IUK Med Online | IUK Med Online
Tuesday, September 18, 2018
Home Blog

Tau PET Tracer Called Accurate for Alzheimer's Diagnosis (CME/CE)

0


Medpage Today

Tau PET Tracer Called Accurate for Alzheimer’s Diagnosis

But role in patient care still uncertain

MedpageToday

  • register today

    Earn Free CME Credits by reading the latest medical news in your specialty.

    sign up

  • by Contributing Writer, MedPage Today

Action Points

  • 18F flortaucipir PET distinguished between Alzheimer disease and other neurodegenerative disorders with high sensitivity and specificity in a cross-sectional multicenter study of patients diagnosed and followed in memory centers.
  • The PET scanning with the 18F tracer was less convincing in identifying mild cognitive impairment due to Alzheimer disease leading the study authors to suggest the test might be more useful in differential diagnosis than early detection of Alzheimer disease.

Positron emission tomography (PET) quantification of tau protein aggregates in the brain with an 18F-labeled tracer called flortaucipir discriminated Alzheimer’s disease from other neurodegenerative diseases with strong though imperfect accuracy, a large, multicenter study found.

Among more than 700 memory disorder clinic patients with established diagnoses, 18F flortaucipir PET had estimated sensitivity and specificity of about 90% each for Alzheimer’s disease versus other neurodegenerative diseases and outperformed established magnetic resonance imaging (MRI) measures, reported Rik Ossenkoppele, PhD, and Oskar Hansson, MD, PhD of Lund University in Sweden, and colleagues in JAMA.

Areas under the receiver operating characteristic curves (AUCs) for different analyses were all greater than 0.9 for distinguishing Alzheimer brains from those of patients with other forms of neurodegeneration. Accuracy was lower for attributing mild cognitive impairment (MCI) to Alzheimer’s disease versus other conditions, with AUC of about 0.8.

“Tau PET imaging has a high accuracy for detecting the pathophysiology of Alzheimer’s disease at the dementia stage,” Ossenkoppele told MedPage Today.

“If a patient presents with memory impairment and mild to moderate dementia and the tau PET scan is abnormal, it is very probable that Alzheimer’s disease causes the syndrome,” he added. “In contrast, if the tau PET scan appears to be normal, the syndrome is most likely due to another type of dementia.”

A tracer that selectively binds tau aggregates, 18F flortaucipir currently is used solely in investigational settings. “The present study in conjunction with post-mortem studies verifying in vivo tau PET signal may facilitate the approval of tau PET tracers for clinical purposes in the next few years,” Ossenkoppele said.

“We think tau PET imaging will improve the diagnostic work-up at many memory clinics in the near future and might replace some less accurate assessments that are routinely used in current clinical practice.”

The road to routine clinical use may still prove rocky, however. PET imaging for amyloid-β plaque burden remains uncommon, in large part because Medicare and private insurance do not generally cover it. Medicare officials have insisted on seeing proof that the imaging — which costs thousands of dollars — improves patients’ clinical management before they will approve broad reimbursement. Studies that could fill the bill have been published, but it is now 6 years after the FDA approved the first amyloid PET tracer and Medicare coverage remains in abeyance. The absence of disease-modifying treatment for Alzheimer’s disease makes it especially difficult to prove that imaging improves patient outcomes.

Study Details

In the new cross-sectional study, Ossenkoppele and colleagues assessed 719 patients across three dementia centers in South Korea, Sweden, and the United States from June 2014 to November 2017. The sample included:

  • 160 cognitively normal controls (26.3% were amyloid-β positive)
  • 126 patients with mild cognitive impairment (65.9% amyloid-β positive)
  • 179 patients with Alzheimer’s dementia (100% amyloid-β positive)
  • 254 patients with various non-Alzheimer neurodegenerative disorders (23.8% amyloid-β positive)

The index test was the 18F flortaucipir PET standardized uptake value ratio (SUVR) in five predefined regions of interest. The reference standard was the clinical diagnosis determined at the specialized memory centers.

In the primary analysis, the researchers assessed the discriminative accuracy of 18F flortaucipir for Alzheimer’s dementia versus all non-Alzheimer’s neurodegenerative disorders. In secondary analyses, they compared 18F flortaucipir SUVR with three established MRI measures.

In line with the recently proposed framework by the National Institute on Aging and the Alzheimer Association (NIA-AA), the researchers included only Alzheimer’s disease dementia and mild cognitive impairment patients who were amyloid-β positive in the primary analysis, to minimize the number of patients with clinically misdiagnosed Alzheimer’s dementia and maximize the number of patients with mild cognitive impairment at a prodromal Alzheimer’s stage.

In the medial-basal and lateral temporal cortex, 18F flortaucipir uptake showed 89.9% sensitivity and 90.6% specificity (SUVR 1.34) for distinguishing Alzheimer’s disease dementia from all non-Alzheimer neurodegenerative disorders.

The AUCs for all five 18F flortaucipir regions of interest also were higher (AUC range 0.92-0.95) compared with the three volumetric MRI measures (AUC range 0.63-0.75). The extent of 18F flortaucipir uptake was less pronounced in patients with mild cognitive impairment due to Alzheimer’s disease compared with Alzheimer’s dementia patients, suggesting 18F PET with flortaucipir may be more valuable for differential diagnosis rather than early disease detection.

‘Pretty Good Marker’

“These findings fit nicely with the new NIA-AA criteria that look at Alzheimer’s disease as a spectrum,” observed Beau Ances MD, PhD, MSc, of Washington University in St. Louis, who was not involved in the study.

“When you look at tau measurements in other neurodegenerative diseases, and look at very specific regions, they are not elevated in comparison to Alzheimer’s disease,” Ances said in an interview with MedPage Today. “So if you look at the right regions and you look at the pathology that we know about this disease, it’s a pretty good marker at differentiating Alzheimer’s from other diseases.”

This imaging also produced “only very, very rare false positives,” noted David Knopman, MD, of the Mayo Clinic in Rochester, Minnesota, who also was not involved in the study. “Although there are also nominally false negatives, it is known from neuropathological studies that there are individuals who have elevated brain amyloid who have very low Braak stage distribution of neurofibrillary tangle pathology.”

