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Expert, Real-Time Advice on HCV

Expert, Real-Time Advice on HCV

According to recent reports, an estimated 3 to 4 million Americans are chronically infected with the hepatitis C virus (HCV), and about half of these people are unaware of their status. These patients can progress to advanced liver disease and/or hepatocellular cancer. With early treatment, however, these outcomes can be prevented, and therapies for HCV are rapidly emerging and improving. With more treatment options becoming available, clinicians can potentially cure more patients than what has been previously possible. Several new direct-acting oral agents for HCV have been recently approved for use in the United States. The initial direct-acting agents were approved in 2011, and more oral agents are expecting approval within the next few years. “These treatments have the potential to cure most patients with HCV, but the rapid pace of drug development has left healthcare providers unsure about optimal treatments,” says David L. Thomas, MD, MPH. “We need credible resources with unbiased guidance on how best to treat patients with HCV.” A Helpful New Resource In 2014, the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA), in collaboration with the International Antiviral Society-USA (IAS-USA), launched HCVguidelines.org, a website that provides up-to-date guidance for the treatment of HCV. The collaboration is the result of ongoing work from the AASLD, IDSA, and IAS-USA. A panel of 26 liver disease and infectious diseases specialists and a patient advocate developed evidenced-based, consensus recommendations for screening, treating, and managing HCV. HCVguidelines.org has been made available to any healthcare provider who treats the disease and for others who need updated information on best practices. “The...
The Importance of HIV/STD Prevention Counseling

The Importance of HIV/STD Prevention Counseling

According to recent estimates, approximately 1.1 million people in the United States are living with HIV, and about 50,000 new HIV infections occur each year. “Reducing transmission remains a key part of HIV prevention,” says Yuko Mizuno, PhD. “To further reduce the spread of HIV, an increased emphasis must be placed on preventing transmissions among individuals who already have the infection.” Research shows that those who are aware of their HIV status are more likely to take the necessary steps to protect themselves and their partners. Dr. Mizuno says that healthcare providers play an important role in offering critical health information and services to patients living with HIV. “In fact,” she says, “the CDC recommends that providers offer prevention counseling for HIV and sexually transmitted diseases (STDs) to all patients living with HIV during their routine clinic visits. Few studies, however, have explored what percentage of people in the U.S. who are living with HIV and receiving care are exposed to HIV/STD prevention counseling and whether it is reaching those who need it the most.” Examining New Data To better understand who is being reached with HIV/STD prevention counseling and how well they are being reached, Dr. Mizuno and colleagues published a study in AIDS evaluating data from the CDC’s Medi-cal Monitoring Project (MMP). The MMP provides nationally representative estimates of behavioral and clinical characteristics of HIV-infected adults receiving care in the U.S., including the estimated prevalence of exposure to HIV/STD risk-reduction interventions. According to the findings, only about 44% of people living with HIV in active care reported receiving one-on-one HIV/STD prevention counseling from their healthcare providers (Table)....

Surprising Results of Three Studies

I like studies that question accepted practices. I also like to question studies that question accepted practices. [See this post about discrediting discredited practices.] Here are three studies with surprising and thought-provoking results. A few years ago, the idea of rapid response teams surfaced. These teams were supposed to be called when patients on regular floors became unstable. It was thought that such teams would be able to intervene more rapidly than simply paging the patient’s physician. Nearly every hospital established rapid response teams, and early studies tended to confirm that they were efficacious. So, all was well. But a recent paper from Critical Care Medicine shows that rapid response teams increase costs and intensive care unit admissions without showing any improvement in risk-adjusted patient outcomes. Naysayers will complain that it wasn’t a randomized, prospective, double-blind study. But it was a large before-and-after cohort study from a respected institution–the Mayo Clinic–and it is probably impossible to do a randomized trial now. The authors concluded that hospitals should at least evaluate their own experiences with rapid response teams. Another study, this time in JAMA, questions the validity of using rates of venous thromboembolic events as markers of hospital quality. It seems the more diligently one looks for VTEs, the more one finds them. Hospitals that did more imaging studies looking for VTEs had significantly higher rates of VTE. It’s called “surveillance bias.” The hospitals with high rates of VTE also had significantly higher rates of adherence to prophylaxis guidelines. So, if a patient was looking for a hospital with high-quality care in the area of venous thromboembolic events, the rate...
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