Search

Infertility is a significant public health concern in the United States. As such, utilization of infertility services, including pharmacotherapeutic treatments, is prevalent, and the role of the pharmacist as part of the health care team is essential. Pharmacists can assist patients by providing education on infertility causes, risk factor mitigation, referrals, nonpharmacologic and pharmacologic management options, navigation of the prescription process, and resource availability for the significant financial burden accompanying infertility treatment. In-depth pharmacotherapeutic information may not be readily available to pharmacists dispensing and counseling on these medications, and infertility management regimens are often varied and complicated requiring more in-depth counseling on use and administration. Given the complexity of infertility management, pharmacists are a valuable patient support and education resource. This article provides an in-depth review of infertility management strategies, both nonpharmacologic and pharmacologic. [ABSTRACT FROM AUTHOR]

Introduction: Pharmacist prescribing of contraception is becoming increasingly available in selected states. The objective of this study was to assess US community pharmacists' perspectives on expanding access, barriers, and facilitators since states have begun pharmacist scope of practice expansions for prescribing contraception. Methods: A survey study of US community pharmacists' support for expanded access models, pharmacist prescribing practices and interest, and importance of safety, cost, and professional practice issues for prescribing was conducted. Results: Pharmacists are generally supportive of pharmacist prescribing and behind-the-counter models for hormonal contraception and generally opposed to over-the-counter access. A majority (65%) are interested in prescribing hormonal contraception. The top motivation for prescribing contraception is enjoying individual patient contact (94%). Safety concerns (eg, patients not obtaining health screenings) remained most important for pharmacist implementation, followed by cost (eg, lack of payment or reimbursement for pharmacists' services), and professional practice (eg, pharmacist time constraints and liability) issues. Conclusion: This study provides an updated understanding of attitudes toward models of expanded access to hormonal contraception, interest in prescribing, and barriers and facilitators to this service among community pharmacists. Many barriers such as time and reimbursement remain unchanged. This information can inform policy and implementation efforts. [ABSTRACT FROM AUTHOR]

Objectives To determine the difference in receipt of activity of daily living ( ADL) assistance between obese and normal-weight older adults. Design Retrospective cohort study. Setting National Health and Aging Trends Study, 2011-2015. Participants U.S. adults aged 65 and older with ADL disability and a body mass index ( BMI) of 18.5 kg/m2 or greater (N = 5,612) Measurements BMI was classified as normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), or obese (≥30.0 kg/m2). Primary outcome was self-reported receipt of help with specific ADLs. Models were adjusted for demographic characteristics (age, sex, race), degree of need (self-reported general health, severity of disability), household resources (income, marriage, people in household, number of children), and cognitive status (dementia, proxy respondent). Results Obese with disabilities had lower rates of receiving assistance with walking inside (odds ratio ( OR) = 0.63, 95% confidence interval ( CI) = 0.50-0.81), walking outside ( OR = 0.76, 95% CI = 0.59-0.97), toileting ( OR = 0.68, 95% CI = 0.52-0.89), and getting in and out of bed ( OR = 0.67, 95% CI = 0.50-0.87) than normal-weight older adults after adjustment for respondent demographic characteristics. Level of need and cognitive status partially explained the associations. In fully adjusted models, older adults with obesity still had significantly lower odds of receiving assistance in getting in and out of bed than normal weight adults ( OR = 0.69, 95% CI = 0.49-0.98). Conclusion Older adults with obesity are less likely to receive assistance for ADL disabilities than their normal-weight counterparts-an important concern because of ongoing demographic changes in the United States. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the geographic distribution of assisted reproductive technology (ART) clinics and the number of ART clinics within U.S. Census metropolitan areas and to estimate the number of reproductive-age women who have geographic access to ART services in the United States.Design: A population-based cross-sectional study.Setting: Not applicable.Patient(s): None.Intervention(s): None.Main Outcome Measure(s): Number of U.S. reproductive-age women living in areas with no ART clinic, a single ART clinic, or more than one ART clinic.Result(s): There were 510 ART clinics in the United States in 2009-2013. Multiple ART clinics were present in 76 metropolitan areas (median population of 1.45 million people), where a total of 442 clinics were located. A single ART clinic was present in 68 metropolitan areas (median population of 454,000 people). Among U.S. reproductive-age women in 2010, 38.1 million (60.4% of the U.S. population) lived in an area with multiple ART clinics, 6.8 million (10.8% of the U.S. population) lived in an area with a single clinic, and 18.2 million (28.8% of the U.S. population) lived in an area (metropolitan and nonmetropolitan) with no ART clinics.Conclusion(s): Nearby geographic access to ART services is limited or absent for more than 25 million reproductive-age women (39.6% of the U.S. population) in the United States. This population estimate should spur continued policy and technological progress to increase access to ART services. [ABSTRACT FROM AUTHOR]

