Madhu Rajaraman

With assistance from the Centers for Disease Control and Prevention, the country of Georgia has launched a hepatitis C elimination program aimed at reducing disease transmission and meeting increased demand for diagnosis and treatment, report Dr. Kiren Mitruka and coauthors in the July 24 CDC Morbidity and Mortality Weekly Report.

Georgia has one of the world’s highest HCV prevalence rates, at 6.7%. To prepare for the launch of the program, efforts focused on describing HCV epidemiology, evaluating laboratory and health care capacity, and conducting program monitoring and evaluation, the report said.

A population-based serosurvey began in Georgia in May 2015, and seven sites have since opened to diagnose and treat HCV patients.

Results from the first phase of the program, which focused on improving access to affordable diagnostics and treatment for HCV patients with severe liver disease, found that 6,491 patients sought treatment and 6,177 (95.2%) initiated diagnostic work-up through July 3, 2015. Among these, 1,519 (24.6%) completed work-up, 1,474 (97.0%) of whom initiated treatment, the investigators reported.

Persisting challenges include the asymptomatic, chronic nature of HCV, which may result in delayed diagnosis, and ongoing transmission in health care settings and among hard to reach populations with the possibility of reinfection.

To address these obstacles, Georgia’s “comprehensive elimination plan” will cover advocacy, prevention, surveillance, testing, and access to care.

“Monitoring and evaluation will continue, and efforts are ongoing to develop an external QA/QC system to be used by laboratories to achieve and maintain biologic safety and quality diagnostic standards,” Dr. Mitruka and colleagues said.

“Georgia’s elimination program can provide information and experience that will assist similar efforts in other parts of the world,” the authors concluded.

Read the full report here: MMWR 2015 July 24.

With assistance from the Centers for Disease Control and Prevention, the country of Georgia has launched a hepatitis C elimination program aimed at reducing disease transmission and meeting increased demand for diagnosis and treatment, report Dr. Kiren Mitruka and coauthors in the July 24 CDC Morbidity and Mortality Weekly Report.

Georgia has one of the world’s highest HCV prevalence rates, at 6.7%. To prepare for the launch of the program, efforts focused on describing HCV epidemiology, evaluating laboratory and health care capacity, and conducting program monitoring and evaluation, the report said.

A population-based serosurvey began in Georgia in May 2015, and seven sites have since opened to diagnose and treat HCV patients.

Results from the first phase of the program, which focused on improving access to affordable diagnostics and treatment for HCV patients with severe liver disease, found that 6,491 patients sought treatment and 6,177 (95.2%) initiated diagnostic work-up through July 3, 2015. Among these, 1,519 (24.6%) completed work-up, 1,474 (97.0%) of whom initiated treatment, the investigators reported.

Persisting challenges include the asymptomatic, chronic nature of HCV, which may result in delayed diagnosis, and ongoing transmission in health care settings and among hard to reach populations with the possibility of reinfection.

To address these obstacles, Georgia’s “comprehensive elimination plan” will cover advocacy, prevention, surveillance, testing, and access to care.

“Monitoring and evaluation will continue, and efforts are ongoing to develop an external QA/QC system to be used by laboratories to achieve and maintain biologic safety and quality diagnostic standards,” Dr. Mitruka and colleagues said.

“Georgia’s elimination program can provide information and experience that will assist similar efforts in other parts of the world,” the authors concluded.

Read the full report here: MMWR 2015 July 24.

With assistance from the Centers for Disease Control and Prevention, the country of Georgia has launched a hepatitis C elimination program aimed at reducing disease transmission and meeting increased demand for diagnosis and treatment, report Dr. Kiren Mitruka and coauthors in the July 24 CDC Morbidity and Mortality Weekly Report.

Georgia has one of the world’s highest HCV prevalence rates, at 6.7%. To prepare for the launch of the program, efforts focused on describing HCV epidemiology, evaluating laboratory and health care capacity, and conducting program monitoring and evaluation, the report said.

A population-based serosurvey began in Georgia in May 2015, and seven sites have since opened to diagnose and treat HCV patients.

Results from the first phase of the program, which focused on improving access to affordable diagnostics and treatment for HCV patients with severe liver disease, found that 6,491 patients sought treatment and 6,177 (95.2%) initiated diagnostic work-up through July 3, 2015. Among these, 1,519 (24.6%) completed work-up, 1,474 (97.0%) of whom initiated treatment, the investigators reported.

