Featuring articles on lung-cancer screening in the NELSON trial, ribociclib and fulvestrant in metastatic breast cancer, vitamin D in pregnancy and asthma, treatment thresholds for neonatal hypoglycemia, and CAR-NK cells in anti-CD19 lymphoid tumors; a review article on placebo and nocebo effects; a Clinical Problem-Solving describing a rapid change in pressure; and Perspective articles on altruism in Extremis, on abuses of FDA regulatory procedures, and on joining forces against delirium.
From a JAMA Network online article (February 4, 2020):
High medical prices and billing practices may reduce public trust in the medical profession and can result in the avoidance of care. In a survey of 1000 patients, 64% reported that they delayed or neglected seeking medical care in the past year because of concern about high medical bills. The field of quality science in health care has developed measures of medical complications; however, there are no standardized metrics of billing quality.
A recent study found that only 53 of 101 hospitals were able to provide a price for standard coronary artery bypass graft surgery. Notably, among the hospitals that provided a price, the price ranged from approximately $44 000 and $448 000 and was not associated with quality of care as measured by risk-adjusted outcomes and the Society of Thoracic Surgeons composite quality score.
In the same way that there is wide variation in pricing, aggressive collection tactics also can be highly variable by institution. In a recent analysis, 36% (48/135) of hospitals in Virginia garnished wages of patients with unpaid medical bills, and 5 hospitals accounted for 4690 garnishment cases in 2017, representing 51% of all cases.7 In total, 20 054 lawsuits were filed in Virginia against patients for unpaid debt. For many hospitals that sue patients, legal action follows multiple attempts to contact patients through letters and calls, and some hospitals may offer to set up payment plans or even negotiate charges.
We’ve come a long way since the first heartbeat was heard. This American Heart Month, we take a look at the history of cardiac care — and celebrate the leading-edge innovations that make a better future possible.
Nationally, there are approximately 18,000 patients on the liver transplant list. Annually, about 6,000 patients receive a liver transplant. Because of the organ shortage, many patients waiting for liver transplants die on the list or become too sick to undergo transplant. Dr. John Roberts offers these solutions: expanded criteria donors, split livers and living donors. Recorded on 10/30/2019.
More from: Organ Failure and Replacement: Why Organs Fail and What Therapies are Available for Organ Replacement (https://www.uctv.tv/organ-failure-rep…)
From a JAMA Network Open online release (Jan 31, 2020):
Steep incidence increases between 49 and 50 years of age are consistent with previously undetected colorectal cancers diagnosed via screening uptake at 50 years. These cancers are not reflected in observed rates of colorectal cancer in the SEER registries among individuals younger than 50 years. Hence, using observed incidence rates from 45 to 49 years of age alone to assess potential outcomes of earlier screening may underestimate cancer prevention benefits.
Early-onset colorectal cancer (EOCRC) incidence rates are increasing, and controversy exists regarding whether average-risk screening should begin at 45 or 50 years of age.1 In 2018, the American Cancer Society recommended that average-risk screening start at 45 years of age.2 Others recommend screening at 50 years of age, although the US Multi-Society Task Force on Colorectal Cancer recommends screening African American individuals at age 45 years of age owing to higher incidence, mortality, and earlier-onset disease.3–6 The American Cancer Society decision incorporated modeling studies that used updated incidence and mortality data encompassing time periods of increasing EOCRC incidence rates; modeling compared life-years gained by initiating screening at 45 vs 50 years.
Think of a hernia like a bulge in a damaged tire. The inner tube or soft tissue is normally contained by the abdominal wall, and if there is a leak or weak spot the soft tissue like fat or intestines can protrude through. Having a hernia will eventually require surgery to repair, and there are several different ways surgeons go about it.
There are many named diets that receive a great deal of attention. But what are they and do they work? David Heber, MD, PhD, from the UCLA Center for Human Nutrition explains these diets.From a News-Medical.net online release:
“Patients can go home after a shorter length of stay in the hospital without increased risk of complications and rehospitalizations,” said Dr. Malaisrie. “Because we found no detrimental effect of accelerated discharge, both patients and physicians should not be averse to discharging patients when medically ready.”
Dr. Malaisrie anticipates that the Northwestern Medicine cardiac ERAS program will result in faster recoveries, reduced complications, decreased time in the hospital, lower costs, and improved patient/family satisfaction. In the future, the researchers plan to closely examine both traditional clinical endpoints and patient-reported outcomes from the program.
“Expectations for recovery after cardiac surgery are being reset in the current era,” he said. “What does this mean for patients? It means that prolonged or taxing recovery is no longer required. Patients should know that recovery from heart surgery is not only quicker, but also better with ERAS programs.”
Listen to a chat with Julia Adler-Milstein, the author of an editorial that comments on a recent Annals of Internal Medicine study detailing the amount of time clinicians typically spend hunched over their EHRs during a patient visit.Why aren’t you able to navigate your electronic health record (EHR) as easily as you can find a recipe on, say, Google?
And, what about those requirements for documenting everything?
Links:
Annals of Internal Medicine editorial
Annals paper on the time clinicians spend
Running time: 17 minutes
At Penn Medicine ENT, we offer patients the most advanced developments in hearing technology. Our multidisciplinary approach to medicine ensures that each patient path is tailored to the patient’s specific needs.
In terms of hearing devices, we offer access to almost every hearing aid manufacturer available, as well as advanced implantable technology. This includes the auditory brain stem implant, which Penn Medicine is the first in the region to offer.
Hearing is currently the only sense that we can completely restore. We’re proud to be able to offer our patients everything available to help restore their communication with family and friends.
Boomers Daily 