Epidemiological burden of depression and its impact on adherence to oral hypoglycemic agents and related economic outcomes in patients with type 2 diabetes

Presence of depression in patients with type 2 diabetes may affect their adherence to oral hypoglycemics and consequently glycemic control and economic outcomes. These potential effects may be more significant when one considers that depression is highly prevalent in patients with diabetes. This study involved two phases. Phase one of the study examined the epidemiological relationship between depression and type 2 diabetes. Phase two of the study examined the impact of depression on patterns of use and adherence to oral hypoglycemics in newly diagnosed type 2 diabetes patients. Impact of depression on expenditures related to type 2 diabetes and overall health care was also estimated. The study also tested the mediating influence of adherence between depression and type 2 diabetes expenditures. Results of phase one of the study indicated that depression was more prevalent in patients with type 2 diabetes as compared to a control group. Results also indicated that females with depression were more likely to develop type 2 diabetes as compared to those without depression. Phase two results indicated that patients without depression had a more favorable pattern of oral hypoglycemic use with a significantly lower proportion of non-depressed patients switching, augmenting, or discontinuing their oral hypoglycemics as compared to depressed patients. Depressed patients were also found to have significantly lower adherence to oral hypoglycemics as compared to non-depressed patients. Multivariate analyses indicated that patients with depression incurred 21.30% higher type 2 diabetes related costs as compared to non-depressed patients. This difference was primarily due to a higher probability of an ER/hospitalization episode in depressed patients. Similarly, patients with depression had 32.10% higher overall health care costs as compared to patients without depression. Depression was associated with increased costs in all areas of health care such as ER/hospitalization, outpatient, and prescription costs. Mediation analysis indicated that adherence to oral hypoglycemics was not a mediator between depression and type 2 diabetes related expenditures. Thus, depression could have potentially impacted type 2 diabetes related outcomes directly through a physiological effect on glycemic levels or indirectly through its impact on adherence to other behaviors such as diet or exercise

Impact of Decmedetomidine on Opioid and Benzodiazepine Dosing Requirements in Children.

Poster presented at: Annual Update on Pediatric Cardiovascular Disease; February 2008; Scottsdale Arizona

Diagnostic outcomes of robotic-assisted bronchoscopy for pulmonary lesions in a real-world multicenter community setting

Abstract Background Robot-assisted bronchoscopy (RAB) is among the newest bronchoscopic technologies, allowing improved visualization and access for small and hard-to-reach nodules. RAB studies have primarily been conducted at academic centers, limiting the generalizability of results to the broader real-world setting, while variability in diagnostic yield definitions has impaired the validity of cross-study comparisons. The objective of this study was to determine the diagnostic yield and sensitivity for malignancy of RAB in patients with pulmonary lesions in a community setting and explore the impact of different definitions on diagnostic yield estimates. Methods Data were collected retrospectively from medical records of patients ≥ 21 years who underwent bronchoscopy with the Monarch® Platform (Auris Health, Inc., Redwood City, CA) for biopsy of pulmonary lesions at three US community hospitals between January 2019 and March 2020. Diagnostic yield was calculated at the index RAB and using 12-month follow-up data. At index, all malignant and benign (specific and non-specific) diagnoses were considered diagnostic. After 12 months, benign non-specific cases were considered diagnostic only when follow-up data corroborated the benign result. An alternative definition at index classified benign non-specific results as non-diagnostic, while an alternative 12-month definition categorized index non-diagnostic cases as diagnostic if no malignancy was diagnosed during follow-up. Results The study included 264 patients. Median lesion size was 19.3 mm, 58.9% were peripherally located, and 30.1% had a bronchus sign. Samples were obtained via Monarch in 99.6% of patients. Pathology led to a malignant diagnosis in 115 patients (43.6%), a benign diagnosis in 110 (41.7%), and 39 (14.8%) non-diagnostic cases. Index diagnostic yield was 85.2% (95% CI: [80.9%, 89.5%]) and the 12-month diagnostic yield was 79.4% (95% CI: [74.4%, 84.3%]). Alternative definitions resulted in diagnostic yield estimates of 58.7% (95% CI: [52.8%, 64.7%]) at index and 89.0% (95% CI: [85.1%, 92.8%]) at 12 months. Sensitivity for malignancy was 79.3% (95% CI: [72.7%, 85.9%]) and cancer prevalence was 58.0% after 12 months. Conclusions RAB demonstrated a high diagnostic yield in the largest study to date, despite representing a real-world community population with a relatively low prevalence of cancer. Alternative definitions had a considerable impact on diagnostic yield estimates