About Covid-19
Which Coronavirus Vaccine Will Work in the Youngest Children?: “Moderna…is expected to send federal officials initial data this week on how well its coronavirus vaccine works for the nation’s youngest children.”
The proposed dose for children younger than 6 years would be two shots of one quarter adult strength.
Pfizer and BioNTech to seek authorization of second coronavirus booster shot for people 65 and older: “Pharmaceutical giant Pfizer and its partner, BioNTech, will seek emergency authorization for a second booster shot of their coronavirus vaccine for people 65 and older, an effort to bolster waning immunity that occurs several months after the first booster, according to three people familiar with the situation.
The submission to the Food and Drug Administration, anticipated as soon as Tuesday, is expected to include ‘real world data’ collected in Israel…”
Comparing Human Milk Antibody Response After 4 Different Vaccines for COVID-19: “We demonstrated that SARS-CoV-2–specific IgA in human milk was present more frequently after vaccination with an mRNA-based vaccine [Pfizer/BioNTech and Moderna] compared with a vector-based vaccine [Astra Zeneca and J&J].”
The differences were substantial between the two vaccine types.
About health insurance
Employers Turn to ‘High-Performing’ Physicians for Cost Savings: “Some of the largest companies in Wisconsin are hoping to save money on health care this year by setting up insurance plans that steer employees to primary care physicians who provide high-quality care for less money.
The half-dozen employers in eastern Wisconsin are expected to save more than 15% of $12,000 per employee in annual medical costs—about $10 million this year for the 5,000 employees who enrolled in the plans, Dave Osterndorf, chief actuary of plan administrator Centivo, said.
The companies include Robert W. Baird & Co., Northwestern Mutual, American Roller Co. LLC, and the Guardian Life Insurance Co.”
Not a new idea, but the fact that businesses are actually turning to such measures indicates the market may really be changing to value-based care.
“It’s never been done before”: How NC plans to use Medicaid dollars to improve social determinants of health: “Starting March 15, Hunger and Health — along with more than 90 otherorganizations throughout 33 western and eastern North Carolina counties — will begin scaling up their work and getting reimbursed for parts of it when the state officially rolls out the Healthy Opportunities Pilot: a first-in-the-nation project which hypothesizes that if we use health care dollars to pay for non-medical health-related services, medical costs will fall and people’s overall health will rise….
In North Carolina, the [1115] waiver means that the state can use up to $650 million in Medicaid money to pay for things such as the delivery of healthy food boxes, paying for someone’s first month’s rent or a security deposit, and case management for families experiencing domestic violence.”
California aims to limit health care costs with new office: “… instead of relying on the market or the courts to keep health care prices in check, California Gov. Gavin Newsom wants to order the state’s hospitals, doctors’ offices and insurance companies to keep their costs below a certain level. If they don't, the state could impose a hefty fine.
That's the goal of the proposed Office of Health Care Affordability, part of Newsom's $286.4 billion budget proposal. At least four other states — Massachusetts, Maryland, Rhode Island and Oregon — have similar offices. But none is as comprehensive as the one proposed in California. The big difference: California would be more willing to punish companies that charge too much.”
About hospitals and healthcare systems
VA reveals sweeping plan to shutter aging clinics, hospitals in favor of new facilities, retooled services: “The Biden administration released a sweeping plan Monday to reposition the sprawling veterans’ health-care system to confront demographic changes and shifts in medicine, recommending the closure of hundreds of hospitals and clinics and construction of new ones in areas with greater demand.”
For a very detailed look, see: VA Recommendations to the AIR Commission.
The VA established the Asset and Infrastructure Review (AIR) Commission to study projected needs and facility readiness to meet those needs. The above link details how the recommendations will be implemented in each of the Veterans Integrated Service Networks (VISNs). [For more background about VISNs, see the US Healthcare System book, pages 339-341].
Investment gains a main driver of health system profits in 2021: The article cites many examples.
6 hospital construction projects worth $1B or more: Hospital expansion continues despite Covid-19 challenges and overall economic conditions.
'World's most ethical companies' list includes 9 health systems: “Ethisphere Institute, a for-profit company that defines and measures corporate ethical standards, has named nine health systems to its 2022 list of ‘world's most ethical companies.’”
It is interesting that three of the nine are in Cleveland.
About pharma
The Top 15 U.S. Pharmacies of 2021: Market Shares and Revenues at the Biggest Companies: The list includes mail order and specialty pharmacies as well as “bricks and mortar” sites. At the top is CVS, followed by Walgreens.
Pfizer Updates Company Position in Russia: “Pfizer will maintain humanitarian supply of medicines to Russians and donate all proceeds to providing direct humanitarian support to the people of Ukraine.”
