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Erb C.T.,Yale University | Ernst A.,Pulmonary | Ernst A.,Reliant Medical Group | Michaud G.C.,Yale University
Clinics in Chest Medicine | Year: 2013

Interventional pulmonologists are regularly asked to perform more complicated and advanced procedures, but reimbursement for the time, effort and skill involved in these procedures has not kept up with other procedural specialties. Further changes in funding and reimbursement are likely under the Affordable Care Act. Understanding and effectively using the current system of funding for interventional pulmonology practices are imperative as we adapt to changing medical needs, legislative mandates, and reimbursement policy. This article reviews the current landscape of insurance and reimbursement in health care and anticipates some changes that might be expected from implementation of the Affordable Care Act. © 2013 Elsevier Inc.


Becker M.A.,University of Chicago | Baraf H.S.B.,Center for Rheumatology and Bone Research | Yood R.A.,Reliant Medical Group | Dillon A.,Kaiser Permanente | And 4 more authors.
Annals of the Rheumatic Diseases | Year: 2013

Objective: To evaluate the long-term safety (up to 3 years) of treatment with pegloticase in patients with refractory chronic gout. Methods: This open-label extension (OLE) study was conducted at 46 sites in the USA, Canada and Mexico. Patients completing either of two replicate randomised placebo-controlled 6-month trials received pegloticase 8 mg every 2 weeks (biweekly) or every 4 weeks (monthly). Safety was evaluated as the primary outcome, with special interest in gout flares and infusion-related reactions (IRs). Secondary outcomes included uratelowering and clinical efficacy. Results: Patients (n=149) received a mean±SD of 28±18 pegloticase infusions and were followed for a mean of 25±11 months. Gout flares and IRs were the most frequently reported adverse events; these were least common in patients with a sustained urate-lowering response to treatment and those receiving biweekly treatment. In 10 of the 11 patients with a serious IR, the event occurred when uric acid exceeded 6 mg/dl. Plasma and serum uric acid levels remained <6 mg/dl in most randomised controlled trial (RCT)-defined pegloticase responders throughout the OLE study and were accompanied by sustained and progressive improvements in tophus resolution and flare incidence. Conclusions: The safety profile of long-term pegloticase treatment was consistent with that observed during 6 months of RCT treatment; no new safety signals were identified. Improvements in clinical status, in the form of flare and tophus reduction initiated during RCT pegloticase treatment in patients maintaining goal range urate-lowering responses were sustained or advanced during up to 2.5 years of additional treatment.


Weinstein C.L.J.,Merck And Co. | Jordan K.,Martin Luther University of Halle Wittenberg | Green S.A.,Merck And Co. | Camacho E.,Comprehensive Cancer Center | And 5 more authors.
Annals of Oncology | Year: 2016

Background: To establish the role of antiemetic therapy with neurokinin-1 (NK1) receptor antagonists (RAs) in nonanthracycline and cyclophosphamide (AC)-based moderately emetogenic chemotherapy (MEC) regimens, this study evaluated single-dose intravenous (i.v.) fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting (CINV) associated with non-AC MEC. Patients and methods: In this international, phase III, double-blind trial, adult cancer subjects scheduled to receive =1 non-AC MEC on day 1 were randomized to a regimen comprising single-dose i.v. fosaprepitant 150 mg or placebo along with ondansetron and dexamethasone on day 1; control regimen recipients received ondansetron on days 2 and 3. Primary end points were the proportion of subjects achieving a complete response (CR; no vomiting and no use of rescue medication) in the delayed phase (25-120 h after MEC initiation) and safety. Secondary end points included CR in the overall and acute phases (0-120 and 0-24 h after MEC initiation, respectively) and no vomiting in the overall phase. Nausea and the Functional Living Index-Emesis were assessed as exploratory end points. Results: The fosaprepitant regimen improved CR significantly in the delayed (78.9% versus 68.5%; P < 0.001) and overall (77.1% versus 66.9%; P < 0.001) phases, but not in the acute phase (93.2% versus 91.0%; P = 0.184), versus control. In the overall phase, the proportion of subjects with no vomiting (82.7% versus 72.9%; P < 0.001) and no significant nausea (83.2% versus 77.9%; P = 0.030) was also significantly improved with the fosaprepitant regimen. The fosaprepitant regimen was generally well tolerated. Conclusion: Single-dose fosaprepitant added to a 5-HT3 RA and dexamethasone was well tolerated and demonstrated superior control of CINV (primary end point achieved) associated with non-AC MEC. This is the first study to evaluate NK1 RA therapy as an i.v. formulation in a well-defined non-AC MEC population. © The Author 2015.


