Just what impact will hepatitis C treatments have on medical spending over the next few years? The answer to this question has been the subject of heated debate thanks to the Sovaldi treatment sold by Gilead Sciences . The medication can cure 90 percent of the patients who have the most common form of the affliction, and costs $1,000 a day for a 12-week course, or $84,000 for one patient. Medications for other diseases may be more expensive, but insurers worry about the potential outlay, given that approximately 3.2 million people in the U.S. are chronically infected with hepatitis C, according to the U.S. Center for Disease Prevention and Control. Some estimates suggest the number is closer to 5 million. For months, state Medicaid programs and private payers have blanched at the cost. Other drug makers hope to catch up to Gilead in the race to develop a still more effective and convenient treatment that works even faster. But it remains unclear to what extent a price war may ensue. Meanwhile, concerns mount these medicines will, collectively, become budget busters. Of course, there is another way to view the issue, which is that the cost of treating patients who may otherwise need countless physician visits, hospital care and a liver transplant can run higher.... |
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Showing posts with label Conditions and Diseases. Show all posts
Showing posts with label Conditions and Diseases. Show all posts
Thursday, June 26, 2014
What Impact Will Hepatitis C Drugs Have on Medical Costs? Look Here
Drug prices are a major and unpredicable cost in calcularing workers' compensation exposure. Recent developments in hepatitis C treatment illustrate the issue. Today's post is shared from blogs.wsj.com
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Monday, January 6, 2014
Why Everyone Seems to Have Cancer
EVERY New Year when the government publishes its Report to the Nation on the Status of Cancer, it is followed by a familiar lament. We are losing the war against cancer.
Half a century ago, the story goes, a person was far more likely to die from heart disease. Now cancer is on the verge of overtaking it as the No. 1 cause of death.
Troubling as this sounds, the comparison is unfair. Cancer is, by far, the harder problem — a condition deeply ingrained in the nature of evolution and multicellular life. Given that obstacle, cancer researchers are fighting and even winning smaller battles: reducing the death toll from childhood cancers and preventing — and sometimes curing — cancers that strike people in their prime. But when it comes to diseases of the elderly, there can be no decisive victory. This is, in the end, a zero-sum game.
The rhetoric about the war on cancer implies that with enough money and determination, science might reduce cancer mortality as dramatically as it has with other leading killers — one more notch in medicine’s belt. But what, then, would we die from? Heart disease and cancer are primarily diseases of aging. Fewer people succumbing to one means more people living long enough to die from the other.
The newest cancer report, which came out in mid-December, put the best possible face on things. If one accounts for the advancing age of the population — with the graying of the baby boomers, death itself is on the rise...
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Friday, December 20, 2013
What Happens in the Brain After a Concussion
A remarkable recent experiment allowed scientists to see inside the skull and brain of animals that had just experienced a concussion, providing sobering new evidence of how damaging even minor brain impacts can be. While the results, which were published in Nature, are worrisome, they also hint at the possibility of treating concussions and lessening their harm. Concussions occur when the brain bounces against the skull after someone’s head is bumped or jolted. Such injuries are fairly common in contact sports, like football and hockey, and there is growing concern that repeated concussions might contribute to lingering problems with thinking or memory. This concern was heightened this week by reports that the brain of the late major league baseball player Ryan Freel showed symptoms of chronic traumatic encephalopathy, a degenerative condition. He reportedly had been hit in the head multiple times during his career. But scientists did not know exactly what happens at a molecular level inside the brain during and after a concussion. The living brain is notoriously difficult to study, since it shelters behind the thick, bony skull and other protective barriers. In some earlier studies, scientists had removed portions of lab animals’ skulls to view what happened to their brains during subsequent impacts. But removing part of the skull causes its own tissue damage and physiological response, muddying any findings about how the brain is... |
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Wednesday, December 11, 2013
Characterizing the quality of supportive cancer care can guide quality improvement of veterans
Objective To evaluate nonhospice supportive cancer care comprehensively in a national sample of veterans.
Design, Setting, and Participants Using a retrospective cohort study design, we measured evidence-based cancer care processes using previously validated indicators of care quality in patients with advanced cancer, addressing pain, nonpain symptoms, and information and care planning among 719 veterans with a 2008 Veterans Affairs Central Cancer Registry diagnosis of stage IV colorectal (37.0%), pancreatic (29.8%), or lung (33.2%) cancer.
