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The American Journal of Managed Care Aug 2023To investigate trends in Medicare coverage of buprenorphine-naloxone film before and after the FDA approval of its first generic versions.
OBJECTIVES
To investigate trends in Medicare coverage of buprenorphine-naloxone film before and after the FDA approval of its first generic versions.
STUDY DESIGN
This study used data from the Part D Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files from 2015 to 2022, which provide information on all stand-alone Medicare/Medicare Advantage Prescription Drug Plans.
METHODS
We examined the percentage of plans that provided coverage of brand-name and generic buprenorphine-naloxone films with strength 8 mg/2 mg during 2015-2022. Median out-of-pocket (OOP) cost for a 30-day supply was estimated among all plans that provided coverage.
RESULTS
Generic buprenorphine-naloxone film was covered by 82% of Medicare Part D plans in 2020, 2 years after market entry. Coverage of brand-name Suboxone film decreased from 76% in 2019 to 42% in 2020. The median OOP cost of buprenorphine-naloxone films faced by Medicare enrollees decreased from $99 in 2019 to $42 in 2020, driven by the lower price of generic films. In contrast, the OOP cost for brand-name buprenorphine-naloxone film increased gradually from $85 in 2015 to $100 in 2022.
CONCLUSIONS
Medicare Part D plan formularies replaced brand-name buprenorphine-naloxone films with the newly approved generic versions. This was accompanied by a substantial decrease in estimated OOP cost faced by Part D enrollees. These changes could potentially increase access to buprenorphine among Medicare enrollees with opioid use disorder.
Topics: Aged; United States; Humans; Buprenorphine, Naloxone Drug Combination; Prescription Drugs; Buprenorphine; Drugs, Generic; Medicare Part D
PubMed: 37616154
DOI: 10.37765/ajmc.2023.89413 -
Aging Clinical and Experimental Research Feb 2024Osteoarthritis (OA) is a disease with systemic implications that go beyond joint problems. Its pathogenic mechanisms involve a variety of systemic conditions that... (Review)
Review
Osteoarthritis (OA) is a disease with systemic implications that go beyond joint problems. Its pathogenic mechanisms involve a variety of systemic conditions that contribute to joint damage. These include metabolic dysfunction, chronic low-grade inflammation, neuroplastic pain, and the influence of the central nervous system in the development of neuropathic pain. Besides, OA can negatively affect other aspects of health, such as quality of life, reduced physical activity, social isolation, depression, and anxiety. OA can be considered a complex system in which pathological interactions involve not only obesity and metabolic dysfunction, but also fragility syndrome, sarcopenia, neurological complications, and systemic energy redistribution. Complex systems are composed of multiple interacting and dynamic parts and exhibit emergent properties that cannot be fully explained by examining their individual components. Chronic low-grade inflammation is characteristic of OA, occurring both in the affected joint, and systemically, mainly due to adipose tissue inflammation in obese patients. Obesity is a key factor in the progression of OA, so primary treatment should focus on its control, while maintaining muscle health. The chronic inflammation could lead to changes in energy distribution among the affected joint tissues. Therefore, OA should be approached as a systemic disease, considering individual patient factors, such as genetics, inflammatory response, and lifestyle. Medical care should be more holistic and personalized. Consideration of a name change, such as "systemic OA", could help to move away from the perception of a disease focused only on the joints.
Topics: Humans; Quality of Life; Osteoarthritis; Inflammation; Pain; Obesity
PubMed: 38376694
DOI: 10.1007/s40520-024-02714-w -
Annals of Medicine Dec 2023Hepatic encephalopathy (HE) implies high morbidity and mortality. The assessment of covert HE (CHE) [i.e. minimal HE (MHE) plus grade 1 HE] is often neglected in Taiwan....
BACKGROUND AND AIMS
Hepatic encephalopathy (HE) implies high morbidity and mortality. The assessment of covert HE (CHE) [i.e. minimal HE (MHE) plus grade 1 HE] is often neglected in Taiwan. Therefore, the aim was to investigate the potential of the animal naming test (ANT and simplified ANT (S-ANT) for assessing CHE in Chinese-speaking regions, specifically Taiwan.
