BACKGROUND: Randomized controlled trials have evaluated the efficacy of low-dose CT (LDCT) lung cancer screening on lung cancer (LC) outcomes. OBJECTIVE: Meta-analyze LDCT lung cancer screening trials. METHODS:We identified studies by searching PubMed, Google Scholar, the Cochrane Registry, ClinicalTrials.gov, and reference lists from retrieved publications. We abstracted data on study design features, stage I LC diagnoses, LC and overall mortality, false positive results, harm from invasive diagnostic procedures, overdiagnosis, and significant incidental findings. We assessed study quality using the Cochrane risk-of-bias tool. We used randomeffects models to calculate relative risks and assessed effect modulators with subgroup analyses and metaregression. RESULTS: We identified 9 studies that enrolled 96,559 subjects. The risk of bias across studies was judged to be low. Overall, LDCT screening significantly increased the detection of stage I LC, RR = 2.93 (95% CI, 2.16-3.98), I 2 = 19%, and reduced LC mortality, RR = 0.84 (95% CI, 0.75-0.93), I 2 = 0%. The number needed to screen to prevent an LC death was 265. Women had a lower risk of LC death (RR = 0.69, 95% CI, 0.40-1.21) than men (RR = 0.86, 95% CI, 0.66-1.13), p value for interaction = 0.11. LDCT screening did not reduce overall mortality, RR = 0.96 (95% CI, 0.91-1.01), I 2 = 0%. The pooled false positive rate was 8% (95% CI, 4-18); subjects with false positive results had < 1 in 1000 risk of major complications following invasive diagnostic procedures. The most valid estimates for overdiagnosis and significant incidental findings were 8.9% and 7.5%, respectively. DISCUSSION: LDCT screening significantly reduced LC mortality, though not overall mortality, with women appearing to benefit more than men. The estimated risks for false positive results, screening complications, overdiagnosis, and incidental findings were low. Long-term survival data were available only for North American and European studies limiting generalizability.
6This 8-week, randomized, double-blind, controlled study compared efficacy and tolerability of telmisartan ⁄ amlodipine (T ⁄ A) single-pill combination (SPC) vs the respective monotherapies in 858 patients with severe hypertension (systolic ⁄ diastolic blood pressure [SBP ⁄ DBP] !180 ⁄ 95 mm Hg). At 8 weeks, T ⁄ A provided significantly greater reductions from baseline in seated trough cuff SBP ⁄ DBP ()47.5 mm Hg ⁄ )18.7 mm Hg) vs T (P<.0001) or A (P=.0002) monotherapy; superior reductions were also evident at 1, 2, 4, and 6 weeks. Blood pressure (BP) goal and response rates were consistently higher with T ⁄ A vs T or A. T ⁄ A was well tolerated, with less frequent treatmentrelated adverse events vs A (12.6% vs 16.4%) and a numerically lower incidence of peripheral edema and treatment discontinuation. In conclusion, treatment of patients with substantially elevated BP with T ⁄ A SPCs resulted in high and significantly greater BP reductions and higher BP goal and response rates than the respective monotherapies. T ⁄ A SPCs were well tolerated. J Clin Hypertens (Greenwich). 2012;14:206-215. Ó2012 Wiley Periodicals, Inc.Based on evidence from a number of large antihypertensive trials, 1-9 most guidelines acknowledge that combination therapy is needed to reduce blood pressure (BP) successfully to goal in the majority of patients; only a minority of patients achieve their BP goal with a single agent.10-14 Also, the Avoiding Cardiovascular Events Through Combination Therapy in Patients Living With Systolic Hypertension (ACCOMPLISH) study showed a significant reduction of cardiovascular (CV) events and death in hypertensive patients at high CV risk treated with a combination of an angiotensin-converting enzyme (ACE) inhibitor and a calcium channel blocker (CCB).15 Nevertheless, despite rigorous and comprehensive guidelines, and a trend towards an increase in the use of combination therapy in treatment practice, 16 several studies have demonstrated the persistence of poor BP goal rates in treated patients. [17][18][19] The impact of poor BP control is compounded by the often high prevalence of other CV risk factors in hypertensive patients (eg, hypercholesterolemia, obesity, type 2 diabetes mellitus [T2DM], and smoking).13 Therefore, an urgent need still remains to improve the management of hypertension. One logical approach would be to use 2 drugs from different classes and complementary mechanisms of action in combination. Such combinations may result in additional BP decreases and improved goal rates, compared with either agent used alone. 20-23Furthermore, single-pill combinations (SPCs) are known to increase treatment adherence and reduce health care costs. [24][25][26][27] A combination of a CCB and an angiotensin II receptor blocker (ARB) is a rational approach for managing hypertension and there is increasing evidence that this combination is effective. 11,13,28,29 The aim of the current study was to compare the efficacy and tolerability of the SPC of telmisartan 80 mg ⁄ amlodipine 10 mg (T80 ⁄ A10) with that of...
