ImportanceTo date, no psychopharmacologic treatment has been found to be uniformly effective in v... more ImportanceTo date, no psychopharmacologic treatment has been found to be uniformly effective in veterans with posttraumatic stress disorder (PTSD); novel targets and approaches are needed to treat this disabling disorder.ObjectiveTo examine whether treatment with the glucocorticoid receptor antagonist mifepristone yields a signal for clinical efficacy in male veterans with PTSD.Design, Setting, and ParticipantsThis phase 2a, double-blind, parallel-group randomized clinical trial was conducted from November 19, 2012 (accrual started), through November 16, 2016 (final follow-up), within the US Department of Veterans Affairs. Participants were male veterans with chronic PTSD and a screening Clinician-Administered PTSD Scale score of 50 or higher. A total of 181 veterans consented to participation. Statistical analysis was conducted between August 2014 and May 2017.InterventionsParticipants were randomized in a 1:1 ratio to mifepristone (600 mg) or matched placebo taken orally for 7 day...
IMPORTANCE Osteoarthritis (OA) is a major cause of disability in the US, with no approved treatme... more IMPORTANCE Osteoarthritis (OA) is a major cause of disability in the US, with no approved treatments to slow progression, but animal models suggest that pulsed low-intensity ultrasonography (PLIUS) may promote cartilage growth. OBJECTIVE To evaluate the efficacy of PLIUS in providing symptom reduction and decreased loss of tibiofemoral cartilage thickness in patients with knee OA.
More than 50 million Americans suffer from chronic pain, and approximately 20 million individuals... more More than 50 million Americans suffer from chronic pain, and approximately 20 million individuals have severe chronic pain that interferes with life or work activities. This is a particular concern for the Veterans Health Administration (VHA) as chronic pain has been found to be more common, severe, and complex in Veterans. In addition to chronic pain, military Veterans often suffer from other complex medical and mental health issues. Opioid analgesics are often used to treat chronic noncancer pain (CNCP); however, there is insufficient evidence that longterm use improves chronic pain or functioning. Furthermore, long-term opioid use is associated with increased mood disorders prevalence and several potential harms including overdose (OD), the development of opioid use disorder (OUD), and possibly death. Nearly 10 million Americans misuse or abuse opioids, which may elevate the risk for developing OUD. An estimated 2 million individuals have OUD, and to date, approximately 450,000 p...
To estimate blood pressure control and identify treatment variables predicting control in treatme... more To estimate blood pressure control and identify treatment variables predicting control in treatment-compliant, hypertensive, male veterans. Outpatient clinic of a Veterans Affairs medical center. Retrospective review of computerized patient records over a 12-month period for demographics, comorbidities, patient-specific blood pressure goals, blood pressure history, antihypertensive therapy, and refill history. Two hundred fifty hypertensive men aged 39-90 years whose antihypertensive regimen remained unchanged over 12 months. The proportion of patients with blood pressures below 160/90 mm Hg was 86%; only 34.8% had pressures below 140/90 mm Hg. Blood pressure control was less common with advancing age (42.1%, 33.7%, and 29.4% for patients aged < 60, 60-75, and > 75 yrs, respectively, p = 0.057 for trend). Treatment intensity was highest in obese men, those aged 60-75 years, and those with a history of chronic heart failure or angina, and lowest in men older than 75 years or with a history of stroke. Blood pressure control was independently associated with therapy with beta-blockers (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.5-10.2, p = 0.005), loop diuretics (OR 4.3, 95% CI 1.6-12.1, p = 0.005), angiotensin-converting enzyme inhibitors (OR 3.1, 95% CI 1.2-8.2, p = 0.025), and long-term simvastatin therapy (OR 3.7, 95% CI 1.9-7.4, p = 0.0001), and with a diagnosis of coronary artery disease (OR 3.2, 95% CI 1.35-7.69, p = 0.009). The relationship between simvastatin therapy and blood pressure control persisted after controlling for the higher treatment intensity in patients taking the drug. Factors predicting poor control included a history of stroke (OR for control 0.36, 95% CI 0.19-0.69, p = 0.002), age over 75 years (OR 0.43, 95% CI 0.18-0.98, p = 0.046), highest low-density lipoprotein tertile (OR 0.37, 95% CI 0.17-0.80, p = 0.013), highest body mass index tertile (OR 0.46, 95% CI 0.21-1.00, p = 0.05), and therapy with two or fewer antihypertensives (OR 0.14, 95% CI 0.04-0.61, p = 0.009). In a compliant veteran population, control of blood pressure appeared inadequate but was significantly more likely in those receiving at least three antihypertensive agents. Long-term therapy with simvastatin was independently associated with increased odds of control.