News Article | December 6, 2016
Site: www.newsmaker.com.au

This report studies Breast Pump in Global market, especially in North America, Europe, China, Japan, Southeast Asia and India, focuses on top manufacturers in global market, with Production, price, revenue and market share for each manufacturer, covering  Philips  Medela  Pigeon  Ameda  Spectra Baby Products  Ardo Medical Market Segment by Regions, this report splits Global into several key Regions, with production, consumption, revenue, market share and growth rate of Breast Pump in these regions, from 2011 to 2021 (forecast), like  North America  Europe  China  Japan  Southeast Asia  India Split by product type, with production, revenue, price, market share and growth rate of each type, can be divided into  Type I  Type II  Type III Split by application, this report focuses on consumption, market share and growth rate of Breast Pump in each application, can be divided into  Application 1  Application 2  Application 3 Global Calcium Channel Blocker Market Research Report 2016  1 Calcium Channel Blocker Market Overview  1.1 Product Overview and Scope of Calcium Channel Blocker  1.2 Calcium Channel Blocker Segment by Type  1.2.1 Global Production Market Share of Calcium Channel Blocker by Type in 2015  1.2.2 Phenylalkylamines, PAAs  1.2.3 Dihydropyridines, DHPs  1.2.4 Benzothiazepines, BTZs  1.2.5 Other  1.3 Calcium Channel Blocker Segment by Application  1.3.1 Calcium Channel Blocker Consumption Market Share by Application in 2015  1.3.2 Application 1  1.3.3 Application 2  1.3.4 Application 3  1.4 Calcium Channel Blocker Market by Region  1.4.1 North America Status and Prospect (2011-2021)  1.4.2 Europe Status and Prospect (2011-2021)  1.4.3 China Status and Prospect (2011-2021)  1.4.4 Japan Status and Prospect (2011-2021)  1.4.5 Southeast Asia Status and Prospect (2011-2021)  1.4.6 India Status and Prospect (2011-2021)  1.5 Global Market Size (Value) of Calcium Channel Blocker (2011-2021) 7 Global Calcium Channel Blocker Manufacturers Profiles/Analysis  7.1 Bayer  7.1.1 Company Basic Information, Manufacturing Base and Its Competitors  7.1.2 Calcium Channel Blocker Product Type, Application and Specification  7.1.2.1 Type I  7.1.2.2 Type II  7.1.3 Bayer Calcium Channel Blocker Production, Revenue, Price and Gross Margin (2015 and 2016)  7.1.4 Main Business/Business Overview  7.2 Pfizer  7.2.1 Company Basic Information, Manufacturing Base and Its Competitors  7.2.2 Calcium Channel Blocker Product Type, Application and Specification  7.2.2.1 Type I  7.2.2.2 Type II  7.2.3 Pfizer Calcium Channel Blocker Production, Revenue, Price and Gross Margin (2015 and 2016)  7.2.4 Main Business/Business Overview  7.3 Roche  7.3.1 Company Basic Information, Manufacturing Base and Its Competitors  7.3.2 Calcium Channel Blocker Product Type, Application and Specification  7.3.2.1 Type I  7.3.2.2 Type II  7.3.3 Roche Calcium Channel Blocker Production, Revenue, Price and Gross Margin (2015 and 2016)  7.3.4 Main Business/Business Overview  7.4 Biovail  7.4.1 Company Basic Information, Manufacturing Base and Its Competitors  7.4.2 Calcium Channel Blocker Product Type, Application and Specification  7.4.2.1 Type I  7.4.2.2 Type II  7.4.3 Biovail Calcium Channel Blocker Production, Revenue, Price and Gross Margin (2015 and 2016)  7.4.4 Main Business/Business Overview  7.5 Reliant Medical Group  7.5.1 Company Basic Information, Manufacturing Base and Its Competitors  7.5.2 Calcium Channel Blocker Product Type, Application and Specification  7.5.2.1 Type I  7.5.2.2 Type II  7.5.3 Reliant Medical Group Calcium Channel Blocker Production, Revenue, Price and Gross Margin (2015 and 2016)  7.5.4 Main Business/Business Overview  7.6 Tanabe Seiyaku  7.6.1 Company Basic Information, Manufacturing Base and Its Competitors  7.6.2 Calcium Channel Blocker Product Type, Application and Specification  7.6.2.1 Type I  7.6.2.2 Type II  7.6.3 Tanabe Seiyaku Calcium Channel Blocker Production, Revenue, Price and Gross Margin (2015 and 2016)  7.6.4 Main Business/Business Overview  7.7 Abbott  7.7.1 Company Basic Information, Manufacturing Base and Its Competitors  7.7.2 Calcium Channel Blocker Product Type, Application and Specification  7.7.2.1 Type I  7.7.2.2 Type II  7.7.3 Abbott Calcium Channel Blocker Production, Revenue, Price and Gross Margin (2015 and 2016)  7.7.4 Main Business/Business Overview  7.8 AstraZeneca  7.8.1 Company Basic Information, Manufacturing Base and Its Competitors  7.8.2 Calcium Channel Blocker Product Type, Application and Specification  7.8.2.1 Type I  7.8.2.2 Type II  7.8.3 AstraZeneca Calcium Channel Blocker Production, Revenue, Price and Gross Margin (2015 and 2016)  7.8.4 Main Business/Business Overview  7.9 Novartis  7.9.1 Company Basic Information, Manufacturing Base and Its Competitors  7.9.2 Calcium Channel Blocker Product Type, Application and Specification  7.9.2.1 Type I  7.9.2.2 Type II  7.9.3 Novartis Calcium Channel Blocker Production, Revenue, Price and Gross Margin (2015 and 2016)  7.9.4 Main Business/Business Overview  7.10 Sciele Pharmaceutical  7.10.1 Company Basic Information, Manufacturing Base and Its Competitors  7.10.2 Calcium Channel Blocker Product Type, Application and Specification  7.10.2.1 Type I  7.10.2.2 Type II  7.10.3 Sciele Pharmaceutical Calcium Channel Blocker Production, Revenue, Price and Gross Margin (2015 and 2016)  7.10.4 Main Business/Business Overview  7.11 Forest  7.12 UDL BioPharma