Persisting challenges include the asymptomatic, chronic nature of HCV, which may result in delayed diagnosis, and ongoing transmission in health care settings and among hard to reach populations with the possibility of reinfection.

To address these obstacles, Georgia’s “comprehensive elimination plan” will cover advocacy, prevention, surveillance, testing, and access to care.

“Monitoring and evaluation will continue, and efforts are ongoing to develop an external QA/QC system to be used by laboratories to achieve and maintain biologic safety and quality diagnostic standards,” Dr. Mitruka and colleagues said.

“Georgia’s elimination program can provide information and experience that will assist similar efforts in other parts of the world,” the authors concluded.

Read the full report here: MMWR 2015 July 24.

Antibiotic exposure was associated with newly diagnosed juvenile idiopathic arthritis, according to results published by Dr. Daniel B. Horton and coauthors from the department of pediatrics at Rutgers Robert Wood Johnson Medical School, New Brunswick, N.J.

In a case-control study that compared children who had newly diagnosed juvenile idiopathic arthritis (JIA) with controls matched by age and gender, antibiotic exposure was associated with an increased rate of JIA (adjusted odds ratio, 2.1; 95% confidence interval, 1.2-3.5). The relationship was strongest within 1 year of diagnosis, and was dose dependent, with an increased magnitude of association with more antibiotic courses (P < .001), Dr. Horton and his colleagues reported.

The findings suggest “a potential role for antibiotics in the pathogenesis of JIA, perhaps mediated through changes in the microbiome,” the authors said. “If this association is causal, antibiotics could be considered a potentially modifiable risk factor for JIA, especially in light of the overprescribing of antibiotics to children, particularly for respiratory tract infections.”

Additionally, children with JIA “may also be at risk for more infections before diagnosis due to immune dysfunction, and a causal role for infections remains a possibility,” the authors concluded.

The full study was published online July 20 in Pediatrics (doi:10.1542/peds.2015-0036).

[email protected]

Antibiotic exposure was associated with newly diagnosed juvenile idiopathic arthritis, according to results published by Dr. Daniel B. Horton and coauthors from the department of pediatrics at Rutgers Robert Wood Johnson Medical School, New Brunswick, N.J.

In a case-control study that compared children who had newly diagnosed juvenile idiopathic arthritis (JIA) with controls matched by age and gender, antibiotic exposure was associated with an increased rate of JIA (adjusted odds ratio, 2.1; 95% confidence interval, 1.2-3.5). The relationship was strongest within 1 year of diagnosis, and was dose dependent, with an increased magnitude of association with more antibiotic courses (P < .001), Dr. Horton and his colleagues reported.

The findings suggest “a potential role for antibiotics in the pathogenesis of JIA, perhaps mediated through changes in the microbiome,” the authors said. “If this association is causal, antibiotics could be considered a potentially modifiable risk factor for JIA, especially in light of the overprescribing of antibiotics to children, particularly for respiratory tract infections.”

Additionally, children with JIA “may also be at risk for more infections before diagnosis due to immune dysfunction, and a causal role for infections remains a possibility,” the authors concluded.

The full study was published online July 20 in Pediatrics (doi:10.1542/peds.2015-0036).

[email protected]

Antibiotic exposure was associated with newly diagnosed juvenile idiopathic arthritis, according to results published by Dr. Daniel B. Horton and coauthors from the department of pediatrics at Rutgers Robert Wood Johnson Medical School, New Brunswick, N.J.

In a case-control study that compared children who had newly diagnosed juvenile idiopathic arthritis (JIA) with controls matched by age and gender, antibiotic exposure was associated with an increased rate of JIA (adjusted odds ratio, 2.1; 95% confidence interval, 1.2-3.5). The relationship was strongest within 1 year of diagnosis, and was dose dependent, with an increased magnitude of association with more antibiotic courses (P < .001), Dr. Horton and his colleagues reported.

The findings suggest “a potential role for antibiotics in the pathogenesis of JIA, perhaps mediated through changes in the microbiome,” the authors said. “If this association is causal, antibiotics could be considered a potentially modifiable risk factor for JIA, especially in light of the overprescribing of antibiotics to children, particularly for respiratory tract infections.”

Additionally, children with JIA “may also be at risk for more infections before diagnosis due to immune dysfunction, and a causal role for infections remains a possibility,” the authors concluded.

The full study was published online July 20 in Pediatrics (doi:10.1542/peds.2015-0036).

[email protected]

Adolescents with restrictive eating disorders had high rates of psychiatric comorbidity and medication use, reported Dr. Maria C. Monge of the division of adolescent/young adult medicine at Boston Children’s Hospital, and her coauthors.

