The Effects Of The Affordable Care Act On The Receipt Of Colonoscopies Among Insured Elderly

Background: The Affordable Care Act (ACA) waived deductibles and eliminated coinsurance for colonoscopies for Medicare beneficiaries beginning on January 1, 2011. This study investigated the effect of the ACA’s removing of financial barriers on the receipt of colonoscopies among insured elderly, who are predominantly covered by Medicare. Moreover, this study examined how income-related disparities in colonoscopy use have changed over the past decade and attempted to quantify various contributions to income-related disparity in the use of colonoscopies among insured elderly. Methods: Five cycles (2008, 2010, 2012, 2014, and 2016) of the Behavioral Risk Factor Surveillance System (BRFSS) were utilized to examine the receipt of colonoscopies among insured elderly aged 65 to 75 prior to the implementation of ACA and then again afterwards. To examine income-related disparities in the use of colonoscopies, individuals aged 65 to 75 were included, and the Concentration Index (CI) was calculated before and after implementation of the ACA. To identify and quantify the contribution of each factor, decomposition of the CIs was conducted. Results: Of 349,899 eligible elderly insured in the age group 65 to 75 years, 236,275 (68%) had received a colonoscopy in the previous 10 years. The receipt of colonoscopies increased from 63% in the pre-ACA years to 70% in the post-ACA years (p time dependent improvements in colonoscopies and other relevant factors. CIs indicated that disparities in colonoscopy use were lessened after the implementation of the ACA. Decomposition analyses showed that whereas decreases in disparities derived largely from income and educational levels, higher levels of income and educational attainment continue to be major contributors to the observed disparities in colonoscopy use. Conclusions: Following the implementation of the ACA, a statistically significant increases in colonoscopy use was observed and may contribute to the observed decreases in the disparity of colonoscopy use. This suggests that eliminating financial barriers to access has improved the CRC screening rate, but achieving the national goal of 80% coverage and the Healthy People 2020 goal will require additional interventions to encourage higher screening level

Caroli's Syndrome with Autosomal Recessive Polycystic Kidney Disease in a Two Month Old Infant

Caroli's syndrome is a rare congenital disorder that involves intrahepatic bile duct ectasia and congenital hepatic fibrosis, frequently seen with concomitant autosomal recessive polycystic kidney disease (ARPKD). Literature on infants with ARPKD is rare. Here, we present a case of a two month old boy who was diagnosed with Caroli's syndrome and ARPKD

Individualized ibuprofen treatment using serial B-type natriuretic peptide measurement for symptomatic patent ductus arteriosus in very preterm infants

PurposePlasma level of B-type natriuretic peptide (BNP), an emerging, sensitive, and specific biomarker of hemodynamically significant patent ductus arteriosus (PDA), rapidly decreases in infants receiving cyclooxygenase inhibitors for ductal closure. We investigated the usefulness of serial BNP measurement as a guide for individual identification of early constrictive responses to ibuprofen in preterm infants with symptomatic PDA (sPDA).MethodsBefore March 2010, the standard course of pharmacological treatment was initiated with indomethacin (or ibuprofen) and routinely followed by 2 additional doses at intervals of 24 hours. After April 2010, individualized pharmacological treatment was used, starting with the first dose of ibuprofen and withholding additional ibuprofen doses if the BNP concentration was <600 pg/mL and clinical symptoms of PDA improved.ResultsThe BNP-guided group received significantly fewer doses of ibuprofen than the standard group did during the first course of treatment and the entire study period. The need for further doses of cyclooxygenase inhibitors and for surgical ligation was not significantly different between the 2 groups. No significant differences were seen in clinical outcomes and/or complications related to sPDA and/or pharmacological treatment.ConclusionIndividualized BNP-guided pharmacological treatment may be used clinically to avoid unnecessary doses of cyclooxygenase inhibitors without increasing the ductal closure failure and the short-term morbidity related to sPDA

Primary Medullary Hemorrhage Associated with Hypertension

Spontaneous primary medullary hemorrhage is a rare event. A 64-year-old man was admitted for sudden-onset vertigo and vomiting. His clinical features were similar to those of lateral medullary syndrome. The patient had no anticoagulant therapy, vascular malformation, or a caudal extension of a pontine hemorrhage. The patient had multiple hypertensive changes, including retinopathy, left ventricular hypertrophy on electrocardiography, multiple cerebral microbleeds, and small-vessel changes on MRI. T2*-weighted gradient echo MRI performed 3 months prior to admission and contrast-enhanced MRI showed no evidence of vascular malformation. We concluded that the patient had uncontrolled hypertension that may have lead to primary medullary hemorrhage