scholarly journals A Global Review on the Utility of Genetic Testing for Familial Hypercholesterolemia

2020 ◽  
Vol 10 (2) ◽  
pp. 23 ◽  
Author(s):  
Rachele M. Hendricks-Sturrup ◽  
Jodi Clark-LoCascio ◽  
Christine Y. Lu
Keyword(s):  
United States ◽  
Genetic Testing ◽  
Familial Hypercholesterolemia ◽  
Clinical Outcomes ◽  
Ldl Cholesterol ◽  
The United States ◽  
Global Perspective ◽  
Ongoing Research ◽  
Increased Risk ◽  
Patient Reported

Familial hypercholesterolemia (FH) is a genetic disorder of cholesterol metabolism that affects an estimated 1/250 persons in the United States and abroad. FH is hallmarked by high low-density lipoprotein (LDL) cholesterol and an increased risk of premature atherosclerotic cardiovascular disease. This review summarizes recent global evidence showing the utility of FH genetic testing across diverse populations. Clinical and other qualitative outcomes following FH genetic testing were improved FH diagnosis, treatment initiation or continued treatment, treatment modification, improved total or LDL cholesterol levels, education on lifestyle management, and genetic counseling. This summary of evidence should be considered by those seeking overall evidence and knowledge gaps on the utility of FH genetic testing from a global perspective and for certain ethnic and age populations. These findings can be used to inform insurance policies and coverage decisions for FH genetic testing, policy recommendations to reduce the clinical and public health burden of FH, clinical practice and guidelines to improve the management of FH populations, and ongoing research involving FH genetic testing. We conclude that further investigations are needed to examine: (1) non-clinical outcomes following FH genetic testing; (2) patient-reported outcomes following FH genetic testing to convey patient experiences, values, and goals; and (3) clinical outcomes following FH genetic testing in non-Caucasian and pediatric populations in the United States and abroad.

Retrospective Analysis of the Medication Utilization and Clinical Outcomes of Patients Treated with Various Regimens for Hepatitis C Infection

2016 ◽  
Vol 30 (2) ◽  
pp. 154-161 ◽  
Author(s):  
William D. Trombatt ◽  
Pamela H. Koerner ◽  
Zoie N. Craft ◽  
Richard T. Miller ◽  
Khalid M. Kamal
Keyword(s):  
United States ◽  
Hepatitis C ◽  
Adverse Events ◽  
Clinical Outcomes ◽  
The United States ◽  
Virologic Response ◽  
Phase Iii ◽  
Hepatitis C Infection ◽  
Medication Utilization ◽  
Patient Reported

Background: The hepatitis C virus (HCV) is the most common chronic blood-borne infection and the leading cause of liver transplantation in the United States. There are approximately 3.2 million people currently infected with HCV in the United States. In late 2013, the introduction of sofosbuvir and simeprevir represented a critical advancement in the treatment of HCV by improving sustained virologic response (SVR) rates. Purpose: The purpose of this study was to evaluate medication utilization and clinical outcomes of patients with HCV who were treated with any Food and Drug Administration-approved combination of ribavirin, peginterferon products, simeprevir, and sofosbuvir. Methods: Prescription records and clinical assessment forms of patients who started HCV therapy and were eligible for SVR between January 1, 2014, and December 31, 2014, were retrospectively reviewed. Data collection included patient demographics, genotype, SVR, patient-reported adverse events, discontinuations, and adherence markers. Results: A total of 367 eligible patients were identified who had initiated treatment during the study period. Genotype 1 was the most common genotype, and an overall SVR rate of 86.9% was observed. Results were similar to those seen in phase III clinical trials. In addition, adverse events of these medications were more tolerable, and discontinuation rates were lower than with previous therapies.

scholarly journals Understanding Implementation Challenges to Genetic Testing for Familial Hypercholesterolemia in the United States

2019 ◽  
Vol 9 (1) ◽  
pp. 9 ◽  
Author(s):  
Rachele Hendricks-Sturrup ◽  
Christine Lu
Keyword(s):  
United States ◽  
Genetic Testing ◽  
Familial Hypercholesterolemia ◽  
Ethnic Diversity ◽  
Heart Association ◽  
The United States ◽  
Cvd Risk ◽  
Implementation Challenges ◽  
The Us ◽  
Control And Prevention