Objectives To determine to what extent demographic, social support, socioeconomic, geographic, medical, and End-of-Life ( EOL) planning factors explain racial and ethnic variation in Medicare spending during the last 6 months of life. Design Retrospective cohort study. Setting Health and Retirement Study ( HRS). Participants Decedents who participated in HRS between 1998 and 2012 and previously consented to survey linkage with Medicare claims (N = 7,105). Measurements Total Medicare expenditures in the last 180 days of life according to race and ethnicity, controlling for demographic factors, social supports, geography, illness burden, and EOL planning factors, including presence of advance directives, discussion of EOL treatment preferences, and whether death had been expected. Results The analysis included 5,548 (78.1%) non-Hispanic white, 1,030 (14.5%) non-Hispanic black, and 331 (4.7%) Hispanic adults and 196 (2.8%) adults of other race or ethnicity. Unadjusted results suggest that average EOL Medicare expenditures were $13,522 (35%, P < .001) more for black decedents and $16,341 (42%, P < .001) more for Hispanics than for whites. Controlling for demographic, socioeconomic, geographic, medical, and EOL-specific factors, the Medicare expenditure difference between groups fell to $8,047 (22%, P < .001) more for black and $6,855 (19%, P < .001) more for Hispanic decedents than expenditures for non-Hispanic whites. The expenditure differences between groups remained statistically significant in all models. Conclusion Individuals-level factors, including EOL planning factors do not fully explain racial and ethnic differences in Medicare spending in the last 6 months of life. Future research should focus on broader systemic, organizational, and provider-level factors to explain these differences. [ABSTRACT FROM AUTHOR]

In this article, the author comments on the report of reseracher P. Littlejohns and his colleagues on the National Institute for Health and Clinical Excellence (NICE) against charges of ageism. He mentions that Littlejohns entirely miss the requirements of the Equality Act 2010. Further the author focuses on the concept of ageing.

Google-based Internet query share (IQS) for rotavirus search terms correlated well with US rotavirus laboratory detections from 2004 to 2010 (r = 0.88; P < .001), capturing the reduction observed during postvaccine years (2008-2010). IQS analysis could become an inexpensive and reliable supplement for monitoring the impact of rotavirus vaccination in the United States. [ABSTRACT FROM AUTHOR]

In this article the author discusses the issue of human rights and its relationship to medical care and medical ethics. He is critical of the universality of human rights and suggests that it is time to take the human out of human rights since in the future humanity will look different due to evolution and advances such as stem cell research and regenerative medicine.

Presents a study that investigated the occurrence of a paradigm shift in the political positioning of caring in Great Britain. Reason behind the need for effective management in caring by social workers; Significance of the shift in the formulation of community care reforms; Measures which promoted further formalization of the carer's role in Great Britain.

The principle that each individual is entitled to an equal opportunity to benefit from any public health care system, and that this entitlement is proportionate neither to the size of their chance of benefitting, nor to the quality of the benefit, nor to the length of lifetime remaining in which that benefit may be enjoyed, runs counter to most current thinking about the allocation of resources for health care. It is my contention that any system of prioritisation of the resources available for healthcare or of rationing such resources must be governed by this principle. This can have apparently paradoxical conclusions in that it can seem wasteful to give someone with a very slim chance of a lifesaving treatment the same priority as someone with a much better chance. In an important and thoughtful recent paper, Julian Savulescu has concentrated on this apparent weakness and has argued for a particular conception of the good or benefit to be achieved by a healthcare system which purports to demonstrate the inadequacies of an equal opportunities approach to prioritisation and to replace it with an altogether better account. This paper will show that a rational 'reasons based consequentialism' is more in line with the equal opportunities approach, which I defended some time ago in these pages, than with that of Savulescu. I shall then examine more closely the conception of equal opportunities in health care and show that if we give weight to an individual's reasons, and what is expected to be good for them, we will opt for exactly the equality based account of distributive justice that I have recommended. [ABSTRACT FROM AUTHOR]