In an analysis of 635 patients (359 of whom had follow-up after 1 year), 20.4% were taking psychopharmacologic medication at intake and 58.7% were taking medication at 1 year (P < .0001). The presence of psychiatric comorbidity was significantly associated with medication use (odds ratio, 10.0).

In 256 patients in which there was additional information about psychopharmacologic medication use, selective serotonin reuptake inhibitors (SSRIs)/serotonin-norepinephrine reuptake inhibitors (SNRIs) was the most common (83%), followed by anxiolytic (18%), antipsychotic (17%), other antidepressant (15%), mood stabilizer (8%), other psychopharmacologic medication not listed elsewhere (cyproheptadine, gabapentin, and guanfacine; 6%), stimulant (6%), and atomoxetine (1%). A total of 30% of patients on these medications were taking two or more at 1-year follow-up.

At 1-year follow-up, 63% of patients had a psychiatric comorbidity. Anxiety was the most common at 44%, followed by depression in 26%. Less-common diagnoses were attention-deficit/hyperactivity disorder in 2%, bipolar disorder in 0.5%, and other diagnoses in 2% including posttraumatic stress disorder, personality disorder, drug abuse, conversion disorder, trichotillomania, oppositional defiant disorder, and body dysmorphic disorder.

“Psychopharmacologic medications may be appropriate for treatment of comorbid conditions in these patients; however, it is unclear from existing studies if the addition of medication changes patients’ trajectories and provides an effective adjunct to weight restoration,” Dr. Monge and her colleagues said. “Continued investigation is needed to ensure [whether] the desired outcomes of the medications are being met, and the risks and rewards of such medications are fully understood in these patients.”

Read the full article here

Adolescents with restrictive eating disorders had high rates of psychiatric comorbidity and medication use, reported Dr. Maria C. Monge of the division of adolescent/young adult medicine at Boston Children’s Hospital, and her coauthors.

In an analysis of 635 patients (359 of whom had follow-up after 1 year), 20.4% were taking psychopharmacologic medication at intake and 58.7% were taking medication at 1 year (P < .0001). The presence of psychiatric comorbidity was significantly associated with medication use (odds ratio, 10.0).

In 256 patients in which there was additional information about psychopharmacologic medication use, selective serotonin reuptake inhibitors (SSRIs)/serotonin-norepinephrine reuptake inhibitors (SNRIs) was the most common (83%), followed by anxiolytic (18%), antipsychotic (17%), other antidepressant (15%), mood stabilizer (8%), other psychopharmacologic medication not listed elsewhere (cyproheptadine, gabapentin, and guanfacine; 6%), stimulant (6%), and atomoxetine (1%). A total of 30% of patients on these medications were taking two or more at 1-year follow-up.

At 1-year follow-up, 63% of patients had a psychiatric comorbidity. Anxiety was the most common at 44%, followed by depression in 26%. Less-common diagnoses were attention-deficit/hyperactivity disorder in 2%, bipolar disorder in 0.5%, and other diagnoses in 2% including posttraumatic stress disorder, personality disorder, drug abuse, conversion disorder, trichotillomania, oppositional defiant disorder, and body dysmorphic disorder.

“Psychopharmacologic medications may be appropriate for treatment of comorbid conditions in these patients; however, it is unclear from existing studies if the addition of medication changes patients’ trajectories and provides an effective adjunct to weight restoration,” Dr. Monge and her colleagues said. “Continued investigation is needed to ensure [whether] the desired outcomes of the medications are being met, and the risks and rewards of such medications are fully understood in these patients.”

Read the full article here

Adolescents with restrictive eating disorders had high rates of psychiatric comorbidity and medication use, reported Dr. Maria C. Monge of the division of adolescent/young adult medicine at Boston Children’s Hospital, and her coauthors.

In an analysis of 635 patients (359 of whom had follow-up after 1 year), 20.4% were taking psychopharmacologic medication at intake and 58.7% were taking medication at 1 year (P < .0001). The presence of psychiatric comorbidity was significantly associated with medication use (odds ratio, 10.0).

In 256 patients in which there was additional information about psychopharmacologic medication use, selective serotonin reuptake inhibitors (SSRIs)/serotonin-norepinephrine reuptake inhibitors (SNRIs) was the most common (83%), followed by anxiolytic (18%), antipsychotic (17%), other antidepressant (15%), mood stabilizer (8%), other psychopharmacologic medication not listed elsewhere (cyproheptadine, gabapentin, and guanfacine; 6%), stimulant (6%), and atomoxetine (1%). A total of 30% of patients on these medications were taking two or more at 1-year follow-up.