In light of the recent phase III study showing high concordance between tau PET and subsequent autopsy, “it is reasonable to conclude that this ligand faithfully represents one of the pathological hallmarks of Alzheimer’s disease,” Knopman told MedPage Today.

This study has several limitations, the researchers noted. Participants were recruited from academic memory centers and already had established diagnoses at the time of PET scanning, so selection bias may have occurred. The clinical diagnosis served as reference standard because there was autopsy data only for six patients, and results with 18F flortaucipir might not apply to other tau PET tracers.

Currently, there is no consensus about the optimal method to determine tau positivity; in this study, analyses were based on dichotomous classifications of positive or negative. Discriminative accuracy was consistent across methods and regions of interest, the authors said, and thresholds for tau positivity were comparable with an independent study. Further research in clinically more representative populations is needed to understand how tau PET could be useful in patient care, they added.

Research at Lund University was supported by the European Research Council, the Swedish Research Council, the Marianne and Marcus Wallenberg Foundation, the Knut and Alice Wallenberg Foundation, the Strategic Research Area MultiPark at Lund University, the Swedish Brain Foundation, the Swedish Alzheimer Foundation, the Parkinson Foundation of Sweden, the Parkinson Research Foundation, the Skane University Hospital Foundation, and the Swedish federal government. Doses of 18F flutemetamol injection were sponsored by GE Healthcare.

Work at the University of California San Francisco was supported by the National Institute on Aging, the Alzheimer’s Association, Tau Consortium, and the Michael J. Fox Foundation.

Research at Gangnam Severance Hospital was financially supported by the National Research Foundation of Korea funded by the Korean government.

For University of California San Francisco and the Swedish BioFINDER studies, the precursor of 18F flortaucipir was provided by Avid Radiopharmaceuticals/Eli Lilly.

Researchers reported relationships with Avid Radiopharmaceuticals/Eli Lilly, GE Healthcare, Piramal, Eisai, Genentech, Lundbeck, Merck, Putnam, Roche, Abbvie, Amgen, Celgene, Ionis, Janssen, Merck, UCB, Toyama, Biogen, Bristol-Myers Squibb, C2N, Cortice, Forum, Pfizer, Rochen, TauRx, Aeton, Alector, Delos, Asceneuron, Quest Diagnostics, Fujirebio, and Euroimmun.

  • Reviewed by Dori F. Zaleznik, MD Associate Clinical Professor of Medicine (Retired), Harvard Medical School, Boston and Dorothy Caputo, MA, BSN, RN, Nurse Planner
1969-12-31T19:00:00-0500

last updated

Take Posttest Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.

Medpage Today

Tau PET Tracer Called Accurate for Alzheimer's Diagnosis

But role in patient care still uncertain

MedpageToday

  • register today

    Earn Free CME Credits by reading the latest medical news in your specialty.

    sign up

  • by Contributing Writer, MedPage Today

Action Points

  • 18F flortaucipir PET distinguished between Alzheimer disease and other neurodegenerative disorders with high sensitivity and specificity in a cross-sectional multicenter study of patients diagnosed and followed in memory centers.
  • The PET scanning with the 18F tracer was less convincing in identifying mild cognitive impairment due to Alzheimer disease leading the study authors to suggest the test might be more useful in differential diagnosis than early detection of Alzheimer disease.

Positron emission tomography (PET) quantification of tau protein aggregates in the brain with an 18F-labeled tracer called flortaucipir discriminated Alzheimer's disease from other neurodegenerative diseases with strong though imperfect accuracy, a large, multicenter study found.

Among more than 700 memory disorder clinic patients with established diagnoses, 18F flortaucipir PET had estimated sensitivity and specificity of about 90% each for Alzheimer's disease versus other neurodegenerative diseases and outperformed established magnetic resonance imaging (MRI) measures, reported Rik Ossenkoppele, PhD, and Oskar Hansson, MD, PhD of Lund University in Sweden, and colleagues in JAMA.

Areas under the receiver operating characteristic curves (AUCs) for different analyses were all greater than 0.9 for distinguishing Alzheimer brains from those of patients with other forms of neurodegeneration. Accuracy was lower for attributing mild cognitive impairment (MCI) to Alzheimer's disease versus other conditions, with AUC of about 0.8.

"Tau PET imaging has a high accuracy for detecting the pathophysiology of Alzheimer's disease at the dementia stage," Ossenkoppele told MedPage Today.

"If a patient presents with memory impairment and mild to moderate dementia and the tau PET scan is abnormal, it is very probable that Alzheimer's disease causes the syndrome," he added. "In contrast, if the tau PET scan appears to be normal, the syndrome is most likely due to another type of dementia."

A tracer that selectively binds tau aggregates, 18F flortaucipir currently is used solely in investigational settings. "The present study in conjunction with post-mortem studies verifying in vivo tau PET signal may facilitate the approval of tau PET tracers for clinical purposes in the next few years," Ossenkoppele said.

"We think tau PET imaging will improve the diagnostic work-up at many memory clinics in the near future and might replace some less accurate assessments that are routinely used in current clinical practice."

The road to routine clinical use may still prove rocky, however. PET imaging for amyloid-β plaque burden remains uncommon, in large part because Medicare and private insurance do not generally cover it. Medicare officials have insisted on seeing proof that the imaging -- which costs thousands of dollars -- improves patients' clinical management before they will approve broad reimbursement. Studies that could fill the bill have been published, but it is now 6 years after the FDA approved the first amyloid PET tracer and Medicare coverage remains in abeyance. The absence of disease-modifying treatment for Alzheimer's disease makes it especially difficult to prove that imaging improves patient outcomes.