Demand management tools are population-based strategies used to control costs and improve utilization of services by assisting health consumers in maintaining their health and seeking appropriate health care. These tools are increasingly used by health care delivery systems and, in the US, by fiscal intermediaries, such as insurance companies. If these tools are not properly applied, there is a clear possibility that their use may lead a reduction of health care services with no improvement in clinical, humanistic, or economic outcomes. Demand management effectiveness has not been rigorously examined by the medical industry or academia. Before adopting or purchasing demand management technologies, health care systems should examine them carefully to determine how the tools were developed and who they were intended to serve. Once implemented, careful tracking of population outcomes is as necessary with these technologies as with any other technologies that can affect health care. [ABSTRACT FROM AUTHOR]

Continues the debate between the author and Peter Singer et al started in the volume 21, number three issue of the `Journal of Medical Ethics,' about the ethical respectability of the use of Quality Adjusted Life Years (QALY) in health care allocation. Calculations of probability; Interests of the rational egoist who must choose from behind a veil of ignorance.

Points out the right of each British citizen to an equal chance of having his individual health needs respected by the publicly funded health care system. Ethical issues arising from the subordination of individual health needs to the improved health status of the whole community.

Reports on the popular use of disease management as an approach to medical care currently being used in managed care circles. What disease management is better suited for; Why it is important to recognize the changing character of the delivery process; Merging of health insurance companies in the United States; What physician practices are being integrated into; Long term promises for disease management.

Norovirus generally causes a mild illness in the community. However, modeling routine hospital admission statistics, we estimate that ~3000 norovirus admissions to English hospitals occur per year, accounting for 0.3% and 0.1% of emergency admissions among elderly and adult patients, respectively, at times of peak activity. These admissions pose a risk for subsequent nosocomial infection outbreaks. [ABSTRACT FROM AUTHOR]

The article discusses previously published titles in the journal, twenty-five, fifty and seventy-five years ago. It mentions that the title "Proximal gastric vagotomy for duodenal ulcer disease-whither to now or to wither now" by Glyn G. Jamieson was in the 1988 issue. It notes that the title "The Zollinger-Ellison Syndrome" by Rusell Jones was in the 1963 issue. It adds that the title "The National Health and Medical Research Council" by K.F. Russel was in the 1938 issue.

The article provides an answer to a question of which asthma patients should receive the pneumococcal vaccine.

The article discusses the cost effectiveness of health benefits offered in Great Britain. To have an idea on the gains made and the gains forgone, NICE should know accurately which gains have foregone. According to Claxton and Culyer, neither NICE or any decision making entity can know which NHS activities will be under their guidance or if these decisions will forego any specific benefit. It is also noted that NICE is making decisions that is based on the moral evaluation and cost effectiveness of alternative resources.

Background: To determine whether deferoxamine prevents the complications of transfusional iron overload in thalassemia major, we evaluated 59 patients (30 were female and 29 male; age range, 7 to 31 years) periodically for 4 to 10 years or until death. Methods: At each follow-up visit, we performed a detailed clinical and laboratory evaluation and measured hepatic iron stores with a noninvasive magnetic device. Results: The body iron burden as assessed by magnetic measurement of hepatic iron stores was closely correlated (R = 0.89, P<0.001) with the ratio of cumulative transfusional iron load to cumulative deferoxamine use (expressed in millimoles of iron per kilogram of body weight, in relation to grams of deferoxamine per kilogram, transformed into the natural logarithm). Each increase of one unit in the natural logarithm of the ratio (transfusional iron load to deferoxamine use) was associated with an increased risk of impaired glucose tolerance (relative risk, 19.3; 95 percent confidence interval, 4.8 to 77.4), diabetes mellitus (relative risk, 9.2; 95 percent confidence interval, 1.8 to 47.7), cardiac disease (relative risk, 9.9; 95 percent confidence interval, 1.9 to 51.2), and death (relative risk, 12.6; 95 percent confidence interval, 2.4 to 65.4). All nine deaths during the study occurred among the 23 patients who had begun chelation therapy later and used less deferoxamine in relation to their transfusional iron load (P<0.001). Conclusions: The early use of deferoxamine in an amount proportional to the transfusional iron load reduces the body iron burden and helps protect against diabetes mellitus, cardiac disease, and early death in patients with thalassemia major. (N Engl J Med 1994;331:567-73.) [ABSTRACT FROM AUTHOR]