The American journal of managed care
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Due to the highly contagious nature of the Omicron variant of SARS-CoV-2 and its subvariants, a high rate of transmission was observed throughout Chengdu, China, within 2 weeks of the relaxation of COVID-19 measures on December 3, 2022, particularly in hospitals. Hospitals experienced different degrees of medical overcrowding during the first 2 weeks, with a high patient volume in the emergency departments and a significant lack of beds in the medical wards, particularly in the respiratory intensive care unit (ICU) and ICU. ⋯ It has been emulated by sister hospitals and was well received by the local populace and municipal government. The hospital made the following significant alterations and modifications to this emergency medical care: (1) immediate establishment of the General ICU (GICU), a temporary unit set up in emergency situations that had most of the functions of but was not as complete as the ICU and had a lower ratio of doctors to nurses; (2) dynamic adjustment of anesthesiologists and respiratory physicians jointly stationed in the GICU; (3) choice of nurses with extensive experience in internal medicine and allocation to the GICU according to a 2:3 ICU bed to nurse ratio; (4) emergency purchase or deployment of pneumonia-related treatment equipment; (5) implementation of the GICU resident rotation system; (6) "twinning" of internal medicine and other departments to add beds; and (7) implementation of uniform hospital bed allocation for inpatients.
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Primary care research represents only 1% of all federally funded projects. However, innovation in primary care is central to advancing health care delivery. ⋯ In this commentary, we report on lessons learned over 2 years (2020-2022) from conducting primary care research through a novel alliance of an ACO consisting of independent practices, a health plan, and several academic researchers, with the support of a private foundation. This collaboration is also notable because it was specifically assembled to address racial and ethnic inequities in the midst of the COVID-19 pandemic.
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The purpose of our study was to assess the relationship between intervention dosage and hospital utilization outcomes among patients with complex health and social needs enrolled in a care management program. We highlight the importance of measuring patient engagement and intervention dosage in program evaluation. ⋯ Our study elucidates a gap in how care management programs for patients with complex health and social needs are evaluated. Although the study shows an association between intervention dosage and care management outcomes, patients' medical complexity and social circumstances are among the factors that can attenuate the dose-response relationship over time.
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Just 3 disease-modifying treatments-edaravone, riluzole, and sodium phenylbutyrate and taurursodiol (PB/TURSO)-are currently FDA approved to slow progression of amyotrophic lateral sclerosis (ALS). A fourth therapy has been recently approved under accelerated approval and is contingent upon verification of clinical benefit in confirmatory trials(s). Therapy selection is based largely upon patient characteristics, as guidelines have not been updated since the recent approval of PB/TURSO or accelerated approval of tofersen. ⋯ Although evidence is lacking for many pharmacologic therapies, providers use symptomatic treatments to address common symptoms including anxiety, depression, emotional lability (pseudobulbar affect), fasciculations, fatigue, insomnia, muscle cramps or spasms, musculoskeletal pain due to immobility, neuropathic type pain, excessive salivation (sialorrhea), spasticity, constipation, and urinary urgency. Emerging agents offer some hope for patients with ALS. Among the drugs, biologics, and interventions under investigation for ALS are an oral tyrosine kinase inhibitor, RIPK1 inhibition, the use of mesenchymal stem cells, antisense oligonucleotides, sequential administration of all experimental treatments in a new study design, and modification of the patient's own mesenchymal stem cells.
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Amyotrophic lateral sclerosis (ALS) is a fatally progressive degenerative disease, with many patients succumbing to the condition within 3 to 5 years after diagnosis. It is a rare, orphan disease with an estimated US prevalence of 25,000 patients. Patients with ALS and their caregivers are faced with a substantial financial burden as a result of the condition, as ALS has an estimated national financial burden of $1.03 billion. ⋯ Other recently approved therapies include oral edaravone, a combination therapy of sodium phenylbutyrate and taurursodiol (PB/TURSO), and tofersen, which is administered intrathecally and approved under an accelerated approval. Long-term studies have shown PB/TURSO to have a dual benefit on survival and function. The Institute for Clinical and Economic Review (ICER) 2022 Evidence Report for ALS does not value the high price points of edaravone and PB/TURSO as cost-effective based on the current evidence, despite valuing the need for new treatment options for this patient population.