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Kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/kff Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.President Trump and Democratic nominee Joe Biden hold widely divergent views on health issues, with the president’s record and response to the coronavirus pandemic likely to play a central role in November’s elections.A new KFF side-by-side comparison examines President Trump’s record and former Vice President Biden’s positions across a wide how does viagra work range of key health issues, including the response to the pandemic, the Affordable Care Act marketplace, Medicaid, Medicare, drug prices, reproductive health, HIV, mental health and opioids, immigration and health coverage, and health costs.The resource provides a concise overview of the candidates’ positions on a range of health policy issues. While the Biden campaign has put forward many specific proposals, the Trump campaign has offered few new proposals for addressing health care in a second term and is instead running on his record in office.It is part of how does viagra work KFF’s ongoing efforts to provide useful information related to the health policy issues relevant for the 2020 elections, including policy analysis, polling, and journalism. Find more on our Election 2020 resource page..

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Credit https://www.cityreal.lv/viagra-no-prescription/ viagra boner. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most viagra boner common form of permanent alopecia in this population.

The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb. Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher viagra boner risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries. During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over.

The prevalence of those with fibroids viagra boner was compared in patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition. In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids.

The findings translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared to age, sex and race matched viagra boner controls. Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between the two conditions remains viagra boner unclear,” she says.

However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be viagra boner screened not only for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition.

The other authors viagra boner on this paper were Ginette A. Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit.

The New England Journal of Medicine Share Fast Facts This study clears up viagra boner how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors. - Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class viagra boner of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows.

The finding, published in the Dec. 21 New England Journal of Medicine, could be used viagra boner to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells.

As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an is viagra covered by insurance infection. These medicines viagra boner have had remarkable success in treating some types of cancers that historically have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma.

The mutational burden viagra boner of certain tumor types has previously been proposed as an explanation for why certain cancers respond better than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow. Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has viagra boner on outcomes to immune checkpoint inhibitors across many different cancer types was unclear.

To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of thousands of tumor samples from viagra boner patients with different tumor types. Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation.

The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half viagra boner of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer. €œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive.

It’s one viagra boner of those things that doesn’t sound right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, viagra boner Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors.

However, he explains, this cancer type is often caused by a virus, which seems to encourage a strong immune response despite the cancer’s lower mutational burden. In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors on cancer types for which viagra boner these drugs haven’t yet been tried.

Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy viagra boner drugs. €œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says.

Yarchoan receives funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

Credit viagra uk how does viagra work. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most how does viagra work common form of permanent alopecia in this population. The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb. Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and how does viagra work clogged arteries.

During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over. The prevalence of those with fibroids was compared in patients with and how does viagra work without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition. In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids. The findings translate to a fivefold increased risk of how does viagra work uterine fibroids in women with CCCA, compared to age, sex and race matched controls.

Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between the two how does viagra work conditions remains unclear,” she says. However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with how does viagra work this type of scarring alopecia should be screened not only for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition.

The other authors how does viagra work on this paper were Ginette A. Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit. The New England Journal of how does viagra work Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors.

- Click to Tweet The how does viagra work “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows. The finding, published in the Dec. 21 New England Journal of Medicine, could be used to guide future clinical trials for these drugs how does viagra work. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells. As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an infection.

These medicines have had remarkable success in treating some types of cancers that historically have how does viagra work had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma. The mutational burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond better than others to immune checkpoint inhibitors says study leader Mark how does viagra work Yarchoan, M.D., chief medical oncology fellow. Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an how does viagra work effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types was unclear.

To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these how does viagra work findings with data on the mutational burden of thousands of tumor samples from patients with different tumor types. Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation. The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how how does viagra work well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer.

€œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive. It’s one of those things that doesn’t sound right when you how does viagra work hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive how does viagra work skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors. However, he explains, this cancer type is often caused by a virus, which seems to encourage a strong immune response despite the cancer’s lower mutational burden.

In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to how does viagra work test checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried. Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs. €œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says.

Yarchoan receives funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

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A key consideration can u buy viagra over the counter in timing of aortic valve replacement (AVR) for patients with aortic stenosis (AS) is whether there is an increased risk of sudden cardiac death (SCD) that might be reduced by relief of outflow obstruction. Minners and colleagues1 addressed this issue in a retrospective analysis can u buy viagra over the counter of outcomes in 1840 patients with mild to moderate AS (aortic maximum velocity 2.5–4.0 m/s) in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Overall the annualised rate of SCD was 0.39% per year with 27 events in asymptomatic patients.

The most recent echocardiogram prior to SCD showed mild–moderate AS in most (80%) of these patients with no difference in SCD event rates in those who progressed to severe AS compared to can u buy viagra over the counter those who did not develop severe valve obstruction. On Cox regression analysis, the only independent risk factors for SCD were age (HR 1.06, 95% CI 1.01 to 1.11 per year, p=0.02), increased left ventricular mass index (HR 1.20, 95% CI 1.10 to 1.32 per 10 g/m2, p<0.001) and lower body mass index (HR 0.87, 95% CI 0.79 to 0.97 per kg/m2, p=0.01) but not the can u buy viagra over the counter severity of valve obstruction (figure 1).Univariate (top) and multivariate (bottom) Cox regression analyses for SCD during 46.1±14.6 months of follow-up in the Simvastatin and Ezetimibe in Aortic Stenosis study. The number of events for each variable is reflected by the dark, horizontal bars with separation at the median for continuous variables.

A forest plot visualisation of HRs for can u buy viagra over the counter SCD is provided on the right. LVED, left ventricular enddiastolic diameter. LVES, left ventricular endsystolic can u buy viagra over the counter diameter.

LVM, left can u buy viagra over the counter ventricular mass. SCD, sudden cardiac death." data-icon-position data-hide-link-title="0">Figure 1 Univariate (top) and multivariate (bottom) Cox regression analyses for SCD during 46.1±14.6 months of follow-up in the Simvastatin and Ezetimibe in Aortic Stenosis study. The number of events for each variable is reflected by the dark, horizontal bars with separation at the can u buy viagra over the counter median for continuous variables.

A forest plot visualisation of HRs for SCD is provided on the right. LVED, left ventricular can u buy viagra over the counter enddiastolic diameter. LVES, left ventricular can u buy viagra over the counter endsystolic diameter.

LVM, left ventricular mass. SCD, sudden cardiac death.The lack of association between AS severity and the risk can u buy viagra over the counter of SCD in the SEAS study is thought-provoking and challenges the conventional wisdom that early AVR would prevent SCD in asymptomatic patients with AS.2 In the past, syncope and SCD in patients with AS were thought to be due to mechanisms such as left ventricle (LV) baroreceptor malfunction, hypotension secondary to peripheral vasodilation in the face of fixed valve obstruction, or a shortened diastolic filling interval at high heart rates leading to a reduced stroke volume. However, it is doubtful that any of these mechanisms would account for SCD when AS is can u buy viagra over the counter only mild to moderate in severity.

€˜It is increasingly recognised that that AS is not simply a mechanical problem of the valve leaflets not opening fully. Instead, AS compromises a complex interplay between the valve, ventricle and vasculature with abnormal function of all three components of the disease process.’ As I conclude in an editorial, ‘It is unlikely that early AVR will reduce the risk of sudden death when severe valve obstruction can u buy viagra over the counter is not present. Perhaps it is time to turn our attention to mitigating the non-valvular disease processes in adults with calcific valve disease.’In another interesting paper in this issue of Heart, Williams and Brown3 hypothesised that the apparent benefit of fractional flow reserve (FFR) guidance of percutaneous coronary intervention (PCI) in patients with chronic coronary syndromes (CCS) might simply be due to utilisation of fewer stents rather than to knowledge about the physiological severity of the coronary lesions.

