Infusion centers associated with substantially better outcomes than the ER for patients with acute pain events and sickle cell disease

Here are summaries of articles that will appear in Annals of Internal Medicine's next issue. These summaries should not be used as a substitute for the complete articles. The information is subject to strict embargo. Media representatives taking possession of it are agreeing to the terms of embargo on both their own behalf and on behalf of the organization. 1. Patients with sickle cell disease and acute pain events are more likely to be treated in an infusion center than in the ER. Abstract: http://www. Abstract: https:/// / www. http:// doi/ 10. 7326/ M20-77171 Editorial: http:/// / www. acpjournals. http:// doi/ 10. 7326/ M21-2650 Summary: http://www. acpjournals. http:// doi/ 10. 7326/ P21–0005 URL goes live after the embargo lifts Prospective cohort studies have shown that patients with sickle cells disease (SCD), and uncomplicated vasoocclusive crises (OVS) are better treated at an infusion centre (IC). These findings were published in Annals of Internal Medicine. Vaso-occlusive events, which are painful and excruciatingly severe, are the most common reason for hospitalization and ED use in SCD. SCD is a rare condition in the United States. However, it is still a significant problem that requires ED care and hospitalization. A systematic review found that patients who present to the ED suffering from severe pain due to these events often face structural and interpersonal racism as well as sub-par care. Johns Hopkins University School of Medicine researchers studied 483 patients with sickle cell disease living within 60 miles of an IC. They wanted to determine if care in ICs would result in better outcomes. Patients treated in an IC received parenteral medication in an average of 70 minutes quicker than patients in an ED. This was compared to the 132 minutes it took in the ED. Patients treated in ICs were 3.8x more likely to have their pain reassessed within thirty minutes and to be discharged home four times more often. These findings suggest that ICs are more likely than EDs to provide guidelines-based care and can improve overall outcomes. These findings, according to the authors are significant because adults with sickle cells disease have historically been underserved in the medical community. Patients and medical systems should have better access to high quality care. Media Contacts: Angela Collom can send you an embargoed PDF at acollom@acponline.org. Patrick Smith, PJSmith@jhmi.edu, can be reached to speak with Sophie Lanzkron MD and MHS, the corresponding author. 2. The gap in life expectancy between HIV-positive people and the general population is closing dramatically Abstract: http://www. Abstract: https:/// / www. http:// doi/ 10. org/ doi/ 10. Editorial: http:/// / www. acpjournals. http:// doi/ 10. org/ doi/ 10. URL goes live after the embargo lifts A cohort observational study found that HIV-positive persons' mortality decreased significantly between 1999 and 2017, with the greatest decline between 2011 and 2017. The risk of death for HIV-positive persons remained slightly higher in the years following their care began than those in the general population. These findings were published in Annals of Internal Medicine. HIV-related deaths have been declining since 1996's introduction of effective treatment. However, it is not clear if those who are HIV-positive in the United States are at a lower risk of death than their peers in the general populace. The University of North Carolina at Chapel Hill used data gathered from the National Center for Health Statistics in order to compare 5-year all cause mortality between 82.766 HIV-positive adults who entered HIV care between 1999 and 2017, at 13 U.S. sites that are part of the North American AIDS Cohort Collaboration on Research and Design. The general population was matched with those in NA-ACCORD based on their calendar time, age and sex. Researchers found that there was a decrease in mortality between HIV-positive people and the general population over time. This difference ranged from 11.1% for those who entered care between 1999 and 2004, to 2.7% for those who entered care from 2011 through 2017. Notably, mortality declined across all demographic groups and was lower among non-Hispanic Blacks than it was among non-Hispanic Whites. The authors believe that the decline in HIV-related mortality is likely due to advances in treatment and care. They also point out that new guidelines indicate earlier treatment and greater involvement in care. There's also a trend to link HIV-infected persons to care sooner in the course, which means at higher CD4 cells counts, and changing patient characteristics over time. This study is crucial because it allows us to understand differences in mortality between HIV-infected persons and the matched U.S. populations. Media contacts: Angela Collom can be reached at acollom@acponline.org to request an embargoed pdf. Jessie K. Edwards PhD is the corresponding author. You can reach her directly at jkedwar@email.unc.edu. This issue also features a new feature: Clinician-educators are vital Centor Annals on Call Abstract: http://www. Abstract: https:/// / www. http:// doi/ 10. 7326/ A20-0116 ###

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