US Health Care Research Articles

Comparing pulsed field ablation and thermal energy catheter ablation for paroxysmal atrial fibrillation: A cost-effectiveness analysis of the ADVENT trial

Background Pulsed field ablation (PFA) has emerged as an effective technology in the treatment of paroxysmal atrial fibrillation (AF). Objective To evaluate the cost-effectiveness of PFA vs. thermal ablation from a US healthcare payer perspective using data from a randomized trial. Methods A hybrid decision tree and Markov model was developed comparing patients receiving PFA to thermal ablation (either radiofrequency or cryoballoon ablation) from a US healthcare payer perspective at 5-, 10-, 20-, and 40-year time horizons. Direct medical costs (in 2024 US Dollars), quality-adjusted life years (QALYs), and the net monetary benefit were evaluated at a willingness-to-pay (WTP) threshold of $100,000/QALY. Univariate and probabilistic sensitivity analyses were performed to test model uncertainty. The budget impact for a standard US healthcare payer with 1 million beneficiaries was also assessed. Results Over a 40-year time horizon, PFA resulted in an additional 0.044 QALYs at a lower cost of $2,871 compared to thermal ablation. PFA was cost-effective in 54.9% of simulations. Anticoagulation and ablation procedure costs had the largest impact on model uncertainty. The expected cost savings per member per month for a US healthcare payer adopting PFA were $0.00015, $0.0059, and $0.02343 in years 1, 4, and 6, respectively. Conclusions PFA was at least as cost-effective as conventional thermal ablation modalities for treatment of paroxysmal AF and potentially reduces US healthcare payer costs. Providers and payers should consider designating PFA among the preferred first-line therapies for eligible patients.

Journey of International Medical Graduates Toward Orthopaedic Surgery Residency in the United States.

International medical graduates (IMGs) are integral to the US healthcare system but are scarce in orthopaedic residency classes. Positive contributions of IMGs to the field of orthopaedic surgery in the United States are well documented, but successfully matching into an orthopaedic residency position as an IMG remains very challenging. The purpose of this study was to review current processes, strategies, and potential barriers of IMGs applying for orthopaedic surgery residency in the United States as an IMG.

Framing diagnostic error: an epidemiological perspective

Diagnostic errors burden the United States healthcare system. Depending on how they are defined, between 40,000 and 4 million cases occur annually. Despite this striking statistic, and the potential benefits epidemiological approaches offer in identifying risk factors for sub-optimal diagnoses, diagnostic error remains an underprioritized epidemiolocal research topic. Magnifying the challenge are the array of forms and definitions of diagnostic errors, and limited sources of data documenting their occurrence. In this narrative review, we outline a framework for improving epidemiological applications in understanding risk factors for diagnostic error. This includes explicitly defining diagnostic error, specifying the hypothesis and research questions, consideration of systemic including social and economic factors, as well as the time-dependency of diagnosis relative to disease progression. Additional considerations for future epidemiological research on diagnostic errors include establishing standardized research databases, as well as identifying potential important sources of study bias.

Navigating Nurse Wellness in Rural America.

The aim of this study's phase 1 was to determine the current wellness levels of RNs in rural America settings, including barriers to maintain and recommendations for wellness. Nurses are experiencing more anxiety and burnout currently than prepandemic. A review of literature revealed a gap in describing nurses' wellness and strategies to maintain wellness in rural American healthcare settings. The Integrative Health and Wellness Assessment (IHWA) V2 2022 holistically measured participants' wellness. The survey was deployed in 2023 to 6989 clinical nurses, nurse leaders, and advanced practice nurses. The IHWA V2 2022 mean was 134.72. Significant findings included age, years of experience, and role. Barriers of insufficient time, work environment, and family responsibilities were identified. Recommendations involved the work environment, stress management, and healthy boundaries with suggestions to implement in rural settings. Study findings can assist leaders to implement interventions that positively impact nurse wellness in rural settings. Interventions promoting wellness are essential for nurses to meet these same needs of their patients.

