51
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Hoque S, Chen BJ, Schoen MW, Carson KR, Keller J, Witherspoon BJ, Knopf KB, Yang YT, Schooley B, Nabhan C, Sartor O, Yarnold PR, Ray P, Bobolts L, Hrushesky WJ, Dickson M, Bennett CL. End of an era of administering erythropoiesis stimulating agents among Veterans Administration cancer patients with chemotherapy-induced anemia. PLoS One 2020; 15:e0234541. [PMID: 32584835 PMCID: PMC7316310 DOI: 10.1371/journal.pone.0234541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/18/2020] [Indexed: 11/18/2022] Open
Abstract
Erythropoisis stimulating agent (ESA) use was addressed in Food and Drug Administration (FDA) Oncology Drug Advisory Committee (ODAC) meetings between 2004 and 2008. FDA safety-focused regulatory actions occurred in 2007 and 2008. In 2007, black box warnings advised of early death and venous thromboembolism (VTE) risks with ESAs in oncology. In 2010, a Risk Evaluation Strategies (REMS) was initiated, with cancer patient consent that mortality and VTE risks were noted with ESAs. We report warnings and REMS impacts on ESA utilization among Veterans Administration (VA) cancer patients with chemotherapy-induced anemia (CIA). Data were from Veterans Affairs database (2003–2012). Epoetin and darbepoetin use were primary outcomes. Segmented linear regression was used to estimate changes in ESA use levels and trends, clinical appropriateness, and adverse events (VTEs) among chemotherapy-treated cancer patients. To estimate changes in level of drug prescription rate after policy actions, model-specific indicator variables as covariates based on specific actions were included. ESA use fell by 95% and 90% from 2005, for epoetin and darbepoetin, from 22% and 11%, respectively, to 1% and 1%, respectively, among cancer patients with CIA, respectively (p<0.01). Following REMS in 2010, mean hematocrit levels at ESA initiation decreased from 30% to 21% (p<0.01). Black box warnings preceded decreased ESA use among VA cancer patients with CIA. REMS was followed by reduced hematocrit levels at ESA initiation. Our findings contrast with privately- insured and Medicaid insured cancer patient data on chemotherapy-induced anemia where ESA use decreased to 3% to 7% by 2010–2012. By 2012, the era of ESA administration to VA to cancer patients had ended but the warnings remain relevant and significant. In 2019, oncology/hematology national guidelines (ASCO/ASH) recommend that cancer patients with chemotherapy-induced anemia should receive ESAs or red blood cell transfusions after risk-benefit evaluation.
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Affiliation(s)
- Shamia Hoque
- Department of Civil and Environmental Engineering, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina, United States of America
- * E-mail:
| | - Brian J. Chen
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Martin W. Schoen
- Department of Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, United States of America
| | - Kenneth R. Carson
- The Washington University School of Medicine and the Saint Louis VA Medical Center, St. Louis, Missouri, United States of America
| | - Jesse Keller
- The Washington University School of Medicine and the Saint Louis VA Medical Center, St. Louis, Missouri, United States of America
| | | | - Kevin B. Knopf
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
| | - Y. Tony Yang
- George Washington University, Washington, DC, United States of America
| | - Benjamin Schooley
- Department of Integrated Information Technology, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina, United States of America
| | - Chadi Nabhan
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
| | - Oliver Sartor
- Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Paul R. Yarnold
- Medical University of South Carolina, Charleston, South Carolina, United States of America
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
| | - Paul Ray
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
| | - Laura Bobolts
- Oncology Analytics, Plantation, Florida, United States of America
- College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - William J. Hrushesky
- The Washington University School of Medicine and the Saint Louis VA Medical Center, St. Louis, Missouri, United States of America
- Medical University of South Carolina, Charleston, South Carolina, United States of America
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
| | - Michael Dickson
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
| | - Charles L. Bennett
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
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52
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Khubchandani J, Jordan TR, Yang YT. Ebola, Zika, Corona…What Is Next for Our World? Int J Environ Res Public Health 2020; 17:ijerph17093171. [PMID: 32370141 PMCID: PMC7246487 DOI: 10.3390/ijerph17093171] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 11/16/2022]
Abstract
In the past century, there have been several pandemics. Within the context of global health, these pandemics have often been viewed from the lens of determinants such as population, poverty, and pollution. With an ever-changing world and the COVID-19 pandemic, the current global determinants of public health need to be expanded. In this editorial, we explore and redefine the major determinants of global public health to prevent future pandemics. Policymakers and global leaders should keep at heart the determinants suggested hereby in any planning, implementation, and evaluation of efforts to improve global public health and prevent pandemics.
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Affiliation(s)
| | - Timothy R. Jordan
- College of Health and Human Services, University of Toledo, Toledo, OH 43606, USA;
| | - Y. Tony Yang
- Center for Health Policy and Media Engagement, George Washington University, Washington, DC 20006, USA;
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53
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Jiang B, Tang R, Zheng DY, Yang YT, Li Y, Yang RR, Liu LG, Yan H. [Clinical effectiveness of super pulsed carbon dioxide fractional laser debridement surgery in treating chronic wounds]. Zhonghua Shao Shang Za Zhi 2020; 36:273-279. [PMID: 32340417 DOI: 10.3760/cma.j.cn501120-20190415-00186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the clinical effectiveness of super pulsed carbon dioxide fractional laser debridement surgery on the treatment of chronic wounds. Methods: From December 2018 to May 2019, 37 patients with chronic wounds who met the inclusion criteria were admitted to the Affiliated Hospital of Southwest Medical University for a prospective randomized controlled study. Using the random number table, the patients were divided into surgical debridement group (19 patients, 4 males and 15 females, aged (58±16) years, 25 wounds) and laser debridement group (18 patients, 9 males and 9 females, aged (58±10) years, 23 wounds). In patients of surgical debridement group, oedematous and aging granulation tissue was scraped from the wound by scalpel handle or curet, and the residual necrotic tissue was removed by sharp surgical instruments. In patients of laser debridement group, oedematous and aging granulation tissue and necrotic tissue was removed by super pulsed carbon dioxide fractional laser therapeutic machine, laser gasification debridement was performed repeatedly till fresh normal tissue layer observed. In patients of the two groups, according to the wound in the first 3 d after the first debridement, debridement dressing was performed twice at least as before, then wound debridement dressing was performed once every 1 to 4 days as before according to the wound conditions. The wound healing rates on 7, 14, 21, and 28 d after the first debridement were calculated. The positive rates of bacterial culture of wounds before and after the first debridement were calculated. The color and texture of the wound granulation tissue before the first debridement and on 7, 14, and 28 d after the first debridement were observed and scored. The pain scores before every debridement, during every debridement, and after every debridement dressing change were evaluated by visual analogue scale. The times of debridement dressing change were recorded. Data were statistically analyzed with two independent sample t test, analysis of variance for repeated measurement, Fisher's exact probability test, Mann-Whitney U test, and Bonferroni correction. Results: (1) On 7, 14, 21, and 28 d after the first debridement, the wound healing rates of patients in laser debridement group (29.5% (24.1%, 36.0%), 47.1% (42.7%, 62.4%), 71.4% (62.2%, 76.8%), and 88.6% (79.2%, 96.3%) were significantly higher than those of surgical debridement group (1.6% (1.0%, 12.8%), 12.7% (2.0%, 16.6%), 24.5% (8.9%, 45.5%), 43.9% (23.2%, 70.8%), Z=3.477, 3.553, 2.721, 2.193, P<0.05 or P<0.01). (2) Before the first debridement, the positive rates of bacterial culture of wounds in patients of laser debridement group and surgical debridement group were 92% (23/25) and 91% (21/23), respectively, which were similar (P>0.05). After the first debridement, the positive rate of bacterial culture of wounds of patients in surgical debridement group was 64% (16/25), which was significantly higher than 13% (3/23) of laser debridement group (P<0.01). (3) On 7, 14, and 28 d after the first debridement, the scores of color and texture of wound granulation tissue of patients in laser debridement group were significantly higher than those of surgical debridement group (Z=3.420, 5.682, 6.142, 4.461, 5.337, 4.458, P<0.01). (4) The pain scores during every debridement and after every debridement dressing change in patients of laser debridement group were significantly lower than those of surgical debridement group (t=2.847, 5.046, P<0.05 or P<0.01). (5) The time of debridement dressing change in laser debridement group was 8.0 (7.0, 10.0) times, which was significantly less than 10.0 (9.5, 12.5) times in surgical debridement group (Z=2.261, P<0.05). Conclusions: Compared with traditional surgical debridement method, super pulsed carbon dioxide fractional laser debridement surgery is more effective in treating patients with chronic wounds. Laser debridement makes the wound healing more efficiently with reduced pain and better infection control; significantly reduces the number of dressing changes, and is especially suitable for the wound treatment in outpatients.
