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Can the President Bar Foreign Travelers from Ebola-Stricken Countries from Entering the United States?, CRS Legal Sidebar (October 23, 2014)

October 31, 2014 Comments off

Can the President Bar Foreign Travelers from Ebola-Stricken Countries from Entering the United States?, CRS Legal Sidebar (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

The recent outbreak of the Ebola virus in West Africa has prompted concern over the risk that foreign travelers may carry the virus to the United States — a concern that has grown since an infected Liberian national who traveled to the United States infected two nurses who cared for him at a Dallas hospital. On Monday, October 21, the Department of Homeland Security announced new screening procedures at U.S. ports of entry for travelers from Ebola-stricken countries in West Africa. Several Members of Congress have gone further and suggested a blanket ban on the admission into the United States of foreign nationals who reside in or have recently traveled to Ebola-stricken countries – a suggestion that the Obama Administration has thus far opposed. Although it has never been used for such purposes, section 212(f) of the Immigration and Nationality Act (INA) seems to confer the President with authority to bar foreign travelers from Ebolastricken countries from entering the United States, if he deems such a restriction necessary to protect U.S. interests, regardless of whether there is a reason to believe that a particular traveler is infected with the Ebola virus.

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New WHO guidelines for mammography screening and referral

October 31, 2014 Comments off

New WHO guidelines for mammography screening and referral
Source: World Health Organization

A new WHO position paper examines the balance of benefits and harms in offering mammography screening to women after the age of 40 in a variety of settings. WHO is also issuing new guidelines for the referral of suspected breast cancer cases in low-resources settings, applicable to primary care.

These two guidelines are part of a broader set of comprehensive breast cancer guidance that will be developed in the coming years.

HHS OIG — Medicare Paid for HIV Drugs for Deceased Beneficiaries

October 31, 2014 Comments off

Medicare Paid for HIV Drugs for Deceased Beneficiaries
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
Under the Medicare Part D program, CMS contracts with private insurance companies, known as sponsors, to provide prescription drug coverage to beneficiaries who choose to enroll. OIG has had ongoing concerns about Medicare paying for drugs and services after a beneficiary has died.
Drugs that treat the human immunodeficiency virus (HIV) can be a target for fraud, waste, and abuse, primarily because they can be very expensive. Although this report focuses on HIV drugs, the issues raised are relevant to all Part D drugs.

HOW WE DID THIS STUDY
We based this study on an analysis of Prescription Drug Event (PDE) records for HIV drugs in 2012. Part D sponsors submit these records to CMS for each drug dispensed to beneficiaries enrolled in their plans. Each record contains information about the drug, beneficiary, pharmacy, and prescriber. We used the Beneficiary Enrollment Database, the Social Security Administration’s Death Master File, and Accurint’s Death Records to identify beneficiaries’ dates of death.

WHAT WE FOUND
Medicare paid for HIV drugs for over 150 deceased beneficiaries. CMS’s current practices allowed most of these payments to occur. Specifically, CMS has edits (i.e., systems processes) in place that reject PDE records for drugs with dates of service more than 32 days after death. CMS’s practices allow payment for drugs that do not meet Medicare Part D coverage requirements. Most of these drugs were dispensed by retail pharmacies.
This review looked only at HIV drugs, which account for one-quarter of one percent of all Part D drugs in 2012. However, our findings have implications for all drugs because Medicare processes PDE records for all drugs the same way. Considering the enormous number of Part D drugs, a change in practice would affect all Part D drugs and could result in significant cost savings for the program and for taxpayers.

WHAT WE RECOMMEND
We recommend that CMS change its practice of paying for drugs that have a date of service within 32 days after the beneficiary’s death. CMS should eliminate or-if necessary for administrative processing issues-shorten the window in which it accepts PDE records for drugs dispensed after a beneficiary’s death. Such a change would prevent inappropriate payments for drugs for deceased beneficiaries and lead to cost savings for the program and for taxpayers. CMS concurred with our recommendation.

Milk intake and risk of mortality and fractures in women and men: cohort studies

October 29, 2014 Comments off

Milk intake and risk of mortality and fractures in women and men: cohort studies
Source: British Medical Journal

Objective
To examine whether high milk consumption is associated with mortality and fractures in women and men.

Design
Cohort studies.

Setting
Three counties in central Sweden.

Participants
Two large Swedish cohorts, one with 61 433 women (39-74 years at baseline 1987-90) and one with 45 339 men (45-79 years at baseline 1997), were administered food frequency questionnaires. The women responded to a second food frequency questionnaire in 1997.

Main outcome measure
Multivariable survival models were applied to determine the association between milk consumption and time to mortality or fracture.