News Media Imaginaries of Artificial Intelligence in Healthcare: A Qualitative Analysis Across China, Germany, and the United States

Artificial intelligence (AI) has attracted much public interest, inspiring both hopes and fears. As countries define pathways for developing and implementing AI, healthcare is emerging as a priority sector. Sociotechnical imaginaries, which can mobilize public support and attract resources for realising sociotechnical visions, play an important role in the trajectories of emerging technologies. News media, in turn, are central to the negotiation, construction, and promotion of such imaginaries. We analyze how news media construct sociotechnical imaginaries of AI in healthcare in China, Germany, and the United States (US), three countries with differing healthcare and media systems, and sociopolitical and -cultural outlook on technologies. Drawing from a thematic analysis of articles from 15 newspapers, we find two powerful, cross-national, collectively held imaginaries: The first imaginary on enhancing healthcare with AI emerged across all three countries; the second imaginary on using AI to manage pandemics or epidemics was only fully developed in Chinese and US coverage, though present as an outlier in German news coverage. Lower-level divergences within each imaginary can be explained by systemic differences between the countries, such as the largely private US healthcare system, the mostly state-controlled Chinese media and healthcare systems, and the German hesitancy toward emerging technologies. This study provides evidence for how powerful imaginaries can emerge across very different sociopolitical and cultural contexts while accounting for contextual national factors.

The Effects of the COVID-19 Pandemic on Age-Based Disparities in Digital Health Technology Use: Secondary Analysis of the 2017-2022 Health Information National Trends Survey.

The COVID-19 pandemic accelerated the adoption of digital health technology, but it could also impact age-based disparities as existing studies have pointed out. Compared with the pre-pandemic period, whether the rapid digitalization of the health care system during the pandemic widened the age-based disparities over a long period remains unclear. This study aimed to analyze the long-term effects of the COVID-19 pandemic on the multifaceted landscape of digital health technology used across diverse age groups among US citizens. We conducted the retrospective observational study using the 2017-2022 Health Information National Trends Survey to identify the influence of the COVID-19 pandemic on a wide range of digital health technology use outcomes across various age groups. The sample included 15,505 respondents, which were categorized into 3 age groups: adults (18-44 years), middle-aged adults (45-64 years), and older adults (more than 65 years). We also designated the time point of March 11, 2020, to divide the pre- and post-pandemic periods. Based on these categorizations, multivariate linear probability models were used to assess pre-post changes in digital health technology use, controlling for demographic, socioeconomic, and health-related variables among different age groups. Essentially, older adults were found to be significantly less likely to use digital health technology compared with adults, with a 26.28% lower likelihood of using the internet for health information (P<.001) and a 32.63% lower likelihood of using health apps (P<.001). The usage of digital health technology for all age groups had significantly increased after the onset of the pandemic, and the age-based disparities became smaller in terms of using the internet to look for health information. However, the disparities have widened for older adults in using the internet to look up test results (11.21%, P<.001) and make appointments (10.03%, P=.006) and using wearable devices to track health (8.31%, P=.01). Our study reveals a significant increase in the use of digital health technology among all age groups during the pandemic. However, while the disparities in accessing online information have narrowed, age-based disparities, particularly for older adults, have widened in most areas such as looking up test results and making appointments with doctors. Therefore, older adults are more likely left behind by the rapidly digitalized US health care system during the pandemic. Policy makers and health care providers should focus on addressing these disparities to ensure equitable access to digital health resources for US baby boomers.

Prevalence and Characteristics of Developmental Disabilities Among Children Who Receive Hearing Health Care.

We aim to determine the prevalence and characteristics of developmental disabilities among the clinical population of children who receive hearing health care in the United States. Using electronic health records of 131,709 children (0-18 years), we identified those with a diagnosis of attention deficit/hyperactivity disorder, autism spectrum disorder, vision differences, cerebral palsy, chromosomal abnormalities, delayed milestones, Down syndrome, or intellectual disability. We determined prevalence, age of first audiology encounter, age of diagnosis for the developmental disability, and hearing status based on the specific disability and the number of diagnoses. Binomial and multinomial logistic regressions were performed. One in four children had a diagnosed developmental disability. The most common disabilities were delayed milestones (11.3%), vision differences (7.4%), attention-deficit/hyperactivity disorder (6.6%), and autism spectrum disorder (6.2%). Half of the children with developmental disabilities had at least one diagnosis before their first audiology encounter. Children with developmental disabilities were more likely to have a reduced hearing or an unknown hearing status than children without developmental diagnoses. For children with reduced hearing, those with developmental disabilities had higher rates of bilateral configurations and poorer hearing severity levels. Developmental disabilities are common among children who seek hearing health care. Moreover, developmental disabilities often co-occur with reduced hearing. Further research and advocacy efforts are critical for creating clinical practices that are inclusive of, and equitable for, children with complex and diverse developmental profiles. https://doi.org/10.23641/asha.27857847.

