Sharon Smith

This study states that Transcarotid artery revascularization (TCAR) using a flow-reversal neuroprotection system has gained popularity for the endovascular treatment of carotid artery atherosclerotic disease owing to its lower risk of stroke or death compared with transfemoral carotid artery stenting. However, specific risk factors associated with stroke or death complications after TCAR have yet to be defined. All patients undergoing TCAR for the treatment of asymptomatic or symptomatic atherosclerotic carotid disease were identified between September 2016 and September 2019 in the Vascular Quality Initiative TCAR Surveillance Project. Our primary outcome was 30-day stroke or death. We created a risk model for 30-day stroke or death using multivariable fractional polynomials and internally validated the model using bootstrapping. This Vascular Quality Initiative TCAR risk score calculator can be used to estimate the risk of stroke or death within 30 days of the procedure. Because TCA...

Spurred by decades of complaints about the high cost of hearing aids, Congress passed a law in 2017 to allow over-the-counter sales, with hopes it would boost competition and lower prices. Four years later, federal regulators have yet to issue rules to implement the law. But changes in the industry are offering consumers relief. In August 2017, President Donald Trump signed the legislation that called for the Food and Drug Administration to issue regulations by 2020 for hearing aids that could be sold in stores without a prescription or a visit to an audiologist or other hearing specialist. That hasn’t happened yet, and President Joe Biden last month ordered the FDA to produce those rules for over-the-counter (OTC) purchases by mid-November. That means it will likely take at least until next summer for consumers to feel the direct effects of the law. Despite the delay, consumers’ options have expanded with more hearing devices entering the market, alternative ways to get them an...

If you live in one of the rural communities tucked into the forested hillsides along the Oregon-California border and need serious medical care, you’ll probably wind up at Asante Rogue Regional Medical Center. It serves about nine counties on either side of the border.   It is one of three hospitals Asante owns in the region. All three ICUs are 100% full of covid patients, according to staff members.   “We’ve had two deaths today. So, it’s a very grim, difficult time,” Dr. Michael Blumhardt, medical director of the hospital’s intensive care unit, said on a recent Tuesday in August. “The delta virus is passing through the region like a buzzsaw.” Unlike earlier covid waves, he said, patients are in their 20s, 30s, 40s and 50s. “We’re seeing clusters of families being admitted. We had a father and an adult daughter admitted to the intensive care unit and he passed away. Right before, I had to put the daughter on life support,” he said.  Overall, vaccinati...

For years, Ely Bair dealt with migraine headaches, jaw pain and high blood pressure, until a dentist recommended surgery to realign his jaw to get to the root of his health problems. The fix would involve two surgeries over a couple of years and wearing braces on his teeth before and in between the procedures. Bair had the first surgery, on his upper jaw, in 2018 at Swedish Medical Center, First Hill Campus in Seattle. The surgery was covered by his Premera Blue Cross plan, and Bair’s out-of-pocket hospital expense was $3,000. He changed jobs in 2019 but still had Premera health insurance. In 2020, he had the planned surgery on his lower jaw at the same hospital where he’d been treated the first time. The surgery went well, and he spent one night in the hospital before being discharged. He was healing well and beginning to see the benefits of the surgeries. Then the bill arrived. The Patient: Ely Bair, 35, a quality assurance analyst. He has a Premera Blue Cross health plan throu...

Medicaid enrollees are getting vaccinated against covid-19 at far lower rates than the general population as states search for the best strategies to improve access to the shots and persuade those who remain hesitant. Efforts by state Medicaid agencies and the private health plans that most states pay to cover their low-income residents has been scattershot and hampered by a lack of access to state data about which members are immunized. The problems reflect the decentralized nature of the health program, funded largely by the federal government but managed by the states. It also points to the difficulty in getting the message to Medicaid populations about the importance of the covid vaccines and challenges they face getting care. “These are some of the hardest-to-reach populations and those often last in line for medical care,” said Craig Kennedy, CEO of Medicaid Health Plans of America, a trade group. Medicaid enrollees often face hurdles accessing vaccines, including worries abou...

After a decade of living with chronic kidney disease, Vonita McGee knows her body is wearing out. At 63, McGee undergoes dialysis sessions three times each week at a Northwest Kidney Centers site near her Burien, Washington, home to rid her blood of waste and water. She has endured the placement of more than a dozen ports, or access sites, in her arms and chest as sites became scarred and unusable. Late last month, doctors performed surgery to install yet another port near her left elbow, but no one is certain it will hold. “Because of scar tissue, I was told this is my last viable access,” she said. Without ongoing dialysis, McGee knows she could face death within days or weeks. But, unlike many of the nearly 500,000 U.S. patients who require dialysis, McGee said she’s had help making peace with the process. “I know that things are coming,” she said. “I’m in awe of death, but I’m not afraid of it anymore.” That’s largely attributed to a novel effort in Washington state that embe...

If you live in one state, does it matter that the doctor treating you online is in another? Surprisingly, the answer is yes, and the ability to conduct certain virtual appointments may be nearing an end. Televisits for medical care took off during the worst days of the pandemic, quickly becoming commonplace. Most states and the Centers for Medicare & Medicaid Services temporarily waived rules requiring licensed clinicians to hold a valid license in the state where their patient is located. Those restrictions don’t keep patients from visiting doctors’ offices in other states, but problems could arise if those same patients used telemedicine. Now states are rolling back many of those pandemic workarounds. Johns Hopkins Medicine in Baltimore, for example, recently scrambled to notify more than 1,000 Virginia patients that their telehealth appointments were “no longer feasible,” said Dr. Brian Hasselfeld, medical director of digital health and telemedicine at Johns Hopkins. Virginia...

