What Is the Price and Claimed Efficacy of Platelet-Rich Plasma Injections for the Treatment of Knee Osteoarthritis in the United States?

2018 ◽  
Vol 32 (09) ◽  
pp. 879-885 ◽  
Author(s):  
Nicolas S. Piuzzi ◽  
Mitchell Ng ◽  
Ariel Kantor ◽  
Kenneth Ng ◽  
Stephanie Kha ◽  
...  
Keyword(s):  
United States ◽  
Standard Deviation ◽  
Knee Osteoarthritis ◽  
Clinical Efficacy ◽  
Health Care Providers ◽  
Platelet Rich Plasma ◽  
The United States ◽  
Care Providers ◽  
Knee Oa ◽  
The Mean

AbstractPlatelet-rich plasma (PRP) injections are often used for the treatment of knee osteoarthritis (OA), despite clinical value and cost-effectiveness not being definitely established. PRP injections are considered as a potential means of reducing pain and improving function in patients with knee OA, in the hope of delaying or avoiding the need for surgical intervention. Centers that offer PRP injections usually charge patients out of pocket and directly market services. Therefore, the purpose of this study was to quantify the current (1) prices and (2) marketed clinical efficacy of autologous PRP injections for knee OA. A prospective cross-sectional study was performed based on 286 centers identified in the United States offering PRP injections for knee OA. A total of 179 (73.4%) centers were successfully contacted via e-mail or phone, using a simulated 52-year-old male patient with knee OA. Scripted questions were asked by the simulated patient to determine the current marketed prices and clinical efficacy, either reported as “good results” or “symptomatic improvement,” claimed by each treating center. The mean price for a single unilateral knee same-day PRP injection was $714 with a standard deviation of $144 (95% confidence interval [CI]: $691–737, n = 153). The mean claim of clinical efficacy was 76% with a standard deviation of 11% (95% CI: 73.5–78.3%, n = 84). Out of the 84 clinics, 10 claimed “90 to 100% efficacy,” 27 claimed “80 to 90%,” 29 claimed “70 to 80%,” 9 claimed “60 to 70%,” 8 claimed “50 to 60%,” and 1 claimed “40 to 60%.” These findings provide a unique perspective on the PRP market for the treatment of knee OA that is valuable to physicians and health care providers in providing better education to patients on the associated costs and purported clinical benefits of PRP injections.

The Stem-Cell Market for the Treatment of Knee Osteoarthritis: A Patient Perspective

2017 ◽  
Vol 31 (06) ◽  
pp. 551-556 ◽  
Author(s):  
Nicolas Piuzzi ◽  
Mitchell Ng ◽  
Morad Chughtai ◽  
Anton Khlopas ◽  
Kenneth Ng ◽  
...  
Keyword(s):  
Stem Cell ◽  
Standard Deviation ◽  
Knee Osteoarthritis ◽  
Clinical Efficacy ◽  
Symptomatic Improvement ◽  
Stem Cell Therapies ◽  
Cell Therapies ◽  
Musculoskeletal Conditions ◽  
Knee Oa ◽  
The Mean

AbstractThe use of stem-cell therapies for the treatment of various musculoskeletal conditions, especially knee osteoarthritis (OA), is rapidly expanding, despite only low-level evidence to support its use. Centers offering these therapies are often marketing and charging patients out-of-pocket costs for such services. Therefore, the purpose of this study was to determine the current marketed: (1) prices and (2) clinical efficacy of stem-cell therapies for knee OA. This was a prospective cross-sectional study which queried 317 U.S. centers that offered direct-to-consumer stem-cell therapies for musculoskeletal conditions. A total of 273 of 317 centers were successfully contacted via phone or e-mail, using a simulated 57-year-old male patient with knee OA. Scripted questions were asked by the simulated patient to determine the marketed prices and clinical efficacy. Centers generally reported the proportion of patients who had “good results” or “symptomatic improvement.” The mean price of a unilateral (same-day) stem-cell knee injection was $5,156 with a standard deviation of $2,446 (95% confidence interval [CI]: $4,550–5,762, n = 65). The mean proportion of claimed clinical efficacy was 82% with a standard deviation of 9.6% (95% CI: 79.0–85.5%, n = 36). Most American stem-cell centers offer therapies for knee OA. The cost of these therapies averages about $5,000 per injection, and centers claim that 80% of the patients had “good results” or “symptomatic improvement,” denoting a gap between what is documented in the published literature and the marketing claims. These findings offer both patients and physicians insight into the current stem-cell market for knee OA. We hope that with this information, providers can more optimally make patients aware of discrepancies between what is being marketed versus the current evidence-based landscape of these therapies for knee OA.