Study Details

In the new cross-sectional study, Ossenkoppele and colleagues assessed 719 patients across three dementia centers in South Korea, Sweden, and the United States from June 2014 to November 2017. The sample included:

  • 160 cognitively normal controls (26.3% were amyloid-β positive)
  • 126 patients with mild cognitive impairment (65.9% amyloid-β positive)
  • 179 patients with Alzheimer's dementia (100% amyloid-β positive)
  • 254 patients with various non-Alzheimer neurodegenerative disorders (23.8% amyloid-β positive)

The index test was the 18F flortaucipir PET standardized uptake value ratio (SUVR) in five predefined regions of interest. The reference standard was the clinical diagnosis determined at the specialized memory centers.

In the primary analysis, the researchers assessed the discriminative accuracy of 18F flortaucipir for Alzheimer's dementia versus all non-Alzheimer's neurodegenerative disorders. In secondary analyses, they compared 18F flortaucipir SUVR with three established MRI measures.

In line with the recently proposed framework by the National Institute on Aging and the Alzheimer Association (NIA-AA), the researchers included only Alzheimer's disease dementia and mild cognitive impairment patients who were amyloid-β positive in the primary analysis, to minimize the number of patients with clinically misdiagnosed Alzheimer's dementia and maximize the number of patients with mild cognitive impairment at a prodromal Alzheimer's stage.

In the medial-basal and lateral temporal cortex, 18F flortaucipir uptake showed 89.9% sensitivity and 90.6% specificity (SUVR 1.34) for distinguishing Alzheimer's disease dementia from all non-Alzheimer neurodegenerative disorders.

The AUCs for all five 18F flortaucipir regions of interest also were higher (AUC range 0.92-0.95) compared with the three volumetric MRI measures (AUC range 0.63-0.75). The extent of 18F flortaucipir uptake was less pronounced in patients with mild cognitive impairment due to Alzheimer's disease compared with Alzheimer's dementia patients, suggesting 18F PET with flortaucipir may be more valuable for differential diagnosis rather than early disease detection.

'Pretty Good Marker'

"These findings fit nicely with the new NIA-AA criteria that look at Alzheimer's disease as a spectrum," observed Beau Ances MD, PhD, MSc, of Washington University in St. Louis, who was not involved in the study.

"When you look at tau measurements in other neurodegenerative diseases, and look at very specific regions, they are not elevated in comparison to Alzheimer's disease," Ances said in an interview with MedPage Today. "So if you look at the right regions and you look at the pathology that we know about this disease, it's a pretty good marker at differentiating Alzheimer's from other diseases."

This imaging also produced "only very, very rare false positives," noted David Knopman, MD, of the Mayo Clinic in Rochester, Minnesota, who also was not involved in the study. "Although there are also nominally false negatives, it is known from neuropathological studies that there are individuals who have elevated brain amyloid who have very low Braak stage distribution of neurofibrillary tangle pathology."

In light of the recent phase III study showing high concordance between tau PET and subsequent autopsy, "it is reasonable to conclude that this ligand faithfully represents one of the pathological hallmarks of Alzheimer's disease," Knopman told MedPage Today.

This study has several limitations, the researchers noted. Participants were recruited from academic memory centers and already had established diagnoses at the time of PET scanning, so selection bias may have occurred. The clinical diagnosis served as reference standard because there was autopsy data only for six patients, and results with 18F flortaucipir might not apply to other tau PET tracers.

Currently, there is no consensus about the optimal method to determine tau positivity; in this study, analyses were based on dichotomous classifications of positive or negative. Discriminative accuracy was consistent across methods and regions of interest, the authors said, and thresholds for tau positivity were comparable with an independent study. Further research in clinically more representative populations is needed to understand how tau PET could be useful in patient care, they added.

Research at Lund University was supported by the European Research Council, the Swedish Research Council, the Marianne and Marcus Wallenberg Foundation, the Knut and Alice Wallenberg Foundation, the Strategic Research Area MultiPark at Lund University, the Swedish Brain Foundation, the Swedish Alzheimer Foundation, the Parkinson Foundation of Sweden, the Parkinson Research Foundation, the Skane University Hospital Foundation, and the Swedish federal government. Doses of 18F flutemetamol injection were sponsored by GE Healthcare.

Work at the University of California San Francisco was supported by the National Institute on Aging, the Alzheimer's Association, Tau Consortium, and the Michael J. Fox Foundation.

Research at Gangnam Severance Hospital was financially supported by the National Research Foundation of Korea funded by the Korean government.

For University of California San Francisco and the Swedish BioFINDER studies, the precursor of 18F flortaucipir was provided by Avid Radiopharmaceuticals/Eli Lilly.

Researchers reported relationships with Avid Radiopharmaceuticals/Eli Lilly, GE Healthcare, Piramal, Eisai, Genentech, Lundbeck, Merck, Putnam, Roche, Abbvie, Amgen, Celgene, Ionis, Janssen, Merck, UCB, Toyama, Biogen, Bristol-Myers Squibb, C2N, Cortice, Forum, Pfizer, Rochen, TauRx, Aeton, Alector, Delos, Asceneuron, Quest Diagnostics, Fujirebio, and Euroimmun.

  • Reviewed by Dori F. Zaleznik, MD Associate Clinical Professor of Medicine (Retired), Harvard Medical School, Boston and Dorothy Caputo, MA, BSN, RN, Nurse Planner
1969-12-31T19:00:00-0500

last updated

Take Posttest Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.



Source link

WHO: Global TB Deaths Down, But More Work Needed

0


Medpage Today

WHO: Global TB Deaths Down, But More Work Needed

Upcoming UN meeting on TB to address gaps in funding, treatment access

MedpageToday

  • by Staff Writer, MedPage Today

Progress on ending tuberculosis (TB) is not happening fast enough, and global leaders must be held accountable for helping to end the TB epidemic, according to the World Health Organization (WHO) and other health leaders.

While deaths from TB continued to decline in 2017, 1.6 million still died from the disease, which still faces challenges with diagnosis and treatment, especially among people living with HIV. WHO officials described TB as a “leading killer of people with HIV.”

The latest data were released in the WHO “Global Tuberculosis Report 2018”, ahead of the first-ever United Nations (UN) General Assembly “high-level meeting” on TB on Sept. 26, 2018. Nearly 50 heads of state and government are expected to attend the New York City meeting.

