A Historical Reflection of Cultural Factors Inhibiting American Healthcare Reform

Past healthcare reform has been blinded by the presence of competing philosophies and ideologies that ultimately yielded ineffective compromises or short-terms solutions. With the ever-shifting political and economic landscapes, the future of our nation’s healthcare is in great peril. This paper is a meta-analysis on obstructions to healthcare reform that will give readers a brief overview of current barriers and a short synopsis of why they may exist. Upon analysis of nearly 100 years of history, I decided to focus on the reform efforts of the American Association for Labor Legislation and the efforts of the FDR, Truman, JFK, LBJ, Nixon, Clinton and Obama administrations. I uncovered the following major inhibitory motifs throughout each successive attempt at national healthcare reform: resistance from organized medicine, distraction by foreign affairs, economic crises, distraction by domestic affairs and lack of legislative prioritization. The presence of these inhibitory motifs throughout 100 years of history tells us that there will never be an ideal time to pursue healthcare reform. The time to act is now

Evaluation of rapid diagnostic tests for assessment of hepatitis B in resource-limited settings

Chronic Hepatitis B (HBV) is the most important cause of liver disease worldwide. There is a need for low-cost tests to aid in diagnosis and management of HBV infection in resource-limited settings. We evaluated the utility of several rapid diagnostic tests (RDT) in three different continents (Europe, South America, Africa). The HBsAg RDT showed optimal sensitivity and specificity. The anti-HBeAb RDT showed acceptable sensitivity and excellent specificity. Our results suggest that these RDTs could be used for screening and management of HBV.Fil: Leathers, James S.. Uc Davis School Of Medicine; Estados UnidosFil: Pisano, María Belén. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Córdoba. Facultad de Medicina. Instituto de Virología Dr. J. M. Vanella; ArgentinaFil: Ré, Viviana Elizabeth. Universidad Nacional de Córdoba. Facultad de Medicina. Instituto de Virología Dr. J. M. Vanella; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Van Oord, Gertine. Erasmus MC. Department of Gastroenterology and Hepatology; Países BajosFil: Sultan, Amir. Addis Ababa University; EtiopíaFil: Boonstra, Andre. Erasmus MC. Department of Gastroenterology and Hepatology; Países BajosFil: Debes, Jose D.. University of Minnesota; Estados Unidos. Erasmus MC. Department of Gastroenterology and Hepatology; Países Bajo

Validation of a point-of-care rapid diagnostic test for hepatitis C for use in resource-limited settings

Treatment of HCV with direct-acting antivirals has enabled the discussion of HCV eradicationworldwide. Envisioning this aim requires implementation of mass screening in resource-limited areas, usuallyconstrained by testing costs. We validated a low-cost, rapid diagnosis test (RDT) for HCV in three different continents in 141individuals. The HCV RDT showed 100% specificity and sensitivity across different samples regardless of genotypeor viral load (in samples with such information, 90%). The HCV test validated in this study can allow for HCV screening in areas of need when properly used.Fil: Leathers, James S.. Vanderbilt University; Estados UnidosFil: Pisano, María Belén. Universidad Nacional de Cordoba. Facultad de Medicina. Instituto de Virología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Ré, Viviana Elizabeth. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Cordoba. Facultad de Medicina. Instituto de Virología; ArgentinaFil: van Oord, Gertine. Erasmus Medical Center; Países BajosFil: Sultan, Amir. Addis Ababa University; EtiopíaFil: Boonstra, Andre. Erasmus Medical Center; Países BajosFil: Debes, Jose D.. Universidad de Minnesota; Estados Unido

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

PIB: A score to select sorafenib treatment candidates for hepatocellular carcinoma in resource-limited settings

Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related death globally. Sorafenib, a multi-tyrosine kinase inhibitor, remains the standard of care for patients with inoperable or advanced-stage HCC. In resource-limited settings without access to surgical or locoregional therapy, sorafenib may be the only option for treating HCC. However, due to a modest survival benefit, as well as the limiting cost of sorafenib in certain regions, appropriate selection of patients for treatment is essential. Evaluation of Barcelona Clinic Liver Cancer (BCLC) criteria in resource-limited settings is frequently unachievable due to a variety of reasons. Using a cohort from the South American liver research network (1336 HCC cases), we created a cost-effective prognostic scoring system to help identify patients likely to have a survival benefit on sorafenib treatment, using simple laboratory variableFil: Leathers, James S.. Vanderbilt University; Estados UnidosFil: Balderramo, Domingo. Universidad de Córdoba; EspañaFil: Prieto, Jhon. Centro de Enfermedades Hepáticas y Digestivas; ColombiaFil: Diehl, Fernando. Universidad de Córdoba; EspañaFil: Gonzalez-Ballerga, Esteban. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Ferreiro, Melina R.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Carrera, Enrique. Hospital Eugenio Espejo; EcuadorFil: Barreyro, Fernando Javier. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; ArgentinaFil: Diaz Ferrer, Javier. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: Singh, Dupinder. University of Minnesota; Estados UnidosFil: Mattos, Angelo Z.. Universidade Federal de Ciencias Da Saúde de Porto Alegre; BrasilFil: Carrilho, Flair. Universidade de Sao Paulo; BrasilFil: Debes, Jose D.. University of Minnesota; Estados Unido

Sorafenib for Treatment of Hepatocellular Carcinoma: A Survival Analysis from the South American Liver Research Network

Goals:We aim to describe the efficacy, safety profile, and variables associated with survival in patients with hepatocellular carcinoma (HCC) treated with sorafenib in South America.Background:Sorafenib has been shown to improve survival in patients with advanced HCC. There are few data on sorafenib use for HCC in South America.Study:We performed a retrospective analysis of HCC cases treated with sorafenib from 8 medical centers in 5 South American countries, between January 2010 and June 2017. The primary endpoint was overall survival (OS), which was defined as time from sorafenib initiation to death or last follow-up. Risk factors for decreased OS were assessed using Cox proportional hazard regression and log-rank tests.Results:Of 1336 evaluated patients, 127 were treated with sorafenib and were included in the study. The median age of individuals was 65 years (interquartile range, 55 to 71) and 70% were male individuals. Median OS in all patients was 8 months (interquartile range, 2 to 17). Variables associated with survival on multivariate analysis were platelets >//<250,000 mm3 were also independently associated with survival (2 vs. 5.5 mo, P=0.03). Patients lived longer if they experienced any side effects from sorafenib use (11 vs. 2 mo, P=0.009). Patients who stopped sorafenib because of side effects had shorter survival compared with patients who were able to tolerate side effects and continue treatment (7.5 vs. 13 mo, P=0.01).Conclusions:Pretreatment elevation of platelets and advanced BCLC stage were independently associated with poor survival on sorafenib in a South American cohort.Fil: Leathers, James S.. Vanderbilt University School Of Medicine; Estados UnidosFil: Balderramo, Domingo. Instituto Universitario de Ciencias Biomédicas de Córdoba; ArgentinaFil: Prieto, John. Centro de Enfermedades Hepáticas y Digestivas; ColombiaFil: Diehl, Fernando. Instituto Universitario de Ciencias Biomédicas de Córdoba; ArgentinaFil: Gonzalez Ballerga, Esteban. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Ferreiro, Melina R.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Carrera, Enrique. Hospital Eugenio Espejo; EcuadorFil: Barreyro, Fernando Javier. Universidad Nacional de Misiones; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; ArgentinaFil: Diaz-Ferrer, Javier. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: Singh, Dupinder. University of Minnesota; Estados UnidosFil: Mattos, Angelo Z.. Universidade Federal de Ciencias Da Saúde de Porto Alegre; BrasilFil: Carrilho, Flair. Universidade de Sao Paulo; BrasilFil: Debes, Jose D.. University of Minnesota; Estados Unido