Articles: disease.
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Curr Opin Anaesthesiol · Apr 2023
ReviewThe uprise of gun violence in the United States: consequences of a dual pandemic.
The global coronavirus disease 2019 (COVID-19) viral outbreak and the rise of the anti-Black racism movement have produced a dual pandemic over the past few years, which has been associated with a dramatic rise in gun violence across the United States. This comprehensive review was performed to examine the current levels of gun violence in the context of these dual pandemics, delineate factors which have synergistically produced this surge in interpersonal violence, and propose future directions. ⋯ Consequences of the COVID-19 pandemic and the anti-Black racism movement have produced a social environment in the United States in recent years where interpersonal violence, especially firearm injuries, have surged. Particularly, during a time of challenged patient care delivery, the medical system struggles to support the increase in trauma volume. A broad approach to improving social determinants of health should be pursued in order to decrease the risk of gun violence from the recent near-historical high levels.
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Patients with rare diseases such as Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL), a hematologic malignancy affecting approximately 1500 new patients per year, experience barriers to care involving both clinical and administrative factors. Optimal patient outcomes depend on timely identification, diagnosis of disease, and treatment initiation. For patients living with Ph+ ALL, the process can be delayed by limited treatment options approved by the US Food and Drug Administration and administrative hurdles that often delay treatment initiation. ⋯ Panelists at the roundtable discussed approaches including the use of guideline-concordant electronic PAs and other digital solutions, expedited approval pathways for use in specific conditions, use of real-world evidence in decision-making, issuance of PA "Gold Cards" to select providers, and a shift to value-based care agreements. Roundtable attendees agreed that, regardless of the strategy for PA-process improvement, there is a need for improved communication between providers and payers to ensure that the decision-making system meets the essential need for timely patient access to optimal care. This article reviews utilization management and guideline-concordant care through the lens of rare diseases and then presents solutions to utilization.
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The goal of obesity management is to improve health. Sustained weight loss of more than 10% overall bodyweight improves many of the complications associated with obesity (eg, prevention and control of type 2 diabetes, hypertension, fatty liver disease, and obstructive sleep apnoea), as well as quality of life. Maintenance of weight loss is the major challenge of obesity management. ⋯ Long-term data on safety, efficacy, and cardiovascular outcomes are awaited. Long-term studies have shown that bariatric surgical procedures typically lead to a durable weight loss of 25% and rapid, sustained improvements in complications of obesity, although they have not yet been compared with new-generation highly effective anti-obesity medications. Further work is required to determine optimal patient-specific treatment strategies, including combinations of lifestyle interventions, anti-obesity medications, endoscopic and bariatric surgical procedures, and to ensure equitable access to effective treatments.