METHODS
A prospective cohort study was conducted, comprising 65 cirrhotic patients and 29 healthy controls (relatives of the patients). Patients were followed up every three months and censored after two years or until death. Hospitalization for overt HE (OHE) and mortality were considered. All subjects underwent ANT, psychometric HE score (PHES), and mini-mental state examination (MMSE). The patients underwent an electroencephalogram (EEG) to detect slowing indicative of MHE. Cut-off values for ANT and S-ANT were assessed by ROC analysis and Youden's index, considering CHE as a reference. The prognostic values for OHE and OHE-free survival were assessed.
RESULTS
Preliminary analysis confirmed that PHES ≤-4 is a good discriminant point for abnormal results. CHE was found in 29 patients: 9 had MHE (PHES ≤ -4 or altered EEG) and 20 had grade 1 HE. ANT and S-ANT were found to have diagnostic values for CHE: AUC = 0.807, 0.786; cut off: 18 and 19, respectively. ANT and S-ANT were found to have prognostic value for OHE, number of hospitalization episodes for OHE, and OHE recurrence-free survival.
CONCLUSIONS
ANT shows promise as a tool for CHE detection, quantification, and follow-up in Taiwan and other Chinese-speaking regions.Key messagesThe animal naming test (ANT) is a simple and valid semantic fluency test that can be easily performed in outpatient or bedside settings in one minute and can also be used as a tool for covert hepatic encephalopathy (CHE) detection, quantification, and follow-up in Taiwan, other Chinese-speaking regions, and many other countries.The diagnostic value of ANT and S-ANT for CHE were found to be significant, with area under the receiver operating characteristic curve (AUROC) values of 0.807 and 0.786 respectively, and cut-off scores of 18 and 19.ANT and S-ANT have prognostic value for the first breakthrough of overt hepatic encephalopathy (OHE), number of hospitalization episodes for OHE, and OHE recurrence-free survival, independent of the MELD score.
Topics: Animals; Humans; East Asian People; Hepatic Encephalopathy; Liver Cirrhosis; Prospective Studies; ROC Curve; Names
PubMed: 37494454
DOI: 10.1080/07853890.2023.2236013 -
American Journal of Clinical Dermatology Sep 2023As research related to skin of color (SOC) in dermatology continues to grow, it is increasingly important to precisely define terminology. The terms 'SOC', 'race', and...
As research related to skin of color (SOC) in dermatology continues to grow, it is increasingly important to precisely define terminology. The terms 'SOC', 'race', and 'ethnicity' are frequently used to analyze differences in dermatologic disease onset, severity, and outcomes. These terms are used interchangeably, are ill-defined across research studies, and frequently conflate biologic and socially constructed categories. SOC has been thought to represent differing degrees of pigment or melanin in the skin, however skin pigment is quite variable among races and ethnicities. Furthermore, certain individuals with less skin pigment may socially consider themselves to be SOC, while the inverse is also true. Fitzpatrick skin phototype classifications in SOC dermatology, while commonly used as an objective measure of diversity, also present with numerous limitations and inaccuracies. We seek to highlight strengths and weaknesses of the current terminology used in SOC dermatology and recommend a more holistic understanding of reported differences, including a framework reflective of upstream socioeconomic, environmental, and historical factors that may be most relevant to reported associations.
Topics: Humans; Dermatology; Ethnicity; Pigmentation Disorders; Skin; Skin Pigmentation; Racial Groups
PubMed: 37328613
DOI: 10.1007/s40257-023-00800-9 -
Computers in Biology and Medicine Dec 2023Large high-quality datasets are essential for building powerful artificial intelligence (AI) algorithms capable of supporting advancement in cardiac clinical research.... (Review)
Review
Large high-quality datasets are essential for building powerful artificial intelligence (AI) algorithms capable of supporting advancement in cardiac clinical research. However, researchers working with electrocardiogram (ECG) signals struggle to get access and/or to build one. The aim of the present work is to shed light on a potential solution to address the lack of large and easily accessible ECG datasets. Firstly, the main causes of such a lack are identified and examined. Afterward, the potentials and limitations of cardiac data generation via deep generative models (DGMs) are deeply analyzed. These very promising algorithms have been found capable not only of generating large quantities of ECG signals but also of supporting data anonymization processes, to simplify data sharing while respecting patients' privacy. Their application could help research progress and cooperation in the name of open science. However several aspects, such as a standardized synthetic data quality evaluation and algorithm stability, need to be further explored.
