Current medical research and opinion
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Observational Study
Characteristics, blood counts, treatments, and clinical outcomes of 5871 patients with polycythemia vera treated in US community practices.
This study aimed to describe clinical characteristics-including blood counts and pharmacologic cytoreductive treatment patterns-and outcomes after 6 months of hydroxyurea (HU) treatment among patients with polycythemia vera (PV) in US community practices. ⋯ Nearly half of high-risk patients with PV did not receive pharmacologic cytoreductive treatment. Of those who did, over half had suboptimal response, suggesting these patients may need dose adjustments, improved adverse effect management, or alternative treatments. Longer follow-up may be needed to assess an association between HU response and survival.
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Value-Based Health Care (VBHC) represents a pivotal shift from volume-based to outcome-driven quality metrics centered on patient-valued outcomes. This approach requires collaboration across all participants in the health care value chain; providers, payers, pharma, policymakers and patients (collectively known as the 5Ps). Despite substantial theoretical endorsement of VBHC's potential for improving health outcomes and system efficiency, empirical evidence detailing its practical implementation remains limited. This field study evaluates the real-word implementation of VBHC within a health care organization. ⋯ The findings highlight that VBHC implementation and adoption is complex and requires incremental advancements, dedicated leadership, and resilient strategic framework spanning over multiple years. A comprehensive understanding of patient populations, risk stratification, and appropriate outcome metrics are essential to measure and deliver the VBHC transformation. Executive endorsement and transition funding during the transformation process are paramount to support this systemic shift. Collaboration among all 5 P stakeholders is essential for success. This field study underscores the importance of continuous learning and adaptation, providing a practical guide to enhance health care quality and efficiency that serves all stakeholders.
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Randomized Controlled Trial
Dupilumab improves sense of smell and clinical outcomes in patients with severe chronic rhinosinusitis with nasal polyps with anosmia.
Loss of sense of smell is a cardinal symptom of chronic rhinosinusitis with nasal polyps (CRSwNP) and significantly impacts health-related quality-of-life. Dupilumab significantly improved smell outcomes (loss of smell [LoS] score; University of Pennsylvania Smell Identification Test [UPSIT]) versus placebo in the phase 3 SINUS-24/-52 studies (clinicaltrials.gov, NCT02898454/NCT02912468) in patients with severe CRSwNP. This post hoc analysis investigated the effect of dupilumab on olfaction using UPSIT smell impairment categories. ⋯ Most patients with severe CRSwNP had anosmia at baseline. Dupilumab treatment significantly improved smell versus placebo, with 14.9% achieving normosmia by week 24. There was a trend for better clinical outcomes in patients with greater smell improvement.