Main Outcomes and Measures We abstracted medical records from diagnosis for 3 years or until death among eligible veterans (lived ≥30 days following diagnosis with ≥1 Veterans Affairs hospitalization or ≥2 Veterans Affairs outpatient visits). Each indicator identified a clinical scenario and an appropriate action. For each indicator for which a veteran was eligible, we determined whether appropriate care was provided. We also determined patient-level quality overall and by pain, nonpain symptoms, and information and care planning domains.
Results Most veterans were older (mean age, 66.2 years), male (97.2%), and white (74.3%). Eighty-five percent received both inpatient and outpatient care, and 92.5% died. Overall, the 719 veterans triggered a mean of 11.7 quality indicators (range, 1-22) and received a mean 49.5% of appropriate care. Notable gaps in care were that inpatient pain screening was common (96.5%) but lacking for outpatients (58.1%). With opioids, bowel prophylaxis occurred for only 52.2% of outpatients and 70.5% of inpatients. Few patients had a timely dyspnea evaluation (15.8%) or treatment (10.8%). Outpatient assessment of fatigue occurred for 31.3%. Of patients at high risk for diarrhea from chemotherapy, 24.2% were offered appropriate antidiarrheals. Only 17.7% of veterans had goals of care addressed in the month after a diagnosis of advanced cancer, and 63.7% had timely discussion of goals following intensive care unit admission. Most decedents (86.4%) were referred to palliative care or hospice before death. Single- vs multiple-fraction radiotherapy should have been considered in 28 veterans with bone metastasis, but none were offered this option.
Conclusions and Relevance These care gaps reflect important targets for improving the patient and family experience of cancer care.
Design, Setting, and Participants Using a retrospective cohort study design, we measured evidence-based cancer care processes using previously validated indicators of care quality in patients with advanced cancer, addressing pain, nonpain symptoms, and information and care planning among 719 veterans with a 2008 Veterans Affairs Central Cancer Registry diagnosis of stage IV colorectal (37.0%), pancreatic (29.8%), or lung (33.2%) cancer.
Main Outcomes and Measures We abstracted medical records from diagnosis for 3 years or until death among eligible veterans (lived ≥30 days following diagnosis with ≥1 Veterans Affairs hospitalization or ≥2 Veterans Affairs outpatient visits). Each indicator identified a clinical scenario and an appropriate action. For each indicator for which a veteran was eligible, we determined whether appropriate care was provided. We also determined patient-level quality overall and by pain, nonpain symptoms, and information and care planning domains.
Results Most veterans were older (mean age, 66.2 years), male (97.2%), and white (74.3%). Eighty-five percent received both inpatient and outpatient care, and 92.5% died. Overall, the 719 veterans triggered a mean of 11.7 quality indicators (range, 1-22) and received a mean 49.5% of appropriate care. Notable gaps in care were that inpatient pain screening was common (96.5%) but lacking for outpatients (58.1%). With opioids, bowel prophylaxis occurred for only 52.2% of outpatients and 70.5% of inpatients. Few patients had a timely dyspnea evaluation (15.8%) or treatment (10.8%). Outpatient assessment of fatigue occurred for 31.3%. Of patients at high risk for diarrhea from chemotherapy, 24.2% were offered appropriate antidiarrheals. Only 17.7% of veterans had goals of care addressed in the month after a diagnosis of advanced cancer, and 63.7% had timely discussion of goals following intensive care unit admission. Most decedents (86.4%) were referred to palliative care or hospice before death. Single- vs multiple-fraction radiotherapy should have been considered in 28 veterans with bone metastasis, but none were offered this option.
Conclusions and Relevance These care gaps reflect important targets for improving the patient and family experience of cancer care.
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Wednesday, December 4, 2013
Rare Cancer Treatments, Cleared by F.D.A. but Not Subject to Scrutiny
When federal regulators permitted the sale of an unproved device that uses intense heat to combat cancer, they did so for a compelling reason, to give hope to some women desperately ill with cervical cancer.