Topics: Humans; Artificial Intelligence; Electrocardiography; Heart; Algorithms; Data Accuracy
PubMed: 37976830
DOI: 10.1016/j.compbiomed.2023.107655 -
Computers in Biology and Medicine Oct 2023As the main technology to solve data islands and mine data value, federated learning has been widely researched and applied, and more and more federated learning...
As the main technology to solve data islands and mine data value, federated learning has been widely researched and applied, and more and more federated learning platforms are emerging. The federated learning platform organizes users, devices and data to collaborate in a crowdsourcing manner and complete specific federated learning tasks. This paper designs the shortest path core-selection incentive mechanism by combining the VCG auction mechanism and the core concept of cooperative games. This mechanism solves the problems of overpayment, false-name attack, and deviation from the core of the VCG mechanism, and saves the expenditure of the federated learning task issuer. It adopts the VCG-nearest principle in the core selection, so that the federated learning task participants get rewards as close as possible to the outcome of VCG mechanism. This mechanism can guarantee four economic attributes: incentive compatibility, individual rationality, alliance rationality, and maximization of social efficiency. Medical experimental results illustrate the effectiveness of the mechanism.
Topics: Humans; Motivation; Learning; Health Expenditures
PubMed: 37678134
DOI: 10.1016/j.compbiomed.2023.107394 -
Clinical Psychology Review Jun 2024Cognitive reappraisal, an adaptive emotion regulation strategy that involves subjectively reinterpreting stressful and adverse experiences in a more positive manner, can... (Meta-Analysis)
Meta-Analysis Review
Cognitive reappraisal, an adaptive emotion regulation strategy that involves subjectively reinterpreting stressful and adverse experiences in a more positive manner, can enhance personal resilience. Personal resilience is a constellation of attributes that facilitate successful coping and an expeditious return to adaptive functioning after exposure to stress or adversity. This meta-analysis evaluated the association between cognitive reappraisal and personal resilience. A systematic and exhaustive search identified 64 independent samples from 55 studies (N = 29,824) that examined the correlation between cognitive reappraisal and personal resilience. A random-effects model revealed a positive summary effect (r = 0.47, p < .001), indicating that higher cognitive reappraisal was associated with higher personal resilience. Six potential meta-moderators were tested: culture, age, name of the cognitive reappraisal measure, name of the personal resilience measure, study design, and publication period. After two extreme effect size outliers were omitted, tests of publication bias did not reveal any publication bias in this line of research. This quantitative synthesis offers compelling evidence showing that cognitive reappraisal skills operate as a protective strategy against stress and adversity and, therefore, enhance personal resilience. The protective benefits of cognitive reappraisal in relation to personal resilience are relatively robust, as the correlations were statistically significant for all subgroups in the meta-moderation analyses.
Topics: Humans; Resilience, Psychological; Cognition; Adaptation, Psychological; Emotional Regulation; Stress, Psychological
PubMed: 38657292
DOI: 10.1016/j.cpr.2024.102428 -
Cureus Apr 2024Introduction Due to the COVID-19 pandemic, the American Association of Medical Colleges (AAMC) recommended that all interviews for residencies and fellowships be...
Introduction Due to the COVID-19 pandemic, the American Association of Medical Colleges (AAMC) recommended that all interviews for residencies and fellowships be conducted in a virtual format. As of March 2024, the Society of Maternal-Fetal Medicine (SMFM) continues to request that all fellowship interviews occur virtually. Without in-person interviews, prospective Maternal-Fetal Medicine (MFM) fellowship applicants must largely rely on program websites to gain insight into each program's offerings, culture, and application requirements. The purpose of this study was to evaluate the content of American College of Graduate Medical Education (ACGME)-accredited Maternal-Fetal Medicine (MFM) fellowship program websites and assess if regional differences exist among website content. Methods All ACGME-accredited MFM fellowship program websites were assessed for 21 defined criteria as of March 2024 and further compared by geographic regions (Midwest, Northeast, South, and West). Analyses were completed using chi-squared univariate tests, with a p < 0.05. Results Of the 108 accredited MFM fellowship programs, 106 programs had a dedicated website (98.15%). Most MFM programs (over 80%) included contact information (102/106), program director name (98/106), faculty names (95/106), application requirements (92/106), current fellow names (91/106), and the program coordinator name (89/106) on their website. Less programs (less than 30%) included diversity, equity, inclusion (DEI) content (28/106), interview dates (28/106), and current fellow research projects or publications (27/106). Western programs were less likely to include the program coordinator's name (12/18 (67%), p = 0.046), but more likely to include DEI content (10/18 (56%), p = 0.005). Northeastern programs were less likely to include their application requirements (24/32 (75%), p = 0.049) and less likely to include pictures of their current fellows (20/32 (63%), p = 0.045). Southern programs were more likely to include the yearly rotation schedule (19/32 (59%), p = 0.040). Midwestern programs were more likely to include information on fellowship benefits or salary (15/24 (63%), p = 0.046). Conclusion This study demonstrated that the content available on MFM fellowship websites varies greatly between programs and geographic regions. Efforts should be made by MFM training institutions to enhance website DEI content, curriculum information, recent fellow publications, and information on program alumni. A detailed and well-structured website may help applicants compare individual programs more equitably in the age of virtual interviewing.
