Sex-specific impact of severe obesity in the outcomes of hospitalized patients with COVID-19: a large retrospective study from the Bronx,New York

It has been demonstrated that obesity is an independent risk factor for worse outcomes in patients with COVID-19. Our objectives were to investigate which classes of obesity are associated with higher in-hospital mortality and to assess the association between obesity and systemic inflammation. This was a retrospective study which included consecutive hospitalized patients with COVID-19 in a tertiary center. Three thousand five hundred thirty patients were included in this analysis (female sex: 1579, median age: 65 years). The median body mass index (BMI) was 28.8 kg/m². In the overall cohort, a J-shaped association between BMI and in-hospital mortality was depicted. In the subgroup of men, BMI 35–39.9 kg/m² and BMI ≥40 kg/m² were found to have significant association with higher in-hospital mortality, while only BMI ≥40 kg/m² was found significant in the subgroup of women. No significant association between BMI and IL-6 was noted. Obesity classes II and III in men and obesity class III in women were independently associated with higher in-hospital mortality in patients with COVID-19. The male population with severe obesity was the one that mainly drove this association. No significant association between BMI and IL-6 was noted.

     

Opportunities for Pharmacists to Aid in the Management of Acid-Peptic Disorders

There is increasing evidence that pharmacists practicing in a myriad of clinical settings, including outpatient clinics and community pharmacies, can play a key role in efforts to manage many chronic diseases. This is especially true for conditions that are prevalent, costly, and where patients frequently self-medicate using over-the-counter drugs. The acid-peptic disorders (e.g. peptic ulcer disease, gastroesophageal reflux, and reflux esophagitis) meet these criteria and present pharmacists with an ideal opportunity to improve patient outcomes, acting independently or as part of a more comprehensive disease management initiative. The opportunity exists for pharmacists to enhance the care of patients with acid-peptic disorders by identifying patients who have one of these conditions, assessing their risk for serious diagnoses (e.g. cancer) or complications (e.g. bleeding), educating patients on self management, and optimizing medical regimens through collaboration with physicians. The major barrier for integrating pharmacists into disease management programs is reimbursement; however, some patients may be willing to pay for these services, and innovative payors may begin to provide compensation to pharmacists, Pharmacists should play a key role in new disease management models designed for conditions, such as acid-peptic disorders, that meet the criteria discussed in this article.     

Selecting a Vendor for Disease Management Programmes

Many health maintenance organisations (HMOs) and provider organisations are developing disease management programmes to improve quality of care and lower costs for patients with chronic diseases. Many of these organisations ultimately decide to outsource these programmes to vendors rather than ‘build’ the programmes themselves. Once the decision is made to outsource a disease management initiative, HMOs and provider organisations face the difficult and important task of selecting a vendor from over 100 companies offering disease management programmes.This article describes an effective vendor selection process. This process enables organisations to identify all potential vendors, efficiently narrow the search to a smaller set of companies likely to offer effective programmes and, ultimately, select a preferred vendor. The article emphasises the importance of achieving and maintaining physician support for the disease management strategy. It outlines how to use a provider advisory committee to enable physicians to provide input into the selection process and to enhance the likelihood of achieving physician support for disease management initiatives.Another critical element within the vendor selection process is evaluating the ability of vendors to deliver financial benefits to the client organisation. For many chronic diseases, competent vendors should be able to ‘guarantee net financial savings’ — savings that are larger than the cost of the disease management programme. Finally, the vendor selection process can be complex and time consuming. Use of a structured procedure to identify vendors, conduct a ‘request for proposal’ process, obtain provider ‘buy-in’, select a vendor, and negotiate a contract can greatly accelerate efforts to outsource disease management programmes. In addition, this approach will increase the likelihood that the selected vendor will help an HMO or provider group achieve its goals with respect to patients with chronic disease.     

Treatment of complicated cutaneous malignant neoplasms by modern radiotherapy: principles, practice, and results.

The indispensability of modern radiotherapy for certain complicated cases of cutaneous malignant neoplasms is demonstrated by a review of its principles and demonstration of results achieved by its practice in five representative cases.     

Kidneys for Sale: Who Disapproves,and Why?

The shortage of transplant kidneys has spurred debate about legalizing monetary payments to donors to increase the number of available kidneys. However, buying and selling organs faces widespread disapproval. We survey a representative sample of Americans to assess disapproval for several forms of kidney market, and to understand why individuals disapprove by identifying factors that predict disapproval, including disapproval of markets for other body parts, dislike of increased scope for markets and distrust of markets generally. Our results suggest that while the public is potentially receptive to compensating kidney donors, among those who oppose it, general disapproval toward certain kinds of transactions is at least as important as concern about specific policy details. Between 51% and 63% of respondents approve of the various potential kidney markets we investigate, and between 42% and 58% want such markets to be legal. A total of 38% of respondents disapprove of at least one market. Respondents who distrust markets generally are not more disapproving of kidney markets; however we find significant correlations between kidney market disapproval and attitudes reflecting disapproval toward certain transactions—including both other body markets and market encroachment into traditionally nonmarket exchanges, such as food preparation.