UnitedHealth Group (United States)

replicable roadmap for other healthcare organizations aiming to elevate board engagement in quality and patient safety. 21

IntroductionDeveloping and implementing trauma clinical guidance is integral to providing quality care to all trauma patients while maintaining a minimum standard of treatment. A mixed-methods novel consensus-building approach was used to identify the current barriers to developing and implementing trauma clinical guidance and highlight the priority areas for change to better support end users.MethodsAs part of year 1 of the Design for Implementation: The Future of Trauma Clinical Guidance and Research Conference Series, preconference participant surveys and hybrid, professionally facilitated, structured dialogue were used to define the ideal future state of trauma clinical guidance development and dissemination. Novel to this context, in-person and virtual “user stories”, a form of structured focus group, were generated, and a “minimum viable product” (MVP), a form of brokered dialogue, was developed. Descriptive statistics and thematic analysis were used to evaluate preconference survey and “user story” results.Results72 in-person and up to 35 virtual attendees participated. The majority (92%) of in-person attendees and nearly half (48%) of virtual attendees completed the preconference survey. Participants identified barriers along the continuum of clinical guidance development, dissemination, and adoption. Areas for improvement centered around the creation, storage, and use of guidance. Across the survey and user stories, participants expressed the need for clinical guidance that is comprehensive, evidence-based, coordinated, and easily accessible by all clinicians both domestically and abroad. The MVP targeted the risks and objectives to improved guidance. A prominent theme throughout this consensus-building assessment was the imperative for collaboration between professional societies for clinical guidance development and dissemination.DiscussionTrauma clinical guidance must be current, consolidated, and coordinated with patient-centered outcomes prioritized. Next steps include turning the MVP produced into a prototype and refining it to inform a national redesign of trauma clinical guidance.Level of evidenceLevel III.

Container orchestration has emerged as the foundation of modern cloud-native application development, fundamentally transforming how distributed systems are designed, deployed, and managed across enterprise environments. Kubernetes, an open-source container orchestration platform, has emerged as the de facto standard for scaling containerized applications and sits at the center of this transformation. The platform's core components, including Pods, Services, and Deployments, establish the foundational architecture for microservices communication and lifecycle management. Advanced deployment strategies encompassing rolling updates, blue-green transitions, and canary releases enable organizations to maintain continuous service availability while implementing frequent code changes. The horizontal and vertical autoscaling capabilities automatically adjust resource allocation based on real-time demand patterns, ensuring optimal performance during traffic fluctuations. Cluster autoscaling complements application-level scaling through intelligent infrastructure provisioning and cost optimization. Comprehensive monitoring and configuration management features provide deep operational visibility while maintaining security and compliance standards. The declarative configuration model eliminates manual intervention requirements, reducing operational overhead while improving system reliability. Health checking mechanisms through liveness and readiness probes ensure automatic failure detection and recovery. The platform's extensive ecosystem integration capabilities support diverse monitoring, logging, and tracing solutions, creating comprehensive observability across distributed application infrastructures and enabling proactive performance optimization strategies.

ABSTRACT Objectives To evaluate the effectiveness of semaglutide 2.4 mg for weight reduction and improvement in cardiometabolic biomarkers at 52 and 68 weeks in a real-world setting in the United States. Methods This noninterventional, retrospective cohort study used the Komodo Health database and included adults with obesity or overweight with ≥1 weight-related condition who initiated treatment with semaglutide 2.4 mg between June 2021 and August 2022 and remained on treatment for 1 year. A paired t-test was used to assess changes in weight, body mass index (BMI), and cardiometabolic biomarkers (systolic blood pressure [SBP], diastolic blood pressure [DBP], glycated hemoglobin [HbA1c], HDL [high-density lipoprotein] cholesterol, LDL [low-density lipoprotein] cholesterol, and triglycerides) from baseline to 52-week and 68-week follow-up. Results Among 4,424 eligible patients, 77% were women and the mean (SD) age was 46.7 (10.0) years and BMI was 36.6 (3.6) kg/m2. Dyslipidemia and hypertension were the most common obesity-related comorbidities at baseline. The mean (%) change in weight from baseline was −15.5 kg (−14.5%; p < 0.001; n = 594) at 52 weeks and −15.9 kg (−14.8%; p < 0.001; n = 391) at 68 weeks. The mean change in BMI from baseline was − 4.8 kg/m2 (n = 1124) at 52 weeks and − 4.9 kg/m2 (n = 700) at 68 weeks. At 52weeks, statistically significant improvements in mean values were observed for SBP (−6.3 mmHg), DBP (−3.1 mmHg), HbA1c (−0.4%), LDL cholesterol (−8.1 mg/dL), and triglycerides (−38.4 mg/dL) (all p < 0.001). Mean change at 52 weeks for HDL cholesterol was 1.0 mg/dL; p = 0.109. Results at 68 weeks were similar. Conclusions In this retrospective cohort study, the real-world effectiveness of semaglutide 2.4 mg was demonstrated by reductions in weight and BMI along with improvements in BP, HbA1c, and lipid panel among patients with obesity or overweight.