PubMed: 38884023
DOI: 10.7759/cureus.58527 -
The Modern Hearing Care Landscape: Toward the Provision of Personalized, Dynamic, and Adaptive Care.Seminars in Hearing Aug 2023New technologies and developments in hearing healthcare are rapidly transforming service models, delivery channels, and available solutions. These advances are reshaping... (Review)
Review
New technologies and developments in hearing healthcare are rapidly transforming service models, delivery channels, and available solutions. These advances are reshaping the ways in which care is provided, leading to greater personalization, service efficiencies, and improved access to care, to name a few benefits. Connected hearing care is one model with the potential to embrace this "customized" hearing experience by forging a hybrid of health-technology connections, as well as traditional face-to-face interactions between clients, providers, and persons integral to the care journey. This article will discuss the many components of connected care, encompassing variations of traditional and teleaudiology-focused services, clinic-based and direct-to-consumer channels, in addition to the varying levels of engagement and readiness defining the touch points for clients to access a continuum of connected hearing care. The emerging hearing healthcare system is one that is dynamic and adaptive, allowing for personalized care, but also shifting the focus to the client's needs and preferences. This shift in the care model, largely driven by innovation and the growing opportunities for clients to engage with hearing technology, brings forth new, exciting, and sometimes uncomfortable discussion points for both the provider and client. The modern hearing care landscape benefits clients to better meet their needs and preferences in a more personalized style, and providers to better support and address those needs and preferences.
PubMed: 37484984
DOI: 10.1055/s-0043-1769621 -
Cureus Jul 2023Background The purpose of the study was to provide a practical landmark for localizing the dorsal branch of the ulnar artery and nerve, to approach for microsurgical...
Background The purpose of the study was to provide a practical landmark for localizing the dorsal branch of the ulnar artery and nerve, to approach for microsurgical flaps, for harvesting nerve grafts and also to avoid these nerves during insertion of wrist arthroscopy portals. Material and methods Forty adult cadaveric upper limbs (20 right and 20 left) were dissected for localizing the dorsal branches of the ulnar artery and nerve. The ramification patterns of the nerve were mapped. The wrist arthroscopy portals are located radial and ulnar to the tendon of extensor carpi ulnaris at the level of the wrist joint, and their designated names are '6R & 6U', respectively. The distance of branches of the nerve from the 6U and 6R portals for wrist arthroscopy was recorded. Results The present study has delineated a subcutaneous dorsomedial triangular area in the distal forearm. The construction of this triangle uses palpable landmarks, i.e. pisiform bone, styloid process and subcutaneous border of the ulna. The measure of the sides of the triangle uses proportion rather than absolute measurements and hence is person specific. The dorsal branches of the ulnar nerve and artery are consistently given off in the triangle's upper third and middle third, respectively. Four branching patterns have been mapped, with one dominant pattern in 67.5% of limbs. In three-fourths of cases, one branch of the dorsal branch of the ulnar nerve consistently overlies the 6U portal and hence runs a higher risk of injury. Conclusion The study suggests more practical, accurate, reliable and consistent surface landmarks for the localization of the dorsal branch of the ulnar artery and nerve for reconstructive microsurgery for distal hand defects.
PubMed: 37593310
DOI: 10.7759/cureus.41981