Personalized Patient Data and Behavioral Nudges to Improve Adherence to Chronic Cardiovascular Medications

Poor medication adherence is common. Text messaging is increasingly used to change patient behavior but often not rigorously tested. To compare different types of text messaging strategies with usual care to improve medication refill adherence among patients nonadherent to cardiovascular medications. Patient-level randomized pragmatic trial between October 2019 to April 2022 at 3 US health care systems, with last follow-up date of April 11, 2023. Adult (18 to <90 years) patients were eligible based on diagnosis of 1 or more cardiovascular condition(s) and prescribed medication to treat the condition. Patients who did not opt out and had a 7-day refill gap were randomized to 1 of 4 study groups. Generic text message refill reminders (generic reminder); behavioral nudge text refill reminders (behavioral nudge); behavioral nudge text refill reminders plus a fixed-message chatbot (behavioral nudge + chatbot); usual care. Primary outcome was refill adherence based on pharmacy data using proportion of days covered at 12 months. Secondary outcomes were clinical events of emergency department visits, hospitalizations, and mortality. Among 9501 enrolled patients, baseline characteristics across the 4 groups were comparable (mean age, 60 years; 47% female [n = 4351]; 16% Black [n = 1517]; 49% Hispanic [n = 4564]). At 12 months, the mean proportion of days covered was 62.0% for generic reminder, 62.3% for behavioral nudge, 63.0% for behavioral nudge + chatbot, and 60.6% for usual care (P = .06). In adjusted analysis, when compared with usual care, mean proportion of days covered was 2.2 percentage points (95% CI, 0.3-4.2; P = .02) higher for generic reminder, 2.0 percentage points (95% CI, 0.1-3.9; P = .04) higher for behavioral nudge, and 2.3 percentage points (95%, 0.4-4.2; P = .02) higher for behavioral nudge + chatbot, none of which were statistically significant after multiple comparisons correction. There were no differences in clinical events between study groups. Text message reminders targeting patients who delay refilling their cardiovascular medications did not improve medication adherence based on pharmacy refill data or reduce clinical events at 12 months. Poor medication adherence may be due to multiple factors. Future interventions may need to be designed to address the multiple factors influencing adherence. ClinicalTrials.gov Identifier: NCT03973931.

Gut-derived PPAR-γ signaling and risk of bacterial enteric infection: insight from thiazolidinedione users in a US population-based study.

Background and Aims The ongoing antimicrobial resistant crisis heralds the need for new therapeutics against enteric infection. In mouse models, colon epithelial peroxisome proliferator-activated receptor-γ (PPAR-γ) signaling limits oxygen and nitrate luminal bioavailability, thereby preventing bacterial pathogen colonization. However, whether this mechanism operates similarly in humans remains uncertain. Methods To investigate, we used the cloud-based TriNetX Analytics Platform which aggregates health records from 117 million patients across 66 US healthcare organizations, to assess the risk of bacterial enteric infection among diabetic patients prescribed thiazolidinediones, a class of PPAR-γ agonists, to other anti0diabetes medications/ . Results Among 85,117 thiazolidinedione users, we observed a 22-49% lower risk of bacterial enteric infections compared to users of other anti-diabetes medications. This reduction in risk was consistent across high-risk individuals, regardless of sex or age. Similar results were replicated in high-risk patients when thiazolidinedione users were directly compared to those on DPP-4 inhibitors. Conclusion These findings support the potential protective role of PPAR-γ signaling against bacterial enteric infection and call for further clinical investigation.

