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The understanding of which factors are associated with inability to access health care services due to the COVID-19 pandemic is limited. We aimed to examine factors associated with being unable to access health care due to the pandemic among Medicare beneficiaries.

A cross-sectional study.

We analyzed the summer and fall 2020 Medicare Current Beneficiary Survey COVID-19 Rapid Response Supplement Questionnaire data. Our study included community-dwelling Medicare beneficiaries 65 years and older (summer n = 8751; fall n = 7421). Logistic regressions were used to examine factors (eg, sociodemographics, comorbidities) associated with being unable to access health care services due to the pandemic.

Approximately 20.9% and 7.5% of the beneficiaries reported they were unable to access health care services due to the pandemic in the summer and fall of 2020, respectively. The most frequent types of services that beneficiaries were unable to access were dental care (summer, 45.5%; fall, 35.1%) and regular checkon makers to target resource allocation and outreach efforts to those populations most at risk.

Existing literature indicates that multimorbidity, mental health (MH) conditions, substance use disorders (SUDs), and social determinants of health are hallmarks of high-need, high-cost patients. Health Resources and Services Administration-funded health centers (HCs) provide care to nearly 30 million patients, but data on their patients' complexity and utilization patterns are limited. We identified subgroups of HC patients based on latent concepts of complexity and utilization.

We used cross-sectional national data from the 2014 Health Center Patient Survey and latent class analyses to identify distinct and homogenous groups of complex high-utilizing patients aged 18 to 64 years.

We included indicators of chronic conditions (CCs), MH, SUD risk, and health behavior to measure complexity. We used number of outpatient and emergency department visits in the past year to measure utilization.

HC patients were separated in 9 distinct groups based on 3 complexity latent classes (MH, multiple CCs, and low riiders or specialists.

To contribute to the literature of best-practice approaches to promote full mu agonist chronic opioid analgesic therapy (COAT) cessation in a population with chronic, noncancer pain by describing initial and extended follow-up outcomes from a limited group program that utilized a standardized, multidisciplinary curriculum containing robust complementary care access in a private practice setting.

A retrospective review of data from electronic health records and the California Prescription Drug Monitoring Program for program participants between October 2017 and December 2019.

Daily oral morphine milligram equivalent (MME) dose use upon entry, at program graduation, at 6 months post graduation, and at extended follow-up of 7 to 24 months post graduation were compared and reported for program participants.

A total of 109 program participants with incoming daily COAT use amounts as high as 600 MME (median, 60 MME; 25% quartile, 36.5 MME; 75% quartile, 90 MME; interquartile range, 53.5 MME) had a successful COAT cessation rate of 90% at program graduation, which was maintained at 6 months and extended follow-up at 95% and 97%, respectively.

This pilot study contributes to the literature by documenting a successful and potentially generalizable strategy to promote COAT cessation, and by providing unusually lengthy follow-up for postintervention COAT cessation monitoring.

This pilot study contributes to the literature by documenting a successful and potentially generalizable strategy to promote COAT cessation, and by providing unusually lengthy follow-up for postintervention COAT cessation monitoring.

In the outpatient setting, combining remote therapy monitoring (RTM) with negative pressure wound therapy (NPWT) can support improved adherence to prescribed therapy. A recent study reported that patients receiving NPWT with RTM required fewer therapy days than patients receiving NPWT alone, possibly reducing costs of care. Our objective was to determine whether RTM reduced 90-day costs in patients undergoing NPWT.

We conducted a retrospective cohort study of patients receiving NPWT with or without RTM in the postacute setting.

Patients beginning NPWT between March 2018 and May 2019 were included. Payer claims data were collected and analyzed with t test for continuous variables and χ2 test for categorical variables. Multiple regressions were performed to control for confounding variables.

Of the 1105 patients included the study, 675 (61%) received RTM and 430 (39%) did not. RTM patients were significantly older (P < .0001), had more ulcers (P = .0004), and had higher Charlson Comorbidity Index (CCI) scores (P < .0001). The unadjusted mean 90-day wound-related cost was not significantly higher for non-RTM patients than for RTM patients (P = .0799). After controlling for differences in age, payer type, CCI score, and wound type, there was a significant reduction in 90-day wound-related costs in the RTM group compared with the non-RTM group ($11,119 vs $14,752; P = .0131). The RTM group had higher NPWT costs ($3757 vs $3289; P = .0035) but lower wound-related non-NPWT costs ($7361 vs $11,462; P = .0045).

This study demonstrated the value of RTM in supporting NPWT adherence and decreasing the costs of wound care in these patients.

This study demonstrated the value of RTM in supporting NPWT adherence and decreasing the costs of wound care in these patients.One-third of health care in the United States is wasted. Despite this recognition, solutions are sparse. The Optimal Care model combines evidence-based medicine, patient-centered technology, and outcomes reporting to transform health care.The authors of this editorial highlight some of the myths surrounding complex care management, identify areas where research could be most informative, and recommend best next steps in developing effective and efficient complex care management programs.

The addition of pembrolizumab to neoadjuvant chemotherapy led to a significantly higher percentage of patients with early triple-negative breast cancer having a pathological complete response (defined as no invasive cancer in the breast and negative nodes) at definitive surgery in an earlier analysis of this phase 3 trial of neoadjuvant and adjuvant therapy. The primary results regarding event-free survival in this trial have not been reported.

