Research Roundup: Tuberculosis; Heart Health; And Spinal Cord Injuries
Editorial pages focus on these and other health issues.
New England Journal of Medicine:
Prediction Of Susceptibility To First-Line Tuberculosis Drugs By DNA Sequencing
The World Health Organization recommends drug-susceptibility testing of Mycobacterium tuberculosis complex for all patients with tuberculosis to guide treatment decisions and improve outcomes. Whether DNA sequencing can be used to accurately predict profiles of susceptibility to first-line antituberculosis drugs has not been clear. (9/26)
JAMA Cardiology:
Variation In Survival After Out-Of-Hospital Cardiac Arrest Between Emergency Medical Services Agencies
The primary outcome was survival to hospital discharge. Secondary outcomes were return of spontaneous circulation at emergency department arrival and favorable functional outcome at hospital discharge (defined as a modified Rankin scale score ≤3). Multivariable hierarchical logistic regression models were used to adjust confounders and clustering of patients within EMS agencies, and calculated median odds ratios (MORs) were used to quantify the extent of residual variation in outcomes between EMS agencies. (Okubo et al, 9/26)
New England Journal of Medicine:
Recovery Of Over-Ground Walking After Chronic Motor Complete Spinal Cord Injury
Persons with motor complete spinal cord injury, signifying no voluntary movement or sphincter function below the level of injury but including retention of some sensation, do not recover independent walking. We tested intense locomotor treadmill training with weight support and simultaneous spinal cord epidural stimulation in four patients 2.5 to 3.3 years after traumatic spinal injury and after failure to improve with locomotor training alone. Two patients, one with damage to the mid-cervical region and one with damage to the high-thoracic region, achieved over-ground walking (not on a treadmill) after 278 sessions of epidural stimulation and gait training over a period of 85 weeks and 81 sessions over a period of 15 weeks, respectively, and all four achieved independent standing and trunk stability. One patient had a hip fracture during training. (Angeli et al, 9/27)
JAMA Internal Medicine:
Labeling Changes And Costs For Clinical Trials Performed Under The US Food And Drug Administration Pediatric Exclusivity Extension, 2007 To 2012
In this study of 54 drugs receiving pediatric exclusivity under the Best Pharmaceuticals for Children Act from September 27, 2007, to December 31, 2012, 31 (57%) demonstrated safety and efficacy in children. Pediatric exclusivity provided pharmaceutical manufacturers with a median net return of $176.0 million and a median ratio of net return to cost of investment of 680%. (Sinha et al, 9/24)
The Henry J. Kaiser Family Foundation:
Data Note: Further Reductions In Navigator Funding For Federal Marketplace States
Since taking office, the Trump administration has dramatically reduced funding for federal marketplace Navigators. The Affordable Care Act (ACA) created Navigator programs to provide outreach, education, and enrollment assistance to consumers eligible for marketplace and Medicaid coverage and requires that they be funded by the marketplaces. Since 2015, the Centers for Medicare and Medicaid Services (CMS) has funded Navigator programs in the 34 states that use the federal marketplace through a multi-year agreement that ends on September 1, 2018. In 2017, as the third year of that funding agreement was about to begin, CMS reduced funding for Navigators by 43%, from $63 million awarded in 2016 to $36.1 million for 2017. On a state-by-state basis, funding reductions ranged from 0% to 96% from the amounts grantees had previously been notified to expect for the 2017-2018 program year. (Pollitz, Tolbert and Diaz, 9/24)
