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Category Archives: Mind Building
Health24.com | OPINION | Millions of people are on treatment for HIV: Why are so many still dying?
Twenty years ago treatment for HIV was a rare luxury in South Africa. Exorbitant costs and President Thabo Mbeki’s government’s fierce opposition to providing antiretroviral treatment (ART) kept it out of the public sector.
They were terrible days. Many lives were lost.
The environment has changed remarkably since then. The turning point came in 2004 when, after four years of struggle, led by the Treatment Action Campaign, the government begrudgingly agreed to start providing ART.
Antiretroviral coverage of people with HIV in South Africa has increased from 0% in 2000 to 71% in 2019. The South African antiretroviral programme is now the largest in the world, with more than five million people on treatment, and increasing. HIV-linked deaths decreased from 150 000 in 2000 – peaking at around 300 000 in 2006 – to 72 000 in 2019.
But deaths have not decreased as much as was hoped. HIV remains a leading cause of death in South Africa. Many people still present to health facilities with advanced HIV disease. And Aids remains a major contributor to hospitalisations and deaths in Africa.
Globally, 690 000 people died from HIV in 2019.
Doctors Without Borders (MSF) supports hospitals in South Africa, Guinea, the Democratic Republic of Congo (DRC), Malawi and the Central African Republic that continue to treat large numbers of people with AIDS. Because people present with very advanced HIV disease, up to one in three dies during their hospital stay.
One of the main challenges remains that diagnostics and drugs aren’t readily available for people suffering from advanced HIV. This group of people is very vulnerable to deadly opportunistic infections such as tuberculosis (TB), meningitis and severe bacterial infections.
This all goes to show the world is very far from the end of Aids.
Gaps
In the last ten years the focus has been on diagnosing people with HIV and starting them on treatment. Efforts around the test-and-treat approach have been mobilised around the UNAIDS 90-90-90 targets: 90% of people with HIV to know their status; 90% of those whose status is known to be on antiretroviral therapy; and 90% of those on antiretrovirals to have an undetectable viral load.
This is necessary but it is not enough to address HIV-related mortality. Life-long treatment requires life-long support. Some people will interrupt treatment; some will struggle to take their tablets every day, risking developing drug resistance and treatment failure.
Today, most people with advanced HIV either are failing or have interrupted treatment. In two MSF-supported studies in the DRC and Kenya, only 20%-35% of inpatients with advanced HIV were ART-naïve (had never accessed treatment) and over half of those on ART had treatment failure.
The reality of treatment interruption and treatment failure requires a new approach.
This is why MSF piloted Welcome Back Services in Khayelitsha, Cape Town. The services focus on the needs of patients returning to care and those failing treatment. Stigmatisation and blaming patients for interrupting or failing treatment is common. This leads to delays in seeking care, and patients presenting as false-naïve – patients retesting for HIV and hiding the fact that they were previously on treatment.
This in turn leads to patients presenting in more advanced stages of the disease or on inadequate treatment.
This is one of the reasons why HIV still claims too many lives. Patients who present very late often have severe immune suppression, multiple concurrent life-threatening illnesses and significant organ damage due to HIV itself. Treatment is complicated by the need for many different medicines, with a higher risk of drug interactions and severe side effects. Even with intensive care, unavailable in most settings, many patients die.
TB is the leading cause of death among people with HIV in resource-limited settings. It is estimated that TB is responsible for around 50% of deaths. Two other leading causes are cryptococcal meningitis, which is responsible for one in five HIV deaths, and severe bacterial infections.
Together, these infectious diseases cause more than two thirds of HIV-related deaths. All three are preventable and treatable – if detected early enough.
No time to lose
There are immediate steps that can be taken.
There are more options than ever to prevent TB disease. New evidence shows that shorter regimens of rifapentine and isoniazid, weekly for three months or daily for one month, are equally effective at treating latent TB and decreasing deaths compared to the older regimen of isoniazid for six to 36 months. And a recent trial demonstrated that a four-month treatment with a new regimen was as efficacious as the current six-month regimen to treat active TB disease.