The report estimated that 10 million people developed TB in 2017, with the number of new cases falling by 2% a year. A statement by WHO estimated that a quarter of the world’s population has TB infection.

At a press conference at the UN in New York City, WHO leaders, Japan, the U.S., and the UN special ambassador on TB discussed the data and urged continued global action, especially from countries with a high TB burden. The Stop TB Initiative hopes to provide “quality care” to 40 million people with the disease from 2018 to 2022.

“We are at the cusp of a historic fight on tuberculosis, but overall we are still off-track,” Tereza Kasaeva, MD, director of WHO Global TB Program said, adding that in 2017, TB claimed over 4,000 lives a day. “We still need to close the gaps and reach all people affected with TB to provide proper care.”

Underdiagnosis — and especially underreporting — was highlighted as a major challenge. Kasaeva said that of the 10 million people with TB in 2017 (including 1 million children), only 6.4 million were detected and officially notified to national authorities. WHO estimated this number was even higher among children, with less than half of those with TB who were reported.

In addition, gaps in treatment, especially for drug-resistant TB, were highlighted. Notably, 558,000 people were estimated to have resistance to first-line TB treatment, rifampicin, and the “vast majority” of these people were estimated to have multidrug-resistant TB.

Kasaeva added that “only one in four people with a resistant form of tuberculosis had access to treatment.” She pointed out the recent update to WHO treatment guidelines for multidrug-resistant TB, stating that the organization is already working with countries to implement these changes. The report found that treatment success for multi-drug resistant TB is only around 55%.

TB and HIV co-infection is another challenge, though the WHO report noted some progress among people living with HIV. Specifically, there was a 44% reduction in deaths among people with HIV (versus a 29% decline among those who were HIV-negative). But only half of the 920,000 cases among people living with HIV were reported and accounted for, the report said.

Officials reiterated their hope that the upcoming meeting will spur action, increase awareness, and increase funding from all countries.

“The feeling in the general assembly is that heads of government need to be aware of what the problem is, and how serious the problem is,” said His Excellency Mr. Koro Bessho, Permanent Representative of Japan to the UN. “TB isn’t something of the past, [but] that’s what the world at large unfortunately feels about TB.”

Officials also addressed the issue of stigma, mainly the lack of activism from the population affected by TB, which is in sharp contrast to people living with HIV.

“There is a feeling that the person [treated for tuberculosis] at the end of 6 months does not suddenly pivot into wanting to be an advocate for diagnosis and treatment, like we saw in the HIV community,” said Ambassador Eric Goosby, UN Special Envoy on TB.

He added that “the medical research mill was not stoked” to develop new targets for TB treatment, unlike in HIV.

Irene Koek, PhD, deputy administrator for global health at the US Agency for International Development (USAID), also said that TB “affects mostly the poorest of the poor, which makes it difficult for activism to come from that population.”

Goosby stressed that accountability will be key at the meeting next week, adding that the global health community must ensure that leaders are held accountable for the actions they promised to take, as well as holding themselves accountable for keeping the pressure on.

“Next week, the world will say ‘No more, no longer, no one is immune to TB,'” he said.

2018-09-18T17:00:00-0400
Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.

Medpage Today

WHO: Global TB Deaths Down, But More Work Needed

Upcoming UN meeting on TB to address gaps in funding, treatment access

MedpageToday

  • by Staff Writer, MedPage Today

Progress on ending tuberculosis (TB) is not happening fast enough, and global leaders must be held accountable for helping to end the TB epidemic, according to the World Health Organization (WHO) and other health leaders.

While deaths from TB continued to decline in 2017, 1.6 million still died from the disease, which still faces challenges with diagnosis and treatment, especially among people living with HIV. WHO officials described TB as a "leading killer of people with HIV."

The latest data were released in the WHO "Global Tuberculosis Report 2018", ahead of the first-ever United Nations (UN) General Assembly "high-level meeting" on TB on Sept. 26, 2018. Nearly 50 heads of state and government are expected to attend the New York City meeting.

The report estimated that 10 million people developed TB in 2017, with the number of new cases falling by 2% a year. A statement by WHO estimated that a quarter of the world's population has TB infection.

At a press conference at the UN in New York City, WHO leaders, Japan, the U.S., and the UN special ambassador on TB discussed the data and urged continued global action, especially from countries with a high TB burden. The Stop TB Initiative hopes to provide "quality care" to 40 million people with the disease from 2018 to 2022.

"We are at the cusp of a historic fight on tuberculosis, but overall we are still off-track," Tereza Kasaeva, MD, director of WHO Global TB Program said, adding that in 2017, TB claimed over 4,000 lives a day. "We still need to close the gaps and reach all people affected with TB to provide proper care."

Underdiagnosis -- and especially underreporting -- was highlighted as a major challenge. Kasaeva said that of the 10 million people with TB in 2017 (including 1 million children), only 6.4 million were detected and officially notified to national authorities. WHO estimated this number was even higher among children, with less than half of those with TB who were reported.

In addition, gaps in treatment, especially for drug-resistant TB, were highlighted. Notably, 558,000 people were estimated to have resistance to first-line TB treatment, rifampicin, and the "vast majority" of these people were estimated to have multidrug-resistant TB.

Kasaeva added that "only one in four people with a resistant form of tuberculosis had access to treatment." She pointed out the recent update to WHO treatment guidelines for multidrug-resistant TB, stating that the organization is already working with countries to implement these changes. The report found that treatment success for multi-drug resistant TB is only around 55%.

TB and HIV co-infection is another challenge, though the WHO report noted some progress among people living with HIV. Specifically, there was a 44% reduction in deaths among people with HIV (versus a 29% decline among those who were HIV-negative). But only half of the 920,000 cases among people living with HIV were reported and accounted for, the report said.

Officials reiterated their hope that the upcoming meeting will spur action, increase awareness, and increase funding from all countries.

