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Tobita K, Sakamoto H, Inami T, Fujisawa D, Takeuchi K, Kikuchi H, Ito J, Goda A, Soejima K, Kohno T. Understanding Patient Perspectives Toward Shared Decision-Making in Patients With Pulmonary Hypertension. Am J Cardiol 2024; 212:23-29. [PMID: 37984635 DOI: 10.1016/j.amjcard.2023.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/15/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
Clinical guidelines for pulmonary hypertension (PH) recommend shared decision-making and individualized treatment. However, patient perspectives on PH treatment goals, preference toward a decision-making style of treatment, and adoption of shared decision-making remain unclear. This cross-sectional questionnaire-based study assessed the patients' preferred and actual participation role in treatment decision-making, rated on 5 scales (ranging from passive [patients leave all decisions to physicians] to active [patients make the decision after physicians show patients several options]) and evaluated the concordance between preferred and actual participation roles. The important factors underlying patients' perspectives in treatment decision-making (i.e., prognosis; symptom, financial, family, and social burdens; patient values; and physician recommendation) were evaluated. Univariate logistic regression analysis was performed to determine the patients with a positive preference toward "physician recommendation" in treatment decision-making. Among 130 patients with PH (median age: 58 years; mean pulmonary arterial pressure: 23 mm Hg; 27.7% were males), 59.2% preferred that "physicians make the decision regarding treatment after showing patients therapeutic options (i.e., intermediate between passive and active roles)." The patient-preferred and actual participation roles in decision-making had moderate agreement (Cohen's kappa = 0.46). The most important factor in treatment decisions was "symptom burden reduction" (93.8%). Although 85.0% of patients chose "physician recommendation" as an important factor, 49.6% chose "alignment with my values." The determinants of patients who chose "physician recommendation" were less severe hemodynamics and better functional capacity. In conclusion, patients with PH preferred that the "physicians make the decision after showing patients therapeutic options" and prioritized physician recommendation over their values.
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Affiliation(s)
- Kazuki Tobita
- Department of Physical Therapy, Saitama Medical University Faculty of Health and Medical Care, Saitama, Japan; Departments of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Hayato Sakamoto
- Department of Rehabilitation, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Takumi Inami
- Departments of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Kaori Takeuchi
- Departments of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Hanako Kikuchi
- Departments of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Junnosuke Ito
- Departments of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Ayumi Goda
- Departments of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Kyoko Soejima
- Departments of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Takashi Kohno
- Departments of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan.
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Mochizuki T, Yano K, Ikari K, Okazaki K. Cut-off values for achieving osteoporosis treatment goals in women with rheumatoid arthritis receiving denosumab. Mod Rheumatol 2023; 33:1204-1206. [PMID: 36484528 DOI: 10.1093/mr/roac145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/02/2022] [Indexed: 11/08/2023]
Affiliation(s)
- Takeshi Mochizuki
- Department of Orthopedic Surgery, Kamagaya General Hospital, Chiba, Japan
| | - Koichiro Yano
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
- Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Torii H, Kishimoto M, Tanaka M, Noguchi H, Chaudhari S. Patient perceptions of psoriatic disease in Japan: Results from the Japanese subgroup of the Understanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) survey. J Dermatol 2022; 49:818-828. [PMID: 35624553 PMCID: PMC9542208 DOI: 10.1111/1346-8138.16423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/31/2022] [Accepted: 04/23/2022] [Indexed: 11/29/2022]
Abstract
The population‐based Understanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) survey was designed to better understand patient and dermatologist perceptions of the disease burden of psoriasis (PsO) and their treatment expectations. UPLIFT was a cross‐sectional, quantitative, online survey conducted in Europe, North America, and Japan between 2 March and 3 June 2020. In Japan, 391 patients reporting a diagnosis of PsO and/or psoriatic arthritis (PsA) were surveyed (75% had PsO alone, 23% had PsO and PsA, and 2% had PsA alone). Self‐reported body surface area (BSA) data were available for 309 Japanese patients, with the majority (80%) reporting PsO‐involved BSA ≤3 palms. Current symptoms of PsO were rated as moderate or severe by 43% of Japanese patients with BSA ≤3 palms, and severe by 44% of patients with BSA 4–10 palms. PsO frequently occurred in ≥1 special areas, most commonly the scalp in 76% of Japanese patients with BSA ≤3 palms, and ≥90% of those with BSA ≥4 palms. Furthermore, musculoskeletal symptoms in 42% of patients with PsO alone were suggestive of PsA. Whereas Japanese patients with BSA ≤3 palms mainly reported receiving topical therapy alone (34%) or no treatment (32%), 64% patients with BSA 4–10 palms reported receiving systemic therapy. Overall, 21% of Japanese patients with self‐perceived mild symptoms of PsO and 48% of patients with special area involvement experienced at least a moderate impact of disease on quality of life (Dermatology Life Quality Index score >5). Moreover, patients and dermatologists differed in their perceptions of determinants of PsO severity and treatment, and office visit discussions. In general, these findings from the Japanese subgroup of the UPLIFT survey demonstrated that a high proportion of patients perceived their symptoms to be moderate or severe irrespective of the level of skin involvement, suggesting a persistent unmet treatment need.