When left untreated, the odds of surviving cryptococcal meningitis are zero. But cryptococcal meningitis can be prevented and there have been advances in treatment. Daily fluconazole is recommended in some countries for prevention of a first episode, and everywhere as secondary prophylaxis to prevent recurrent disease. Treatment with flucytosine and amphotericin B reduces mortality by 40%. Yet these medicines are still missing in many – if not most – health structures in Africa.
Steps can be taken to prevent death from advanced HIV. These include earlier detection at the primary care level – before patients develop disease so severe that they seek hospital admission. The longer the delay to diagnosis and treatment, the lower the chances of survival.
This is where CD4 tests and rapid tests for TB and cryptococcal meningitis are life-saving.
What is needed urgently to save lives is accelerated access to a package of care for the prevention, diagnosis and treatment of advanced HIV at the primary care and hospital level, along with strategies with clear targets to decrease Aids mortality.
Gilles van Cutsem, Honorary Research Associate, Centre for Infectious Disease Epidemiology and Research, University of Cape Town
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Image credit: Getty Images
Health24.com | New Zealand had great success in containing Covid-19, but public wellbeing paid a price
- People worldwide have been experiencing high levels of distress during the Covid-19 pandemic
- A New Zealand survey shows that, despite eliminating the virus, people’s mental health took a knock
- Researchers are encouraging governments to prioritise mental wellbeing during this time
The 2020 Covid-19 pandemic has been causing an enormous amount of mental distress all over the world.
While many countries struggled to cope with high numbers of seriously ill patients, New Zealand’s speedy reaction contained and ultimately eliminated the virus. These measures, however, came at a cost, not just to the country’s economy, but also to its people’s mental wellbeing, according to recent survey results.
About halfway through their toughest lockdown, a demographically representative public survey revealed higher than normal levels of stress, anxiety, and depression, especially among younger people.
“New Zealand’s lockdown successfully eliminated Covid-19 from the community, but our results show this achievement brought a significant psychological toll,” study co-author and psychologist Susanna Every-Palmer from the University of Otago, Canada, said in a news release.
The survey results, which included 2 010 responses from adult New Zealanders between 15 and 18 April, corresponding to days 19 to 22 of the lockdown, were published in PLOS One.
Younger people more severely affected
According to the results, the level of mental distress was much higher in younger adults, with almost half of those aged between 18 and 24 experiencing moderate to severe psychological distress, compared to less than one in 10 adults aged 65 years and older.
“Substantially increased rates of distress were seen among those who reported having lost their jobs or experienced a reduction in work as a result of the pandemic, those who had potential vulnerabilities to Covid-19, or identified their health status as poor, and those who had a past diagnosis of a mental illness,” said Every-Palmer.
However, it’s worth noting that the study couldn’t distinguish whether it was the lockdown itself that was causing the mental health effects or the broader threat of the pandemic.
Older people felt safer in NZ than elsewhere
Despite older people being at greater risk of severe Covid-19 and mortality, and having less social connection via online platforms, their mental health appeared to be less affected by the situation.
“This is not to say older people were unscathed,” the authors explained, but Every-Palmer explained that “older people may also have felt they were safer in New Zealand than elsewhere”.
Overall, younger age groups appeared particularly vulnerable, which could be attributable to the lockdown’s implementation coinciding with different daily disruptions and economic impacts for different age groups.
Increase in domestic violence, sexual assault
Sadly, with the lockdown came consequences like people being confined to their homes, and a subsequent rise in domestic violence in many instances. This was consistent with local media reports, the authors noted.
Almost one in 10 participants directly experienced some form of family harm, the authors wrote. More cases of physical assault, sexual assault, harassment, and intimidation in the home were being reported – between three and four times higher than normal, according to the survey.
These results also correspond with similar increases in domestic abuse around the world during lockdown, including South Africa, News24 reported during level 3 lockdown.
The silver lining
Despite the negative toll on the economy, wellbeing, and safety of women, the majority of survey respondents (62%) said they could see the “silver lining” of remaining in isolation, whether it be for themselves or for society.