In a Monte Carlo simulation using data from the PCI strata of the Bypass Angioplasty Revascularization Investigation 2 Diabetes study, random deferral of PCI progressively reduced the risk of death and myocardial infarction at 1 year, suggesting that FFR-guided deferral of PCI improves outcomes simply because fewer stents are placed.In an editorial, Weintraub and Boden4 put this data into the context of 30 years of can u buy viagra over the counter clinical trials comparing PCI with optimal medical therapy from CCS and conclude ‘In contrast to patients with acute coronary syndrome, there remains no convincing evidence that PCI will prevent events in patients with stable angina and chronic ischaemic heart disease. We know that, if needed, PCI will ameliorate severe angina, but we also know can u buy viagra over the counter that this may not be a durable effect. By contrast, for the great majority of patients who are not disabled by angina, PCI can be safely deferred in both diabetic and non-diabetic patients, with revascularisation reserved only for those with unacceptable angina or who develop an acute coronary syndrome during follow-up.

The role of FFR remains uncertain at best and need not be performed routinely in all patients with CCS, though it can u buy viagra over the counter may be useful where the visual estimation of angiographical severity is uncertain.’Cardiac involvement in patients with sepsis contributes to adverse outcomes with most previous studies focusing on left ventricular dysfunction. In order to assess the impact of right ventricular involvement on outcomes in sepsis Kim and colleagues5 performed a retrospective cohort study of 778 patients with septic shock with echocardiographic imaging. Sepsis-induced cardiac dysfunction was present in 34.7% of the entire cohort, affecting the LV in 67.3% and the right ventricle (RV) can u buy viagra over the counter in 40.7% of these patients.

Any type of sepsis-induced cardiac can u buy viagra over the counter dysfunction was associated with a significantly higher 28-day mortality (35.9 vs 26.8%. P<0.01), longer intensive care unit length of stay and longer duration of mechanical ventilator, compared with those without cardiac dysfunction. Isolated RV dysfunction was rare (24/270, 8.9%) but was associated with a higher risk of 28-day mortality can u buy viagra over the counter (adjusted OR 2.77, 95% CI 1.20 to 6.40, p=0.02) (figure 2).Comparisons of survival curves between each type of dysfunction.

LV, left ventricle. RV, right ventricle." data-icon-position data-hide-link-title="0">Figure 2 Comparisons of survival curves can u buy viagra over the counter between each type of dysfunction. LV, left can u buy viagra over the counter ventricle.

RV, right ventricle.The mechanisms of cardiac dysfunction in patients with sepsis are summarised in an editorial by Dugar and Vallabhajosyula6 (figure 3). They also point out the challenges in understanding cardiac involvement in patients with sepsis including the effect of timing of can u buy viagra over the counter imaging on detection, difficulties in measuring RV systolic performance, and differing definitions of RV dysfunction. They conclude can u buy viagra over the counter.

€˜there is a crucial need to understand the how to identify RV dysfunction in sepsis and the causative mechanisms associated with higher mortality in this population, which will significantly influence how we prevent and manage this disease process.’Mechanism of RV dysfunction associated organ failure and mortality in sepsis. RV, right ventricular." can u buy viagra over the counter data-icon-position data-hide-link-title="0">Figure 3 Mechanism of RV dysfunction associated organ failure and mortality in sepsis. RV, right ventricular.The Education-in-Heart article in this issue by Steiner and Kirkpatrick7 focuses on palliative care in management of pateints with cardiovascular disease.

Palliative care now encompasses much more than end-of-life comfort measures can u buy viagra over the counter. Instead, ‘Palliative care is a specialised type of medical care that focuses on improving communication about goals of care, maximising quality of life and reducing symptoms’ and thus applies to many of our patients at many time points in their disease course can u buy viagra over the counter. Each of you will want to read the entire article yourself which includes several useful tools, such as the one shown in figure 4, to improve conversations with patients about treatment options, goals of care and planning for adverse outcomes.Ask-Tell-Ask tool to guide difficult conversations." data-icon-position data-hide-link-title="0">Figure 4 Ask-Tell-Ask tool to guide difficult conversations.Be sure to try the two Image Challenge questions in this issue.8 9 Over 150 board-review format multiple choice questions based on all types of cardiac images can be found in our online archive on the Heart homepage (https://heart.bmj.com/pages/collections/image_challenges/).In symptomatic patients with severe aortic stenosis (AS), there is no question that aortic valve replacement (AVR) relieves symptoms and prolongs life.

In asymptomatic patients, clinical decision making is less clear because of the need to balance the risks of intervention and a prosthetic valve against the risks can u buy viagra over the counter of continued watchful waiting. On the other hand, symptom onset is inevitable in patients with severe AS—the decision is not whether but rather when to replace the valve.The primary rationale for deferring AVR until a later date is the lack of evidence that AVR before symptom onset would improve longevity. In addition, can u buy viagra over the counter the risks, discomfort and disability associated with a surgical or transcatheter procedure are postponed until a later date.

Furthermore, if a mechanical AVR is chosen, can u buy viagra over the counter delaying intervention reduces the length of time the patient is exposed to the risks and inconvenience of warfarin anticoagulation. If a bioprosthetic AVR is chosen, implantation later in life increases the likelihood that the valve will not deteriorate to the point of reintervention during the patient’s lifetime. Unfortunately, patients can u buy viagra over the counter with AS do not have the option of a normal aortic valve.

Instead the diseased native valve is replaced with an imperfect prosthetic valve.On the other hand, accumulating evidence from advanced imaging studies shows that aortic valve obstruction is associated with adverse changes in left ventricular (LV) structure and function, even in the absence of symptoms, which may not resolve after AVR.1 In addition, observational studies suggest that there may be an increased risk of sudden cardiac death in apparently asymptomatic patients with severe AS, although the magnitude and predictors of risk remain unclear.In order to provide clarity about the risk of sudden death in asymptomatic adults with AS, Minners and colleagues examined the data from the Simvastatin and Ezetimibe in Aortic ….

A key consideration in timing of aortic valve replacement (AVR) for patients with aortic stenosis (AS) is whether there is an increased risk of sudden cardiac death (SCD) that might be reduced how does viagra work by relief of outflow obstruction. Minners and colleagues1 addressed this issue in a retrospective analysis of outcomes how does viagra work in 1840 patients with mild to moderate AS (aortic maximum velocity 2.5–4.0 m/s) in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Overall the annualised rate of SCD was 0.39% per year with 27 events in asymptomatic patients.

The most recent how does viagra work echocardiogram prior to SCD showed mild–moderate AS in most (80%) of these patients with no difference in SCD event rates in those who progressed to severe AS compared to those who did not develop severe valve obstruction. On Cox regression analysis, the only independent risk factors for SCD were age (HR 1.06, 95% CI 1.01 to 1.11 per year, p=0.02), increased left ventricular mass index (HR 1.20, 95% CI 1.10 to 1.32 per 10 g/m2, p<0.001) and lower body mass index (HR 0.87, 95% CI 0.79 to 0.97 per kg/m2, p=0.01) but not the severity of valve obstruction (figure 1).Univariate (top) and multivariate (bottom) Cox regression analyses how does viagra work for SCD during 46.1±14.6 months of follow-up in the Simvastatin and Ezetimibe in Aortic Stenosis study. The number of events for each variable is reflected by the dark, horizontal bars with separation at the median for continuous variables.

A forest plot how does viagra work visualisation of HRs for SCD is provided on the right. LVED, left ventricular enddiastolic diameter. LVES, left how does viagra work ventricular endsystolic diameter.