"The feeling in the general assembly is that heads of government need to be aware of what the problem is, and how serious the problem is," said His Excellency Mr. Koro Bessho, Permanent Representative of Japan to the UN. "TB isn't something of the past, [but] that's what the world at large unfortunately feels about TB."

Officials also addressed the issue of stigma, mainly the lack of activism from the population affected by TB, which is in sharp contrast to people living with HIV.

"There is a feeling that the person [treated for tuberculosis] at the end of 6 months does not suddenly pivot into wanting to be an advocate for diagnosis and treatment, like we saw in the HIV community," said Ambassador Eric Goosby, UN Special Envoy on TB.

He added that "the medical research mill was not stoked" to develop new targets for TB treatment, unlike in HIV.

Irene Koek, PhD, deputy administrator for global health at the US Agency for International Development (USAID), also said that TB "affects mostly the poorest of the poor, which makes it difficult for activism to come from that population."

Goosby stressed that accountability will be key at the meeting next week, adding that the global health community must ensure that leaders are held accountable for the actions they promised to take, as well as holding themselves accountable for keeping the pressure on.

"Next week, the world will say 'No more, no longer, no one is immune to TB,'" he said.

2018-09-18T17:00:00-0400
Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.



Source link

More Price Transparency Needed in Health Marketplace, Senators Told

0


Medpage Today

More Price Transparency Needed in Health Marketplace, Senators Told

Prices are highly variable and mostly unavailable ahead of time

MedpageToday

  • by News Editor, MedPage Today

WASHINGTON — Making healthcare prices more transparent would go a long way toward helping healthcare consumers become better shoppers, several senators and witnesses said Tuesday at a Senate hearing.

“For years, patients were more or less OK with [not knowing prices] because insurance companies and the government paid most of the bills,” Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Health, Education, Labor, & Pensions Committee, said at a committee hearing on healthcare price transparency. “However, as premiums increased, more Americans were covered by plans with high deductibles … According to the Kaiser Family Foundation, half of all single covered workers in 2017 had a deductible of at least $1,000, which is Kaiser’s threshold for a high deductible — an increase of 34 percentage points from 2012.”

“More Americans showing an interest in shopping around … [but] without better information, healthcare stays in [a] black box, making it hard for Americans to be good consumers, make good decisions, and pay reasonable amounts for necessary healthcare,” he said.

The committee heard from several witnesses who are trying to make prices easier to find. But just knowing the price isn’t enough, said Nancy Giunto, executive director of the Washington Health Alliance, in Seattle. “Cost transparency is very important but it’s not enough. We must be able to look at costs and understand what we get for it; do the services I pay for improve my health and are they clinically appropriate?”

Giunto offered four suggestions for helping patients to be better healthcare consumers:

  • Teach patients that healthcare costs and quality are highly variable
  • Prioritize health literacy and eliminate medical jargon
  • Deliver objective, easy-to-understand information available on demand to consumers at the point of care or when they are seeking care
  • Enlist physicians and other clinicians to promote transparency

Bill Kampine, co-founder of Healthcare Bluebook, a health pricing website based in Nashville, Tenn., told the story of the firm’s other co-founder, Jeff Rice, MD, who asked about the price for an upcoming surgical procedure for his son and was given an in-network minimum estimate of $15,000. He asked whether there was another option and was given another facility to call — the price at that one? $1,500. “Same doctor, same quality, and more convenient for Jeff and his family,” said Kampine. “Every day across the U.S., consumers face this level of variability … Consumers who shop for care before [their procedure] are two to three times more likely” to select cost-effective, high-quality providers.

St. George Surgical Center in St. George, Utah, is one place that has posted its surgical prices clearly on its website. “We have ‘upfront’ pricing on our website for over 220 procedures,” explained Ty Tippets, the center’s administrator. “Since posting our prices online, our patient base has expanded.” The center recently served a patient from Montana who needed a knee anterior cruciate ligament (ACL) reconstruction. The patient looked at the St. George’s website “and called to make sure we didn’t have a typo,” Tippets said. “The best price he found in Montana was $30,000, and that was just for the hospital; ours was $6,335, including the doctor’s fees, facility fees, and anesthesia.” The surgery center has a very low infection rate and very high patient satisfaction, he added.

A disclaimer on the surgery center’s website, however, notes that the upfront prices only apply to those customers who pay all cash ahead of time — not to those who use their health insurance coverage. Only about 10% of the surgery center’s patients take the all-cash option, Tippets said in response to a question from Sen. Elizabeth Warren (D-Mass.). Prices for patients with insurance vary, and the surgery center can only tell the insured patients what its facility charges would be, while the physicians would charge separately, he said.

Sen. Lisa Murkowski (R-Alaska) wondered what Congress could do to get more people to shop around for care. “If I’m not feeling well … does this mean I should start shopping around now when I’m feeling ill? Or do I look at my family history and say, ‘I better do an analysis early on because I’m likely to need in the next 10 years services for cardiology in my community’? How do we engage people early? It seems like so much of what we’re doing is after the fact.”

Leah Binder, president and CEO of The Leapfrog Group, an organization that analyzes healthcare quality, said that the government’s role “should be as narrow as possible in looking at this issue…. Their role is to make sure this data is scientifically sound and available.” After that, private organizations like hers “have incentive to reach out to the public and engage them. We need the data, and that’s what we’re missing.”

“Help us teach consumers that healthcare is shoppable,” said Giunto. “When things get solved locally with people who have skin in the game, it’s an opportunity for improvement.”

Murkowski wondered aloud if part of the issue was generational. Whereas older people might not be used to shopping for care, “I think young people look at this and say, ‘You shop for everything.'”

Binder agreed. “With millenials, as soon as they realize they’re not immortal, that’s when we’ll see a transformation because they will not tolerate the level of transparency we have now,” she said.

Cash incentives might also help, said Kampine: “They can be [something like] $500, $1,000 to encourage patients to make high-quality, cost-effective choices on their care.”

Doctors can also play a big role, he added. Although physicians often know there is a price difference among various facilities, they don’t know exactly how much. “They don’t have the tools to help patients make better choices … There’s a huge opportunity to go to referring physicians and make sure they have the information in their hands.”

