Articles: treatment.
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Multicenter Study
Loss to follow-up of patients after antiviral treatment as an additional barrier to HCV elimination.
Eliminating hepatitis C virus (HCV) infections is a goal set by the World Health Organization. This has become possible with the introduction of highly effective and safe direct-acting antivirals (DAA) but limitations remain due to undiagnosed HCV infections and loss of patients from the cascade of care at various stages, including those lost to follow-up (LTFU) before the assessment of the effectiveness of the therapy. The aim of our study was to determine the extent of this loss and to establish the characteristics of patients experiencing it. ⋯ In a real-world population of nearly 19,000 HCV-infected patients, we documented a 2.7% loss to follow-up rate. Independent predictors of this phenomenon were male gender, GT3 infection, HIV co-infection, alcohol addiction, mental illnesses, lack of prior antiviral treatment and discontinuation of DAA therapy.
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Anesthesia and analgesia · Oct 2024
Intraoperative Hypotension Prediction: Current Methods, Controversies, and Research Outlook.
Intraoperative hypotension prediction has been increasingly emphasized due to its potential clinical value in reducing organ injury and the broad availability of large-scale patient datasets and powerful machine learning tools. Hypotension prediction methods can mitigate low blood pressure exposure time. However, they have yet to be convincingly demonstrated to improve objective outcomes; furthermore, they have recently become controversial. ⋯ We present a start of a risk-benefit analysis of hypotension prediction methods in clinical practice. We conclude by coalescing this analysis with the current evidence to offer an outlook on prediction methods for intraoperative hypotension. A shift in research toward tailoring hypotension prediction methods to individual patients and pursuing methods to predict appropriate treatment in response to hypotension appear most promising to improve outcomes.
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The voltage-gated sodium channel NaV1.7 plays an important role in pain processing according to genetic data. Those data made NaV1.7 a popular drug target, especially since its relatively selective expression in nociceptors promised pain relief without the adverse effects associated with broader sodium channel blockade. Despite encouraging preclinical data in rodents, NaV1.7-selective inhibitors have not yet proven effective in clinical trials. ⋯ Nearly all preclinical studies gave a single dose of drug unlike the repeat dosing used clinically, thus precluding preclinical data from demonstrating whether tolerance or other slow processes occur. In summary, preclinical testing of NaV1.7-selective inhibitors aligned poorly with clinical testing. Beyond issues that have already garnered widespread attention in the pain literature, our results highlight the treatment regimen and choice of pain model as areas for improvement.
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Critical care medicine · Oct 2024
Heterogeneity in the Effect of Early Goal-Directed Therapy for Septic Shock: A Secondary Analysis of Two Multicenter International Trials.
The optimal approach for resuscitation in septic shock remains unclear despite multiple randomized controlled trials (RCTs). Our objective was to investigate whether previously uncharacterized variation across individuals in their response to resuscitation strategies may contribute to conflicting average treatment effects in prior RCTs. ⋯ Treatment response to EGDT varied across patients in two multicenter RCTs with large benefits for some patients while others were harmed. Patient characteristics, including albumin, were most important in identifying HTE.
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Interhospital transfer is often required in the care of patients with hemorrhagic stroke. Guidelines recommend a door-in-door-out (DIDO) time of ≤120 minutes at the transferring emergency department (ED); however, it is unknown whether DIDO times are related to clinical outcomes of hemorrhagic stroke. ⋯ These findings suggest that EDs currently expedite the transfer of the sickest patients; however, prospective studies and more granular data are needed to understand the impact of early treatment and timing of transfer for patients with hemorrhagic stroke.