Risk assessment and real-world outcomes in chronic thromboembolic pulmonary hypertension: insights from a UK pulmonary hypertension referral service.

OBJECTIVES: This study was conducted to evaluate the ability of risk assessment to predict healthcare resource utilisation (HCRU), costs, treatments, health-related quality of life (HRQoL) and survival in patients diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH). DESIGN: Retrospective observational study. SETTING: Pulmonary hypertension referral centre in the UK. PARTICIPANTS: Adults diagnosed with CTEPH between 1 January 2012 and 30 June 2019 were included. Cohorts were retrospectively defined for operated patients (received pulmonary endarterectomy (PEA)) and not operated; further subgroups were defined based on risk score (low, intermediate or high risk for 1-year mortality) at diagnosis. PRIMARY AND SECONDARY OUTCOME MEASURES: Demographics, clinical characteristics, comorbidities, treatment patterns, HRQoL, HCRU, costs and survival outcomes were analysed. RESULTS: Overall, 683 patients were analysed (268 (39%) operated; 415 (61%) not operated). Most patients in the operated and not-operated cohorts were intermediate risk (63%; 53%) or high risk (23%; 31%) at diagnosis. Intermediate-risk and high-risk patients had higher HCRU and costs than low-risk patients. Outpatient and accident and emergency visits were lower postdiagnosis for both cohorts and all risk groups versus prediagnosis. HRQoL scores noticeably improved in the operated cohort post-PEA, and less so in the not-operated cohort at 6-18 months postdiagnosis. Survival at 5 years was 83% (operated) and 49% (not operated) and was lower for intermediate-risk and high-risk patients compared with low-risk patients. CONCLUSIONS: Findings from this study support that risk assessment at diagnosis is prognostic for mortality in patients with CTEPH. Low-risk patients have better survival and HRQoL and lower HCRU and costs compared with intermediate-risk and high-risk patients.

Estradiol-17ß Pharmacokinetics and Histological Assessment of the Ovaries and Uterine Horns following Intramuscular Administration of Estradiol Cypionate in Feral Cats.

The control of feral cats (Felis catus) in Australia is a key biological conservation issue. Male cats are more difficult to control than female cats. Collared and tagged female cats displaying estrous behavior have been considered as a way to lure male cats and reveal their locations. As female cats are seasonal breeders, artificial induction of estrous behavior following the administration of a long-acting estrogen could improve their use for this purpose. Estradiol cypionate was intramuscularly administered to nine entire non-pregnant female feral cats, of unknown estrous status, at 0.1, 0.3, or 0.5 mg/kg. Mean peak serum concentrations of estradiol-17ß were 365 pg/mL (0.1 mg/kg), 1281 pg/mL (0.3 mg/kg), and 1447 pg/mL (0.5 mg/kg). The time-course of estradiol-17ß concentrations after various doses of estradiol cypionate was assessed using non-compartmental and non-linear mixed-effects methods. At the highest-studied dose (0.5 mg/kg), the 50th percentile of estradiol-17ß concentrations exceeded 0.1 ng/mL for 11.8 days, and 0.05 ng/mL for 14.6 days. The duration increased with increasing dose. No signs of toxicity were noticed in any cat during the study. This information will be useful to ongoing studies that are investigating ways to reduce the abundance of feral cats in Australia, especially adult male cats.

A Review of Prognostic Tools in Heart Failure.

A minority of patients with end-stage disease are referred to palliative medicine for consultation in advanced heart failure. Educating stakeholders, including primary care, cardiology, and critical care of the benefits of hospice and palliative medicine for patients with poor prognosis, may increase appropriately timed referrals and improve quality of life for these patients. This article reviews multiple tools useful in prognostication in the setting of advanced heart failure.

Leadership models in health care - a case for servant leadership.

Our current health care system is broken and unsustainable. Patients desire the highest quality care, and it needs to cost less. To regain public trust, the health care system must change and adapt to the current needs of patients. The diverse group of stakeholders in the health care system creates challenges for improving the value of care. Health care providers are in the best position to determine effective ways of improving the value of care. To create change, health care providers must learn how to effectively lead patients, those within health care organizations, and other stakeholders. This article presents servant leadership as the best model for health care organizations because it focuses on the strength of the team, developing trust and serving the needs of patients. As servant leaders, health care providers may be best equipped to make changes in the organization and in the provider-patient relationship to improve the value of care for patients.