-
Scientific Reports Dec 2023Heart failure (HF) presents manifestations in both cardiac and vascular abnormalities. Pulmonary hypertension (PH) is prevalent in up 50% of HF patients. While pulmonary...
Heart failure (HF) presents manifestations in both cardiac and vascular abnormalities. Pulmonary hypertension (PH) is prevalent in up 50% of HF patients. While pulmonary arterial hypertension (PAH) is closely associated with pulmonary artery (PA) stiffness, the association of HF caused, post-capillary PH and PA stiffness is unknown. We aimed to assess and compare PA stiffness and blood flow hemodynamics noninvasively across HF entities and control subjects without HF using CMR. We analyzed data of a prospectively conducted study with 74 adults, including 55 patients with HF across the spectrum (20 HF with preserved ejection fraction [HFpEF], 18 HF with mildly-reduced ejection fraction [HFmrEF] and 17 HF with reduced ejection fraction [HFrEF]) as well as 19 control subjects without HF. PA stiffness was defined as reduced vascular compliance, indicated primarily by the relative area change (RAC), altered flow hemodynamics were detected by increased flow velocities, mainly by pulse wave velocity (PWV). Correlations between the variables were explored using correlation and linear regression analysis. PA stiffness was significantly increased in HF patients compared to controls (RAC 30.92 ± 8.47 vs. 50.08 ± 9.08%, p < 0.001). PA blood flow parameters were significantly altered in HF patients (PWV 3.03 ± 0.53 vs. 2.11 ± 0.48, p < 0.001). These results were consistent in all three HF groups (HFrEF, HFmrEF and HFpEF) compared to the control group. Furthermore, PA stiffness was associated with higher NT-proBNP levels and a reduced functional status. PA stiffness can be assessed non-invasively by CMR. PA stiffness is increased in HFrEF, HFmrEF and HFpEF patients when compared to control subjects.Trial registration The study was registered at the German Clinical Trials Register (DRKS, registration number: DRKS00015615).
Topics: Adult; Humans; Heart Failure; Pulmonary Artery; Pulse Wave Analysis; Stroke Volume; Magnetic Resonance Spectroscopy; Prognosis
PubMed: 38114509
DOI: 10.1038/s41598-023-49325-5 -
World Journal of Cardiology Feb 2024Physical inactivity remains in high levels after cardiac surgery, reaching up to 50%. Patients present a significant loss of functional capacity, with prominent muscle...
Physical inactivity remains in high levels after cardiac surgery, reaching up to 50%. Patients present a significant loss of functional capacity, with prominent muscle weakness after cardiac surgery due to anesthesia, surgical incision, duration of cardiopulmonary bypass, and mechanical ventilation that affects their quality of life. These complications, along with pulmonary complications after surgery, lead to extended intensive care unit (ICU) and hospital length of stay and significant mortality rates. Despite the well-known beneficial effects of cardiac rehabilitation, this treatment strategy still remains broadly underutilized in patients after cardiac surgery. Prehabilitation and ICU early mobilization have been both showed to be valid methods to improve exercise tolerance and muscle strength. Early mobilization should be adjusted to each patient's functional capacity with progressive exercise training, from passive mobilization to more active range of motion and resistance exercises. Cardiopulmonary exercise testing remains the gold standard for exercise capacity assessment and optimal prescription of aerobic exercise intensity. During the last decade, recent advances in healthcare technology have changed cardiac rehabilitation perspectives, leading to the future of cardiac rehabilitation. By incorporating artificial intelligence, simulation, telemedicine and virtual cardiac rehabilitation, cardiac surgery patients may improve adherence and compliance, targeting to reduced hospital readmissions and decreased healthcare costs.
PubMed: 38456068
DOI: 10.4330/wjc.v16.i2.67 -
JAMA Network Open May 2024Integration of pharmacies with physician practices, also known as medically integrated dispensing, is increasing in oncology. However, little is known about how this...
IMPORTANCE
Integration of pharmacies with physician practices, also known as medically integrated dispensing, is increasing in oncology. However, little is known about how this integration affects drug use, expenditures, medication adherence, or time to treatment initiation.
OBJECTIVE
To examine the association of physician-pharmacy integration with oral oncology drug expenditures, use, and patient-centered measures.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study used claims data from a large commercial insurer in the US to analyze changes in outcome measures among patients treated by pharmacy-integrating vs nonintegrating community oncologists in 14 states between January 1, 2011, and December 31, 2019. Commercially insured patients were aged 18 to 64 years with 1 of the following advanced-stage diagnoses: breast cancer, colorectal cancer, kidney cancer, lung cancer, melanoma, or prostate cancer. Data analysis was conducted from May 2023 to March 2024.
