Stephen Brunton - Academia.edu (original) (raw)
Papers by Stephen Brunton
Diabetes Spectrum, 2018
Objective. Many patients with type 2 diabetes do not reach glycemic goals despite basal insulin t... more Objective. Many patients with type 2 diabetes do not reach glycemic goals despite basal insulin treatment. This study assessed the achievement of a target A1C <7.0% (<53 mmol/mol) after initiation of basal insulin in two settings. Methods. This was a retrospective analysis of pooled randomized controlled trial (RCT) data, from 11 24-week studies of patients initiating basal insulin performed between 2000 and 2005 and of outpatient electronic medical record (EMR) data from the General Electric Centricity database for insulin-naive patients initiating basal insulin between 2005 and 2012. Baseline characteristics stratified by target A1C and fasting plasma glucose (FPG) attainment were compared descriptively. Results. In the RCT dataset, 49.0% of patients failed to achieve the target A1C at 6 months versus 72.4% and 72.9% at 6 and 12 months in the EMR dataset, respectively. Despite this, in the RCT dataset, 79.4% of patients achieved the target A1C and/or an FPG <130 mg/dL. In...
Current Medical Research and Opinion, 2008
Clinical Diabetes, 2021
The Chief Residents Summit on Intensifying Diabetes Management, now in its 15th year, has resulte... more The Chief Residents Summit on Intensifying Diabetes Management, now in its 15th year, has resulted in real-world improvements in patient outcomes and has shown itself to be an effective model for teaching diabetes to family medicine residents. This article describes the program and the evidence supporting its effectiveness.
Alzheimer's & Dementia
Innovation in Aging
Mild cognitive impairment (MCI) and Alzheimer’s disease (AD) dementia are characterized by cognit... more Mild cognitive impairment (MCI) and Alzheimer’s disease (AD) dementia are characterized by cognitive impairment and in AD a progressive functional impairment. This study sought to understand the role of geriatricians in treating patients with MCI/mild AD dementia. An anonymous, online survey was conducted in the US with 301 healthcare professionals (HCPs), including 75 primary care providers who practice as board certified geriatricians, and treat ≥10 patients per month with MCI/mild AD dementia. Geriatricians reported that among their patients with MCI/mild AD dementia, they initially make this diagnosis 70% of the time. Geriatricians reported that the topics commonly discussed with patients at the time of diagnosis are treatment options (85%), care management strategies (81%) and disease progression (80%). When referring patients to other specialties for treatment, geriatricians most often referred to neurologists (41%). Most (83%) geriatricians considered themselves the coordinat...
The Journal of family practice, 2019
As a continuing medical education provider accredited by the Accreditation Council for Continuing... more As a continuing medical education provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), Primary Care Education Consortium (PCEC) requires any individual in a position to influence educational content to disclose any financial interest or other personal relationship with any commercial interest. This includes any entity producing, marketing, re-selling or distributing health care goods or services consumed by, or used on, patients. Mechanisms are in place to identify and resolve any potential conflict of interest prior to the start of the activity. In addition, any discussion of off-label, experimental, or investigational use of drugs or devices will be disclosed by the faculty. Dr. Roth discloses that he serves on the advisory boards for Eisai, Idorsia Janssen, Jazz, and Merck.
