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The number of comorbidities a patient has can increase their risk of polypharmacy. A study of over 1.4 million patients in Scotland examined pharmacy data and comorbidities in patients with left ventricular systolic dysfunction. It found that patients with more comorbidities had higher rates of polypharmacy, rather than being related to the left ventricular systolic dysfunction diagnosis. This suggests doctors should monitor patients with multiple comorbidities more closely to reduce polypharmacy risks.
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by guest on September 24, 2014http://hyper.ahajournals.org/Downloaded from by guest on September 24, 2014http://hyper.ahajournals.org/Downloaded from
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Clinical Trial
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document. Permissions and Rights Question and Answer this process is available in the
click Request Permissions in the middle column of the Web page under Services. Further information about
Office. Once the online version of the published article for which permission is being requested is located,
can be obtained via RightsLink, a service of the Copyright Clearance Center, not the EditorialHypertensionin
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by guest on September 24, 2014http://hyper.ahajournals.org/Downloaded from by guest on September 24, 2014http://hyper.ahajournals.org/Downloaded from
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perspectives and perspectives Pleuni s. Pennings Department of Biology, Stanford University,
CA, UsA health. [thtectious Disease Reports 2013: 5sles] [page 24]
feriew European patients with transmitted drug limited settings, Stadeli and Richman found half-
lives. Efoetive monotheeagy is mest likely resistance whe were treated with a fally artive that
7\% of patients who have been on ART for to occur in patients on NNETI-hased
treatcombination of drugs, 95s had fully s.p. 6.11 months had resistasoe, 114 after 12.23 metts,
because NNRTIs typically hane longer pressed viral Wad afler one year. of the months and 21N
after 36 months of more.' A half tives than NKTls." Howerer, the impor patients who were
trealod with an insulficient- similar effect has been reported for patients in tance of effective
monotherapy for mesistance Vy strong regimen, k.W had fully suppressed high incoeme
couatries. For example, a large is debaled. "ln low income countries, there is viral lnad after one
year. stady from the IK meports that the percentage concern alout resistance doe to unplanned In
low-income couatries, patients with of putients with at least one drug-resistance treaament
interruptions when patients are transmitted drug resistance may start insaff- mutation increases
from 11 to 14 to 15s after faced with stock-osts at the bospital or pharciently strong ART
regimens, because viral fout, six and eight years respectively for macy. For example, Mareellio
ed " "show that genotpping is usualy not available and trans. patients on NNRTL-bsed treatment.'
This treatment interruptions occur in Camserwon mitted resistance not delected. Insulficienlly
stady shows that even a patient whose viral doe to drug shortages in hospitals. strong treatments
will be less effective i i population did not exhe resistance during six reducing the viral bod,
which, in turn, can lead years of treatiment has a peokability of around to the evolution of multi
class drug resistance. ZN to acquire resistance during the next year In addition, even if testing is
done, fener sec- of treatsent. ond lise trealment options are wailable for In general, treatments
based on NNRTls or patients in low-income countries. unboosted Pls are more susceptible to
resist. Multi-chass drug resistanoe typically occurs ance than treatment based on a ritonaic- when
a virus that is resistant to ose drod boosted PI (bPI)." bPI regimens are less sus acquires
resistance to another drug. In prindAcquired drug resistance ceplible to resistance, parth because
resist- ple, it is possible that a vinis acquires muliple ance to the bll itself is unlikely to evolve,
bet dres-resishoce mutations at the samse time. during antiretroviral treatment also because, in
the prosence of the hPl, it is but data sagsest that this is uncommon. F.
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Health Administration data between October 1, 2015, and December 31, 2017, for patients
aged 65 years or older hospitalized for noncardiovascular diagnoses and who experienced
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2) About a third of shared patients with diabetes known at UPHS did not have HbA1c testing at UPHS, though most had recent HbA1c testing at PVAMC showing good control.
3) Lack of data sharing between PVAMC and UPHS leads to incomplete information and redundant HbA1c testing, though increased interoperability could help address these issues and provide a more accurate assessment of quality of care.
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should you cut and paste text from websites or other sources. HIV drug resistance: problems and
perspectives and perspectives Pleuni s. Pennings Department of Biology, Stanford University,
CA, UsA health. [thtectious Disease Reports 2013: 5sles] [page 24]
feriew European patients with transmitted drug limited settings, Stadeli and Richman found half-
lives. Efoetive monotheeagy is mest likely resistance whe were treated with a fally artive that
7\% of patients who have been on ART for to occur in patients on NNETI-hased
treatcombination of drugs, 95s had fully s.p. 6.11 months had resistasoe, 114 after 12.23 metts,
because NNRTIs typically hane longer pressed viral Wad afler one year. of the months and 21N
after 36 months of more.' A half tives than NKTls." Howerer, the impor patients who were
trealod with an insulficient- similar effect has been reported for patients in tance of effective
monotherapy for mesistance Vy strong regimen, k.W had fully suppressed high incoeme
couatries. For example, a large is debaled. "ln low income countries, there is viral lnad after one
year. stady from the IK meports that the percentage concern alout resistance doe to unplanned In
low-income couatries, patients with of putients with at least one drug-resistance treaament
interruptions when patients are transmitted drug resistance may start insaff- mutation increases
from 11 to 14 to 15s after faced with stock-osts at the bospital or pharciently strong ART
regimens, because viral fout, six and eight years respectively for macy. For example, Mareellio
ed " "show that genotpping is usualy not available and trans. patients on NNRTL-bsed treatment.'
This treatment interruptions occur in Camserwon mitted resistance not delected. Insulficienlly
stady shows that even a patient whose viral doe to drug shortages in hospitals. strong treatments
will be less effective i i population did not exhe resistance during six reducing the viral bod,
which, in turn, can lead years of treatiment has a peokability of around to the evolution of multi
class drug resistance. ZN to acquire resistance during the next year In addition, even if testing is
done, fener sec- of treatsent. ond lise trealment options are wailable for In general, treatments
based on NNRTls or patients in low-income countries. unboosted Pls are more susceptible to
resist. Multi-chass drug resistanoe typically occurs ance than treatment based on a ritonaic- when
a virus that is resistant to ose drod boosted PI (bPI)." bPI regimens are less sus acquires
resistance to another drug. In prindAcquired drug resistance ceplible to resistance, parth because
resist- ple, it is possible that a vinis acquires muliple ance to the bll itself is unlikely to evolve,
bet dres-resishoce mutations at the samse time. during antiretroviral treatment also because, in
the prosence of the hPl, it is but data sagsest that this is uncommon. F.
CompAct - Adherence Series 2014
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New pattern clinical study
New pattern clinical study of adverse drug reaction to ART may
lead to chase drug discovery in anti-retroviral drug towards zero
adverse drug reaction
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Clinical Outcomes of Intensive Inpatient Blood Pressure.pdf
OBJECTIVE To examine the association of intensive treatment of elevated inpatient BPs
with in-hospital clinical outcomes of older adults hospitalized for noncardiac conditions.
DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study examined Veterans
Health Administration data between October 1, 2015, and December 31, 2017, for patients
aged 65 years or older hospitalized for noncardiovascular diagnoses and who experienced
elevated BPs in the first 48 hours of hospitalization.
INTERVENTIONS Intensive BP treatment following the first 48 hours of hospitalization,
defined as receipt of intravenous antihypertensives or oral classes not used prior to
admission.
MAIN OUTCOME AND MEASURES The primary outcomewas a composite of inpatient mortality,
intensive care unit transfer, stroke, acute kidney injury, B-type natriuretic peptide elevation,
and troponin elevation. Data were analyzed between October 1, 2021, and January 10, 2023,
with propensity score overlap weighting used to adjust for confounding between those who
did and did not receive early intensive treatment.
