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Directly observed therapy (DOT) for monitoring tuberculosis (TB) treatment is intended to reduce disease transmission, mortality and acquired drug resistance by facilitating treatment adherence and support. Synchronous (S-VOT) and asynchronous (A-VOT) video observed therapy are mHealth solutions for remotely monitoring medication ingestion. This paper synthesizes literature through December 2018 to describe existing VOT approaches, summarize evidence, identify knowledge gaps, evaluate VOT strengths and weaknesses, and examine patient and provider factors influencing VOT feasibility and acceptability. High rates of adherence and patient acceptance were obtained using both VOT methods. VOT reduced travel time for TB program staff and/or patients, improving program efficiency compared to in-person DOT while maintaining high patient satisfaction. The impact of VOT on TB treatment outcomes, such as cure and relapse, require further study with longer follow-up. Individual patient, provider and program factors should be considered in selecting either or both VOT approaches for provision of patient-centered care.

Directly observed therapy (DOT) for monitoring tuberculosis (TB) treatment is intended to reduce disease transmission, mortality and acquired drug resistance by facilitating treatment adherence and support. Synchronous (S-VOT) and asynchronous (A-VOT) video observed therapy are mHealth solutions for remotely monitoring medication ingestion. This paper synthesizes literature through December 2018 to describe existing VOT approaches, summarize evidence, identify knowledge gaps, evaluate VOT strengths and weaknesses, and examine patient and provider factors influencing VOT feasibility and acceptability. High rates of adherence and patient acceptance were obtained using both VOT methods. VOT reduced travel time for TB program staff and/or patients, improving program efficiency compared to in-person DOT while maintaining high patient satisfaction. The impact of VOT on TB treatment outcomes, such as cure and relapse, require further study with longer follow-up. Individual patient, provider and program factors should be considered in selecting either or both VOT approaches for provision of patient-centered care.

Introduction: FNAC has a pivotal role in the evaluation of breast lesions. Cytological grading systems are being utilized for the categorization of breast lesions. Modified Masood’s scoring System (MMSS) is used to improve the grading system for accurate pre-operative diagnosis. This study aims to assess the effectiveness and accuracy of the Modified Masood Scoring System for evaluating breast lesions and their correlation with histopathological diagnosis. Materials and Methods: This is a prospective study conducted in the Department of Pathology, MGM Medical College, Navi Mumbai which included 40 patients who presented with clinically palpable breast lump and were subjected to FNAC along with histopathological examination. The cytological smears were grouped into four categories according to MMSS. Correlation and concordance analysis between cytological categories and histopathological diagnosis was carried out. Observations and Results: The age of the patients ranged from 17 to 70 years with a mean age of 38.12 years, right-sided breast lesions were more common as compared to the left side. Of the total 40 cases, 27 cases were benign, and 13 cases were malignant on histopathology. The most common benign breast lesion was Fibroadenoma [Figure 1] and the malignant lesion was infiltrating duct carcinoma [Figure 2]. The sensitivity, specificity, Positive predictive value, Negative predictive value, and diagnostic accuracy were 76.9%, 100%, 100%, 90%, and 92.5% respectively. Conclusion: MMSS is simple, cost-effective, easily reproducible, reliable, and can be applied to FNAC aspirates to increase the diagnostic accuracy of Breast Lesions. [ABSTRACT FROM AUTHOR]

Background: Oral anticoagulants (OACs), such as apixaban and warfarin, are indicated for reducing the risk of recurrent venous thromboembolism (VTE) and are often initiated in the hospital. The aim of this study was to evaluate OAC continuity from inpatient to outpatient settings and the risk of recurrent VTE among patients with an initial event. Methods: This retrospective cohort study utilized hospital charge data and medical and prescription claims from 1 July 2016 to 31 December 2022 to identify adults treated with apixaban or warfarin while hospitalized for VTE. Patients were followed to assess switching or discontinuation post-discharge and the risk of recurrent VTE. The index date was the date of the first apixaban or warfarin claim within 30 days post-discharge. Results: Of the 19,303 eligible patients hospitalized with VTE, 85% (n = 16,401) were treated with apixaban and 15% (n = 2902) received warfarin. After discharge, approximately 70% had ≥1 fill for their respective apixaban or warfarin therapy. The cumulative incidence of discontinuation over the 6 months following index was 50.5% and 52.2% for the apixaban and warfarin cohorts, respectively; the cumulative incidence of switching was 6.0% and 20.9%, respectively. The incidence rates of recurrent VTE were 1.2 and 2.5 per 100 person-years for the apixaban and warfarin cohorts, respectively. Conclusions: The majority of patients continued their apixaban or warfarin therapy following hospital discharge; however, a considerable proportion either switched or discontinued OAC upon transitioning from inpatient care. Among those who continued therapy, discontinuation, switch, and recurrent VTE occurred less often with apixaban vs. warfarin. [ABSTRACT FROM AUTHOR]

