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Objectives: Identifying characteristics associated with patients’ confidence managing diabetes may aid the primary care provider in offering diabetes self-management education and support to patients. This analysis assessed the relationship between demographic, health, economic, access to care, satisfaction with care, and healthcare utilization characteristics with patients’ confidence managing diabetes. Methods: United States adults with diabetes in the 2020 Medical Expenditure Panel Survey were included in this retrospective cross-sectional analysis. Characteristics related statistically to patients’ confidence managing diabetes in multivariable logistic regression analysis were reported. Results: Among the 1,516 eligible individuals, 76.3% stated they were very confident/confident with their diabetes management. Adults who perceived their health positively (odds ratio 2.3, 95% confidence interval [CI] 1.3–3.9), completed ≥30 min moderate/vigorous exercise five times weekly (odds ratio 1.6, 95% CI 1.0–2.6), had at least one inpatient discharge in 2020 (odds ratio 3.5, 95% CI 1.5–8.1), said it was not difficult to telephone their usual provider (odds ratio 3.3, 95% CI 1.4–7.8), and had no emergency room visits in 2020 (odds ratio 2, 95% CI 1.1–3.3) had higher odds of stating they were very confident or confident with their diabetes management. Conclusion: The characteristics associated with being very confident/confident managing diabetes should be considered by primary healthcare physicians and other healthcare professionals when helping patients manage diabetes.

The aim of this study was to assess the associations between the characteristics of United States (US) adults (≥50 years) who used opioids and self-reported pain severity using a nationally representative dataset.

Globally, gastric cancer is a major cause of cancer mortality, with a 5-year survival rate of 32% for locally advanced and metastatic gastric cancer (A/MCG). This systematic literature review summarized the clinical, safety, and humanistic outcomes associated with systemic regimens administered as a first-line therapy for A/MGC. The search included articles published in English in PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and the American Society of Clinical Oncology meeting library, from inception to April 2022. Phase II and III randomized controlled trials (RCTs) conducted among western populations diagnosed with stage III and IV A/MGC were included. Two investigators independently reviewed the studies, conducted data extraction, and assessed risk of bias in accordance with PRISMA guidelines. Twenty-four randomized controlled trials totaling 8705 patients were included. Median overall survival ranged from 5.0 to 13.1 months, median progression-free survival ranged from 2.0 to 7.7 months, and objective response ranged from 13.0 to 64.1%. Two studies reported high quality-of-life outcomes. Grade 3 and 4 adverse events were reported in most studies. This review provides a comprehensive overview of first-line systemic therapy outcomes in western populations with A/MGC. With the evolving treatment landscape of A/MGC, an improvement in clinical outcomes can be seen in recently published RCTs with immunotherapies. The potential of new targeted treatments and immunotherapies may present more favorable forthcoming options for treating A/MGC.

There is little published research on limited physical functioning in United States (US) adults with arthritis. The objective of this cross-sectional 2021 Medical Expenditure Panel Survey (MEPS) database study was to investigate the variables associated with limited physical functioning in US adults with arthritis. Logistic regression tested the associations of predisposing, enabling, and need variables with the dependent variable (limited physical functioning). This study included 5102 US adults with arthritis, reflecting an estimated weighted population of 64,136,870 US adults with arthritis. In the final multivariable logistic regression model, age ≥ 70 and ages 60–69 (vs. 18–49 years), female (vs. male) sex, having quite a bit/extreme or moderate (vs. little) pain, and having 6+ or 4–5 (vs. 0–1) comorbid conditions were all associated with higher odds of the person stating they had limited physical functioning. Whereas high school or less (vs. more than high school), being employed (vs. unemployed), being married (vs. not married), having excellent/very good or good (vs. poor) general health, and exercise (vs. no exercise) were each associated with lower odds of the person reporting they had limited physical functioning. Future work may be considered to explore these variables in greater detail.