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Affiliation(s)
- B Jiang
- Department of Plastic Surgery and Burns, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - R Tang
- Department of Plastic Surgery and Burns, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - D Y Zheng
- Department of Plastic Surgery and Burns, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Y T Yang
- Department of Plastic Surgery and Burns, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Y Li
- Department of Plastic Surgery and Burns, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - R R Yang
- Department of Plastic Surgery and Burns, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - L G Liu
- Department of Plastic Surgery and Burns, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - H Yan
- Department of Plastic Surgery and Burns, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
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Chen Z, Xiong H, Li JX, Li H, Tao F, Yang YT, Wu B, Tang W, Teng JX, Fu Q, Yang L. [COVID-19 with post-chemotherapy agranulocytosis in childhood acute leukemia: a case report]. Zhonghua Xue Ye Xue Za Zhi 2020; 41:341-343. [PMID: 32149486 PMCID: PMC7364917 DOI: 10.3760/cma.j.issn.0253-2727.2020.0004] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Z Chen
- Department of Hematology and Oncology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430016, China
| | - H Xiong
- Department of Hematology and Oncology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430016, China
| | - J X Li
- Department of Hematology and Oncology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430016, China
| | - H Li
- Department of Hematology and Oncology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430016, China
| | - F Tao
- Department of Hematology and Oncology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430016, China
| | - Y T Yang
- Department of Hematology and Oncology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430016, China
| | - B Wu
- Department of Hematology and Oncology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430016, China
| | - W Tang
- Department of Hematology and Oncology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430016, China
| | - J X Teng
- Department of Hematology and Oncology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430016, China
| | - Q Fu
- Department of Hematology and Oncology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430016, China
| | - L Yang
- Department of Hematology and Oncology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430016, China
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Affiliation(s)
- Benjamin Mason Meier
- Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Roojin Habibi
- Global Strategy Lab, York University, Toronto, ON M3J 2S5, Canada
| | - Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University, Washington, DC 20006, USA
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56
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Affiliation(s)
- Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University School of Nursing, Washington, DC
- Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC
| | - Patricia J Zettler
- Drug Enforcement and Policy Center, Moritz College of Law, Ohio State University, Columbus
- Ohio State University Comprehensive Cancer Center, Columbus
| | - Theodore L Wagener
- Center for Tobacco Research, Ohio State University Comprehensive Cancer Center, Columbus
- Department of Internal Medicine, Ohio State University, Columbus
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57
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Yang YT, Pendo E, Reiss DR. The Americans with disabilities act and healthcare employer-mandated vaccinations. Vaccine 2020; 38:3184-3186. [DOI: 10.1016/j.vaccine.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
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58
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Schoen MW, Hoque S, Witherspoon BJ, Schooley B, Sartor O, Yang YT, Yarnold PR, Knopf KB, Hrushesky WJM, Dickson M, Chen BJ, Nabhan C, Bennett CL. End of an era for erythropoiesis-stimulating agents in oncology. Int J Cancer 2020; 146:2829-2835. [PMID: 32037527 DOI: 10.1002/ijc.32917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/17/2019] [Accepted: 01/07/2020] [Indexed: 12/15/2022]
Abstract
Erythropoiesis-stimulating agents (ESAs) are available to treat chemotherapy-induced anemia (CIA). In 2007-2008, regulatory notifications advised of venous thromboembolism and mortality risks while the Center for Medicare and Medicaid Services' restricted ESA initiation to patients with hemoglobin <10 g/dl. In 2010, a Risk Evaluation and Mitigation Strategies required consent prior to administration. We evaluated ESA utilization from 2003 to 2012 and obtained private health insurer claims data for persons with lung, colorectal, or breast cancer from 2001 to 2012. ESA use for CIA was determined by an ESA claim after chemotherapy, up to 6 months after treatment. We identified 839,948 commercially insured patients, including 24,785 patients with ESA-treated CIA (3.2%). Darbepoetin use increased 3.9-fold from 2003 to 2007 (12.3% to 48.7%) and then decreased 95% to 2.6% by 2012. Epoetin use decreased 90% from 2003 to 2012 (30.3% to 3.1%). Between 2003 and 2012, mean epoetin dosing decreased 0.8-fold (244,979 in 2003 vs. 196,216 units in 2012), but increased 1.8-fold for darbepoetin-treated CIA (262 in 2003 to 467 μg in 2012). Among CIA patients, transfusions were low (4.5%) in 2002-2007, then increased 2.2-fold between 2008 and 2012. Safety initiatives between 2007 and 2010 facilitated reductions in ESA use combined with changes in coverage. These data show the efficacy of regulatory efforts, publication of adverse events and changes in reimbursement in reducing use of ESAs. Future studies are warranted to optimize deimplementation strategies to improve patient safety.
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Affiliation(s)
- Martin W Schoen
- Department of Medicine, Saint Louis University School of Medicine, St. Louis, Missouri.,John Cochran Veterans Affairs Medical Center, St. Louis, Missouri
| | - Shamia Hoque
- Department of Civil and Environmental Engineering, University of South Carolina, Columbia, South Carolina
| | | | - Benjamin Schooley
- Department of Civil and Environmental Engineering, University of South Carolina, Columbia, South Carolina
| | - Oliver Sartor
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Y Tony Yang
- George Washington University, Washington, District of Columbia
| | - Paul R Yarnold
- Medical University of South Carolina, Charleston, South Carolina.,The University of South Carolina College of Pharmacy, Columbia, South Carolina
| | - Kevin B Knopf
- The University of South Carolina College of Pharmacy, Columbia, South Carolina
| | - William J M Hrushesky
- Medical University of South Carolina, Charleston, South Carolina.,The University of South Carolina College of Pharmacy, Columbia, South Carolina
| | - Michael Dickson
- The University of South Carolina College of Pharmacy, Columbia, South Carolina
| | - Brian J Chen
- Arnold School of Public Health of the University of South Carolina, Columbia, South Carolina
| | - Chadi Nabhan
- The University of South Carolina College of Pharmacy, Columbia, South Carolina
| | - Charles L Bennett
- Medical University of South Carolina, Charleston, South Carolina.,The University of South Carolina College of Pharmacy, Columbia, South Carolina
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59
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Affiliation(s)
- Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University School of Nursing, Washington, DC.,Milken Institute School of Public Health, Department of Health Policy and Management, George Washington University, Washington, DC
| | - Robert S Olick
- Center for Bioethics and Humanities, State University of New York Upstate Medical University, Syracuse
| | - Jana Shaw
- Department of Pediatrics, State University of New York Upstate Medical University, Syracuse
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60
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Affiliation(s)
- Y Tony Yang
- School of Nursing, Center for Health Policy and Media Engagement, George Washington University, Washington, DC.,Milken Institute School of Public Health, Department of Health Policy and Management, George Washington University, Washington, DC
| | - David A Broniatowski
- School of Engineering and Applied Science, Department of Engineering Management and Systems Engineering, George Washington University, Washington, DC
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61
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Affiliation(s)
- Y Tony Yang
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
| | - Brian Chen
- Department of Health Services Policy and Management, University of South Carolina, Columbia
| | - Charles L Bennett
- Center for Medication Safety and Efficacy, University of South Carolina, Columbia.,Department of Clinical Pharmacy and Outcomes Science, University of South Carolina, Columbia
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Jiang XL, Gu XY, Zhou XX, Chen XM, Zhang X, Yang YT, Qin Y, Shen L, Yu WF, Su DS. Intestinal dysbacteriosis mediates the reference memory deficit induced by anaesthesia/surgery in aged mice. Brain Behav Immun 2019; 80:605-615. [PMID: 31063849 DOI: 10.1016/j.bbi.2019.05.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/17/2019] [Accepted: 05/03/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD) is associated with increased morbidity and mortality and has become a major concern for patients and caregivers. POCD is most common in older patients. Previous studies demonstrated that the gut microbiome affects cognitive function and behaviour, and perioperative factors, including the operation itself, antibiotics, opioids or acid-inducing drugs, affect the gut microbiome. Thus, we hypothesised that intestinal dysbacteriosis caused by anaesthesia/surgery induces POCD. METHODS Tibial fracture internal fixation was performed in 18-month-old C57BL/6 mice under isoflurane anaesthesia to establish the POCD model. The Morris water maze was used to measure reference memory after anaesthesia/surgery. High-throughput sequencing of 16S rRNA from faecal samples was used to investigate changes in the abundance of intestinal bacteria after anaesthesia/surgery. To confirm the role of the gut microbiome in POCD, we pretreated mice with compound antibiotics or mixed probiotics (VSL#3). Anaesthesia/surgery impaired reference memory and induced intestinal dysbacteriosis in aged mice. RESULTS The 16S rRNA sequencing data revealed 37 genera (18 families) of bacteria that changed in abundance after anaesthesia/surgery. Pretreating mice with compound antibiotics or mixed probiotics (VSL#3) prevented the learning and memory deficits induced by anaesthesia/surgery. We further conducted quantitative real-time polymerase chain reaction (qRT-PCR) of 22 common types of bacteria among the 37 total types to verify the results of bacterial flora changes after anaesthesia/surgery. Numbers of 8 types of bacteria changed after anaesthesia/surgery but returned to normal after treatment with a mix of probiotics. CONCLUSIONS Our data suggest that deficits in reference memory induced by anaesthesia/surgery are mediated by intestinal dysbacteriosis.
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Affiliation(s)
- X L Jiang
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai 200127, China
| | - X Y Gu
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai 200127, China
| | - X X Zhou
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai 200127, China
| | - X M Chen
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai 200127, China
| | - X Zhang
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai 200127, China
| | - Y T Yang
- Department of Anesthesiology, First Hospital in Quanzhou City of Fujian Medical University, Quanzhou, Fujian 362000, China
| | - Y Qin
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai 200127, China
| | - L Shen
- Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - W F Yu
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai 200127, China
| | - D S Su
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai 200127, China.
