scholarly journals Comparing Diagnosis and Treatment of Pulmonary Hypertension Patients at a Pulmonary Hypertension Center versus Community Centers

Diseases ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 5
Author(s):  
Hollie Saunders ◽  
Scott A. Helgeson ◽  
Ahmed Abdelrahim ◽  
Kathleen Rottman-Pietrzak ◽  
Victoria Reams ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Specific Treatment ◽  
Diagnostic Group ◽  
Accurate Diagnosis ◽  
Multiple Resources ◽  
State Management ◽  
Disease State Management ◽  
Specific Medication ◽  
Acquisition Costs ◽  
Evidence Based Guidelines

Once patients are diagnosed with pulmonary hypertension it is important to identify the correct diagnostic group as it will have implications on the disease state management. Pulmonary hypertension is increasingly diagnosed and treated in general medical practices; however, evidence-based guidelines recommend evaluation and treatment in pulmonary hypertension centers for accurate diagnosis and appropriate treatment recommendations. We conducted a retrospective cohort study of 509 random patients 18 years and older who were evaluated in our pulmonary hypertension clinic from January 2005 to December 2018. 68.4% (n = 348) had their diagnostic group clarified or changed. Pulmonary hypertension was deemed an incorrect diagnosis in 12.4% (n = 63). A total of 114 patients (22.4%) had been initiated on pulmonary hypertension specific treatment prior to presentation. Pulmonary hypertension specific medication was stopped in 57 (50.0%) cases. The estimated monthly saving of the stopped medication based on wholesale acquisition costs was USD 396,988.05–419,641.05, a monthly saving of USD 6964.70–7362.12 per patient. Evaluation outside of a pulmonary hypertension center may lead to misdiagnosis and inappropriate or inadequate treatment. Pulmonary arterial hypertension directed therapy improves median survival, but inappropriate therapy may cause harm; therefore, patients benefit from a specialized center with multiple resources to secure an accurate diagnosis and tailored treatment for their condition.

scholarly journals Clinical evaluation of pulmonary hypertension using patient-reported outcomes: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Miguel Ángel Amor-García ◽  
Sara Ibáñez-García ◽  
Xandra García-González ◽  
Teresa Mombiela ◽  
Cristina Villanueva-Bueno ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pulmonary Hypertension ◽  
Clinical Evaluation ◽  
Patient Reported Outcomes ◽  
Specific Treatment ◽  
Tertiary Hospital ◽  
Functional Class ◽  
Cross Sectional ◽  
Patient Reported

Abstract Background Patients with pulmonary hypertension (PH) have progressive and disabling symptoms, as well as a burden of treatments and a difficult clinical evaluation that make health-related quality of life a particularly relevant endpoint in this disease. The objective of the study was to evaluate patient-reported outcomes of patients receiving specific treatment for PH in a tertiary hospital using a specific questionnaire (Cambridge Pulmonary Hypertension Outcome Review-CAMPHOR) in the pharmacy consultation. Methods A cross-sectional, observational, descriptive study was conducted. It included all patients receiving specific treatment for PH in a tertiary hospital in Madrid, Spain. The inclusion period comprised between August to December 2019. CAMPHOR questionnaires containing three domains: symptoms, activities and quality of life were completed by the patients at the pharmacy consultation. Demographic and clinical variables, including WHO Functional Class (WHO FC), PH-specific tests and hemodynamic parameters, were recorded. Non-parametric analyses to assess relations between variables and CAMPHOR domains were performed. Results Thirty-six patients consented to participate in the study and completed the questionnaire. Median scores for symptoms, activities, and quality of life domains were 5.5 (2.5–10), 8.0 (4.5–10.5) and 3.5 (1–7.5), respectively. Statistically significant differences were found in the three domains when comparing by WHO FC, in the activities domain for 6-m walking test and in the quality of life domain for patients who had emergency visits or hospitalizations in the last year. Conclusions The CAMPHOR questionnaire could be useful as a complementary test to achieve an integrated evaluation of PH patients, who could complete it easily during their routine pharmacy visits.

