Chronic Disruptions to Circadian Rhythms Promote Tumor Growth, Reduce Efficacy of Cancer Therapy—But How? – PR News

"Our findings strongly indicate that environmental or physiological disturbances of circadian rhythms such as shift work, abnormal sleep timing, or irregular psycho-sociological stresses can affect variability in both cancer growth and response to cancer drugs,” said first author Yool Lee, a research associate in the Sehgal Lab. “Given this, it is reasonable to expect that resetting of the body clock by scheduled light-exposure, meal-times, or exercise, alongside a carefully timed chemotherapy regimen, would improve anti-tumor treatment. Taken together, our study identifies the mechanisms behind tumor growth following circadian disturbances, and highlights the importance of judicious application of cancer chronotherapy.”

While it’s reported that chronic disruptions of circadian rhythms, or internal body clocks, can lead to an increased risk of cancer, the underlying mechanisms by which the disturbances promote tumor growth had been largely unknown.

The findings also suggest that “chronotherapy”—the delivery of treatment timed to the host’s circadian rhythm—can improve disease outcomes of drugs that inhibit tumor growth in mice. Researchers found that one drug used for the treatment of breast cancer, Palbociclib, was more effective when taken in the morning than at night. Delivery of drug at a time of greater efficacy is expected to reduce the dose required, and thereby reduce side effects. However, chronic circadian disruption—which researchers achieved by simulating frequent jet-lag—reduced the efficacy of the therapy in human cultured cells, a finding that was validated in mice.

To identify the cellular and molecular mechanisms driving this change, researchers used the hormone dexamethasone to chronically advance daily rhythms in human cultured cells, mimicking frequent jet-lag. They found the treatment altered expression of multiple genes, and increased expression of a cell-cycle control protein called cyclin D1. Cyclin D1, in turn, activated cyclin D-dependent kinase 4/6 (CDK4/6), proteins that are a part of a cell-cycle regulatory pathway. In this case, CDK4/6 halted the cell from growing larger and caused it to synthesize new DNA, which led to accelerated cell division rates.

"Our findings strongly indicate that environmental or physiological disturbances of circadian rhythms such as shift work, abnormal sleep timing, or irregular psycho-sociological stresses can affect variability in both cancer growth and response to cancer drugs,” said first author Yool Lee, a research associate in the Sehgal Lab. “Given this, it is reasonable to expect that resetting of the body clock by scheduled light-exposure, meal-times, or exercise, alongside a carefully timed chemotherapy regimen, would improve anti-tumor treatment. Taken together, our study identifies the mechanisms behind tumor growth following circadian disturbances, and highlights the importance of judicious application of cancer chronotherapy.”

Chronic Disruptions to Circadian Rhythms Promote Tumor Growth, Reduce Efficacy of Cancer Therapy—But How? – PR News: 

How going digital can transform the patient experience

In today’s environment of rapid disruption, every healthcare company must go through a digital transformation to survive and develop a strategy that will align its evolution to rapidly changing patient expectations. But what lies beyond the buzzwords? Join us for the real talk. The way we work and how we engage our customers has to fundamentally change but how can you make actual progress and drive transformation?

Webinar Registration

In this session we will explore:

Real lessons and learnings from people who are actively walking the path of digital transformation
How to change the way you think so you can change what you do
The role of people, process, and technology in digital transformation
How to think about partners, performance, and key activations
How to deliver connected patient experiences that deliver impact, build trust and promote loyalty
No matter where you are on your transformation journey this session will present valuable information on how you can create an ecosystem of connected patient experiences.

Register now.

This goal applies to all providers, pharma, and the health ecosystem. Connecting the dots is more important than ever.

What if you can deliver the next generation of healthcare?

How Technology Is Helping (and Hurting) Health Care

Technology is everywhere in health care — and for many reasons, that's a good thing. It's fast, it's efficient, and it can reduce errors. And yet, technology is not a cure-all. It can make people complacent, introduce new errors, and get in the way of meaningful face-to-face interactions.

