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It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced in the detection, management,

/pdf/acc-aha-2006-guidelines-for-the-management-of-patients-with-27qfh9fc7i.pdf

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

Introduction 1. Woman's Place in Man's Life Cycle 2. Images of Relationship 3. Concepts of Self and Morality 4. Crisis and Transition 5. Women's Rights and Women's Judgment 6. Visions of Maturity References Index of Study Participants General Index

In a Different Voice. Psychological Theory and Women’s Development. Cambridge, MA (Harvard University Press) 1982.

Acute kidney injury (AKI) is a complex disorder for which currently there is no accepted definition. Having a uniform standard for diagnosing and classifying AKI would enhance our ability to manage these patients. Future clinical and translational research in AKI will require collaborative networks of investigators drawn from various disciplines, dissemination of information via multidisciplinary joint conferences and publications, and improved translation of knowledge from pre-clinical research. We describe an initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI. Members representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI participated in a two day conference in Amsterdam, The Netherlands, in September 2005 and were assigned to one of three workgroups. Each group's discussions formed the basis for draft recommendations that were later refined and improved during discussion with the larger group. Dissenting opinions were also noted. The final draft recommendations were circulated to all participants and subsequently agreed upon as the consensus recommendations for this report. Participating societies endorsed the recommendations and agreed to help disseminate the results. The term AKI is proposed to represent the entire spectrum of acute renal failure. Diagnostic criteria for AKI are proposed based on acute alterations in serum creatinine or urine output. A staging system for AKI which reflects quantitative changes in serum creatinine and urine output has been developed. We describe the formation of a multidisciplinary collaborative network focused on AKI. We have proposed uniform standards for diagnosing and classifying AKI which will need to be validated in future studies. The Acute Kidney Injury Network offers a mechanism for proceeding with efforts to improve patient outcomes.

Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury

Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

https://www.medpagetoday.com/upload/2014/3/3/02536-1.pdf

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size.

What is the appropriate size criterion for resection of thoracic aortic aneurysms

Objective
Osteoarthritis (OA) is a major debilitating disease affecting ∼27 million persons in the US. Yet, the financial costs to patients and insurers remain poorly understood. The purpose of this study was to quantify by multivariate analyses the relationships between OA and annual health care expenditures borne by patients and insurers.

Methods
Data from the Medical Expenditure Panel Survey (MEPS) for the years 1996–2005 were used. MEPS is a large, nationally representative US database that includes information on health care expenditures, medical conditions, health insurance status, and sociodemographic characteristics. Individual and nationally aggregated cost estimates are provided.

Results
OA was found to contribute substantially to health care expenditures. Among women, OA increased out-of-pocket (OOP) expenditures by $1,379 per annum (2007 dollars) and insurer expenditures by $4,833. Among men, OA increased OOP expenditures by $694 per annum and insurer expenditures by $4,036. Given the high prevalence of OA, the aggregate effects on health care expenditures were very large. OA raised aggregate annual medical care expenditures by $185.5 billion. Of that amount, insurer expenditures were $149.4 billion and OOP expenditures were $36.1 billion. Because of the greater prevalence of OA in women and their more intensive use of health care, total expenditures for this group accounted for $118 billion, or almost two-thirds of the total increase in health care expenditures resulting from OA.

Conclusion
The health care cost burden associated with OA is quite large for all groups examined and is disproportionately higher for women. Although insurers bear the brunt of treatment costs for OA, the OOP costs are also substantial.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.24984

Insurer and out‐of‐pocket costs of osteoarthritis in the US: Evidence from national survey data

Familial Thoracic Aortic Aneurysms and Dissections—Incidence, Modes of Inheritance, and Phenotypic Patterns

Background: We compared access to health care, use ofservices,andhealthcareexperiencesforMexicansand other Latinos by citizenship and immigrant authorization status. Methods: We acquired data from the 2003 California Health Interview Survey, with 42044 participants representative of noninstitutionalized households. Participants were differentiated by ethnicity/race, national origin, and citizenship/immigration authorization status. Outcomemeasuresincludedhavingausualsourceofcare, problems in obtaining necessary care, use of physician and emergency department care, and 3 experiences with health care. Multivariate analyses measured the associationsofcitizenship/immigrationauthorizationstatuswith theoutcomemeasuresamongforeign-bornMexicansand other Latinos vs their US-born counterparts. Results:In multivariate analyses, undocumented Mexicans had 1.6 fewer physician visits (P.01); compared withUS-bornMexicans;otherundocumentedLatinoshad 2.1 fewer visits (P.01) compared with their US-born counterparts.Bothundocumentedgroupswerelesslikely to report difficulty obtaining necessary health care than US-born Mexicans (odds ratio, 0.68; P.01) and other US-born Latinos (odds ratio, 0.40; P.01), respectively. Undocumented Mexicans were less likely to have ausualsourceofcare(oddsratio,0.70;P.01)andwere more likely to report negative experiences than USborn Mexicans (odds ratio, 1.93;P.01). Findings were similar for other undocumented Latinos, with the exception of having a usual source of care. Patterns of access to and use of health care services tended to improve with changing legal status. Conclusion:In this large sample, undocumented Mexicans and other undocumented Latinos reported less use of health care services and poorer experiences with care compared with their US-born counterparts, after adjustment for confounders in multivariate analyses.

/pdf/health-care-access-use-of-services-and-experiences-among-upyoxd6bhy.pdf

John A. Rizzo

Papers

Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size.

What is the appropriate size criterion for resection of thoracic aortic aneurysms

Insurer and out‐of‐pocket costs of osteoarthritis in the US: Evidence from national survey data

Familial Thoracic Aortic Aneurysms and Dissections—Incidence, Modes of Inheritance, and Phenotypic Patterns

Health Care Access, Use of Services, and Experiences Among Undocumented Mexicans and Other Latinos