“People reported taking the opportunity to pause, reflect, consider priorities, recreate healthy habits, and they appreciated the environmental benefits brought by reduced travel,” said Every-Palmer.
In fact, a change in events such as working from home, spending more time with family, and living in a quieter environment reportedly gave some respondents the opportunity to pause, reflect and consider their priorities, the results indicate.
Respondents also showed a more positive attitude towards the end of the research period, which could mean that lockdown simply takes some time to get used to.
Governments need to take action
However, Every-Palmer pointed out that the consequences of the pandemic will be pervasive and prolonged, and urged governments to step in and prioritise their people’s mental wellbeing.
“Our findings emphasise the need to put resources into supporting mental well-being both during and after lockdowns.
“Governments should make providing mental health support a similar priority to other health measures, such as contact tracing, provision of personal protective equipment, and procurement of ventilators,” she said.
Every-Palmer added that supporting the population’s psychological well-being includes ensuring people have access to accurate information, basic necessities and specialist mental health services, among other things.
“Free access to high-quality e-therapies and telehealth support also becomes increasingly important if people are afraid or are not allowed to leave their homes.”
Image: Getty/Dimitri Otis
Health24.com | Exercising while wearing your face mask on is not dangerous, researchers say
- Face masks don’t restrict breathing during exercise, researchers say
- This means that they’re harmless and should therefore be worn when exercising
- An exception, however, is in cases where people suffer from severe cardiopulmonary disease
Since a face mask is supposed to cover the mouth and nose in order to limit the spread of the new coronavirus, wearing one while exercising is uncomfortable for most people.
However, contrary to previous findings that wearing a mask during exercising impairs oxygen intake – as well as the World Health Organization’s official advice, stating that “people should NOT wear masks while exercising, as masks may reduce the ability to breathe comfortably” – a new study suggests that this isn’t the case.
According to the researchers who looked at the effects of face masks on the cardiorespiratory system (the heart, blood vessels, and lungs) during physical activity, most people should be able to breathe perfectly well with a mask on while exercising, despite it not feeling comfortable.
“There might be a perceived greater effort with activity, but the effects of wearing a mask on the work of breathing, on gases like oxygen and CO2 in blood or other physiological parameters, are small, often too small to be detected,” study author and exercise physiologist, Susan Hopkins from the University of California San Diego (UCSD), said in a news release by the university.
The findings were published in the Annals of the American Thoracic Society.
Exercising with face mask harmless
For their study, Hopkins and colleagues reviewed existing scientific literature on the effects of different face masks, including surgical masks, N95 respirators, and cloth face masks, on cardiorespiratory response during physical activity.
Based on their analysis, they said that current evidence suggests while face masks worn by healthy people during exercise result in minimal resistance to airflow, they do not seem to significantly impact lung function and oxygen intake, and are therefore harmless.
They did acknowledge that dyspnea (breathing discomfort) may potentially increase when exercising with a face mask, especially when one is not used to doing so.
“Wearing a face mask can be uncomfortable,” says Hopkins.
“There can be tiny increases in breathing resistance. You may re-inhale warmer, slightly enriched CO2 air. And if you’re exercising, the mask can cause your face to become hot and sweaty.
“But these are sensory perceptions. They do not impact cardiopulmonary function in healthy people.”
Exceptions for certain people
The authors also gave the assurance that their findings apply to both young and old adults, irrespective of gender. However, there is an exception in patients with severe cardiopulmonary disease who have an increased risk of experiencing exertional dyspnea, they cautioned.
“In such cases, these individuals might feel too uncomfortable to exercise, and that should be discussed with their doctor,” Hopkins said.
“However, the fact that these individuals are at great risk should they contract Covid-19 must also be considered.”
The researchers also disclosed that the literature investigating this issue is evolving and that further studies are still needed to support these findings.
READ | The importance of staying active while staying in
READ | Here are the best and worst materials for face masks
Image: Getty/LeoPatrizi
NaNoWriMo Days 16-17
The morning I hit a nice milestone for my novel-in-progress, getting it just beyond 30K words, so I’m still ahead of schedule for reaching 50K words by November 30th. The daily target of 1667 words continues to work well.