Technology is here to stay and we need to learn how to get the most value from the digital world that health care increasingly relies upon. That was the focus of our conversation on the June 1 WIHI, The Digital Transformation: How Technology Is Helping (and Hurting) Health Care. 

How Technology Is Helping (and Hurting) Health Care

The Digital Health Care Transformation


Insurers' message on 'Medicare for All': We're part of the answer | Healthcare Dive: Healthcare

National Nurse's Day

These are the ones who are on the front lines. Nurses make doctor's days better !  Nurses care more ! Take a nurse to lunch, bring in some snacks (healthy ones) to the nurse station.  Thank a nurse today, bring a flower.  Where would we all be without nurses ?

On behalf of the editorial staff here at Health Train Express

HHS To Deliver Value-Based Transformation in Primary Care | CMS

HHS To Deliver Value-Based Transformation in Primary Care

The CMS Primary Cares Initiative to Empower Patients and Providers to Drive Better Value and Results

Medicare and CMS have been emphasizing their role in revising our health system to advantage primary care, and to increase reimbursement to primary care physicians.  The health care reimbursement system heavily favors specialists whose fees are heavily weighted for procedures. In the past family physicians, some internists, and pediatricians have been at the bottom of the pay scale.

In the past several years this has improved. The statistics just released in early 2019 reflect the improvement .


“For years, policymakers have talked about building an American healthcare system that focuses on primary care, pays for value, and places the patient at the center. These new models represent the biggest step ever taken toward that vision,” said HHS Secretary Alex Azar. “Building on the experience of previous models and ideas of past administrations, these models will test out paying for health and outcomes rather than procedures on a much larger scale than ever before. These models can serve as an inflection point for the value-based transformation of our healthcare system, and American patients and providers will be the first ones to benefit.”

Empirical evidence shows that strengthening primary care is associated with higher quality, better outcomes, and lower costs within and across major population subgroups. Despite this evidence, primary care spending accounts for a small portion of the total cost of care and is even lower for patients with complex, chronic conditions. Primary care clinicians serve on the front lines of the healthcare delivery system, furnishing services across a wide range of specialties, from family medicine to behavioral health to gerontology. For many patients, the primary care clinician is the first point of contact with the healthcare delivery system. CMS’s experience with innovative models, programs and demonstrations to date have shown that when incentives for primary care clinicians are aligned to reward the provision of high-value care, the quality and cost-effectiveness of patient care improves.

Base upon maximizing the value of health care, HHS has proposed the following new categories of payment using several new criteria.

Primary Care First and Direct Contracting.

The five payment model options are:

Primary Care First (PCF)
Primary Care First – High Need Populations
Direct Contracting – Global
Direct Contracting – Professional
Direct Contracting – Geographic

Readers should refer to these details for each category


















HHS NEWS: HHS To Deliver Value-Based Transformation in Primary Care | CMS: HHS To Deliver Value-Based Transformation in Primary CareThe CMS Primary Cares Initiative to Empower Patients and Providers to Drive Better Value and Results

Overdose Attempts Skyrocket Among Teens, Young Adults

Suicide attempts by drug overdoses and other "self-poisonings" more than doubled among U.S. youth in the last decade, a new study reveals.

And attempts by girls and young women more than tripled during that time period, according to the analysis of National Poison Data System information.

Most of the self-poisonings "are drug overdoses, but they use a lot of over-the-counter meds [such as] acetaminophen, antihistamines, along with their prescription meds," explained study co-author Henry Spiller. He directs the Central Ohio Poison Center at Nationwide Children's Hospital in Columbus.

The findings showed that there were more than 1.6 million intentional self-poisoning cases among 10- to 24-year-olds nationwide between 2000 and 2018 -- more than 71% (1.1 million) involving females.

Suicide is the second-leading cause of death among Americans in that age group. While more males die by suicide, females attempt suicide more than males. Self-poisoning is the most common method in suicide attempts and third-most common method of suicide in teens, the researchers said.

"In youth overall, from 2010 to 2018, there was a 141% increase in attempts by self-poisoning reported to U.S. poison centers, which is concerning," Spiller said.