EXPOSURE
Treatment by a pharmacy-integrating oncologist, ascertained by the presence of an on-site pharmacy or nonpharmacy dispensing site.
MAIN OUTCOMES AND MEASURES
Oral, intravenous (IV), total, and out-of-pocket drug expenditures for a 6-month episode of care; share of patients prescribed oral drugs; days' supply of oral drugs; medication adherence measured by proportion of days covered; and time to treatment initiation. The association between an oncologist's pharmacy integration and each outcome of interest was estimated using the difference-in-differences estimator.
RESULTS
Between 2012 and 2019, 3159 oncologists (745 females [27.1%], 2002 males [72.9%]) treated 23 968 patients (66.4% female; 53.4% aged 55-64 years). Of the 3159 oncologists, 578 (18.3%) worked in practices that integrated with pharmacies (with a low rate in 2011 of 0% and a high rate in 2019 of 31.5%). In the full sample (including all cancer sites), after physician-pharmacy integration, no significant changes were found in oral drug expenditures, IV drug expenditures, or total drug expenditures. There was, however, an increase in days' supply of oral drugs (5.96 days; 95% CI, 0.64-11.28 days; P = .001). There were no significant changes in out-of-pocket expenditures, medication adherence, or time to treatment initiation of oral drugs. In the breast cancer sample, there was an increase in oral drug expenditures ($244; 95% CI, $41-$446; P = .02) and a decrease in IV drug expenditures (-$4187; 95% CI, -$8293 to -$80; P = .05).
CONCLUSIONS AND RELEVANCE
Results of this cohort study indicated that the integration of oncology practices with pharmacies was not associated with significant changes in expenditures or clear patient-centered benefits.
Topics: Humans; Female; Male; Middle Aged; Adult; Neoplasms; Medication Adherence; United States; Cohort Studies; Health Expenditures; Antineoplastic Agents; Adolescent; Young Adult; Oncologists
PubMed: 38780938
DOI: 10.1001/jamanetworkopen.2024.12998 -
Journal of Multidisciplinary Healthcare 2024Management of care for people with Pulmonary TB at home using Information and Communication Technology (ICT) tools and innovative approaches, such as tools for... (Review)
Review
Management of care for people with Pulmonary TB at home using Information and Communication Technology (ICT) tools and innovative approaches, such as tools for telecommunications online education. In the nursing sector, the use of telecommunications is called telenursing. The purpose of this study is to determine the types of telecommunications-based interventions, especially telenursing, in monitoring the level of treatment adherence in patients with pulmonary TB. This study used a scoping review method approach to determine the type of telecommunications-based interventions, especially telenursing, in monitoring the level of treatment adherence in patients with pulmonary TB. Literature distribution using several sources, namely EBSCOhost, Scopus (Elsevier), and PubMed. To facilitate obtaining appropriate literature, PICO techniques are used in conducting literature searches, P (population/problem/patient), I (intervention, prognostic factor, exposure), C (comparison, control), and O (outcome). Keywords used in English "Tuberculosis OR Pulmonary Tuberculosis AND Telehealth OR Telehealth Nursing AND Medication Adherence OR Medication Compliance OR Behavior". In total from the 13 articles obtained, the articles used several telehealth to pulmonary TB patients with various implementations, such as the Directly Observed Therapy, Short Course (DOTS) (n = 7). These four implementations have the same goal and support adherence to taking medication and daily recovery in pulmonary TB patients. Overall characteristics of pulmonary TB patients in the reviewed articles are pediatric TB patients (0-14 years), adult TB (18-30 years). A total of 9 studies used a sample population of adult TB patients (18-30 years), TB undergoing Directly Observed Treatment Short-course (DOTS), TB receiving medical care and TB patients actively receiving treatment. The most influential effectiveness of telehealth in helping the treatment process of Pulmonary TB patients is Directly Observed Treatment Short-course (DOTS) because the main focus of the DOTS strategy is patient discovery and cure, priority is given to infectious TB patients without ruling out other types of TB.
PubMed: 38196938
DOI: 10.2147/JMDH.S440314 -
Journal of Clinical Medicine Mar 2024Acute respiratory distress syndrome (ARDS) is a well-defined clinical entity characterized by the acute onset of diffuse pulmonary injury and hypoxemia not explained by... (Review)
Review
Acute respiratory distress syndrome (ARDS) is a well-defined clinical entity characterized by the acute onset of diffuse pulmonary injury and hypoxemia not explained by fluid overload. The COVID-19 pandemic brought about an unprecedented volume of patients with ARDS and challenged our understanding and clinical approach to treatment of this clinical syndrome. Unique to COVID-19 ARDS is the disruption and dysregulation of the pulmonary vascular compartment caused by the SARS-CoV-2 virus, which is a significant cause of hypoxemia in these patients. As a result, gas exchange does not necessarily correlate with respiratory system compliance and mechanics in COVID-19 ARDS as it does with other etiologies. The purpose of this review is to relate the mechanics of COVID-19 ARDS to its underlying pathophysiologic mechanisms and outline the lessons we have learned in the management of this clinic syndrome.
