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The RUC. "an Independent Group of Physicians?" - But It Includes Executives and Board Members of For-Profit Health Care Corporations and Large Hospital Systems
Introduction We just discussed how a major story in Politico has once again drawn attention to the opaque RUC (Resource Based Relative Value System Update Committee) and its important role in determining what physicians are paid for different kinds of services, and hence the incentives that have helped make the US health care system so procedurally oriented.  (See the end of our last post for a summary of the complex issues that swirl around the RUC.)The Politico article covered most of the bases, but notably omitted how the RUC may be tied to various large health care organizations, especially for-profit, and how the...
Source: Health Care Renewal - August 28, 2014 Category: Health Management Tags: AMA boards of directors conflicts of interest health care prices healthcare executive hospital systems perverse incentives regulatory capture RUC Source Type: blogs

Extracorporeal lung support technologies - bridge to recovery and bridge to lung transplantation in adult patients: an evidence-based analysis.
The objective of this analysis was to assess the effectiveness, safety, and cost-effectiveness of extracorporeal lung support technologies in the improvement of pulmonary gas exchange and the survival of adult patients with acute pulmonary failure and those with end-stage chronic progressive lung disease as a bridge to lung transplantation (LTx). The application of these technologies in primary graft dysfunction (PGD) after LTx is beyond the scope of this review and is not discussed. CLINICAL APPLICATIONS OF EXTRACORPOREAL LUNG SUPPORT: Extracorporeal lung support technologies [i.e., Interventional Lung Assist (ILA) and ex...
Source: Ontario Health Technology Assessment Series - December 20, 2015 Category: Journals (General) Tags: Ont Health Technol Assess Ser Source Type: research

Short-acting erythropoiesis-stimulating agents for anaemia in predialysis patients.
CONCLUSIONS: Epoetin alpha given at higher doses for extended intervals (two or four weekly) is non-inferior to more frequent dosing intervals in maintaining final Hb levels with no significant differences in adverse effects in non-dialysed CKD patients. However the data are of low methodological quality so that differences in efficacy and safety cannot be excluded. Further large, well designed, RCTs with patient-centred outcomes are required to assess the safety and efficacy of large doses of the shorter acting ESAs, including biosimilars of epoetin alpha, administered less frequently compared with more frequent administr...
Source: Cochrane Database of Systematic Reviews - January 8, 2017 Category: Journals (General) Authors: Hahn D, Esezobor CI, Elserafy N, Webster AC, Hodson EM Tags: Cochrane Database Syst Rev Source Type: research

Antimicrobial agents for preventing peritonitis in peritoneal dialysis patients.
CONCLUSIONS: In this update, we identified limited data from RCTs and quasi-RCTs which evaluated strategies to prevent peritonitis and exit-site/tunnel infections. This review demonstrates that pre/peri-operative intravenous vancomycin may reduce the risk of early peritonitis and that antifungal prophylaxis with oral nystatin or fluconazole reduces the risk of fungal peritonitis following an antibiotic course. However, no other antimicrobial interventions have proven efficacy. In particular, the use of nasal antibiotic to eradicate Staphylococcus aureus, had an uncertain effect on the risk of peritonitis and raises questio...
Source: Cochrane Database of Systematic Reviews - April 8, 2017 Category: Journals (General) Authors: Campbell D, Mudge DW, Craig JC, Johnson DW, Tong A, Strippoli GF Tags: Cochrane Database Syst Rev Source Type: research

Dietary interventions for adults with chronic kidney disease.
CONCLUSIONS: Dietary interventions have uncertain effects on mortality, cardiovascular events and ESKD among people with CKD as these outcomes were rarely measured or reported. Dietary interventions may increase health-related quality of life, eGFR, and serum albumin, and lower blood pressure and serum cholesterol levels.Based on stakeholder prioritisation of dietary research in the setting of CKD and preliminary evidence of beneficial effects on risks factors for clinical outcomes, large-scale pragmatic RCTs to test the effects of dietary interventions on patient outcomes are required. PMID: 28434208 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - April 23, 2017 Category: Journals (General) Authors: Palmer SC, Maggo JK, Campbell KL, Craig JC, Johnson DW, Sutanto B, Ruospo M, Tong A, Strippoli GF Tags: Cochrane Database Syst Rev Source Type: research

Interventions to prevent hemodynamic instability during renal replacement therapy for acute kidney injury: a systematic review protocol
DiscussionHIRRT is a common complication of renal replacement therapy not only in ESKD but also in the critically ill AKI population. It can result in early discontinuation of dialysis, further organ injury from hypoperfusion, and possibly negatively impact renal recovery. This systematic review will synthesize the existing evidence on the interventions employed to predict or prevent episodes HIRRT in critically ill patients with RRT-requiring AKI. This systematic review will allow for an understanding the current evidence for interventions to limit HIRRT in AKI and, in doing so, may also highlight areas in need of further...
Source: Systematic Reviews - June 15, 2017 Category: International Medicine & Public Health Source Type: research

Continuous erythropoiesis receptor activator (CERA) for the anaemia of chronic kidney disease.
CONCLUSIONS: There is low certainty evidence that CERA has little or no effects on patient-centred outcomes compared with placebo, epoetin alfa or beta or darbepoetin alfa for adults with CKD. The effects of CERA among children who have CKD have not studied in RCTs. PMID: 28782299 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - August 7, 2017 Category: General Medicine Authors: Saglimbene VM, Palmer SC, Ruospo M, Natale P, Craig JC, Strippoli GF Tags: Cochrane Database Syst Rev Source Type: research

