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https://www.readbyqxmd.com/read/28730619/real-world-adherence-and-persistence-with-direct-oral-anticoagulants-in-adults-with-atrial-fibrillation
#1
Beenish S Manzoor, Todd A Lee, Lisa K Sharp, Surrey M Walton, William L Galanter, Edith A Nutescu
BACKGROUND: Evidence of adherence and persistence patterns in anticoagulation (AC) therapy comparing treatment-naïve and non-naïve patients is lacking. The objective of this study was to evaluate patterns of medication adherence and persistence in a real-world setting among AC-naïve and AC-experienced atrial fibrillation (AF) patients treated with direct oral anticoagulants (DOACs). METHODS: AF patients newly initiating a DOAC with a minimum of 6 months of continuous health plan enrollment pre and post-index date (first DOAC prescription) were identified from the Truven Health MarketScan(®) Commercial and Medicare Supplemental databases (2009-2013)...
July 21, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28729355/insurance-clearance-for-early-phase-oncology-clinical-trials-following-the-affordable-care-act
#2
Kenneth L Kehl, Cheryl P Fullmer, Siqing Fu, Goldy C George, Kenneth R Hess, Filip Janku, Daniel D Karp, Shumei Kato, Cynthia K Kizer, Razelle Kurzrock, Aung Naing, Shubham Pant, Sarina A Piha-Paul, Vivek Subbiah, Apostolia M Tsimberidou, David S Hong
Purpose: The Affordable Care Act (ACA) required that private insurance plans allow clinical trial participation and cover standard-of-care costs, but the impact of this provision has not been well-characterized. We assessed rates of insurance clearance for trial participation within our large early-phase clinical trials program, before and after implementation of the requirement.Experimental Design: We analyzed the departmental database for the Clinical Center for Targeted Therapy (CCTT) at MD Anderson Cancer Center (Houston, TX)...
July 20, 2017: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
https://www.readbyqxmd.com/read/28728722/transcatheter-aortic-valve-replacement-a-review
#3
REVIEW
John H Braxton, Kelly S Rasmussen, Milind S Shah
Patients with inoperable, high-risk, and intermediate-risk aortic stenosis can now be treated with transcatheter aortic valve replacement. Centers for Medicare and Medicaid Services and the Food and Drug Administration selectively choose centers based on experience and require a collaborative, multidisciplinary team approach in the treatment and decision making for these patients. The work-up has been streamlined. Gated multislice computed tomography angiogram has emerged as the gold standard for assessment of valve anatomy and sizing of the transcatheter heart valve...
August 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/28728713/lung-cancer-screening-and-its-impact-on-surgical-volume
#4
REVIEW
Andrew P Dhanasopon, Anthony W Kim
Lung cancer screening has demonstrated a reduction in lung cancer mortality by 20%. Annual low-dose computed tomography examination in high-risk individuals is now recommended by multiple national health care organizations and is covered under Medicare and Medicaid services. The impact of this public health intervention is projected to increase the case load for the thoracic surgery workforce.
August 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/28728688/transcatheter-versus-surgical-aortic%C3%A2-valve%C3%A2-replacement-propensity-matched-comparison
#5
J Matthew Brennan, Laine Thomas, David J Cohen, David Shahian, Alice Wang, Michael J Mack, David R Holmes, Fred H Edwards, Naftali Z Frankel, Suzanne J Baron, John Carroll, Vinod Thourani, E Murat Tuzcu, Suzanne V Arnold, Roberta Cohn, Todd Maser, Brenda Schawe, Susan Strong, Allen Stickfort, Elizabeth Patrick-Lake, Felicia L Graham, Dadi Dai, Fan Li, Roland A Matsouaka, Sean O'Brien, Fan Li, Michael J Pencina, Eric D Peterson
BACKGROUND: Randomized trials support the use of transcatheter aortic valve replacement (TAVR) for the treatment of aortic stenosis in high- and intermediate-risk patients, but the generalizability of those results in clinical practice has been challenged. OBJECTIVES: The aim of this study was to determine the safety and effectiveness of TAVR versus surgical aortic valve replacement (SAVR), particularly in intermediate- and high-risk patients, in a nationally representative real-world cohort...
