The American journal of the medical sciences
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High out-of-pocket (OOP) cost is a barrier to healthcare access and treatment compliance. Our study examined high OOP healthcare cost and burden trends in adults with kidney disease (KD). ⋯ Though high OOP burden declined between 2002 and 2011 in the US population with KD, most of the decline was among the publicly insured, so the uninsured populations with KD remain vulnerable. Providers and policy makers should be aware of the vulnerability of uninsured individuals with KD to high OOP burden.
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Multiple studies have addressed ethnic diabetes mellitus (diabetes) care inequalities. But few have assessed whether ethnicity influences patient perceptions of diabetic quality-of-life (QOL). The authors therefore designed a cross-sectional study to quantify the overall QOL associated with diabetes in consecutive white (Caucasian) and black (African-American) participants. ⋯ Diabetes-related QOL was similar in matched cohorts of adult white and black participants with diabetes mellitus. This study suggests utilities for diabetes mellitus can be used in economic analyses without adjustment for white and black ethnicity.
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Observational Study
Use and Outcomes of Triple Antithrombotic Therapy with Non-Vitamin K Antagonists in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention.
Triple antithrombotic therapy (TT) is recommended for patients with nonvalvular atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). However, there is a lack of comparative data in a real-world clinical setting between non-vitamin K antagonist oral anticoagulants (NOAC) and vitamin K antagonists (VKA). The aim of this study was to compare the safety and efficacy of TT with NOAC or VKA after PCI in patients with AF at 1-year of follow-up. ⋯ In this real-world study, patients with AF undergoing PCI treated on NOAC-based TT showed lower bleeding rates than those on VKA, with a lower rate of major bleeding events, while efficacy was similar between groups.
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Case Reports
Delayed Respiratory Distress in a Patient With Chronic Obstructive Pulmonary Disease After Abdominal Surgery.
Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for perioperative complications. The frequency of complications depends on the severity of COPD, the type of anesthesia used, the surgical site, and other comorbidities. Patients undergoing upper abdominal surgery have significant changes in lung volumes, likely secondary to changes in diaphragm function and abdominal pain, and these changes increase the risk for complications, including acute respiratory failure, atelectasis, pneumonia and unplanned reintubation. ⋯ However, on the fourth day he noted significant dyspnea and radiographic studies revealed atelectasis. Over the next week the patient remained symptomatic and dependent on noninvasive ventilation; he eventually had a rapid response to corticosteroids. This case indicates that atelectasis can develop late following a surgical procedure and that multiple factors potentially influence development of this complication.
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Observational Study
Association Between Time to Defibrillation and Neurologic Outcome in Patients With In-Hospital Cardiac Arrest.
The influence of time to defibrillation in patients with shockable in-hospital cardiac arrest (IHCA) has not been fully assessed. This study investigated the association between time to defibrillation and neurologic outcome in shockable IHCA survivors. ⋯ A graded inverse association between time to defibrillation and neurologic outcome was observed beyond 3 minutes following cardiac arrest. A target time to defibrillation of <3 minutes may be a practical target goal in resource-limited hospitals.