About the public’s health
NIH launches clinical trial of three mRNA HIV vaccines: “The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, has launched a Phase 1 clinical trial evaluating three experimental HIV vaccines based on a messenger RNA (mRNA) platform—a technology used in several approved COVID-19 vaccines. NIAID is sponsoring the study, called HVTN 302, and the NIAID-funded HIV Vaccine Trials Network (HVTN), based at Fred Hutchinson Cancer Research Center in Seattle, is conducting the trial.”
Novel Malaria Treatment for Children Receives First Approval: “Australian regulators have approved a simple drug combination as an effective cure for a form of malaria in children ages 2 to 16…
The drug is a single dose of tafenoquine (brand name Kozenis), administered along with the traditional chloroquine treatment. The approval was announced on Monday by the nonprofit Medicines for Malaria Venture, which helped develop the drug.
Tafenoquine, made by GlaxoSmithKline, can cure a type of malaria caused by Plasmodium vivax, which is most common in South and Southeast Asia, South America and the Horn of Africa.”
Light exposure during sleep impairs cardiometabolic function: “This laboratory study shows that, in healthy adults, one night of moderate (100 lx) light exposure during sleep increases nighttime heart rate, decreases heart rate variability (higher sympathovagal balance), and increases next-morning insulin resistance when compared to sleep in a dimly lit (<3 lx) environment. Moreover, a positive relationship between higher sympathovagal balance and insulin levels suggests that sympathetic activation may play a role in the observed light-induced changes in insulin sensitivity…
These results demonstrate that a single night of exposure to room light during sleep can impair glucose homeostasis... Attention to avoiding exposure to light at night during sleep may be beneficial for cardiometabolic health.” [Emphasis added]
Also, turn off the TV before falling asleep.
Association of Low- and No-Calorie Sweetened Beverages as a Replacement for Sugar-Sweetened Beverages With Body Weight and Cardiometabolic Risk: A Systematic Review and Meta-analysis: “There are concerns that low- and no-calorie sweetened beverages (LNCSBs) do not have established benefits, with major dietary guidelines recommending the use of water and not LNCSBs to replace sugar-sweetened beverages (SSBs). Whether LNCSB as a substitute can yield similar improvements in cardiometabolic risk factors vs water in their intended substitution for SSBs is unclear…
This systematic review and meta-analysis found that using LNCSBs as an intended substitute for SSBs was associated with small improvements in body weight and cardiometabolic risk factors without evidence of harm and had a similar direction of benefit as water substitution. The evidence supports the use of LNCSBs as an alternative replacement strategy for SSBs over the moderate term in adults with overweight or obesity who are at risk for or have diabetes.”
The results are interesting because some previous studies showed that artificially sweetened beverages increase weight by “tricking” the body into thinking it was ingesting sweets without the associated satiety.
New US Preventive Services Task Force Recommendations on Screening for Eating Disorders: “For the first time, the US Preventive Services Task Force (USPSTF) reviewed eating disorder screening in asymptomatic adolescents and adults and gave it an I statement for insufficient evidence, which was supported by an evidence report and systematic review.The USPSTF only reviewed evidence for adolescents and adults with no signs or symptoms of eating disorders and with a normal or high body mass index (BMI). It is important to note that the insufficient evidence statement is not a recommendation for or against screening, but rather that there is not enough evidence to make a recommendation either way.”
See the Table for a good review of the different types of eating disorders.
About healthcare IT
Check this site for coverage of HIMSS22.
Epic integrates AI tools for symptom assessment: “Epic added digital health company Ada Health's artificial intelligence tools to its App Orchard online marketplace…
Healthcare providers can now offer patients AI-powered symptom assessments within their Epic MyChart patient portal, which can then be accessed by the care team through the EHR.”
Meditech and Google Health to collaborate on clinical search in Expanse EHR: “Today at HIMSS22, Meditech and Google Health have announced their intent to collaborate on an integrated solution within Meditech's Expanse EHR platform.
The combined technology will enable the use of Google Health's search and summarization capabilities within the Expanse EHR with the aim of helping clinicians provide the best care through quick and easy access to information from multiple sources with a longitudinal view of a patient's health history.”
How Cincinnati Children's uses VR in the OR: A really interesting story about the use of virtual reality in planning pediatric cardiac surgery.
About healthcare personnel
Primary Care in High-Income Countries: How the United States Compares: From the Commonwealth Fund study comparing 10 high income countries.
”Highlights
U.S. adults are the least likely to have a regular physician or place of care, or a longstanding relationship with a primary care provider.
Access to home visits or after-hours care is lowest in the U.S.
U.S. primary care providers are the most likely to screen for social service needs.
Half of U.S. primary care physicians report adequate coordination with specialists and hospitals — around the average for the 11 countries studied.”
About healthcare quality and safety
Patient Safety Excellence Award: Healthgrades just published its 2022 safety report.