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Affiliation(s)
- Hideshi Torii
- Division of Dermatology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
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Okubo Y, Tang AC, Inoue S, Torisu-Itakura H, Ohtsuki M. Comparison of Treatment Goals between Users of Biological and Non-Biological Therapies for Treatment of Psoriasis in Japan. J Clin Med 2021; 10:jcm10245732. [PMID: 34945027 PMCID: PMC8709044 DOI: 10.3390/jcm10245732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/29/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Previously, our cross-sectional observational study in Japan revealed high (68%) discordance within treatment goals between psoriasis patients and their physicians. Objective: This secondary analysis aimed to determine whether patient and physician users of biologics have higher treatment goals than users of non-biologics. Methods: A survey for both patients and physicians on background characteristics, disease severity, treatment goals, treatment satisfaction, and health-related quality of life was conducted at 54 sites. Association between treatment goals and biologic/non-biologic users was assessed using ordinal logistic regression models. Results: In total, 449 patient-physician pairs agreed to participate; 425 completed the survey and were analyzed. More biologic users than non-biologic users reported complete clearance (Psoriasis Area and Severity Index 100) as a treatment goal (patient-reported: 23.6% vs. 16.1%; physician-reported: 26.9% vs. 2.2%). Biologic users were significantly associated with higher treatment goals than non-biologic users (patient-reported: 1.8 (1.15–2.87) (odds ratio (9 5% CI)), p = 0.01; physician-reported: 11.0 (5.72–21.01), p < 0.01). Among biologic users, higher treatment goals were associated with higher treatment satisfaction (patient- and physician-rated); lower treatment goals were associated with back lesions and increasing patient age (patient-rated) and higher disease severity (physician-rated). Conclusion: Use of biologics among patients with psoriasis was associated with higher treatment goals. Further use of biologics contributed to treatment satisfaction. Appropriate treatment goals that are shared among patients and their physicians may improve treatment outcomes.
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Affiliation(s)
- Yukari Okubo
- Department of Dermatology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan;
| | - Ann Chuo Tang
- Eli Lilly Japan K.K., Akasaka Garden City 13F, 4-15-1 Akasaka, Minato-ku, Tokyo 107-0052, Japan
- Correspondence:
| | - Sachie Inoue
- Crecon Medical Assessment Inc., 2-12-15 Shibuya, Shibuya-ku, Tokyo 150-0002, Japan;
| | - Hitoe Torisu-Itakura
- Eli Lilly Japan K.K., Lilly Plaza One Bldg., 5-1-28, Isogamidori, Chuo-ku, Kobe 651-0086, Japan;
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke 329-0498, Tochigi-ken, Japan;
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Martín-Broto J, Reichardt P, Jones RL, Stacchiotti S. Different approaches to advanced soft tissue sarcomas depending on treatment line, goal of therapy and histological subtype. Expert Rev Anticancer Ther 2020; 20:15-28. [PMID: 32349558 DOI: 10.1080/14737140.2020.1753510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Although rapid evolution over the past few years in advanced soft tissue sarcoma (STS) management has not been without its challenges, it has brought clarity in several areas.Areas covered: This article summarizes the proceedings of the third edition of the Soft Tissue Sarcoma: Evidence and Experience symposium held March 2019 in Madrid, Spain. An update is provided of current approaches to advanced STS management. Case studies illustrate the role of trabectedin in advanced STS management.Expert opinion: First-line treatment of advanced STS requires distinct therapeutic strategies depending on goal: tumor shrinkage or tumor control. Since all sarcoma patients benefit from active treatment irrespective of age or line of therapy, oncologists have a duty to offer active systemic therapies unless the patient is unfit for treatment or chooses to end active treatment. Beyond the first line, histology becomes increasingly relevant for treatment selection. Agents with activity in specific sarcoma subtypes have been identified. Rare tumors represent a substantial medical need requiring strong international collaboration between research groups, pharmaceutical companies, regulatory agencies, and patients to identify active drugs per subtype. Multidisciplinary care in an expert sarcoma center is the primary means of reducing morbidity and mortality in patients with sarcoma.