LVM, left how does viagra work ventricular mass. SCD, sudden cardiac death." data-icon-position data-hide-link-title="0">Figure 1 Univariate (top) and multivariate (bottom) Cox regression analyses for SCD during 46.1±14.6 months of follow-up in the Simvastatin and Ezetimibe in Aortic Stenosis study. The number of how does viagra work events for each variable is reflected by the dark, horizontal bars with separation at the median for continuous variables.

A forest plot visualisation of HRs for SCD is provided on the right. LVED, left ventricular enddiastolic diameter how does viagra work. LVES, left how does viagra work ventricular endsystolic diameter.

LVM, left ventricular mass. SCD, sudden cardiac death.The lack of association between AS severity and the risk of SCD in the SEAS study is thought-provoking and challenges the conventional wisdom that early AVR would prevent SCD in asymptomatic patients with AS.2 In the past, syncope and SCD in patients with AS were thought to be due to mechanisms such as left ventricle (LV) baroreceptor malfunction, hypotension secondary to peripheral vasodilation in the face of fixed valve obstruction, or a shortened diastolic filling interval at high heart rates leading to a reduced how does viagra work stroke volume. However, it is doubtful that any of these mechanisms would account for SCD when AS is only how does viagra work mild to moderate in severity.

€˜It is increasingly recognised that that AS is not simply a mechanical problem of the valve leaflets not opening fully. Instead, AS compromises a complex interplay between the valve, ventricle and vasculature with abnormal function of all three components of the disease process.’ As I conclude how does viagra work in an editorial, ‘It is unlikely that early AVR will reduce the risk of sudden death when severe valve obstruction is not present. Perhaps it is time to turn our attention to mitigating the non-valvular disease processes in adults with calcific valve disease.’In another interesting paper in this issue of Heart, Williams and Brown3 hypothesised that the apparent benefit of fractional flow reserve (FFR) guidance of percutaneous coronary intervention (PCI) in patients with chronic coronary syndromes (CCS) might simply be due to utilisation of fewer stents rather than to knowledge about the physiological severity of the coronary lesions.

In a Monte Carlo simulation using data from the PCI strata of the how does viagra work Bypass Angioplasty Revascularization Investigation 2 Diabetes study, random deferral of PCI progressively reduced the risk of death and myocardial infarction at 1 year, suggesting that FFR-guided deferral of PCI improves outcomes simply because fewer stents are placed.In an editorial, Weintraub and Boden4 put this data into the context of 30 years of clinical trials comparing PCI with optimal medical therapy from CCS and conclude ‘In contrast to patients with acute coronary syndrome, there remains no convincing evidence that PCI will prevent events in patients with stable angina and chronic ischaemic heart disease. We know that, if needed, PCI will ameliorate severe angina, but we how does viagra work also know that this may not be a durable effect. By contrast, for the great majority of patients who are not disabled by angina, PCI can be safely deferred in both diabetic and non-diabetic patients, with revascularisation reserved only for those with unacceptable angina or who develop an acute coronary syndrome during follow-up.

The role of FFR remains uncertain at best and need not be performed routinely in all patients with CCS, though it may be useful where the visual estimation of angiographical severity is uncertain.’Cardiac involvement in patients with sepsis contributes how does viagra work to adverse outcomes with most previous studies focusing on left ventricular dysfunction. In order to assess the impact of right ventricular involvement on outcomes in sepsis Kim and colleagues5 performed a retrospective cohort study of 778 patients with septic shock with echocardiographic imaging. Sepsis-induced cardiac dysfunction was present in 34.7% of the entire cohort, affecting the LV in 67.3% and the right ventricle (RV) in 40.7% how does viagra work of these patients.

Any type how does viagra work of sepsis-induced cardiac dysfunction was associated with a significantly higher 28-day mortality (35.9 vs 26.8%. P<0.01), longer intensive care unit length of stay and longer duration of mechanical ventilator, compared with those without cardiac dysfunction. Isolated RV dysfunction was rare (24/270, 8.9%) but was associated with a higher risk of 28-day mortality (adjusted OR 2.77, 95% CI 1.20 to 6.40, p=0.02) (figure 2).Comparisons of survival curves between each type how does viagra work of dysfunction.

LV, left ventricle. RV, right ventricle." data-icon-position data-hide-link-title="0">Figure 2 Comparisons of survival curves between each type of how does viagra work dysfunction. LV, left how does viagra work ventricle.

RV, right ventricle.The mechanisms of cardiac dysfunction in patients with sepsis are summarised in an editorial by Dugar and Vallabhajosyula6 (figure 3). They also point out the challenges in understanding cardiac involvement in patients with sepsis including the effect of timing of imaging on detection, difficulties in measuring RV systolic performance, and differing definitions how does viagra work of RV dysfunction. They conclude how does viagra work.

€˜there is a crucial need to understand the how to identify RV dysfunction in sepsis and the causative mechanisms associated with higher mortality in this population, which will significantly influence how we prevent and manage this disease process.’Mechanism of RV dysfunction associated organ failure and mortality in sepsis. RV, right ventricular." data-icon-position data-hide-link-title="0">Figure 3 Mechanism how does viagra work of RV dysfunction associated organ failure and mortality in sepsis. RV, right ventricular.The Education-in-Heart article in this issue by Steiner and Kirkpatrick7 focuses on palliative care in management of pateints with cardiovascular disease.

Palliative care now how does viagra work encompasses much more than end-of-life comfort measures. Instead, ‘Palliative care is a specialised type of medical care that focuses on how does viagra work improving communication about goals of care, maximising quality of life and reducing symptoms’ and thus applies to many of our patients at many time points in their disease course. Each of you will want to read the entire article yourself which includes several useful tools, such as the one shown in figure 4, to improve conversations with patients about treatment options, goals of care and planning for adverse outcomes.Ask-Tell-Ask tool to guide difficult conversations." data-icon-position data-hide-link-title="0">Figure 4 Ask-Tell-Ask tool to guide difficult conversations.Be sure to try the two Image Challenge questions in this issue.8 9 Over 150 board-review format multiple choice questions based on all types of cardiac images can be found in our online archive on the Heart homepage (https://heart.bmj.com/pages/collections/image_challenges/).In symptomatic patients with severe aortic stenosis (AS), there is no question that aortic valve replacement (AVR) relieves symptoms and prolongs life.

In asymptomatic patients, clinical decision making is less clear because of the need to balance the risks of intervention and a prosthetic how does viagra work valve against the risks of continued watchful waiting. On the other hand, symptom onset is inevitable in patients with severe AS—the decision is not whether but rather when to replace the valve.The primary rationale for deferring AVR until a later date is the lack of evidence that AVR before symptom onset would improve longevity. In addition, the risks, discomfort and how does viagra work disability associated with a surgical or transcatheter procedure are postponed until a later date.

Furthermore, if a mechanical AVR is chosen, delaying intervention reduces the length of time the patient is exposed to how does viagra work the risks and inconvenience of warfarin anticoagulation. If a bioprosthetic AVR is chosen, implantation later in life increases the likelihood that the valve will not deteriorate to the point of reintervention during the patient’s lifetime. Unfortunately, patients with AS do not have the option of a how does viagra work normal aortic valve.

Instead the diseased native valve is replaced with an imperfect prosthetic valve.On the other hand, accumulating evidence from advanced imaging studies shows that aortic valve obstruction is associated with adverse changes in left ventricular (LV) structure and function, even in the absence of symptoms, which may not resolve after AVR.1 In addition, observational studies suggest that there may be an increased risk of sudden cardiac death in apparently asymptomatic patients with severe AS, although the magnitude and predictors of risk remain unclear.In order to provide clarity about the risk of sudden death in asymptomatic adults with AS, Minners and colleagues examined the data from the Simvastatin and Ezetimibe in Aortic ….