The Journal of Family Practice, 2020
multivitamin was found to be the most popular supplement (58%) followed by vitamin D (31%), vitam... more multivitamin was found to be the most popular supplement (58%) followed by vitamin D (31%), vitamin C (28%), and protein (21%). The top reason for taking a dietary supplement was to improve overall health and wellness. Notably, supplement users were more likely to practice healthy lifestyle habits than non-users and less than one-quarter of supplements taken by adults were recommended by their physician or other health care provider. 1 The failure of the American diet to ensure micronutri-NUTRITIONAL STATUS IN THE UNITED STATES Although nutrition experts often advise that individuals consuming the standard American diet with 3 square meals a day do not need vitamins or nutritional supplements, it appears the American public disagrees. In fact, in 2019 the Council for Responsible Nutrition reported in its Consumer Survey on Dietary Supplements that 79% of adult females and 74% of adult males used dietary supplements with usage rates highest among those age 35 to 54 (81%) and those age >55 (79%). 1 A S2 CONTINUING MEDICAL EDUCATION LEARNING OBJECTIVES • Identify common shortfalls in the typical American diet. • Address the link between poor diet quality and chronic disease. DISCLOSURES As a continuing medical education provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), Primary Care Education Consortium (PCEC) requires any individual in a position to influence educational content to disclose any financial interest or other personal relationship with any commercial interest. This includes any entity producing, marketing, reselling or distributing health care goods or services consumed by, or used on, patients. Mechanisms are in place to identify and resolve any potential conflict of interest prior to the start of the activity. In addition, any discussion of off-label, experimental, or investigational use of drugs or devices will be disclosed by the faculty. Dr. Quan discloses he has no real or apparent conflicts of interests to report. Gregory Scott, PharmD, RPh, editorial support, discloses he has no real or apparent conflicts of interests to report. Additional PCEC staff report no conflicts of interest. SPONSORSHIP This activity is sponsored by Primary Care Education Consortium, in collaboration with the Primary Care Metabolic Group. ACCREDITATION The Primary Care Education Consortium is accredited by the Accreditation Council for Continuing Medical Education (AC-CME) to provide continuing medical education for physicians. CREDIT DESIGNATION AMA PRA Category 1-Primary Care Education Consortium designates this enduring material for a maximum of 1.0 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. CME is available September 1, 2020 to August 31, 2021.
Gastro Hep Advances, 2022
BACKGROUND AND AIMS: Helicobacter pylori eradication rates have declined as antibiotic resistance... more BACKGROUND AND AIMS: Helicobacter pylori eradication rates have declined as antibiotic resistance rates have increased. In addition, adherence to treatment guidelines is suboptimal. It is therefore important that contemporary, realworld evidence of diagnostic and treatment patterns is explored and compared with evidence-based guidelines. The Study of Acid-Related Disorders investigated unmet needs among patients with H pylori infection and past or current dyspepsia. METHODS: Gastroenterologists (GIs) and family physicians (FPs) or general practitioners (GPs) treating patients with H pylori infection and past or current dyspepsia completed a physician survey and invited patients to complete a patient survey; data were also extracted from the medical records of enrolled patients. RESULTS: Two hundred fifty-one physicians and 77 patients were enrolled. A total of 19.5% of patients were diagnosed by serology, whereas the urea breath test was used by 6.5% of GIs and 50.0% of FPs or GPs. A total of 68.6% of GIs and 79.8% of FPs or GPs selected clarithromycin, amoxicillin, and proton pump inhibitor triple therapy as their ideal first-line treatment. Physicians reported that 52.9% of patients experienced dyspepsia daily. A total of 46.8% of patients believed that complete resolution of dyspepsia would indicate effective treatment. As their treatment goal, 69.3% of physicians selected improvement in overall symptoms, whereas 92.2% of patients specified improvement in dyspepsia. Only 28.7% of physicians were satisfied with current treatment options. A total of 59.7% of patients took all of their prescribed medicine(s). A total of 59.7% of patients would prefer to take fewer pills; 45.5% would prefer convenience packs. CONCLUSION: This study reveals a lack of adherence to current H pylori guidelines for diagnosis, testing, and treatment. New treatment options that are more efficacious and simpler for patients to adhere to are needed.
Journal of the American Medical Directors Association, 2022
and Takeda; receives research support from NIA, Janssen, and Roche; is on the safety monitoring c... more and Takeda; receives research support from NIA, Janssen, and Roche; is on the safety monitoring committee for Anavex, EryDel, ITI, Newron, Intra-Cellular Therapies, Merck, and Newron; and on the speakers bureau for Acadia Pharmaceuticals Inc and Biogen.
