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Messinger-Rapport BJ, Little MO, Morley JE, Gammack JK. Clinical Update on Nursing Home Medicine: 2017. J Am Med Dir Assoc 2017; 18:928-940. [PMID: 29080572 DOI: 10.1016/j.jamda.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 01/09/2023]
Abstract
This is the 11th annual Clinical Update from the AMDA meeting article. This year the topics covered are hypertension after the Systolic Blood Pressure Intervention Trial; chronic obstructive pulmonary disease risk factors, diagnosis and management including end-of-life planning, and the difficulties with exacerbations such as breathlessness; diagnosis and treatment of cognitive impairment and dementia; and wound care and pressure ulcer management.
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Affiliation(s)
| | - Milta O Little
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
| | - Julie K Gammack
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
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Schivo M, Albertson TE, Haczku A, Kenyon NJ, Zeki AA, Kuhn BT, Louie S, Avdalovic MV. Paradigms in chronic obstructive pulmonary disease: phenotypes, immunobiology, and therapy with a focus on vascular disease. J Investig Med 2017; 65:953-963. [PMID: 28258130 DOI: 10.1136/jim-2016-000358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2017] [Indexed: 12/21/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous syndrome that represents a major global health burden. COPD phenotypes have recently emerged based on large cohort studies addressing the need to better characterize the syndrome. Though comprehensive phenotyping is still at an early stage, factors such as ethnicity and radiographic, serum, and exhaled breath biomarkers have shown promise. COPD is also an immunological disease where innate and adaptive immune responses to the environment and tobacco smoke are altered. The frequent overlap between COPD and other systemic diseases, such as cardiovascular disease, has influenced COPD therapy, and treatments for both conditions may lead to improved patient outcomes. Here, we discuss current paradigms that center on improving the definition of COPD, understanding the immunological overlap between COPD and vascular inflammation, and the treatment of COPD-with a focus on comorbid cardiovascular disease.
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Affiliation(s)
- Michael Schivo
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Comparative Respiratory Biology and Medicine, Genome and Biomedical Sciences Facility, University of California Davis, Davis, California, USA
| | - Timothy E Albertson
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Department of Medicine, Veterans Administration Northern California Healthcare System, Mather, California, USA
| | - Angela Haczku
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Comparative Respiratory Biology and Medicine, Genome and Biomedical Sciences Facility, University of California Davis, Davis, California, USA
| | - Nicholas J Kenyon
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Comparative Respiratory Biology and Medicine, Genome and Biomedical Sciences Facility, University of California Davis, Davis, California, USA
| | - Amir A Zeki
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Comparative Respiratory Biology and Medicine, Genome and Biomedical Sciences Facility, University of California Davis, Davis, California, USA
| | - Brooks T Kuhn
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Samuel Louie
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Comparative Respiratory Biology and Medicine, Genome and Biomedical Sciences Facility, University of California Davis, Davis, California, USA
| | - Mark V Avdalovic
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Department of Medicine, Veterans Administration Northern California Healthcare System, Mather, California, USA
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Moll K, Sun SX, Ellis JJ, Howe A, Amin A. Impact of roflumilast on exacerbations of COPD, health care utilization, and costs in a predominantly elderly Medicare Advantage population. Int J Chron Obstruct Pulmon Dis 2015; 10:565-76. [PMID: 25834417 PMCID: PMC4365739 DOI: 10.2147/copd.s79025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) exacerbations are associated with declining lung function and health-related quality of life, and increased hospitalization and mortality. Clinical trials often poorly represent the elderly and thus have only partial applicability to their clinical care. Objective To compare exacerbations, COPD-related health care utilization (HCU), and costs in a predominantly elderly Medicare COPD population initiated on roflumilast versus those not initiated on roflumilast. Methods Deidentified administrative claims data from a large, national payer were utilized. Medicare patients aged 40–89 years with at least one COPD diagnosis from May 1, 2010 to December 31, 2012 were included. Members with at least one roflumilast pharmacy claim (index) were assigned to the roflumilast group and those without were assigned to the non-roflumilast group. Proxy index dates for the non-roflumilast group were randomly assigned for similar distribution of all patients’ time at risk. Subjects with at least one pre-index COPD exacerbation had to be continuously enrolled for ≥365 days pre-index and post-index. Unadjusted and adjusted difference-in-difference (DID) analyses contrasted pre-index with post-index changes in exacerbations, HCU, and costs of roflumilast treatment compared with non-roflumilast treatment. Results A total of 500 roflumilast and 60,145 non-roflumilast patients were included (mean age 69.7 and 72.3 years, respectively; P<0.0001). Unadjusted DID favored roflumilast for all exacerbations, with greater pre-index to post-index reductions in mean per 30-day COPD-related hospitalizations (−0.0182 versus −0.0013, P=0.009), outpatient visits (−0.2500 versus −0.0606, P<0.0001), and COPD-related inpatient costs (−US$141 versus −US$11, P=0.0346) and outpatient costs (−US$31 versus −US$4, P<0.0001). Multivariate analyses identified significantly improved pre-index to post-index COPD-related total costs (P=0.0005) and total exacerbations (P<0.0001) for the roflumilast group versus non-roflumilast group. Conclusion In a predominantly elderly Medicare COPD population, newly initiated roflumilast patients displayed similar or significantly better unadjusted reductions in all exacerbation-related, COPD-related HCU-related, and COPD-related costs outcomes compared with non-roflumilast patients. These analyses also suggest better adjusted COPD-related costs and total exacerbations for roflumilast-initiated patients.
