SAGE open medicine
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Opioids are being prescribed at increasing rates in primary care practices, and among individual providers there is significant variability in opioid prescribing. Primary care practices also vary significantly in complexity of their patients, ranging from healthy patients to those with multiple comorbidities. Our objective was to examine individual primary care providers for an association between their opioid prescribing and the complexity/risk of their panel of patients (a panel of patients is a group of patients whose medical care is the responsibility of a specific healthcare provider or care team). ⋯ When examining differences in primary care providers' opioid prescribing practices, the Centers for Medicare and Medicaid Services endorsed risk score (the hierarchical condition category score) can help adjust for population differences of a provider's patients.
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The Aboriginal people of Australia have much poorer health and social indicators and a substantial life expectancy gap compared to other Australians, with premature cardiovascular disease a major contributor to poorer health. This article draws on research undertaken to examine cardiovascular disparities and focuses on ways in which primary care practitioners can contribute to reducing cardiovascular disparities and improving Aboriginal health. ⋯ Primary care practitioners have an important role in improving Aboriginal cardiovascular care outcomes. It is essential that they recognise the special needs of their Aboriginal patients and work at multiple levels both outside and inside the clinic for prevention and management of disease. A toolkit of proactive and holistic opportunities for interventions is proposed.
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Dolutegravir, an HIV integrase inhibitor, is a relatively new treatment option. To assess the tolerability, side effects, and time to viral decline to non-detectable in patients newly started on dolutegravir. ⋯ Dolutegravir was found to be efficacious and well tolerated in HIV-infected treatment-naive patients.
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The ε4 allele of Apolipoprotein E is involved in lipid metabolism. Oxidative stress produces an increase in lipid peroxidation that has been implicated in the pathogenic cascade in Alzheimer's disease. This study estimated the effect of the ε4 allele, malondialdehyde and lipid levels on the risk for Alzheimer's disease. ⋯ The presence of ε4 allele and elevated malondialdehyde levels are independent risk factors for Alzheimer's disease. These findings support the hypothesis that lipid peroxidation and ε4 allele contribute to the pathogenic cascade in Alzheimer's disease by different pathways.
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There is a class I recommendation for implantable cardioverter-defibrillator deactivation discussions to occur between physicians and heart failure patients. Few studies have reported the patient's perspective on the timing of implantable cardioverter-defibrillator deactivation discussions. ⋯ The patient preferences identified in this study support the need to include information on implantable cardioverter-defibrillator deactivation at implant, with change in clinical status and within broader discussions about end-of-life treatment preferences. Using this process to help patients determine and communicate their implantable cardioverter-defibrillator deactivation preferences may reduce the number of patients experiencing distressing implantable cardioverter-defibrillator shocks at end of life.