Ivanova J.I.,Analysis Group Inc. | Birnbaum H.G.,Analysis Group Inc. | Yushkina Y.,Analysis Group Inc. | Sorg R.A.,Analysis Group Inc. | And 2 more authors.
Journal of Opioid Management | Year: 2013

Objectives: To estimate the prevalence of opioid-related side effects among patients with chronic noncancer pain (CNCP) who initiated opioids and compare healthcare costs of patients with and without side effects using patient survey, medical charts, and claims data. Patients, participants: Patients initiating opioids, who were aged ≥18 years, had ≥1 pain diagnosis, and did not have cancer, were identified through claims data and medical records from a Central Massachusetts medical group practice and mailed surveys between October 2010 and July 2012. Main outcomes measures: Prevalence of opioid-related side effects was estimated from patient surveys, charts, and claims data within 90 days after opioid initiation (study period). Study period healthcare costs were compared between patients with and without side effects (self-reported problematic side effects or side effects recorded in medical charts or claims). Results: Among patients with CNCP who initiated opioids and completed the survey (N = 167), the average age was 53 years, and 62.9 percent were women. Based on the survey, charts, and claims, 91.6 percent, 15.0 percent, and 19.2 percent of patients, respectively, had ≥1 opioid-related side effect. Overall, 59.3 percent of patients reported having ≥1 problematic side effect or side effect recorded in charts or claims. In the analysis that controlled for baseline characteristics and resource use, patients with versus without side effects had higher mean study period healthcare costs ($3,347 vs $2,521, p = 0.049). Conclusions: Prevalence of opioid-related side effects among patients with CNCP who initiated opioids was substantially higher based on patient survey than from charts or claims. Opioid-related side effects were associated with significantly higher healthcare costs. © 2013 Journal of Opioid Management, All Rights Reserved.


