A Rare, Fatal Skin Disease Has Been Cured in Patients For The First Time : ScienceAlert

Toxic Epidermolysis Necrotic

A rare and potentially fatal skin infection with nightmarish outcomes may soon have a cure.

The infection starts as a seemingly harmless rash, and before a person knows it, more than 30 percent of the skin on their body begins to blister and peel off in sheets, usually starting with the face and chest before progressing to the mouth, eyes, and genitals. 

Without treatment the TEN has a 60% mortality rate

Infections, organ failure, and pneumonia can soon follow. In a third of all cases, the condition proves fatal. For those who survive, recovery can take months and usually requires similar treatment to burn victims.

The debilitating infection is an immune response to medication, called toxic epidermal necrolysis (TEN). While it is thankfully scarce, impacting a million or two people worldwide every year, its onset is highly unpredictable.

TEN is linked with more than 200 medications, and it can impact all age groups and ethnicities, although it tends to be more common in females than males and is 100 times more prevalent in those with the human immunodeficiency virus ( HIV).

The infection starts as a seemingly harmless rash, and before a person knows it, more than 30 percent of the skin on their body begins to blister and peel off in sheets, usually starting with the face and chest before progressing to the mouth, eyes, and genitals.

Infections, organ failure, and pneumonia can soon follow. In a third of all cases, the condition proves fatal. For those who survive, recovery can take months and usually requires similar treatment to burn victims.

The debilitating infection is an immune response to medication, called toxic epidermal necrolysis (TEN). While it is thankfully sporadic, impacting a million or two people worldwide every year, its onset is highly unpredictable.

TEN is linked with more than 200 medications, and it can impact all age groups and ethnicities, although it tends to be more common in females than males and is 100 times more prevalent in those with the human immunodeficiency virus ( HIV).

An international team of researchers, led by biochemists at the Max Planck Institute in Germany, now claim to have cured seven patients with TEN or a slightly less severe version of the infection, known as Stevens-Johnson syndrome (SJS). None of the patients reported side effects.

Key steps of the JAK-STAT pathway. JAK-STAT signaling is made of three major proteins: cell-surface receptors, Janus kinases (JAKs), and signal transducer and activator of transcription proteins (STATs). Once a ligand (red triangle) binds to the receptor, JAKs add phosphates (red circles) to the receptor. Two STAT proteins then bind to the phosphates, and then the STATs are phosphorylated by JAKs to form a dimer. The dimer enters the nucleus, binds to DNA, and causes transcription of target genes. The JAK-STAT system consists of three main components: (1) a receptor (green), which penetrates the cell membrane; (2) Janus kinase (JAK) (yellow), which is bound to the receptor, and; (3) a Signal Transducer and Activator of Transcription (STAT) (blue), which carries the signal into the nucleus and DNA. The red dots are phosphates. After the cytokine binds to the receptor, JAK adds a phosphate to (phosphorylates) the receptor. This attracts the STAT proteins, which are also phosphorylated and bind to each other, forming a pair (dimer). The dimer moves into the nucleus, binds to the DNA, and causes the transcription of genes. Enzymes that add phosphate groups are called protein kinases.[5]

The class of drugs, called JAK inhibitors (JAKi), seem to work by suppressing an overactive immune pathway.  Altogether, they identified six proteins involved in the JAK/STAT pathway that are upregulated in those with the skin infection.

The JAK/STAT pathway is the main driver of skin inflammation, damaged skin cells, and epidermal detachment.

A Rare, Fatal Skin Disease Has Been Cured in Patients For The First Time : ScienceAlert

Inside UnitedHealth’s Playbook for Limiting Mental Health Coverage — ProPublica

Inside UnitedHealth’s Playbook for Limiting Mental Health Coverage — ProPublica

Reporting Highlights

• An Insurer Sanctioned: Three states found United’s algorithmic system to limit mental health coverage illegal; when they fought it, the insurer agreed to restrict it.
• A Patchwork Problem: The company is policing mental health care with arbitrary thresholds and cost-driven targets, highlighting a key flaw in the U.S. regulatory structure.
• United’s Playbook Revealed: The poorest and most vulnerable patients are now most at risk of losing mental health care coverage as United targets them for cost savings.

Why I Left The Network. 

Testimony by Carter J Carter who became a therapist to help young people.

Rosemarie Marmor wanted to support victims of emotional trauma.

Kendra F. Dunlap wanted to serve people of color.

To understand the forces that drive even the most well-intentioned therapists from insurance networks, ProPublica plunged into a problem most often explored in statistics and one-off perspectives. Reporters spoke to hundreds of providers in nearly all 50 states, from rural communities to big cities.

