Articles: adult.
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Glucagon-like peptide-1 receptor agonist (GLP-1a) medications have been shown in randomized controlled trials (RCTs) to have consistent and impressive effectiveness in lowering hemoglobin A1c (HbA1c) and weight, but limited data exist on the efficacy of GLP-1a medications in clinical practice. We studied the association between GLP-1a therapy and changes in weight and HbA1c in a real-world patient population. In this retrospective cohort study of patients seen in a primary care clinic between 2012 and 2021, we examined the change in weight and HbA1c over 12 months in a cohort of patients with at least one prescription for a GLP-1a. ⋯ For treated and without GLP-1a patients, respectively, the proportion of patients with a decrease in BMI was 65 versus 64% (p = 0.86), and the proportion with a decrease in HbA1c was 73 versus 69% (p = 0.28). In clinical practice, GLP-1a therapy was associated with more modest reductions in weight and HbA1c than shown in prior RCTs. As GLP-1a use continues to expand throughout primary care, the real-world impact of this pharmacotherapy will require further evaluation.
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Observational Study
Relationship between intra-operative urine output and postoperative acute kidney injury in paediatric cardiac surgery: A retrospective cohort study.
Intra-operative urine output (UO) has been shown to predict postoperative acute kidney injury (AKI) in adults; however, its significance in children undergoing cardiac surgery remains unknown. ⋯ Intra-operative UO was not associated with postoperative AKI during paediatric cardiac surgery. However, we found a significant association between UO and postoperative moderate-to-severe AKI. This suggests that reductions in intra-operative urine output below a specific threshold may be associated with postoperative renal dysfunction.
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Understanding changes in vaccine hesitancy, overall and by sociodemographic characteristics, may highlight sub-populations for whom more intensive efforts are needed to increase vaccine uptake and confidence. ⋯ This study highlights concerning trends in vaccine hesitancy and uptake of the COVID-19 and other recommended vaccines. We found that some high-risk groups (e.g. smokers) and population subgroups have become more vaccine hesitant, suggesting the need for improved and intensified strategies to increase vaccine confidence and uptake. Future research may focus on qualitative inquiry to understand specific concerns and determinants contributing to increased hesitancy among these groups to help inform interventions and communication campaigns to support vaccination.
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People with disabilities are at increased risk for severe COVID-19 health outcomes and face barriers accessing COVID-19 vaccines. The aim of this study is to examine receipt of ≥ 1 dose of the COVID-19 vaccine, intention to vaccinate in the future, and reasons for not vaccinating among people with disabilities and functional limitations using a large, nationally representative dataset of adults in the United States. ⋯ Efforts to ensure high and equitable vaccination coverage include working with communities to strengthen the message that the vaccine is safe and effective, educating health professionals about the need to recommend and promote vaccines, and making vaccination sites more accessible for people who need additional accommodations.