The Special Perils of Being Old and Sick in Prison

2020 ◽  
Vol 32 (5) ◽  
pp. 276-284
Author(s):  
William J. Jefferson
Keyword(s):  
United States ◽  
Health Care ◽  
Medical Care ◽  
Health Care Providers ◽  
The United States ◽  
United States Constitution ◽  
Care Providers ◽  
Medical Practitioners ◽  
Medical Needs ◽  
Access To Medical Care

The United States Supreme Court declared in 1976 that deliberate indifference to the serious medical needs of prisoners constitutes the unnecessary and wanton infliction of pain…proscribed by the Eighth Amendment. It matters not whether the indifference is manifested by prison doctors in their response to the prisoner’s needs or by prison guards intentionally denying or delaying access to medical care or intentionally interfering with treatment once prescribed—adequate prisoner medical care is required by the United States Constitution. My incarceration for four years at the Oakdale Satellite Prison Camp, a chronic health care level camp, gives me the perspective to challenge the generally promoted claim of the Bureau of Federal Prisons that it provides decent medical care by competent and caring medical practitioners to chronically unhealthy elderly prisoners. The same observation, to a slightly lesser extent, could be made with respect to deficiencies in the delivery of health care to prisoners of all ages, as it is all significantly deficient in access, competencies, courtesies and treatments extended by prison health care providers at every level of care, without regard to age. However, the frailer the prisoner, the more dangerous these health care deficiencies are to his health and, therefore, I believe, warrant separate attention. This paper uses first-hand experiences of elderly prisoners to dismantle the tale that prisoner healthcare meets constitutional standards.

A survey of Instagram users with asthma to evaluate the acceptability of a planned clinical trial intervention (Preprint)

2020 ◽  
Author(s):  
Kerry Spitzer ◽  
Brent Heineman ◽  
Marcella Jewell ◽  
Michael Moran ◽  
Peter Lindenauer
Keyword(s):  
United States ◽  
Social Media ◽  
Health Care Providers ◽  
College Education ◽  
The United States ◽  
Survey Study ◽  
Care Providers ◽  
Healthy Behaviors ◽  
Social Media Platforms ◽  
Hispanic White

BACKGROUND Asthma is a chronic lung disease that affects nearly 25 million individuals in the United States. There is a need for more research into the potential for health care providers to leverage existing social media platforms to improve healthy behaviors and support individuals living with chronic health conditions. OBJECTIVE In this study, we assess the willingness of Instagram users with poorly controlled asthma to participate in a pilot study that uses Instagram as a means of providing social and informational support. In addition, we explore the potential for adapting photovoice and digital storytelling to social media. METHODS A survey study of Instagram users living with asthma in the United States, between the ages of 18 to 40. RESULTS Over 3 weeks of recruitment, 457 individuals completed the pre-survey screener; 347 were excluded. Of the 110 people who were eligible and agreed to participate in the study, 82 completed the study survey. Respondents mean age was 21(SD = 5.3). Respondents were 56% female (n=46), 65% (n=53) non-Hispanic white, and 72% (n=59) had at least some college education. The majority of respondents (n = 66, 81%) indicated that they would be willing to participate in the study. CONCLUSIONS Among young-adult Instagram users with asthma there is substantial interest in participating in a study that uses Instagram to connect participants with peers and a health coach in order to share information about self-management of asthma and build social connection.

Patients' Perceptions of Different Information Exchange Mechanisms: An Exploratory Study in the United States

2020 ◽  
Vol 59 (04/05) ◽  
pp. 162-178
Author(s):  
Pouyan Esmaeilzadeh
Keyword(s):  
United States ◽  
Health Care ◽  
Health Information ◽  
Health Care Providers ◽  
Information Exchange ◽  
The United States ◽  
Exchange Mechanism ◽  
Care Providers ◽  
Security Risks ◽  
Direct Exchange