Social Media, Survey, and Medical Literature Data Reveal Escalating Antisemitism Within the United States Healthcare Community.

Antisemitism has been rising for decades and worsened following the events of Oct 7, 2023. Although anecdotal evidence suggests that these trends extend into the US medical community, quantitative data have been lacking. To address this gap, we quantitated publications about antisemitism, analyzed social media posts from the accounts of 220,405 healthcare professionals, and disseminated a survey to members of Jewish medical associations. Publications and social media posts about antisemitism rose > fivefold, while posts promoting antisemitic stereotypes increased 2-fourfold. Most Jewish-identifying medical students and professionals (75.4%) reported exposure to antisemitism. Together, our results suggest that antisemitism is escalating within the US healthcare community.

The role of artificial intelligence and machine learning in optimizing U.S. healthcare supply chain management

This paper aims to review the role of Artificial Intelligence and Machine Learning in managing the healthcare supply chain in the United States. Healthcare supply chains face several challenges such as fragmentation, lack of real-time visibility, and inventory management issues. However, there are solutions with the help of AI and machine learning, including the availability of predictive analytics to improve demand forecasting, optimization algorithms for inventory and logistics, and automated quality control. Application areas demand forecasting, supplier selection, logistics optimization, quality control, and real-time tracking. The applications of AI in healthcare supply chains have the potential to improve the healthcare supply chain in terms of reduced costs, increased efficiency, optimized decision-making, and better patient outcomes. However, the implementation experience has shown several challenges such as data quality, privacy concerns, regulatory compliance, and workforce adaptation within organizations. Successful implementations in various health organizations in the US give valuable insights into how AI could be well implemented. The future presents several opportunities for supply chain optimization with the rise of blockchain and Internet of Things (IoT) integration. For healthcare supply chains to adopt AI, organizations should have specific AI plans, start with pilot projects in high-impact areas, invest in data infrastructure, and ensure strong leadership support. As AI becomes increasingly critical for competitive advantage, it has the potential to create more resilient, efficient, and patient-centric supply chains in the US healthcare system.

The current state of spirituality: A four world view

ABSTRACT Though spirituality has become more prevalent in holistic Biopsychosocial-Spiritual (BPSS) health it is still scarcely acknowledged by the US healthcare system, its clinicians and along with it its systemic benefits. This article aims to provide a summarization of those benefits through Peek’s (2008) four world view (i.e. clinical, financial, operational, and training) of health care and discuss the lack of acknowledgment amongst these benefits. To better diversify the authors outlook on spirituality the modern clinical version of spirituality (Koenig 2008) was utilized as a clinical framework. The application of this framework is due in part to clinicians and their discomfort being one of the driving forces behind the lack of acknowledgment. Through this framework, clinicians can create a more welcoming stance for diverse spiritual presentations and increase acknowledgment of spirituality for their patients within the healthcare system. Due to this framework being conducive to a clinical stance it would benefit the acknowledgment of spirituality by beginning in the world of training. This stance would directly address clinician discomfort and increase the overall acknowledgment of spirituality. Improvements within the training world should be prioritized while also highlighting important conversations that should be happening simultaneously in the other three worlds (Table 1).

The impact of regenerative medicine and tissue engineering on US healthcare

Regenerative medicine and tissue engineering are transformative fields with the potential to address some of the most pressing challenges in modern healthcare. This review explores the current field of regenerative medicine in the United States, focusing on its foundational principles, clinical breakthroughs, economic impact, regulatory frameworks, and integration challenges. Key advancements are highlighted across stem cell therapies, engineered tissues and organs, biomaterials, scaffolds, and gene therapy, with case studies illustrating successful applications. Additionally, this review assesses the economic implications, including market growth, treatment costs, and the shifting dynamics of insurance coverage and funding, which collectively shape the financial feasibility of these innovations. The paper also identifies critical barriers to widespread adoption, such as infrastructure limitations, training requirements for healthcare providers, ethical considerations, and the need for standardization in quality control. In examining future directions, the review emphasizes emerging technologies, strategic policy recommendations, and essential research priorities that could drive sustainable integration into healthcare systems. By providing a comprehensive overview of these areas, this paper highlights the potential long-term impact of regenerative medicine on public health and highlights the pathways necessary for its safe, effective, and equitable implementation in the United States.