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Affiliation(s)
- Javier Martín-Broto
- Medical Oncology Department in University Hospital Virgen del Rocio and Institute of Biomedicine of Sevilla (IBIS), (HUVR, CSIC, University of Sevilla), Sevilla, Spain
| | - Peter Reichardt
- Department of Oncology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Robin L Jones
- Royal Marsden Hospital, Institute of Cancer Research, London, UK
| | - Silvia Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Benekos T, Kosmeri C, Vlahos A, Milionis H. Nine-year overview of dyslipidemia management in children with heterozygous familial hypercholesterolemia: a university hospital outpatient lipid clinic project in Northwestern Greece. J Pediatr Endocrinol Metab 2020; 33:533-538. [PMID: 32084003 DOI: 10.1515/jpem-2019-0250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 01/15/2020] [Indexed: 02/03/2023]
Abstract
Background To assess the efficacy and safety of lipid-lowering treatment in children with heterozygous familial hypercholesterolemia (HeFH) aged ≤12 years attending a tertiary hospital-based outpatient lipid clinic. Methods Data in 318 children from the University Hospital of Ioannina (Northwestern Greece) Outpatient Lipid Clinic Project for Children and Adolescents with Dyslipidemia from March 2009 to December 2018 were analyzed. We assessed the efficacy and safety treatment alongside any possible predictors of the achievement of the treatment target. Results Of 318 children with hyperlipidemia, 72 were diagnosed having HeFH based on clinical criteria and genetic confirmation. Compared with non-familial hypercholesterolemia (non-FH) children, those with FH had a higher occurrence of positive family history of premature cardiovascular disease, and higher levels of total, low-density lipoprotein-cholesterol (LDL-C), apolipoprotein B (apoB) and lipoprotein (a) (Lp(a)). Treatment regimens included either atorvastatin 10-20 mg/day, rosuvastatin 5-10 mg/day, pitavastatin 2-4 mg/day monotherapy or in combination with ezetimibe. The treatment goal of LDL-C (<135 mg/dL, 3.5 mmol/L) was achieved in 69% of children treated. The achievement of the treatment targets correlated positively with male sex and inversely with the Dutch Lipid Clinic Network Score, baseline total, LDL-C and apoB levels. No clinically significant changes in liver or muscle-related laboratory tests were reported; no effect on growth or sexual maturation was noted. Conclusions This study confirms that lipid-lowering treatment in HeFH children initiated in the setting of a specialized tertiary hospital-based outpatient lipid clinic is efficacious and safe. Children of male sex and low baseline lipid values had a better achievement of treatment target.