At 1-year follow-up, 63% of patients had a psychiatric comorbidity. Anxiety was the most common at 44%, followed by depression in 26%. Less-common diagnoses were attention-deficit/hyperactivity disorder in 2%, bipolar disorder in 0.5%, and other diagnoses in 2% including posttraumatic stress disorder, personality disorder, drug abuse, conversion disorder, trichotillomania, oppositional defiant disorder, and body dysmorphic disorder.

“Psychopharmacologic medications may be appropriate for treatment of comorbid conditions in these patients; however, it is unclear from existing studies if the addition of medication changes patients’ trajectories and provides an effective adjunct to weight restoration,” Dr. Monge and her colleagues said. “Continued investigation is needed to ensure [whether] the desired outcomes of the medications are being met, and the risks and rewards of such medications are fully understood in these patients.”

Read the full article here

Molecular profiling may be useful to thyroid surgeons in a variety of scenarios, but results should be interpreted with proper knowledge of cancer prevalence at the clinician’s institution, report Dr. Robert L. Ferris and coauthors of the University of Pittsburgh Cancer Institute.

A large, prospective single-center study examined seven-gene mutational panel performance, and found that for the AUS/FLUS cytologic category, mutation identification had a positive predictive value of 88% for histologic cancers, with a false-positive rate of 12%, the authors said.

©Sebastian Kaulitzki/Fotolia.com

Results from two analyses of the gene expression classifier (GEC) test emphasized the importance of cancer prevalence at the institution in interpretation of negative predictive value (NPV) and positive predictive value (PPV). In the first study, though the overall calculated sensitivity for GEC was 94%, the high malignancy rate at the institution resulted in a lower estimated NPV of 90%. The second study found an estimated sensitivity and specificity to be 83% and 10%, respectively, and decreases in estimated NPV (94%) and PPV (16%), Dr. Ferris and his colleagues reported.

“Given the well established and frequently dramatic variations in cancer prevalence in thyroid cytology specimens, clinicians are urged to be aware of the prevalence of disease by cytologic category in their tested patients and carefully consider how local disease prevalence may change PPV and NPV of molecular diagnostic tests when applied to their unique clinical practice,” the authors said in the report.

Additionally, “the use of molecular profiling in cytologic indeterminate categories should be interpreted judiciously and with discretion by the clinician, who must be aware of institutional cytopathologic performance results, as well as the individual clinical and sonographic factors for each patient,” they concluded.

Read the full article in Thyroid (doi/pdf/10.1089/thy.2014.0502).

Molecular profiling may be useful to thyroid surgeons in a variety of scenarios, but results should be interpreted with proper knowledge of cancer prevalence at the clinician’s institution, report Dr. Robert L. Ferris and coauthors of the University of Pittsburgh Cancer Institute.

A large, prospective single-center study examined seven-gene mutational panel performance, and found that for the AUS/FLUS cytologic category, mutation identification had a positive predictive value of 88% for histologic cancers, with a false-positive rate of 12%, the authors said.

©Sebastian Kaulitzki/Fotolia.com

Results from two analyses of the gene expression classifier (GEC) test emphasized the importance of cancer prevalence at the institution in interpretation of negative predictive value (NPV) and positive predictive value (PPV). In the first study, though the overall calculated sensitivity for GEC was 94%, the high malignancy rate at the institution resulted in a lower estimated NPV of 90%. The second study found an estimated sensitivity and specificity to be 83% and 10%, respectively, and decreases in estimated NPV (94%) and PPV (16%), Dr. Ferris and his colleagues reported.

“Given the well established and frequently dramatic variations in cancer prevalence in thyroid cytology specimens, clinicians are urged to be aware of the prevalence of disease by cytologic category in their tested patients and carefully consider how local disease prevalence may change PPV and NPV of molecular diagnostic tests when applied to their unique clinical practice,” the authors said in the report.

Additionally, “the use of molecular profiling in cytologic indeterminate categories should be interpreted judiciously and with discretion by the clinician, who must be aware of institutional cytopathologic performance results, as well as the individual clinical and sonographic factors for each patient,” they concluded.

Read the full article in Thyroid (doi/pdf/10.1089/thy.2014.0502).

Molecular profiling may be useful to thyroid surgeons in a variety of scenarios, but results should be interpreted with proper knowledge of cancer prevalence at the clinician’s institution, report Dr. Robert L. Ferris and coauthors of the University of Pittsburgh Cancer Institute.

