副甲状腺切除术中的差异:谁能接受初级甲状腺功能障碍症的适当治疗?
Alaa Sada1, Kristine T Hanson2, Elizabeth B Habermann2
1Department of Surgery, Mayo Clinic, Rochester, Minnesota.
The Journal of surgical research
|July 3, 2023
概括
甲状腺切除术在一次性甲状腺功能障碍症 (PHPT) 中表现不佳. 拥有政府保险的患者面临更长的手术等待时间,突出了医疗护理获取方面的差异.
科学领域:
- 内分泌学 在内分泌学.
- 手术瘤学手术瘤学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 原发性副甲状腺功能障碍 (PHPT) 是一种常见的内分泌疾病,尽管已确立的好处,但经常被副甲状腺切除术治疗不足.
- 对PHPT的手术干预对于管理高血症及其相关并发症至关重要,但在获取上存在差异.
研究的目的:
- 评估在被诊断为PHPT的患者中接受副甲状腺切除术的差异.
- 确定PHPT手术护理的潜在障碍,重点关注人口和保险相关因素.
主要方法:
- 在卫生系统中,对在2013-2018年间被诊断患有PHPT的成年患者进行了回顾性分析.
- 使用Kaplan-Meier和多变量Cox比例危险分析来评估副甲状腺切除术率和相关因素.
主要成果:
- 在2409名患者中,50%的患者在一年内接受了副甲状腺切除术;在那些符合强烈的外科指示的人群中,这一比例更高 (54%).
- 具有商业/自助/无保险身份和年龄较小 (≤50岁) 的患者更有可能接受副甲状腺切除术.
- 患有医疗补助/医疗保险的患者经历了更长的中位数手术时间,并且即使有强烈的迹象,也不太可能接受手术.
结论:
- 在PHPT的甲状腺切除术中观察到显著的差异,特别是与保险类型相关.
- 有政府保险的患者面临延迟和手术可能性降低,这表明获得护理的障碍.
- 需要对转诊和手术接入障碍进行进一步调查,以确保所有PHPT患者得到公平的治疗.
相关概念视频
00:59The Parathyroid Glands
2.2K
The two pairs of parathyroid glands embedded within the posterior surface of the thyroid gland are restricted by a dense capsule around them. These glands comprise two distinct cell populations—parathyroid oxyphil and parathyroid principal cells- pivotal in calcium homeostasis.
Oxyphil cells, whose functions remain elusive, emerge during late puberty, adding a layer of complexity to the parathyroid gland's intricacies. In contrast, principal parathyroid cells undertake a vital role by...
Oxyphil cells, whose functions remain elusive, emerge during late puberty, adding a layer of complexity to the parathyroid gland's intricacies. In contrast, principal parathyroid cells undertake a vital role by...
2.2K
01:26Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers
209
Receptor tyrosine kinase inhibitors (TKIs) and calcium channel blockers (CCBs) are two critical categories of drugs employed in the treatment of pulmonary artery hypertension (PAH). PAH is a disease that causes high blood pressure in the pulmonary arteries, resulting in chest pain, fatigue, and shortness of breath.
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
209
01:28Treatment for Pulmonary Arterial Hypertension: Phosphodiesterase Inhibitors
194
Phosphodiesterase 5 (PDE5) inhibitors are potent enzymes that function to hydrolyze cyclic nucleotides to their corresponding 5' monophosphates. Their unique biochemical properties have been applied in treating Pulmonary Arterial Hypertension (PAH).
Among the PDE5 inhibitors, sildenafil (Revatio) stands out as a competitive and selective inhibitor. It operates by elevating cellular levels of cGMP and augmenting signaling through the cGMP-PKG pathway, promoting vasodilation. Upon oral...
Among the PDE5 inhibitors, sildenafil (Revatio) stands out as a competitive and selective inhibitor. It operates by elevating cellular levels of cGMP and augmenting signaling through the cGMP-PKG pathway, promoting vasodilation. Upon oral...
194
01:17Hormones and Bone Tissue
2.7K
The endocrine system produces and secretes hormones, which interact with the skeletal system. These hormones control bone growth, maintain bone once it is formed, and remodel it.
Hormones That Influence Osteoblasts and/or Maintain the Matrix
Several hormones are necessary for controlling bone growth and maintaining the bone matrix. The pituitary gland secretes growth hormone (GH), which, as its name implies, controls bone growth. This happens in several ways: first, it triggers chondrocyte...
Hormones That Influence Osteoblasts and/or Maintain the Matrix
Several hormones are necessary for controlling bone growth and maintaining the bone matrix. The pituitary gland secretes growth hormone (GH), which, as its name implies, controls bone growth. This happens in several ways: first, it triggers chondrocyte...
2.7K
01:27Peripheral Artery Disease III: Interprofessional Care
11
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
11
01:23Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
218
Prostacyclin receptor agonists are a class of therapeutic agents integral to managing pulmonary arterial hypertension (PAH). These drugs operate by mimicking the action of prostaglandin I2, or PGI2, a naturally occurring compound in the body.
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
218