1969-12-31T19:00:00-0500

last updated

Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.

Medpage Today

More Price Transparency Needed in Health Marketplace, Senators Told

Prices are highly variable and mostly unavailable ahead of time

MedpageToday

  • by News Editor, MedPage Today

WASHINGTON -- Making healthcare prices more transparent would go a long way toward helping healthcare consumers become better shoppers, several senators and witnesses said Tuesday at a Senate hearing.

"For years, patients were more or less OK with [not knowing prices] because insurance companies and the government paid most of the bills," Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Health, Education, Labor, & Pensions Committee, said at a committee hearing on healthcare price transparency. "However, as premiums increased, more Americans were covered by plans with high deductibles ... According to the Kaiser Family Foundation, half of all single covered workers in 2017 had a deductible of at least $1,000, which is Kaiser's threshold for a high deductible -- an increase of 34 percentage points from 2012."

"More Americans showing an interest in shopping around ... [but] without better information, healthcare stays in [a] black box, making it hard for Americans to be good consumers, make good decisions, and pay reasonable amounts for necessary healthcare," he said.

The committee heard from several witnesses who are trying to make prices easier to find. But just knowing the price isn't enough, said Nancy Giunto, executive director of the Washington Health Alliance, in Seattle. "Cost transparency is very important but it's not enough. We must be able to look at costs and understand what we get for it; do the services I pay for improve my health and are they clinically appropriate?"

Giunto offered four suggestions for helping patients to be better healthcare consumers:

  • Teach patients that healthcare costs and quality are highly variable
  • Prioritize health literacy and eliminate medical jargon
  • Deliver objective, easy-to-understand information available on demand to consumers at the point of care or when they are seeking care
  • Enlist physicians and other clinicians to promote transparency

Bill Kampine, co-founder of Healthcare Bluebook, a health pricing website based in Nashville, Tenn., told the story of the firm's other co-founder, Jeff Rice, MD, who asked about the price for an upcoming surgical procedure for his son and was given an in-network minimum estimate of $15,000. He asked whether there was another option and was given another facility to call -- the price at that one? $1,500. "Same doctor, same quality, and more convenient for Jeff and his family," said Kampine. "Every day across the U.S., consumers face this level of variability ... Consumers who shop for care before [their procedure] are two to three times more likely" to select cost-effective, high-quality providers.

St. George Surgical Center in St. George, Utah, is one place that has posted its surgical prices clearly on its website. "We have 'upfront' pricing on our website for over 220 procedures," explained Ty Tippets, the center's administrator. "Since posting our prices online, our patient base has expanded." The center recently served a patient from Montana who needed a knee anterior cruciate ligament (ACL) reconstruction. The patient looked at the St. George's website "and called to make sure we didn't have a typo," Tippets said. "The best price he found in Montana was $30,000, and that was just for the hospital; ours was $6,335, including the doctor's fees, facility fees, and anesthesia." The surgery center has a very low infection rate and very high patient satisfaction, he added.

A disclaimer on the surgery center's website, however, notes that the upfront prices only apply to those customers who pay all cash ahead of time -- not to those who use their health insurance coverage. Only about 10% of the surgery center's patients take the all-cash option, Tippets said in response to a question from Sen. Elizabeth Warren (D-Mass.). Prices for patients with insurance vary, and the surgery center can only tell the insured patients what its facility charges would be, while the physicians would charge separately, he said.

Sen. Lisa Murkowski (R-Alaska) wondered what Congress could do to get more people to shop around for care. "If I'm not feeling well ... does this mean I should start shopping around now when I'm feeling ill? Or do I look at my family history and say, 'I better do an analysis early on because I'm likely to need in the next 10 years services for cardiology in my community'? How do we engage people early? It seems like so much of what we're doing is after the fact."

Leah Binder, president and CEO of The Leapfrog Group, an organization that analyzes healthcare quality, said that the government's role "should be as narrow as possible in looking at this issue.... Their role is to make sure this data is scientifically sound and available." After that, private organizations like hers "have incentive to reach out to the public and engage them. We need the data, and that's what we're missing."

"Help us teach consumers that healthcare is shoppable," said Giunto. "When things get solved locally with people who have skin in the game, it's an opportunity for improvement."

Murkowski wondered aloud if part of the issue was generational. Whereas older people might not be used to shopping for care, "I think young people look at this and say, 'You shop for everything.'"

Binder agreed. "With millenials, as soon as they realize they're not immortal, that's when we'll see a transformation because they will not tolerate the level of transparency we have now," she said.

Cash incentives might also help, said Kampine: "They can be [something like] $500, $1,000 to encourage patients to make high-quality, cost-effective choices on their care."

Doctors can also play a big role, he added. Although physicians often know there is a price difference among various facilities, they don't know exactly how much. "They don't have the tools to help patients make better choices ... There's a huge opportunity to go to referring physicians and make sure they have the information in their hands."

1969-12-31T19:00:00-0500

last updated

Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.



Source link

Survey Finds Burnout Rampant During Residency (CME/CE)

0


Take Posttest



Source link

Chemical in cigarette smoke may damage important aspect of vision

0



September 18, 2018 / 9:33 PM / Updated 7 minutes ago

Chemical in cigarette smoke may damage important aspect of vision

(Reuters Health) – Exposure to a chemical in tobacco smoke could make it more difficult for people to see in low-contrast conditions, such as low light, fog or glare, a new study suggests.

FILE PHOTO: A man flicks ashes from his cigarette over a dustbin in Shanghai January 10, 2014. REUTERS/Aly Song/File Photo

Researchers found that higher levels of cadmium in the blood were associated with diminished contrast sensitivity, they report in JAMA Ophthalmology.

“This particular aspect of vision is really important because it affects your ability to see the end of a curb or put a key into a lock in low light,” said lead author Adam Paulson of the University of Wisconsin, Madison, School of Medicine. “It’s something that at this point in time there’s no way to correct, unlike visual acuity, which you can easily correct with glasses or contact lenses.”

