Health and Disability

By CMS’s own calculation, 40 percent or nearly 5,000 home health companies — mainly small businesses — will experience a “net loss” in revenue due to the cuts and go into the red by 2017. That will put many of them out of business.

The National Association for Home Care and Hospice calculates the losses will be much more severe, affecting 75 percent of all home health care companies.

Nearly a half million skilled home care workers are also projected to lose their jobs over the next four years due to the cuts, according to the program’s supporters.

The cuts may also have a disproportionate impact on minorities and those living in underserved rural communities.

A November 2013 study by Avalere Health, a Washington, D.C., health care business analysis firm, found that two out of three home health care recipients fall at or below the federal poverty line.

The drug, nilotinib, improved and even reversed impaired cognition, motor skills and non-motor function in patients with Parkinson's disease and Lewy bodydementia, in a small phase 1 clinical trial.

It also significantly changed biomarkers, the toxic proteins linked to disease progression, accord to Dr. Charbel Moussa, PhD, and Dr. Fernando Pagan, PhD, both of Georgetown University Medical Center in Washington (GUMC), who conducted the preclinical research.

All patients experienced benefits, and 10 of them reported meaningful clinical improvements, but the most dramatic was in observable behavior.

Most patients experienced an improvement in cognition, motor skills and non-motor function improvement (such as constipation). One individual confined to a wheelchair was able to walk again; three others who could not talk were able to hold conversations.

On stopping the nilotinib treatment, despite restarting their L-dopa therapies, patients again underwent cognitive and motor decline.

Alan Hoffman, PhD, who participated in the study, had fallen eight times in the 6 weeks before the trial, but during the 6 months of the study, fell only once. He says that his speech and thinking are improved.

He adds:

"Before the nilotinib, I did almost nothing around the house. Now, I empty the garbage, unload the dishwasher, load the washer and the dryer, set the table, even take responsibility for grilling. My wife says it's life-changing for her and for my children and grandchildren. To say that nilotinib has made a change in our lives is a huge understatement."

Medicare’s drug program, known as Part D, already spent an eye-popping $4.8 billion for hepatitis C drugs in 2014, not including rebates. The high amount partly reflected the medications’ breakthrough nature. Before the new drugs, there was no cure for hepatitis C; the new drugs cure the disease in more than 90 percent of patients.

But the cure comes at enormous cost: A 12-week course of treatment with the most popular drug has a list price of about $95,000, or $1,100 a day.

Pharmacies filled more than 183,000 prescriptions for hepatitis C drugs from January to June, and were on track for all of 2015 to far outpace the nearly 288,000 prescriptions filled in 2014, the data shows.

Researchers have reported the strongest evidence yet that rising antibiotic resistance could have disastrous consequences for patients undergoing surgery or cancerchemotherapy.

A 30% reduction in the efficacy of antibiotic prophylaxis (preventive use of antibiotics) could result in 120,000 additional infections and 6,300 infection-related deaths every year in the US alone.

Antibiotics are key to modern health care. Without them, life-giving invasive medical procedures become extremely risky.

Prophylactic antibiotics are used routinely in surgery, organ transplantation and cancer chemotherapy to prevent infections.

Increasing antibiotic resistance threatens the safety of these procedures and could result in increased rates of morbidity, amputation or death.

In the US, an estimated 157,500 surgical site infections resulted during inpatient surgery in 2011. A 3% mortality rate is associated with surgical site infections, and patients who develop such infections have between two and 11 times higher mortality rate than those who do not.

The Centers for Disease Control and Prevention (CDC) estimate that around 650,000 patients a year receive chemotherapy for cancer in the US; approximately 10% acquire an infection that requires a hospital visit.

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In peripheral neuropathy, the damaged nerve fibers have a heightened response to normal signals and send incorrect messages to pain centers in the brain - a process known as "peripheral and central sensitization."

The chronic pain condition can present in various forms and follow different patterns. For example, in one of the most common, diabetic neuropathy, nerve damage occurs in an ascending pattern. Pain and numbness often are felt symmetrically in both feet followed by a gradual progression up both legs.

The new discovery surrounds the activity of a part of the brain called the anterior cingulate cortex (ACC), thought to be the region most consistently involved in pain processing.