Abstract Background Patients may seek health care services from various providers during treatment. These providers could serve in a network (affiliated) or practice separately (unaffiliated). Thus, using secure and reliable health information exchange (HIE) mechanisms would be critical to transfer sensitive personal health information (PHI) across distances. Studying patients' perceptions and opinions about exchange mechanisms could help health care providers build more complete HIEs' databases and develop robust privacy policies, consent processes, and patient education programs. Objectives Due to the exploratory nature of this study, we aim to shed more light on public perspectives (benefits, concerns, and risks) associated with the four data exchange practices in the health care sector. Methods In this study, we compared public perceptions and expectations regarding four common types of exchange mechanisms used in the United States (i.e., traditional, direct, query-based, patient-mediated exchange mechanisms). Traditional is an exchange through fax, paper mailing, or phone calls, direct is a provider-to-provider exchange, query-based is sharing patient data with a central repository, and patient-mediated is an exchange mechanism in which patients can access data and monitor sharing. Data were collected from 1,624 subjects using an online survey to examine the benefits, risks, and concerns associated with the four exchange mechanisms from patients' perspectives. Results Findings indicate that several concerns and risks such as privacy concerns, security risks, trust issues, and psychological risks are raised. Besides, multiple benefits such as access to complete information, communication improvement, timely and convenient information sharing, cost-saving, and medical error reduction are highlighted by respondents. Through consideration of all risks and benefits associated with the four exchange mechanisms, the direct HIE mechanism was selected by respondents as the most preferred mechanism of information exchange among providers. More than half of the respondents (56.18%) stated that overall they favored direct exchange over the other mechanisms. 42.70% of respondents expected to be more likely to share their PHI with health care providers who implemented and utilized a direct exchange mechanism. 43.26% of respondents believed that they would support health care providers to leverage a direct HIE mechanism for sharing their PHI with other providers. The results exhibit that individuals expect greater benefits and fewer adverse effects from direct HIE among health care providers. Overall, the general public sentiment is more in favor of direct data transfer. Our results highlight that greater public trust in exchange mechanisms is required, and information privacy and security risks must be addressed before the widespread implementation of such mechanisms. Conclusion This exploratory study's findings could be interesting for health care providers and HIE policymakers to analyze how consumers perceive the current exchange mechanisms, what concerns should be addressed, and how the exchange mechanisms could be modified to meet consumers' needs.

Searching and Making Meaning of the COVID-19 Pandemic: Perspectives of African Immigrants in the United States

2021 ◽  
pp. 002216782110224
Author(s):  
Angela U. Ekwonye ◽  
Nina Truong
Keyword(s):  
United States ◽  
Health Care Providers ◽  
Meaning Making ◽  
Democratic Republic Of Congo ◽  
Central Africa ◽  
African Immigrants ◽  
The United States ◽  
Care Providers ◽  
Making Meaning ◽  
The Impact

African immigrants continue to be disproportionately affected by the COVID-19 pandemic. It is unclear how they are searching for and finding meaning in the face of this adversity. This study sought to understand how African immigrants in the United States are searching for and making meaning of the COVID-19 pandemic. We conducted in-depth interviews remotely with 20 immigrants from West Africa (Nigeria and Ghana), East Africa (Somali and Rwanda), and Central Africa (Democratic Republic of Congo). The meaning-making model was used as a framework to understand the processes of coping during a significant, adverse life event. The study found that some participants attempted to reduce the impact of the COVID-19 pandemic on their global meaning by seeking answers as to why the pandemic occurred and creating positive illusions. Some redefined their priorities and reframed the pandemic in a positive light. Participants found meaning in the form of accepting the pandemic as a reality of life, appreciating events previously taken for granted, and making positive changes in their lives. This study’s findings can inform health care providers of the meaning-making processes of African immigrants’ and the need to assist them in their search for meaning.

Limitation of Private Attending Pediatricians' Neonatal Intensive Care Privileges in Level III Institutions Throughout the United States

PEDIATRICS ◽  
1994 ◽  
Vol 94 (2) ◽  
pp. 190-193
Author(s):  
Rita G. Harper ◽  
Concepcion G. Sia ◽  
Regina Spinazzola ◽  
Raul A. Wapnir ◽  
Shahnaz Orner ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care ◽  
Health Care Providers ◽  
Curriculum Design ◽  
Neonatal Intensive Care ◽  
District Of Columbia ◽  
The United States ◽  
Geographic Region ◽  
Neonatal Intensive Care Units ◽  
Care Providers

