admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER

Vitamin D deficiency.

Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma

https://cyberleninka.org/article/n/148766.pdf

Cytochrome P450 enzymes in drug metabolism: Regulation of gene expression, enzyme activities, and impact of genetic variation

Bevacizumab plus Irinotecan,Fluorouracil,and Leucovorin for Metastatic Colorectal Cancer

Background: Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope.

Purpose: The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field.

Methods: A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, “Rehabilitation and Chronic Care,” determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members.

Results: An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed.

Conclusions: The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease

Read More: http://www.atsjournals.org/doi/abs/10.1164/rccm.201309-1634ST

/pdf/an-official-american-thoracic-society-european-respiratory-5fbz6s326i.pdf

An official American thoracic society/European respiratory society statement: Key concepts and advances in pulmonary rehabilitation

OBJECTIVES We sought to determine whether health insurance coverage of colorectal cancer (CRC) screening varied based on risk. BACKGROUND Population-wide screening guidelines for cancer often incorporate risk information, with modified screening recommendations for those at higher risk due to family history or other factors. METHODS In a nationwide Internet- and mail-based survey of health insurance plan medical directors, respondents were asked about their organization's policies towards coverage of CRC screening for persons at average and higher risk of CRC. Additional questions asked about whether the insurer had a definition of increased risk, and coverage of genetic testing for familial CRC syndromes. RESULTS Survey invitations were sent to 1158 medical directors; 133 (11%) completed the survey. All plans covered screening for average and high-risk persons. The onset of screening was earlier and intervals were more frequent for higher risk compared to average risk persons, with most respondents stating coverage was determined by "physician discretion." While 75% had a definition of high risk, only 55% covered genetic testing. CONCLUSIONS Most insurers offer enhanced coverage of CRC screening, most commonly following the discretion of the physician. Whether this coverage results in earlier, more frequent, or more complete screening of higher risk persons remains uncertain.

Health insurer policies toward risk-stratified colorectal cancer screening: a survey of health plan medical directors.

Objectives. To compare cancer care among American Indian and Alaska Native (AIAN) patients with other racial groups. Methods. We used Washington State cancer registry records to identify 33,624 patients < age 65 diagnosed with local and regional stage breast, colorectal, and lung cancer from 1997 to 2003. Records were linked with regional tribal registry and Medicaid records to identify AIAN. Results. Enrollment in Medicaid at or after diagnosis was 50% for AIAN, 34% for Hispanic, 33% for black, and 18% for Asian/Pacific Islander compared to 13% of white cancer patients. AIAN were equally as likely as whites and other minority groups to receive surgery for breast and colorectal cancer, but significantly less likely (OR = 0.67) to receive surgery for lung cancer. Medicaid patients in general were less likely to receive surgery within 2 months of diagnosis, but AIAN were no less likely to receive timely surgery compared to other racial groups. Conclusion. AIAN rely more heavily than other racial groups on Medicaid for insurance after they are diagnosed with cancer. Issues associated with Medicaid enrollment, as well as non-insurance related factors may account for delays in time to surgery and lower rates of lung cancer surgery among AIAN.

Cancer Care of American Indians and Alaska Natives and Other Racial Groups Enrolled in Public and Private Insurance Plans

Pmh33: neuroleptic drug exposure and tardive dyskinesia: a records-based case-control study

6037 Background: Historical survival evaluation of clinical trials for advanced NSCLC suggests that median survival improved by 0.4 months over a 22 year period. Survival in clinical trails is eval...

Time from diagnosis to treatment initiation in advanced non-small cell lung cancer (NSCLC): Time trends and racial differences

Rationale A decision to implement innovative disease management interventions in health plans often requires evidence of clinical benefit and financial impact The Pediatric Asthma Care PORT II trial evaluated the outcomes of two asthma care strategies in children (ages 3 – 17) – a peer leader based physician behavior change intervention (PLE) and a practice-based redesign (Planned Asthma Care Intervention (PACI)) The purpose of this study is to estimate the cost-effectiveness of the interventions Methods This was a three-arm cluster randomized trial conducted in 41 primary care practices within 3 managed care organizations 638 children with mild to moderate persistent asthma were observed for up to two years Practices were randomized to PLE (N=226), PACI (N=213) or usual care (N=199) The primary outcome was average symptom-free days (SFD) estimated from GEE models Costs for the interventions, asthma-related hospitalizations, ED visits, office visits and medications were included Non-medical costs were excluded Results Mean annual costs per patient were: PACI=$1436, PLE=$970 and Usual Care=$388 The incremental difference in annual SFD for the interventions compared to usual care was 65 (95% CI −36 to 169 days) for PLE and 133 (95% CI 21 to 247 days) for PACI Compared to usual care the incremental cost-effectiveness ratio (ICER) was $90 per SFD gained for PLE and $79 per SFD gained for PACI In subgroup analyses, ICERs varied by child's age and baseline medication use Conclusions The cost-effectiveness ratios of these interventions are greater than those of other asthma interventions tested in other settings

David K. Blough

Papers

Health insurer policies toward risk-stratified colorectal cancer screening: a survey of health plan medical directors.

Cancer Care of American Indians and Alaska Natives and Other Racial Groups Enrolled in Public and Private Insurance Plans

Pmh33: neuroleptic drug exposure and tardive dyskinesia: a records-based case-control study

Time from diagnosis to treatment initiation in advanced non-small cell lung cancer (NSCLC): Time trends and racial differences

Cost-effectiveness of physician peer leader education and practice-based redesign in managed care: The pediatric asthma care PORT-II trial