Evaluation of a disease state management guideline for urinary tract infection

2016 ◽  
Vol 47 (6) ◽  
pp. 451-456 ◽  
Author(s):  
Monika T. Zmarlicka ◽  
Sophia M. Cardwell ◽  
Jared L. Crandon ◽  
David P. Nicolau ◽  
Mitchell H. McClure ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Disease State ◽  
Management Guideline ◽  
State Management ◽  
Disease State Management

Evidence-based guidelines for acute stabilization and management of neonates with persistent pulmonary hypertension of the newborn

2021 ◽  
Author(s):  
Molly K Ball ◽  
Ruth Seabrook ◽  
Elizabeth M Bonachea ◽  
Bernadette Chen ◽  
Omid Fathi ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Neonatal Intensive Care ◽  
Best Practice ◽  
Clinical Care ◽  
Persistent Pulmonary Hypertension ◽  
High Morbidity ◽  
Evidence Based ◽  
Extensive Literature ◽  
Disciplinary Expertise ◽  
Evidence Based Guidelines

Persistent pulmonary hypertension of the newborn, or PPHN, represents a challenging condition associated with high morbidity and mortality. Management is complicated by complex pathophysiology and limited neonatal specific evidence-based literature, leading to a lack of universal contemporary clinical guidelines for the care of these patients. To address this need and to provide consistent high-quality clinical care for this challenging population in our neonatal intensive care unit, we sought to develop a comprehensive clinical guideline for the acute stabilization and management of neonates with PPHN. Utilizing cross-disciplinary expertise and incorporating an extensive literature search to guide best practice, we present an approachable, pragmatic, and clinically relevant guide for the bedside management of acute PPHN.

scholarly journals Renal manifestations of sarcoidosis: from accurate diagnosis to specific treatment

2020 ◽  
Vol 46 (1) ◽  
pp. 15-25 ◽  
Author(s):  
Filipe A. Saliba C. Correia ◽  
Giovanni S. Marchini ◽  
Fábio C. Torricelli ◽  
Alexandre Danilovic ◽  
Fábio C. Vicentini ◽  
...  
Keyword(s):  
Specific Treatment ◽  
Accurate Diagnosis

scholarly journals Circulating Blood-Based Biomarkers in Pulmonary Hypertension

2022 ◽  
Vol 11 (2) ◽  
pp. 383
Author(s):  
Marta Banaszkiewicz ◽  
Aleksandra Gąsecka ◽  
Szymon Darocha ◽  
Michał Florczyk ◽  
Arkadiusz Pietrasik ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Biochemical Parameters ◽  
Specific Treatment ◽  
Right Heart Failure ◽  
Insufficient Data ◽  
Myocardial Remodeling ◽  
Right Heart ◽  
Cell Dysfunction ◽  
Diagnosis And Prognosis ◽  
Different Types

Pulmonary hypertension (PH) is a serious hemodynamic condition, characterized by increased pulmonary vascular resistance (PVR), leading to right heart failure (HF) and death when not properly treated. The prognosis of PH depends on etiology, hemodynamic and biochemical parameters, as well as on response to specific treatment. Biomarkers appear to be useful noninvasive tools, providing information about the disease severity, treatment response, and prognosis. However, given the complexity of PH, it is impossible for a single biomarker to be adequate for the broad assessment of patients with different types of PH. The search for novel emerging biomarkers is still ongoing, resulting in a few potential biomarkers mirroring numerous pathophysiological courses. In this review, markers related to HF, myocardial remodeling, inflammation, hypoxia and tissue damage, and endothelial and pulmonary smooth muscle cell dysfunction are discussed in terms of diagnosis and prognosis. Extracellular vesicles and other markers with complex backgrounds are also reviewed. In conclusion, although many promising biomarkers have been identified and studied in recent years, there are still insufficient data on the application of multimarker strategies for monitoring and risk stratification in PH patients.

scholarly journals Treatment of pulmonary hypertension associated with chronic obstructive pulmonary disease: a systematic review

2021 ◽  
pp. 00348-2021
Author(s):  
Ragdah Arif ◽  
Arjun Pandey ◽  
Ying Zhao ◽  
Kyle Arsenault-Mehta ◽  
Danya Khoujah ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Hypertension ◽  
Pulmonary Disease ◽  
Treatment Effect ◽  
Specific Treatment ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Phosphodiesterase Type 5 Inhibitors ◽  
Clinical Benefits