International Journal of General Medicine, 2021
The presence of hallucinations and delusions in patients with neurodegenerative disease correlate... more The presence of hallucinations and delusions in patients with neurodegenerative disease correlates negatively with function, cognition, quality of life, and survival. When these patients still have insight, the treatment of mild hallucinations may reduce the risk of progression to more severe symptoms, specifically hallucinations without insight or delusions. On October 22, 2020, a multidisciplinary consensus panel comprising United States-based experts in geriatric psychiatry, geriatric medicine, family medicine, movement disorders, and neuropsychology was convened remotely to discuss best practices for using telemedicine to evaluate, diagnose, and treat psychosis in patients with neurodegenerative diseases. This review reflects the opinions and recommendations discussed at this meeting. Despite drawbacks, telemedicine can offer several advantages over in-person care, particularly for older adults, and may be a unique opportunity for care of patients with neuropsychiatric symptoms. While telemedicine may not be suitable for all patients, it allows the involvement of specialists from multiple geographic locations and the extension of care to homebound individuals. Patients with neurodegenerative diseases who are likely to become homebound as the disease advances may benefit greatly from telemedicine as a standard of care. Healthcare provided via telemedicine should be nothing less than what would be offered to the patient in person. Telemedicine may present some difficulties, including technological issues and inherent constraints of remote care, but with proper planning many problems could be diminished. Technical issues associated with telemedicine are inevitable but may be partially offset by providing clear directions ahead of any televisit to ensure connectivity and access to the videoconferencing platform. Alternative procedures to communicate should be established in the eventuality of technological issues. Using these strategies, telemedicine can serve as a valuable complement to traditional in-person practices for the diagnosis and management of hallucinations and delusions associated with Parkinson's disease psychosis or dementia-related psychosis.
SUMMARY The ability of nonpharmacologic and oral pharmacolog-ic therapies to maintain glycemic co... more SUMMARY The ability of nonpharmacologic and oral pharmacolog-ic therapies to maintain glycemic control in type 2 dia-betes almost invariably dissipates. Insulin therapy, there-fore, is eventually needed in the majority of patients withtype 2 diabetes. While many options are available, thenewer insulin analogs (insulin glargine, biphasic insulinaspart 70/30, and 75% insulin lispro protamine/25%insulin lispro), which more closely mimic the releaseand action of endogenous insulin in healthy persons,offer several advantages over conventional humaninsulins. Comprehensive care for the person with type 2diabetes includes diabetes education, ongoing adjust-ments and changes to therapy, and self-managementsupport guided by appropriate monitoring and screen-ing for the complications of diabetes. REFERENCES 1. Turner RC, Millns H, Neil HA, et al. Risk factors for coronary artery disease innon-insulin dependent diabetes mellitus: United Kingdom Prospective DiabetesStudy (UKPDS: 23). BMJ . 1998;...
Great improvements have been made to insulin preparations over the years, including the developme... more Great improvements have been made to insulin preparations over the years, including the development of insulin analogs, which were designed to overcome the disadvantages of traditional human insulins in the treatment of type 1 and type 2 diabetes. Insulin analogs more closely mimic the physiological insulin profile and are therefore associated with an improved balance between glycemic control and tolerability. They are also associated with a lower risk of hypoglycemia, less weight gain, and greater treatment flexibility than human insulins. These benefits, in combination with new insulin delivery devices, such as pens, have greatly improved patients’ treatment satisfaction and medication adherence, leading to improvements in clinical outcome. This article reviews the advantages of insulin analogs over human insulin for the treatment of type 1 and type 2 diabetes. Insulin was first used to treat diabetes in the 1920s. Early advances in therapy consisted of improvements in the purific...
SPONSORSHIP This activity is sponsored by PCEC and supported by funding from Bayer. and prescript... more SPONSORSHIP This activity is sponsored by PCEC and supported by funding from Bayer. and prescription analgesics. Prescription opioids are commonly used to treat musculoskeletal pain, although there is increasing awareness of the potential harm of opioid-related adverse events and misuse. Importantly, most musculoskeletal aches and pains are acute in nature and selftreatable with OTC analgesics, and flares associated with chronic conditions may also be appropriate for OTC management. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat musculoskeletal pain and are among the world’s most consumed prescription and OTC medications. Every day, approximately 30 million people worldwide use NSAIDs. In the United States, there are an estimated 30 billion doses of NSAIDs consumed annually, with over 100 million prescriptions written every year. In the United States, an OTC analgesic usage rate of 76% was reported, with more women self-medicating than men. Consumers with m...