PubMed: 38610598
DOI: 10.3390/jcm13071833 -
The Journal of Allergy and Clinical... May 2024Poor adherence to asthma and chronic obstructive pulmonary disease maintenance therapies impairs health outcomes. Proven and cost-effective programs to promote adherence...
Cost-Effectiveness and Impact on Health Care Utilization of Interventions to Improve Medication Adherence and Outcomes in Asthma and Chronic Obstructive Pulmonary Disease: A Systematic Literature Review.
BACKGROUND
Poor adherence to asthma and chronic obstructive pulmonary disease maintenance therapies impairs health outcomes. Proven and cost-effective programs to promote adherence and persistence are not yet in regular widespread use. Implementation costs are a potential barrier to uptake of such programs.
OBJECTIVE
We undertook a systematic literature review and narrative synthesis of studies investigating the cost-effectiveness of treatment adherence-promoting programs or that determined their impact on health care budget directly or via health care resource use (HCRU).
METHODS
We identified relevant publications using Medline and PreMEDLINE (PubMed), Embase (Embase.com, Elsevier), and EconLit for publications between January 2000 and July 2021. We also searched clinical trial databases and selected conference proceedings.
RESULTS
Of 1,910 potentially relevant articles, 26 met prespecified inclusion criteria and underwent data extraction. Eleven reported a direct assessment of adherence, 15 included economic evaluations, and 17 described HCRU. None included an analysis of biologic medication use. When they were studied, interventions were often found to be highly cost-effective, with dominant incremental cost-effectiveness ratios in some cases. Reductions in direct costs and HCRU (health care visits, hospital admissions, and/or the use of medications, including add-on/reliever treatment and antibiotics) were frequently reported. Reported use of maintenance treatments improved in some studies. Counseling and/or digitally informed programs were used in all cases in which favorable outcomes were observed.
CONCLUSIONS
Adherence-promoting interventions are mostly cost-effective and often result in reduced HCRU and associated costs. Multidisciplinary care involving one-to-one advice and digitally enhanced communications appear to offer the greatest benefit.
Topics: Humans; Cost-Benefit Analysis; Asthma; Pulmonary Disease, Chronic Obstructive; Medication Adherence; Patient Acceptance of Health Care
PubMed: 38182099
DOI: 10.1016/j.jaip.2023.12.049 -
Human Vaccines & Immunotherapeutics Dec 2024Tuberculosis (TB), caused by the intracellular pathogen (), affects the lungs of infected individuals (pulmonary TB) but can also affect other sites (extrapulmonary...
Tuberculosis (TB), caused by the intracellular pathogen (), affects the lungs of infected individuals (pulmonary TB) but can also affect other sites (extrapulmonary TB). The only licensed vaccine bacillus (BCG) protects infants and young children but exhibits variable efficacy in protecting against adult pulmonary TB. Poor compliance and prolonged treatment regimens associated with the use of chemotherapy has contributed to the development of multidrug-resistant (MDR) and extensively drug-resistant (XDR) . Thus, there is an urgent need for the design of more effective vaccines against TB. The development of safe and novel adjuvants for human use is critical. In this study, we demonstrate that saponin-based TQL1055 adjuvant when formulated with a TLR4 agonist (PHAD) and specific immunodominant antigens (ESAT-6 and Ag85B) and delivered intramuscularly in mice, the SA-TB vaccine induced potent lung immune responses. Additionally, the SA-TB vaccine conferred significant protection against infection, comparable with levels induced by BCG. These findings support the development of a SA-TB vaccine comprising TQL1055, as a novel, safe and effective TB vaccine for potential use in humans.
Topics: Adult; Child; Infant; Humans; Animals; Mice; Child, Preschool; Mycobacterium tuberculosis; BCG Vaccine; Adjuvants, Immunologic; Tuberculosis Vaccines; Tuberculosis, Pulmonary; Mycobacterium bovis; Saponins
PubMed: 38190806
DOI: 10.1080/21645515.2024.2302070 -
Scientific Reports Nov 2023Systemic sclerosis (SSc) is an autoimmune disease characterized by vasculopathy, immune dysregulation, and multi-organ fibrosis. Interstitial lung disease (ILD) is a...
