Proportion of patients received DES, by occupation.

<p>Proportion of patients received DES, by occupation.</p

Proportion of patients received DES, by income.

<p>Proportion of patients received DES, by income.</p

Hierarchical regression models for estimating the probability of receiving a drug-eluting stent.

<p>Hierarchical regression models for estimating the probability of receiving a drug-eluting stent.</p

Distribution of patient characteristics: Patients who received a drug-eluting stent or bare-metal stent.

<p>Distribution of patient characteristics: Patients who received a drug-eluting stent or bare-metal stent.</p

Discretionary decisions and disparities in receiving drug-eluting stents under a universal healthcare system: A population-based study

<div><p>Objectives</p><p>One of the main objectives behind the expansion of insurance coverage is to eliminate disparities in health and healthcare. However, researchers have not yet fully elucidated the reasons for disparities in the use of high-cost treatments among patients of different occupations. Furthermore, it remains unknown whether discretionary decisions made at the hospital level have an impact on the administration of high-cost interventions in a universal healthcare system. This study investigated the adoption of drug-eluting stents (DES) versus bare metal-stents (BMS) among patients in different occupations and income levels, with the aim of gauging the degree to which the inclination of health providers toward treatment options could affect treatment choices at the patient-level within a universal healthcare system.</p><p>Design and participants</p><p>We adopted a cross-sectional observational study design using hierarchical modeling in conjunction with the population-based National Health Insurance database of Taiwan. Patients who received either a BMS or a DES between 2007 and 2010 were included in the study.</p><p>Results</p><p>During the period of study, 42,124 patients received a BMS (65.3%) and 22,376 received DES (34.7%). Patients who were physicians or the family members of physicians were far more likely to receive DES (OR: 3.18, CI: 2.38–4.23) than were patients who were neither physicians nor in other high-status jobs (employers, other medical professions, or public service). Similarly, patients in the top 5% income bracket had a higher probability of receiving a DES (OR: 2.23, CI: 2.06–2.47, p < .001), than were patients in the lowest income bracket. After controlling for patient-level factors, the inclination of hospitals (proportion of DES>50% or between 25% and 50%) was shown to be strongly associated with the selection of DESs (OR: 3.64 CI: 3.24–4.09 and OR: 2.16, CI: 2.01–2.33, respectively).</p><p>Conclusions</p><p>Even under the universal healthcare system in Taiwan, socioeconomic disparities in the use of high-cost services remain widespread. Differences in the care received by patients of lower socioeconomic status may be due to the discretionary decisions of healthcare providers.</p></div

Proportion of patients in the same occupation or income class who received a drug-eluting stent, as differentiated by the hospital's inclination toward DES use (i.e., the proportion of patients that received a DES compared to other treatment options).

<p>Proportion of patients in the same occupation or income class who received a drug-eluting stent, as differentiated by the hospital's inclination toward DES use (i.e., the proportion of patients that received a DES compared to other treatment options).</p

Additional file 1: of Single and dual antiplatelet therapy in elderly patients of medically managed myocardial infarction

eTable 1. The care facilities of study subjects during the index acute myocardial infarction. eTable 2. Relative risks of various clinical outcomes in patients receiving different antiplatelet therapies using shared frailty model controlling for 174 individual hospitals. eTable 3. Relative risks of various clinical outcomes in patients receiving different antiplatelet therapies using shared frailty model controlling for 11 different levels of hospitals. (DOCX 20 kb

The Impact of Endothelial Progenitor Cells on Restenosis after Percutaneous Angioplasty of Hemodialysis Vascular Access

<div><p>Objective</p><p>We prospectively investigate the relation between baseline circulating endothelial progenitor cells and the subsequent development of restenosis after angioplasty of hemodialysis vascular access.</p><p>Background</p><p>Effect of angioplasty for hemodialysis vascular access is greatly attenuated by early and frequent restenosis. Circulating endothelial progenitor cells (EPCs) play a key role in vascular repair but are deficient in hemodialysis patients.</p><p>Method</p><p>After excluding 14 patients due to arterial stenosis, central vein stenosis, and failed angioplasty, 130 patients undergoing angioplasty for dysfunctional vascular access were prospectively enrolled. Flow cytometry with quantification of EPC markers (defined as CD34⁺, CD34⁺KDR⁺, CD34⁺KDR⁺CD133⁺) in peripheral blood immediately before angioplasty procedures was used to assess circulating EPC numbers. Patients were followed clinically for up to one year after angioplasty.</p><p>Results</p><p>During the one-year follow-up, 95 patients (73%) received interventions for recurrent access dysfunction. Patients in the lower tertile of CD34⁺KDR⁺ cell count had the highest restenosis rates (46%) at three month (early restenosis), compared with patients in the medium and upper tertiles of CD34⁺KDR⁺ cell count (27% and 12% respectively, p = 0.002). Patients in the lower tertile of CD34⁺KDR⁺ cell count received more re-interventions during one year. Patients with early restenosis had impaired EPC adhesive function and increased senescence and apoptosis. In multivariate analysis, the CD34⁺KDR⁺ and CD34⁺KDR⁺CD133⁺ cell counts were independent predictors of target-lesion early restenosis.</p><p>Conclusion</p><p>Our results suggest that the deficiency of circulating EPCs is associated with early and frequent restenosis after angioplasty of hemodialysis vascular access.</p></div

Comparisons of EPC levels according to the presence and timing of target-lesion restenosis at one year.

<p>EPC, endothelial progenitor cell; MNCs: mononuclear cells.</p><p>Timing of restenosis: early restenosis, within 3 months; late, restenosis within 4–12 months.</p

Vascular access and clinical events during follow-up period.

<p>Timing of restenosis or re-intervention: early, within 3 months; late, within 4–12 months; P for Chi-square test.</p