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€œDespite a new wave which began on 25 July which Viet Nam is now also in the process of best site bringing under effective control, it is globally recognized that Viet Nam demonstrated one of the world’s most successful responses to the COVID-19 pandemic between generic brand viagra January and April 16. After that date, no cases of local transmission were recorded for 99 consecutive days.There were less than 400 cases of infection across the country during that period, most of them imported, and zero deaths, a remarkable accomplishment considering the country’s population of 96 million people and the fact that it shares a 1,450 km land border with China.Long-term planning pays offKamal Malhotra is the UN Resident Coordinator in Viet Nam. , by UN Viet Nam/Nguyen Duc HieuViet Nam’s success has drawn international attention because of its early, proactive, response, led by the generic brand viagra government, and involving the whole political system, and all aspects of the society. With the support of theWorld Health Organization (WHO) and other partners, Viet Nam had already put a long-term plan in place, to enable it to cope with public health emergencies, building on its experience dealing with previous disease outbreaks, such as SARS, which it also handled remarkably well.Viet Nam’s successful management of the COVID-19 outbreak so far can, therefore, be at least partly put down to the its investment during “peacetime”.

The country has now demonstrated that preparedness to deal with infectious disease is a key ingredient for protecting people and securing public health in times of pandemics such as COVID-19.As early as January 2020, Viet Nam conducted its first risk assessment, immediately after the identification of a cluster of cases of “severe pneumonia with unknown etiology” in Wuhan, China generic brand viagra. From the time that the first two COVID-19 cases were confirmed in Viet Nam in the second half of January 2020, the government started to put precautionary measures into effect by strengthening entry-screening measures and extending the Tết (Lunar New Year) holiday for schools. © UNICEFTeachers and students were able to return to school in Lao Cai, Viet Nam, in May.By 13 February 2020, the number of cases had climbed to 16 with limited local transmission detected in a village near the capital city, Hanoi. As this had the potential generic brand viagra to cause a further spread of the virus in Viet Nam, the country implemented a targeted three-week village-wide quarantine, affecting 11,000 people.

There were then no further local cases for three weeks.But Viet Nam had simultaneously developed its broader quarantine and isolation policy to control COVID-19. As the next wave began in early March, through an imported case from the UK, the government knew that it was crucial to contain virus transmission as fast as possible, in order also to safeguard its economy.Viet Nam therefore closed its borders and suspended international flights from mainland China in February, extending this to UK, Europe, the US and then the rest of the world progressively in March, whilst requiring all travelers entering the country, including its nationals, to undergo 14-day mandatory quarantine on arrival.This helped generic brand viagra the authorities keep track of imported cases of COVID-19 and prevent further local transmission which could have then led to wider community transmission. Both the military and local governments were mobilized to provide testing, meals and amenity services to all quarantine facilities which remained free during this period.No lockdown requiredWhile there was never a nationwide lockdown, some restrictive physical distancing measures were implemented throughout the country. On 1 April 2020, the Prime Minister issued a nationwide two week generic brand viagra physical distancing directive, which was extended by a week in major cities and hotspots.

People were advised to stay at home, non-essential businesses were requested to close, and public transportation was limited.Such measures were so successful that, by early May, following two weeks without a locally confirmed case, schools and businesses resumed their operations and people could return to regular routines. Green One UN House, the home of most UN agencies in Viet Nam, remained open throughout this period, with the Resident Coordinator, WHO Representative and approximately 200 UN staff and consultants physically in the office throughout this period, to provide vital support to the Government and people of Viet Nam.Notably, the Vietnamese public had been exceptionally compliant with government directives and advice, partly as a result of trust built up thanks to real time, transparent communication from the Ministry of Health, supported by the WHO and other UN agencies. Innovative methods were used to keep the generic brand viagra public informed and safe. For instance, regular text updates were sent by the Ministry of Health, on preventive measures and COVID-19’s symptoms.

A COVID-19 song was released, with lyrics raising public awareness of the generic brand viagra disease, which later went viral on social media with a dance challenge on Tik Tok initiated by Quang Dang, a local celebrity.. UN Viet Nam/Nguyen Duc HieuYoung people in Viet Nam take part in International Youth Day 2020 festivities in June. Protecting the vulnerableStill, challenges remain to ensure that the people across the country, especially the hardest hit people, from small and medium-sized enterprises (SMEs) and poor and vulnerable groups, are well generic brand viagra served by an adequately resourced and effectively implemented social protection package. The UN in Viet Nam is keen to help the government support clean technology-based SMEs, with the cooperation of international financial institutions, which will need to do things differently from the past and embrace a new, more inclusive and sustainable, perspective on growth.Challenges remainAs I write, Viet Nam stands at a critical point with respect to COVID-19.

On 25 July, 99 days after being COVID-free in terms of local transmission, a new case was confirmed in Da Nang, a well-known tourist destination. Hundreds of thousands of people flocked to the city and generic brand viagra surrounding region over the summer.The government is once again demonstrating its serious commitment to containing local virus transmission. While there have been a few hundred new local transmission cases and 24 deaths, all centered in a major hospital in Danang (sadly, all the deaths were of people with multiple pre-conditions) aggressive contact tracing, proactive case management, extensive quarantining measures and comprehensive public communication activities are taking place.I am confident that the country will be successful in its efforts to once again successfully contain the virus, once more over the next few weeks.”The Review Committee will advise whether any amendments to the International Health Regulations (IHR) are necessary to ensure it is as effective as possible, WHO Director General Tedros Adhanom Ghebreyesus told journalists. He said generic brand viagra the COVID-19 pandemic has been “an acid test” for many countries, organizations and the treaty.

“Even before the pandemic, I have spoken about how emergencies such as the Ebola outbreak in eastern DRC (the Democratic Republic of the Congo) have demonstrated that some elements of the IHR may need review, including the binary nature of the mechanism for declaring a public health emergency of international concern,” said Mr. Tedros. Interaction with pandemic panel The IHR Review Committee will active ingredient in viagra hold generic brand viagra its first meeting on 8 and 9 September. The committee will also interact with two other entities, exchanging information and sharing findings.

They are the Independent Panel for Pandemic Preparedness and Response, established last month to evaluate global response to the COVID-19 pandemic, and the Independent Oversight Advisory Committee for generic brand viagra the WHO Health Emergencies Programme. It is expected that the committee will present a progress report to the World Health Assembly, WHO’s decision-making body, at its resumed session in November. The Assembly comprises delegations generic brand viagra from WHO’s 194 member States who meet annually in May. A truncated virtual session was held this year due to the pandemic.

The committee will present its full report to the Assembly in 2021. Committed to generic brand viagra ending COVID-19 The IHR was first adopted in 1969 and is legally-binding on 196 countries, including all WHO Member States. It was last revised in 2005. The treaty outlines rights and obligations for countries, including generic brand viagra the requirement to report public health events, as well as the criteria to determine whether or not a particular event constitutes a “public health emergency of international concern”.

Mr. Tedros underscored WHO’s commitment to ending the pandemic, “and to working with all countries to learn from it, and to ensure that together we build the healthier, safer, fairer world that we want.” Invest in mental health WHO is also shining generic brand viagra light on the pandemic’s impact on mental health at a time when services have suffered disruptions. For example, Mr. Tedros said lack of social interaction has affected many people, while others have experienced anxiety and fear.

Meanwhile, some mental health facilities have generic brand viagra been closed and converted to COVID-19 treatment facilities. Globally, close to one billion people are living with a mental disorder. In low- and middle-income countries, more than three-quarters of people with mental, generic brand viagra neurological and substance use disorders do not receive treatment. World Mental Health Day is observed annually on 10 October, and WHO and partners are calling for a massive scale-up in investments.