American Journal of Gastroenterology, 2021
oxyntic cells within the patch. These IPs rarely benefit from aggressive acid blocking therapy. I... more oxyntic cells within the patch. These IPs rarely benefit from aggressive acid blocking therapy. In our study we found that symptoms secondary to IPs improved in a vast majority of patients after RFA, APC or manual removal. Some further avenues of research could compare methods of removal as well as determining efficacy of removal when patients have other concomitant GI conditions. Although the study population was small, the magnitude of the number of patients with improvement of symptoms was significant. Our results suggest that further studies are necessary to select which symptomatic individuals could benefit from IP ablation.
American Journal of Gastroenterology, 2021
The Journal of Family Practice, 2021
Low-dose aspirin (acetylsalicylic acid [ASA]; 75 to 100 mg/d) is widely used in the prevention of... more Low-dose aspirin (acetylsalicylic acid [ASA]; 75 to 100 mg/d) is widely used in the prevention of cardiovascular (CV) events based on the results of large-scale studies supporting a benefit. However, questions remain regarding the benefit-risk relationship in certain settings since long-term use of ASA is not devoid of risk. Incontrovertible evidence supports the benefits of ASA treatment, which exceed the risks, in patients who have had a previous CV event (myocardial infarction, stroke, unstable angina, or transient ischemic attack). Nonetheless, the question remains for those patients who have not had a previous event (primary prevention), where the risk of CV events is lower and, consequently, the absolute benefit is also lower than in patients who have a history of a CV event or its equivalent (secondary prevention). Recent evidence from large-scale clinical trials shows that administration of low-dose ASA is associated with a reduced risk of CV events with a corresponding smal...
Diabetes Spectrum, 2018
Objective. Many patients with type 2 diabetes do not reach glycemic goals despite basal insulin t... more Objective. Many patients with type 2 diabetes do not reach glycemic goals despite basal insulin treatment. This study assessed the achievement of a target A1C <7.0% (<53 mmol/mol) after initiation of basal insulin in two settings. Methods. This was a retrospective analysis of pooled randomized controlled trial (RCT) data, from 11 24-week studies of patients initiating basal insulin performed between 2000 and 2005 and of outpatient electronic medical record (EMR) data from the General Electric Centricity database for insulin-naive patients initiating basal insulin between 2005 and 2012. Baseline characteristics stratified by target A1C and fasting plasma glucose (FPG) attainment were compared descriptively. Results. In the RCT dataset, 49.0% of patients failed to achieve the target A1C at 6 months versus 72.4% and 72.9% at 6 and 12 months in the EMR dataset, respectively. Despite this, in the RCT dataset, 79.4% of patients achieved the target A1C and/or an FPG <130 mg/dL. In...
Current Medical Research and Opinion, 2008
Clinical Diabetes, 2021
The Chief Residents Summit on Intensifying Diabetes Management, now in its 15th year, has resulte... more The Chief Residents Summit on Intensifying Diabetes Management, now in its 15th year, has resulted in real-world improvements in patient outcomes and has shown itself to be an effective model for teaching diabetes to family medicine residents. This article describes the program and the evidence supporting its effectiveness.