Yesterday I added 2050 words, which I think is the first time I’ve gone over 2K words in a day. I got into the flow of an emotionally juicy scene and didn’t want to stop till I got to the end of it. I got caught up in the characters’ feelings as I channeled their dialogue, and the words flowed as fast as I could type. This was the first time I cried while writing this story. If this novel were made into a movie, I could see people crying while watching that scene too. It could use a lot of editing, but the core of it feels potent and meaningful. It felt very satisfying to write a scene with a lot of raw and nuanced emotion in it. This came from having the characters communicate with more honesty and emotional risk-taking.
Interestingly there’s a Nano badge called “Weepy Writer” that you earn by shedding a tear or two over your novel, so I gave myself credit for earning that one.
When I get into the flow of a scene, I often feel some emotion as I write, although usually not as strong as during yesterday’s writing session. Even though I’m working with fictional characters, their interactions feel increasingly real and genuine to me, and this leads me to discover some emotional truths in their interactions. The situations that the characters face are emotionally similar to real situations that real people often face as well, and this makes me feel extra sympathy for people who experience similar challenges.
Sometimes as I’m writing a dialog between a couple of characters, it feels like I’m doing a deep personal journaling session. When I was writing a scene this morning, I got confused partway through, wondering if I had drifted away from writing dialogue and was actually doing something closer to personal introspection. I paused and read back a little of what I wrote and realized that the scene still made sense either way. That gave me an eery feeling that my writing was happening at the intersection of two different worlds.
I’m finding this writing adventure to be deeper and more growth-oriented than I expected. I figured it would be a growth experience in terms of the skills to learn, the practice, and the daily discipline – that seemed obvious to me before I started. I didn’t expect that writing fiction would lead me into deeper reframes about life, work, and human nature.
I’m glad I took the plunge and gave myself permission to explore this. I use the word “permission” because I previously had some limiting frames about fiction writing. I often looked upon it as being a less worthy pursuit than writing nonfiction, like fiction is just optional play writing but not particularly important or serious. That framing caused me to delay this goal for many years. I regarded the goal of writing a novel as a side excursion into fantasy, like getting lost in an immersive video game for a while.
After just a few weeks, my attitude has shifted a lot. I now see that there’s something precious and worthwhile to be discovered in the world of fiction. I’m feeling more inspired and enthralled by this project as I go along. I think there’s more gold here than I realized, like a different way of connecting with beauty.
Machine learning guarantees robots’ performance in unknown territory
A small drone takes a test flight through a space filled with randomly placed cardboard cylinders acting as stand-ins for trees, people or structures. The algorithm controlling the drone has been trained on a thousand simulated obstacle-laden courses, but it’s never seen one like this. Still, nine times out of 10, the pint-sized plane dodges all the obstacles in its path.
This experiment is a proving ground for a pivotal challenge in modern robotics: the ability to guarantee the safety and success of automated robots operating in novel environments. As engineers increasingly turn to machine learning methods to develop adaptable robots, new work by Princeton University researchers makes progress on such guarantees for robots in contexts with diverse types of obstacles and constraints.
“Over the last decade or so, there’s been a tremendous amount of excitement and progress around machine learning in the context of robotics, primarily because it allows you to handle rich sensory inputs,” like those from a robot’s camera, and map these complex inputs to actions, said Anirudha Majumdar, an assistant professor of mechanical and aerospace engineering at Princeton.
However, robot control algorithms based on machine learning run the risk of overfitting to their training data, which can make algorithms less effective when they encounter inputs that differ from those they were trained on. Majumdar’s Intelligent Robot Motion Lab addressed this challenge by expanding the suite of available tools for training robot control policies, and quantifying the likely success and safety of robots performing in novel environments.
In three new papers, the researchers adapted machine learning frameworks from other arenas to the field of robot locomotion and manipulation. They turned to generalization theory, which is typically used in contexts that map a single input onto a single output, such as automated image tagging. The new methods are among the first to apply generalization theory to the more complex task of making guarantees on robots’ performance in unfamiliar settings. While other approaches have provided such guarantees under more restrictive assumptions, the team’s methods offer more broadly applicable guarantees on performance in novel environments, said Majumdar.