The UN generic brand viagra agency also will host its first-ever global online advocacy event on mental health where experts, musicians and sports figures will discuss action to improve mental health, in addition to sharing their stories. Global fight against polio continues The milestone eradication of wild poliovirus in Africa does not mean the disease has been defeated globally, Mr. Tedros reminded journalists. WHO announced on Tuesday that the continent has been declared free of the virus, which can cause paralysis, generic brand viagra after no cases were reported for four years “We still have a lot of work to do to eradicate polio from the last two countries where it exists.

Afghanistan and Pakistan,” he said. Mr. Tedros also congratulated Togo, which on Wednesday celebrated the end of sleeping sickness as a public health problem. The disease, officially known as human African Trypanosomiasis, is spread by tsetse flies and is fatal without treatment..

€œDespite a new wave which began how does viagra work on 25 July which Viet Nam is now also in the process of bringing under effective control, it is globally recognized that Viet Nam demonstrated one of the world’s most successful responses to the COVID-19 pandemic between January and April reddit viagra 16. After that date, no cases of local transmission were recorded for 99 consecutive days.There were less than 400 cases of infection across the country during that period, most of them imported, and zero deaths, a remarkable accomplishment considering the country’s population of 96 million people and the fact that it shares a 1,450 km land border with China.Long-term planning pays offKamal Malhotra is the UN Resident Coordinator in Viet Nam. , by UN Viet Nam/Nguyen Duc HieuViet Nam’s success has drawn international attention because how does viagra work of its early, proactive, response, led by the government, and involving the whole political system, and all aspects of the society. With the support of theWorld Health Organization (WHO) and other partners, Viet Nam had already put a long-term plan in place, to enable it to cope with public health emergencies, building on its experience dealing with previous disease outbreaks, such as SARS, which it also handled remarkably well.Viet Nam’s successful management of the COVID-19 outbreak so far can, therefore, be at least partly put down to the its investment during “peacetime”. The country has now demonstrated that preparedness to deal with infectious disease is a how does viagra work key ingredient for protecting people and securing public health in times of pandemics such as COVID-19.As early as January 2020, Viet Nam conducted its first risk assessment, immediately after the identification of a cluster of cases of “severe pneumonia with unknown etiology” in Wuhan, China.

From the time that the first two COVID-19 cases were confirmed in Viet Nam in the second half of January 2020, the government started to put precautionary measures into effect by strengthening entry-screening measures and extending the Tết (Lunar New Year) holiday for schools. © UNICEFTeachers and students were able to return to school in Lao Cai, Viet Nam, in May.By 13 February 2020, the number of cases had climbed to 16 with limited local transmission detected in a village near the capital city, Hanoi. As this had the potential to cause how does viagra work a further spread of the virus in Viet Nam, the country implemented a targeted three-week village-wide quarantine, affecting 11,000 people. There were then no further local cases for three weeks.But Viet Nam had simultaneously developed its broader quarantine and isolation policy to control COVID-19. As the next wave began in early March, through an imported case from the UK, the government knew that it was crucial to contain virus transmission as fast as possible, in order also to safeguard its economy.Viet Nam therefore how does viagra work closed its borders and suspended international flights from mainland China in February, extending this to UK, Europe, the US and then the rest of the world progressively in March, whilst requiring all travelers entering the country, including its nationals, to undergo 14-day mandatory quarantine on arrival.This helped the authorities keep track of imported cases of COVID-19 and prevent further local transmission which could have then led to wider community transmission.

Both the military and local governments were mobilized to provide testing, meals and amenity services to all quarantine facilities which remained free during this period.No lockdown requiredWhile there was never a nationwide lockdown, some restrictive physical distancing measures were implemented throughout the country. On 1 April 2020, the Prime Minister issued a nationwide two week physical distancing directive, which was extended by a week in how does viagra work major cities and hotspots. People were advised to stay at home, non-essential businesses were requested to close, and public transportation was limited.Such measures were so successful that, by early May, following two weeks without a locally confirmed case, schools and businesses resumed their operations and people could return to regular routines. Green One UN House, the home of most UN agencies in Viet Nam, remained open throughout this period, with the Resident Coordinator, WHO Representative and approximately 200 UN staff and consultants physically in the office throughout this period, to provide vital support to the Government and people of Viet Nam.Notably, the Vietnamese public had been exceptionally compliant with government directives and advice, partly as a result of trust built up thanks to real time, transparent communication from the Ministry of Health, supported by the WHO and other UN agencies. Innovative methods were used to keep the how does viagra work public informed and safe.

For instance, regular text updates were sent by the Ministry of Health, on preventive measures and COVID-19’s symptoms. A COVID-19 song was released, with lyrics raising public awareness of the disease, how does viagra work which later went viral on social media with a dance challenge on Tik Tok initiated by Quang Dang, a local celebrity.. UN Viet Nam/Nguyen Duc HieuYoung people in Viet Nam take part in International Youth Day 2020 festivities in June. Protecting the vulnerableStill, challenges remain how does viagra work to ensure that the people across the country, especially the hardest hit people, from small and medium-sized enterprises (SMEs) and poor and vulnerable groups, are well served by an adequately resourced and effectively implemented social protection package. The UN in Viet Nam is keen to help the government support clean technology-based SMEs, with the cooperation of international financial institutions, which will need to do things differently from the past and embrace a new, more inclusive and sustainable, perspective on growth.Challenges remainAs I write, Viet Nam stands at a critical point with respect to COVID-19.

On 25 July, 99 days after being COVID-free in terms of local transmission, a new case was confirmed in Da Nang, a well-known tourist destination. Hundreds of thousands of people flocked to the city and surrounding region over the summer.The government is once again demonstrating its serious commitment to containing how does viagra work local virus transmission. While there have been a few hundred new local transmission cases and 24 deaths, all centered in a major hospital in Danang (sadly, all the deaths were of people with multiple pre-conditions) aggressive contact tracing, proactive case management, extensive quarantining measures and comprehensive public communication activities are taking place.I am confident that the country will be successful in its efforts to once again successfully contain the virus, once more over the next few weeks.”The Review Committee will advise whether any amendments to the International Health Regulations (IHR) are necessary to ensure it is as effective as possible, WHO Director General Tedros Adhanom Ghebreyesus told journalists. He said the COVID-19 pandemic has been “an acid test” for how does viagra work many countries, organizations and the treaty. “Even before the pandemic, I have spoken about how emergencies such as the Ebola outbreak in eastern DRC (the Democratic Republic of the Congo) have demonstrated that some elements of the IHR may need review, including the binary nature of the mechanism for declaring a public health emergency of international concern,” said Mr.

Tedros. Interaction with how does viagra work pandemic panel The IHR Review Committee will hold its first meeting on 8 and 9 read September. The committee will also interact with two other entities, exchanging information and sharing findings. They are the Independent Panel for Pandemic Preparedness and Response, established last month to evaluate global response to how does viagra work the COVID-19 pandemic, and the Independent Oversight Advisory Committee for the WHO Health Emergencies Programme. It is expected that the committee will present a progress report to the World Health Assembly, WHO’s decision-making body, at its resumed session in November.

The Assembly comprises delegations from WHO’s 194 member States who meet how does viagra work annually in May. A truncated virtual session was held this year due to the pandemic. The committee will present its full report to the Assembly in 2021. Committed to ending COVID-19 The IHR was first adopted in 1969 and is legally-binding on how does viagra work 196 countries, including all WHO Member States. It was last revised in 2005.