Alzheimer's & Dementia
Innovation in Aging
Mild cognitive impairment (MCI) and Alzheimer’s disease (AD) dementia are characterized by cognit... more Mild cognitive impairment (MCI) and Alzheimer’s disease (AD) dementia are characterized by cognitive impairment and in AD a progressive functional impairment. This study sought to understand the role of geriatricians in treating patients with MCI/mild AD dementia. An anonymous, online survey was conducted in the US with 301 healthcare professionals (HCPs), including 75 primary care providers who practice as board certified geriatricians, and treat ≥10 patients per month with MCI/mild AD dementia. Geriatricians reported that among their patients with MCI/mild AD dementia, they initially make this diagnosis 70% of the time. Geriatricians reported that the topics commonly discussed with patients at the time of diagnosis are treatment options (85%), care management strategies (81%) and disease progression (80%). When referring patients to other specialties for treatment, geriatricians most often referred to neurologists (41%). Most (83%) geriatricians considered themselves the coordinat...
The Journal of family practice, 2019
As a continuing medical education provider accredited by the Accreditation Council for Continuing... more As a continuing medical education provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), Primary Care Education Consortium (PCEC) requires any individual in a position to influence educational content to disclose any financial interest or other personal relationship with any commercial interest. This includes any entity producing, marketing, re-selling or distributing health care goods or services consumed by, or used on, patients. Mechanisms are in place to identify and resolve any potential conflict of interest prior to the start of the activity. In addition, any discussion of off-label, experimental, or investigational use of drugs or devices will be disclosed by the faculty. Dr. Roth discloses that he serves on the advisory boards for Eisai, Idorsia Janssen, Jazz, and Merck.
The Journal of Family Practice, 2020
multivitamin was found to be the most popular supplement (58%) followed by vitamin D (31%), vitam... more multivitamin was found to be the most popular supplement (58%) followed by vitamin D (31%), vitamin C (28%), and protein (21%). The top reason for taking a dietary supplement was to improve overall health and wellness. Notably, supplement users were more likely to practice healthy lifestyle habits than non-users and less than one-quarter of supplements taken by adults were recommended by their physician or other health care provider. 1 The failure of the American diet to ensure micronutri-NUTRITIONAL STATUS IN THE UNITED STATES Although nutrition experts often advise that individuals consuming the standard American diet with 3 square meals a day do not need vitamins or nutritional supplements, it appears the American public disagrees. In fact, in 2019 the Council for Responsible Nutrition reported in its Consumer Survey on Dietary Supplements that 79% of adult females and 74% of adult males used dietary supplements with usage rates highest among those age 35 to 54 (81%) and those age >55 (79%). 1 A S2 CONTINUING MEDICAL EDUCATION LEARNING OBJECTIVES • Identify common shortfalls in the typical American diet. • Address the link between poor diet quality and chronic disease. DISCLOSURES As a continuing medical education provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), Primary Care Education Consortium (PCEC) requires any individual in a position to influence educational content to disclose any financial interest or other personal relationship with any commercial interest. This includes any entity producing, marketing, reselling or distributing health care goods or services consumed by, or used on, patients. Mechanisms are in place to identify and resolve any potential conflict of interest prior to the start of the activity. In addition, any discussion of off-label, experimental, or investigational use of drugs or devices will be disclosed by the faculty. Dr. Quan discloses he has no real or apparent conflicts of interests to report. Gregory Scott, PharmD, RPh, editorial support, discloses he has no real or apparent conflicts of interests to report. Additional PCEC staff report no conflicts of interest. SPONSORSHIP This activity is sponsored by Primary Care Education Consortium, in collaboration with the Primary Care Metabolic Group. ACCREDITATION The Primary Care Education Consortium is accredited by the Accreditation Council for Continuing Medical Education (AC-CME) to provide continuing medical education for physicians. CREDIT DESIGNATION AMA PRA Category 1-Primary Care Education Consortium designates this enduring material for a maximum of 1.0 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. CME is available September 1, 2020 to August 31, 2021.