Over the next two years, however, the few hospitals that purchased the $500,000 device did not take part in a study of patients that the manufacturer agreed to perform as a part of the machine’s approval. Cancer experts also said they were surprised that the Food and Drug Administration had approved the machine in the first place.
The reason: The group of woman for whom the F.D.A. approved the treatment — those with advanced cervical cancer who are too ill for chemotherapy — is so small. “I see, like, one patient like this a year,” said Dr. Junzo P. Chino, a cancer expert at Duke University.
A look at the F.D.A.’s decision to approve the device, which is called the BSD-2000, opens a window onto a little-known regulation known as the humanitarian device exemption.
The program, even its critics agree, is based on the best intentions. Because companies have little incentive to run costly trials for products used by small groups of patients, the exemption requires a producer only to show that a device is safe and has a “probable” benefit, rather than prove its effectiveness, the usual standard.
The rule, which is similar to one governing drugs for extremely rare diseases, also does not require the F.D.A., companies or...
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Wednesday, November 27, 2013
Exposure to Shift Work as a Risk Factor for Diabetes
Using telephone survey data from 1111 retired older adults (≥65 years; 634 male, 477 female), we tested the hypothesis that exposure to shift work might result in increased self-reported diabetes. Five shift work exposure bins were considered: 0 years, 1-7 years, 8-14 years, 15-20 years, and 20 years. Shift work exposed groups showed an increased proportion of self-reported diabetes (χ2 = 22.32, p < 0.001), with odds ratios (ORs) of about 2 when compared to the 0-year group. The effect remained significant after adjusting for gender and body mass index (BMI) (OR ≥ 1.4; χ2 = 10.78, p < 0.05). There was a significant shift work exposure effect on BMI (χ2 = 80.70, p < 0.001) but no significant gender effect (χ2 = 0.37, p 0.50).
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Saturday, November 9, 2013
Detection and Prevention
DID YOU KNOW? 100,000 crashes each year are caused by fatigued drivers55% of drowsy driving crashes are caused by drivers less than 25 years oldBeing awake for 18 hours is equal to a blood alcohol concentration (BAC) of 0.08%, which is legally drunk and leaves you at equal risk for a crash How can you tell if you are “driving while drowsy”? Here are some signs that should tell a driver to stop and rest:* Difficulty focusing, frequent blinking, or heavy eyelids* Daydreaming; wandering/disconnected thoughts* Trouble remembering the last few miles driven; missing exits or traffic signs* Yawning repeatedly or rubbing your eyes* Trouble keeping your head up* Drifting from your lane, tailgating, or hitting a shoulder rumble strip* Feeling restless and irritable Are You at Risk? Before you drive, check to see if you are:* Sleep-deprived or fatigued (6 hours of sleep or less triples your risk)* Suffering from sleep loss (insomnia), poor quality sleep, or a sleep debt* Driving long distances without proper rest breaks* Driving through the night, mid afternoon or when you would normally be asleep* Taking sedating medications (antidepressants, cold tablets, antihistamines)* Working more than 60 hours a week (increases your risk by 40%)* Working more than one job and your main job involves shift work* Drinking even small amounts of alcohol* Driving alone or on a long, rural, dark or boring road Specific At-Risk Groups The risk of having a crash due to drowsy driving is not... |
Wednesday, November 6, 2013
Neuroscience may offer hope to millions robbed of silence by tinnitus
Occupational and traumatic hearing loss claims usually have a "tinnitus component" in measurable disability as a compensable portion of the award. Today's post is shared from pbs.org . On Easter Sunday in 2008, the phantom noises in Robert De Mong’s head dropped in volume -- for about 15 minutes. For the first time in months, he experienced relief, enough at least to remember what silence was like. And then they returned, fierce as ever. It was six months earlier that the 66-year-old electrical engineer first awoke to a dissonant clamor in his head. There was a howling sound, a fingernails-on-a-chalkboard sound, “brain zaps” that hurt like a headache and a high frequency "tinkle" noise, like musicians hitting triangles in an orchestra. Many have since disappeared, but two especially stubborn noises remain. One he describes as monkeys banging on symbols. Another resembles frying eggs and the hissing of high voltage power lines. He hears those sounds every moment of every day. De Mong was diagnosed in 2007 with tinnitus, a condition that causes a phantom ringing, buzzing or roaring in the ears, perceived as external noise. When the sounds first appeared, they did so as if from a void, he said. No loud noise trauma had preceded the tinnitus, as it does for some sufferers -- it was suddenly just there. And the noises haunted him, robbed him of sleep and fueled a deep depression. He lost interest in his favorite hobby: tinkering with his ‘78 Trans Am and his two Corvettes. He stopped going into work. |
Sunday, November 3, 2013
Exposures Caused by Dampness in Office Buildings, Schools, and Other Nonindustrial Buildings
Office buildings, schools, and other nonindustrial buildings may develop moisture and dampness problems from roof and window leaks, high indoor humidity, and flooding events, among other things.