ObjectiveImplantable loop recorders (ILRs) are increasingly used for long-term rhythm monitoring after ischaemic and cryptogenic stroke, with the goal of detecting atrial fibrillation (AF) and subsequent initiation of oral anticoagulation to reduce risk of adverse clinical outcomes. There is a need to determine the effectiveness of different rhythm monitoring strategies in this context.MethodsWe conducted a retrospective cohort analysis of individuals with commercial and Medicare Advantage insurance in Optum Labs Data Warehouse who had incident ischaemic or cryptogenic stroke and no prior cardiovascular implantable electronic device from 1 January 2016 to 30 June 2021. Patients were stratified by rhythm monitoring strategy: ILR, long-term continuous external cardiac monitor (>48 hours to 30 days) or Holter monitor (≤48 hours). The primary outcome was risk-adjusted all-cause mortality at 12 months. Secondary outcomes included new diagnosis of AF and oral anticoagulation, bleeding, and costs.ResultsAmong 48 901 patients with ischaemic or cryptogenic stroke, 9235 received an ILR, 29 103 long-term continuous external monitor and 10 563 Holter monitor only. Mean age was 69.9 (SD 11.9) years and 53.5% were female. During the 12-month follow-up period, patients who received ILRs compared with those who received long-term continuous external monitors had a higher odds of new diagnosis of AF and oral anticoagulant initiation (adjusted OR 2.27, 95% CI 2.09 to 2.48). Compared with patients who received long-term continuous external monitors, those who received ILRs had similar 12-month mortality (HR 1.00; 95% CI 0.89 to 1.12), with approximately $13 000 higher costs at baseline (including monitor cost) and $2500 higher costs during 12-month follow-up.ConclusionsIn this large real-world study of patients with ischaemic or cryptogenic stroke, ILR placement resulted in more diagnosis of AF and initiation of oral anticoagulation, but no difference in mortality compared with long-term continuous external monitors.

By utilizing Optum Life Sciences Claims Data, we constructed Real World Data (RWD) cohorts comprising over 3 million patients and simulated a clinical trial observational study design to evaluate over 200 FDA-approved drugs with COVID-19 repurposing potential, and identified a dozen candidates exhibiting significant reduction in the odds of severe COVID-19 outcomes such as death, intensive care unit (ICU) admission, hospitalization and pneumonia. Notably, certain drug combinations demonstrated effects comparable to those of COVID-19 vaccines. Furthermore, our study revealed a novel finding: a quantitative linear relationship between COVID-19 outcomes and overall patient health risks. This discovery enabled a more precise estimation of drug efficacy using the risk adjustment. The top performing drugs identified include emtricitabine, tenofovir, folic acid, progesterone, estradiol, epinephrine, disulfiram, nitazoxanide and some drug combinations including aspirin-celecoxib.

Posteromedial knee friction syndrome is a condition rarely discussed in the literature and is characterized as the abnormal movement between the semitendinosus tendon and medial tibial condyle or gracilis and semitendinosus tendons versus semimembranosus tendon or tibial collateral ligament over the tibial crest, causing irritation of the soft tissue around. It occurs especially in active individuals. For the diagnosis, it is recommended to investigate signs and symptoms – pain (mainly in the medial joint line), edema, instability – and relate them to an imaging examination – magnetic resonance imaging (MRI). The literature emphasizes the use of MRI as an imaging method. However, ultrasound undoubtedly has valuable functions, in a way that allows the dynamic study of the posteromedial structures, and also, the treatment guided by ultrasound with corticosteroid and anesthetic. Conservative – physiotherapy and neuromuscular re-education – and surgical – removing the semimembranosus tendon and releasing the semitendinosus and gracilis tendons – treatments are the options for treatment. We present a case of a 46-year-old woman posteromedial friction syndrome diagnosed by an MRI and treated with physiotherapy and local corticosteroid therapy.