In the first paper, a proof of principle for applying the machine learning frameworks, the team tested their approach in simulations that included a wheeled vehicle driving through a space filled with obstacles, and a robotic arm grasping objects on a table. They also validated the technique by assessing the obstacle avoidance of a small drone called a Parrot Swing (a combination quadcopter and fixed-wing airplane) as it flew down a 60-foot-long corridor dotted with cardboard cylinders. The guaranteed success rate of the drone’s control policy was 88.4%, and it avoided obstacles in 18 of 20 trials (90%).
The work, published Oct. 3 in the International Journal of Robotics Research, was coauthored by Majumdar; Alec Farid, a graduate student in mechanical and aerospace engineering; and Anoopkumar Sonar, a computer science concentrator from Princeton’s Class of 2021.
When applying machine learning techniques from other areas to robotics, said Farid, “there are a lot of special assumptions you need to satisfy, and one of them is saying how similar the environments you’re expecting to see are to the environments your policy was trained on. In addition to showing that we can do this in the robotic setting, we also focused on trying to expand the types of environments that we could provide a guarantee for.”
“The kinds of guarantees we’re able to give range from about 80% to 95% success rates on new environments, depending on the specific task, but if you’re deploying [an unmanned aerial vehicle] in a real environment, then 95% probably isn’t good enough,” said Majumdar. “I see that as one of the biggest challenges, and one that we are actively working on.”
Still, the team’s approaches represent much-needed progress on generalization guarantees for robots operating in unseen environments, said Hongkai Dai, a senior research scientist at the Toyota Research Institute in Los Altos, California.
“These guarantees are paramount to many safety-critical applications, such as self-driving cars and autonomous drones, where the training set cannot cover every possible scenario,” said Dai, who was not involved in the research. “The guarantee tells us how likely it is that a policy can still perform reasonably well on unseen cases, and hence establishes confidence on the policy, where the stake of failure is too high.”
In two other papers, to be presented Nov. 18 at the virtual Conference on Robot Learning, the researchers examined additional refinements to bring robot control policies closer to the guarantees that would be needed for real-world deployment. One paper used imitation learning, in which a human “expert” provides training data by manually guiding a simulated robot to pick up various objects or move through different spaces with obstacles. This approach can improve the success of machine learning-based control policies.
To provide the training data, lead author Allen Ren, a graduate student in mechanical and aerospace engineering, used a 3D computer mouse to control a simulated robotic arm tasked with grasping and lifting drinking mugs of various sizes, shapes and materials. Other imitation learning experiments involved the arm pushing a box across a table, and a simulation of a wheeled robot navigating around furniture in a home-like environment.
The researchers deployed the policies learned from the mug-grasping and box-pushing tasks on a robotic arm in the laboratory, which was able to pick up 25 different mugs by grasping their rims between its two finger-like grippers — not holding the handle as a human would. In the box-pushing example, the policy achieved 93% success on easier tasks and 80% on harder tasks.
“We have a camera on top of the table that sees the environment and takes a picture five times per second,” said Ren. “Our policy training simulation takes this image and outputs what kind of action the robot should take, and then we have a controller that moves the arm to the desired locations based on the output of the model.”
A third paper demonstrated the development of vision-based planners that provide guarantees for flying or walking robots to carry out planned sequences of movements through diverse environments. Generating control policies for planned movements brought a new problem of scale — a need to optimize vision-based policies with thousands, rather than hundreds, of dimensions.
“That required coming up with some new algorithmic tools for being able to tackle that dimensionality and still be able to give strong generalization guarantees,” said lead author Sushant Veer, a postdoctoral research associate in mechanical and aerospace engineering.
A key aspect of Veer’s strategy was the use of motion primitives, in which a policy directs a robot to go straight or turn, for example, rather than specifying a torque or velocity for each movement. Narrowing the space of possible actions makes the planning process more computationally tractable, said Majumdar.