For this Alert, we buildings [AIHA 2008]. This can lead to the growth of mold, fungi, and bacteria; the release of volatile organic compounds; and the breakdown ofice bn wet materials. Outdoors,molds live in the soil, on plants, and on dead or decaying matter. There are thousands of species of molds and they can be any color. Different mold species can adapt to different moisture conditions. Research studies have shown that exposures to building dampness and mold have been associated with respiratory symptoms, asthma, hypersensitivity pneumonitis, rhinosinusitis, bronchitis, and respiratory infections. Individuals with asthma or hypersensitivity pneumonitis may be at risk for progression to more severe disease if the relationship between illness and exposure to the damp building is not recognized and exposures continue. NIOSH Alert: Preventing Occupational Respiratory Disease from Exposures Caused by Dampness in Office Buildings, Schools, and Other Nonindustrial Buildings [PDF - 1.25 MB] |
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Friday, November 1, 2013
Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis
In the United States, approximately 14 million people have had cancer and more than 1.6 million new cases are diagnosed each year. By 2022, it is projected that there will be 18 million cancer survivors and, by 2030, cancer incidence is expected to rise to 2.3 million new diagnoses per year. However, more than a decade after the IOM first studied the quality of cancer care, the barriers to achieving excellent care for all cancer patients remain daunting. Therefore, the IOM convened a committee of experts to examine the quality of cancer care in the United States and formulate recommendations for improvement. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis presents the committee’s findings and recommendations.
The committee concluded that the cancer care delivery system is in crisis due to a growing demand for cancer care, increasing complexity of treatment, a shrinking workforce, and rising costs. Changes across the board are urgently needed to improve the quality of cancer care. All stakeholders – including cancer care teams, patients and their families, researchers, quality metrics developers, and payers, as well as HHS, other federal agencies, and industries – must reevaluate their current roles and responsibilities in cancer care and work together to develop a higher quality cancer care delivery system. Working toward the recommendations outlined in this report, the cancer care community can improve the quality...
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Sunday, October 27, 2013
Increased in risk of specific NHL subtypes associated with occupational exposure to TCE
Trichloroethylene |
Study published linking trichloroethylene exposure to cancer.
The chemical compound trichloroethylene (C2HCl3) is a chlorinated hydrocarbon commonly used as an industrial solvent. It is a clear non-flammable liquid with a sweet smell.
"Objectives We evaluated the association between occupational exposure to trichloroethylene (TCE) and risk of non-Hodgkin lymphoma (NHL) in a pooled
analysis of four international case-control studies.
Methods Overall, the pooled study population included 3788 NHL cases and 4279 controls. Risk of NHL and its major subtypes associated with TCE exposure was calculated with unconditional logistic regression and polytomous regression analysis, adjusting by age, gender and study.
Results Risk of follicular lymphoma (FL), but not NHL overall or other subtypes, increased by probability (p=0.02) and intensity level (p=0.04), and with the combined analysis of four exposure metrics assumed as independent (p=0.004). After restricting the analysis to the most likely exposed study subjects, risk of NHL overall, FL and chronic lymphocytic leukaemia (CLL) were elevated and increased by duration of exposure (p=0.009, p=0.04 and p=0.01, respectively) and with the combined analysis of duration, frequency and intensity of exposure (p=0.004, p=0.015 and p=0.005, respectively). Although based on small numbers of exposed, risk of all the major NHL subtypes, namely diffuse large B-cell lymphoma, FL and CLL, showed increases in risk ranging 2–3.2-fold in the highest category of exposure intensity. No significant heterogeneity in risk was detected by major NHL subtypes or by study.