Cost-effectiveness analysis of immune checkpoint inhibitors combined with targeted therapy and chemotherapy for HPV/HIV-related cervical cancer.

To systematically assess the cost-effectiveness of immune checkpoint inhibitors compared to the current standard therapy for human papillomavirus (HPV) and human immunodeficiency virus (HIV)-related cervical cancer. A partitioned survival model spanning a 20-year period was created to evaluate the cost and effectiveness of atezolizumab combined with bevacizumab and chemotherapy (ABC), and pembrolizumab combined with bevacizumab and chemotherapy (PBC) vs bevacizumab combined with chemotherapy (BC), based on clinical data from the BEATcc and KEYNOTE-826 trials. Royston-Parmar models were used for survival estimation. Costs and health state utilities were sourced from existing literature and publicly accessible databases. Cumulative costs (in US dollars), life years, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were measured and compared. The evaluation was from the US healthcare payer perspective, with the willingness-to-pay threshold set at $100,000 to $150,000. Deterministic sensitivity analysis (DSA), probabilistic sensitivity analysis (PSA), and scenario analyses were conducted. The base-case analysis showed QALYs of 2.05 for BC, 3.18 for PBC, and 2.85 for ABC. PBC increased life-years by 1.76 and ABC by 1.18, with PBC showing the highest effectiveness. Total costs were $272,377 for BC, $715,472 for ABC, and $694,239 for PBC; severe adverse event (SAE) costs were $6189 for BC, $7603.31 for ABC, and $13,640 for PBC, indicating BC had the lowest SAE costs. The ICERs compared to BC were $372,151/QALY for PBC and $553,995/QALY for ABC. Given that the willingness-to-pay threshold was $100,000 to $150,000/QALY, both PBC and ABC exceed this threshold and were not considered cost-effective. BC had the lowest QALYs and the lowest costs, making it the least expensive option and the most cost-effective choice. DSA results indicated that drug prices and utility values were the main factors affecting cost-effectiveness. PSA confirmed BC as the most cost-effective option within a willingness-to-pay threshold of $0 to $300,000, primarily because it was the least costly. Immune checkpoint inhibitors significantly improve survival benefits for patients. However, their addition is costly and unlikely to be cost-effective for HPV/HIV-related metastatic cervical cancer.

US cost-effectiveness analysis of apixaban compared with warfarin, dabigatran and rivaroxaban for nonvalvular atrial fibrillation, focusing on equal value of life years and health years in total.

Aim: Warfarin and direct-acting oral anticoagulants (DOACs) are widely prescribed to patients with nonvalvular atrial fibrillation (NVAF) to reduce risk of stroke and systemic embolism (SE). This study aimed to assess the cost-effectiveness of apixaban compared with warfarin, dabigatran and rivaroxaban, for patients with NVAF from a US healthcare payer (Medicare) perspective. Methods: A cohort-level Markov model was developed based on a previously published model, for the US setting, factoring in anticipated price decreases due to market entry of generic drugs. Two retrospective cohort studies in US Medicare patients provided inputs to quantify clinical events in the base case setting and in a scenario analysis. For this study, equal value of life-years (evLYs) and health years in total (HYT) were used. Cost-effectiveness was assessed based on a willingness-to-pay threshold of $100,000 per evLY gained (evLYG) or HYT gained (HYTG). Results: Apixaban treatment was associated with gains of 2.23, 1.08 and 1.72 evLYs and 2.26, 1.08 and 1.73 HYTs, compared with warfarin, dabigatran and rivaroxaban, respectively. In the base case analysis from a Medicare perspective, apixaban was cost-effective (i.e., value for money) compared with warfarin, dabigatran and rivaroxaban, with corresponding incremental cost-effectiveness ratio (ICER) per evLYG (and HYTG) of $10,501 ($10,350), $7809 ($7769) and $758 ($768), respectively. When a societal perspective was included, and in a scenario analysis using US Medicare data from the Ray et al. study to quantify treatment effects, apixaban dominated rivaroxaban (i.e., less expensive and more effective) in terms of ICER per evLYG (and HYTG). Conclusion: Using dynamic pricing assumptions, treatment with apixaban compared with warfarin, dabigatran and rivaroxaban was associated with incremental evLYs and HYT and represents a cost-effective treatment option in patients with NVAF, from a US healthcare payer (Medicare) perspective.