We randomly assigned, in a 21 ratio, patients with previously untreated stage II or III triple-negative breast cancer to receive neoadjuvant therapy with four cycles of pembrolizumab (at a dose of 200 mg) or placebo every 3 weeks plus paclitaxel and carboplatin, followed by four cycles of pembrolizumab or placebo plus doxorubicin-cyclophosphamide or epirubicin-cyclophosphamide. After definitive surgery, patients received adjuvant pembrolizumab (pembrolizumab-chemotherapy group) or placebo (placebo-chemotherapy group) every 3 weeks for up to nine cycles. The primaryfety profiles of pembrolizumab and chemotherapy.

In patients with early triple-negative breast cancer, neoadjuvant pembrolizumab plus chemotherapy, followed by adjuvant pembrolizumab after surgery, resulted in significantly longer event-free survival than neoadjuvant chemotherapy alone. (Funded by Merck Sharp and Dohme, a subsidiary of Merck; KEYNOTE-522 ClinicalTrials.gov number, NCT03036488.).

In patients with early triple-negative breast cancer, neoadjuvant pembrolizumab plus chemotherapy, followed by adjuvant pembrolizumab after surgery, resulted in significantly longer event-free survival than neoadjuvant chemotherapy alone. (Funded by Merck Sharp and Dohme, a subsidiary of Merck; KEYNOTE-522 ClinicalTrials.gov number, NCT03036488.).

Patients with recurrent cervical cancer have a poor prognosis. Cemiplimab, the fully human programmed cell death 1 (PD-1)-blocking antibody approved to treat lung and skin cancers, has been shown to have preliminary clinical activity in this population.

In this phase 3 trial, we enrolled patients who had disease progression after first-line platinum-containing chemotherapy, regardless of their programmed cell death ligand 1 (PD-L1) status. Women were randomly assigned (11) to receive cemiplimab (350 mg every 3 weeks) or the investigator's choice of single-agent chemotherapy. The primary end point was overall survival. Progression-free survival and safety were also assessed.

A total of 608 women were enrolled (304 in each group). In the overall trial population, median overall survival was longer in the cemiplimab group than in the chemotherapy group (12.0 months vs. MMP inhibitor 8.5 months; hazard ratio for death, 0.69; 95% confidence interval [CI], 0.56 to 0.84; two-sided P<0.001). The overall survival benefit wrecurrent cervical cancer after first-line platinum-containing chemotherapy. (Funded by Regeneron Pharmaceuticals and Sanofi; EMPOWER-Cervical 1/GOG-3016/ENGOT-cx9 ClinicalTrials.gov number, NCT03257267.).

Survival was significantly longer with cemiplimab than with single-agent chemotherapy among patients with recurrent cervical cancer after first-line platinum-containing chemotherapy. (Funded by Regeneron Pharmaceuticals and Sanofi; EMPOWER-Cervical 1/GOG-3016/ENGOT-cx9 ClinicalTrials.gov number, NCT03257267.).

Controversy exists over the use of bone cement in hip fractures treated with hemiarthroplasty. Only limited data on quality of life after cemented as compared with modern uncemented hemiarthroplasties are available.

We conducted a multicenter, randomized, controlled trial comparing cemented with uncemented hemiarthroplasty in patients 60 years of age or older with an intracapsular hip fracture. The primary outcome was health-related quality of life measured with the use of utility scores on the EuroQol Group 5-Dimension (EQ-5D) questionnaire at 4 months after randomization (range of scores, -0.594 to 1, with higher scores indicating better quality of life; range for minimal clinically important difference, 0.050 to 0.075).

A total of 610 patients were assigned to undergo cemented hemiarthroplasty and 615 to undergo modern uncemented hemiarthroplasty; follow-up data were available for 71.6% of the patients at 4 months. The mean EQ-5D utility score was 0.371 in patients assigned to the cemented group and der with an intracapsular hip fracture, cemented hemiarthroplasty resulted in a modestly but significantly better quality of life and a lower risk of periprosthetic fracture than uncemented hemiarthroplasty. (Funded by the National Institute for Health Research; WHiTE 5 ISRCTN number, ISRCTN18393176.).

The Ad26.COV2.S vaccine was highly effective against severe-critical coronavirus disease 2019 (Covid-19), hospitalization, and death in the primary phase 3 efficacy analysis.

We conducted the final analysis in the double-blind phase of our multinational, randomized, placebo-controlled trial, in which adults were assigned in a 11 ratio to receive single-dose Ad26.COV2.S (5×10

viral particles) or placebo. The primary end points were vaccine efficacy against moderate to severe-critical Covid-19 with onset at least 14 days after administration and at least 28 days after administration in the per-protocol population. Safety and key secondary and exploratory end points were also assessed.

Median follow-up in this analysis was 4 months; 8940 participants had at least 6 months of follow-up. In the per-protocol population (39,185 participants), vaccine efficacy against moderate to severe-critical Covid-19 at least 14 days after administration was 56.3% (95% confidence interval [CI], 51.3 to 60.8; 484 cases in the vaccine group vs.