461. Meeting the Health and Social Needs of America's Unhoused and Housing-Unstable Populations: A Position Paper From the American College of Physicians.
Access to safe and stable housing has both a direct and indirect effect on health. Experiencing homelessness and housing instability can induce stress and trauma, worsening behavioral health and substance use. The absence of safe and stable living conditions can make it challenging to rest, recuperate, and recover from health ailments and can pose barriers to treatment adherence. Homelessness and housing instability is associated with high rates of numerous diseases and chronic conditions. Its cyclical relationship with other social drivers of health can exacerbate health disparities. As a result, unhoused persons experience unique health challenges and require a health care system and professionals designed to meet their distinct needs. Physicians and other health professionals have a role in educating themselves about the needs of unhoused patients as well as making themselves aware of community and government resources available to these populations. Policymakers must support health professionals in these efforts by supporting the data infrastructure needed to facilitate these referrals to resources, supporting research into best practices for caring for these populations, and investing in community-based organization capacity. Policy action is needed to address the underlying drivers of homelessness, including a dearth of affordable housing, while also addressing the short-term need for safe shelter now. In this position paper, the American College of Physicians (ACP) recognizes the need to address universal access to housing to fulfill one's right to health. ACP offers several recommendations to prevent homelessness and promote the necessary health care and social needs of unhoused populations.
462. A Risk Profile Using Simple Hematologic Parameters to Assess Benefits From Baricitinib in Patients Hospitalized With COVID-19: A Post Hoc Analysis of the Adaptive COVID-19 Treatment Trial-2.
作者: Catharine I Paules.;Jing Wang.;Kay M Tomashek.;Tyler Bonnett.;Kanal Singh.;Vincent C Marconi.;Richard T Davey.;David C Lye.;Lori E Dodd.;Otto O Yang.;Constance A Benson.;Gregory A Deye.;Sarah B Doernberg.;Noreen A Hynes.;Robert Grossberg.;Cameron R Wolfe.;Seema U Nayak.;William R Short.;Jocelyn Voell.;Gail E Potter.;Rekha R Rapaka.
来源: Ann Intern Med. 2024年177卷3期343-352页
The ACTT risk profile, which was developed from ACTT-1 (Adaptive COVID-19 Treatment Trial-1), demonstrated that hospitalized patients with COVID-19 in the high-risk quartile (characterized by low absolute lymphocyte count [ALC], high absolute neutrophil count [ANC], and low platelet count at baseline) benefited most from treatment with the antiviral remdesivir. It is unknown which patient characteristics are associated with benefit from treatment with the immunomodulator baricitinib.
467. Trends in Psychological Distress and Outpatient Mental Health Care of Adults During the COVID-19 Era.
作者: Mark Olfson.;Chandler McClellan.;Samuel H Zuvekas.;Melanie Wall.;Carlos Blanco.
来源: Ann Intern Med. 2024年177卷3期353-362页
In addition to the physical disease burden of the COVID-19 pandemic, concern exists over its adverse mental health effects.
468. Reducing Care Overuse in Older Patients Using Professional Norms and Accountability : A Cluster Randomized Controlled Trial.
作者: Stephen D Persell.;Lucia C Petito.;Ji Young Lee.;Daniella Meeker.;Jason N Doctor.;Noah J Goldstein.;Craig R Fox.;Theresa A Rowe.;Jeffrey A Linder.;Ryan Chmiel.;Yaw Amofa Peprah.;Tiffany Brown.
来源: Ann Intern Med. 2024年177卷3期324-334页
Effective strategies are needed to curtail overuse that may lead to harm.
471. Trends in Discharge Rates for Acute Pulmonary Embolism in U.S. Emergency Departments.
作者: Nathan W Watson.;Brett J Carroll.;Anna Krawisz.;Alec Schmaier.;Eric A Secemsky.
来源: Ann Intern Med. 2024年177卷2期134-143页
Outpatient management of select patients with low-risk acute pulmonary embolism (PE) has been proven to be safe and effective, yet recent evidence suggests that patients are still managed with hospitalization. Few studies have assessed contemporary real-world trends in discharge rates from U.S. emergency departments (EDs) for acute PE.
472. Association of Low Glomerular Filtration Rate With Adverse Outcomes at Older Age in a Large Population With Routinely Measured Cystatin C.
作者: Edouard L Fu.;Juan-Jesus Carrero.;Yingying Sang.;Marie Evans.;Junichi Ishigami.;Lesley A Inker.;Morgan E Grams.;Andrew S Levey.;Josef Coresh.;Shoshana H Ballew.
来源: Ann Intern Med. 2024年177卷3期269-279页
The commonly accepted threshold of glomerular filtration rate (GFR) to define chronic kidney disease (CKD) is less than 60 mL/min/1.73 m2. This threshold is based partly on associations between estimated GFR (eGFR) and the frequency of adverse outcomes. The association is weaker in older adults, which has created disagreement about the appropriateness of the threshold for these persons. In addition, the studies measuring these associations included relatively few outcomes and estimated GFR on the basis of creatinine level (eGFRcr), which may be less accurate in older adults.
473. Health Care Contact Days Among Older Adults in Traditional Medicare : A Cross-Sectional Study.
作者: Ishani Ganguli.;Emma D Chant.;E John Orav.;Ateev Mehrotra.;Christine S Ritchie.
来源: Ann Intern Med. 2024年177卷2期125-133页
Days spent obtaining health care outside the home can represent not only access to needed care but also substantial time, effort, and cost, especially for older adults and their care partners. Yet, these "health care contact days" have not been characterized.
475. Gene Therapy Versus Common Care for Eligible Individuals With Sickle Cell Disease in the United States : A Cost-Effectiveness Analysis.
作者: Anirban Basu.;Aaron N Winn.;Kate M Johnson.;Boshen Jiao.;Beth Devine.;Jane S Hankins.;Staci D Arnold.;M A Bender.;Scott D Ramsey.
来源: Ann Intern Med. 2024年177卷2期155-164页
Sickle cell disease (SCD) and its complications contribute to high rates of morbidity and early mortality and high cost in the United States and African heritage community.
|