Several new medications for pulmonary arterial hypertension (PAH) have recently been introduced; however, current real-world data regarding US patients with PAH are limited. We conducted a retrospective administrative claims study to examine PAH treatment patterns and summarize healthcare utilization and costs among patients with newly diagnosed PAH treated in US clinical practice. Patients newly treated for PAH from 1 January 2010 to 31 March 2015 were followed for ≥12 months. Patient characteristics, treatment patterns, healthcare resource utilization, and costs were described. Adherence (proportion of days covered), persistence (months until therapy discontinuation/modification), and the probability of continuing the index regimen were analyzed by index regimen cohort (monotherapy versus combination therapy). Of 1637 eligible patients, 93.8% initiated treatment with monotherapy and 6.2% with combination therapy. The most common index regimen was phosphodiesterase type 5 inhibitor (PDE-5I) monotherapy (70.0% of patients). A total of 581 patients (35.5%) modified their index regimen during the study. Most patients (55.4%) who began combination therapy did so on or within six months of the index date. Endothelin receptor agonists (ERAs) and combination therapies were associated with higher adherence than PDE-5Is and monotherapies, respectively. Healthcare utilization was substantial across the study population, with costs in the combination therapy cohort more than doubling from baseline to follow-up. The majority of patients were treated with monotherapies (most often, PDE-5Is), despite combination therapies and ERAs being associated with higher medication adherence. Index regimen adjustments occurred early and in a substantial proportion of patients, suggesting that inadequate clinical response to monotherapies may not be uncommon.

The paper reviews evidence that before any change in diabetics' fundi, changes occur to blood flow, ERG and visual functions. In the case of colour vision and contrast sensitivity, the changes are partially reversed by breathing oxygen, and therefore are the result of retinal hypoxia. There are also other evidences that hypoxia is a major factor in the development of diabetic retinopathy (DR). Therefore in diabetics with early retinopathy, but normal photopic vision, functional disturbance might appear in dark adaptation, since in such circumstances, (as shown by Linsenmeier and his colleagues) the already low retinal PO2 markedly decreases. This hypothesis has been tested and results consistent with the hypothesis (and with a number of older reports) have been obtained. The significance of this finding to early DR is discussed, and a mechanism suggested whereby prolonged periods of hypoxia during dark adaptation could generate changes in retinal capillaries. Such periods occur each night, and their elimination in diabetics could be therapeutic.

Objective Sequelae of traumatic brain injury (TBI) include depression, which could exacerbate the poorer cognitive and functional recovery experienced by older adults. The objective of this study was to estimate incidence rates of depression following hospital discharge for TBI among Medicare beneficiaries aged ≥65 years, quantify the increase in risk of depression following TBI, and evaluate risk factors for incident depression post-TBI. Design Retrospective analysis of Medicare claims data Participants Medicare beneficiaries ≥65 years hospitalized for traumatic brain injury (TBI) during 2006–2010 who survived to hospital discharge and had no documented diagnosis of depression prior to the study period(n=67,347). Measurement Diagnosis of depression during the study period. Results The annualized incidence rate of depression per 1,000 beneficiaries was 62.8 (95% confidence interval (CI) 61.6,64.1) pre-TBI and 123.9 (95%CI 121.6,126.2) post-TBI. Annualized incidence rates were highest immediately following hospital discharge and declined over the twelve months post-TBI. TBI increased the risk of incident depression in men (hazard ratio (HR) 1.95;95%CI 1.84,2.06, Wald χ2=511.4,df =1,p < 0.001) and in women (HR 1.69;95%CI 1.62,1.77, Wald χ2=589.3,df =1,p < 0.001). The strongest predictor of depression post-TBI for both men and women was discharge to a skilled nursing facility: men (odds ratio (OR) 1.91;95%CI 1.77,2.06, Wald χ2=277.1,df = 1,p < 0.001), women: (OR 1.72;95%CI 1.63,1.83, Wald χ2=324.2,df = 1,p < 0.001). Conclusions TBI significantly increased the risk of depression among older adults, especially among men and those discharged to a skilled nursing facility. Results from this study will help increase awareness of the risk of depression post-TBI among older adults.

Using administrative data to document disease severity, this study replicates and expands on findings obtained from the registry study; disease severity was associated with higher healthcare resource utilization and costs. Stakeholders' implications for patient management are discussed.