Gastro Hep Advances, 2022
BACKGROUND AND AIMS: Helicobacter pylori eradication rates have declined as antibiotic resistance... more BACKGROUND AND AIMS: Helicobacter pylori eradication rates have declined as antibiotic resistance rates have increased. In addition, adherence to treatment guidelines is suboptimal. It is therefore important that contemporary, realworld evidence of diagnostic and treatment patterns is explored and compared with evidence-based guidelines. The Study of Acid-Related Disorders investigated unmet needs among patients with H pylori infection and past or current dyspepsia. METHODS: Gastroenterologists (GIs) and family physicians (FPs) or general practitioners (GPs) treating patients with H pylori infection and past or current dyspepsia completed a physician survey and invited patients to complete a patient survey; data were also extracted from the medical records of enrolled patients. RESULTS: Two hundred fifty-one physicians and 77 patients were enrolled. A total of 19.5% of patients were diagnosed by serology, whereas the urea breath test was used by 6.5% of GIs and 50.0% of FPs or GPs. A total of 68.6% of GIs and 79.8% of FPs or GPs selected clarithromycin, amoxicillin, and proton pump inhibitor triple therapy as their ideal first-line treatment. Physicians reported that 52.9% of patients experienced dyspepsia daily. A total of 46.8% of patients believed that complete resolution of dyspepsia would indicate effective treatment. As their treatment goal, 69.3% of physicians selected improvement in overall symptoms, whereas 92.2% of patients specified improvement in dyspepsia. Only 28.7% of physicians were satisfied with current treatment options. A total of 59.7% of patients took all of their prescribed medicine(s). A total of 59.7% of patients would prefer to take fewer pills; 45.5% would prefer convenience packs. CONCLUSION: This study reveals a lack of adherence to current H pylori guidelines for diagnosis, testing, and treatment. New treatment options that are more efficacious and simpler for patients to adhere to are needed.
Journal of the American Medical Directors Association, 2022
and Takeda; receives research support from NIA, Janssen, and Roche; is on the safety monitoring c... more and Takeda; receives research support from NIA, Janssen, and Roche; is on the safety monitoring committee for Anavex, EryDel, ITI, Newron, Intra-Cellular Therapies, Merck, and Newron; and on the speakers bureau for Acadia Pharmaceuticals Inc and Biogen.
International Journal of General Medicine, 2021
The presence of hallucinations and delusions in patients with neurodegenerative disease correlate... more The presence of hallucinations and delusions in patients with neurodegenerative disease correlates negatively with function, cognition, quality of life, and survival. When these patients still have insight, the treatment of mild hallucinations may reduce the risk of progression to more severe symptoms, specifically hallucinations without insight or delusions. On October 22, 2020, a multidisciplinary consensus panel comprising United States-based experts in geriatric psychiatry, geriatric medicine, family medicine, movement disorders, and neuropsychology was convened remotely to discuss best practices for using telemedicine to evaluate, diagnose, and treat psychosis in patients with neurodegenerative diseases. This review reflects the opinions and recommendations discussed at this meeting. Despite drawbacks, telemedicine can offer several advantages over in-person care, particularly for older adults, and may be a unique opportunity for care of patients with neuropsychiatric symptoms. While telemedicine may not be suitable for all patients, it allows the involvement of specialists from multiple geographic locations and the extension of care to homebound individuals. Patients with neurodegenerative diseases who are likely to become homebound as the disease advances may benefit greatly from telemedicine as a standard of care. Healthcare provided via telemedicine should be nothing less than what would be offered to the patient in person. Telemedicine may present some difficulties, including technological issues and inherent constraints of remote care, but with proper planning many problems could be diminished. Technical issues associated with telemedicine are inevitable but may be partially offset by providing clear directions ahead of any televisit to ensure connectivity and access to the videoconferencing platform. Alternative procedures to communicate should be established in the eventuality of technological issues. Using these strategies, telemedicine can serve as a valuable complement to traditional in-person practices for the diagnosis and management of hallucinations and delusions associated with Parkinson's disease psychosis or dementia-related psychosis.