July 25, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28727517/comparative-toxicity-and-effectiveness-of-trastuzumab-based-chemotherapy-regimens-in-older-women-with-early-stage-breast-cancer
#6
Katherine E Reeder-Hayes, Anne Marie Meyer, Sharon Peacock Hinton, Ke Meng, Lisa A Carey, Stacie B Dusetzina
Purpose The combination of chemotherapy and trastuzumab is the standard of care for adjuvant treatment of human epidermal growth factor receptor 2-positive breast cancer. Two regimens have been widely adopted in the United States: doxorubicin, cyclophosphamide, paclitaxel, and trastuzumab (ACTH) and docetaxel, carboplatin, and trastuzumab (TCH). No head-to-head comparison of these regimens has been conducted in a clinical trial, and existing trial data have limited generalizability to older patients. Methods We used SEER-Medicare data from 2005 to 2013 to compare outcomes of ACTH versus TCH among patients age older than 65 years...
July 20, 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28726159/diagnosis-and-treatment-delays-among-elderly-breast-cancer-patients-with-pre-existing-mental-illness
#7
Kristy Iglay, Melissa L Santorelli, Kim M Hirshfield, Jill M Williams, George G Rhoads, Yong Lin, Kitaw Demissie
PURPOSE: This study aimed to compare diagnosis and treatment delays in elderly breast cancer patients with and without pre-existing mental illness. METHODS: A retrospective cohort study was conducted using the Surveillance, Epidemiology and End Results-Medicare data including 16,636 women 68+ years, who were diagnosed with stage I-IIIa breast cancer in the United States from 2005 to 2007. Mental illness was identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes recorded on inpatient and outpatient claims during the 3 years prior to breast cancer diagnosis...
July 19, 2017: Breast Cancer Research and Treatment
https://www.readbyqxmd.com/read/28726119/a-cost-effectiveness-analysis-of-the-diagnostic-strategies-for-differentiating-focal-nodular-hyperplasia-from-hepatocellular-adenoma
#8
Chong Hyun Suh, Kyung Won Kim, Seong Ho Park, Sangjin Shin, Jeonghoon Ahn, Junhee Pyo, Atul B Shinagare, Katherine M Krajewski, Nikhil H Ramaiya
OBJECTIVES: We evaluated the cost-effectiveness of a gadoxetic acid-enhanced MRI (EOB-MRI) strategy compared with conventional MRI strategy and biopsy to differentiate focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA). METHODS: A decision tree model was constructed to compare the cost-effectiveness of EOB-MRI, conventional MRI with extracellular contrast agents, and biopsy as the initial diagnostic modality in patients with incidentally detected focal liver lesions suspected of being FNH or HCA...
July 19, 2017: European Radiology
https://www.readbyqxmd.com/read/28725856/association-between-medicare-star-ratings-for-patient-experience-and-medicare-spending-per-beneficiary-for-us-hospitals
#9
Stephen Trzeciak, John P Gaughan, Joshua Bosire, Mark Angelo, Adam S Holzberg, Anthony J Mazzarelli
OBJECTIVE: To test the association between patient experience and Centers for Medicare and Medicaid Services (CMS) spending at the hospital level. METHODS: Using CMS Hospital Compare data set, we analyzed 2014 data for CMS patient experience star ratings and the hospital Medicare Spending per Beneficiary (MSPB) Measure, which assesses price-standardized, risk-adjusted payments for services provided to Medicare beneficiaries for an episode of care from 3 days before hospital admission to 30 days following discharge...
March 2017: Journal of patient experience
https://www.readbyqxmd.com/read/28724152/cost-of-incremental-expansion-of-an-existing-family-medicine-residency-program
#10
Evan A Ashkin, Warren P Newton, Brian Toomey, Ronald Lingley, Cristen P Page
BACKGROUND AND OBJECTIVES: Expanding residency training programs to address shortages in the primary care workforce is challenged by the present graduate medical education (GME) environment. The Medicare funding cap on new GME positions and reductions in the Health Resources and Services Administration (HRSA) Teaching Health Center (THC) GME program require innovative solutions to support primary care residency expansion. Sparse literature exists to assist in predicting the actual cost of incremental expansion of a family medicine residency program without federal or state GME support...