In a hospital news release, he added that "the severity of outcomes in adolescents has also increased, especially in 10- to 15-year-olds."

The study was published online May 1 in The Journal of Pediatrics.

Study co-author John Ackerman is the suicide prevention coordinator at the Center for Suicide Prevention and Research at Nationwide Children's Hospital.

"Suicide in children under 12 years of age is still rare, but suicidal thoughts and attempts in this younger age group do occur, as these data show," he said in the news release.

Ackerman called on parents and caregivers not to panic, but to talk to their children and undertake suicide prevention strategies, such as storing medications safely and limiting access to things that could be deadly.

"There are many resources and crisis supports available around the clock to aid in the prevention of suicide, and suicide prevention needs to start early," he said.

Parents should regularly ask children how they are doing and if they ever have thoughts about suicide, Ackerman advised. That's especially important if parents detect warning signs, such as social media posts about feeling hopeless or wanting to die; a young person giving away prized possessions or suddenly becoming calm or cheerful after a long period of depression.

"There is no need to wait until there is a major crisis to talk about a plan to manage emotional distress. Actually, a good time to talk directly about suicide or mental health is when things are going well," Ackerman suggested.

If you or your child need immediate help due to suicidal thoughts, go to your local emergency department immediately or call the Nationwide Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). You can reach the Crisis Text Line by texting "START" to 741-741.

If you suspect an overdose, call the national Poison Help hotline at 1-800-222-1222.






























ReachMD

Why Can't I Get My Prescription Filled

Electronic health records offer a function called CPOE *Computerized Order Entry" which provides an electronic means for ordering medications and tests within the hospital. EHRs also allow prescriptions to be sent to a pharmacy.  However many drugs require prior authorization (PA).

That has been a manual process. The provider is required to send a form detailing what medications have already been tried and failed due to ineffectiveness, side effects or a complication. The authorization is then sent manually from the health plan to the pharmacy manually.  The process is inefficient and is repeated many times a day, occupying time which can be better used caring for patients.

A critical process is still performed manually ten years after the implementation of the EHR. This arduous and repetitive process often causes the prescriber to write a prescription that may be less expensive even though it will be less effective to avoid the bureaucracy of requesting a PA.

Prior Authorizations (PAs) have become increasingly burdensome for providers — they contribute to 92 percent of care delays and an estimated 77 million are submitted manually each year. In fact, the process has become so burdensome that many physicians get fed up with the process end up writing for less-effective prescriptions because they know the preferred drug will require prior authorization.

Regardless of the decision, this is a problem that has yet to be resolved despite the development of new technology and software — such as electronic prior authorizations (ePAs) — that have tried to streamline the process. While these solutions have helped, they are temporary at best, as their lack of widespread adoption still leaves physicians and their staff responsible for the time and financial commitment associated with PAs.


What if there was a way to remove the responsibility from providers’ shoulders entirely? I believe there is, and it’s as simple as making prior authorizations a pharmacy responsibility.

Why should PAs be a pharmacy responsibility?

The answer is simple: they’re the pharmacy’s to lose.

There is no financial incentive for a provider to file a PA. Instead, they do so out of moral obligation to their patients (and because that’s the way it’s always been done, since providers are the only ones with access to the patient information needed to complete the PA). Pharmacies, on the other hand, have all the financial incentive to become principal participants in the process. After all, the faster a prescription is approved by an insurance company, the sooner (and more frequently) those prescriptions can get filled.

The problem is, most pharmacies don’t identify PAs as a financial incentive. The process can be time-consuming and tedious — as providers know well — so most pharmacies haven’t even considered it as an option. Of those who have, few choose to take on such a task, opting instead to let the system run its course and simply take whatever prescriptions come in organically. This leads not only to delays in patient care but also to alarmingly lengthy gaps between getting prescriptions filled. But the fact remains approvals (or denials) of PAs ultimately affect a pharmacy’s ability to bring in prescriptions and revenue, so pharmacies should be more proactive in participating with physicians in the care process.

Why hasn’t this been considered before?

