The American journal of medicine
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Review
Propensity Score Matching: The 'Devil is in the Details' Where More May Be Hidden than You Know.
Propensity score matching has been used with increasing frequency in the analyses of non-prespecified subgroups of randomized clinical trials, and in retrospective analyses of clinical trial data sets, registries, observational studies, electronic medical record analyses, and more. The method attempts to adjust post hoc for recognized unbalanced factors at baseline such that the data once analyzed will hopefully approximate or indicate what a prospective randomized data set-the "gold standard" for comparing two or more therapies-would have shown. ⋯ Thus, propensity score matching analyses may omit, due to nonrecognition, the effects of several clinically important but not considered factors that can affect the outcomes of the analyses being reported, causing them to possibly be misleading, or hypothesis-generating at best. This review discusses this issue, using several specific examples, and is targeted at clinicians to make them aware of the limitations of such analyses when they apply their results to patients in their care.
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This study evaluated the efficacy and safety of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR) in low surgical risk patients. ⋯ Among older low-risk patients with severe aortic stenosis, TAVR is associated with a lower rate of death or disabling stroke compared with SAVR. Transcatheter aortic valve replacement is also associated with improved quality-of-life, reduced bleeding and atrial fibrillation, but higher paravalvular leak and pacemaker implantation rates.
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Tens (or hundreds) of thousands of Americans die each year as a result of preventable medical errors. Changes in the practice and business of medicine have caused some to question whether burnout among physicians and other healthcare providers may adversely affect patient outcomes. ⋯ We have all heard the airplane safety announcement remind us to "Please put on your own oxygen mask first before assisting others." Unfortunately, like many airline passengers (very few of whom use oxygen masks correctly when they are needed), physicians often do not recognize symptoms of burnout or depression, and even less often do they seek help. We detail the causes and consequences of physician burnout and propose solutions to increase physician work satisfaction.
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The most common causes of chronic liver disease in the developed world-nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH)-are the hepatic manifestations of an insulin-resistant state that is linked to visceral adiposity and systemic inflammation. NAFLD and NASH lead to an expansion of epicardial adipose tissue and the release of proinflammatory adipocytokines that cause microcirculatory dysfunction and fibrosis of the adjoining myocardium, resulting in atrial fibrillation as well as heart failure with a preserved ejection fraction (HFpEF). ⋯ Interventions include 1) weight loss by caloric restriction, bariatric surgery, or intensive exercise, and 2) drugs that ameliorate fat-mediated inflammation in both the liver and heart (eg, statins, metformin, sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and pioglitazone). Patients with NAFLD or NASH commonly have an inflammation-related atrial and ventricular myopathy, which may contribute to symptoms and long-term outcomes.
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Peak lung function and rate of decline predict future airflow obstruction and nonrespiratory comorbid conditions. Associations between lung function trajectories and emphysema have not been explored. ⋯ Lower peak and accelerated decline in FEV1 are risk factors for future emphysema independent of smoking status.