Depression affects over 17 million American adults yearly and has been identified as the leading cause of disability in people between the ages of 15 and 44 years. There is evidence that feeling neglect or a lack of parental attachment during childhood is associated with depression. One construct that has been overlooked is love from a parent. The purpose of this study was to analyze the association between individuals who felt not wanted/loved during adolescence and lifetime depression and to examine this association by gender. We examined 5114 participants aged 24–32 years at Wave IV of the National Longitudinal Study of Adolescent Health (Add Health) public use dataset. We used logistic regression analysis to determine the association between an individual feeling not wanted/loved by their parent/caregiver prior to age 18, covariates, and lifetime depression. We then stratified by gender and ran logistic models for both men and women separately. Overall, 16.2% (n = 827) reported lifetime depression diagnosis, while 16.5% of the participants reported feeling not wanted/loved "often," while 29.8% reported it as "sometimes." Feeling not wanted/loved "often" was associated with higher odds of depression (AOR = 3.00; 95% CI, 2.45–3.66; p <.001) versus "sometimes" (AOR = 1.59; 95% CI, 1.31–1.90; p <.001). When stratified by gender, feeling not loved/wanted was associated with depression among both men (AOR = 3.70; 95% CI, 2.60–5.25; p <.001) and women (AOR = 2.73; 95% CI, 2.13–3.48; p <.001). Feeling not loved or wanted by a parent/caregiver during adolescence has serious implications, for both men and women. Future studies should further examine this construct and identify family-based interventions that focus on parent/caregiver and child relationships. [ABSTRACT FROM AUTHOR]

The widespread use of electronic medical records (EMRs) among health care providers in the US presents opportunities for innovative solutions to improve health outcomes and increase efficiency in care delivery. These opportunities have remained largely untapped, however, due to the sizeable divide separating medical research from clinical practice and the long lag time between scientific discovery and clinical application. In this article, we present a roadmap for bridging this gap through an ongoing effort in the state of Connecticut to improve the identification and management of patients at risk for suicidal behavior. By working to embed research in the clinical enterprise through the development of a "learning health system," this initiative will inform and empower health care providers to address unrecognized risk in their patients. Fundamental to this system is a robust health information exchange that harvests and standardizes clinical information from diverse health care settings and provides opportunities for real-time communication with clinicians. [ABSTRACT FROM AUTHOR]

The article discusses research on progressive massive fibrosis (PMF). It describes a case of a 71-year-old male who worked in a coal mine for 12 years, and presented with shortness of breath on moderate exertion, chest discomfort and dry cough for two months. It presents an overview of a study in a Brazilian hospital which discovered 119 undiagnosed cases of silicotuberculosis in persons exposed to silica dust. It describes the pathophysiology and diagnosis of PMF in patients.

Aim: Vaginitis and other vaginal discharge syndromes lead to high healthcare utilization. Molecular tests like syndromic multiplex real-time (RT) polymerase chain reaction (PCR)-based tests are highly sensitive and specific at diagnosing the infectious causes of vaginitis. This study compared the healthcare resource utilization (HCRU) and direct all-cause healthcare costs among patients with vaginitis in the US receiving next-day syndromic multiplex RT-PCR tests with those receiving other PCR tests or no diagnostic test of interest. Patients & methods: This retrospective study utilized claims data from IQVIA PharMetrics ® Plus database to identify adult patients with a diagnosis for vaginitis (first claim = index) from January 2021 to April 2023, with 6 months of continuous enrollment prior to (baseline) and after index (follow-up). Pairwise comparisons were conducted between RT-PCR and 1:1 propensity matched Other PCR and No Test subcohorts for all-cause HCRU and costs during follow-up. Results: Each of the RT-PCR, Other PCR and No Test subcohorts included 1946 matched patients. Mean(SD) follow-up total cost was significantly lower for the RT-PCR than the No Test subcohort ($5607 [$15,122] vs $6680 [$20,751], p = 0.0023). Mean(SD) overall outpatient and other medical service costs were lower for RT-PCR versus Other PCR (outpatient: $2964 [$9666] vs $3174 [$7113], p = 0.0110; other medical: $1961 [$9244] vs $2099 [$6475], p = 0.0002) and No Test subcohorts (outpatient: $2964 [$9666] vs $4067 [$12,341], p < 0.0001; other medical: $1961 [$9244] vs $2973 [$11,685]; p < 0.0001). A lower proportion had any outpatient service HCRU in RT-PCR versus Other PCR subcohort (92.6% vs 94.2%, p = 0.0349). A lower proportion had any other medical service claim in RT-PCR versus Other PCR (78.3% vs 83.2%, p < 0.0001) and No Test subcohorts (78.3% vs 83.0%, p = 0.0001). Physician office, emergency room (ER), prescription use and costs were similar between the subcohorts. Conclusion: The use of syndromic multiplex RT-PCR diagnostics with next day test results in patients with vaginitis was associated with lower outpatient costs and total healthcare costs than those in the no test cohort over 6 months. These findings indicate that use of syndromic multiplex RT-PCR diagnostics may contribute to improved patient management compared with clinical diagnosis alone.