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63
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Bennett CL, Schooley B, Taylor MA, Witherspoon BJ, Godwin A, Vemula J, Ausdenmoore HC, Sartor O, Yang YT, Armitage JO, Hrushesky WJ, Restaino J, Thomsen HS, Yarnold PR, Young T, Knopf KB, Chen B. Caveat Medicus: Clinician experiences in publishing reports of serious oncology-associated adverse drug reactions. PLoS One 2019; 14:e0219521. [PMID: 31365527 PMCID: PMC6668902 DOI: 10.1371/journal.pone.0219521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/25/2019] [Indexed: 11/17/2022] Open
Abstract
Oncology-associated adverse drug/device reactions can be fatal. Some clinicians who treat single patients with severe oncology-associated toxicities have researched case series and published this information. We investigated motivations and experiences of select individuals leading such efforts. Clinicians treating individual patients who developed oncology-associated serious adverse drug events were asked to participate. Inclusion criteria included having index patient information, reporting case series, and being collaborative with investigators from two National Institutes of Health funded pharmacovigilance networks. Thirty-minute interviews addressed investigational motivation, feedback from pharmaceutical manufacturers, FDA personnel, and academic leadership, and recommendations for improving pharmacovigilance. Responses were analyzed using constant comparative methods of qualitative analysis. Overall, 18 clinicians met inclusion criteria and 14 interviewees are included. Primary motivations were scientific curiosity, expressed by six clinicians. A less common theme was public health related (three clinicians). Six clinicians received feedback characterized as supportive from academic leaders, while four clinicians received feedback characterized as negative. Three clinicians reported that following the case series publication they were invited to speak at academic institutions worldwide. Responses from pharmaceutical manufacturers were characterized as negative by 12 clinicians. One clinician’s wife called the post-reporting time the “Maalox month,” while another clinician reported that the manufacturer collaboratively offered to identify additional cases of the toxicity. Responses from FDA employees were characterized as collaborative for two clinicians, neutral for five clinicians, unresponsive for negative by six clinicians. Three clinicians endorsed developing improved reporting mechanisms for individual physicians, while 11 clinicians endorsed safety activities that should be undertaken by persons other than a motivated clinician who personally treats a patient with a severe adverse drug/device reaction. Our study provides some of the first reports of clinician motivations and experiences with reporting serious or potentially fatal oncology-associated adverse drug or device reactions. Overall, it appears that negative feedback from pharmaceutical manufacturers and mixed feedback from the academic community and/or the FDA were reported. Big data, registries, Data Safety Monitoring Boards, and pharmacogenetic studies may facilitate improved pharmacovigilance efforts for oncology-associated adverse drug reactions. These initiatives overcome concerns related to complacency, indifference, ignorance, and system-level problems as barriers to documenting and reporting adverse drug events- barriers that have been previously reported for clinician reporting of serious adverse drug reactions.
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Affiliation(s)
- Charles L Bennett
- The University of South Carolina College of Pharmacy, Columbia, South Carolina, United States of America
| | - Benjamin Schooley
- College of Engineering and Computing, University of South Carolina, Columbia, South Carolina, United States of America
| | - Matthew A Taylor
- University of South Carolina School of Medicine, Columbia, South Carolina, United States of America
| | - Bartlett J Witherspoon
- Medical University of the University of South Carolina, Charleston, South Carolina, United States of America
| | - Ashley Godwin
- The University of South Carolina College of Pharmacy, Columbia, South Carolina, United States of America
| | - Jayanth Vemula
- The University of South Carolina College of Pharmacy, Columbia, South Carolina, United States of America
| | - Henry C Ausdenmoore
- The University of South Carolina College of Pharmacy, Columbia, South Carolina, United States of America
| | - Oliver Sartor
- Tulane University School of Medicine, New Orleans, Los Angeles, United States of America
| | - Y Tony Yang
- George Washington University, Washington, Washington, D.C., United States of America
| | - James O Armitage
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - William J Hrushesky
- University of South Carolina School of Medicine, Columbia, South Carolina, United States of America.,Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - John Restaino
- The University of South Carolina College of Pharmacy, Columbia, South Carolina, United States of America
| | | | - Paul R Yarnold
- The University of South Carolina College of Pharmacy, Columbia, South Carolina, United States of America
| | | | - Kevin B Knopf
- Alameda Health System, Oakland, California, United States of America
| | - Brian Chen
- The University of South Carolina College of Pharmacy, Columbia, South Carolina, United States of America
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Abstract
The basic reproduction number (R0), also called the basic reproduction ratio or rate or the basic reproductive rate, is an epidemiologic metric used to describe the contagiousness or transmissibility of infectious agents. R0 is affected by numerous biological, sociobehavioral, and environmental factors that govern pathogen transmission and, therefore, is usually estimated with various types of complex mathematical models, which make R0 easily misrepresented, misinterpreted, and misapplied. R0 is not a biological constant for a pathogen, a rate over time, or a measure of disease severity, and R0 cannot be modified through vaccination campaigns. R0 is rarely measured directly, and modeled R0 values are dependent on model structures and assumptions. Some R0 values reported in the scientific literature are likely obsolete. R0 must be estimated, reported, and applied with great caution because this basic metric is far from simple.
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Baumann KE, Paynter J, Petousis-Harris H, Prymula R, Yang YT, Shaw J. Comparison of vaccination coverage of four childhood vaccines in New Zealand and New York State. J Paediatr Child Health 2019; 55:781-788. [PMID: 30426581 DOI: 10.1111/jpc.14289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/18/2018] [Accepted: 07/20/2018] [Indexed: 11/29/2022]
Abstract
AIM To ensure that children are vaccinated, different national governments use diverse strategies. We compared childhood vaccination coverage rates between New York State (NYS) and New Zealand (NZ) as the vaccination strategies are different. METHODS We used vaccination records from the NYS Immunisation Information System and the National Immunisation Register of NZ to measure (i) vaccination coverage by school entry and by age six; (ii) coverage of different socio-demographic groups; and (iii) trend in vaccination coverage between 2011 and 2015. RESULTS We analysed the records of 583 767 NYS children and 269 800 NZ children 7 years of age. NZ children were 3.3-21.5% more likely than NYS children to receive each of the vaccines. Compared to NYS, NZ children were 39.6% more likely to be up-to-date by the start of school and 28.1% more likely to be up-to-date by age 6 years. Both NYS and NZ had statistically significant increases in the proportion of children who were up to date on each vaccine and all vaccines by the start of school and by 6 years of age (P < 0.001). CONCLUSIONS We identified under-vaccinated groups and examined the point in the vaccine series where children were most vulnerable to being under-vaccinated. This information is useful in targeting future investigations and interventions aimed at mitigating disparities in vaccine coverage. This comparison of regions with different vaccination programmes and policies is important when considering whether the particular vaccination coverage strategies of one region could be adapted and applied for the benefit of another.
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Affiliation(s)
| | - Janine Paynter
- Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Helen Petousis-Harris
- Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Roman Prymula
- Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Y Tony Yang
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, United States
| | - Jana Shaw
- Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic.,Department of Pediatrics, Golisano Children's Hospital, SUNY Upstate Medical University, Syracuse, New York, United States
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Zuo LG, Ge ST, Wang X, Zhu YK, Liu ZH, Yang YT, Jiang CQ, Li SQ, Liu ML. [Analysis on prognosis and influencing factors of postoperative low anterior resection syndrome for rectal cancer patients undergoing laparoscopic anus-preserving radical resection]. Zhonghua Wei Chang Wai Ke Za Zhi 2019; 22:573-578. [PMID: 31238637 DOI: 10.3760/cma.j.issn.1671-0274.2019.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the prognosis and influencing factors of postoperative low anterior resection syndrome (LARS) for rectal cancer patients undergoing laparoscopic sphincter-preserving radical resection. Methods: A retrospective case-control study was used in this study. Clinical data of 268 rectal cancer patients undergoing laparoscopic sphincter-preserving radical resection at Department of Gastrointestinal Surgery of The First Affiliated Hospital of Bengbu Medical College from January 2016 to January 2018 were retrospectively collected. Inclusion criteria: (1) operation procedure was total mesorectal excision (TME) and sphincter-preserving radical resection; (2) rectal cancer was confirmed by postoperative pathology; (3) age of patient was ≥ 18 years old. Exclusion criteria: (1) patient who had history of pelvic surgery and pelvic fractures, which would affect the anorectal function; (2) patient who had history of preoperative chronic constipation and irritable bowel syndrome, which would affect defecation; (3) patient who developed postoperative complications, such as anastomotic leakage, which would affect defecation function; (4) patient who received long-term use of drugs, which would affect the function of gastrointestinal tract or anus; (5) patient suffered from mental illness, who was unable to communicate properly; (6) patient who was lack of clinical data or had incomplete clinical data. Patients were followed up at 3, 6 and 12 months postoperatively, and LARS was diagnosed and graded according to the LARS score scale. The LARS score ranged from 0 to 42 points, and 0 to 20 was difined as no LARS, 21 to 29 was mild LARS, and 30 to 42 was severe LARS. LARS score >20 points at any time point was defined as postoperative LARS. Severe LARS transferring into mild LARS and mild LARS transferring into no LARS was defined as symptom improvement. Incidence and outcomes of LARS were evaluated. The factors associated with LARS outcomes were analyzed using χ(2) test and logistic regression model. Results: A total of 268 patients were enrolled. The incidence of LARS was 42.9% (115/268), 32.5% (87/268) and 20.1% (54/268) at 3, 6, and 12 months postoperatively respectively, and no new case of LARS was found after 3 months postoperatively. The incidence of mild LARS was 25.7% (69/268), 17.2% (46/268) and 8.6% (23/268) at 3, 6, and 12 months postoperatively respectively, and mild LARS incidence at 6 months was significantly lower than that at 3 months (χ(2)=5.857, P=0.016), and was significantly higher than that at 12 months (χ(2)=8.799, P=0.003). The incidence of severe LARS was 17.2% (46/268), 15.3% (41/268) and 11.6% (31/268) at 3, 6, and 12 months postoperatively respectively, without significant difference among 3 time points (all P>0.05). The improvement rate within one year after surgery in patients with mild LARS diagnosed at 3 months was significantly higher than that in patients with severe LARS (88.4% vs. 32.6%, χ(2)=38.340, P<0.001). Univariate analysis showed that female, distance from anastomosis to anal verge < 5 cm and tumor diameter ≥ 5 cm were associated with unsatisfied LARS outcomes (all P<0.05). Logistic regression analysis showed that distance from anastomosis to anal verge <5 cm was an independent risk factor for LARS outcome (OR=3.589, 95% CI: 1.163 to 2.198, P<0.001). Conclusions: The incidence of LARS after laparoscopic sphincter-preserving radical resection decreases with time. The improvement rate within postoperative 1-year of severe LARS is lower than that of mild LARS. Low anastomotic position may lead to impaired improvement of LARS.