Conclusions Our pooled analysis apparently supports the hypothesis of an increase in risk of specific NHL subtypes associated with occupational exposure to TCE.
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Wednesday, October 23, 2013
Questioning Statins for Older Patients
Limiting medication can reduce overall patient care costs. The efficacy of controlling cholesterol in the "very old" population is now being discussed. Today's post was shared from the NYTimes.com.
Should older adults take statins if they have elevated cholesterol but no evidence of heart disease? It’s a surprisingly controversial question, given the number of seniors taking statins. Recently AMDA, a professional group representing physicians working in nursing homes, highlighted the issue in a list of five questionable medical tests and treatments. The list was drawn up as part of the national “Choosing Wisely” campaign, which alerts consumers to inappropriate or overused medical interventions, an effort that caregivers would do well to follow. The standout item on the AMDA list: “Don’t routinely prescribe lipid-lowering medications in individuals with a limited life expectancy.” That means anyone older than 70, according to the medical society. Dr. Hosam Kamel, an Arkansas geriatrician who is vice chair of AMDA’s clinical practice committee, said that there is scarce scientific evidence supporting the use of statins by 70- or 80-year-olds without pre-existing cardiovascular disease. Only a handful of studies have focused on outcomes (heart attacks, strokes, premature death) in this older population. Most of the data on the benefits of statin use come from larger studies that looked at adults of varying ages. The results... |
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Thursday, October 10, 2013
Deaths Linked to Cardiac Stents Rise as Overuse Seen
Cardiovascular claims that are deemed compensable are costly medical and pharmaceutical claims. The procedures are expensive an risky and the pharmaceutical maintenance and monitoring is lifelong and expensive.Today's post is shared from Bloomberg.com
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When Bruce Peterson left the U.S. Postal Service after 24 years delivering mail, he started a travel agency. It was his dream career, his wife Shirlee said.
Then he went to see cardiologist Samuel DeMaio for chest pain. DeMaio put 21 coronary stents in Peterson’s chest over eight months, and in one procedure tore a blood vessel and placed five of the metal-mesh tubes in a single artery, the Texas Medical Board staff said in a complaint. Unneeded stents weakened Peterson’s heart and exposed him to complications including clots, blockages “and ultimately his death,” the complaint said. DeMaio paid $10,000 and agreed to two years’ oversight to settle the complaint over Peterson and other patients in 2011. He said his treatment didn’t contribute to Peterson’s death. “We’ve learned a lot since Bruce died,” Shirlee Peterson said. “Too many stents can kill you.” Peterson’s case is part of the expanding impact of U.S. medicine’s binge on cardiac stents -- implants used to prop open the arteries of 7 million Americans in the last decade at a cost of more than $110 billion. When stents are used to restore blood flow in heart attack patients, few dispute they are beneficial. These and other acute cases account for about half of the 700,000 stent procedures in the U.S. annually. Among the other half -- elective-surgery patients in stable... |
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Thursday, October 3, 2013
Asthma related to cleaning agents: a clinical insight
Cleaning workers are exposed to many substances ans irritants.Today post is from bmj.org.
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In recent years, there has been a growing concern about the potential role of exposure to cleaning products in the initiation and aggravation of asthma.
Epidemiological surveys have consistently documented increased prevalence3–5 and incidence6–8 rates of asthma in workers exposed to cleaning materials and/or disinfectants, especially in domestic cleaners3,4 and healthcare workers.
In addition, some studies have reported an increased risk of work-related asthma symptoms in exposed workers.
However, there is still limited knowledge on the specific exposures and pathophysiological mechanisms involved in cleaning-related asthma.
Cleaning materials typically contain a wide variety of ingredients, some of which are respiratory irritants, such as chlorine-releasing agents and ammonia, while others are potential airway sensitizers.
Asthma in cleaners has been mostly associated with the irritant effects of cleaning products, which may exacerbate asthma and, at high exposure levels, cause acute irritant-induced asthma (or ‘reactive airways dysfunction syndrome’)
Nevertheless, occasional case reports have ascribed occupational asthma (OA) due to specific airway hypersensitivty to components of detergents or disinfectants.2 Overall the determinants of cleaning-related asthma symptoms remain largely uncertain since most...
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