RESULTS Among 66 140 included patients (mean [SD] age, 74.4 [8.1] years; 97.5%male
and 2.6%female; 17.4%Black, 1.7%Hispanic, and 75.9%White), 14 084 (21.3%) received
intensive BP treatment in the first 48 hours of hospitalization. Patients who received early
intensive treatment vs those who did not continued to receive a greater number of additional
antihypertensives during the remainder of their hospitalization (mean additional doses, 6.1
[95%CI, 5.8-6.4] vs 1.6 [95%CI, 1.5-1.8], respectively). Intensive treatment was associated
with a greater risk of the primary composite outcome (1220 [8.7%] vs 3570 [6.9%]; weighted
odds ratio [OR], 1.28; 95%CI, 1.18-1.39), with the highest risk among patients receiving
intravenous antihypertensives (weighted OR, 1.90; 95%CI, 1.65-2.19). Intensively treated
patients were more likely to experience each component of the composite outcome except
for stroke and mortality. Findings were consistent across subgroups stratified by age, frailty,
preadmission BP, early hospitalization BP, and cardiovascular disease history.
CONCLUSIONS AND RELEVANCE The study’s findings indicate that among hospitalized
older adults with elevated BPs, intensive pharmacologic antihypertensive treatment
was associated with a greater risk of adverse events. These findings do not support
the treatment of elevated inpatient BPs without evidence of end organ damage,
and they highlight the need for randomized clinical trials of inpatient BP treatment targets
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1) Insulin supplies are often erratic and unavailable to those with insulin-dependent diabetes in many developing countries. Insulin is rarely available in rural areas and sometimes unavailable even in large urban centers.
2) The costs of insulin vary widely around the world, placing it out of reach for many in poorer countries. In Tanzania, one vial can cost a month's wages, and additional costs for supplies further burden patients.
3) Ensuring access to insulin is the responsibility of governments, but current policies hinder availability and affordability. While some efforts have been made through donations, a sustainable solution is needed to provide this life-saving drug to those who need it.
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Hypertension is a major global health problem and leading risk factor for cardiovascular disease. Control remains poor despite being largely controllable. The diagnosis of hypertension is based on office blood pressure measurements, but out-of-office measurements such as ambulatory or home monitoring are recommended to confirm the diagnosis. Lifestyle changes are key to non-pharmacological treatment, while first-line pharmacological treatments include ACE inhibitors, ARBs, calcium channel blockers, and diuretics. Despite efforts, rates of awareness, treatment and control of hypertension remain disappointingly low globally.
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- 1. COMMENT3 The number of comorbidities a patient has can increase the patient’s risk of polypharmacy. In a study of 1.4 million patients in Scotland, the researchers examined data to view pharmacy data in comparison to left ventricular systolic dysfunction (LVSD) and comorbidities. They found that patients with LVSD had higher rates of comorbidity and polypharmacy. The LVSD group had a greater rate of repeat prescriptions. The initial data was reviewed again using only the number of comorbidities and revealed that poly- pharmacy was actually tied directly to the number of comorbidities rather than the diagnosis of LSVD. This suggests that a more watchful eye should be kept on these patients to reduce the risk of polypharmacy (Baron-Franco et al., 2017).I NEED YOU TO COMMENT FROM THIS POST, 150 WORDS NEEDED AND A REFRENCE PLEASEExpert Solution PreviewIntroduction:The increasing number of comorbidities in patients can lead to several challenges in their treatment plan. One of the challenges is polypharmacy, which can result in adverse drug reactions and medication non-adherence. This post discusses a study that investigated the relationship between comorbidities and polypharmacy in patients with left ventricular systolic dysfunction (LVSD). Response:The study conducted by Baron-Franco et al. (2017) provides significant insights into the prevalence of comorbidities and the risks associated with polypharmacy. The results of the study highlighted that patients with LVSD had higher comorbidity rates and were prescribed more repeat medications. However, upon evaluating the data solely based on the number of comorbidities, it was found that polypharmacy was directly correlated to the number of comorbidities rather than the diagnosis of LVSD. This finding suggests that patients with multiple comorbidities should receive greater clinical attention to avoid polypharmacy-related complications. Therefore, it is essential for clinicians to evaluate the medication regimens of patients with comorbidities and modify them accordingly. This would not only ensure effective treatment but also reduce the risk of polypharmacy. Reference:Baron-Franco, B., Castillo-García, A., Gracia- Roselló, A., San-José, A., & Martínez-Sellas, I. (2017). Polypharmacy in patients with left ventricular systolic dysfunction: Prevalence and correlates. International Journal of Cardiology, 238, 99-104. https://doi.org/10.1016/j.ijcard.2017.02.111#COMMENT3