July 2017: Family Medicine
https://www.readbyqxmd.com/read/28723861/medicaid-and-uninsured-hepatocellular-carcinoma-patients-have-more-advanced-tumor-stage-and-are-less-likely-to-receive-treatment
#11
Jennifer Wang, John Ha, Aristeo Lopez, Taft Bhuket, Benny Liu, Robert J Wong
GOALS: To evaluate the impact of insurance status on tumor stage at diagnosis, treatment received, and overall survival among adults with hepatocellular carcinoma (HCC). BACKGROUND: Insurance status affects access to care, which impacts timely access to cancer screening for early detection and treatment. STUDY: Using the 2007 to 2012 Surveillance, Epidemiology, and End Results (SEER) database, we retrospectively evaluated US adults with HCC...
July 18, 2017: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/28723720/trends-in-hysteropexy-and-apical-support-for-uterovaginal-prolapse-in-the-united-states-from-2002-to-2012
#12
Annetta M Madsen, Christina Raker, Vivian W Sung
OBJECTIVES: Our objective was to describe trends in hysteropexy and apical support for uterovaginal prolapse (UVP) from 2002 to 2012 in the United States. We identified patient and hospital variables associated with hysteropexy and apical support. METHODS: We used the Nationwide Inpatient Sample and International Classification of Diseases, Ninth Revision codes to identify a population of women 18 years or older with UVP undergoing pelvic organ prolapse surgery from January 1, 2002, to December 31, 2012...
July 19, 2017: Female Pelvic Medicine & Reconstructive Surgery
https://www.readbyqxmd.com/read/28722536/travel-burden-associated-with-granulocyte-colony-stimulating-factor-administration-in-a-medicare-aged-population-a-geospatial-analysis
#13
J Mark Stephens, Mark Bensink, Charles Bowers, Christopher S Hollenbeak
OBJECTIVE: Prophylaxis with granulocyte colony-stimulating factors (G-CSFs) is recommended for patients receiving myelosuppressive chemotherapy regimens with a high risk of febrile neutropenia (FN). G-CSFs should be administered starting the day after chemotherapy, necessitating return trips to the oncology clinic at the end of each cycle. We examined the travel burden related to prophylactic G-CSF injections after chemotherapy in the United States (US). METHODS: We used 2012-2014 Medicare claims data to identify a national cohort of beneficiaries age 65+ with non-myeloid cancers who received both chemotherapy and prophylactic G-CSFs...
July 19, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28722466/assessing-the-generalizability-of-the-national-lung-screening-trial-comparison-of-stage-1-patients
#14
Nichole T Tanner, Lin Dai, Brett C Bade, Mulugeta Gebregziabher, Gerard A Silvestri
RATIONALE: The findings of the National Lung Screening Trial (NLST) is the basis for screening high risk individuals based on age and smoking history. While screening is covered for eligible Medicare beneficiaries, the generalizability of the NLST in the elderly population has been questioned. OBJECTIVE: Compare outcomes of patients diagnosed with stage 1 non-small cell lung cancer(NSCLC) in the NLST to a nationally representative cohort of elderly patients Methods: Analysis of SEER-Medicare and NLST datasets for stage 1 patients ages 65-74 Measurements and Main Results: Lung cancer-specific mortality, all-cause mortality, and 30-60-90 day treatment mortality were measured...
July 19, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28722207/antihypertensive-drug-associated-angioedema-effect-modification-by-race-ethnicity
#15
Marsha E Reichman, Michael Wernecke, David J Graham, Jiemin Liao, John Yap, Yoganand Chillarige, Mary Ross Southworth, Stephine Keeton, Margie R Goulding, Katrina Mott, Jeffrey A Kelman
PURPOSE: Assess angioedema risk with exposure to angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) compared with beta-blockers, by race/ethnicity. METHODS: New-user cohorts of Medicare beneficiaries 65 years or older initiating ACEI, ARB, or beta-blocker treatment from March 2007 to March 2014 were constructed. Angioedema incidence rates by drug and race/ethnicity were computed for 1-30 and 31-365 days of treatment. Cox proportional hazards regression was used to examine angioedema risk between cohorts...