The interviews underscore how the nation’s insurers — quietly, and with minimal pushback from lawmakers and regulators — have assumed an outsize role in mental health care.

It is often the insurers, not the therapists, that determine who can get treatment, what kind they can get, and for how long. More than a dozen therapists said insurers urged them to reduce care when their patients were on the brink of harm, including suicide.

All the while, providers struggled to stay in business as insurers withheld reimbursements that sometimes came months late. Some spent hours a week chasing down the meager payments, listening to music and sending faxes into the abyss.

Several insurers told ProPublica that they are committed to ensuring access to mental health providers, emphasizing that their plans are in compliance with state and federal laws. Insurers also said they have practices in place to make sure reimbursement rates reflect market value and to support and retain providers, for which they continually recruit.

Therapists have tried to stick it out.

They have forgone denied payments.

They have taken second jobs.

They have sought therapy for their own support.

But the hundreds who spoke with ProPublica said they each faced a moment in which they decided they had to leave the network.

Why I left the network

Health Care

What Mental Health Care Protections Exist in Your State?

Insurers have wide latitude on when and how they can deny mental health care. We looked at the laws in all 50 states and found that some are charting new paths to secure mental health care access.

by Annie Waldman and Maya Miller

Co-published with NPR News

Aug. 27, 7 a.m. EDT

 Series: America’s Mental Barrier: How Insurers Interfere With Mental Health Care

 

Accessing mental health care can be a harrowing ordeal. Even if a patient finds a therapist in their network, their insurance company can overrule that therapist and decide the prescribed treatment isn’t medically necessary.

This kind of interference is driving mental health professionals to flee networks, which makes treatment hard to find and puts patients in harm’s way.

ProPublica sought to understand what legal protections patients have against insurers impeding their mental health care.

Most Americans — more than 164 million of them — have insurance plans through employers. These are generally regulated by federal law.

Although the law requires insurers to offer the same access to mental health care as to physical care, it doesn’t require them to rely on evidence-based guidelines or those endorsed by professional societies in determining medical necessity. Instead, when deciding what to pay for, the government allows insurers to set their own standards.

“If insurers are allowed to home bake their own medical necessity standards, you can pretty much bet that they’re going to be infected by financial conflicts of interest,” said California psychotherapist and attorney Meiram Bendat, who specializes in protecting access to mental health treatment.

Federal lawmakers who want to boost patient protections could look to their counterparts in states who are pioneering stronger laws.

Although these state laws govern only plans under state jurisdiction, such as individual or small-group policies purchased through state marketplaces, experts told ProPublica they could, when enforced, serve as a model for broader legislation.

“States are laboratories for innovation,” said Lauren Finke, senior director of policy at The Kennedy Forum, a nonprofit that has advocated for state legislation that improves access to mental health care. “States can take it forward and use it for proof of concept, and then that can absolutely be reflected at the federal level.”

ProPublica reporters delved into the laws in all 50 states to determine how some are trying to chart new paths to secure mental health care access.

Many of the new protections are only just starting to be enforced, but ProPublica found that a few states have begun punishing companies for violations and forcing them into compliance.

Because of the Interference

Your Psychotropic Guidelines

Guidelines Infographic

Infographic by Matthew Lally MD

Board-Certified Psychiatrist. Board-certified Addiction Medicine

I don't know about you, but for me, it is extremely difficult to know and implement all the recommended psychiatric medication monitoring. A big part of the problem is that we don't have a great resource for this.

I built an animated, touchscreen website to tell you what needs to be monitored for each psych med and when to check it. It is evidence-based with links directly to FDA documents. There is no pharma input, no download is needed, and it's free for anyone to use.

Even psychiatrists are challenged to use these medications.

All the side effects are verified on the label required by the FDA

Many of us are visual learners. The graphic presentation allows for rapid learning and recognition.

Most patients are reticent to take psychotropic medications when they are already suffering from emotional problems.

You can find the FDA list of side effects from psychotropic medications by visiting the official FDA website. Here are the steps to access this information:

Go to the FDA's website: www.fda.gov

Search for the specific medication: Use the search bar to enter the name of the psychotropic medication you are interested in.

Check the drug's label: Look for the medication's prescribing information or package insert, which includes detailed information on side effects, warnings, and other pertinent data.

Review the Drug Safety Information: You can also explore the "Drug Safety" section for updates and announcements regarding various medications.

For a comprehensive list of psychotropic medications, you might also consider resources like the National Institutes of Health (NIH) or the National Library of Medicine's MedlinePlus

Anti-Cancer Nutrition

The power of Fruits to prevent cancers.