The purpose of this paper is to provide a description and evaluation of a graduate-level Health Services Research Methods course offered at the University of Arizona R. Ken Coit College of Pharmacy. This three-credit, round-table discussion-style course introduces students to fundamental concepts in healthcare study design and teaches them how to design and critique example studies for a variety of commonly encountered study designs. The course is assessed through essay-style examinations, development of a research proposal, and low-stakes weekly assignments. Twenty-seven students have completed the course in the past five years. Feedback from student course surveys was almost unanimously positive, with few meaningful suggestions for improvement. The description and evaluation of a graduate-level Health Services Research Methods course at one institution indicates that students had a largely favorable experience with the course. Considerations for future revisions to the course are discussed alongside other lessons learned.

Studies have explored the association of particular conditions, or combinations of conditions, and pain among specific populations. However, there is limited information regarding the association of the number of comorbid conditions, as well as other demographic, economic, health, and limitation variables, with pain among adults in the United States. This cross-sectional database study aimed to examine the relationships between number of comorbid conditions (including cancer, arthritis, joint pain, stroke, heart attack, angina, coronary heart disease, high cholesterol, high blood pressure, other heart diseases, diabetes, asthma, chronic bronchitis, and emphysema), demographic, economic, health, and limitation variables with pain among United States adults using 2021 Medical Expenditure Panel Survey data. A multivariable logistic model assessed the association between the number of comorbid conditions (≥6, 5, 4, 3, 2, 1, versus 0 conditions) and quite a bit/extreme (versus little/moderate) pain, adjusting for demographic, economic, health, and limitation variables. The study found that greater numbers of comorbid conditions were associated with higher odds of quite a bit or extreme pain. In addition, age, education, employment, income, overall health, regular physical activity, and three limitation variables were each associated with pain in the multivariable model. These findings offer insight into the association between number of comorbid conditions and other variables with pain and suggest areas where interventions may be helpful to help improve pain outcomes for United States adults.

Migraine is a prevalent disease associated with high levels of disability and is often underdiagnosed and undertreated. This systematic literature review aimed to identify the types of pharmacological and non-pharmacological strategies that community-dwelling adults report using to manage migraine. A systematic literature review of relevant databases, grey literature, websites, and journals was conducted from 1 January 1989 to 21 December 2021. Study selection, data extraction, and risk of bias assessment were completed independently by multiple reviewers. Data were extracted on migraine management strategies and categorized as opioid and non-opioid medications and medical, physical, psychological, or self-initiated strategies. A total of 20 studies were included. The sample sizes ranged from 138 to 46,941, with a mean age of 34.7 to 79.9 years. The data were typically collected using self-administered questionnaires (nine studies), interviews (five studies), online surveys (three studies), paper-based surveys (two studies), and a retrospective database (one study). Community-dwelling adults with migraine reported they primarily used medications, specifically triptans (range 9–73%) and non-steroidal anti-inflammatory drugs (NSAIDs) (range 13–85%) to manage migraine. Except for medical strategies, the use of other non-pharmacological strategies was low. Common non-pharmacological strategies included consulting physicians (range 14–79%) and heat or cold therapy (35%).

Contemporary estimates of the association between functional impairment and health costs among United States (US) older adults who documented having pain are unavailable. We used a retrospective database design and developed unadjusted and adjusted linear regression models to assess total, office, outpatient, emergency department, inpatient, and prescribed drug costs between older US adults with and without functional impairment. We included US adults aged ≥ 50 in the 2020 Medical Expenditure Panel Survey dataset who documented having pain in the past month. We also included only those who had positive health costs. Among the 40,092,210 US adults aged ≥ 50 who documented having pain in the past month, we found 37% had functional impairment. In adjusted linear regression models, we found adults with functional impairment (versus adults without functional impairment) had 57.2% higher total health costs and 54.1% higher prescribed drug costs. We did not observe any statistical differences between groups for office, outpatient, emergency department, or inpatient costs. In conclusion, the higher total and prescribed drug costs we found among US older adults with pain and a functional impairment draws attention to the financial burden of functional impairment among these individuals, which needs to be addressed.