A large, prospective single-center study examined seven-gene mutational panel performance, and found that for the AUS/FLUS cytologic category, mutation identification had a positive predictive value of 88% for histologic cancers, with a false-positive rate of 12%, the authors said.

©Sebastian Kaulitzki/Fotolia.com

Results from two analyses of the gene expression classifier (GEC) test emphasized the importance of cancer prevalence at the institution in interpretation of negative predictive value (NPV) and positive predictive value (PPV). In the first study, though the overall calculated sensitivity for GEC was 94%, the high malignancy rate at the institution resulted in a lower estimated NPV of 90%. The second study found an estimated sensitivity and specificity to be 83% and 10%, respectively, and decreases in estimated NPV (94%) and PPV (16%), Dr. Ferris and his colleagues reported.

“Given the well established and frequently dramatic variations in cancer prevalence in thyroid cytology specimens, clinicians are urged to be aware of the prevalence of disease by cytologic category in their tested patients and carefully consider how local disease prevalence may change PPV and NPV of molecular diagnostic tests when applied to their unique clinical practice,” the authors said in the report.

Additionally, “the use of molecular profiling in cytologic indeterminate categories should be interpreted judiciously and with discretion by the clinician, who must be aware of institutional cytopathologic performance results, as well as the individual clinical and sonographic factors for each patient,” they concluded.

Read the full article in Thyroid (doi/pdf/10.1089/thy.2014.0502).

Survivors of young adult cancers had 1.5 times more hospitalizations than did controls in a population-based study spanning 20 years, Dr. Devon P. Richardson and coauthors at the University of Toronto reported online in the Journal of Clinical Oncology.

Investigators compared a cohort of 20,275 patients enrolled in the Ontario Cancer Registry who were aged 20-44 years at the time of diagnosis, and had survived at least 5 years cancer free, with 101,344 noncancer controls selected from a roster of all individuals eligible for the Ontario Health Insurance Plan. Over one-third of survivors were hospitalized during the 20-year study period, and the adjusted relative rate (ARR) of hospitalizations, compared with controls, was 1.51 (95% confidence interval, 1.48-1.54). Hospitalization rates were highest in survivors of upper GI cancers (ARR, 2.49), leukemia (ARR, 2.23), and urologic (ARR, 2.20) cancers, the investigators reported.

In the first three follow-up periods (5-8, 9-11, and 12-14 years after diagnosis), the hospitalization rate in survivors (per 100 person-years) stayed constant at 0.22, whereas the rate decreased significantly in the last two time periods: 0.17 at 15-17 years and 0.15 for 18-20 years after diagnosis (P <.0001). The hospitalization rate among controls was relatively constant during the entire time period, ranging from 0.12 to 0.14, they said.

“The results of our study show that 5-year survivors of cancer diagnosed during young adulthood will have morbidities that increase the number of hospitalizations in this cohort compared with control subjects for at least 20 years after diagnosis,” the authors wrote.

Read the full article here: J. Clin. Oncol. 2015 July 13 (doi:10.1200/JCO.2014.60.1914).

Survivors of young adult cancers had 1.5 times more hospitalizations than did controls in a population-based study spanning 20 years, Dr. Devon P. Richardson and coauthors at the University of Toronto reported online in the Journal of Clinical Oncology.

Investigators compared a cohort of 20,275 patients enrolled in the Ontario Cancer Registry who were aged 20-44 years at the time of diagnosis, and had survived at least 5 years cancer free, with 101,344 noncancer controls selected from a roster of all individuals eligible for the Ontario Health Insurance Plan. Over one-third of survivors were hospitalized during the 20-year study period, and the adjusted relative rate (ARR) of hospitalizations, compared with controls, was 1.51 (95% confidence interval, 1.48-1.54). Hospitalization rates were highest in survivors of upper GI cancers (ARR, 2.49), leukemia (ARR, 2.23), and urologic (ARR, 2.20) cancers, the investigators reported.

In the first three follow-up periods (5-8, 9-11, and 12-14 years after diagnosis), the hospitalization rate in survivors (per 100 person-years) stayed constant at 0.22, whereas the rate decreased significantly in the last two time periods: 0.17 at 15-17 years and 0.15 for 18-20 years after diagnosis (P <.0001). The hospitalization rate among controls was relatively constant during the entire time period, ranging from 0.12 to 0.14, they said.