The treaty outlines rights and obligations for countries, including the requirement to report public health events, as well as the criteria to determine whether or not a particular event constitutes a “public how does viagra work health emergency of international concern”. Mr. Tedros underscored WHO’s commitment to ending the pandemic, “and to working with all countries to learn from it, and to ensure that together we build the healthier, safer, fairer world that we want.” Invest in mental how does viagra work health WHO is also shining light on the pandemic’s impact on mental health at a time when services have suffered disruptions. For example, Mr. Tedros said lack of social interaction has affected many people, while others have experienced anxiety and fear.

Meanwhile, some mental health facilities have been closed and how does viagra work converted to COVID-19 treatment facilities. Globally, close to one billion people are living with a mental disorder. In low- and middle-income countries, more than three-quarters of people with mental, neurological and substance use how does viagra work disorders do not receive treatment. World Mental Health Day is observed annually on 10 October, and WHO and partners are calling for a massive scale-up in investments. The UN agency also will host its first-ever global online advocacy event on mental health where experts, musicians and sports figures will discuss action how does viagra work to improve mental health, in addition to sharing their stories.

Global fight against polio continues The milestone eradication of wild poliovirus in Africa does not mean the disease has been defeated globally, Mr. Tedros reminded journalists. WHO announced on Tuesday that the continent has been declared free of the virus, which can cause paralysis, after no cases were reported for four years “We still have a lot of work to do to eradicate polio how does viagra work from the last two countries where it exists. Afghanistan and Pakistan,” he said. Mr.

Tedros also congratulated Togo, which on Wednesday celebrated the end of sleeping sickness as a public health problem. The disease, officially known as human African Trypanosomiasis, is spread by tsetse flies and is fatal without treatment..

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11 September 2020 We are pleased to announce enhanced flexibility of training for senior healthcare scientists The Institute of Biomedical Science (IBMS), how long does viagra last Royal College of Pathologists (RCPath), National School of Healthcare Science in Health Education England (NSHCS in HEE), Academy for Healthcare Science (ACHS) and Manchester Academy of Healthcare Science Education (MAHSE) have come together to broaden the eligibility criteria for the Higher Specialist Scientific Training (HSST) Programme. The changes will have a direct and positive impact on newly eligible IBMS members who wish to undertake the program.Professor Berne Ferry, Head of the National School of Healthcare Science, who contributed towards the changes commented:Opening up the entry criteria for HSST to allow all eligible scientists to enter the programme is a positive step forward in Healthcare Scientist Education and Training. Allowing eligible Biomedical Scientists to apply is hugely welcomed and the NSHCS in HEE is delighted how long does viagra last to jointly announce this initiative with the IBMS, RCPath, the ACHS and the MAHSE.

Having Biomedical Scientists undertaking HSST alongside Clinical Scientist colleagues can only strengthen, diversify and unify the NHS scientific workforce and help to deliver the necessary scientific leadership which will be crucial for patients in the future.IBMS Council member Dr Jane Needham, the IBMS lead on this project, commented:This is really wonderful news. It provides a career pathway and an exciting opportunity for our how long does viagra last Biomedical Scientists to apply and develop their clinical and scientific knowledge and expertise through the consultant level HSST training programme, with the key benefit of improving and enhancing the clinical care and services we provide to our patients.On reviewing the changes, IBMS President Allan Wilson commented:The inclusion of Biomedical Scientists as an eligible professional group for the HSST programme will provide a route to consultant level posts for Biomedical Scientists and recognises the breadth and depth of experience and clinical skills that exist within the profession. This new training route will improve patient pathways by the addition of experienced clinical experts to the currently stretched consultant capacity.

This is tremendous news for Biomedical Scientists and healthcare in the UK.If you have any how long does viagra last questions after reading the statement please contact us via. Website@ibms.orgRead the statement and new eligibility criteria in full (or download) below:Joint Statement on HSST EligibilitySignificant scientific workforce shortages at senior levels have been identified in several Life Science specialties, which have been further highlighted during the COVID-19 pandemic. The Higher Specialist Scientific Training (HSST) Programme trains Healthcare Scientists to consultant level, however HSST is currently not open to all individual scientists with the potential to develop and take on the role of a consultant scientist.The National School of Healthcare Science in Health Education England, Academy for Healthcare Science, Institute of Biomedical Science (IBMS), Royal College of Pathologists (RCPath) and Manchester Academy how long does viagra last of Healthcare Scientist Education are pleased to announce a widening of the of the eligibility criteria for HSST.

The new criteria will allow appropriately qualified senior Biomedical Scientists, who can demonstrate ability to work at Level 7 via academic and professional qualifications, to apply to join the programme. Both Biomedical Scientists and Clinical Scientists will be subject to the same HSST how long does viagra last interview process to determine suitability and readiness. The qualifications to confer eligibility will include:1) HCPC Registration as a Biomedical Scientist, IBMS Specialist Diploma and relevant MSc2) HCPC Registration as a Biomedical Scientist, IBMS Specialist Diploma and IBMS Higher Specialist Diploma or IBMS 2-part Fellowship Special Exam3) HCPC Registration as a Biomedical Scientist, IBMS Specialist Diploma and IBMS Diploma of Expert PracticeEligible individuals will also need to meet the requirements of the Universities to commence a doctoral level programme, including a First or 2:1 Bachelor’s degree and a Master’s degree in a relevant subject area or evidence of having written at that standard, and a minimum of four years working in a professional role.

In addition, training departments will need to achieve HSST training accreditation through the NSHCS how long does viagra last to be successful in the commissioning rounds. This includes demonstration of suitable workplace and research supervision at doctoral level, access to training to meet the specialism curriculum and HSS Standards of Proficiency, and senior level trust support.All Life Science HSSTs must obtain Fellowship of the Royal College of Pathologists during the programme in order to complete HSST, in addition to the academic qualification and evidence of their workplace training. These requirements of how long does viagra last the programme are identical for Clinical Scientists and Biomedical Scientists on HSST.This revised admission criteria to HSST is endorsed by NHS Education for Scotland - Healthcare Science.

We look forward to working with all agencies concerned with the development of the next generation of consultant-level healthcare scientists.All scientists who successfully complete the HSST programme or equivalence are eligible to join the Academy for Healthcare Science HSS Register and become a Fellow.This change to the HSST eligibility criteria will apply from 2021 entry to the HSST programme.7 September 2020 The four day digital event will feature content aimed at all IBMS members and will be free to attend SAVE THE DATE - 16-19th NovemberOur new, virtual CPD event, The Biomedical Scientist Live, will feature a packed line up of knowledge sharing sessions including. Workshops, seminars, discussions and how long does viagra last demonstrations. The dedicated event website will be live soon and will include more information on how to sign up, free for IBMS members, and the programme of talks.

11 September 2020 We https://www.cityreal.lv/get-viagra-online/ are pleased to announce enhanced flexibility of training for senior healthcare scientists how does viagra work The Institute of Biomedical Science (IBMS), Royal College of Pathologists (RCPath), National School of Healthcare Science in Health Education England (NSHCS in HEE), Academy for Healthcare Science (ACHS) and Manchester Academy of Healthcare Science Education (MAHSE) have come together to broaden the eligibility criteria for the Higher Specialist Scientific Training (HSST) Programme. The changes will have a direct and positive impact on newly eligible IBMS members who wish to undertake the program.Professor Berne Ferry, Head of the National School of Healthcare Science, who contributed towards the changes commented:Opening up the entry criteria for HSST to allow all eligible scientists to enter the programme is a positive step forward in Healthcare Scientist Education and Training. Allowing eligible Biomedical Scientists to apply is hugely welcomed and the NSHCS in HEE how does viagra work is delighted to jointly announce this initiative with the IBMS, RCPath, the ACHS and the MAHSE.