Koci F.,Reliant Medical Group | Eltibi R.,Reliant Medical Group | Hadley M.,Saint Vincent Hospital | Kumar D.,Reliant Medical Group
Texas Heart Institute Journal | Year: 2014

Although chest pain in association with ST-segment electrocardiographic deviation is often indicative of cardiac ischemia, it has also been associated with noncardiac conditions. The case of a 63-year-old woman that we report here is extraordinary because her presentation of “acute abdomen” did not appear severe enough to warrant urgent surgical intervention, whereas the chest pain and electrocardiographic changes (supported by rising troponin levels) created strong clinical suspicion of acute coronary syndrome. Was the evidence of cardiac ischemia a primary event, or was it a sequela of an acute surgical condition? Noncardiac surgical cases associated with evidence of myocardial injury can be extremely challenging from a diagnostic and management perspective. We believe that the accuracy of the clinical diagnosis is crucial to a well-considered approach. © 2014 by the Texas Heart ® Institute, Houston.


Daniel A.,Saint Vincent Hospital | Rapose A.,University of Massachusetts Medical School | Rapose A.,Reliant Medical Group
Journal of Infection and Public Health | Year: 2015

Introduction: Clostridium difficile is a serious reemerging pathogen in Europe and North America. C. difficile infection (CDI) has been of concern over the last decade in view of its significant morbidity and mortality, as well as the high health care costs involved with each case. Although multiple risk factors are known to be associated with CDI, a number of patients develop severe infection even in the absence of known risk factors. CDI is diagnosed by the detection of the toxin A/B in stools by enzyme immunoassay (EIA) or by polymerase chain reaction (PCR). There is conflicting literature regarding whether any particular group of antibiotics is associated with higher risk for CDI. There is also a tendency to perform repeated stool tests for toxin A/B if the first test is negative. We evaluated 100 consecutive hospitalized patients who tested positive for C. difficile over a one-year period. Methods: We performed a retrospective analysis of 100 consecutive patients with CDI admitted to our hospital between July 2008 and June 2009. Patient records were reviewed for risk factors, treatment, and clinical outcomes. We also evaluated the number of stool tests performed for the detection of C. difficile and fecal leukocyte testing in each patient. Results: The majority of the patients were more than 60 years of age (87%). Forty-four percent of patients presented from a nursing facility. More than 50% were on Proton Pump Inhibitors (PPIs) at the time of admission. Co-morbidities in our patients included malignancy in 28%, diabetes mellitus in 25%, and chronic renal disease in 23%. Most of the patients had multiple co-morbidities. Patients who had taken antibiotics in the previous six months constituted 74% of the total study population. A beta-lactam alone or in combination with other antibiotics was prescribed in 48%, quinolones in 13% and clindamycin in 4% of patients. Stool samples were tested only once in 53% of patients and twice or more in 43%. Metronidazole was the initial therapy in 86% of patients. Intensive care unit stay was required in 33% of patients. Seventeen percent died during their hospitalization. Conclusions: Elderly patients are especially vulnerable to CDI when exposed to antibiotics, and higher mortality and morbidity is observed in this age group. PPI use was common in our patients. Metronidazole was used as the first line agent in the majority of patients. We also determined a tendency to test for the C. difficile toxin in more than one stool sample. All of these practices need to be modified based on the current guidelines. © 2014 King Saud Bin Abdulaziz University for Health Sciences.