Defining key deprescribing measures from electronic health data: A multisite data harmonization project.

Stopping or reducing risky or unneeded medications ("deprescribing") could improve older adults' health. Electronic health data can support observational and intervention studies of deprescribing, but there are no standardized measures for key variables, and healthcare systems have differing data types and availability. We developed definitions for chronic medication use and discontinuation based on electronic health data and applied them in a case study of benzodiazepines and Z-drugs in five diverse US healthcare systems. We conducted a retrospective cohort study of adults age 65+ from 2017 to 2019 with chronic benzodiazepine or Z-drug use. We determined whether sites had access to medication orders and/or dispensings. We developed definitions for chronic use and discontinuation using both data types. Discontinuation definitions were based on (1) gaps in medication availability during follow-up or (2) not having medication available at a fixed time point. We examined the impact of varying the gap length and requiring a 30-day period without orders/dispensings ("halo") around the fixed time point. We compared results derived from orders versus dispensings at one site. Approximately 1.6%-2.6% of older adults had chronic benzodiazepine/Z-drug use (total N = 6775, ranging from 431 to 2122 across sites). Depending on the definition and site, the proportion discontinuing use during 12 months ranged from 6% to 49%. Requiring a longer gap or a 30-day "halo" resulted in lower estimates. At one site, only 56% of those with chronic use defined from orders also qualified based on dispensings, and the discontinuation rate at 180 days was 20% from orders versus 32% from dispensings. Requiring a gap of ≥90 days or a "halo" around a time point may more accurately capture discontinuation than using a shorter gap or no halo. Orders data underestimate discontinuation compared to dispensings. Work is needed to adapt these definitions for other drug classes and settings.

Mortality Risks of US Healthcare Workers

Introduction: Physicians and nurses have lower annual mortality rates than the general population. One explanation for the low mortality rates of these healthcare workers emphasizes their specialized medical knowledge and greater access to healthcare while a second emphasizes their generally higher level of education. We evaluated the extent to which general educational level accounts for the lower all-cause mortality rates of US healthcare than non-healthcare workers. We also compared cause-specific mortality risks of healthcare and non-healthcare workers. MethodsA nationally representative sample of healthcare workers (n=176,000) and non-healthcare workers (n=1,662,000) from the 2008 American Community Survey (n=3,310,000) was followed through 2019 for mortality. Cox models estimated hazard ratios of all-cause and cause-specific mortality for six healthcare worker groups. Analyses were performed in 2024. ResultsAge- and sex-standardized all-cause death rates per 100,000 were lower for healthcare (370.7, 95%CI=361.5-379.9) than non-healthcare (442.2, 95%CI=439.2-445.2) workers (p<0.001). However, this difference was not evident after additionally adjusting for level of education (aHR=1.00, 0.97-1.02). In fully adjusted models, hazards of mortality were lower for healthcare than non-healthcare workers for cardiovascular disease (aHR=0.94, 0.89-0.99) and lung cancer (aHR=0.89, 95%=0.81-0.98), but higher for pancreatic cancer (aHR=1.21, 1.05-1.39) and external causes of death (aHR=1.20, 1.10-1.30). ConclusionsHigher educational attainment accounted for the longer life expectancy of US healthcare workers than other workers. Nevertheless, healthcare work relative to non-healthcare work was associated with lower hazards of deaths due to cardiovascular diseases and lung cancer, but higher hazards of deaths due to external causes.

Brodalumab: Six-Year US Pharmacovigilance Report.

