of the composite outcome. Statistical analyses included chi-square tests, Student's t-tests, or non-parametric equivalents, as appropriate.

Results: A total of 210 patients met the inclusion criteria, with 149 remaining on unchanged P2Y12 therapy and 61 undergoing de-escalation. There was no statistically significant difference in the composite outcome between the unchanged and de-escalated groups (n [%]: 25 [17] vs. 6 [10]; χ² [1, N = 210] = 1.658, p = 0.198). Additionally, secondary outcomes, including all-cause mortality, urgent revascularization, stent thrombosis, stroke, and major bleeding, did not differ significantly between groups.

Conclusions: A composite outcome of all-cause mortality, urgent revascularization, stent thrombosis, stroke, and major bleeding at one year was similar between patients who continued ticagrelor or prasugrel and those de-escalated to clopidogrel within 30 days of PCI. Larger studies are needed to confirm these findings and assess the optimal timing for therapy adjustments.

Introduction: In 2022, the U.S. healthcare expenditure totaled $4.5 trillion, representing 17.3% of its gross domestic product. Despite this, 26 million Americans remain uninsured, often relying on out-of-pocket payments for essential services like cancer screenings. Kansas, with its high uninsured rate, faces unique challenges, emphasizing the need to analyze the cost burden of these critical yet repeatable interventions.

Methods: Authors of this cross-sectional study analyzed hospital pricing transparency data for breast, lung, and colon cancer screening costs across 124 Kansas hospitals. Data on self-pay costs were collected and compared between urban and rural regions, as well as geographic price variations. Statistical analyses included measures of central tendency, Kruskal-Wallis tests, and Mann-Whitney U tests to evaluate differences.

Results: Pricing disparities were evident across Kansas. Urban hospitals charged higher prices for chest computed tomography (CT) scans, while rural hospitals had elevated costs for colonoscopies and mammograms. Notable price variation included Northeast Kansas colonoscopy prices, which ranged from $595 to $11,684. Rural residents faced a greater financial burden, spending 7% of their income on screenings compared to 6% for urban residents. Median screening prices statewide were $2,247 for colonoscopies, $1,109 for chest CT scans, and $228 for mammograms.

Conclusions: These disparities call for targeted policy interventions, such as Medicaid expansion, standardized pricing regulations, and increased support for low-cost clinics. Enhanced hospital pricing transparency is critical for empowering patients and reducing financial burdens. This study highlights the urgent need for equitable access to cancer screenings in Kansas.