Veer and Majumdar evaluated the vision-based planners on simulations of a drone navigating around obstacles and a four-legged robot traversing rough terrain with slopes as high as 35 degrees — “a very challenging problem that a lot of people in robotics are still trying to solve,” said Veer.
In the study, the legged robot achieved an 80% success rate on unseen test environments. The researchers are working to further improve their policies’ guarantees, as well as assessing the policies’ performance on real robots in the laboratory.
The work was supported in part by the U.S. Office of Naval Research, the National Science Foundation, a Google Faculty Research Award and an Amazon Research Award.
AI tool may predict movies’ future ratings
Movie ratings can determine a movie’s appeal to consumers and the size of its potential audience. Thus, they have an impact on a film’s bottom line. Typically, humans do the tedious task of manually rating a movie based on viewing the movie and making decisions on the presence of violence, drug abuse and sexual content.
Now, researchers at the USC Viterbi School of Engineering, armed with artificial intelligence tools, can rate a movie’s content in a matter of seconds, based on the movie script and before a single scene is shot. Such an approach could allow movie executives the ability to design a movie rating in advance and as desired, by making the appropriate edits on a script and before the shooting of a single scene. Beyond the potential financial impact, such instantaneous feedback would allow storytellers and decision-makers to reflect on the content they are creating for the public and the impact such content might have on viewers.
Using artificial intelligence applied to scripts, Shrikanth Narayanan, University Professor and Niki & C. L. Max Nikias Chair in Engineering, and a team of researchers from the Signal Analysis and Interpretation Lab (SAIL) at USC Viterbi, have demonstrated that linguistic cues can effectively signal behaviors on violent acts, drug abuse and sexual content (actions that are often the basis for a film’s ratings) about to be taken by a film’s characters.
Method:
Using 992 movie scripts that included violent, substance-abuse and sexual content, as determined by Common Sense Media, a non-profit organization that rates and makes recommendations for families and schools, the SAIL research team trained artificial intelligence to recognize corresponding risk behaviors, patterns and language.
The AI tool created receives as input all the script, processes it through a neural network and scans it for semantics and sentiment expressed. In the process, it classifies sentences and phrases as positive, negative, aggressive and other descriptors. The AI tool automatically classifies words and phrases into three categories: violence, drug abuse and sexual content.
Victor Martinez, a doctoral candidate in computer science at USC Viterbi and the lead researcher on the study, which will appear in The Proceedings of the 2020 Conference on Empirical Methods in Natural Language Processing said, “Our model looks at the movie script, rather than the actual scenes, including e.g. sounds like a gunshot or explosion that occur later in the production pipeline. This has the benefit of providing a rating long before production to help filmmakers decide e.g. the degree of violence and whether it needs to be toned down.”
The research team also includes Narayanan, a professor of electrical and computer engineering, computer science and linguistics, Krishna Somandepalli, a Ph.D. candidate in Electrical and Computing Engineering at USC Viterbi, and Professor Yalda T. Uhls of UCLA’s Department of Psychology. They discovered many interesting connections between the portrayals of risky behaviors.
“There seems to be a correlation in the amount of content in a typical film focused on substance abuse and the amount of sexual content. Whether intentionally or not, filmmakers seem to match the level of substance abuse-related content with sexually explicit content,” said Martinez.
Another interesting pattern also emerged. “We found that filmmakers compensate for low levels of violence with joint portrayals of substance abuse and sexual content,” Martinez said.
Moreover, while many movies contain depictions of rampant drug-abuse and sexual content, the researchers found it highly unlikely for a film to have high levels of all three risky behaviors, perhaps because of Motion Picture Association (MPA) standards.
They also found an interesting connection between risk behaviors and MPA ratings. As sexual content increases, the MPA appears to put less emphasis on violence/substance-abuse content. Thus, regardless of violent and substance abuse content, a movie with a lot of sexual content will likely receive an R rating.
Narayanan whose SAIL lab has pioneered the field of media informatics and applied natural language processing in order to bring awareness in the creative community about the nuances of storytelling, calls media “a rich avenue for studying human communication, interaction and behavior, since it provides a window into society.”