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Affiliation(s)
- L G Zuo
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Bengbu Medical College, Anhui Bengbu 233004, China; Key Laboratory of Tissue Transplantation of Anhui Province, Bengbu Medical College Anhui Bengbu 233030, China
| | - S T Ge
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Bengbu Medical College, Anhui Bengbu 233004, China; Key Laboratory of Tissue Transplantation of Anhui Province, Bengbu Medical College Anhui Bengbu 233030, China
| | - X Wang
- Department of Clinical Medicine, Bengbu Medical College, Anhui Bengbu 233030, China
| | - Y K Zhu
- Department of Clinical Medicine, Bengbu Medical College, Anhui Bengbu 233030, China
| | - Z H Liu
- Department of Clinical Medicine, Bengbu Medical College, Anhui Bengbu 233030, China
| | - Y T Yang
- Department of Clinical Medicine, Bengbu Medical College, Anhui Bengbu 233030, China
| | - C Q Jiang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Bengbu Medical College, Anhui Bengbu 233004, China
| | - S Q Li
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Bengbu Medical College, Anhui Bengbu 233004, China
| | - M L Liu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Bengbu Medical College, Anhui Bengbu 233004, China
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Affiliation(s)
- Y Tony Yang
- George Washington University, Washington, DC (Y.T.Y.)
| | - Stanton Glantz
- University of California, San Francisco, San Francisco, California (S.G.)
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Ding XB, Chen J, Yang YT, Peng X, Yan H, Peng YZ. [Retrospective cohort study on the correlation between high value of lactic acid and risk of death in 127 patients with extensive burn during shock stage]. Zhonghua Shao Shang Za Zhi 2019; 35:326-332. [PMID: 31154729 DOI: 10.3760/cma.j.issn.1009-2587.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the relationship between serum lactic acid value and risk of death in patients with extensive burn during shock stage and the related influencing factors. Methods: Clinical data of 127 patients (111 males and 16 females) with extensive burn admitted to Institute of Burn Research of the First Affiliated Hospital of Army Medical University from January 2009 to December 2013 and Department of Plastic Surgery and Burns of the Affiliated Hospital of Southwest Medical University from January 2016 to December 2018, who met the admission criteria, were retrospectively analyzed. The patients aged 21 to 62 years, with total burn area more than 50% total body surface area. All patients were treated with antishock therapy after admission. (1) According to the treatment outcome, the patients were divided into survival group (n=98) and death group (n=29). The gender, age, total burn area, partial-thickness burn area, full-thickness burn area, abbreviated burn severity index (ABSI), admission time after injury, number of patients with inhalation injury, number of patients with acute renal failure, and serum lactic acid values on admission and at post admission hour (PAH) 12, 24, 36, and 48 were recorded. (2) According to the optimal positive cut-off value of serum lactic acid 48 hours after admission, the patients were divided into high lactic acid group and normal lactic acid group. Age, gender, total burn area, indexes at PAH 48 including urea nitrogen, creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total serum bilirubin, alkaline phosphatase (ALP), albumin, white blood cell count, platelet count, lymphocyte count, prothrombin time (PT), hematocrit value, oxygenation index, respiratory index (RI), the alveolar-arterial oxygen partial pressure difference, mean arterial pressure (MAP) at PAH 48, the average urine volume within 48 hours after admission, the total volume of intravenous fluid infusion within 48 hours after admission, the volume of fluid infusion per kilogram of body mass within the first 24 hours after admission, the volume of fluid infusion per one percent of body surface area per kilogram of body mass within the first 24 hours after admission, the volume of urine per kilogram of body mass per hour within the first 24 hours after admission, and the percentage of hospital death were recorded. Data were processed with t test, chi-square test, and Fisher's exact probability test. Cox regression analysis was used to screen independent risk factors affecting the prognosis of patients. Receiver operating characteristic curve (ROC) of serum lactic acid value at PAH 48 of 127 patients was drawn to predict patients' death and determine the optimal positive cut-off value. Multivariate logistic regression analysis was used to screen independent risk factors causing increase of serum lactic acid. Results: (1) There were significantly statistical differences in total burn area, full-thickness burn area, and ABSI of patients between survival group and death group (t=6.257, 4.476, 5.727, P<0.01), while other indexes between the two groups were close. (2) The serum values of lactic acid of patients in death group on admission and at PAH 12, 24, 36, and 48 were (4.00±0.28), (4.50±0.26), (4.02±0.31), (3.48±0.22), (3.40±0.19) mmol/L, respectively, which were significantly higher than those in survival group [(3.30±0.21), (3.20±0.19), (2.33±0.17), (1.85±0.18), (1.50±0.09) mmol/L, t=14.552, 29.603, 38.133, 40.648, 74.973, P<0.05 or P<0.01]. (3) Cox regression analysis showed that the serum value of lactic acid at PAH 48 was the independent risk factor affecting the prognosis of patients, with risk ratio of 1.853 and 95% confidence interval of 1.342-2.559, P<0.01. (4) The total area under ROC of serum value of lactic acid at PAH 48 to predict death of 127 patients was 0.811, with 95% confidence interval of 0.699-0.924, P<0.01. The optimal positive cut-off value of serum value of lactic acid was 1.75 mmol/L, with sensitivity of 75.0% and specificity of 79.5% for predicting death. (5) There were significantly statistical differences in total burn area, ALT, AST, ALP, PT, total serum bilirubin, total volume of intravenous fluid infusion within 48 hours after admission, volume of fluid infusion per kilogram of body mass within the first 24 hours after admission, and percentage of hospital deaths of patients between high lactic acid group (n=34) and normal lactic acid group (n=93), t=3.592, 6.797, 10.367, 2.089, 2.880, 4.517, 2.984, 4.044, χ(2)=58.498, P<0.05 or P<0.01, while other indexes were close between the two groups. (6) Multivariate logistic regression analysis showed that AST and total serum bilirubin were independent risk factors for increase of serum lactic acid, with odds ratios of 1.021 and 1.064 and 95% confidence intervals of 1.001-1.040 and 1.001-1.132, P<0.05. Conclusions: Serum value of lactic acid at PAH 48 can independently predict the death of patients with extensive burns. Liver injury is an important risk factor causing hyperlacticemia during burn shock stage. Widespread increase of vascular permeability and large amount of fluid resuscitation are the core factors leading to aggravation of abdominal organ injury.
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Affiliation(s)
- X B Ding
- Department of Plastic Surgery and Burns, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - J Chen
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing 400038, China
| | - Y T Yang
- Department of Plastic Surgery and Burns, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - X Peng
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing 400038, China
| | - H Yan
- Department of Plastic Surgery and Burns, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Y Z Peng
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing 400038, China
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Yang YT, Benjamin-Neelon SE. Recent progress in children's meals law in restaurants in Baltimore City and California State: Making a healthy beverage option the default choice. Prev Med 2019; 123:160-162. [PMID: 30910520 DOI: 10.1016/j.ypmed.2019.03.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/08/2019] [Accepted: 03/16/2019] [Indexed: 12/26/2022]
Abstract
In July 2018, Baltimore became the largest US city to prohibit restaurants from including sugar-sweetened beverages on kids' menus. In September 2018, California made history by becoming the first US state to require either water or milk as the default beverage with children's meals at all restaurants. Supporters of children's meals laws view them as helping to change the culture of health on beverage preferences and subtly influencing the choices of patrons. Using subtle methods of influencing children's beverage choices at restaurants, or nudges, will not on its own eradicate childhood obesity. However, the law aims to make healthier choices easier options and to influence people's choices in predictable ways without restricting their options. Evidence from a wide range of fields shows that people tend to stick with defaults and that setting beneficial defaults has high rates of acceptability. The laws in Baltimore and California, along with the other jurisdictions that have passed similar legislation, reflect a growing understanding - among restaurant owners, community members and policymakers alike - of the importance of feeding children healthy meals. They also signal that making healthier beverages the default option on children's menus is gaining strength in the US. Cities and states across the country should consider enacting similar laws as part of a greater public health initiative to combat the childhood obesity epidemic.
