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Filename: controllers/Detail.php
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Filename: controllers/Detail.php
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Background: Older patients with advanced chronic kidney disease (CKD) face difficult decisions about managing kidney failure, frequently experiencing decisional conflict, regret, and treatment misaligned with preferences.
Objective: To assess whether a decision aid about kidney replacement therapy improved decisional quality compared with usual care.
Design: Multicenter, randomized, controlled trial. (ClinicalTrials.gov: NCT03522740).
Setting: 8 outpatient nephrology clinics associated with 4 U.S. centers.
Participants: English-fluent patients, 70 years and older with nondialysis CKD stages 4 to 5 recruited from 2018 to 2020.
Intervention: DART (Decision-Aid for Renal Therapy) is an interactive, web-based decision aid for older adults with CKD. Both groups received written education about treatments.
Measurements: Change in the decisional conflict scale (DCS) score from baseline to 3, 6, 12, and 18 months. Secondary outcomes included change in prognostic and treatment knowledge and change in uncertainty.
Results: Among 400 participants, 363 were randomly assigned: 180 to usual care, 183 to DART. Decisional quality improved with DART with mean DCS declining compared with control (mean difference, -8.5 [95% CI, -12.0 to -5.0]; < 0.001), with similar findings at 6 months, attenuating thereafter. At 3 months, knowledge improved with DART versus usual care (mean difference, 7.2 [CI, 3.7 to 10.7]; < 0.001); similar findings at 6 months were modestly attenuated at 18 months (mean difference, 5.9 [CI, 1.4 to 10.3]; = 0.010). Treatment preferences changed from 58% "unsure" at baseline to 28%, 20%, 23%, and 14% at 3, 6, 12, and 18 months, respectively, with DART, versus 51% to 38%, 35%, 32%, and 18% with usual care.
Limitation: Latinx patients were underrepresented.
Conclusion: DART improved decision quality and clarified treatment preferences among older adults with advanced CKD for 6 months after the DART intervention.
Primary Funding Source: Patient-Centered Outcomes Research Institute (PCORI).
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http://dx.doi.org/10.7326/M22-1543 | DOI Listing |
Ann Med
December 2025
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Background: Uric acid (UA) plays an important role in cardiovascular diseases, yet its implications in elderly patients remains incompletely understood. This study aimed to explore the impact of UA on the prognosis in advanced-age patients with acute coronary syndrome (ACS).
Methods: We included 526 patients aged 80 and older who were diagnosed with ACS.
J Health Econ Outcomes Res
December 2024
Milliman (United States).
Rising oncology healthcare costs have led to value-based care reimbursement models that coordinate care and improve quality while reducing overall spending. These models are increasingly important for traditional Medicare and other payers. To compare the incidence of adverse events (AEs), AE-associated excess costs, and total cost of care (TCOC) of 3 cohorts receiving first-line treatment for metastatic pancreatic ductal adenocarcinoma (mPDAC).
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December 2024
Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.
Prostate cancer is a common malignancy with an increasing incidence in ageing populations. However, older patients with prostate cancer are often underrepresented in traditional clinical trials. The electronic Prostate Cancer Australian and Asian Database (ePAD) is a multi-centre, multi-national prospective clinical registry, that records real world data from a broader population.
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December 2024
Tianjin Central Hospital of Obstetrics and Gynecology/Nankai University Affiliated Maternity Hospital, Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin, 300100, People's Republic of China.
Purpose: To investigate the follicle microenvironments of women with premature ovarian insufficiency (POI), with normal ovarian reserve function, and who are older (age >40 years) and to identify potential therapeutic targets.
Patients And Methods: In total, 9 women who underwent in vitro fertilization(IVF) or intracytoplasmic sperm injection(ICSI) were included in this study. The first punctured follicle of each patient was used.
Ther Adv Infect Dis
December 2024
Division of Infectious Diseases, University of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, Mail Stop 1186, Toledo, OH 43614, USA.
Background: Outpatient parenteral antibiotic therapy (OPAT) enhances patient safety, improves outcomes, and reduces healthcare costs by decreasing 30-day readmissions and adverse events. However, the optimal structure and follow-up protocols for OPAT programs remain undefined. Identifying high-risk patients for readmission and managing adverse drug events (ADEs) are critical components of OPAT care.
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