Reinventing the E.R. for America’s Mental-Health Crisis

“In 2012, Scott Zeller, who was then the head of psychiatric emergency services at the Alameda Health System, in Oakland, California, was growing frustrated with the status quo. Many observers blamed long wait times for psychiatric patients on a sharp decline in the number of psychiatric beds in public hospitals. Zeller thought they were missing a more fundamental point. “Why is mental illness the only emergency where the treatment plan is, Let’s find them a bed somewhere?” Zeller asked. “If someone comes in with an asthma attack, we don’t say, ‘We’ve got a gurney here in the back for you. … Read More

Cost-effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors for Patients With Heart Failure and Preserved Ejection Fraction—Living on the Edge

Excerpt – In this issue of JAMA Cardiology, Cohen and colleagues have performed a formal cost-effectiveness analysis of SGLT2 [sodium-glucose cotransporter-2] inhibitors for patients with heart failure and an ejection fraction more than 40%. They developed a computer-simulation model to project the long-term clinical benefits and costs for patients with HFpEF [heart failure with preserved ejection fraction] with and without SGLT2 inhibition. Their model was based on pooled estimates of baseline risk and effectiveness of SGLT2 inhibitors derived from the EMPEROR-PRESERVED and DELIVER trials. Because these trials followed up patients for a median of only 2.3 years, the authors extrapolated … Read More

Population Genomic Screening for Three Common Hereditary Conditions: A Cost-Effectiveness Analysis

“Population genomic screening, which was envisioned almost 20 years ago with the publication of the draft human genome sequence, is recognized by the Centers for Disease Control and Prevention (CDC) as having notable potential to improve public health. In 2014, the CDC’s Office of Public Health Genomics designated Tier 1 genomic applications as those with evidence-based guidelines and recommendations to prevent morbidity and mortality associated with genetic risk. The initial 3 autosomal dominant conditions assigned to Tier 1—Lynch syndrome (LS) (high risk for colorectal cancer [CRC]), hereditary breast and ovarian cancer syndrome (HBOC), and familial hypercholesterolemia (FH)—cause a high lifetime … Read More

CAR-T research is flourishing but is hampered by outdated precautions, experts say

Excerpt – “When we started in 2010, we were appropriately concerned that genetic engineering would create so-called Frankenstein cells that would be uncontrollable,” [professor at the University of Pennsylvania and a CAR-T pioneer Carl] June said. “There were lots of regulatory issues put in that has slowed research. But 11 to 12 years in, more than 20,000 people treated, and it’s never happened — the Frankenstein cell turned into a CAR-T tumor hasn’t happened. Autologous cells are safe, they don’t need to be regulated as in experimental, early stage by the FDA.” [..] Innovation is needed in the CAR-T field, … Read More

How to battle superbugs with viruses that “eat” them

As antibiotic resistance spreads, bacteriophages could help avert a crisis “Antibiotics are vital to modern medicine. [..] Life expectancy would drop by a third if they did not exist. But after decades of overuse their powers are fading. Some bacteria have evolved resistance, creating a growing army of “superbugs” against which there is no effective treatment. Antimicrobial resistance is expected to kill 10m people a year by 2050, up from around 1m in 2019. [..] Microbiologists have known for decades that disease-causing bacteria can suffer from illnesses of their own. They are susceptible to attack by bacteriophages (“phages” for short): … Read More

Current concepts in coronary artery revascularisation

“More than five decades after the introduction of CABG and four decades after the introduction of PCI into clinical practice, the procedural and long-term outcomes of the two revascularisation methods are now well characterised. Although technological improvements will continue to increase their safety and efficacy, the relative advantages and disadvantages of the two interventions will probably remain substantially unchanged. A limitation of available data is that they are from prevalently young, White, male, HIC [high-income countries] populations. The results of coronary revascularisation in women, non-White racial and ethnic groups, older adults, and LMICs [low- and middle-income countries] require further and … Read More

Beyond Wegovy and Ozempic: Biotechs vie for piece of red-hot weight loss market with novel strategies

“This class of drugs [GLP-1 agonists], though, often causes severe nausea in early weeks and doesn’t lead to significant weight loss in everyone. There’s growing concern that in addition to fat loss, the drugs lead to muscle loss that could prove detrimental for older patients. And for most people, the costly drugs may need to be taken forever to sustain the effects. [..] Versanis’ bimagrumab, which increases muscle while cutting fat, stands out because all currently available obesity drugs lead to muscle loss. In a trial for Wegovy, for example, about 40% of the weight that people lost was lean mass. Some … Read More

Study: Single dose of HPV vaccine up to 98% effective

“A new study from researchers at the Kenya Medical Research Institute (KEMRI) and Massachusetts General Hospital (MGH) showed a single dose of human papillomavirus virus (HPV) vaccine was highly efficacious in preventing HPV, the virus that causes cervical cancer, in girls and women ages 15 to 20. The study results were announced at the 35th International Papillomavirus Conference in Washington, DC, this week. Researchers described the findings from their randomized, multicenter, double-blind, controlled trial, which included 2,275 participants in Kenya between the ages of 15 and 20. The women were randomly assigned to receive either a single dose of the bivalent … Read More

What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss

“we examine real-world data from a cohort based in a UK primary care clinic offering a low-carbohydrate approach to people with T2D [type 2 diabetes] from 2013 to 2021. The physiological mechanisms behind remission induced by dietary weight loss were first demonstrated in 2011. Since then the idea of drug-free T2D remission has gained international momentum. [..] Advice on lowering dietary carbohydrate was offered routinely by our team of nine specially trained GPs and three practice nurses to patients with T2D (defined as HbA1c >48 mmol/mol on two occasions) starting in March 2013. Our protocol includes important information around the deprescribing of … Read More

Aldosterone, a hormone that prevents dehydration, is linked to worsening kidney disease, study suggests

“In the observational study [published in the European Heart Journal on 2022.8.7], researchers analyzed health data from 3,680 people with chronic kidney disease for nearly 10 years. Those with elevated levels of aldosterone, a crucial, salt-conserving hormone made by the adrenal glands, which sit atop the kidneys, had a higher risk of serious kidney disease progression during the study period: they are more likely to lose half their kidney function, start dialysis, or develop end-stage kidney disease. [Excerpts of an interview with Ashish Verma, kidney specialist and assistant professor of medicine at Boston University School of Medicine:] [Verma:] We found … Read More