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Affiliation(s)
- Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University School of Nursing, United States of America; Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, United States of America.
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States of America
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Yang YT, Ortendahl J. How does the Cox maze procedure compare? Cost-effectiveness analysis of alternative treatments of atrial fibrillation. Curr Med Res Opin 2019; 35:957-961. [PMID: 30411990 DOI: 10.1080/03007995.2018.1546681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Data related to the cost effectiveness of surgical interventions and catheter ablation is sparse. This model-based analysis assessed the clinical and economic trade-offs involved in using catheter ablation or the Cox maze procedure in treating patients with atrial fibrillation. METHODS A deterministic model was developed to project 1 year and lifetime health-related outcomes, costs, quality-adjusted life years (QALYs) and cost effectiveness of each treatment in patients with atrial fibrillation. Using previously unpublished Inova Heart and Vascular Institute (IHVI) data for patients undergoing either procedure, 1 year cost and clinical efficacy inputs were estimated. This data was supplemented with published literature and used to estimate costs, utilities, mortality and likelihood of patient improvement. Results were reported as cost-effectiveness ratios in $/QALY. Sensitivity analyses were conducted to assess the robustness of results. RESULTS Patients initially treated with a Cox maze procedure were estimated to have higher costs than those treated with catheter ablation, both after 1 year and over the lifetime. However, patients undergoing the Cox maze procedure also had lower rates of 1 year mortality than catheter ablation patients (3.5% vs. 8.5%) and the highest rate of improvement following treatment, resulting in higher QALYs (12.4 vs. 10.2). Compared to catheter ablation, the lifetime incremental cost-effectiveness ratio for the Cox maze surgical procedure was $12,794 per QALY gained. Without quality adjustment, the ratio was $11,315. Results were most sensitive to the likelihood of improvement following each intervention and the cost of the initial procedure. CONCLUSIONS At a societal willingness to pay of $100,000/QALY, Cox maze procedure was found to both increase overall and quality-adjusted survival and constitute an effective use of resources in patients with atrial fibrillation.
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Affiliation(s)
- Y Tony Yang
- a Center for Health Policy and Media Engagement , George Washington University School of Nursing, and Department of Health Policy and Management, George Washington University Milken Institute School of Public Health , Washington , DC , USA
| | - Jesse Ortendahl
- b Partnership for Health Analytic Research LLC , Beverly Hills , CA , USA
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Chen B, Nagai S, Armitage JO, Witherspoon B, Nabhan C, Godwin AC, Yang YT, Kommalapati A, Tella SH, DeAngelis C, Raisch DW, Sartor O, Hrushesky WJ, Ray PS, Yarnold PR, Love BL, Norris LB, Knopf K, Bobolts L, Riente J, Luminari S, Kane RC, Hoque S, Bennett CL. Regulatory and Clinical Experiences with Biosimilar Filgrastim in the U.S., the European Union, Japan, and Canada. Oncologist 2019; 24:537-548. [PMID: 30842244 DOI: 10.1634/theoncologist.2018-0341] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/14/2018] [Indexed: 11/17/2022] Open
Abstract
Biosimilar filgrastims are primarily indicated for chemotherapy-induced neutropenia prevention. They are less expensive formulations of branded filgrastim, and biosimilar filgrastim was the first biosimilar oncology drug administered in European Union (EU) countries, Japan, and the U.S. Fourteen biosimilar filgrastims have been marketed in EU countries, Japan, the U.S., and Canada since 2008, 2012, 2015, and 2016, respectively. We reviewed experiences and policies for biosimilar filgrastim markets in EU countries and Japan, where uptake has been rapid, and in the U.S. and Canada, where experience is rapidly emerging. U.S. regulations for designating biosimilar interchangeability are under development, and such regulations have not been developed in most other countries. Pharmaceutical substitution is allowed for new filgrastim starts in some EU countries and in Canada, but not Japan and the U.S. In EU countries, biosimilar adoption is facilitated with favorable hospital tender offers. U.S. adoption is reportedly 24%, while the second filgrastim biosimilar is priced 30% lower than branded filgrastim and 20% lower than the first biosimilar filgrastim approved by the U.S. Food and Drug Administration. Utilization is about 60% in EU countries, where biosimilar filgrastim is marketed at a 30%-40% discount. In Japan, biosimilar filgrastim utilization is 45%, primarily because of 35% discounts negotiated by Central Insurance and hospital-only markets. Overall, biosimilar filgrastim adoption barriers are small in many EU countries and Japan and are diminishing in Canada in the U.S. Policies facilitating improved U.S. adoption of biosimilar filgrastim, based on positive experiences in EU countries and Japan, including favorable insurance coverage; larger price discount relative to reference filgrastim pricing; closing of the "rebate trap" with transparent pricing information; formal educational efforts of patients, physicians, caregivers, and providers; and allowance of pharmaceutical substitution of biosimilar versus reference filgrastim, should be considered. IMPLICATIONS FOR PRACTICE: We reviewed experiences and policies for biosimilar filgrastims in Europe, Japan, Canada, and the U.S. Postmarketing harmonization of regulatory policies for biosimilar filgrastims has not occurred. Acceptance of biosimilar filgrastims for branded filgrastim, increasing in the U.S. and in Canada, is commonplace in Japan and Europe. In the U.S., some factors, accepted in Europe or Japan, could improve uptake, including acceptance of biosimilars as safe and effective; larger cost savings, decreasing "rebate traps" where pharmaceutical benefit managers support branded filgrastim, decreased use of patent litigation/challenges, and allowing pharmacists to routinely substitute biosimilar for branded filgrastim.
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Affiliation(s)
- Brian Chen
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- William Jennings Bryan Dorn VA Medical Center, Columbia, South Carolina, USA
| | - Sumimasa Nagai
- Translational Research Center, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Bartlett Witherspoon
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chadi Nabhan
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Ashley C Godwin
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University, Washington, D.C., USA
| | - Anuhya Kommalapati
- School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Sri Harsha Tella
- School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | | | - Dennis W Raisch
- College of Pharmacy, University of New Mexico, Albuquerque, New Mexico, USA
| | - Oliver Sartor
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - William J Hrushesky
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul S Ray
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Paul R Yarnold
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Bryan L Love
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - LeAnn B Norris
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Kevin Knopf
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
- Alameda Health System, Oakland, California, USA
| | - Laura Bobolts
- Oncology Analytics Inc., Plantation, Florida, USA
- Nova Southeastern University College of Pharmacy, Fort Lauderdale, Florida, USA
| | - Joshua Riente
- William Jennings Bryan Dorn VA Medical Center, Columbia, South Carolina, USA
| | - Stefano Luminari
- Hematology, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Robert C Kane
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Shamia Hoque
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Charles L Bennett
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
- William Jennings Bryan Dorn VA Medical Center, Columbia, South Carolina, USA
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Lei Y, Yang YT, Zhan Y. [Evaluation of bioceramic putty repairment in primary molars pulpotomy]. Beijing Da Xue Xue Bao Yi Xue Ban 2019; 51:70-74. [PMID: 30773547 DOI: 10.19723/j.issn.1671-167x.2019.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the clinical characteristics and effectiveness of bioceramic putty repairment (iroot BP Plus) used as pulp capping agents on pulpotomy in primary molars. METHODS Forty primary molars were treated by pulpotomy with bioceramic putty repairmen as the pulp capping agents at the Third Clinical Division of Peking University School and Hospital of Stomatology, from September 2016 to September 2017. The children who were followed up over one year were selected as the subjects of this study. The teeth were checked clinically and radiographically during fixed intervals, and classified into one of five outcomes: N, H, P0, PX, PY. N, absence of clinical symptoms, and absence of apical radiolucency; H, absence of clinical symptoms, and nonpathologic radiographic change present; P0, absence of clinical symptoms, and pathologic change present, no need for treatment; PX, present or absence of clinical symptoms, pathologic change present treatment or extract immediately; PY, premature loss of deciduous tooth. Molars classified into N and H were regarded as successful, classified into P0, PX and PY were regarded as failed. RESULTS Followed up for 12-24 months (the average follow up time was 16months), thirty four children were finally included, aged from 3.1 years to 8.5 yaers (the average age was 4.3 years), forty primary molars were included. Thirty four primary molars were included into N group, with absence of clinical symptoms, absence of apical radiolucency. Two molars were included into H group with physiological root absorption. One molar was included into P0group with absence of clinical symptoms butinternal absorption of the root. Three molars were included into PX group, with gingival fistula and apical radiolucency. None was included into PY group. Thirty six teeth got successful treatment, four molars failed. One year success rate of pulpotomy of primary molars using bioceramic putty repairment was 95%. CONCLUSION Current evidence suggests that bioceramic putty repairment as a pulpotomy medicament showed satisfied clinical and radiographic result in pulpotomy of primary molars. Bioceramic putty repairment is an acceptable material when used in pulpotomy of primary molars.