“The results of our study show that 5-year survivors of cancer diagnosed during young adulthood will have morbidities that increase the number of hospitalizations in this cohort compared with control subjects for at least 20 years after diagnosis,” the authors wrote.

Read the full article here: J. Clin. Oncol. 2015 July 13 (doi:10.1200/JCO.2014.60.1914).

Survivors of young adult cancers had 1.5 times more hospitalizations than did controls in a population-based study spanning 20 years, Dr. Devon P. Richardson and coauthors at the University of Toronto reported online in the Journal of Clinical Oncology.

Investigators compared a cohort of 20,275 patients enrolled in the Ontario Cancer Registry who were aged 20-44 years at the time of diagnosis, and had survived at least 5 years cancer free, with 101,344 noncancer controls selected from a roster of all individuals eligible for the Ontario Health Insurance Plan. Over one-third of survivors were hospitalized during the 20-year study period, and the adjusted relative rate (ARR) of hospitalizations, compared with controls, was 1.51 (95% confidence interval, 1.48-1.54). Hospitalization rates were highest in survivors of upper GI cancers (ARR, 2.49), leukemia (ARR, 2.23), and urologic (ARR, 2.20) cancers, the investigators reported.

In the first three follow-up periods (5-8, 9-11, and 12-14 years after diagnosis), the hospitalization rate in survivors (per 100 person-years) stayed constant at 0.22, whereas the rate decreased significantly in the last two time periods: 0.17 at 15-17 years and 0.15 for 18-20 years after diagnosis (P <.0001). The hospitalization rate among controls was relatively constant during the entire time period, ranging from 0.12 to 0.14, they said.

“The results of our study show that 5-year survivors of cancer diagnosed during young adulthood will have morbidities that increase the number of hospitalizations in this cohort compared with control subjects for at least 20 years after diagnosis,” the authors wrote.

Read the full article here: J. Clin. Oncol. 2015 July 13 (doi:10.1200/JCO.2014.60.1914).

The Centers for Medicare & Medicaid Services has proposed a Comprehensive Care for Joint Replacement payment model to improve patient outcomes from hip and knee replacement surgery, the agency announced July 9.

Under the proposed rule, the hospital in which the surgery takes place would be responsible for cost and quality of care from the time of surgery through 90 days after the procedure, or an “episode” of care. Then, based on cost performance and the quality of care delivered, the facility would either receive a financial reward or be required to repay Medicare for a portion of the costs, CMS said in a statement.

“This payment would give hospitals an incentive to work with physicians, home health agencies, and nursing facilities to make sure beneficiaries receive the coordinated care they need with the goal of reducing avoidable hospitalizations and complications,” the agency said.

The new model is an effort to improve the lack of coordinated care that may lead to postsurgery complications and high readmission rates in Medicare beneficiaries who receive these procedures.

“Joint replacements are the most commonly performed Medicare inpatient surgery and their utilization is predicted to continue to grow,” CMS said. “They can require long recoveries that may include extensive rehabilitation or other post-acute care, which provides many opportunities to reward providers that improve patient outcomes.”

Read the proposed rule here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-17190.pdf

[email protected]

The Centers for Medicare & Medicaid Services has proposed a Comprehensive Care for Joint Replacement payment model to improve patient outcomes from hip and knee replacement surgery, the agency announced July 9.

Under the proposed rule, the hospital in which the surgery takes place would be responsible for cost and quality of care from the time of surgery through 90 days after the procedure, or an “episode” of care. Then, based on cost performance and the quality of care delivered, the facility would either receive a financial reward or be required to repay Medicare for a portion of the costs, CMS said in a statement.

“This payment would give hospitals an incentive to work with physicians, home health agencies, and nursing facilities to make sure beneficiaries receive the coordinated care they need with the goal of reducing avoidable hospitalizations and complications,” the agency said.

The new model is an effort to improve the lack of coordinated care that may lead to postsurgery complications and high readmission rates in Medicare beneficiaries who receive these procedures.

“Joint replacements are the most commonly performed Medicare inpatient surgery and their utilization is predicted to continue to grow,” CMS said. “They can require long recoveries that may include extensive rehabilitation or other post-acute care, which provides many opportunities to reward providers that improve patient outcomes.”

Read the proposed rule here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-17190.pdf

[email protected]

The Centers for Medicare & Medicaid Services has proposed a Comprehensive Care for Joint Replacement payment model to improve patient outcomes from hip and knee replacement surgery, the agency announced July 9.