Objective. To determine the privileges of Private Attending Pediatricians (PAP) in caring for newborns requiring intensive (ITC), intermediate (IMC), or continuing (CC) care in Level III neonatal intensive care units (NICUs) throughout the United States. Design. A two-page mail questionnaire was sent to 429 Level III NICUs to obtain the statement best describing the PAPs' privileges, the number of PAP, and some of the PAPs' functions. Level III NICUs were classified by geographic region as Eastern, Central, or Western United States. Results. Responses were received from 301 NICUs (70%) representing 48 states, the District of Columbia, and >9000 PAP. Twenty-two institutions had no PAP. In the remaining 279 institutions, 96% (267/279) had restricted the PAPs' privileges partially or completely. In 32% (88/279), the PAP were not allowed to render any type of NICU care. In 18% (51/279) of the institutions, the PAP were allowed to render CC only. In 27% (76/279) of the institutions, the PAP were allowed to render IMC and CC only. Limitation of PAPs' privileges were reported in all geographic areas in the U.S., were more pronounced in the Eastern than the Central or Western sections of the country, and were noted in institutions with small (≤10) as well as large (≥60) numbers of PAP. Limitation of PAPs' privileges was determined by the PAP him/herself in many institutions. Proficiency in resuscitation was considered to be a needed skill. Communication with parents of an infant under the care of a neonatologist was encouraged. Conclusions. The PAPs' privileges were limited partially or completely in most Level III NICUs. Knowledge of this restricted role impacts significantly on curriculum design for pediatric house officers, number and type of health care providers required for Level III NICUs and future house officer's career choices.

Pediatric Collections: Vaping: Effects and Solutions

2020 ◽  
Author(s):  
Keyword(s):  
Public Health ◽  
United States ◽  
Health Care ◽  
Health Care Providers ◽  
Electronic Cigarettes ◽  
The United States ◽  
Care Providers ◽  
Tobacco Products ◽  
Pediatric Health ◽  
Pediatric Health Care

Electronic cigarettes are the tobacco products most commonly used by youths in the United States. The use of e-cigarettes, also known as vaping or JUULing, is a public health epidemic. This collection offers reviews and research to assist pediatric health care providers in identifying and treating adolescent use and exposure to e-cigarettes. https://shop.aap.org/pediatric-collections-vaping-effects-and-solutions-paperback/

Fraud and Abuse: United States ex rel Merena v. SmithKline Beecham Corp.; United States ex rel Spear v. SmithKline Beecham Clinical Lab.; United States ex rel Grossenbacher v. SmithKline Beecham Clinical Lab.

2000 ◽  
Vol 28 (2) ◽  
pp. 191-193 ◽  
Author(s):  
Allyson Behm
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Providers ◽  
Laboratory Tests ◽  
The United States ◽  
Care Providers ◽  
Individual Analysis ◽  
Court Of Appeals ◽  
The Third ◽  
The Government

The United States Court of Appeals for the Third Circuit held that when quitam relators file a multi-claim complaint under the Fraudulent Claims Act (FCA), their share of the proceeds must be based on an individual analysis of each claim. More importantly, the court held that relators are not entitled to any portion of the settlement of a specific claim if that claim was subject to dismissal under section 3730(e)(4) Relator Merena filed a quitam suit against his employer, SmithKline Beecham (SKB), claiming, among other things, that SKB defrauded the government by billing for laboratory tests that were not performed, paying illegal kickbacks to health care providers, and participating in an “automated chemistry” scheme. Soon thereafter, additional relators filed suit.

MMPI-2 Scores of Puerto Rican, Mexican, and U.S. Latino College Students: A Research Note

2000 ◽  
Vol 87 (1) ◽  
pp. 266-268 ◽  
Author(s):  
Jose J. Cabiya ◽  
Denise A. Chavira ◽  
Francisco C. Gomez ◽  
Emilia Lucio ◽  
Jeanett Castellanos ◽  
...  
Keyword(s):  
United States ◽  
College Students ◽  
Puerto Rico ◽  
Standard Deviation ◽  
Puerto Rican ◽  
The United States ◽  
Clinical Scale ◽  
The Mean ◽  
The One ◽  
Scale Data

In this brief report, we present MMPI-2 basic validity and clinical scale data of Latino-descent persons from Puerto Rico ( n = 290), Mexico ( n = 1,920), and the United States ( n = 28). All were administered one of three Spanish translations of the MMPI-2. A review of the mean scores of these respective groups indicates similarities across all scales. Differences among these three groups, with the exception of the Mf scale (which is keyed to sex), were well within the one standard deviation band. More importantly, these findings are promising given the fact that three different translations of the MMPI-2 were applied.

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