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Affiliation(s)
- Y Lei
- Third Clinical Division, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100083, China
| | - Y T Yang
- Third Clinical Division, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100083, China
| | - Y Zhan
- Third Clinical Division, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100083, China
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Affiliation(s)
- Y. Tony Yang
- Center for Health Policy and Media Engagement, George Washington University School of Nursing, Washington, DC
- Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC
| | - Jerzy P. Szaflarski
- Department of Neurology, University of Alabama at Birmingham School of Medicine
- University of Alabama at Birmingham Epilepsy Center
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74
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Affiliation(s)
- Ross D Silverman
- Department of Health Policy and Management, Fairbanks School of Public Health, Indiana University, Indianapolis.,McKinney School of Law, Indiana University, Indianapolis
| | - Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University School of Nursing, Washington, DC.,Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC
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75
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Affiliation(s)
- Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University School of Nursing, Washington, DC.,Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC
| | - James Colgrove
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
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76
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Abstract
The basic reproduction number (R0), also called the basic reproduction ratio or rate or the basic reproductive rate, is an epidemiologic metric used to describe the contagiousness or transmissibility of infectious agents. R0 is affected by numerous biological, sociobehavioral, and environmental factors that govern pathogen transmission and, therefore, is usually estimated with various types of complex mathematical models, which make R0 easily misrepresented, misinterpreted, and misapplied. R0 is not a biological constant for a pathogen, a rate over time, or a measure of disease severity, and R0 cannot be modified through vaccination campaigns. R0 is rarely measured directly, and modeled R0 values are dependent on model structures and assumptions. Some R0 values reported in the scientific literature are likely obsolete. R0 must be estimated, reported, and applied with great caution because this basic metric is far from simple.
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77
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Leslie TF, Delamater PL, Yang YT. Author’s reply : “It could have been much worse: The Minnesota measles outbreak of 2017”. Vaccine 2019; 37:685. [DOI: 10.1016/j.vaccine.2018.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
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78
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Chen BK, Yang YT, Gajadhar R. Early evidence from South Carolina's Medicare-Medicaid dual-eligible financial alignment initiative: an observational study to understand who enrolled, and whether the program improved health? BMC Health Serv Res 2018; 18:913. [PMID: 30497468 PMCID: PMC6267870 DOI: 10.1186/s12913-018-3721-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Individuals dually eligible for Medicare and Medicaid coverage are among the sickest patients in the United States. Prior literature has identified a lack of care coordination or even conflicts of interest between the two programs as barriers to more efficient care and better health outcomes among dual-eligibles. The purpose of this study is to assess characteristics of dual eligibles who participated in South Carolina’s 2015 voluntary Medicare-Medicaid financial alignment demonstration project, and to evaluate whether their participation led to better observable health outcomes. Methods We obtained all inpatient and emergency department visits, and all Medicaid outpatient visits of individuals identified as Medicare-Medicaid dual eligibles from 2011 to 2016 from South Carolina’s Revenue and Fiscal Affairs Office. We employed logistic regressions to assess the characteristics of participants and quitters in the Medicare-Medicaid financial alignment demonstration project. To evaluate the impact of participation on health outcomes, we used an event study analysis that examines trends in outcomes over time, with participation in the demonstration project as the triggering event, and a difference-in-differences methodology that compares changes in health outcomes before and after participation in the demonstration project compared with a control group. Results Urban patients, female patients, and patients with heart problems, social and mental disorders, and importantly, patients with multiple comorbidities (as indicated by a higher Charlson comorbidity index) are less likely to join South Carolina’s demonstration project. Once having joined, female patients and patients with a higher Charlson index appear to be more likely to quit. Those who joined did not appear to enjoy better health outcomes in the short time frame. Conclusions Policy makers should explore and address reasons why dual eligibles with complex health problems hesitate to join the alignment project, and continue to monitor whether such a program improves health given that a prolonged period of exposure to the program may be required to achieve better health among the nation’s most vulnerable patients.
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Affiliation(s)
- Brian K Chen
- University of South Carolina, 915 Greene Street Suite 354, Columbia, SC, 29208, USA.
| | - Y Tony Yang
- George Washington University, 1919 Pennsylvania Ave. NW Suite 500, Washington, DC, 20006, USA
| | - Rachelle Gajadhar
- University of South Carolina, 3010 Farrow Rd. Suite 300, Columbia, SC, 29203, USA
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79
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Affiliation(s)
- Y Tony Yang
- George Washington University, Washington, DC (Y.T.Y.)
| | - Stanton Glantz
- University of California, San Francisco, San Francisco, California (S.G.)
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80
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Liu Y, Li F, Yang YT, Xu XD, Chen JS, Chen TL, Chen HJ, Zhu YB, Lin JY, Li Y, Xie XM, Sun XL, Ke YQ. IGFBP2 promotes vasculogenic mimicry formation via regulating CD144 and MMP2 expression in glioma. Oncogene 2018; 38:1815-1831. [PMID: 30368528 DOI: 10.1038/s41388-018-0525-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/21/2018] [Accepted: 09/10/2018] [Indexed: 01/03/2023]
Abstract
Vasculogenic mimicry (VM) refers to the fluid-conducting channels formed by aggressive tumor cells rather than endothelial cells (EC) with elevated expression of genes associated with vascularization. VM has been considered as one of the reasons that glioblastoma becomes resistant to anti-VEGF therapy. However, the molecular basis underlying VM formation remains unclear. Here we report that the insulin-like growth factor-binding protein 2 (IGFBP2) acts as a potent factor to enhance VM formation in glioma. Evidence showed that elevated IGFBP2 expression was positively related with VM formation in patients with glioma. Enforced expression of IGFBP2 increased network formation of glioma cells in vitro by activating CD144 and MMP2 (Matrix Metalloproteinase 2). U251 cells with stable knockdown of IGFBP2 led to decreased VM formation and tumor progression in orthotopic mouse model. Mechanistically, IGFBP2 interacts with integrin α5 and β1 subunits and augments CD144 expression in a FAK/ERK pathway-dependent manner. Luciferase reporter and ChIP assay suggested that IGFBP2 activated the transcription factor SP1, which could bind to CD144 promoter. Thus, IGFBP2 acts as a stimulator of VM formation in glioma cells via enhancing CD144 and MMP2 expression.
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Affiliation(s)
- Y Liu
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangzhou, China.,Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Guangzhou, China
| | - F Li
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangzhou, China.,Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Guangzhou, China
| | - Y T Yang
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangzhou, China.,Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Guangzhou, China
| | - X D Xu
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangzhou, China.,Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Guangzhou, China
| | - J S Chen
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangzhou, China.,Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Guangzhou, China
| | - T L Chen
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangzhou, China.,Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Guangzhou, China
| | - H J Chen
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangzhou, China.,Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Guangzhou, China
| | - Y B Zhu
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangzhou, China.,Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Guangzhou, China
| | - J Y Lin
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangzhou, China.,Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Guangzhou, China
| | - Y Li
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangzhou, China.,Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Guangzhou, China
| | - X M Xie
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangzhou, China.,Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Guangzhou, China
| | - X L Sun
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China. .,The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangzhou, China. .,Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Guangzhou, China.
| | - Y Q Ke
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China. .,The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangzhou, China. .,Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Guangzhou, China.
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81
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Affiliation(s)
- Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University School of Nursing, Washington, DC; Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC.
| | - Eric Weintraub
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Md
| | - Rebecca L Haffajee
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
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82
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Yang YT, Chen B. Precision medicine and sharing medical data in real time: opportunities and barriers. Am J Manag Care 2018; 24:356-358. [PMID: 30130030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sharing massive amounts of medical data is critical to precision medicine. The California Department of Public Health recently started to partner with certain hospitals in the state to better understand cancer trends by collecting and securely sending standardized cancer data directly to the California Cancer Registry. This initiative is the first of its kind in the United States. This has afforded the cancer registry the opportunity to perform real-time surveillance on data reported via participating hospitals, and researchers can use advanced methods to analyze these data. Other states are likely to follow California's lead. However, there are barriers to increased data-sharing efforts. How these barriers can be addressed to facilitate data sharing while protecting individual privacy, reducing the risk of data misuse, and enhancing public trust becomes critical as precision medicine moves forward.
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Affiliation(s)
- Y Tony Yang
- 1919 Pennsylvania Ave NW, Ste 500, Washington, DC 20006.
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83
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Abstract
In July 2017, the Food and Drug Administration (FDA) announced that it wants to reduce the nicotine in cigarettes to make them less addictive. Also, it is delaying for several years a key regulation affecting cigars and e-cigarettes, including flavored vaping products that tend to appeal to younger consumers. Specifically, it postponed the requirement that such products be approved by the agency. Both actions are part of a comprehensive plan to eventually wean smokers off conventional cigarettes and steer them toward less harmful alternative forms of nicotine. With its new approach to the fight against smoking, the FDA has unquestionably made great strides toward more effectively addressing the prevalence of related deaths and diseases in the U.S. However, much important work must be undertaken before this ultimate goal can be accomplished. For instance, further research into long-term effects of e-cigarettes must be conducted before these products can truly be seen as safer alternatives to combustible cigarettes. Additionally, public education is necessary to inform smokers about the range of tobacco products available and the actual harms associated with their use. Finally, the agency might have to work alongside the powerful tobacco industry to minimize potential legal challenges and to convince businesses that a shift to low-nicotine products and e-cigarettes is best for their future success and for the health of the American citizenry.
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Affiliation(s)
- Y Tony Yang
- Department of Health Administration and Policy, George Mason University, Fairfax, VA 22030, USA.
