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Aim: Geographic disparities persist in the USA despite locoregional organ sharing policies. The impact of national organ sharing policies on waiting‐list mortality on a regional basis remains unknown. Methods: Data on all adult liver transplants between 1 February 2002 and 31 March 2015 were obtained from the United Network for Organ Sharing/Organ and Transplantation Network. Multivariable Cox proportional hazards models were constructed in a time‐to‐event analysis to estimate waiting‐list mortality for the pre‐ and post‐Share35 eras. Results: In the analyzed time period, 134 247 patients were listed for transplantation and 54 510 received organs (42.8%). Listing volume increased following the introduction of the Share35 organ sharing policy (15 976 candidates pre‐ vs. 18 375 post) without significant regional changes as did the number of transplants (7210 pre‐ vs. 8224 post). Waiting‐list mortality improved from 12.2% to 8.1% (P < 0.001). Adjusted waiting‐list mortality ratios remained geographically disparate. Region 10 and region 11 had lower hazard ratios (HR) but still had increased mortality (1.46, 95% confidence interval [CI] 1.34–1.60, P < 0.001; and HR 1.49, 95% CI 1.37–1.62, P < 0.001, respectively). Regions 3 and 6 had increased HR with persistently elevated waiting‐list mortality (1.79, 95% CI 1.66–1.93, P < 0.001; and HR 1.29, 95% CI 1.16–1.45, P < 0.001, respectively). Model for End‐state Liver Disease (MELD) exception continued to propagate a survival benefit (HR 0.65, 95% CI 0.63–0.68, P < 0.001). Conclusions: Although overall waiting‐list mortality has decreased, geographic disparities persist, but appear reduced despite broader sharing policies enacted by Share35. The advantage afforded by MELD exception, while still present, was diminished by Share35 as organs are being shifted to MELD >35 candidates. The disparities highlighted by our findings imply a need to review current allocation policies to best balance local, regional, and national transplant environments. [ABSTRACT FROM AUTHOR]

The article focuses on an observational multicenter study conducted in several liver transplant centers in the U.S. to determine the effectiveness and reliability of the decision made by the liver transplant committees. It mentions that liver transplant committees decide to keep the patients that require liver transplants on waiting lists. The study found that the decision taken by the committees to keep the patient on the waiting list is reasonable. INSET: untitled.

The article discusses the study which investigates the feasibility, toxicity and efficacy of intensity-modulated radiation therapy (IMRT) and concurrent capecitabine in the treatment of unresectable hepatocellular carcinoma in the U.S. The results of the study established acceptable toxicity with predicting local control. The results suggested that dose intensification can be incorporated in the treatment regimen for unresectable hepatocellular carcinoma.

Like many areas of the country, the state of Tennessee is experiencing a recent and growing rise in the rate of methamphetamine use, particularly in rural areas of the state. While substance use is a known risk factor for contracting HIV/AIDS, there is limited information regarding the risk behaviors of rural methamphetamine users. This paper seeks to document the existence of known HIV risk behaviors as they relate to rural southern methamphetamine use. Qualitative interviews with ninety-seven current and former methamphetamine users from the Cumberland Plateau area, a rural mountainous region in the state of Tennessee, suggest that methamphetamine users are putting themselves at risk for contracting HIV/AIDS and other blood-borne diseases through high-risk injection and sexual behaviors. Additionally, the results present the perceptions of respondents regarding the impact of methamphetamine use on rural communities and related service needs. [ABSTRACT FROM AUTHOR]

The James H. Quillen Veterans Affairs Medical Center, the medical institution currently know as James H. Quillen Veterans Affairs Medical Center (VA), situated at Mountain Home in Johnson City, Tennessee, is very different from its modest beginnings 100 years ago, as of October 2003. Today the medical center stands as a visionary and leader in the health care industry. This article focuses on work done by this medical institution in past 100 years. This comprehensive care medical facility serves more than 25,000 veterans in its four-state service area. Since 1995, the VA has moved to an outpatient model of care and increased its patient load by 109% while decreasing the cost per patient and the number of employees providing these services. The quality of VA health care compared with private sector best practices far exceeds the norm while the VA provides care to an older and more medically complex population.

Purpose. The question of whether publication of selected clinical trials is temporally followed by changes in prescribing of adjunctive lipid-lowering medications was evaluated. Methods. In this retrospective preanalysis and postanalysis, Veterans Health Administration (VHA) patients 18 years or older who received a new or renewed order for any lipid-lowering medication between April 2, 2004, and September 2, 2014, were included. This period was chosen based on the publication dates of three trials investigating the efficacy of nonstatin medications: Simvastatin with or without Ezetimibe in Familial Hypercholesterolemia (ENHANCE, April 3, 2008), Effects of Combination Lipid Therapy in Type 2 Diabetes Mellitus (ACCORD Lipid, March 14, 2010), and Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy (AIM-HIGH, December 15, 2011). Annual prescribing rates for ezetimibe, fibrates, and niacin were analyzed for 4 years before and after the ENHANCE, ACCORD, and AIM-HIGH trial publication dates, respectively (3 years for niacin in AIM-HIGH) and reported as percent of patients in the cohort. Results. Among patients receiving lipid-lowering medications, relatively low overall prescribing rates were observed for all three target medications. Prescribing rates for each medication decreased after its respective trial publication, with ezetimibe having the greatest change. Conclusion. Prescribing of ibrates, niacin, and ezetimibe in the VHA system decreased after the publication of landmark trials assessing their addition to a statin, consistent with the recommendations in the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline, which did not encourage routine use of adjunctive therapies to lower the risk of cardiovascular disease. [ABSTRACT FROM AUTHOR]