SUMMARY The ability of nonpharmacologic and oral pharmacolog-ic therapies to maintain glycemic co... more SUMMARY The ability of nonpharmacologic and oral pharmacolog-ic therapies to maintain glycemic control in type 2 dia-betes almost invariably dissipates. Insulin therapy, there-fore, is eventually needed in the majority of patients withtype 2 diabetes. While many options are available, thenewer insulin analogs (insulin glargine, biphasic insulinaspart 70/30, and 75% insulin lispro protamine/25%insulin lispro), which more closely mimic the releaseand action of endogenous insulin in healthy persons,offer several advantages over conventional humaninsulins. Comprehensive care for the person with type 2diabetes includes diabetes education, ongoing adjust-ments and changes to therapy, and self-managementsupport guided by appropriate monitoring and screen-ing for the complications of diabetes. REFERENCES 1. Turner RC, Millns H, Neil HA, et al. Risk factors for coronary artery disease innon-insulin dependent diabetes mellitus: United Kingdom Prospective DiabetesStudy (UKPDS: 23). BMJ . 1998;...
Great improvements have been made to insulin preparations over the years, including the developme... more Great improvements have been made to insulin preparations over the years, including the development of insulin analogs, which were designed to overcome the disadvantages of traditional human insulins in the treatment of type 1 and type 2 diabetes. Insulin analogs more closely mimic the physiological insulin profile and are therefore associated with an improved balance between glycemic control and tolerability. They are also associated with a lower risk of hypoglycemia, less weight gain, and greater treatment flexibility than human insulins. These benefits, in combination with new insulin delivery devices, such as pens, have greatly improved patients’ treatment satisfaction and medication adherence, leading to improvements in clinical outcome. This article reviews the advantages of insulin analogs over human insulin for the treatment of type 1 and type 2 diabetes. Insulin was first used to treat diabetes in the 1920s. Early advances in therapy consisted of improvements in the purific...
SPONSORSHIP This activity is sponsored by PCEC and supported by funding from Bayer. and prescript... more SPONSORSHIP This activity is sponsored by PCEC and supported by funding from Bayer. and prescription analgesics. Prescription opioids are commonly used to treat musculoskeletal pain, although there is increasing awareness of the potential harm of opioid-related adverse events and misuse. Importantly, most musculoskeletal aches and pains are acute in nature and selftreatable with OTC analgesics, and flares associated with chronic conditions may also be appropriate for OTC management. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat musculoskeletal pain and are among the world’s most consumed prescription and OTC medications. Every day, approximately 30 million people worldwide use NSAIDs. In the United States, there are an estimated 30 billion doses of NSAIDs consumed annually, with over 100 million prescriptions written every year. In the United States, an OTC analgesic usage rate of 76% was reported, with more women self-medicating than men. Consumers with m...
American Journal of Gastroenterology, 2021
oxyntic cells within the patch. These IPs rarely benefit from aggressive acid blocking therapy. I... more oxyntic cells within the patch. These IPs rarely benefit from aggressive acid blocking therapy. In our study we found that symptoms secondary to IPs improved in a vast majority of patients after RFA, APC or manual removal. Some further avenues of research could compare methods of removal as well as determining efficacy of removal when patients have other concomitant GI conditions. Although the study population was small, the magnitude of the number of patients with improvement of symptoms was significant. Our results suggest that further studies are necessary to select which symptomatic individuals could benefit from IP ablation.
American Journal of Gastroenterology, 2021
The Journal of Family Practice, 2021
Low-dose aspirin (acetylsalicylic acid [ASA]; 75 to 100 mg/d) is widely used in the prevention of... more Low-dose aspirin (acetylsalicylic acid [ASA]; 75 to 100 mg/d) is widely used in the prevention of cardiovascular (CV) events based on the results of large-scale studies supporting a benefit. However, questions remain regarding the benefit-risk relationship in certain settings since long-term use of ASA is not devoid of risk. Incontrovertible evidence supports the benefits of ASA treatment, which exceed the risks, in patients who have had a previous CV event (myocardial infarction, stroke, unstable angina, or transient ischemic attack). Nonetheless, the question remains for those patients who have not had a previous event (primary prevention), where the risk of CV events is lower and, consequently, the absolute benefit is also lower than in patients who have a history of a CV event or its equivalent (secondary prevention). Recent evidence from large-scale clinical trials shows that administration of low-dose ASA is associated with a reduced risk of CV events with a corresponding smal...