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84
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Yang YT, Chen B, Bennett CL. Offshore Pharmaceutical Trials: Evidence, Economics, and Ethics. Mayo Clin Proc Innov Qual Outcomes 2018; 2:226-228. [PMID: 30225454 PMCID: PMC6132216 DOI: 10.1016/j.mayocpiqo.2018.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/11/2018] [Accepted: 04/13/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Y Tony Yang
- Department of Health Administration and Policy, George Mason University, Fairfax, VA
| | - Brian Chen
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC
| | - Charles L Bennett
- Center for Medication Safety and Efficacy, University of South Carolina, Columbia, SC
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85
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Shaw J, Mader EM, Bennett BE, Vernyi-Kellogg OK, Yang YT, Morley CP. Immunization Mandates, Vaccination Coverage, and Exemption Rates in the United States. Open Forum Infect Dis 2018; 5:ofy130. [PMID: 29977973 PMCID: PMC6016709 DOI: 10.1093/ofid/ofy130] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/31/2018] [Indexed: 11/26/2022] Open
Abstract
Background Vaccination coverage among children entering kindergarten in the United States is high, but interstate variations exist. The relationship between state immunization laws and vaccination coverage has not been fully assessed. We evaluated associations of state laws on both measles, mumps, and rubella (MMR) and diphtheria, tetanus, and pertussis (DTaP) vaccination coverage and exemptions to school immunization requirements. Methods We conducted a retrospective, longitudinal analysis of the effect of state immunization laws on vaccination coverage and exemptions among US kindergarteners from SY 2008 to SY 2014. The primary outcome measures were state-level kindergarten entry vaccination coverage rates for 2-dose MMR and 4-dose DTaP vaccines. Secondary outcome measures included rates of state-level exemptions (ie, medical, religious, philosophical) to school immunization requirements. Results We found that state policies that refer to Advisory Committee on Immunization Practices recommendations were associated with 3.5% and 2.8% increases in MMR and DTaP vaccination rates. Health Department–led parental education was associated with 5.1% and 4.5% increases in vaccination rates. Permission of religious and philosophical exemptions was associated with 2.3% and 1.9% decreases in MMR and DTaP coverage, respectively, and a 1.5% increase in both total exemptions and nonmedical exemptions, respectively. Conclusions We found higher vaccination coverage and lower nonmedical exemption rates for MMR and DTaP vaccines in states adopting Advisory Committee on Immunization Practices guidelines for school entry. Adherence to these best practices was a successful strategy to increase vaccination coverage and reduce vaccination exemptions.
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Affiliation(s)
- Jana Shaw
- Department of Pediatrics, SUNY Upstate Medical University, Golisano Children’s Hospital, Syracuse, New York
- Correspondence: J. Shaw, MD, MPH, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University, Golisano Children’s Hospital, 750 East Adams Street, Syracuse, NY 13210 ()
| | - Emily M Mader
- Department of Family Medicine, SUNY Upstate Medical University, Syracuse, New York
| | - Brittany E Bennett
- Department of Family Medicine, SUNY Upstate Medical University, Syracuse, New York
| | | | - Y Tony Yang
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
| | - Christopher P Morley
- Department of Family Medicine, SUNY Upstate Medical University, Syracuse, New York
- Department of Public Health & Preventive Medicine, SUNY Upstate Medical University, Syracuse, New York
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86
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Yang YT, Silverman RD. Mandatory influenza vaccination and religious accommodation for healthcare workers: Lessons from recent legal challenges. Vaccine 2018; 36:3998-4000. [PMID: 29789239 DOI: 10.1016/j.vaccine.2018.05.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Y Tony Yang
- Department of Health Administration and Policy, George Mason University, 4400 University Drive, Fairfax, VA 22030, United States.
| | - Ross D Silverman
- Department of Health Policy and Management, Fairbanks School of Public Health, and McKinney School of Law, Indiana University, 1050 Wishard Blvd., Indianapolis, IN 46202, United States.
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87
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Delamater PL, Leslie TF, Yang YT. Examining the spatiotemporal evolution of vaccine refusal: nonmedical exemptions from vaccination in California, 2000-2013. BMC Public Health 2018; 18:458. [PMID: 29688861 PMCID: PMC5913803 DOI: 10.1186/s12889-018-5368-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 03/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccine hesitancy continues to be an issue throughout the United States, as numerous vaccine hesitant parents are choosing to exempt their children from school-entry vaccination requirements for nonmedical reasons, despite the safety and effectiveness of vaccines. We conduct an analysis of how vaccine refusal, measured by the use of nonmedical exemptions (based on personal or religious beliefs) from vaccination (NMEs), evolved across space and over time in California. METHODS Using school-entry data from the California Department of Public Health, we examined NMEs for students entering kindergarten in California from 2000 to 2013. We conduct global and local spatial autocorrelation analysis to determine whether NME use became more geographically clustered over the study period and whether the location of local clusters of high use were temporally stable. We conducted a grouping analysis that identified the general temporal trends in NME use over the time period. RESULTS The use of NMEs increased from 0.73% of all kindergarteners in 2000 to 3.09% in 2013 and became more geographically clustered over the study period. Local geographic clusters of high use were relatively isolated early in the study period, but expanded in size over time. The grouping analysis showed that regions with high NME use early in the study period were generally few (15% of all US Census tracts) and relatively isolated. Regions that had low initial NME use and moderate to large increases over the study period were located in close proximity to the initial high use regions. The grouping analysis also showed that roughly half of all tracts had 0% or very low NME use throughout the study period. CONCLUSIONS We found an observable spatial structure to vaccine refusal and NME use over time, which appeared to be a self-reinforcing process, as well as a spatially diffusive process. Importantly, we found evidence that use of NMEs in the initially isolated regions appeared to stimulate vaccine refusal in geographically proximal regions. Thus, our results suggest that efforts aimed at decreasing future NME use may be most effective if they target regions where NME use is already high, as well as the nearby regions.
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Affiliation(s)
- Paul L Delamater
- Department of Geography, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Timothy F Leslie
- Department of Geography and Geoinformation Science, George Mason University, Fairfax, VA, USA
| | - Y Tony Yang
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
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88
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Affiliation(s)
- Y Tony Yang
- From the Department of Health Administration and Policy, George Mason University, Fairfax, VA (Y.T.Y.); and the Columbia Law School and the Mailman School of Public Health, Columbia University, New York, NY (K.U.)
| | - Kristen Underhill
- From the Department of Health Administration and Policy, George Mason University, Fairfax, VA (Y.T.Y.); and the Columbia Law School and the Mailman School of Public Health, Columbia University, New York, NY (K.U.)
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89
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Leslie TF, Delamater PL, Yang YT. It could have been much worse: The Minnesota measles outbreak of 2017. Vaccine 2018; 36:1808-1810. [PMID: 29496348 PMCID: PMC6626669 DOI: 10.1016/j.vaccine.2018.02.086] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/19/2018] [Accepted: 02/20/2018] [Indexed: 12/18/2022]
Abstract
In 2017, Minnesota battled its largest measles outbreak in nearly 30 years, with 79 cases, most of them Somali-American children. In this study, we gathered vaccination and enrollment data for incoming kindergarteners in Minnesota over fall 2012-2016 from the Minnesota Department of Health. We also gathered the number of measles cases by county in 2017. We found that MMR coverage has substantial variation across districts and district types. The minimum MMR coverage is 58.3% and the maximum is 100%. Private schools, which represent approximately six percent of Minnesota's kindergarten enrollment, have a substantially lower coverage rate, with an overall coverage of 83.00%. The 2017 outbreak was relatively isolated. However, the MMR coverage data suggests that other communities could have been at risk given their geographic proximity to the outbreak and modest coverage rates.
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Affiliation(s)
- Timothy F Leslie
- Department of Geography and Geoinformation Science, George Mason University, Fairfax, VA, USA.
| | - Paul L Delamater
- Department of Geography, University of North Carolina, Chapel Hill, NC, USA
| | - Y Tony Yang
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
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90
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Abstract
Micro-structural characteristics and electrical properties of an n-type GaN epilayer on Al2O3 irradiated by 290-MeV 238U32+ ions to various fluences were investigated using atomic force microscopy (AFM), scanning electron microscopy (SEM), high-resolution X-ray diffraction (HRXRD), and Raman scattering spectroscopy. AFM images show that the nano-hillocks generated, and the diameter and density of the nano-hillocks, increase obviously with increasing ion fluence, accompanied by an increase in surface roughness. SEM images display that the Al, O, and C elements appear on the GaN surface, along with a spiral-like, layered volcanic-cone structure formed at the highest-fluence irradiation. HRXRD reveals that the dislocation density increases, as the lattices gradually expand, and that Ga2O3 was produced with increasing ion fluence. Raman scattering spectra show that no N and Ga vacancies were produced, the free-carrier concentration decreases, while its mobility first increases and then exhibits a significant reduction with increasing ion fluence.