Systemic sclerosis (SSc) is an autoimmune disease characterized by vasculopathy, immune dysregulation, and multi-organ fibrosis. Interstitial lung disease (ILD) is a complication of SSc and a leading cause of SSc-death. The administration of hypochlorous acid (HOCl) intradermally in the mouse (HOCl-SSc) purportedly shows several features typical of SSc. We studied the model by injecting BALB/c mice daily intradermally with HOCl for 6-weeks, an exposure reported to induce lung fibrosis. On day 42, the skinfold thickness and the dermal thickness were two and three times larger respectively in the HOCl group compared to controls. HOCl treatment did not result in histological features of pulmonary fibrosis nor significant changes in lung compliance. Automated image analysis of HOCl mice lungs stained with picrosirius red did not show increased collagen deposition. HOCl injections did not increase pulmonary mRNA expression of pro-fibrotic genes nor induced the production of serum advanced oxidation protein products and anti-topoisomerase 1 antibodies. Immune cells in bronchoalveolar lavage fluid (BALF) and whole lung digests were not increased in HOCl-treated animals. Since lung fibrosis is proposed to be triggered by oxidative stress, we injected HOCl to Nrf2 mice, a mouse deficient in many antioxidant proteins. Lung compliance, histology, and BALF leukocyte numbers were comparable between Nrf2 mice and wild-type controls. We conclude that the HOCl-SSc model does not manifest SSc-lung disease.
Topics: Animals; Mice; Pulmonary Fibrosis; Hypochlorous Acid; Bleomycin; NF-E2-Related Factor 2; Skin; Fibrosis; Lung Diseases, Interstitial; Scleroderma, Systemic; Lung; Disease Models, Animal
PubMed: 37996447
DOI: 10.1038/s41598-023-47083-y -
International Journal of Chronic... 2023Exercise compliance was known as important to improve long-term health conditions for Chronic obstructive pulmonary disease (COPD) patients, however, little was known...
BACKGROUND AND AIM
Exercise compliance was known as important to improve long-term health conditions for Chronic obstructive pulmonary disease (COPD) patients, however, little was known about the determinants which affect their exercise compliance. This study aimed to investigate factors related to exercise compliance of COPD elderly patients.
METHODS
This cross-sectional study included elderly patients with stable COPD participants. Random cluster sampling and a survey, including the Exercise Compliance Scale, mMRC Dyspnea Index Scale, Social Support Scale, Anxiety Self-Assessment Scale, and Self-rating Depression Scale, were used. Data were analyzed using Spearman correlation and backward logistic regression.
RESULTS
124 participants (45.90%) had poor exercise compliance while 146 had good compliance (54.10%). The backward logistic regression showed household monthly income (¥501-¥1500: OR=21.54, P<0.05; ¥3001-¥5000: OR=32.76, P<0.05), two chronic comorbidities (OR=17.13, P<0.05), and the moderate dyspnea (OR=16.87, P<0.05) might help to improve exercise compliance. While female COPD patients (OR=0.11, P<0.01) who had server dyspnea (OR=0.02, P<0.05) and depression (OR=0.84, P<0.05) might have more difficulties adhering to exercise.
CONCLUSION
Low exercise compliance in community-dwelling elderly COPD patients could be affected by sex, monthly income level, number of chronic comorbidities, dyspnea, and depression.
Topics: Aged; Humans; Female; Pulmonary Disease, Chronic Obstructive; Cross-Sectional Studies; Patient Compliance; Dyspnea; Exercise
PubMed: 37705674
DOI: 10.2147/COPD.S424137 -
Pharmaceuticals (Basel, Switzerland) Oct 2023Tuberculosis (TB), an infection caused by , is one of the primary causes of death globally. The treatment of TB is long and based on several drugs, producing problems in... (Review)
Review
Tuberculosis (TB), an infection caused by , is one of the primary causes of death globally. The treatment of TB is long and based on several drugs, producing problems in compliance and toxicity, increasing resistance to first-line antibiotics that result in multidrug-resistant TB and extensively drug-resistant TB. Thus, the need for new anti-TB treatments has increased. Here, we review some model strategies to study gene therapy based on the administration of a recombinant adenovirus that encodes diverse cytokines, such as IFNγ, IL12, GM/CSF, OPN, TNFα, and antimicrobial peptides to enhance the protective immune response against . These models include a model of progressive pulmonary TB, a model of chronic infection similar to latent TB, and a murine model of pulmonary transmission to close contacts. We also review new vaccines that deliver antigens via particle- or virus-based vectors and trigger protective immune responses. The results obtained in this type of research suggest that this is an alternative therapy that has the potential to treat active TB as an adjuvant to conventional antibiotics and a promising preventive treatment for latent TB reactivation and transmission. Moreover, Ad vector vaccines are adequate for preventing infectious diseases, including TB.
PubMed: 37895946
DOI: 10.3390/ph16101475