Objective: To estimate the prevalence of diagnosed vasomotor symptoms (VMS) due to menopause among US women aged 40-64 years and assess sociodemographic differences in VMS prevalence and risk of discontinuing VMS-related treatment. Materials and Methods: This retrospective study evaluated merged data from IQVIA's PharMetrics Plus medical claims and consumer attributes databases for 2017-2020. VMS diagnosis was identified using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes. Continuous enrollment was required ≥6 months before and 12 months after diagnosis date. Treatment discontinuation was measured for VMS-related treatments initiated at diagnosis or during the 12 months after diagnosis. Treatment duration was measured from diagnosis to the first day of a ≥90-day treatment gap. A Cox proportional hazards model was used to determine factors associated with risk of treatment discontinuation. Results: Among 7,386,206 eligible women, the 4-year prevalence of diagnosed VMS in 2017-2020 was 79.1 per 1,000 and was highest among non-Hispanic White women (82.5 per 1,000), followed by Hispanic (77.3), Black (71.6), and Asian women (64.5). Rates were higher among women living in urban areas and those with higher education and income. Among women newly diagnosed with VMS ( n = 226,262), median treatment duration was 297 days. Black, Asian, and Hispanic women had higher risks of discontinuing treatment than non-Hispanic White women. Lower income was also associated with higher risk of discontinuation than higher income. Conclusion: Lower prevalence of diagnosed VMS and higher risk of treatment discontinuation were observed among racial/ethnic minorities and women with less education and income, suggesting possible underdiagnosis and unmet needs.

Background: Venous thromboembolism (VTE) is a major public health condition that renders patients at risk of recurrent events, which significantly increases their morbidity, mortality, and health care costs. Apart from warfarin, direct oral anticoagulants, such as apixaban, dabigatran, or rivaroxaban, are approved for VTE treatment. Cardiovascular drugs are largely impacted by formulary restrictions; however, the impact on oral anticoagulants (including warfarin and direct oral anticoagulants) in VTE has not been well studied., Objective: To describe the extent of payer-rejected claims for oral anticoagulants for VTE and the factors associated with rejected claims. Prescription abandonment of oral anticoagulants and the time to an eventual fill for oral anticoagulant after rejection or abandonment were also evaluated., Methods: A retrospective cohort study was conducted among patients with VTE newly prescribed an oral anticoagulant (first claim was the index) between October 2016 and October 2021. Descriptive statistics were used to describe the proportion of patients with paid (ie, filled), rejected, or abandoned index oral anticoagulant prescription and journey to paid prescription among those with initial rejection. Multivariable logistic regression was used to identify factors associated with initial rejection., Results: Among the overall sample (N = 297,312), 74.3% had initial oral anticoagulant prescriptions approved, 9.1% had them rejected, and 16.7% abandoned them. Of the patients with initial rejection, 82.1% eventually filled their oral anticoagulant prescriptions; however, for 14.2% of these patients, the first fill was for an oral anticoagulant other than that initially prescribed. The mean time to a first fill for an oral anticoagulant after an initial rejection was 18.3 days. More than half of the patients with an initial rejected oral anticoagulant claim had at least 1 additional rejection during the follow-up period. Of the patients who abandoned their initial oral anticoagulant prescription, 83.9% filled an oral anticoagulant prescription during follow-up; the mean time to fill for the index oral anticoagulant was 15.6 days. Oral anticoagulant type, Medicare payer coverage, prescribing physician specialty, and VTE diagnosis setting of care were significantly associated with index oral anticoagulant claim rejection ( P < 0.05)., Conclusions: Rejection and abandonment may delay access to oral anticoagulant treatment. Factors contributing to these scenarios should be understood and addressed for proper VTE management.

Background: Suicide rates in the U.S. have continued to rise over the last 2 decades. The increased availability and broader legalization of cannabis is a public health concern, particularly among adolescents. The objective of this study was to examine the association between the age of cannabis initiation and lifetime suicidal ideations and attempts in a sample of adults aged 18 or older., Methods: Data are from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001 to 2003 (N = 15 238). The primary objective of the CPES was to collect data about the prevalence of mental disorders, impairments associated with these disorders, and their treatment patterns from representative samples of majority and minority adult populations in the U.S. Logistic regression analyses were conducted to test the association between cannabis initiation age (early ⩽14 years old; later >14 years old) and outcomes of lifetime suicide ideation and attempts. Cigarette use, cannabis use, gender, income, race, education, and age were controlled for the analyses., Results: Overall, 12.5% of participants reported suicide ideation, while 4.2% reported attempt. Early cannabis use was associated with a higher risk of suicide ideation (AOR = 3.32, 95% CI [2.75, 3.80]) than later cannabis use (AOR = 2.15, 95% CI [1.92, 2.39]). Early cannabis use was associated with a higher risk of suicide attempt (AOR = 4.38, 95% CI [3.48, 5.52]) than later cannabis use (AOR = 2.56, 95% CI [2.14, 3.06]). Wald chi-squared tests revealed significant differences between the early and late initiation for both ideation (χ 2  = 26.99; P  < .001) and attempts (χ 2  = 26.02; P  < .001)., Conclusions: Significant associations were found between early initiation of cannabis and suicide behaviors. As suicide rates continue to rise, it is recommended that clinicians, treatment providers, and other professionals consider the use of cannabis at an early age as a risk for subsequent suicide behaviors., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)