Smoking can raise cadmium levels, as can consumption of leafy green vegetables and shellfish, Paulson said. It may be possible to eat greens and avoid cadmium if you can find produce that has not been treated with pesticides, he added.

For a closer look at the impact of two heavy metals, cadmium and lead, Paulson and his colleagues analyzed data from a larger study dubbed the Beaver Dam Offspring Study, which was designed to look at the aging process. Volunteers enrolled in that study between 2005 and 2008.

Both lead and cadmium accumulate in the retina, Paulsen said.

The retina is the layer of nerve cells at the back of the eye that senses light and sends signals to the brain.

Volunteers’ contrast sensitivity was examined through an eye test. Instead of making letters smaller and smaller, researchers made successive reductions in the contrast between the letters and the background. Volunteers would start with black letters against a white background. Then, with each iteration, the letters would become more and more washed out.

At the beginning of the study, all 1,983 participants had no impairment. All were retested at five and 10 years after the study started. At the 10-year mark, nearly one quarter of the study volunteers had some impairment of their contrast sensitivity, and that impairment was associated with levels of cadmium, but not lead.

That doesn’t necessarily mean that lead won’t impact contrast sensitivity. “Levels of lead in our study population were actually quite low,” Paulsen said. “It could be that in our study there wasn’t enough exposure to lead. It’s possible that another study might find an association.”

The new study suggests “that certain trace chemicals that we are exposed to in small amounts could be harming our eyes in subtle, incremental ways over time,” said Dr. Mandeep S. Singh of the Wilmer Eye Institute at Johns Hopkins Medicine. “Here, the investigators implicate cadmium, which is present at relatively high levels in cigarette smoke, but there could be other culprits which we don’t know about. But it is another good reason to avoid smoking.”

Many people don’t realize they can have good visual acuity, 20-20, and still not feel like they can see well, Singh said in an email. “Even people who can read all the way down to the smallest letters on the eye chart can have deficits in contrast sensitivity that tells us their vision is not OK.”

Cadmium is a neurotoxin, and it could be damaging the nerve cells of the vision system, Singh said.

Even those with 20-20 vision can experience problems with daily living if their contrast sensitivity is impaired, said Dr. Nicholas J. Volpe, George and Edwina Tarry Professor and chairman of the department of ophthalmology at Northwestern University’s Feinberg School of Medicine in Chicago.

Contrast sensitivity declines as we age, Volpe said. But the new study suggests there might be other factors that can affect it.

Volpe cautioned that the study has found an association, but it can’t prove that cadmium actually causes contrast sensitivity to decline. It’s possible cadmium is a marker for some other factor.

Another issue is that the researchers weren’t able to say that cadmium, independent of smoking, was associated with contrast sensitivity declines, Volpe said. So, until there are more studies, “I don’t know that we’ll be checking cadmium levels,” he said. “More often I’ll be saying, don’t smoke.”

SOURCE: bit.ly/2OChQam JAMA Ophthalmology, online September 13, 2018.




Source link

Women's sexual health after menopause may be best treated by gynecologists

0



September 18, 2018 / 8:43 PM / Updated 3 minutes ago

Women's sexual health after menopause may be best treated by gynecologists

(Reuters Health) – Postmenopausal women who experience problems like vaginal dryness, painful intercourse or urinary incontinence may want to see a gynecologist instead of a primary care provider for help, a recent study suggests.

That’s because gynecologists may be more knowledgeable about what’s known as vulvovaginal atrophy, a common but often overlooked condition that can seriously impact women’s lives after menopause and lead to avoidance of intimacy, loss of libido, and painful sex.

For the study, researchers asked 90 primary care providers and 29 gynecologists multiple choice questions about how to recognize vulvovaginal atrophy and surveyed participants about how often they assessed patients for these issues and what barriers stopped them from doing this.

Overall, gynecologists got correct answers to knowledge questions about vulvovaginal atrophy 77 percent of the time on average, compared to 63 percent for primary care providers, researchers report in Menopause.

This makes sense, given how much more often gynecologists give women pelvic exams that would show changes in the vulva and vagina and any development of atrophy, and because gynecologists are more familiar with hormones that might be prescribed to relieve some symptoms of vulvovaginal atrophy, said lead study author Dr. Kimberly Vesco of the Kaiser Permanente Center for Health Research Northwest in Portland.

“Before we learned that Pap smears could safely be discontinued at age 65 for most women, gynecologists regularly saw the changes of vulvovaginal atrophy,” Vesco said by email. “Also, gynecologists regularly see women with conditions that may require hormone therapy – contraception, endometriosis, menopause, osteoporosis, etc. – and have much more familiarity with hormone therapies compared to primary care doctors.”

Primary care providers were less likely to assess women for symptoms, the survey found.

In addition, primary care providers were less confident in their ability to advise patients on symptoms and recommend treatments.

Lack of time and lack of patient education materials about symptoms and treatment were the reasons doctors cited most often as barriers to diagnosing and treating vulvovaginal atrophy.

Women go through menopause when they stop menstruating, which typically happens between ages 45 and 55. As the ovaries curb production of the hormones estrogen and progesterone in the years leading up to menopause and afterward, women can experience symptoms ranging from vaginal dryness to mood swings, joint pain, memory trouble and insomnia.

“The healthy vagina is lined by cells that are well hydrated and that release fluid into the vagina, and this encourages the growth of healthy bacteria,” said Dr. Susan Davis of Monash University in Melbourne, Australia, who is president of the International Menopause Society.

“When estrogen levels fall at menopause the lining of the vagina changes; the lining cells change and release less fluid,” Davis, who wasn’t involved in the study, said by email. “So the vagina becomes dryer, less elastic, more fragile, less acidic- even alkaline sometimes and this allows unhealthy bacteria to grow.”

As a result, there’s less lubrication and sex can be painful, Davis added. Women might also feel vaginal irritation or itching or experience bacterial infections that may cause unpleasant odor or discharge.