Chronic obstructive pulmonary disease-associated pulmonary hypertension (COPD-PH) is an increasingly recognised condition which contributes to worsening dyspnea and poor survival in COPD. It is uncertain whether specific treatment of COPD-PH, including use of medications approved for pulmonary arterial hypertension (PAH), improves clinical outcomes. This systematic review and meta-analysis assesses potential benefits and risks of therapeutic options COPD-PH.We searched Medline and Embase for relevant publications until Sep 2020. Articles were screened for studies on treatment of COPD-PH for at least 4 weeks in 10 or more patients. Screening, data extraction, and risk of bias assessment were performed independently in duplicate. When possible, relevant results were pooled using the random effects model.Supplemental long-term O2 therapy (LTOT) mildly reduced mean pulmonary artery pressure (PAP), slowed progression of PH, and reduced mortality, but other clinical or functional benefits were not assessed. Phosphodiesterase type-5 inhibitors significantly improved systolic PAP (pooled treatment effect −5.9 mmHg; 95%CI −10.3, −1.6), but had inconsistent clinical benefits. Calcium-channel blockers and endothelin receptor antagonists had limited hemodynamic, clinical, or survival benefits. Statins had limited clinical benefits despite significantly lowering systolic PAP (pooled treatment effect −4.6 mmHg; 95% CI: −6.3, −2.9).This review supports guideline recommendations for LTOT in hypoxemic COPD-PH patients as well as recommendations against treatment with PAH-targeted medications, Effective treatment of COPD-PH depends upon research into the pathobiology, and future high-quality studies comprehensively assessing clinically relevant outcomes are needed.

Disorders of the peripheral nerves

2019 ◽  
pp. 483-502
Author(s):  
Manoj Sivan ◽  
Margaret Phillips ◽  
Ian Baguley ◽  
Melissa Nott
Keyword(s):  
Natural History ◽  
Brachial Plexus ◽  
Peripheral Nerves ◽  
Surgical Intervention ◽  
Specific Treatment ◽  
Accurate Diagnosis ◽  
Guillain Barre Syndrome ◽  
Hereditary Motor ◽  
Guillain Barré ◽  
Rehabilitation Strategy

Accurate diagnosis is important for the rehabilitation of people with disorders of the peripheral nerves. There are a small but increasing number of disorders that are now specifically treatable. Even in those disorders of peripheral nerves that do not currently have a specific treatment, accurate diagnosis remains important in order to determine natural history and prognosis. This will help to determine the rehabilitation strategy. Some conditions may recover spontaneously—such as Guillain–Barré syndrome—while others are progressive—such as the hereditary motor and sensory neuropathies. Some may require surgical intervention (e.g. the brachial plexus injuries). Disorders of peripheral nerves usually consist of several symptoms, and this chapter covers a range of disorders to indicate the range and extent of these disorders.

Effect of Visit Frequency of Pharmacist-Led Diabetes Medication Management Program

2020 ◽  
pp. 089719002094868
Author(s):  
Amy Frederick ◽  
Joyce Juan ◽  
Delaney Ivy ◽  
Yolanda Munoz Maldonado
Keyword(s):  
Blood Pressure ◽  
Hemoglobin A1c ◽  
Medication Management ◽  
Retrospective Chart Review ◽  
Management Program ◽  
P Value ◽  
State Management ◽  
Disease State Management ◽  
Visit Frequency ◽  
Patients With Diabetes

Background: Pharmacists have a positive effect on clinical outcomes in chronic disease state management, however, few studies have evaluated the effect that frequency of visits may have on diabetes biomarkers such as hemoglobin A1c and blood pressure readings. Methods: Under the medication management program (MMP), patients with diabetes were seen monthly by pharmacists until early 2015, when time between visits was increased to every 3 months. A retrospective chart review was conducted to evaluate the primary outcome of the percent change in hemoglobin A1c and blood pressure after the change in visit frequency. Results: In the 303 patients enrolled, no statistical difference existed between the pre and post average A1c (p-value = 0.10). The intermediate average A1c was statistically lower from the preintervention mean A1c (p-value = 0.001) but not from the postintervention mean A1c (p-value = 0.30). No statistical differences were seen between systolic blood pressure and diastolic blood pressure. Conclusion: Patients who have been seen by a clinical pharmacist more frequently (every month or every other month) for several years may be able to maintain their reduction in A1c with less-frequent visits (every 3 to 6 months).

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