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Affiliation(s)
- Thomas Benekos
- Outpatient Lipid Clinic for Children and Adolescents of the University Hospital of Ioannina, University of Ioannina, Ioannina, Greece.,Child Health Department, University of Ioannina, Ioannina, Greece
| | - Chrysoula Kosmeri
- Outpatient Lipid Clinic for Children and Adolescents of the University Hospital of Ioannina, University of Ioannina, Ioannina, Greece.,Child Health Department, University of Ioannina, Ioannina, Greece
| | - Antonios Vlahos
- Outpatient Lipid Clinic for Children and Adolescents of the University Hospital of Ioannina, University of Ioannina, Ioannina, Greece.,Child Health Department, University of Ioannina, Ioannina, Greece
| | - Haralampos Milionis
- Outpatient Lipid Clinic for Children and Adolescents of the University Hospital of Ioannina, University of Ioannina, Ioannina, Greece.,Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece
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Forst DA, Quain K, Landay SL, Anand M, Kaslow-Zieve E, Mesa MM, Jacobs JM, Dietrich J, Parsons MW, Horick N, Greer JA, Batchelor TT, Jackson VA, El-Jawahri A, Temel JS. Perceptions of prognosis and goal of treatment in patients with malignant gliomas and their caregivers. Neurooncol Pract 2020; 7:490-497. [PMID: 33014389 DOI: 10.1093/nop/npaa021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Patients with malignant gliomas have a poor prognosis. However, little is known about patients' and caregivers' understanding of the prognosis and the primary treatment goal. Methods We conducted a prospective study in patients with newly diagnosed malignant gliomas (N = 72) and their caregivers (N = 55). At 12 weeks after diagnosis, we administered the Prognosis and Treatment Perceptions Questionnaire to assess understanding of prognosis and the Hospital Anxiety and Depression Scale to evaluate mood. We used multivariable regression analyses to explore associations between prognostic understanding and mood and McNemar tests to compare prognostic perceptions among patient-caregiver dyads (N = 48). Results A total of 87.1% (61/70) of patients and 79.6% (43/54) of caregivers reported that it was "very" or "extremely" important to know about the patient's prognosis. The majority of patients (72.7%, [48/66]) reported that their cancer was curable. Patients who reported that their illness was incurable had greater depressive symptoms (B = 3.01, 95% CI, 0.89-5.14, P = .01). There was no association between caregivers' prognostic understanding and mood. Among patient-caregiver dyads, patients were more likely than caregivers to report that their primary treatment goal was cure (43.8% [21/48] vs 25.0% [12/48], P = .04) and that the oncologist's primary goal was cure (29.2% [14/48] vs 8.3% [4/48], P = .02). Conclusions Patients with malignant gliomas frequently hold inaccurate perceptions of the prognosis and treatment goal. Although caregivers more often report an accurate assessment of these metrics, many still report an overly optimistic perception of prognosis. Interventions are needed to enhance prognostic communication and to help patients cope with the associated distress.
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Affiliation(s)
- Deborah A Forst
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Kit Quain
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Sophia L Landay
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Maya Anand
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Emilia Kaslow-Zieve
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Michelle M Mesa
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Jamie M Jacobs
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Jorg Dietrich
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Michael W Parsons
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Nora Horick
- Massachusetts General Hospital Biostatistics Center, Boston, Massachusetts
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Tracy T Batchelor
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Vicki A Jackson
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Areej El-Jawahri
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Jennifer S Temel
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
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Koh KH, Goh CC, Goh SCP, Koh YLE, Tan NC. Blood pressure goal attainment in multi-ethnic Asian patients with hypertension and dyslipidaemia in primary care. Singapore Med J 2019; 61:469-475. [PMID: 31489431 DOI: 10.11622/smedj.2019102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Hypertension and dyslipidaemia are major risk factors for cardiovascular diseases and achieving treatment goals mitigates such risks. This study determined demographic and medication-related factors associated with blood pressure (BP) goal attainment in patients with concomitant hypertension and dyslipidaemia. METHODS This paper is a sub-analysis of the Lipid HEALTH study, a questionnaire survey focusing on adult Asian patients with both dyslipidaemia and hypertension. An interviewer-administered questionnaire was used to obtain demographic and clinical information. Laboratory and prescription data was retrieved from electronic health records. BP goals were defined by international guidelines. Data was audited and analysed, and logistic regression analysis was used to identify factors determining BP goal attainment. RESULTS Among the 851 included patients, 49.7% attained their BP goals. 37.0% were on monotherapy, 57.6% on ≥ 2 BP-lowering medications, and 5.4% had no pharmacologic treatment. Among those on pharmacotherapy, 51.2% failed to achieve BP goals. Calcium channel blockers were the most frequently prescribed medications. Attainment of BP goals was significantly associated with: not having Type 2 diabetes mellitus (odds ratio [OR] 2.27, 95% confidence interval [CI] 1.61-3.13); attaining low-density lipoprotein cholesterol goal (OR 2.02, 95% CI 1.45-2.81); being solely on dietary control (OR 2.19, 95% CI 1.09-4.39); and receiving monotherapy (OR 1.71, 95% CI 1.18-2.48). CONCLUSION BP treatment goals were attained by half of the patients with dyslipidaemia and hypertension, and half of those on pharmacotherapy. Type 2 diabetes mellitus and low-density lipoprotein cholesterol control were significantly associated with BP goal attainment.