Earthquakes to Floods: A Scoping Review of Health-related Disaster Research in Low- and Middle-income Countries
Conclusion Our scoping review assessed the characteristics of peer-reviewed publications of empirical health-related disaster research conducted in LMICs and published in 2003-2012. To our knowledge, this is the first synthesis to focus exclusively on health-related empirical research conducted during disasters. We found that many health-related research publications focus on the most devastating events, namely those that affect the largest number of people and those with the highest mortality rates. The most common research topics were those requiring the most immediate attention, such as traumatology, wounds, and the res...
Source: PLOS Currents Disasters - August 30, 2018 Category: International Medicine & Public Health Authors: Catherine M. Tansey Source Type: research

Drought in the Semiarid Region of Brazil: Exposure, Vulnerabilities and Health Impacts from the Perspectives of Local Actors
Conclusion The results obtained from this research shows, in general, the fragility in the social and political infrastructure necessary to improve the living conditions of populations, particularly those that depend on family agriculture in drought prone areas. The conditions of social, economic and environmental vulnerabilities presented in the region can be amplified by the drought process, and can aggravate the impacts resulting drought events, thus disadvantaging the population of this region, as shown in the Fig. 1. The general perception of the interviewees of the health sector shows an agreement with what is found...
Source: PLOS Currents Disasters - October 29, 2018 Category: International Medicine & Public Health Authors: Aderita Sena Source Type: research

Machine perfusion preservation versus static cold storage for deceased donor kidney transplantation.
CONCLUSIONS: HMP is superior to SCS in deceased donor kidney transplantation. This is true for both DBD and DCD kidneys, and remains true in the modern era (studies performed in the last decade). As kidneys from DCD donors have a higher overall DGF rate, fewer perfusions are needed to prevent one episode of DGF (7.26 versus 13.60 in DBD kidneys).Further studies looking solely at the impact of HMP on DGF incidence are not required. Follow-up reports detailing long-term graft survival from participants of the studies already included in this review would be an efficient way to generate further long-term graft survival data.E...
Source: Cochrane Database of Systematic Reviews - March 14, 2019 Category: General Medicine Authors: Tingle SJ, Figueiredo RS, Moir JA, Goodfellow M, Talbot D, Wilson CH Tags: Cochrane Database Syst Rev Source Type: research

Fast Intracortical Sensory-Motor Integration: A Window Into the Pathophysiology of Parkinson ’s Disease
Conclusion and Outlook In this review, we have discussed the possible contributions of the fast-afferent somatosensory pathway, the intracortical integrative component and the fast-efferent corticomotor pathway to alterations of SAI in PD. We concluded that PD-related changes in SAI are most likely caused at the cortical level, where sensory input is rapidly integrated into a motor output. This makes SAI a useful tool to probe how PD impacts on the sensorimotor integration processing at the cortical level. Studies performed on PD patients have shown variable results, ranging from reduced to normal or even enhanced SAI fi...
Source: Frontiers in Human Neuroscience - April 7, 2019 Category: Neuroscience Source Type: research

Urgent-start peritoneal dialysis versus conventional-start peritoneal dialysis for people with chronic kidney disease.
CONCLUSIONS: In patients with CKD who require dialysis urgently without ready-to-use dialysis access in place, urgent-start PD may increase the risk of dialysate leak and has uncertain effects on catheter blockage, malposition or readjustment, PD dialysate flow problems, infectious complications, exit-site bleeding, technique survival, and patient survival compared with conventional-start PD. PMID: 33320346 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - December 15, 2020 Category: General Medicine Authors: Htay H, Johnson DW, Craig JC, Teixeira-Pinto A, Hawley CM, Cho Y Tags: Cochrane Database Syst Rev Source Type: research

Infodemiology of renal diseases: a novel opportunity to investigate public global interest.
CONCLUSIONS: GT is a reliable tool in evaluating global interest for renal diseases in different geographical areas and temporal patterns. Although infodemiology represents a method for investigating the dissemination of information at a global level, our results suggest the need for increasing general population's interest for renal diseases especially, and move from simple interest to global awareness in the view of prevention strategies. PMID: 33506908 [PubMed - in process]
Source: European Review for Medical and Pharmacological Sciences - January 29, 2021 Category: Drugs & Pharmacology Tags: Eur Rev Med Pharmacol Sci Source Type: research

P049  Skeletal muscle involvement in COVID-19 infection: a case report and systematic review
Conclusion Severe skeletal manifestations such rhabdomyolysis occur in covid-19. More research is needed to discover if this is through direct viral invasion of the tissues, or indirectly via systemic cytokine release, hyperlactataemia and hypo-oxygenation. CK should be routinely checked in those critically unwell or with severe myalgia or weakness to identify treatable rhabdomyolysis early. Chronic autoimmune conditions such as the idiopathic inflammatory myopathies may have viral environmental triggers, and one case tested positive for a myositis specific antibody. Whether patients with acute covid- 19 related myositis...
Source: Rheumatology - April 26, 2021 Category: Rheumatology Source Type: research

HMG CoA reductase inhibitors (statins) for dialysis patients.
CONCLUSIONS: Statins have little or no beneficial effects on mortality or cardiovascular events and uncertain adverse effects in adults treated with dialysis despite clinically relevant reductions in serum cholesterol levels. PMID: 24022428 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - September 11, 2013 Category: Journals (General) Authors: Palmer SC, Navaneethan SD, Craig JC, Johnson DW, Perkovic V, Nigwekar SU, Hegbrant J, Strippoli GF Tags: Cochrane Database Syst Rev Source Type: research