Having Biomedical Scientists undertaking HSST alongside Clinical Scientist colleagues can only strengthen, diversify and unify the NHS scientific workforce and help to deliver the necessary scientific leadership which will be crucial for patients in the future.IBMS Council member Dr Jane Needham, the IBMS lead on this project, commented:This is really wonderful news. It provides a career pathway and an exciting opportunity for our Biomedical Scientists to apply and develop their clinical and scientific knowledge and how does viagra work expertise through the consultant level HSST training programme, with the key benefit of improving and enhancing the clinical care and services we provide to our patients.On reviewing the changes, IBMS President Allan Wilson commented:The inclusion of Biomedical Scientists as an eligible professional group for the HSST programme will provide a route to consultant level posts for Biomedical Scientists and recognises the breadth and depth of experience and clinical skills that exist within the profession. This new training route will improve patient pathways by the addition of experienced clinical experts to the currently stretched consultant capacity.

This is tremendous news for Biomedical Scientists and healthcare in the UK.If how does viagra work you have any questions after reading the statement please contact us via. Website@ibms.orgRead the statement and new eligibility criteria in full (or download) below:Joint Statement on HSST EligibilitySignificant scientific workforce shortages at senior levels have been identified in several Life Science specialties, which have been further highlighted during the COVID-19 pandemic. The Higher Specialist Scientific Training (HSST) Programme trains Healthcare Scientists to consultant level, however HSST is currently not open to all individual scientists with how does viagra work the potential to develop and take on the role of a consultant scientist.The National School of Healthcare Science in Health Education England, Academy for Healthcare Science, Institute of Biomedical Science (IBMS), Royal College of Pathologists (RCPath) and Manchester Academy of Healthcare Scientist Education are pleased to announce a widening of the of the eligibility criteria for HSST.

The new criteria will allow appropriately qualified senior Biomedical Scientists, who can demonstrate ability to work at Level 7 via academic and professional difference between viagra and cialis qualifications, to apply to join the programme. Both Biomedical how does viagra work Scientists and Clinical Scientists will be subject to the same HSST interview process to determine suitability and readiness. The qualifications to confer eligibility will include:1) HCPC Registration as a Biomedical Scientist, IBMS Specialist Diploma and relevant MSc2) HCPC Registration as a Biomedical Scientist, IBMS Specialist Diploma and IBMS Higher Specialist Diploma or IBMS 2-part Fellowship Special Exam3) HCPC Registration as a Biomedical Scientist, IBMS Specialist Diploma and IBMS Diploma of Expert PracticeEligible individuals will also need to meet the requirements of the Universities to commence a doctoral level programme, including a First or 2:1 Bachelor’s degree and a Master’s degree in a relevant subject area or evidence of having written at that standard, and a minimum of four years working in a professional role.

In addition, training departments will need to achieve HSST training how does viagra work accreditation through the NSHCS to be successful in the commissioning rounds. This includes demonstration of suitable workplace and research supervision at doctoral level, access to training to meet the specialism curriculum and HSS Standards of Proficiency, and senior level trust support.All Life Science HSSTs must obtain Fellowship of the Royal College of Pathologists during the programme in order to complete HSST, in addition to the academic qualification and evidence of their workplace training. These requirements of the programme are identical for Clinical Scientists and Biomedical Scientists on HSST.This revised admission criteria to HSST is endorsed how does viagra work by NHS Education for Scotland - Healthcare Science.

We look forward to working with all agencies concerned with the development of the next generation of consultant-level healthcare scientists.All scientists who successfully complete the HSST programme or equivalence are eligible to join the Academy for Healthcare Science HSS Register and become a Fellow.This change to the HSST eligibility criteria will apply from 2021 entry to the HSST programme.7 September 2020 The four day digital event will feature content aimed at all IBMS members and will be free to attend SAVE THE DATE - 16-19th NovemberOur new, virtual CPD event, The Biomedical Scientist Live, will feature a packed line up of knowledge sharing sessions including. Workshops, seminars, how does viagra work discussions and demonstrations. The dedicated event website will be live soon and will include more information on how to sign up, free for IBMS members, and the programme of talks.

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Global health leaders discussed the challenges of climate change and widening inequality during the closing keynote you can find out more sssion, diy viagra 'Climate Change, Social Determinants of Health. Leading Recovery and Preparing for the Future'.The diy viagra speakers were Prof Jan Semenza, lead of the Health Determinants Programme, European Centre for Disease Prevention and Control (ECDC) in Sweden, Professor Prof Sam Shah, founder &. Director, Faculty of Future Health in the UK, Dr Hans Kluge, regional director for Europe, WHO in Denmark and Hal Wolf, president and CEO, HIMSS, US. WHY IT MATTERS HIMSS20 Digital Learn on-demand, earn credit, find products and solutions diy viagra.

Get Started >>. It is predicted that climate change will cause around 250,000 additional diy viagra annual deaths between 2030 and 2050. The combined effect of climate change, and increasing inequality, could lead to a more divided world. This could exacerbate the impact of social and environmental determinants of diy viagra health, for example, clean air.

Safe drinking water. Sufficient quantity diy viagra and quality of food. Secure shelter. And access to quality health and care services.ON THE diy viagra RECORDProfessor Jan Semenza said climate change would impact health.

€œExtreme weather events such as heat or rising sea levels are modulated by a number of vulnerabilities, or factors, such as the human capital in the human population, social capital, financial capital, fiscal capital and natural capital. Exposure can cause diy viagra injuries, fatalities, drownings, heat- related mortality, morbidity, displacement. A whole slew of different kinds of risks”. Semenza said a Matched Case Control Study was carried out between 1992 and 2012 in Denmark, Finland, Norway and diy viagra Sweden to determine whether excess precipitation could mobilise and transport pathogens, leading to water-borne outbreaks.

This showed there was an association between heavy precipitation events and water-borne outbreaks.Dr Hans Kluge, WHO, said. €œThe relationship between health and economic development and social cohesion, diy viagra is linked to climate change. An economy of wellbeing is a fair and environmentally friendly society where everyone has his social safety protector and where health does not put on an economic burden but is a job creator.What citizens legitimately, and reasonably, expect from the health authorities is to guarantee the fundamental right to universal health coverage. But for diy viagra that you need solidarity.

If solidarity does not come from the heart, it should come from the brain because no-one is safe until everyone is safe”.Hal Wolf, HIMSS, said. €œThe stark realisation from COVID-19 is that borders have nothing to with the spread of disease and no-one is safe until everyone diy viagra is safe. We do not understand how to bring the most basic healthcare and the most basic service to each and every village, and every country, around the world. We are going to continue to create vulnerabilities that will start someplace else, spread across the borders and really put everyone in jeopardy, so this idea that strong economies will remain strong and invulnerable diy viagra to the hardships of individuals, who don’t have the same capabilities, or luxuries, just isn’t true.”He said digital health might help.

€œIt is one of the big equalisers. We will face shortages of primary care physicians and clinicians so we have to create, through digital health, some of those equalisers, which can spread all the way down to the most basic phone in the most basic village and that’s a positive step forward.“ Professor Sam Shah, faculty of Future Health in the diy viagra UK also recognised the potential impact of digital to help citizens access services. However, he questioned whether the right technology was reaching the right people but concluded that the digital divide was “probably just a transitory state”. However, he warned that wider society was becoming diy viagra increasingly divided.

€œCOVID-19, if anything, has exacerbated, highlighted and exposed the widening of inequalities in society. The gap between those who have diy viagra and those who have not. The results of this are very different, in everything from life expectancy, outcomes and access to services.”Shah said that climate change could cause a range of problems such as respiratory illness, cardiovascular disease, injuries, and premature death. He also believed it would have an impact on mental health diy viagra and wellbeing.