Cardiovascular disease (CVD) is the leading cause of death in the United States (US), with familial hypercholesterolemia (FH) being a major inherited and genetic risk factor for premature CVD and atherosclerosis. Genetic testing has helped patients and providers confirm the presence of known pathogenic and likely pathogenic variations in FH-associated genes. Key organizations, such as the Centers for Disease Control and Prevention (CDC), American Heart Association (AHA), FH Foundation, and National Lipid Association (NLA), have recognized the clinical utility of FH genetic testing. However, FH genetic testing is underutilized in clinical practice in the US for reasons that are underexplored through the lens of implementation science. In this commentary, we discuss seven key implementation challenges that must be overcome to strengthen the clinical adoption of FH genetic testing in the US. These implementation challenges center on evidence of cost-effectiveness, navigating patient and provider preferences and concerns, gender and ethnic diversity and representation in genetic testing, and establishing clinical consensus around FH genetic testing based on the latest and most relevant research findings. Overcoming these implementation challenges is imperative to the mission of reducing CVD risk in the US.

scholarly journals Barriers and Facilitators to Genetic Testing for Familial Hypercholesterolemia in the United States: A Review

2019 ◽  
Vol 9 (3) ◽  
pp. 32 ◽  
Author(s):  
Rachele M. Hendricks-Sturrup ◽  
Kathleen M. Mazor ◽  
Amy C. Sturm ◽  
Christine Y. Lu
Keyword(s):  
United States ◽  
Genetic Testing ◽  
Familial Hypercholesterolemia ◽  
Systematic Approach ◽  
The United States ◽  
Barriers And Facilitators ◽  
Clinical Settings ◽  
Vascular Events ◽  
Potential Barriers ◽  
The Us

Familial Hypercholesterolemia (FH) is an underdiagnosed condition in the United States (US) and globally, affecting an estimated 1/250 individuals. It is a genetic risk factor for premature cardiovascular disease and is responsible for an estimated 600,000 to 1.2 million preventable vascular events. Studies show that FH genetic testing can identify a causal gene variant in 60 to 80% of clinically suspected FH cases. However, FH genetic testing is currently underutilized in clinical settings in the US despite clinical recommendations and evidence supporting its use. Reasons for underutilization are not well understood. We conducted a literature review in the PubMed/MEDLINE database and eight peer-reviewed journals. After filtering for and reviewing 2340 articles against our inclusion criteria, we included nine commentaries or expert opinions and eight empirical studies reported between January 2014 and March 2019 in our review. After applying the Consolidated Framework for Implementation Research (CFIR), we identified a total of 26 potential barriers and 15 potential facilitators (estimated barrier to facilitator ratio of 1.73). We further estimated ratios of potential barriers to facilitators for each CFIR domain (Characteristics of Intervention, Outer Setting, Inner Setting, Characteristics of Individuals, and Process). Findings derived from our systematic approach to the literature and calculations of estimated baseline ratios of barriers and facilitators can guide future research to understand FH genetic testing implementation in diverse clinical settings. Our systematic approach to the CFIR could also be used as a model to understand or compare barriers and facilitators to other evidence-based genetic testing processes in health care settings in the US and abroad.

scholarly journals COVID-19 outcomes among U.S. Military Health System beneficiaries include complications across multiple organ systems and substantial functional impairment

2021 ◽  
Author(s):  
Stephanie A Richard ◽  
Simon D Pollett ◽  
Charlotte A Lanteri ◽  
Eugene V Millar ◽  
Anthony C Fries ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Health System ◽  
Clinical Outcomes ◽  
Symptom Onset ◽  
The United States ◽  
Military Health System ◽  
Military Health ◽  
Patient Reported ◽  
The Impact

Abstract Background We evaluated the clinical outcomes, functional burden, and complications one month after COVID-19 infection in a prospective United States Military Health System (MHS) cohort of active duty, retiree, and dependent populations using serial patient-reported outcome surveys and electronic medical record (EMR) review. Methods MHS beneficiaries presenting at nine sites across the United States with a positive SARS-CoV-2 test, a COVID-19 like illness, or a high-risk SARS-CoV-2 exposure were eligible for enrollment. Medical history and clinical outcomes were collected through structured interviews and ICD-based EMR review. Risk factors associated with hospitalization were determined by multivariate logistic regression. Results A total of 1,202 participants were enrolled. There were 1,070 laboratory confirmed SARS-CoV-2 cases and 132 SARS-CoV-2 negative participants. In the first month post-symptom onset among the SARS-CoV-2 positive cases, there were 214 hospitalizations, 79% requiring oxygen, 22 ICU admissions, and 9 deaths. Risk factors for COVID-19 associated hospitalization included race (increased for Asian, Black, and Hispanic compared to non-Hispanic White), age (age 45-64 and 65+ compared to <45), and obesity (BMI>=30 compared to BMI<30). Over 2% of survey respondents reported the need for supplemental oxygen and 31% had not returned to normal daily activities at one-month post-symptom onset. Conclusions Older age, reporting Asian, Black or Hispanic race/ethnicity, and obesity are associated with SARS-CoV-2 hospitalization. A proportion of acute SARS-CoV-2 infections require long-term oxygen therapy; the impact of SARS-CoV-2 infection on short-term functional status was substantial. A significant number of MHS beneficiaries had not yet returned to normal activities by one month.