Results
During a mean follow-up of 20.1 years, 15 541 women died and 17 252 had a fracture, of whom 4259 had a hip fracture. In the male cohort with a mean follow-up of 11.2 years, 10 112 men died and 5066 had a fracture, with 1166 hip fracture cases. In women the adjusted mortality hazard ratio for three or more glasses of milk a day compared with less than one glass a day was 1.93 (95% confidence interval 1.80 to 2.06). For every glass of milk, the adjusted hazard ratio of all cause mortality was 1.15 (1.13 to 1.17) in women and 1.03 (1.01 to 1.04) in men. For every glass of milk in women no reduction was observed in fracture risk with higher milk consumption for any fracture (1.02, 1.00 to 1.04) or for hip fracture (1.09, 1.05 to 1.13). The corresponding adjusted hazard ratios in men were 1.01 (0.99 to 1.03) and 1.03 (0.99 to 1.07). In subsamples of two additional cohorts, one in males and one in females, a positive association was seen between milk intake and both urine 8-iso-PGF2α (a biomarker of oxidative stress) and serum interleukin 6 (a main inflammatory biomarker).

Conclusions
High milk intake was associated with higher mortality in one cohort of women and in another cohort of men, and with higher fracture incidence in women. Given the observational study designs with the inherent possibility of residual confounding and reverse causation phenomena, a cautious interpretation of the results is recommended.

See also: Editorial – Milk and Mortality

Medical Cost Offsets from Prescription Drug Utilization Among Medicare Beneficiaries

October 27, 2014 Comments off

Medical Cost Offsets from Prescription Drug Utilization Among Medicare Beneficiaries (PDF)
Source: Journal of Managed Care & Specialty Pharmacy

This brief commentary extends earlier work on the value of adherence to derive medical cost offset estimates from prescription drug utilization. Among seniors with chronic vascular disease, 1% increases in condition- specific medication use were associated with significant ( P < 0.001) reductions in gross nonpharmacy medical costs in the amounts of 0.63% for dyslipidemia, 0.77% for congestive heart failure, 0.83% for diabetes, and 1.17% for hypertension.

Ebola Virus Disease: Information for U.S. Healthcare Workers

October 24, 2014 Comments off

Ebola Virus Disease: Information for U.S. Healthcare Workers
Source: U.S. Department of Health and Human Services, Health Resources and Services Administration

National Call on Preparing Nurses to Safely Care for Patient with Ebola recording and transcript, plus information from the CDC, curated by CDC experts.

Estimating the Future Number of Cases in the Ebola Epidemic — Liberia and Sierra Leone, 2014–2015

October 24, 2014 Comments off

Estimating the Future Number of Cases in the Ebola Epidemic — Liberia and Sierra Leone, 2014–2015
Source: Morbidity and Mortality Weekly Report (CDC)

The first cases of the current West African epidemic of Ebola virus disease (hereafter referred to as Ebola) were reported on March 22, 2014, with a report of 49 cases in Guinea. By August 31, 2014, a total of 3,685 probable, confirmed, and suspected cases in West Africa had been reported. To aid in planning for additional disease-control efforts, CDC constructed a modeling tool called EbolaResponse to provide estimates of the potential number of future cases. If trends continue without scale-up of effective interventions, by September 30, 2014, Sierra Leone and Liberia will have a total of approximately 8,000 Ebola cases. A potential underreporting correction factor of 2.5 also was calculated. Using this correction factor, the model estimates that approximately 21,000 total cases will have occurred in Liberia and Sierra Leone by September 30, 2014. Reported cases in Liberia are doubling every 15–20 days, and those in Sierra Leone are doubling every 30–40 days. The EbolaResponse modeling tool also was used to estimate how control and prevention interventions can slow and eventually stop the epidemic. In a hypothetical scenario, the epidemic begins to decrease and eventually end if approximately 70% of persons with Ebola are in medical care facilities or Ebola treatment units (ETUs) or, when these settings are at capacity, in a non-ETU setting such that there is a reduced risk for disease transmission (including safe burial when needed). In another hypothetical scenario, every 30-day delay in increasing the percentage of patients in ETUs to 70% was associated with an approximate tripling in the number of daily cases that occur at the peak of the epidemic (however, the epidemic still eventually ends). Officials have developed a plan to rapidly increase ETU capacities and also are developing innovative methods that can be quickly scaled up to isolate patients in non-ETU settings in a way that can help disrupt Ebola transmission in communities. The U.S. government and international organizations recently announced commitments to support these measures. As these measures are rapidly implemented and sustained, the higher projections presented in this report become very unlikely.

See also:
Importation and Containment of Ebola Virus Disease — Senegal, August–September 2014
Control of Ebola Virus Disease — Firestone District, Liberia, 2014
Ebola Virus Disease Outbreak — Nigeria, July–September 2014
Ebola Virus Disease Outbreak — West Africa, September 2014
Frequently Asked Questions About “Alternative” Therapies for Ebola (NCCAM)

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