Agency for Healthcare Research and Quality.

Agency for Healthcare Research and Quality.

significantly more common in PXE patients in the intracranial internal carotid artery (75% vs 44%), the arteries of the arms (20% vs 3%), the femoral-popliteal arteries (74% vs 44%), and the infrapopliteal arteries (84% vs 38%). In these arteries, calcification scores also indicated more severe calcification. Severe calcification was significantly more prevalent in PXE patients compared to controls in the internal intracranial carotid artery (36% vs 19%; P < .001), femoral-popliteal arteries (51% vs 31%; P < .001), and infrapopliteal arteries (61% vs 24%; P < .001). In the hospital controls, significant more severe calcification was observed for the thoracic aorta, the mesenteric arteries, and the external iliac arteries. No significant differences in prevalence of arterial calcification were observed in other arterial beds, such as the coronary arteries (45% vs 43%; P ¼ .776), the carotid arteries (52% vs 46%; P ¼ .476), and the abdominal aorta (71% vs 63%; P ¼ .287). Subgroup analyses of patients younger than 55 years only showed similar differences in prevalence of arterial calcifications between PXE patients and controls, with most pronounced calcifications in the arteries of the lower legs (67% vs 8%). Similar patterns were observed in those without concomitant diabetes or renal dysfunction. Comments: This study adds to our information regarding the location of arterial disease in patients with PXE, confirming that leg arteries are commonly involved and more so than a control population of similar demographics. The involvement of the intracranial internal carotid artery might explain the suspected brain involvement in PXE, which has not be clearly investigated in the past. The involvement of arm arteries with calcification is extremely rare without diabetes and/or renal failure and may suggest PXE in patients so discovered at an early age. The major limitation of this study is the use of hospital controls that have disease states, which might confound the interpretation, but the overall effect is likely minor.

Agency for Healthcare Research and Quality.

Greater integration of medication-assisted treatment (MAT) for opioid use disorder (OUD) in U.S. primary care settings would expand access to treatment for this condition. Models for integrating MAT in primary care vary in how they are structured. This paper summarizes findings of a technical report for the Agency for Healthcare Research and Quality (AHRQ) describing OUD MAT models of care, based on a literature review and interviews with key informants in the field. The report describes 12 representative models of care for integrating MAT in primary care settings that could be considered for adaptation across diverse healthcare settings. Common components of existing care models include (1) pharmacotherapy with buprenorphine or naltrexone, (2) provider and community education, (3) coordination/integration of OUD with other medical/psychological needs, and (4) psychosocial services/interventions. Models varied with respect to how each component is implemented. Decisions about adopting MAT models of care should be individualized to address the unique milieu of each implementation setting.

In adults at increased CVD risk but without prior CVD events, statin therapy was associated with reduced risk of all-cause and cardiovascular mortality and CVD events, with greater absolute benefits in patients at greater baseline risk.

Agency for Healthcare Research and Quality.

The Agency for Healthcare Research and Quality (AHRQ), through its Evidencebased Practice Centers (EPCs), sponsors the development of evidence reports and technology assessments to assist publicand private-sector organizations in their efforts to improve the quality of health care in the United States. The reports and assessments provide organizations with comprehensive, science-based information on common, costly medical conditions and new health care technologies. The EPCs systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments. AHRQ expects that the EPC evidence reports and technology assessments will inform individual health plans, providers, and purchasers as well as the health care system as a whole by providing important information to help improve health care quality. The full report and this summary are available at www.effectivehealthcare.ahrq. gov/reports/final.cfm. d. In patients with chronic pain, what is the comparative effectiveness of opioids plus nonopioid interventions (pharmacological or nonpharmacological) versus opioids or nonopioid interventions alone on outcomes related to pain, function, quality of life, and doses of opioids used? Key Question 2. Harms and Adverse Events a. In patients with chronic pain, what are the risks of opioids versus placebo or no opioid on: (1) opioid abuse, addiction, and related outcomes; (2) overdose; and (3) other harms, including gastrointestinal-related harms, falls, fractures, motor vehicle accidents, endocrinological harms, infections, cardiovascular 3 events, cognitive harms, and psychological harms (e.g., depression)? b. How do harms vary depending on: (1) the specific type or cause of pain (e.g., neuropathic, musculoskeletal [including back pain], fibromyalgia, sickle cell disease, inflammatory pain, headache disorders); (2) patient demographics; (3) patient comorbidities (including past or current substance use disorder or at high risk for addiction); (4) the dose of opioids used? Key Question 3. Dosing Strategies