July 19, 2017: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/28721034/readmission-after-copd-exacerbation-scale-determining-30-day-readmission-risk-for-copd-patients
#16
Christine Sm Lau, Brianna L Siracuse, Ronald S Chamberlain
BACKGROUND: COPD affects over 13 million Americans, and accounts for over half a million hospitalizations annually. The Hospital Readmission Reduction Program, established by the Affordable Care Act requires the Centers for Medicare and Medicaid Services to reduce payments to hospitals with excess readmissions for COPD as of 2015. This study sought to develop a predictive readmission scale to identify COPD patients at higher readmission risk. METHODS: Demographic and clinical data on 339,389 patients from New York and California (derivation cohort) and 258,113 patients from Washington and Florida (validation cohort) were abstracted from the State Inpatient Database (2006-2011), and the Readmission After COPD Exacerbation (RACE) Scale was developed to predict 30-day readmission risk...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28720635/increased-public-accountability-for-hospital-nonprofit-status-potential-impacts-on-residency-positions
#17
Melanie C Raffoul, Robert L Phillips
BACKGROUND: The Institute of Medicine recently called for greater graduate medical education (GME) accountability for meeting the workforce needs of the nation. The Affordable Care Act expanded community health needs assessment (CHNA) requirements for nonprofit and tax-exempt hospitals to include community assessment, intervention, and evaluation every 3 years but did not specify details about workforce. Texas receives relatively little federal GME funding but has used Medicaid waivers to support GME expansion...
July 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28719692/association-of-changing-hospital-readmission-rates-with-mortality-rates-after-hospital-discharge
#18
Kumar Dharmarajan, Yongfei Wang, Zhenqiu Lin, Sharon-Lise T Normand, Joseph S Ross, Leora I Horwitz, Nihar R Desai, Lisa G Suter, Elizabeth E Drye, Susannah M Bernheim, Harlan M Krumholz
Importance: The Affordable Care Act has led to US national reductions in hospital 30-day readmission rates for heart failure (HF), acute myocardial infarction (AMI), and pneumonia. Whether readmission reductions have had the unintended consequence of increasing mortality after hospitalization is unknown. Objective: To examine the correlation of paired trends in hospital 30-day readmission rates and hospital 30-day mortality rates after discharge. Design, Setting, and Participants: Retrospective study of Medicare fee-for-service beneficiaries aged 65 years or older hospitalized with HF, AMI, or pneumonia from January 1, 2008, through December 31, 2014...
July 18, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28719084/defending-a-never-event
#19
John R Shepperd
There are medical mishaps that have been deemed "Never Events" by the Centers for Medicare & Medicaid Services (CMS). This term refers generally to preventable occurrences so egregious that they should never occur. But they do occur. And when they do, litigation often follows. This article focuses on one such Never Event-the operating room fire-with strategies on how to defend it. Information provided in this article was derived from a review of the relevant literature and from the author's personal experience defending lawsuits arising from Never Events, including a jury trial involving a surgeon who was sued for a patient's injuries after a fire erupted in the operating room...
July 2017: Journal of Healthcare Risk Management: the Journal of the American Society for Healthcare Risk Management
https://www.readbyqxmd.com/read/28718694/updating-survival-estimates-in-patients-with-chronic-lymphocytic-leukemia-or-small-lymphocytic-lymphoma-cll-sll-based-on-treatment-free-interval-length
#20
Eric M Ammann, Tait D Shanafelt, Kara B Wright, Bradley D McDowell, Brian K Link, Elizabeth A Chrischilles
We hypothesized that the length of treatment-free survival following (a) initial diagnosis and (b) first-line treatment would be associated with improved subsequent five-year relative survival (RS5) in patients with chronic lymphocytic leukemia or small lymphocytic lymphoma (CLL/SLL). 19,879 patients incident CLL/SLL cases (median age = 76 years) were identified from SEER-Medicare. RS5 improved from 0.73 (95% CI: 0.72, 0.74) at diagnosis to 0.81 (95% CI: 0.80, 0.82) at year 1 and 0.89 (95% CI: 0.83, 0.96) at year 10 among those who had not received treatment...
July 18, 2017: Leukemia & Lymphoma
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