Clinical Characteristics of Patients Diagnosed with Strongyloidiasis in a United States Urban Outpatient Dermatology Department: A Case Series

2017 ◽  
Vol 1 (3) ◽  
pp. 156-160
Author(s):  
Jacqueline Watchmaker ◽  
Sean Legler ◽  
Dianne De Leon ◽  
Vanessa Pascoe ◽  
Robert Stavert
Keyword(s):  
United States ◽  
Case Series ◽  
The United States ◽  
Screening Tools ◽  
Dermatology Department ◽  
Cutaneous Manifestations ◽  
Serologic Testing ◽  
Patient Reported ◽  
History Of ◽  
Endemic Areas

Background: Although considered a tropical disease, strongyloidiasis may be encountered in non-endemic regions, primarily amongst immigrants and travelers from endemic areas.  Chronic strongyloides infection may be under-detected owing to its non-specific cutaneous presentation and the low sensitivity of commonly used screening tools. Methods: 18 consecutive patients with serologic evidence of strongyloides infestation who presented to a single urban, academic dermatology clinic between September 2013 and October 2016 were retrospectively included.  Patient age, sex, country of origin, strongyloides serology titer, absolute eosinophil count, presenting cutaneous manifestations, and patient reported subjective outcome of pruritus after treatment were obtained via chart review.  Results: Of the 18 patients, all had non-specific pruritic dermatoses, 36% had documented eosinophila and none were originally from the United States. A majority reported subjective improvement in their symptoms after treatment. Conclusion:  Strongyloides infection and serologic testing should be considered in patients living in non-endemic regions presenting with pruritic dermatoses and with a history of exposure to an endemic area.Key Points:Chronic strongyloidiasis can be encountered in non-endemic areas and clinical manifestations are variableEosinophilia was not a reliable indicator of chronic infection in this case series Dermatologists should consider serologic testing for strongyloidiasis in patients with a history of exposure and unexplained pruritus

A Global Perspective on Securitized Debt

2018 ◽  
Author(s):  
Steven L Schwarcz
Keyword(s):  
United States ◽  
Financial Crisis ◽  
Capital Market ◽  
Global Financial Crisis ◽  
The United States ◽  
Global Perspective ◽  
Capital Markets Union ◽  
The Global Financial Crisis ◽  
Asset Backed Securities ◽  
The Eu

Securitisation represents a significant worldwide source of capital market financing. European investors commonly invest in asset-backed securities issued in U.S. securitisation transactions, and vice versa One of the key goals of the European Commission's proposed Capital Markets Union (CMU) is to further facilitate securitisation as a source of capital market financing as a viable alternative to bank-based finance for companies operating in the EU. To that end, this chapter explains securitisation and attempts to put its rise, its decline after the global financial crisis, and its recent CMU-inspired revival into a global perspective. It examines not only securitisation's relationship to the financial crisis but also post-crisis comparative regulatory approaches in the EU and the United States.

The Oxford Handbook of Comic Book Studies

2019 ◽  
Keyword(s):  
United States ◽  
Comic Books ◽  
Academic Discipline ◽  
World System ◽  
Comic Book ◽  
The United States ◽  
Global Perspective ◽  
Visual Narrative ◽  
The Subject ◽  
Book Studies

Comic book studies has developed as a solid academic discipline, becoming an increasingly vibrant and field in the United States and globally. A growing number of dissertations, monographs, and edited books publish every year on the subject, while world comics represent the fastest-growing sector of publishing. The Oxford Handbook of Comic Book Studies examines the history and evolution of the visual narrative genre from a global perspective, bringing together readable, jargon-free essays written by established and emerging scholars from diverse geographic, institutional, gender, and national backgrounds. In particular, the Handbook explores how the term “global comics” has been defined, as well the major movements and trends that drive the field. Each essay will help readers understand comic books as a storytelling form grown within specific communities, and will also show how these forms exist within what can be considered a world system of comics.

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