“At SAIL, we are designing technologies and tools, based on AI, for all stakeholders in this creative business — the writers, film-makers and producers — to raise awareness about the varied important details associated in telling their story on film,” Narayanan said.
“Not only are we interested in the perspective of the storytellers of the narratives they weave,” Narayanan said, “but also in understanding the impact on the audience and the ‘take-away’ from the whole experience. Tools like these will help raise societally-meaningful awareness, for example, through identifying negative stereotypes.”
Added Martinez: “In the future, I’m interested in studying minorities and how they are represented, particularly in cases of violence, sex and drugs.”
Algorithm-driven digital program helped lower patients’ cholesterol, blood pressure
Using a remotely-delivered, algorithm-driven program for disease management, patients experienced significant improvement in cholesterol and blood pressure levels, according to late-breaking research presented today at the American Heart Association’s Scientific Sessions 2020. The virtual meeting is Friday, November 13-Tuesday, November 17, 2020, and is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science for health care. The manuscript of this study is simultaneously published today in Circulation, the American Heart Association’s flagship journal.
Failure to appropriately treat hypercholesterolemia (high cholesterol) and hypertension (high blood pressure) remains an ongoing clinical challenge that increases the risk of heart attacks, stroke and cardiovascular death. Using digital tools, clinicians at Brigham and Women’s Hospital in Boston, Massachusetts, initiated and continue to conduct a remote, algorithmically driven, hypercholesterolemia and hypertension management program.
Between January of 2018 and May of 2020, researchers screened 18,810 patients and enrolled 5,000 patients into either the cholesterol program, the hypertension program — or both. Among the 3,939 patients enrolled in the cholesterol program, 35% had established atherosclerotic cardiovascular disease (ASCVD); 25% had diabetes but no ASCVD; and 31% had a low-density lipoprotein cholesterol (LDL-C) >190 mg/dL. Doctors, pharmacists and support specialists helped design these management programs to initiate and adjust the medication doses, also known as titration, to achieve maximum benefits for patients while minimizing clinically important side effects.
“To better control cholesterol and blood pressure, both of which are major cardiovascular risk factors, we need new end-to-end treatment solutions that improve patient identification, data collection, education and care delivery, including standardizing medication regimens. We are redefining treatment pathways to address persistent gaps in health care, overcome clinical inertia and address the problems of limited access to physicians by expanding remotely-delivered care,” says the study’s lead author Benjamin M. Scirica, M.D., M.P.H., a cardiologist at Brigham and Women’s Hospital and associate professor of medicine at the Harvard School of Medicine, both in Boston.
Using electronic health records and doctor referrals, the program identified people with uncontrolled LDL-C and/or high blood pressure. Patients received digitally connected blood pressure cuffs for use at home, and pharmacists and support staff used the clinical algorithms to initiate and titrate medications at preset intervals until treatment goals were achieved.
Results of the study include:
- An overall LDL-C reduction of 52 mg/dl (42%) occurred in patients who completed the titration phase of the program.
- Significant LDL-C reductions were achieved in patients who met one of four cholesterol-risk categories — established atherosclerotic cardiovascular disease, diabetes, severe hypercholesterolemia (LDL >190 mg/dL) or high-risk primary prevention.
- The average reduction in blood pressure was 14 mmHg systolic and 6 mmHg diastolic reduction.
- An overall LDL-C reduction of 24 mg/dl (18%) was achieved in all patients enrolled.
“This is an effective and efficient strategy to care for high-risk yet undertreated patients and to optimize guideline-directed therapy. Specialized out-of-office treatment for cholesterol and blood pressure control reduces the need for in-person visits and allows for collaborative decision-making in-patient care. The results of our study provide a model for expanding remote health care delivery to increase access to care, to help reduce health inequities and to improve health care quality,” said Scirica.
Story Source:
Materials provided by American Heart Association. Note: Content may be edited for style and length.
More than 70,000 excess deaths during the pandemic
Rising Covid-19 deaths push the total number of UK deaths further above expected levels
Covid in Scotland: Level 4 lockdown to be imposed in 11 council areas
The move means more than two million people will be living under the country’s toughest Covid restrictions.