The purpose of this cross-sectional study was to investigate the relationship between Body Mass Index (BMI), cholesterol, and cancer in United States (US) adults. Data were collected from the 2020 Medical Expenditure Panel Survey (MEPS). Eligible participants were US adults (≥18 years) with data on BMI, cholesterol, and cancer status, who were alive at the end of the data collection period. An adjusted logistic regression model assessed associations between eight possible combinations of BMI and cholesterol status (independent variable) with cancer diagnosis (dependent variable). Among 27,805 individuals in the 2020 MEPS data, 20,818 met the eligibility criteria (weighted N = 252,340,615). Of these 2668 (weighted N = 29,770,359) had cancer and 18,150 (weighted N = 222,570,256) did not have cancer. In the adjusted logistic regression model, underweight and normal weight individuals with high cholesterol were associated with higher odds of cancer (odds ratio, OR = 2.002, and 95% confidence interval, CI = 1.032–3.885, and OR = 1.326 and 95% CI = 1.047–1.681, respectively), while obese individuals with normal cholesterol were associated with lower odds of cancer (OR = 0.681; 95% CI = 0.543–0.853) compared to normal weight individuals with normal cholesterol. This study offers insights into specific groups of individuals who may be prioritized for cancer prevention. Further research is required to investigate these findings in additional subpopulations.

In the last two decades in the United States (US), the previous research has focused on medication optimization, including polypharmacy. Polypharmacy is associated with several negative outcomes, which may be resolved by deprescribing medications that are no longer necessary. Although deprescribing is a critical aspect of a pharmacist’s role, some studies have demonstrated that student pharmacists are less familiar with their future role in deprescribing. Thus, this study aimed to explore student pharmacists’ perceptions of deprescribing in the pharmacy curriculum. This qualitative study was conducted with student pharmacists enrolled in three Doctor of Pharmacy (Pharm.D.) programs in the US. The participants, all student pharmacists at the time of the study, were identified via an email requesting their voluntary participation in a focus group study. The focus groups were conducted via an online platform over three months in 2022, and recruitment continued until thematic saturation was obtained. Using thematic analysis, the corpus of the transcribed data was imported into Dedoose®, a qualitative software that facilitated the analysis. Three themes emerged from the data: (1) the importance of deprescribing; (2) barriers to deprescribing; (3) education recommendations. The data highlight that the student pharmacists believe integrating deprescribing content into the clinical, didactic, and simulation education would help them overcome the identified obstacles. Colleges of pharmacy should consider emphasizing the importance of deprescribing in their curriculum, creating programs to assist future pharmacists in addressing the barriers to deprescribing, and adopting the suggested educational strategies to improve the deprescribing education that is offered.

Many countries are observing significant growth rates in electric vehicle (EV) uptake, often backed by financial incentives or regulation and legislation. The availability of large multi-charger sites for rapid EV charging with an experience similar to conventional refuelling stations lowers the barrier to acceptance for drivers considering the switch to using an EV. The question arises about how to size such a facility at the design and planning stage, as well as accommodating growth in the number of EVs in daily use. One of the important factors is the vehicle arrival rate and the corresponding power and energy demand. EV charging is a function of several parameters, all of which are stochastic in nature, such as the vehicle daily travelled distance, charging start time and the required energy. To account for uncertainty in the parameters, a stochastic model has been designed to simulate realistic vehicle arrival rates. The model accounts for EVs coming from the site catchment area and opportunistic charging from passing traffic travelling on the major roads adjacent to the site, the seasonality of parameters, and charging at places other than the site (competitive charging). The model produced plausible EV arrival patterns for both local and passing traffic, and reproduced the characteristic power demand at the case study site. All estimates incorporate uncertainty, reflecting realistic variability of the important parameters. The model in independent of location, uses open-source data, and is structured flexibly, making it adaptable to new sites as part of the technical and business planning process.