While the study wasn’t designed to assess differences in women’s symptoms or quality of life based on what type of doctor they saw, the results suggest that physicians need more education about medical issues related to menopause, said Dr. Mary Jane Minkin, a clinical professor of obstetrics, gynecology and reproductive sciences at Yale Medical School in New Haven, Connecticut.

If doctors don’t ask patients about symptoms of menopause, women may not bring it up, Minkin, who wasn’t involved in the study, said by email.

“Many women don’t think of VVA as a treatable condition, and many do not link it to menopause,” Minkin added. “Many women also don’t want to think about a condition linked to getting older (we are a youth centric society).”

SOURCE: bit.ly/2NQ9Sxs Menopause, online August 27, 2018.




Source link

Alarm Raised on Safety of Commercial Probiotics

0




Source link

Pelzman's Picks: Chronic Pain and Suicide

0


Medpage Today

Pelzman’s Picks: Chronic Pain and Suicide

Also, how should hospital quality be assessed?

MedpageToday

  • by

Fred N. Pelzman, MD, of Weill Cornell Internal Medicine Associates and weekly blogger for MedPage Today, follows what’s going on in the world of primary care medicine. Pelzman’s Picks is a compilation of links to blogs, articles, tweets, journal studies, opinion pieces, and news briefs related to primary care that caught his eye.

2018-09-18T15:00:00-0400
Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.

Medpage Today

Pelzman's Picks: Chronic Pain and Suicide

Also, how should hospital quality be assessed?

MedpageToday

  • by

Fred N. Pelzman, MD, of Weill Cornell Internal Medicine Associates and weekly blogger for MedPage Today, follows what's going on in the world of primary care medicine. Pelzman's Picks is a compilation of links to blogs, articles, tweets, journal studies, opinion pieces, and news briefs related to primary care that caught his eye.

2018-09-18T15:00:00-0400
Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.



Source link

Machine Tops Humans in Fibrotic Lung Disease Classification

0


Medpage Today

Machine Tops Humans in Fibrotic Lung Disease Classification

Nearly instantaneous results also matched prognostic abilities

MedpageToday

  • by Deputy Managing Editor, MedPage Today

PARIS — Robots scored another win against humans, this time with an artificial intelligence (AI) program outperforming thoracic radiologists for classifying fibrotic lung diseases in a new study reported here.

Examining 150 high-resolution CT images of fibrotic lung disease, a deep learning algorithm showed better accuracy compared with 91 self-identified “expert” radiologists (median 73.3% versus 70.7%, respectively), with the AI system outperforming two-thirds of them, reported Simon L.F. Walsh, MD, of King’s College Hospital Foundation Trust in London.

The results were presented at the European Respiratory Society (ERS) meeting and published simultaneously in the Lancet Respiratory Medicine.

“Just before someone asks, it’s not an attempt to replace radiologists,” Walsh said toward the end of his presentation here. “That’s always the first question.”

“This is a diagnostic tool,” he explained, pointing to the fact that while expert centers have top radiologists, idiopathic pulmonary fibrosis (IPF) patients are also seen in rural settings and in the community, and have to travel to referral centers for access to imaging expertise.

“Anything that improves or speeds up diagnostic accuracy in IPF essentially means less biopsies and that appears to me, at least in my discussion with patients, that that is one of the major concerns,” said Walsh.

As fibrotic lung disease patients who have usual interstitial pneumonia (UIP) generally perform worse, Walsh’s group tested this as well, and found that the algorithm was equivalent at distinguishing UIP cases from non-UIP cases (HR 2.88, 95% CI 1.79-4.61, P<0.0001) compared with the group of expert radiologists’ majority opinion (HR 2.74, 95% CI 1.67-4.48, P<0.0001).

On Fleischner Society high-resolution CT criteria for UIP, median interobserver agreement was moderate between radiologists (κw=0.56) but good between the algorithm and radiologists (κw=0.64).

In a comment that accompanied the study, David Levin, MD, of the Mayo Clinic in Rochester, Minnesota, highlighted that due to the rare presentation and varied forms, radiologic diagnosis of interstitial lung disease can be a challenge, as can the further diagnosis of pulmonary fibrosis even for subspecialist radiologists.

“Although the results show that deep learning methods can classify fibrotic lung disease with essentially equivalent performance to subspecialist radiologists, there are several limitations,” Levin said, noting in part that as deep learning algorithm is improved with ever-increasing amounts of data, only 929 scans made up the training set.

He also pointed to the fact that a gold standard for UIP diagnosis does not currently exist, and that the labeling of the training CT set could be a source of potential bias introduction as it was performed by a single radiologist.

“Despite these limitations, the overall performance of the algorithm was remarkable,” said Levin.

The study from Walsh’s group used 1,157 images of diffuse fibrotic lung disease to train (929 scans), validate (89), and initially test (139) the algorithm. To increase the data input for the algorithm, each image in the training set was divided up into up to 500 four-image sets, which were each separately analyzed.

The final test used 150 high-resolution CT images that had been identified by the expert thoracic radiologists in a previous study — about one-third of the cases were of IPF.

“We demonstrated the generalizability of the algorithm by testing it on a data set which essentially had been labeled by a set of radiologists who were not part of the training process, which is important,” said Walsh.

Interobserver agreement was similar between the radiologists’ majority opinion and the algorithm (κw=0.69), and the majority opinion and each radiologist (κw=0.67), though the algorithm again outperformed over half (62%) of the radiologists.

The CT images were classified using 2011 international guidelines from the American Thoracic Society, ERS, and others for the diagnosis of IPF as well as the Fleischner Society diagnostic criteria for IPF.

Walsh is the founder of Thoracic.AI, a developer of machine learning applications for fibrotic lung disease. He also disclosed relationships with Boehringer Ingelheim, InterMune, Roche, Sanofi-Genzyme, and Bracco.

Co-authors reported relationships with Roche and Boehringer Ingelheim.

Levin reported no conflicts of interest.

2018-09-18T15:30:00-0400
Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.

Medpage Today

Machine Tops Humans in Fibrotic Lung Disease Classification

Nearly instantaneous results also matched prognostic abilities

MedpageToday