Under the proposed rule, the hospital in which the surgery takes place would be responsible for cost and quality of care from the time of surgery through 90 days after the procedure, or an “episode” of care. Then, based on cost performance and the quality of care delivered, the facility would either receive a financial reward or be required to repay Medicare for a portion of the costs, CMS said in a statement.

“This payment would give hospitals an incentive to work with physicians, home health agencies, and nursing facilities to make sure beneficiaries receive the coordinated care they need with the goal of reducing avoidable hospitalizations and complications,” the agency said.

The new model is an effort to improve the lack of coordinated care that may lead to postsurgery complications and high readmission rates in Medicare beneficiaries who receive these procedures.

“Joint replacements are the most commonly performed Medicare inpatient surgery and their utilization is predicted to continue to grow,” CMS said. “They can require long recoveries that may include extensive rehabilitation or other post-acute care, which provides many opportunities to reward providers that improve patient outcomes.”

Read the proposed rule here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-17190.pdf

[email protected]

Black patients with stage III colon cancer were less likely than non-Hispanic whites to receive adjuvant chemotherapy during 1990-1991 and again in 2010, report Dr. Caitlin C. Murphy and her coauthors from the University of North Carolina at Chapel Hill.

An analysis of data from the Surveillance, Epidemiology, and End Results Program found the disparity disappeared after 1991, but a significant difference reemerged in 2010. Receipt of chemotherapy increased among white and black patients during the years 1990 and 1991 (white, 58.2%; black, 45.2%) to the year 2005 (white, 71.8%; black, 71.4%) and decreased in 2010 (white, 66.3%; black, 56.9%). There was no difference in the proportion of white and black patients who received adjuvant chemotherapy in 1995 (white, 58.3%; black, 57.9%), 2000 (white, 66.1%; black, 66.2%), and 2005, but there were marked disparities in the period encompassing 1990 and 1991 and in the year 2010, Dr. Murphy and her coauthors report.

In regression models, black race was still associated with lower receipt of adjuvant chemotherapy after adjusting for age, comorbidity, insurance, and year of diagnosis (relative risk, 0.82; 95% confidence interval, 0.72-0.93).

The racial disparity in chemotherapy receipt in 2010 may reflect differences in the ability to pay for cancer treatment during the economic downturn that followed the 2008 financial crisis. Black Americans were disproportionately affected by the 2008 recession, and 28% reported losing a job as a result, the investigators wrote.

Read the full article here: http://dx.doi.org/10.1200/JCO.2015.61.3026

Black patients with stage III colon cancer were less likely than non-Hispanic whites to receive adjuvant chemotherapy during 1990-1991 and again in 2010, report Dr. Caitlin C. Murphy and her coauthors from the University of North Carolina at Chapel Hill.

An analysis of data from the Surveillance, Epidemiology, and End Results Program found the disparity disappeared after 1991, but a significant difference reemerged in 2010. Receipt of chemotherapy increased among white and black patients during the years 1990 and 1991 (white, 58.2%; black, 45.2%) to the year 2005 (white, 71.8%; black, 71.4%) and decreased in 2010 (white, 66.3%; black, 56.9%). There was no difference in the proportion of white and black patients who received adjuvant chemotherapy in 1995 (white, 58.3%; black, 57.9%), 2000 (white, 66.1%; black, 66.2%), and 2005, but there were marked disparities in the period encompassing 1990 and 1991 and in the year 2010, Dr. Murphy and her coauthors report.

In regression models, black race was still associated with lower receipt of adjuvant chemotherapy after adjusting for age, comorbidity, insurance, and year of diagnosis (relative risk, 0.82; 95% confidence interval, 0.72-0.93).

The racial disparity in chemotherapy receipt in 2010 may reflect differences in the ability to pay for cancer treatment during the economic downturn that followed the 2008 financial crisis. Black Americans were disproportionately affected by the 2008 recession, and 28% reported losing a job as a result, the investigators wrote.

Read the full article here: http://dx.doi.org/10.1200/JCO.2015.61.3026

Black patients with stage III colon cancer were less likely than non-Hispanic whites to receive adjuvant chemotherapy during 1990-1991 and again in 2010, report Dr. Caitlin C. Murphy and her coauthors from the University of North Carolina at Chapel Hill.