Oranges

Peaches

Vegetables

Living a long and fulfilling life involves a combination of healthy habits, a positive mindset, and strong social connections. Here are some key factors to consider:

### 1. **Balanced Diet**

   - **Eat Whole Foods:** Incorporate plenty of fruits, vegetables, whole grains, and lean proteins into your diet.

   - **Stay Hydrated:** Drink plenty of water and limit sugary drinks.

### 2. **Regular Exercise**

   - **Stay Active:** Aim for at least 150 minutes of moderate aerobic activity each week. Activities can include walking, cycling, or swimming.

   - **Strength Training:** Include muscle-strengthening activities at least twice a week.

### 3. **Mental Well-being**

   - **Manage Stress:** Practice mindfulness, meditation, or yoga to help reduce stress levels.

   - **Stay Curious:** Engage in lifelong learning and hobbies to keep your mind sharp.

### 4. **Social Connections**

   - **Build Relationships:** Maintain strong ties with family and friends. Social engagement is linked to longer life.

   - **Volunteer:** Helping others can enhance your sense of purpose and community.

### 5. **Regular Health Check-ups**

   - **Preventive Care:** Regular check-ups and screenings can help catch potential health issues early.

### 6. **Avoid Harmful Behaviors**

   - **Limit Alcohol and Quit Smoking:** Reducing or eliminating these can significantly improve health outcomes.

### 7. **Positive Outlook**

   - **Practice Gratitude:** Focusing on positive aspects of life can improve mental resilience.

   - **Find Purpose:** Engage in activities that give you a sense of purpose and fulfillment.

By integrating these practices into your daily routine, you can enhance not only the length of your life but also its quality.

Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition - The Lancet

How do they do it?   Lessons the United States should heed.

Bismarck's Health Insurance Act of 1883 established the first social health insurance system in the world. The German statutory health insurance system was built on the defining principles of solidarity and self-governance, and these principles have remained at the core of its continuous development for 135 years.

A gradual expansion of population and benefits coverage has led to what is, in 2017, universal health coverage with a generous benefits package. Self-governance was initially applied mainly to the payers (the sickness funds) but was extended in 1913 to cover relations between sickness funds and doctors, which in turn led to the right for insured individuals to freely choose their healthcare providers. In 1993, the freedom to choose one's sickness fund was formally introduced, and reforms that encouraged competition and strengthened market orientation have gradually gained importance in the past 25 years; these reforms were designed and implemented to protect the principles of solidarity and self-governance. 

Introduction

The German statutory health insurance system is recognized as one of the prototypes of modern health system configurations. Since its introduction in 1883 by the German Chancellor Otto von Bismarck, the guiding principle of the German health system has been solidarity among the insured. Solidarity manifests itself both on the income side and the provision side of statutory health insurance: all insured persons, irrespective of health risk, contribute a percentage of their income, and these contributions entitle the individuals to benefits according to health needs—irrespective of their socioeconomic situation, ability to pay, or geographical location. In this pooled-risk system, people with high income support people with low income, young people support elderly people, healthy people support people who are sick, and people without children support people with children.1,2 The Bismarck model is often compared with the Beveridge health system, which underlies a tax-financed national health service, and with health systems that are based on market principles.3,4 This highly stylized differentiation persists even though health systems worldwide have evolved by incorporating elements of each of the three models to meet new challenges, such as an aging population, new diagnostic and therapeutic technologies, and doubts about quality and cost-effectiveness, and to accommodate the advent of new instruments, such as health-technology assessment and diagnosis-related groups.

The story reveals the history of the German health system dating to its origins in 1883.

It is time for the United States to admit to the arrogance of "an exceptional system" and admit that our health system has a failing grade.

The Medicare 5-star rating system of quality is an empty box allowing hospitals to check the boxes to attain false quality values. 

Furthermore, hospitals are notified when the audit will occur and adjust their 'best practices' for the visit of the inspectors.

Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition - The Lancet

Remote Care Today Turnkey Solutions

In-home Virtual Care has become a major focus for Medicare and with good reason. The results for patients, physicians, hospitals, and home health care agencies have been more than remarkable.

​

They have been astounding.

REMOTE CARE & YOU,

THE PATIENT

Outside of their offices, physicians don't know what is happening with their patients. That's why Remote Care Management is becoming the "go-to" program for seniors across the country. Remote care allows your physician to monitor your health continuously, so your medical care is always tailored to your needs. And it's covered by Medicare. (Copay may apply.)