This report studies Calcium Channel Blocker in Global market, especially in North America, Europe, China, Japan, Southeast Asia and India, focuses on top manufacturers in global market, with Production, price, revenue and market share for each manufacturer, covering  Bayer  Pfizer  Roche  Biovail  Reliant Medical Group  Tanabe Seiyaku  Abbott  AstraZeneca  Novartis  Sciele Pharmaceutical  Forest  UDL BioPharma Market Segment by Regions, this report splits Global into several key Regions, with production, consumption, revenue, market share and growth rate of Calcium Channel Blocker in these regions, from 2011 to 2021 (forecast), like  North America  Europe  China  Japan  Southeast Asia  India Split by product type, with production, revenue, price, market share and growth rate of each type, can be divided into  Phenylalkylamines, PAAs  Dihydropyridines, DHPs  Benzothiazepines, BTZs  Other  Split by application, this report focuses on consumption, market share and growth rate of Calcium Channel Blocker in each application, can be divided into  Application 1  Application 2  Application 3 Global Calcium Channel Blocker Market Research Report 2016  1 Calcium Channel Blocker Market Overview  1.1 Product Overview and Scope of Calcium Channel Blocker  1.2 Calcium Channel Blocker Segment by Type  1.2.1 Global Production Market Share of Calcium Channel Blocker by Type in 2015  1.2.2 Phenylalkylamines, PAAs  1.2.3 Dihydropyridines, DHPs  1.2.4 Benzothiazepines, BTZs  1.2.5 Other  1.3 Calcium Channel Blocker Segment by Application  1.3.1 Calcium Channel Blocker Consumption Market Share by Application in 2015  1.3.2 Application 1  1.3.3 Application 2  1.3.4 Application 3  1.4 Calcium Channel Blocker Market by Region  1.4.1 North America Status and Prospect (2011-2021)  1.4.2 Europe Status and Prospect (2011-2021)  1.4.3 China Status and Prospect (2011-2021)  1.4.4 Japan Status and Prospect (2011-2021)  1.4.5 Southeast Asia Status and Prospect (2011-2021)  1.4.6 India Status and Prospect (2011-2021)  1.5 Global Market Size (Value) of Calcium Channel Blocker (2011-2021) 7 Global Calcium Channel Blocker Manufacturers Profiles/Analysis  7.1 Bayer  7.1.1 Company Basic Information, Manufacturing Base and Its Competitors  7.1.2 Calcium Channel Blocker Product Type, Application and Specification  7.1.2.1 Type I  7.1.2.2 Type II  7.1.3 Bayer Calcium Channel Blocker Production, Revenue, Price and Gross Margin (2015 and 2016)  7.1.4 Main Business/Business Overview  7.2 Pfizer  7.2.1 Company Basic Information, Manufacturing Base and Its Competitors  7.2.2 Calcium Channel Blocker Product Type, Application and Specification  7.2.2.1 Type I  7.2.2.2 Type II  7.2.3 Pfizer Calcium Channel Blocker Production, Revenue, Price and Gross Margin (2015 and 2016)  7.2.4 Main Business/Business Overview  7.3 Roche  7.3.1 Company Basic Information, Manufacturing Base and Its Competitors  7.3.2 Calcium Channel Blocker Product Type, Application and Specification  7.3.2.1 Type I  7.3.2.2 Type II  7.3.3 Roche Calcium Channel Blocker Production, Revenue, Price and Gross Margin (2015 and 2016)  7.3.4 Main Business/Business Overview  7.4 Biovail  7.4.1 Company Basic Information, Manufacturing Base and Its Competitors  7.4.2 Calcium Channel Blocker Product Type, Application and Specification  7.4.2.1 Type I  7.4.2.2 Type II  7.4.3 Biovail Calcium Channel Blocker Production, Revenue, Price and Gross Margin (2015 and 2016)  7.4.4 Main Business/Business Overview  7.5 Reliant Medical Group  7.5.1 Company Basic Information, Manufacturing Base and Its Competitors  7.5.2 Calcium Channel Blocker Product Type, Application and Specification  7.5.2.1 Type I  7.5.2.2 Type II  7.5.3 Reliant Medical Group Calcium Channel Blocker Production, Revenue, Price and Gross Margin (2015 and 2016)  7.5.4 Main Business/Business Overview  7.6 Tanabe Seiyaku  7.6.1 Company Basic Information, Manufacturing Base and Its Competitors  7.6.2 Calcium Channel Blocker Product Type, Application and Specification  7.6.2.1 Type I  7.6.2.2 Type II  7.6.3 Tanabe Seiyaku Calcium Channel Blocker Production, Revenue, Price and Gross Margin (2015 and 2016)  7.6.4 Main Business/Business Overview  7.7 Abbott  7.7.1 Company Basic Information, Manufacturing Base and Its Competitors  7.7.2 Calcium Channel Blocker Product Type, Application and Specification  7.7.2.1 Type I  7.7.2.2 Type II  7.7.3 Abbott Calcium Channel Blocker Production, Revenue, Price and Gross Margin (2015 and 2016)  7.7.4 Main Business/Business Overview  7.8 AstraZeneca  7.8.1 Company Basic Information, Manufacturing Base and Its Competitors  7.8.2 Calcium Channel Blocker Product Type, Application and Specification  7.8.2.1 Type I  7.8.2.2 Type II  7.8.3 AstraZeneca Calcium Channel Blocker Production, Revenue, Price and Gross Margin (2015 and 2016)  7.8.4 Main Business/Business Overview  7.9 Novartis  7.9.1 Company Basic Information, Manufacturing Base and Its Competitors  7.9.2 Calcium Channel Blocker Product Type, Application and Specification  7.9.2.1 Type I  7.9.2.2 Type II  7.9.3 Novartis Calcium Channel Blocker Production, Revenue, Price and Gross Margin (2015 and 2016)  7.9.4 Main Business/Business Overview  7.10 Sciele Pharmaceutical  7.10.1 Company Basic Information, Manufacturing Base and Its Competitors  7.10.2 Calcium Channel Blocker Product Type, Application and Specification  7.10.2.1 Type I  7.10.2.2 Type II  7.10.3 Sciele Pharmaceutical Calcium Channel Blocker Production, Revenue, Price and Gross Margin (2015 and 2016)  7.10.4 Main Business/Business Overview  7.11 Forest  7.12 UDL BioPharma