Pharmacotherapy the Journal of Human Pharmacology and Drug Therapy, Feb 1, 2004
To estimate blood pressure control and identify treatment variables predicting control in treatme... more To estimate blood pressure control and identify treatment variables predicting control in treatment-compliant, hypertensive, male veterans. Outpatient clinic of a Veterans Affairs medical center. Retrospective review of computerized patient records over a 12-month period for demographics, comorbidities, patient-specific blood pressure goals, blood pressure history, antihypertensive therapy, and refill history. Two hundred fifty hypertensive men aged 39-90 years whose antihypertensive regimen remained unchanged over 12 months. The proportion of patients with blood pressures below 160/90 mm Hg was 86%; only 34.8% had pressures below 140/90 mm Hg. Blood pressure control was less common with advancing age (42.1%, 33.7%, and 29.4% for patients aged < 60, 60-75, and > 75 yrs, respectively, p = 0.057 for trend). Treatment intensity was highest in obese men, those aged 60-75 years, and those with a history of chronic heart failure or angina, and lowest in men older than 75 years or with a history of stroke. Blood pressure control was independently associated with therapy with beta-blockers (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.5-10.2, p = 0.005), loop diuretics (OR 4.3, 95% CI 1.6-12.1, p = 0.005), angiotensin-converting enzyme inhibitors (OR 3.1, 95% CI 1.2-8.2, p = 0.025), and long-term simvastatin therapy (OR 3.7, 95% CI 1.9-7.4, p = 0.0001), and with a diagnosis of coronary artery disease (OR 3.2, 95% CI 1.35-7.69, p = 0.009). The relationship between simvastatin therapy and blood pressure control persisted after controlling for the higher treatment intensity in patients taking the drug. Factors predicting poor control included a history of stroke (OR for control 0.36, 95% CI 0.19-0.69, p = 0.002), age over 75 years (OR 0.43, 95% CI 0.18-0.98, p = 0.046), highest low-density lipoprotein tertile (OR 0.37, 95% CI 0.17-0.80, p = 0.013), highest body mass index tertile (OR 0.46, 95% CI 0.21-1.00, p = 0.05), and therapy with two or fewer antihypertensives (OR 0.14, 95% CI 0.04-0.61, p = 0.009). In a compliant veteran population, control of blood pressure appeared inadequate but was significantly more likely in those receiving at least three antihypertensive agents. Long-term therapy with simvastatin was independently associated with increased odds of control.
ImportanceTo date, no psychopharmacologic treatment has been found to be uniformly effective in v... more ImportanceTo date, no psychopharmacologic treatment has been found to be uniformly effective in veterans with posttraumatic stress disorder (PTSD); novel targets and approaches are needed to treat this disabling disorder.ObjectiveTo examine whether treatment with the glucocorticoid receptor antagonist mifepristone yields a signal for clinical efficacy in male veterans with PTSD.Design, Setting, and ParticipantsThis phase 2a, double-blind, parallel-group randomized clinical trial was conducted from November 19, 2012 (accrual started), through November 16, 2016 (final follow-up), within the US Department of Veterans Affairs. Participants were male veterans with chronic PTSD and a screening Clinician-Administered PTSD Scale score of 50 or higher. A total of 181 veterans consented to participation. Statistical analysis was conducted between August 2014 and May 2017.InterventionsParticipants were randomized in a 1:1 ratio to mifepristone (600 mg) or matched placebo taken orally for 7 day...
IMPORTANCE Osteoarthritis (OA) is a major cause of disability in the US, with no approved treatme... more IMPORTANCE Osteoarthritis (OA) is a major cause of disability in the US, with no approved treatments to slow progression, but animal models suggest that pulsed low-intensity ultrasonography (PLIUS) may promote cartilage growth. OBJECTIVE To evaluate the efficacy of PLIUS in providing symptom reduction and decreased loss of tibiofemoral cartilage thickness in patients with knee OA.
More than 50 million Americans suffer from chronic pain, and approximately 20 million individuals... more More than 50 million Americans suffer from chronic pain, and approximately 20 million individuals have severe chronic pain that interferes with life or work activities. This is a particular concern for the Veterans Health Administration (VHA) as chronic pain has been found to be more common, severe, and complex in Veterans. In addition to chronic pain, military Veterans often suffer from other complex medical and mental health issues. Opioid analgesics are often used to treat chronic noncancer pain (CNCP); however, there is insufficient evidence that longterm use improves chronic pain or functioning. Furthermore, long-term opioid use is associated with increased mood disorders prevalence and several potential harms including overdose (OD), the development of opioid use disorder (OUD), and possibly death. Nearly 10 million Americans misuse or abuse opioids, which may elevate the risk for developing OUD. An estimated 2 million individuals have OUD, and to date, approximately 450,000 p...