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Affiliation(s)
- Kim Hwee Koh
- SingHealth Polyclinics - Pasir Ris, Singapore.,Duke-NUS Medical School, Singapore
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Brunton S, Rozjabek HM, Pilon D, Lafeuille MH, Kamstra R, Wynant W, Bookhart BK, Lefebvre P. Real-world impact of glycated hemoglobin reduction on treatment intensification and glycated hemoglobin goal attainment in type 2 diabetes mellitus patients initiated on a sodium glucose co-transporter 2 (SGLT2) inhibitor (SGLT2i). Curr Med Res Opin 2019; 35:1607-1614. [PMID: 30964362 DOI: 10.1080/03007995.2019.1605160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To evaluate the impact of a 0.2% reduction in glycated hemoglobin (HbA1c) on treatment intensification, poor HbA1c control and HbA1c goal attainment in patients with type 2 diabetes mellitus (T2DM) initiated on a sodium glucose co-transporter 2 (SGLT2) inhibitor (SGLT2i).Methods: IQVIATM Health Plan Claims Data - US and IQVIATM Ambulatory EMR Data - US databases (29 October 2012-31 March 2016) were used to identify adults with T2DM initiated on an SGLT2i (index date) who had HbA1c measurements pre- and post-index, and ≥6 months of eligibility pre-index (baseline). HbA1c change was defined as the difference between the first post-index and the last pre-index measurements. Cox regression models were used to assess treatment intensification, poor HbA1c control (i.e. HbA1c > 9%, among patients <9% at baseline) and goal attainment (HbA1c < 7%, <8%; among patients with HbA1c above goal at baseline) adjusting for HbA1c change and baseline characteristics. Patients were observed up to one year after the first HbA1c measurement or end of eligibility. Hazard ratios (HRs) and 95% confidence intervals (CIs) were reported.Results: A total of 938 patients (mean age 54.9, 42.5% female, mean HbA1c 8.5%) were selected. Following SGLT2i initiation, each 0.2% reduction in HbA1c levels was associated with a decreased risk of treatment intensification (HR [95% CI] = 0.90 [0.86-0.92]), a decreased likelihood of reaching HbA1c > 9% (HR [95% CI] = 0.85 [0.79-0.88]) and higher likelihoods of achieving a treatment goal of HbA1c < 7% (HR [95% CI] = 1.17 [1.12-1.21]) and HbA1c < 8% (HR [95% CI] = 1.08 [1.04-1.10]).Conclusions: In T2DM patients, each HbA1c reduction of 0.2% following the initiation of an SGLT2i was associated with a significant positive impact on treatment intensification and HbA1c goal attainment.
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Gotoh M, Okubo K, Okamoto Y, Yonekura S, Kaneko S, Konno A. [INVESTIGATION OF TREATMENT GOAL IN ALLERGEN IMMUNOTHERAPY FOR JAPANESE CEDAR POLLINOSIS]. Arerugi 2018; 67:938-947. [PMID: 30146626 DOI: 10.15036/arerugi.67.938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND/OBJECTIVE As few reports are available on treatment goal for Japanese cedar pollinosis treated with allergen immunotherapy, therapeutic effect has to be assessed based on subjective symptoms in clinical practice. This research was conducted to investigate the informative treatment goal in clinical practice by using the results of TO-194SL phase III clinical trial. METHODS In this investigation, correlation between total nasal symptom medication score (TNSMS), which was predefined as the primary endpoint, and secondary endpoints evaluated by severe symptom day, quality of life (QOL) score, and overall evaluation by subject, was firstly investigated. Based on the results, stratified analyses of the secondary endpoints to confirm relationships on the stratified results, TNSMS, and cedar season were performed. RESULTS Correlation between TNSMS and evaluations which were severe symptom day, QOL score, and overall evaluation by subject was reasonably observed. TNSMS generally showed 3 or below (classified as mild) throughout the entire pollen season when these evaluations reached each threshold. CONCLUSIONS The results of this investigation suggest that a few evaluation items would help patients to realize the therapeutic effects of allergen immunotherapy if they could be the treatment goal in clinical practice.