BACKGROUND: Distal radius fractures are common, accounting for approximately 18% of all fractures in adults. Operative management is common, and there are numerous variants of plates used. However, data on safety and complication rates for different plates are limited. OBJECTIVE: To determine whether the rate of complications differed between two distinct types of volar plate design for distal radius fracture fixation, one using predetermined fixed angles for the locking screws or pegs and the other using a variable angle locking design for the locking screws or pegs. Our null hypothesis was that the rate of complications would be the same in each group. MATERIALS AND METHODS: A retrospective chart review was performed on patients with unstable distal radius fractures treated operatively between 2008 and 2011. Patients treated with external fixation or small fragment plates were excluded; all remaining patients underwent internal fixation with 1 of 3 plate designs: Stryker Universal Distal Radius Plate, Acumed Acu-Loc, or Trimed Volar Bearing Plate. RESULTS: A total of 189 patients underwent surgical treatment for an unstable distal radius fracture with a volar plate. Fixed angle plates were used in 60 patients and polyaxial locking plates using a rotatable bearing were used in 148 patients. In the fixed angle plate group, 11 required a second operation on the affected limb for a total of 18 procedures. In 7 of 11 patients, secondary surgery was directly related to complications from the hardware (symptomatic hardware, loose hardware and tendon rupture). All 7 of these patients were in the fixed angle plate group, for a rate of hardware related complications of 12% (7/60). No hardware related complications occurred in patients in the group treated with a polyaxial locking plate (0/129). The complication rate in the fixed angle plate group is significantly different than 0, the rate observed in the polyaxial locking plate group (z score = 3.95, P < 0.001). CONCLUSIONS: Our data suggest that treatment of unstable distal radius fractures with a volar bearing variable angle plate fixation is safe and effective. In our series, there was a significant reduction in the rate of hardware-related complications with the polyaxial locking plate as compared with a fixed angle plate.Therapeutic, Level III, retrospective comparative study. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Haider A.,Reliant Medical Group
Annals of Long-Term Care | Year: 2012

Hallucinations are commonly encountered in nursing home residents. In many cases, they are attributed to psychiatric pathology, but they may have other causes. The author reports one such case of a resident whose visual hallucinations resulted from age-related macular degeneration, a condition known as Charles Bonnet syndrome. In such cases, reassuring the resident and informing the staff regarding the etiology of the hallucinations can avoid the use of antipsychotics and other medications and help the resident emotionally and symptomatically. Any resident who reports visual hallucinations should undergo a through eye examination because identification and correction of these problems can help diminish or eliminate the problem without the need of pharmacotherapy or other interventions that can increase the risk of adverse events. It is also important for the resident's friends and family members to understand that hallucinations are a common occurrence in many visually impaired elderly people, and that they approach such instances with empathy and reassurance, as this will help the resident tremendously.

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