The biggest roadblock to efficiently dealing with PAs is the pharmacy’s lack of access to relevant and necessary patient information. By default, providers have been assigned the responsibility for filing PAs simply because they have access to all the information required to submit them. Pharmacies, on the other hand, only have part of the information needed. Software companies like CoverMyMeds help to fill in some of the gaps, but PAs still ultimately find their way back to providers for missing patient information and submission. And since there’s no financial incentive for providers to complete them, PAs get put on the backburner, piling up until finally time is set aside to complete them.

What the industry ultimately needs is a solution that removes the burden from providers entirely, while still giving pharmacies secure and confidential access to the information they need from the get-go.

Pharmacies can do this by proactively coordinating with providers to obtain the information necessary to correctly and completely fill and submit a PA, perhaps through (read-only) access to the provider’s electronic medical records (EMR) system. Doing so creates a touchless system for providers that decreases downtime in the prescription-filling process and ultimately gets patients the best prescriptions, faster.

The Tufts Center for the Study of Drug Development most recently estimated the cost of bringing a new drug to pharmacy shelves at $2.7 billion. But that cost only increases when PAs enter the picture.

Physicians often hesitate to prescribe new drugs (even if they’re the best option) because of PA requirements, making it more difficult for a new medication to enter the market and for patients to get the prescriptions they need. By shifting the responsibility of PAs from providers to pharmacies, physicians can feel more confident in prescribing the medication they want the first time, making it easier for new medications to make it from shelves to homes, and ultimately driving healthcare costs down.

In the end, prior authorizations can never be a single party’s responsibility — a successful solution depends on the partnership of pharmacies and providers who work together for the benefit of patients. In doing so, pharmacies and providers can build stronger working relationships and, together, provide patients with a better quality of care.






The answer to your prior authorization problem is simpler than you think: Pharmacies and providers can build stronger working relationships and, together, provide patients with better quality of care.

Health insurance deductibles soar, leaving Americans with unaffordable bills - Los Angeles Times

Soaring health insurance deductibles have strained family budgets, saddled many with debt and driven millions to skip care. It's the result of a revolution that has transformed U.S. health insurance, shifting a growing share of costs to workers and their families.

A medical crisis has largely been ignored by the media and Congress for the past year or more during the turmoil of investigations and congressional polarization during non-productive investigations of self-interest groups in Congress

Soaring deductibles and medical bills are pushing millions of American families to the breaking point, fueling an affordability crisis that is pulling in middle-class households with health insurance as well as the poor and uninsured.

In the last 12 years, annual deductibles in job-based health plans have nearly quadrupled and now average more than $1,300.

Yet Americans’ savings are not keeping pace, data show. And more than four in 10 workers enrolled in a high-deductible plan report they don’t have enough savings to cover the deductible.

One in six Americans who get insurance through their jobs say they’ve had to make “difficult sacrifices” to pay for healthcare in the last year, including cutting back on food, moving in with friends or family, or taking extra jobs. And one in five says healthcare costs have eaten up all or most of their savings.  Those are among the key findings of a Times examination of job-based health insurance — the most common form of coverage for working-age Americans — which has undergone a rapid transformation, requiring patients to pay thousands of dollars out of their own pockets.

The conclusions are based in part on a nationwide poll conducted in partnership with the nonprofit Kaiser Family Foundation, or KFF. Two Washington-based think tanks — the Health Care Cost Institute and the Employee Benefit Research Institute — provided supplemental analysis.

How the LA Times/Kaiser Family Foundation poll was conducted »

The Times also interviewed doctors, business leaders, researchers and dozens of Americans with high-deductible coverage and reviewed scores of studies and surveys of health insurance in the U.S.

At a time when healthcare is poised to be a central issue in the 2020 presidential election, these sources provide a comprehensive look at changes that have profoundly reshaped insurance.

The explosion in cost-sharing is endangering patients’ health as millions, including those with serious illnesses, skip care, independent research, and the Times/KFF poll show.

The shift in costs has also driven growing numbers of Americans with health coverage to charities and crowd-funding sites like GoFundMe in order to defray costs.

Health insurance deductibles soar, leaving Americans with unaffordable bills - Los Angeles Times: