No abstract

Uninsured populations have poor treatment engagement and are less likely to receive evidence-based interventions for depression. The objective of the current study was to retrospectively examine depression screening, diagnosis, and treatment patterns among uninsured patients in primary care. Study sample included all patients ( N = 11,803) seen in nine community-based clinics. Key variables included depression screener and/or a depression diagnosis, anti-depressant initiation, behavioral health visits, and patient follow up measures. Treatment patterns from the subsample of patients diagnosed with depression were analyzed by collecting the number of behavioral health visits and antidepressant use six months (180 days) following the diagnosis. Utilization of the depression screening tool was high (67%, n = 7,935) and 24% ( n = 2,789) of the patients had a diagnosis of depression, however, more than half of the patients with a depression diagnosis did not have a recorded treatment plan ( n = 1,474). The odds of anti-depressant use and behavioral visits for Hispanic patients were significantly greater than for Non-Hispanic patients. Universal screening with brief measures in primary care is improving, however, guideline-concordant depression treatment remains elusive for uninsured populations.

No abstract

This study is the first analysis of UNOS STAR data on recipient work status pre-HTx demonstrating: (1) an improvement in post-transplant survival for working HTx candidates; and (2) an association between working pre-HTx and longer post-HTx survival. Given that work status before HTx may be a modifiable risk factor for better outcomes after HTx, we strongly recommend that UNOS consider these important findings for moving forward this patient-centered research on work status. Working at listing and working at HTx are associated with long-term survival benefits. The association may be reciprocal, where working identifies less ill patients and also improves well-being. Consideration should be given to giving additional weight to work status during organ allocation. Work status may also be a modifiable factor associated with better post-HTx outcomes.

No abstract

For personal use only. Permission required for all other uses.

Our hypothesis was that patients managed with noninvasive ventilation (NIV) on the wards could be risk-stratified with initial pulse oximetry/fraction of inspired oxygen (SpO 2 /FiO 2 ) ratios and tidal volumes (Vte). A prospective study of consecutive patients with acute respiratory failure requiring NIV on the wards was conducted. A multivariate logistic regression model and a negative binomial regression model were used. A total of 403 patients (55.8% women) had a mean age of 65.0 ± 14.9 years with a mean body mass index of 32.1 ± 11.1 kg/m 2 . The 28-day mortality was 14.1%, and the intubation rate was 16.1%. Pneumonia was associated with the highest 28-day mortality (22.5%) and rate of intubation (36.7%) when compared with chronic obstructive pulmonary disease (4.4% and 7.3%) or congestive heart failure (22.2% and 13.4%). The SpO 2 /FiO 2 groups were <214 (26.6%), 214 -357 (66.0%), and 357 (7.4%). Those in the SpO 2 /FiO 2 < 214 group had a higher 28-day mortality rate (odds ratio [OR] ¼ 8.19; 95% confidence interval [CI] 1.02 -65.7), intubation rate (OR ¼ 3.7; 95% CI 1.1 -12.1), intensive care unit admission rate (OR ¼ 2.9; 95% CI 1.2 -7.4), and length of stay (relative risk ¼ 2.0; 95% CI 1.3 -3.0). A Vte/predicted body weight <7.7 mL/kg was associated with increased intubations (OR ¼ 3.1; 95% CI 1.3 -7.4), intensive care unit admissions (OR ¼ 2.5; 95% CI 1.3 -4.6), and 30-day readmissions (OR ¼ 2.9; 95% CI 1.2 -6.8). In conclusion, in patients without acute respiratory distress syndrome who had acute respiratory failure managed with noninvasive ventilation on the wards, severe hypoxemia as assessed by a simple SpO 2 /FiO 2 214 was associated with poor outcomes.

Objectives: To determine healthcare resource use and costs in patients with acute heart failure (AHF) and chronic heart failure during for 12 months in a Spanish population-based setting. Methods: A retrospective observational study was made based on review of records of patients aged $40 years who requested care. Two study groups were identified (AHF yes/no). Main measurements: comorbidity, clinical variables (functional class, aetiology), metabolic syndrome (MS) and mortality. The cost model included direct/indirect health costs. The statistical analysis was made using multiple regression models, and statistical significance was p ,0.05. Results: We included 1,204 patients (prevalence: 4.1%, mean age: 73.3 years, 53.4% female): 72.0% had high blood pressure, 49.8% dyslipidaemia, 36.9% diabetes and 35.1% atrial fibrillation and 38.5% (N = 464) had $ 1 episode of AHF. AHF patients had a higher proportion of NYHA III-IV (52.1% vs. 38.8%, p = 0.002), MS (50.3% vs. 45.4%, 0.052) and mortality (15.6% vs. 7.0%, p ,0.001). The total cost of AHF was V 10,591 vs. V 4,544 for chronic heart failure (p ,0.001).