MARYLAND HEIGHTS, Mo. — Fans of the band Wilco could have reasonably interpreted frontman Jeff Tweedy singing “I Am Trying to Break Your Heart” at an Aug. 13 concert at St. Louis Music Park as the universe explaining the past year or so. For example, 30-year-old fan Lazarus Pittman had planned to see Wilco and co-headliner Sleater-Kinney in August 2020 at the open-air venue in this suburb west of St. Louis. Then the show was postponed because of the covid-19 pandemic. Pittman got sick with the coronavirus. He quit his job as a traffic engineer in Connecticut to relocate to St. Louis for his girlfriend — only to have her break up with him before he moved. But he still trekked from New England to Missouri in a converted minivan for the rescheduled outdoor show. “Covid’s been rough, and I’m glad things are opening up again,” he said. Yet hours before Pittman planned to cross off the concert from his bucket list, he learned the latest wrinkle: He needed proof of vaccination or a negati...

Can’t see the audio player? Click here to listen on SoundCloud . You can also listen on Spotify , Apple Podcasts , Stitcher , Pocket Casts or wherever you listen to podcasts. Click here for a transcript of the episode. The Food and Drug Administration gave full approval this week to the covid-19 vaccine from Pfizer and BioNTech, which will henceforth be known as “Comirnaty.” It is not clear how many vaccine-hesitant Americans will now be willing to get a jab, but the approval has prompted many public and private employers to implement mandates for their workers. Meanwhile, the U.S. House, back early from its summer break, overcame a brief rebellion by some Democratic moderates to pass a budget resolution that starts the process for a giant social-spending measure addressing many new health benefits. This week’s panelists are Julie Rovner of KHN, Joanne Kenen of Politico, Tami Luhby of CNN and Sarah Karlin-Smith of the Pink Sheet. Among the takeaways from this week’s episode: Ho...

Two state government websites in Georgia recently stopped posting updates on covid-19 cases in prisons and long-term care facilities, just as the dangerous delta variant was taking hold. Data has been disappearing recently in other states as well. Florida, for example, now reports covid cases, deaths and hospitalizations once a week, instead of daily, as before. Both states, along with the rest of the South, are battling high infection rates. Public health experts are voicing concern about the pullback of covid information. Dr. Georges Benjamin, executive director of the American Public Health Association, called the trend “not good for government and the public” because it gives the appearance of governments “hiding stuff.” A month ago, the Georgia agency that runs state prisons stopped giving public updates on the number of new covid cases among inmates and staff members. The Department of Corrections, in explaining this decision, cited its successful vaccination rates and “a de...

SACRAMENTO, Calif. — As the election to recall California Gov. Gavin Newsom approaches, abortion-rights groups are warning that Californians’ right to an abortion is on the ballot. Newsom, a Democrat, himself tweeted that “abortion access” is at stake. “There’s no question that if a Republican is elected, access to abortion in California will be restricted,” Jodi Hicks, president of Planned Parenthood Affiliates of California, said at a press conference in July. But this message is strategic and is more about firing up left-leaning voters than it is about policy, said Rob Stutzman, a Republican political strategist. “There’s no indication from polling in this election that [abortion] is at all what Californians think this election is about,” Stutzman said. “This fits into the type of campaign that they’re running, which isn’t persuasion; it’s motivation to turn out.” In reality, California has some of the strongest abortion protections in the country and restricting them would be...

Corticosteroids are an essential component of liver transplant (LT) immunosuppressive regimens, although they are frequently associated with a slew of side effects. Budesonide is an oral corticosteroid that is extensively metabolized in the liver and has little systemic absorption. The purpose of this study was to look into the safety and effectiveness of budesonide in the treatment of acute cellular rejection (ACR) in juvenile LT recipients. All pediatric patients who had LT at our center and were administered oral budesonide for the treatment of ACR were subjected to a retrospective descriptive study. Alanine aminotransferase (ALT) levels and reported side effects were examined. Budesonide was administered to 29 individuals for the treatment of ACR, with 65.5 percent having biopsy-proven acute rejection and 34.5 percent having suspected ACR. When compared to readings 1 month, 3 months, and 6 months following budesonide therapy, there was a substantial reduction in ALT from the time o...

The purpose of this prospective intention-to-diagnose pilot research was to evaluate the accuracy of serum and fecal amino-acids in distinguishing de novo juvenile inflammatory bowel disease (IBD) from non-IBD children. Following laboratory tests or endoscopy, patients with suspected IBD were assigned to the IBD or non-IBD groups based on the updated Porto-criteria. Fecal calprotectin levels were measured, and a blood and fecal sample were taken. High performance liquid chromatography was used to examine the amino acid profiles of feces and serum.  There were substantial differences in nine fecal amino acids between IBD and non-IBD. There were no significant changes in serum. This study highlights the potential of fecal amino-acids as new, adjuvant noninvasive, and low-cost biomarkers in juvenile IBD diagnosis. Reference: https://journals.lww.com/jpgn/Abstract/2020/09000/Fecal_Amino_Acid_Profiles_Exceed_Accuracy_of_Serum.16.aspx source https://www.physiciansweekly.com/fecal-a...