Brodalumab is a human interleukin-17 receptorA antagonist indicated for the treatment of moderate-to-severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy and have failed to respond or have lost response to other systemic therapies. In the USA, brodalumab has a boxed warning regarding suicidal ideation and behavior and is only available under a Risk Evaluation and Mitigation Strategy, but no causal association has been established. To assess long-term safety of brodalumab, we summarize pharmacovigilance data from 6years of real-world clinical practice. Crude adverse event (AE) reporting rates per 100 patients were calculated for common AEs and AEs of special interest reported to Ortho Dermatologics by US patients and healthcare providers from August 15, 2017 through August 14, 2023. Brodalumab exposure was estimated as time from the first to last prescription-dispensing authorization dates. Adverse events were defined by Medical Dictionary for Regulatory Activities v26.0 Preferred Terms and standardized MedDRA queries. Data were collected from 5138 US patients (estimated exposure of 6900 patient-years). Over 6years, 13 cases of adjudicated major adverse cardiovascular events were reported (0.25 events/100 patients). The rate of serious infections was 2.20 events/100 patients. Since the 5-year report, there was one new case of Candida infection and a serious fungal infection of the elbow. Among 57 reported malignancies affecting 49 patients, 4 were deemed possibly related to brodalumab. One new case of indeterminate inflammatory bowel disease unrelated to brodalumab was reported. No new suicide attempts were reported in year6, and there were no completed suicides throughout 6years. Pharmacovigilance data throughout 6years are consistent with the safety profile of brodalumab established in clinical trials and previous US pharmacovigilance reports, with no completed suicides and a low fungal infection rate.

Safety and efficacy of outpatient intravenous diuresis in decompensated heart failure: a systematic review.

Heart failure (HF) burdens the US healthcare system, with annual costs exceeding $30 billion. Outpatient intravenous (OP IV) diuresis in clinic or home settings may potentially improve outcomes and reduce costs, though limited data exists. This systematic review evaluates the safety, efficacy, and outcomes of OP IV diuresis in managing decompensated HF as a hospitalization alternative. Following PRISMA 2020 guidelines, this systematic review used MeSH terms in MEDLINE, SCOPUS, CINAHL Complete, and Cochrane Central. From 16 selected studies, 15 were single-center; 6 prospective, 9 retrospective; and 1 was a randomized trial comparing OP IV diuresis to oral home regimen. Demographics, visit data, and outcomes were collected, and 30-day outcomes were compared to inpatient IV (IP IV) diuresis from 2021 Medicare HF hospitalizations. The review included 1,590 unique patients treated with OP IV diuretics, with a mean age of 70 ± 6 years, 69.7% male, and 74.8% NYHA III-IV. Minimal adverse post-diuresis events such as hypokalemia, hypotension, and worsening renal function occurred (4.5%, 0.7%, and 2.3% respectively). Post-visit mean weight loss was -2.2 ± 1.1 kg. The 30-day readmission rate for OP IV diuresis was significantly lower than IP IV diuresis (20.0% vs. 22.6%; p = 0.0.401), and 30-day mortality was also lower (5.6% vs. 10.7%; p = 0.003). OP IV diuresis is a safe and effective treatment for decompensated HF with minimal risk of adverse events. Data demonstrate reduced 30-day readmission, mortality rates, cost. These findings highlight the potential of OP IV diuresis as an enhanced alternative HF care; however, further randomized control trials are needed to evaluate long-term outcomes.

What to Expect When Switching to a Biosimilar: A US Healthcare Professional’s Perspective

Abstract Biologics are medications made up of large, complex molecules that are manufactured in living tissues or cells and can be used to treat autoimmune conditions such as inflammatory bowel disease. Biosimilars are biologics that are highly similar to an approved biologic medicine. Biosimilars cost less for manufacturers to make than the original biologic (known as the reference product) and can help more people have access to treatment. Insurance companies in the United States may require a patient to switch their treatment from a reference product to a biosimilar to help decrease the cost of treatment. In this article, a physician assistant and a pharmacist discuss the patient experience when a patient is switched to a biosimilar. The most common questions patients have when being switched are around the safety and effectiveness of biosimilars. The authors explain that all biosimilars must go through a rigorous process mandated by the US Food and Drug Administration to prove they have the same side effects and effectiveness as the biologics on which they are based. It is important for healthcare professionals to proactively educate patients who are being switched about biosimilars. Advance practice providers, physicians, and pharmacists should work with patients to answer their questions to enable them to feel comfortable starting or switching to a biosimilar.