With 24 remote care management CPT codes, CMS will pay physicians to provide remote patient monitoring, or a physician may contract with a qualified provider, to provide these services on behalf of the physician.

​Regular communication to ensure:            

Mental & Physical Wellness

Vitals Collected & Transmitted Regularly     

Medication Adherence                          

Healthy Habits /Exercise Adherence

Following the Plan of Care  

CCM - Chronic Care Management

RPM - Remote Physiologic/Patient Monitoring

RTM - Remote Therapeutic Monitoring

BHI - Behavioral Health Integration

      Plus: TCM, PCM, PIN, CHI, SDOH, CGT

Pulmonary Rehabilitation (Three Months, In-Home)

Cardiac Rehabilitation (Three Months, In-Home)

CereSkills

The Benefits for Physicians

No upfront expense - No equipment cost

Reduce staffing workload

New staff for your practice at no cost

Happier and more efficient practice

Healthier and happier patients

New net revenue for your practice​  (CMS approved with appropriate CPT codes)

Telemedicine Specific Codes

99421-99423: Online digital evaluation and management services.

99441-99443: Telephone evaluation and management services.

Mental Health Services

90832-90837: Psychotherapy codes that can be used for telehealth.

90791: Psychiatric diagnostic evaluation.

Other Services

99457: Remote physiological monitoring treatment management services.

99458: Additional remote monitoring services.

Remote Care Today Turnkey Solutions

The Fountain of Youth: Radical extension of the human lifespan, science fiction or reality?

Tales of sacred, restorative waters existed well before the birth of Spanish conquistador Juan Ponce de León around 1474. Alexander the Great, for example, was said to have come across a healing “river of paradise” in the fourth century B.C., and similar legends cropped up in such disparate locations as the Canary Islands, Japan, Polynesia, and England. During the Middle Ages, some Europeans even believed in the mythical king Prester John, whose kingdom allegedly contained a fountain of youth and a river of gold. “You could trace that up until today,” said Ryan K. Smith, a history professor at Virginia Commonwealth University. “People are still touting miracle cures and miracle waters.”

Spanish sources asserted that the Taino Indians of the Caribbean also spoke of a magic fountain and rejuvenating river that existed somewhere north of Cuba. These rumors conceivably reached the ears of Ponce de León, who is thought to have accompanied Christopher Columbus on his second voyage to the New World in 1493. After helping to brutally crush a Taino rebellion on Hispaniola in 1504, Ponce de León was granted a provincial governorship and hundreds of acres of land, where he used forced Indian labor to raise crops and livestock. In 1508 he received royal permission to colonize San Juan Bautista (now Puerto Rico). He became the island’s first governor a year later but was soon pushed out in a power struggle with Christopher Columbus’ son Diego.

Eight years later, Ponce de León returned to Florida’s southwestern coast in an attempt to establish a colony, but he was mortally wounded by an Indian arrow. Just before leaving, he sent letters to his new king, Charles V, and to the future Pope Adrian VI. Once again, the explorer made no mention of the Fountain of Youth, focusing instead on his desire to settle the land, spread Christianity, and discover whether Florida was an island or a peninsula. No log of either voyage has survived, and no archaeological footprint has ever been uncovered.

Nonetheless, historians began linking Ponce de León with the Fountain of Youth not long after his death. In 1535 Gonzalo Fernández de Oviedo y Valdés accused Ponce de León of seeking the fountain to cure his sexual impotence. “He was being discredited [as] an idiot and weakling,” Smith explained. “This is machismo culture in Spain at the height of the Counter-Reformation.” The accusation is almost certainly untrue, Smith added, since Ponce de León fathered several children and was under 40 years old at the time of his first expedition.

Hernando de Escalante Fontaneda, who lived with Indians in Florida for many years after surviving a shipwreck, also derided Ponce de León in his 1575 memoir, saying it was a cause for merriment that he sought out the Fountain of Youth. One of the next authors to weigh in was Antonio de Herrera y Tordesillas, the Spanish king’s chief historian of the Indies. In 1601 he penned a detailed and widely read account of Ponce de León’s first voyage. Although Herrera only referred to the Fountain of Youth in passing, writing that it turned “old men to boys,” he helped solidify it in the public’s imagination. “They are really more entertainment than attempts to write a true history,” Francis said of these works.

The Fountain of Youth legend was now alive and well.

In 2024 The Fountain of Youth is promoted in supplements, and the science of genetics, DNA, antioxidants, hormones, and preventive medicine. It has been enhancing with life saving surgeries on the heart and the avoidance of pollution and toxic elements.

The Fountain of Youth, Where is it?