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Affiliation(s)
- L Q Zhang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - C H Zhang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, China.
| | - J J Li
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Y C Meng
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Y T Yang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, China
| | - Y Song
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, China
| | - Z N Ding
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, China
| | - T X Yan
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
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91
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92
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Vedam S, Stoll K, MacDorman M, Declercq E, Cramer R, Cheyney M, Fisher T, Butt E, Yang YT, Powell Kennedy H. Mapping integration of midwives across the United States: Impact on access, equity, and outcomes. PLoS One 2018; 13:e0192523. [PMID: 29466389 PMCID: PMC5821332 DOI: 10.1371/journal.pone.0192523] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 01/16/2018] [Indexed: 12/02/2022] Open
Abstract
METHODS Our multidisciplinary team examined published regulatory data to inform a 50-state database describing the environment for midwifery practice and interprofessional collaboration. Items (110) detailed differences across jurisdictions in scope of practice, autonomy, governance, and prescriptive authority; as well as restrictions that can affect patient safety, quality, and access to maternity providers across birth settings. A nationwide survey of state regulatory experts (n = 92) verified the 'on the ground' relevance, importance, and realities of local interpretation of these state laws. Using a modified Delphi process, we selected 50/110 key items to include in a weighted, composite Midwifery Integration Scoring (MISS) system. Higher scores indicate greater integration of midwives across all settings. We ranked states by MISS scores; and, using reliable indicators in the CDC-Vital Statistics Database, we calculated correlation coefficients between MISS scores and maternal-newborn outcomes by state, as well as state density of midwives and place of birth. We conducted hierarchical linear regression analysis to control for confounding effects of race. RESULTS MISS scores ranged from lowest at 17 (North Carolina) to highest at 61 (Washington), out of 100 points. Higher MISS scores were associated with significantly higher rates of spontaneous vaginal delivery, vaginal birth after cesarean, and breastfeeding, and significantly lower rates of cesarean, preterm birth, low birth weight infants, and neonatal death. MISS scores also correlated with density of midwives and access to care across birth settings. Significant differences in newborn outcomes accounted for by MISS scores persisted after controlling for proportion of African American births in each state. CONCLUSION The MISS scoring system assesses the level of integration of midwives and evaluates regional access to high quality maternity care. In the United States, higher MISS Scores were associated with significantly higher rates of physiologic birth, less obstetric interventions, and fewer adverse neonatal outcomes.
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Affiliation(s)
- Saraswathi Vedam
- Birth Place Lab, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- University of Sydney, School of Medicine, Sydney, Australia
| | - Kathrin Stoll
- Birth Place Lab, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marian MacDorman
- Maryland Population Research Center, University of Maryland, College Park, Maryland, United States of America
| | - Eugene Declercq
- School of Public Health, Boston University, Boston, Massachusetts, United States of America
| | - Renee Cramer
- Law, Politics and Society, Drake University, Des Moines, Iowa, United States of America
| | - Melissa Cheyney
- Department of Anthropology, Oregon State University College of Liberal Arts, Corvallis, Oregon, United States of America
| | - Timothy Fisher
- Department of Obstetrics and Gynecology, Geisel School of Medicine, Dartmouth University, Lebanon, New Hampshire, United States of America
| | - Emma Butt
- Birth Place Lab, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Y. Tony Yang
- Health Administration and Policy, George Mason University, Fairfax, Virginia, United States of America
| | - Holly Powell Kennedy
- Department of Midwifery, Yale School of Nursing, Orange, Connecticut, United States of America
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93
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Yang YT, Shaw J. Sudden infant death syndrome, attention-deficit/hyperactivity disorder and vaccines: Longitudinal population analyses. Vaccine 2018; 36:595-598. [DOI: 10.1016/j.vaccine.2017.12.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 12/09/2017] [Accepted: 12/14/2017] [Indexed: 11/15/2022]
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94
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Yang YT. European Court of Justice ruling on vaccine liability and its implications for the United States. Vaccine 2017; 35:6583-6584. [DOI: 10.1016/j.vaccine.2017.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/06/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
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95
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Affiliation(s)
- Y. Tony Yang
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
| | - Brian Chen
- Department of Health Services Policy and Management, University of South Carolina, Columbia
| | - Charles L. Bennett
- Center for Medication Safety and Efficacy, University of South Carolina, Columbia
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96
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Affiliation(s)
- Brian Chen
- Arnold School of Public Health, University of South Carolina, Columbia
| | - Y Tony Yang
- College of Health and Human Services, George Mason University, Fairfax, Virginia
| | - Charles L Bennett
- South Carolina College of Pharmacy, University of South Carolina, Columbia
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97
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Abstract
This study evaluates the statewide change in medical exemptions in the first year under California Senate bill 277 and if medical exemptions increased in regions with high personal belief exemption use prior to its enactment.
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Affiliation(s)
- Paul L. Delamater
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill
| | - Timothy F. Leslie
- Department of Geography and Geoinformation Science, George Mason University, Fairfax, Virginia
| | - Y. Tony Yang
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
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98
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Affiliation(s)
- Y Tony Yang
- Department of Health Administration and Policy, George Mason University, MS: 1J3, 4400 University Drive, Fairfax, VA, USA
| | - Dorit Rubinstein Reiss
- The University of California Hastings College of the Law, 200 McAllister St, San Francisco, CA, USA
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99
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Noxon V, Knopf KB, Norris LB, Chen B, Yang YT, Qureshi ZP, Hrushesky W, Lebby AA, Schooley B, Hikmet N, Dickson M, Thamer M, Cotter D, Yarnold PR, Bennett CL. Tale of Two Erythropoiesis-Stimulating Agents: Utilization, Dosing, Litigation, and Costs of Darbepoetin and Epoetin Among South Carolina Medicaid-Covered Patients With Cancer and Chemotherapy-Induced Anemia. J Oncol Pract 2017; 13:e562-e573. [PMID: 28504901 DOI: 10.1200/jop.2016.019364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The US Food and Drug Administration (FDA) has approved epoetin and darbepoetin for chemotherapy-induced anemia (CIA). Approved epoetin and darbepoetin dosing schedules were three times per week and weekly, respectively, although off-label, less frequent scheduling was common. In 2004, 2007, and 2008, a US Food and Drug Administration Advisory Committees warned of risks associated with erythropoiesis-stimulating agents. During this period, lawsuits alleging illegal darbepoetin marketing practices have concluded, resulting in $1.1 billion in fines and settlements and one criminal conviction. No prior study, to our knowledge, has reported on the use of darbepoetin versus epoetin for CIA. METHODS We evaluated the dosing, utilization, and costs of erythropoiesis-stimulating agents among 3,761 South Carolina Medicaid patients with CIA. RESULTS Epoetin and darbepoetin utilization rates were 22% and 28% in 2003, 10% and 33% in 2007, and 3% and 7% in 2010, respectively. Mean per-patient per-administration epoetin and darbepoetin doses were 40,983 IU and 191 µg, respectively, in 2003 and 47,753 IU and 369 µg, respectively, in 2010. Mean monthly patient costs for epoetin and darbepoetin were $1,030 and $981, respectively, in 2003 and $932 and $1,352, respectively, in 2010. Epoetin use decreased steadily between 2002 and 2010; darbepoetin use increased steadily between 2003 and 2007 and then decreased steadily thereafter. Per-patient dosing of darbepoetin, but not epoetin, increased steadily between 2003 and 2010, and monthly per-patient epoetin costs decreased 3% while the per-patients costs of darbepoetin increased 30% between 2003 and 2010. CONCLUSION To our knowledge, our findings are the first data reporting on epoetin versus darbepoetin use for CIA and support recently concluded lawsuits involving allegations of illegal marketing practices of the manufacturer of darbepoetin.
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Affiliation(s)
- Virginia Noxon
- University of South Carolina; William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; George Mason University, Fairfax, VA; and Medical Technology and Practice Patterns Institute, Washington, DC
| | - Kevin B Knopf
- University of South Carolina; William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; George Mason University, Fairfax, VA; and Medical Technology and Practice Patterns Institute, Washington, DC
| | - LeAnn B Norris
- University of South Carolina; William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; George Mason University, Fairfax, VA; and Medical Technology and Practice Patterns Institute, Washington, DC
| | - Brian Chen
- University of South Carolina; William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; George Mason University, Fairfax, VA; and Medical Technology and Practice Patterns Institute, Washington, DC
| | - Y Tony Yang
- University of South Carolina; William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; George Mason University, Fairfax, VA; and Medical Technology and Practice Patterns Institute, Washington, DC
| | - Zaina P Qureshi
- University of South Carolina; William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; George Mason University, Fairfax, VA; and Medical Technology and Practice Patterns Institute, Washington, DC
| | - William Hrushesky
- University of South Carolina; William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; George Mason University, Fairfax, VA; and Medical Technology and Practice Patterns Institute, Washington, DC
| | - Akida A Lebby
- University of South Carolina; William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; George Mason University, Fairfax, VA; and Medical Technology and Practice Patterns Institute, Washington, DC
| | - Benjamin Schooley
- University of South Carolina; William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; George Mason University, Fairfax, VA; and Medical Technology and Practice Patterns Institute, Washington, DC
| | - Neset Hikmet
- University of South Carolina; William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; George Mason University, Fairfax, VA; and Medical Technology and Practice Patterns Institute, Washington, DC
| | - Michael Dickson
- University of South Carolina; William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; George Mason University, Fairfax, VA; and Medical Technology and Practice Patterns Institute, Washington, DC
| | - Mae Thamer
- University of South Carolina; William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; George Mason University, Fairfax, VA; and Medical Technology and Practice Patterns Institute, Washington, DC
| | - Dennis Cotter
- University of South Carolina; William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; George Mason University, Fairfax, VA; and Medical Technology and Practice Patterns Institute, Washington, DC
| | - Paul R Yarnold
- University of South Carolina; William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; George Mason University, Fairfax, VA; and Medical Technology and Practice Patterns Institute, Washington, DC
| | - Charles L Bennett
- University of South Carolina; William Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; George Mason University, Fairfax, VA; and Medical Technology and Practice Patterns Institute, Washington, DC
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100
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Affiliation(s)
- Y. Tony Yang
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
| | - Brian Chen
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, USA
| | - Tanya Wanchek
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
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