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Affiliation(s)
- Keran Moll
- Comprehensive Health Insights, Inc., Humana, Louisville, KY, USA
| | - Shawn X Sun
- Health Economics and Outcomes Research, Forest Laboratories, LLC, an affiliate of Actavis, Inc., Jersey City, NJ, USA
| | - Jeffrey J Ellis
- Comprehensive Health Insights, Inc., Humana, Louisville, KY, USA
| | - Andrew Howe
- Comprehensive Health Insights, Inc., Humana, Louisville, KY, USA
| | - Alpesh Amin
- Department of Medicine, University of California-Irvine, Orange, CA, USA
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Ore T, Ireland P. Chronic obstructive pulmonary disease hospitalisations and mortality in Victoria: analysis of variations by socioeconomic status. Aust N Z J Public Health 2015; 39:243-9. [PMID: 25559228 DOI: 10.1111/1753-6405.12305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 08/01/2014] [Accepted: 08/01/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This paper analysed chronic obstructive pulmonary disease (COPD) hospitalisations, unplanned readmissions and deaths in Victoria to identify associations with socioeconomic status (SES). METHODS The data was taken from the Victorian Admitted Episodes Dataset, the Victorian Health Information Surveillance System, the Victorian Burden of Disease Study and the Australian Bureau of Statistics' Index of Relative Socioeconomic Disadvantage. RESULTS COPD separations have a greater variation by SES than all separations. The average age-standardised separation rate (10.43) for the top percentile Local Government Areas (LGA) was 5.8 times that of the bottom percentile LGAs (1.80). The top percentile group was the lowest SES group (effect size = 0.93). There were significant negative correlations between the age-standardised COPD separation rates and SES across LGAs (r = -0.60) and Regions (r = -0.89). Analysis of readmissions (r = -0.49), mortality data (r = -0.51) and the burden of disease data (r = -0.39) also showed significant inverse associations between COPD and SES. CONCLUSIONS AND IMPLICATIONS Victorians living in the most disadvantaged areas have a greater burden from COPD, highlighting a need to prioritise public health services interventions to improve outcomes.
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Affiliation(s)
- Timothy Ore
- Department of Health, Commission for Hospital Improvement, Victoria
| | - Paul Ireland
- Department of Health, Commission for Hospital Improvement, Victoria
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Tan LD, Chan AL, Albertson TE. New combination treatments in the management of asthma: focus on fluticasone/vilanterol. J Asthma Allergy 2014; 7:77-83. [PMID: 24833910 PMCID: PMC4014386 DOI: 10.2147/jaa.s39625] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Despite the 2007 National Asthma Education and Prevention Program Expert Panel 3 guidelines for the treatment of uncontrolled asthma, many patients with poorly controlled asthma still continue to tax the health care system. Controlling asthma symptoms and preventing acute exacerbations have been the foundation of care. Using long-term controller treatments such as inhaled corticosteroids (ICS) and inhaled long-acting beta2-agonists (LABAs) is a common approach. While patient responses to recommended pharmacotherapy may vary, poor adherence to therapy also contributes to poor asthma control. A once-daily combination inhaler, such as fluticasone furoate, an ICS, in combination with vilanterol, a LABA, offers increased convenience and potential improved adherence, which should result in enhanced clinical outcomes and reduced exacerbations. The ICS/LABA combination inhaler of fluticasone furoate and vilanterol is currently approved in the United States for use in the maintenance of chronic obstructive pulmonary disease and to reduce exacerbations. This paper reviews the expanding literature on the efficacy of fluticasone furoate and vilanterol in treating asthma.
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Affiliation(s)
- Laren D Tan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA ; Department of Medicine, Veterans Administration Northern California Health Care System, Mather, CA
| | - Andrew L Chan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA ; Department of Medicine, Veterans Administration Northern California Health Care System, Mather, CA
| | - Timothy E Albertson
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA ; Department of Medicine, Veterans Administration Northern California Health Care System, Mather, CA ; Department of Emergency Medicine, School of Medicine, University of California, Davis, Sacramento, CA, USA
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