Radical extension of the human lifespan, science fiction or reality?

AI in healthcare: Latest updates on generative AI, ChatGPT, more | Modern Healthcare

Tracking the latest in AI, ChatGPT

Organizations use AI to solve some of their most fundamental challenges, from health systems and payers to vendors. The release of OpenAI’s generative AI-enabled chatbot ChatGPT has opened healthcare organizations to a world of possibilities. Check back for the latest in healthcare AI. 

The companies said that GE HealthCare signed an AI-centered partnership with radiology provider RadNet on Monday. The two companies will work together to develop AI solutions that can address clinical challenges in imaging. Its initial work within this collaboration will focus on women receiving breast care through AI-enabled mammography systems. The Chicago-based digital health company is looking to stake its claim as radiology emerges as a key area poised to benefit from AI. RadNet, which operates nearly 400 imaging centers, saw a 20% jump in its share price on Monday after the deal was announced.

Patients want small talk from AI doctors

Patients don’t mind an artificial intelligence doctor as long as they’re willing to engage in small talk, according to a study from researchers at Penn State. Researchers asked 382 online participants to interact with a medical chatbot over two visits spaced about two weeks apart. They found that the more social information an AI doctor recalls about patients, the higher the patients’ satisfaction, but only if they were offered privacy control. The AI doctor used a pre-compiled script to chat with patients about topics related to diet, fitness, lifestyle, sleep, and mental health.

Where health systems are heading with AI

Health system executives are cautious about the hype of AI. They are trying to understand the risks, opportunities, and processes needed to adopt the technology. Here’s what executives at seven healthcare organizations said about where they stand with AI today.   

Microsoft partners with Medline for AI tool

Technology giant Microsoft announced Wednesday it planned to build an AI tool with medical supply chain company Medline. The companies said the tool, dubbed Mpower, will aim to ease inventory management workflows and give users recommendations they can choose to implement. The tool will be built on Microsoft’s 365 suite of applications. Last Thursday, Microsoft said it was adding new AI tools for healthcare customers in partnership with electronic health record vendor Epic Systems. 

GE Healthcare to lead generative health AI consortium

GE Healthcare said it is taking a leadership role in Synthia, a consortium that will evaluate synthetic data generation methods for their use in the development of AI in healthcare. Synthetic data is artificially generated to replicate real patient data. Synthetic data may potentially be used to overcome challenges such as the scarcity of real datasets, biased or non-generalizable training data, and privacy concerns. GE will be joined by investment Gates Ventures and big pharmaceutical companies Novo Nordisk and Pfizer. The Chicago-based digital health company is looking to stake its claim as radiology emerges as a key area poised to benefit from AI.

Community Health Systems to bring in AI chatbots for call centers

Community Health Systems said Monday it has signed a deal to bring chatbots from artificial intelligence startup Denim Health to work in the health system’s call centers. The Franklin, Tennessee-based hospital chain will use Denim’s AI chatbots in its call center to serve around 1,000 CHS-affiliated primary care providers and handle more than 25,000 inbound calls daily. The health system said it has been working with Denim Health since late 2023 to develop the technology and incorporate conversational AI into its call centers. A CHS spokesperson said staffing would not be affected by this move. 

Abridge launches AI research effort with Epic, CMS

AI vendor Abridge is launching a clinical research collaborative dedicated to studying the impact of ambient AI across five key focus areas: clinician experience, patient experience, healthcare costs, outcomes, and health equity. Dr. Jackie Gerhart, chief medical officer at EHR vendor Epic will be a part of Abridge’s research collaborative along with leaders from Yale New Haven Health System, Stanford School of Medicine, University of California San Francisco, The University of Chicago Pritzker School of Medicine and the Centers for Medicare and Medicaid Services. Ambient AI documentation technology takes a recording of a doctor-patient conversation and turns it into usable clinical notes in the electronic health record. Abridge, which is partnering with Epic for the EHR company’s Workshop program, is one of the leading vendors in the space. 

California governor signs AI bills targeting providers, insurers

California Gov. Gavin Newsom (D) has signed several artificial intelligence-related bills into law, including two specifically focused on healthcare. Read more. 

Duke Health, SAS sign two-year deal for AI development

Durham, North Carolina-based Duke Health has signed a two-year contract with global analytics company SAS. Through the collaboration, Duke Health will use SAS’ Viya data and AI platform and health applications. They will also work together to develop and commercialize AI-powered digital twinning solutions and real-time process monitoring. The two organizations have previously announced their partnership in April 2023. 

 

AI in healthcare: Latest updates on generative AI, ChatGPT, more | Modern Healthcare