Why Did the "Dean of Health Care Economics" Urge Reforms that "Appeal to Some Special Interests?"
We have often discussed, some would say belabored, the importance of the "anechoic effect" in health care. Particular issues which would make those who benefit the most from our current dysfunctional health care system uncomfortable are often considered not to appropriate for polite conversation. A prominent recent article in JAMA provided a great example of how there are certain topics that health care, services, and policy experts avoid discussing.Summary of the Article The article was by Victor R Fuchs, who has been called the" dean of health care economics." His topic was why US health care is so expensive compared to those in other countries, but provides little additional value for the extra expense. [Fuchs VR. How and why US health care differs from that in other OECD countries. JAMA 2013; 309: 33-34. Link here.]His explained the differences as follows:- "US individuals appear more distrustful of government...." Thus presumably they shun government operation of health systems, which can lead to lowering administrative costs, and more effective negotiating "with drug companies and physicians and to control investment in hospitals and equipment."- "reluctance to achieve more equal outcomes for the population through redistributive public policy." He attributed this to attitudes stressing personal responsibility for success, and the heterogeneity of the popu...
Authors: Shigematsu T, Asada S, Endo Y, Kawata T, Fukagawa M, Akizawa T Abstract Purpose: Evocalcet is a novel oral calcimimetic drug that has demonstrated similar efficacy to cinacalcet in regulating serum parathyroid hormone (PTH), calcium, and phosphate levels, with fewer upper gastrointestinal tract-related adverse drug reactions (ADRs) in patients with secondary hyperparathyroidism undergoing hemodialysis in Japan. We investigated the efficacy and safety of once-daily oral evocalcet under different dialysate calcium concentrations. Patients and Methods: A post hoc analysis by dialysate calcium concent...
Publication date: Available online 5 June 2020Source: American Journal of Kidney DiseasesAuthor(s): An S. De Vriese, Marijke Reynders
CONCLUSIONS: The study shows an important correlation between oral health, oral hygiene habits, dental assistance and clinical intercurrences with hospitalization in dialysis patients. The results are weighty to establish protocols that can, directly improve, critical health outcomes of end-stage kidney disease patients under dialysis treatment. PMID: 32489089 [PubMed - indexed for MEDLINE]
FRIDAY, June 5, 2020 -- Patients who report choosing dialysis to please doctors or family members more often report decisional regret, according to a study published online June 4 in the Clinical Journal of the American Society of Nephrology. Fahad...
CONCLUSION: A significant rise in cerebral oxygenation was observed following the manual compression of arteriovenous fistula. Therefore, the arteriovenous fistula could have a role in impaired cerebral oxygenation in hemodialysis patients. PMID: 32489138 [PubMed - as supplied by publisher]
CONCLUSION: Findings of our experimental model suggest that concentration of aspired drug is effected by the distance between the central venous catheter and central venous dialysis catheter, being lowest when the drug is infused distally to central venous dialysis catheter. Furthermore, the concentration of the tracer is directly proportional to the infusion speed and far less effected by the aspiration rate of the drug. PMID: 32489133 [PubMed - as supplied by publisher]
CONCLUSION: depressive symptoms are associated with burden of comorbidities, greater number of disease complications, hemodialytic intercurrences and functional dependence. Physical exercise practice can be an effective care strategy. PMID: 32490957 [PubMed - in process]
(ERA-EDTA) Analysis of a Spanish experience shows that COVID-19 is frequent in hemodialysis patients, who appear to be at risk for worse outcome. A dramatic finding from the own experience, register and published papers from Spain is that the risk of dialysis patients dying of COVID-19 is very high at 1:4. These patients require special protection, and routine unconditional tests should be carried out on patients and staff in dialysis units.
We read with great interest the study by Smyth B, et al.,1 which performed a sub-analysis in 95 participants from the ACTIVE Dialysis trial, who had cardiac magnetic resonance imaging (MRI), and showed that extended dialysis (median 24 h/week) was associated with reduction in LV mass index (LVMI) and improved ejection fraction (EF), but similar LV end-diastolic volume (EDV) compared with standard dialysis (median 12 h/week) over a 12-month follow-up period. Studies using cardiac MRI in hemodialysis patients are scarce, in part because this method is less widely used in daily practice compared with echocardiography.
THURSDAY, June 4, 2020 -- More than 1 in 5 adults getting dialysis for kidney failure are sorry they started it, a new study finds. Patients who began treatment to make their doctors or family members happy are least pleased with the decision,...
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