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Affiliation(s)
- Minoru Gotoh
- Department of Otorhinolaryngology, Nippon Medical School Tama Nagayama Hospital
| | - Kimihiro Okubo
- Department of Otorhinolaryngology, Graduate School of Medicine, Nippon Medical School
| | - Yoshitaka Okamoto
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University
| | - Syuji Yonekura
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University
| | - Shinya Kaneko
- Department of Clinical Development, Torii Pharmaceutical Co., Ltd
| | - Akiyoshi Konno
- Allergy and Head and Neck Tumor Center, Southern Tohoku General Hospital
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Buckheit K, Moskal D, Spinola S, Maisto SA, Chung T. Alcohol treatment goal choice predicts longitudinal drinking outcomes in adolescent substance users. J Child Adolesc Subst Abuse 2018; 27:1-10. [PMID: 30906178 DOI: 10.1080/1067828x.2017.1384776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Social cognitive theory suggests that when individuals select their own goals, they work harder to achieve them as compared to clinician-imposed goals. Moreover, achieving goals during the course of treatment may increase self-efficacy, which could positively predict outcome. Research in clinical samples of adults with alcohol use disorder supports the utility of treatment goal choice in predicting longitudinal outcomes; a total abstinence (TA) goal choice has been associated with better clinical outcomes (e.g. greater percentage of days abstinent, more days to relapse to heavy drinking) compared to a controlled use (CU) goal choice. Treatment of adolescents presents unique challenges, because adolescents tend to be resistant to treatment and often enter treatment in response to external pressures (e.g. parent, school system). Data from 110 adolescents aged 14 to 18 were collected upon admission to outpatient substance use disorder treatment. A series of hierarchical linear regressions was used to test the utility of the alcohol treatment goal choice variable in predicting drinking outcomes at 6-, 12-, and 24-month follow-ups. Separate models were run to examine binge drinking days, percentage of days abstinent, and drinks per drinking day at each time point. Goal choice significantly predicted drinking outcomes at the 12-month follow-up, but not at the 6- or 24-month time points, such that TA goal choice was associated with better clinical outcomes. These findings are relevant to treatment planning, as they suggest that goal choice may have clinical utility as a predictor of alcohol use disorder clinical course in adolescents.
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Affiliation(s)
| | - Dezarie Moskal
- Department of Psychology, Syracuse University, Syracuse, NY 13244
| | - Suzanne Spinola
- Department of Psychology, Syracuse University, Syracuse, NY 13244
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY 13244
| | - Tammy Chung
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213
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Abstract
Pulmonary arterial hypertension (PAH) is a severe and progressive intrinsic disease of the precapillary lung vasculature. Since the introduction of PAH-targeted drugs, survival of PAH patients seems to have improved. Randomized controlled trials have led to evidence-based guidelines to direct treatment in adults. However, since disease characteristics differ between adults and children, it is hazardous to simply extrapolate these guidelines to children. Moreover, pediatric data on treatment strategies and how to assess treatment response remain virtually absent. Optimal treatment strategies are highly needed to guide therapy and improve survival in children with PAH. This review provides an overview of currently available treatments for PAH and the limited efficacy and safety data in children (with the exclusion of perinatal pulmonary vascular diseases, as persistent pulmonary hypertension of the newborn). We also discuss potential treatment goals and how the available data can be translated into treatment strategies in pediatric PAH.
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Affiliation(s)
- Willemijn M H Zijlstra
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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