An analysis of data from the Surveillance, Epidemiology, and End Results Program found the disparity disappeared after 1991, but a significant difference reemerged in 2010. Receipt of chemotherapy increased among white and black patients during the years 1990 and 1991 (white, 58.2%; black, 45.2%) to the year 2005 (white, 71.8%; black, 71.4%) and decreased in 2010 (white, 66.3%; black, 56.9%). There was no difference in the proportion of white and black patients who received adjuvant chemotherapy in 1995 (white, 58.3%; black, 57.9%), 2000 (white, 66.1%; black, 66.2%), and 2005, but there were marked disparities in the period encompassing 1990 and 1991 and in the year 2010, Dr. Murphy and her coauthors report.

In regression models, black race was still associated with lower receipt of adjuvant chemotherapy after adjusting for age, comorbidity, insurance, and year of diagnosis (relative risk, 0.82; 95% confidence interval, 0.72-0.93).

The racial disparity in chemotherapy receipt in 2010 may reflect differences in the ability to pay for cancer treatment during the economic downturn that followed the 2008 financial crisis. Black Americans were disproportionately affected by the 2008 recession, and 28% reported losing a job as a result, the investigators wrote.

Read the full article here: http://dx.doi.org/10.1200/JCO.2015.61.3026

Major depressive disorder and telomere length appear to have no association, Dr. Naomi M. Simon and her have reported.

A study of 166 adults with major depressive disorder (MDD) and 166 controls found that there was no significant difference in telomere length between MDD patients (mean standard deviation = 9.1) and those without any psychiatric illness (mean SD = 8.9), when measured by Southern blot test or confirmatory quantitative polymerase chain reaction assays, reported Dr. Simon of the department of psychiatry at Massachusetts General Hospital, Boston, and her colleagues.

The study findings did find a significant association between gender and telomerase activity, with higher activity in males with depression, compared with controls (P = .0079), Dr. Simon and her colleagues reported.

“When extensively controlling for a range of measured covariates at entry and in analyses, including age, gender, trauma, and loss, and medical comorbidity, our cross-sectional analyses suggest that telomere length may not be independently associated with MDD,” the authors wrote. “It is possible that some previous positive reports may include unmeasured confounding of the MDD-telomere length relationship, such as medical conditions or obesity, contributing to variability across studies,” they concluded.

Read the full study here: (Psychoneuroendocrinology 2015;58:9-22 [doi:10.1016/j.psyneuen/2015.04.004]).

Major depressive disorder and telomere length appear to have no association, Dr. Naomi M. Simon and her have reported.

A study of 166 adults with major depressive disorder (MDD) and 166 controls found that there was no significant difference in telomere length between MDD patients (mean standard deviation = 9.1) and those without any psychiatric illness (mean SD = 8.9), when measured by Southern blot test or confirmatory quantitative polymerase chain reaction assays, reported Dr. Simon of the department of psychiatry at Massachusetts General Hospital, Boston, and her colleagues.

The study findings did find a significant association between gender and telomerase activity, with higher activity in males with depression, compared with controls (P = .0079), Dr. Simon and her colleagues reported.

“When extensively controlling for a range of measured covariates at entry and in analyses, including age, gender, trauma, and loss, and medical comorbidity, our cross-sectional analyses suggest that telomere length may not be independently associated with MDD,” the authors wrote. “It is possible that some previous positive reports may include unmeasured confounding of the MDD-telomere length relationship, such as medical conditions or obesity, contributing to variability across studies,” they concluded.

Read the full study here: (Psychoneuroendocrinology 2015;58:9-22 [doi:10.1016/j.psyneuen/2015.04.004]).

Major depressive disorder and telomere length appear to have no association, Dr. Naomi M. Simon and her have reported.

A study of 166 adults with major depressive disorder (MDD) and 166 controls found that there was no significant difference in telomere length between MDD patients (mean standard deviation = 9.1) and those without any psychiatric illness (mean SD = 8.9), when measured by Southern blot test or confirmatory quantitative polymerase chain reaction assays, reported Dr. Simon of the department of psychiatry at Massachusetts General Hospital, Boston, and her colleagues.

The study findings did find a significant association between gender and telomerase activity, with higher activity in males with depression, compared with controls (P = .0079), Dr. Simon and her colleagues reported.

“When extensively controlling for a range of measured covariates at entry and in analyses, including age, gender, trauma, and loss, and medical comorbidity, our cross-sectional analyses suggest that telomere length may not be independently associated with MDD,” the authors wrote. “It is possible that some previous positive reports may include unmeasured confounding of the MDD-telomere length relationship, such as medical conditions or obesity, contributing to variability across studies,” they concluded.

Read the full study here: (Psychoneuroendocrinology 2015;58:9-22 [doi:10.1016/j.psyneuen/2015.04.004]).