Introduction: Changes in reimbursement policy have made nicotine replacement therapy (NRT) much more available, but little is known about what happens to patients after they receive their prescription. This study describes rates of successfully filling prescriptions for NRT and its association with type of insurance. Methods: We identified 224 patients who received a prescription for NRT during an outpatient visit to an academic medical center between January 1st 2016 and February 10th 2017. We conducted telephone surveys to assess whether they tried to fill their prescriptions and if so, determine the effects of insurance type on the ability to successfully fill the prescription. Results: Of 117 patients completing the survey, 23 (19.6%) did not attempt to fill and 6 (5.1%) had no insurance. Of the 90 patients with insurance who attempted to fill their prescription, 67 (74.4%) were successful and 23 (25.6%) were unsuccessful in obtaining medications. Success varied by insurance with successful fills ranging from 34 (87.2%) of those with commercial insurance, 24 (70.6%) with Medicaid, to 9 (52.9%) with Medicare. Of 37 participants living with another smoker, 31 (83.7%) wanted an NRT prescription specifically for their partner; several volunteered that they had shared patches with their partner. Conclusions: Despite widespread coverage for NRT, many patients may still encounter difficulties in getting their prescriptions filled. Some tobacco users might also benefit from getting NRT prescriptions for their partners that smoke.
Bundle branch reentrant ventricular tachycardia (BBR-VT) is an uncommon form of macro-reentrant ventricular tachycardia (VT) characterized by a fast (200-300 beats/min) wide complex tachycardia involving the His-Purkinje system. It can present with syncope, hemodynamic instability, or cardiac arrest. Diagnosis is challenging and is based on electrophysiological findings. Radiofrequency catheter ablation is currently regarded as the first-line therapy.CASE PRESENTATION: 56-year-old male with a history of morbid obesity (BMI 70), HTN, type 2 DM, and atrial tachycardia on Sotalol was admitted for acute hypoxemic respiratory failure. Baseline ECG had intraventricular conduction delay (IVCD) with PVCs. He developed persistent atrial tachycardia in the setting of respiratory failure, so Flecainide was initiated. After 2 doses, he developed wide complex tachycardia with HR above 200s. Flecainide was discontinued, and he was started on Amiodarone. Arrhythmia recurred the next day with HR 210, successfully treated with Lidocaine. However, patient developed atrial tachycardia that degenerated to VT storm despite Amiodarone, Lidocaine, Adenosine, and 3 unsuccessful attempts at defibrillation. Thus, Procainamide was initiated, and he stabilized after 1 hour. He continued to have recurrences of VT which were felt to be BBR-VT. The use of fluoroscopic imaging and electrophysiologic mapping was limited due to patient size. A dual-chamber pacemaker was implanted with an unsuccessful attempt at ablation in OR. Arrhythmias recurred, and pacemaker interrogation demonstrated atrial tachycardia with 1:1, 2:1, and Wenckebach conduction with HR 130s. Procainamide was stopped on day 10 without further VT until day 13, but PVCs noted. The patient then developed atrial tachycardia that transitioned into BBRVT with HR 200s.AV node and right bundle ablation with mapping technology were performed on day 14 after finding bed accommodation. Postablation, his pacemaker was reprogrammed to non-tracking mode. No further ventricular arrhythmias were observed.DISCUSSION: Atrial tachycardia initiated this patient's BBR-VT. Anti-arrhythmic therapy used may have further delayed conduction in the His-Purkinje system and promoted BBR-VT. His QRS morphology during BBR-VT was of typical right bundle block with AV dissociation. BBR-VT was suspected due to underlying IVCD with atrial tachycardia and PVCs. The diagnosis was ultimately confirmed in the EP lab. It is important to recognize BBR-VT and understand its associations, as pharmacologic antiarrhythmic therapy is usually ineffective and may worsen the condition. Radiofrequency catheter ablation of either bundle branch will treat BBR-VT definitively, as observed in this patient.CONCLUSIONS: BBR-VT has a high risk for morbidity and mortality and is difficult to treat with pharmacologic interventions or cardioversion. Treat definitively with radiofrequency catheter ablation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.