To estimate blood pressure control and identify treatment variables predicting control in treatme... more To estimate blood pressure control and identify treatment variables predicting control in treatment-compliant, hypertensive, male veterans. Outpatient clinic of a Veterans Affairs medical center. Retrospective review of computerized patient records over a 12-month period for demographics, comorbidities, patient-specific blood pressure goals, blood pressure history, antihypertensive therapy, and refill history. Two hundred fifty hypertensive men aged 39-90 years whose antihypertensive regimen remained unchanged over 12 months. The proportion of patients with blood pressures below 160/90 mm Hg was 86%; only 34.8% had pressures below 140/90 mm Hg. Blood pressure control was less common with advancing age (42.1%, 33.7%, and 29.4% for patients aged < 60, 60-75, and > 75 yrs, respectively, p = 0.057 for trend). Treatment intensity was highest in obese men, those aged 60-75 years, and those with a history of chronic heart failure or angina, and lowest in men older than 75 years or with a history of stroke. Blood pressure control was independently associated with therapy with beta-blockers (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.5-10.2, p = 0.005), loop diuretics (OR 4.3, 95% CI 1.6-12.1, p = 0.005), angiotensin-converting enzyme inhibitors (OR 3.1, 95% CI 1.2-8.2, p = 0.025), and long-term simvastatin therapy (OR 3.7, 95% CI 1.9-7.4, p = 0.0001), and with a diagnosis of coronary artery disease (OR 3.2, 95% CI 1.35-7.69, p = 0.009). The relationship between simvastatin therapy and blood pressure control persisted after controlling for the higher treatment intensity in patients taking the drug. Factors predicting poor control included a history of stroke (OR for control 0.36, 95% CI 0.19-0.69, p = 0.002), age over 75 years (OR 0.43, 95% CI 0.18-0.98, p = 0.046), highest low-density lipoprotein tertile (OR 0.37, 95% CI 0.17-0.80, p = 0.013), highest body mass index tertile (OR 0.46, 95% CI 0.21-1.00, p = 0.05), and therapy with two or fewer antihypertensives (OR 0.14, 95% CI 0.04-0.61, p = 0.009). In a compliant veteran population, control of blood pressure appeared inadequate but was significantly more likely in those receiving at least three antihypertensive agents. Long-term therapy with simvastatin was independently associated with increased odds of control.
Pharmacotherapy the Journal of Human Pharmacology and Drug Therapy, Feb 1, 2004
To estimate blood pressure control and identify treatment variables predicting control in treatme... more To estimate blood pressure control and identify treatment variables predicting control in treatment-compliant, hypertensive, male veterans. Outpatient clinic of a Veterans Affairs medical center. Retrospective review of computerized patient records over a 12-month period for demographics, comorbidities, patient-specific blood pressure goals, blood pressure history, antihypertensive therapy, and refill history. Two hundred fifty hypertensive men aged 39-90 years whose antihypertensive regimen remained unchanged over 12 months. The proportion of patients with blood pressures below 160/90 mm Hg was 86%; only 34.8% had pressures below 140/90 mm Hg. Blood pressure control was less common with advancing age (42.1%, 33.7%, and 29.4% for patients aged < 60, 60-75, and > 75 yrs, respectively, p = 0.057 for trend). Treatment intensity was highest in obese men, those aged 60-75 years, and those with a history of chronic heart failure or angina, and lowest in men older than 75 years or with a history of stroke. Blood pressure control was independently associated with therapy with beta-blockers (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.5-10.2, p = 0.005), loop diuretics (OR 4.3, 95% CI 1.6-12.1, p = 0.005), angiotensin-converting enzyme inhibitors (OR 3.1, 95% CI 1.2-8.2, p = 0.025), and long-term simvastatin therapy (OR 3.7, 95% CI 1.9-7.4, p = 0.0001), and with a diagnosis of coronary artery disease (OR 3.2, 95% CI 1.35-7.69, p = 0.009). The relationship between simvastatin therapy and blood pressure control persisted after controlling for the higher treatment intensity in patients taking the drug. Factors predicting poor control included a history of stroke (OR for control 0.36, 95% CI 0.19-0.69, p = 0.002), age over 75 years (OR 0.43, 95% CI 0.18-0.98, p = 0.046), highest low-density lipoprotein tertile (OR 0.37, 95% CI 0.17-0.80, p = 0.013), highest body mass index tertile (OR 0.46, 95% CI 0.21-1.00, p = 0.05), and therapy with two or fewer antihypertensives (OR 0.14, 95% CI 0.04-0.61, p = 0.009). In a compliant veteran population, control of blood pressure appeared inadequate but was significantly more likely in those receiving at least three antihypertensive agents. Long-term therapy with simvastatin was independently associated with increased odds of control.
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