Senior author Philippe Séguéla, a professor in the department of neurology and neurosurgery, and colleagues discovered new information about a type of channel that controls the transmission of pain signals to the ACC.

From lab tests on rats, they found that blocking these channels - called hyperpolarization-activated cyclic nucleotide-gated (HCN) channels - reduced over-stimulation of the ACC and dramatically decreased feelings of pain.

"Our study has revealed one important mechanism linking chronic pain to abnormal activity of the ACC and it provides a cellular and molecular explanation for the overstimulation of neurons in the prefrontal cortex," says Prof. Séguéla. "This gives us new perspectives on therapeutic strategies that could target the HCN channels to help relieve chronic pain."

More recently, using brain scans of the prefrontal regions of the brain, researchers have also discovered that emotional, psychological and cognitive factors can influence pain perception in neuropathic pain.

In the largest nursing home study to date on the effect of high dose flu vaccine, researchers found that shots with four times the strength of standard flu shots significantly reduced the risk of being hospitalized during theinfluenza season. There was a 1.2 percent difference (19.7 percent versus 20.9 percent) in admission for the group that received the high dose vaccine compared to the one that received the standard dose vaccine. The findings were presented as a late breaking research presentation on Oct. 10 at the Infectious Diseases Society of America meeting in San Diego.

"If given to all approximately 1.5 million nursing home residents, a one percent drop in hospitalizations would translate to thousands fewer being hospitalized," said Stefan Gravenstein, MD, MPH, lead author of the study, Director of the Center for Geriatrics and Palliative Care at University Hospitals Case Medical Center, and on faculty at both the Case Western Reserve University School of Medicine and adjunct at the Warren Alpert Medical School at Brown University.

According to the Centers for Disease Control and Prevention (CDC), the risk of hospitalization is one in five during the flu season, the same as in this study.

The study involved more than 50,000 participants 65 years old and older (nearly 14,000 were over the age of 90) from 823 nursing homes in 38 states. The residents were given influenza shots to help protect them from influenza during the period of November 2013 to March 2014.

Anorexia nervosa is a serious eating disorder, affecting over 3 million Americans. New research published in Psychosomatic Medicine suggests that people with this debilitating disease may have very different gut microbial communities than those found in healthy individuals.

Moreover, researchers at the University of North Carolina (UNC) School of Medicine speculate that this bacterial imbalance could be linked to some of the psychological symptoms related to the disorder, which has the highest mortality rate of any mental health issue.

The research, led by Ian Carroll, PhD, senior author of the paper and assistant professor of medicine in the UNC Center for Gastrointestinal Biology and Disease, suggests that gut bacteria, the trillions of bacteria that affect digestive health and immunity, could play a prominent role in the symptoms of anorexia nervosa

Fibromyalgia is the second most common rheumatic disorder behind osteoarthritis and, though still widely misunderstood, is now considered to be a lifelong central nervous system disorder, which is responsible for amplified pain that shoots through the body in those who suffer from it. Daniel Clauw, M.D., professor of anesthesiology, University of Michigan, analyzed the neurological basis for fibromyalgia in a plenary session address today at the American Pain Society Annual Scientific Meeting.

"Fibromyalgia can be thought of both as a discreet disease and also as a final common pathway of pain centralization and chronification. Most people with this condition have lifelong histories of chronic pain throughout their bodies," said Clauw. "The condition can be hard to diagnose if one isn't familiar with classic symptoms because there isn't a single cause and no outward signs."

Clauw explained that fibromyalgia pain comes more from the brain and spinal cord than from areas of the body in which someone may experience peripheral pain. The condition is believed to be associated with disturbances in how the brain processes pain and other sensory information. He said physicians should suspect fibromyalgia in patients with multifocal (mostly musculoskeletal) pain that is not fully explained by injury or inflammation.

The American Geriatrics Society (AGS) has released its second updated and expanded Beers Criteria--lists of potentially inappropriate medications for older adults who are not receiving hospice or palliative care, and one of the most frequently cited reference tools in the field of geriatrics. The Society also unveiled a suite of new companion resources--including a list of alternative therapies for potentially inappropriate medications and more detailed guidance on best practices for implementing AGS recommendations--all published online in theJournal of the American Geriatrics Society and available for free from GeriatricsCareOnline.org.