He said the wider social determinants of diy viagra health, such as education, employment and housing, could significantly affect health, particularly mental health.Access sessions from the HIMSS &. Health 2.0 European Digital Conference 'On Demand' and find all the latest news and deveopments from the event here.Hyland, a Westlake, Ohio-based content services and enterprise imaging technology vendor, signed a definitive agreement to acquire content services platform Alfresco this week.The move follows Hyland's acquisition of German robotic process automation software developer Another Monday this past month."We continue to grow our business and advance our platform organically and via acquisitions," said Bill Priemer, president and CEO of Hyland, in a statement.WHY IT MATTERSHyland, which provides content services for a variety of industries – including financial services, government, higher education, insurance and healthcare – has products in use at more than half of Fortune 100 companies, says the vendor.Its cloud-based, SaaS platform includes security features such as version control, data classification and at-rest data encryption, according to the company's website.Expected to close in the fourth quarter of 2020, Alfresco's entire business of cloud-native content services solutions for enterprises with large volumes of unstructured content will likely be managed under Hyland."With this acquisition Alfresco brings significant geographic and industry experience to Hyland as well as an open source community as a new source of product innovation," said Jay Bhatt, president and CEO of Alfresco. Another Monday, meanwhile, houses four complementary software products for automation, including tools for automatic process documentation, development, conduction and monitoring."The RPA market is an exciting and challenging space with rapid growth and a vast number of possible applications that organizations can easily combine and integrate for better and more flexible business processes support," said Hans Martens, CEO of Another Monday, in a statement."We see Hyland as diy viagra the best fit to embed our RPA technology into their powerful automation platform, to truly implement easy, end-to-end automation for everyone," Martens continued.Hyland also this past month announced new enhancements to its platform, including updated mobile capabilities and an improved upgrade process.THE LARGER TRENDSusan deCathelineau, senior vice president of healthcare sales and services at Hyland, told Healthcare IT News earlier this year that unstructured information – such as clinical documents, narratives, consents and images – has largely been overlooked when it comes to interoperability concerns. She also pointed to artificial intelligence as a needed complement to physicians overwhelmed by data and noted that moving to the cloud was an essential shift for the healthcare industry."The hesitancy that used to surround cloud adoption in healthcare now is being replaced by the realization of its ultimate inevitability.

Once again, this diy viagra shift in mindset largely has to do with data overload," she said.Hyland had at the time recently acquired the blockchain-credentialing vendor LearningMachine, another in a string of acquisitions dating back years.ON THE RECORD"This acquisition will expand our global reach, enabling us to help more organizations achieve their digital transformation goals and become more informed, empowered and connected," said Priemer in a statement. Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.With the increasing spread of COVID-19 infections, the governor of Arizona declared a moratorium on “elective surgeries” on March 19, 2020, in order to conserve hospital PPE supplies and build capacity for potential COVID-19 patients needing hospitalization.The moratorium lasted for six weeks and was finally lifted on May 1, 2020.

The end of the suspension resulted in a backlog of more than 3,000 surgical procedures at Phoenix Children’s Hospital.THE PROBLEM HIMSS20 Digital Learn on-demand, earn credit, find products and solutions. Get Started >>. “While it is true that elective surgeries are typically nonurgent, many of these are medically necessary and important for a child’s health and well-being,” explained Dr. Vinay Vaidya, chief medical information officer at Phoenix Children’s Hospital.“Besides the delay in surgery for the patient, deferring all elective surgeries put a major financial strain on hospitals across the country.

The challenge we had to address was how to resume the thousands of deferred surgeries, in addition to the new surgeries that were being added each day.”These operations needed to be conducted in a timely and efficient manner while ensuring utmost safety for patients and healthcare providers. The scheduling of surgeries is a complex process that involves many players and requires a series of sequential and interdependent actions. The COVID-19 pandemic added magnitudes of complexity to each step in this process.“This was an unprecedented situation that needed coordination across our entire system of care, from executive leadership to surgeons, anesthesiologists, nursing staff, operating room staff, schedulers, and ultimately patients and their families,” Vaidya said.“We needed to build a common communication highway, based on information technology, that would provide real-time visibility through the entire scheduling process, and to all stakeholders.”PROPOSALOnce the moratorium on elective surgeries was lifted, the process of rescheduling the backlog of more than 3,000 cases could begin.Clearly, what was needed was much more than simply throwing additional scheduling staff to work through the backlog one patient at a time, Vaidya said. Amidst a pandemic, staff had to rewrite the rules of how a surgical scheduling process would unfold.“Based on our previous experience of successfully using https://www.cityreal.lv/viagra-tablet/ information technology in general, and data analytic dashboards in particular, it was evident at the very outset that we would need a similar approach to address the complex logistics,” he said.

€œThe solution to resuming these surgeries was the development of a proprietary dashboard, which could facilitate the entire triage of operations.”MEETING THE CHALLENGEGiven the challenges posed by COVID-19, it was important to take into consideration a number of factors such as. The type of surgery, medical necessity and need for hospital/ICU stay, Vaidya explained. These elements needed to be balanced with the availability of PPE, adequate staffing, general and ICU bed availability, and ventilator availability, while ensuring the highest standards of safety for patients and hospital staff.“Using a careful and well-planned approach, a surgical prioritization was developed and uniformly communicated to all surgical teams,” Vaidya said. €œTo support the assignment of surgical priority for 3,000-plus cases, a new dashboard was created.

This technology allowed each surgeon to review all their respective cases, and rapidly assign a priority of high, medium or low to all the backlogged cases, as well as new cases.”As this data was captured electronically, it was used to feed a separate dashboard created specifically for the schedulers, who found it easy to work through the list, based on surgical priority. This significantly improved the efficiency of the process, allowing staff to schedule a much higher number of patients each day than previously possible."The technology allowed for synergies across the enterprise in addressing the multifaceted challenges of resuming these operations."Dr. Vinay Vaidya, Phoenix Children’s Hospital“For those patients who were successfully scheduled for surgery, it was mandatory to test them for COVID-19 in the 72 hours preceding the date of surgery,” Vaidya noted.“This process was also facilitated using the dashboard, which displayed the patients who were scheduled for COVID-19 testing, those who completed the test, and those who tested negative and were finally cleared for surgery. It also identified patients who tested positive for COVID-19 and needed to have their surgeries postponed.”The entire end-to-end electronic process provided a single enterprise-wide view that allowed streamlined tracking of the patient throughout the multiple steps, not unlike that of an Amazon package, right from ordering to final delivery, Vaidya described.“This also obviated the need for inefficient and time-consuming internal communication via emails, phone calls and spreadsheets between the surgeons, operating room staff and the schedulers,” Vaidya said.

€œThe dashboard thus became the de facto central hub and the single source of truth, updated in real time, and extensively used across the entire organization, from the frontline staff right up to senior leadership.”Vaidya added that it is important to point out that the hospital was able to accomplish all of this very quickly.“We already had in place an existing robust data warehouse structure that was receiving feeds from almost every information system used in the hospital, including live feeds from our EHR,” he said. €œIn addition, much of the data needed for the dashboards had already been prepackaged into ready-to-use analysis cubes that had been previously built for other surgical projects preceding COVID-19.”Finally, a couple of data analysts who were already proficient in rapidly building visually informative, interactive, actionable dashboards using Microsoft’s Power BI software, were able to deliver the dashboards in record time.RESULTSThe one success metric of this project that stands out is that the hospital was not only able to catch up quickly on the backlog of surgeries, but actually ended up performing 166 more surgeries in June and July of this year, compared with the same period last year – 4,199 versus 4,033 – Vaidya reported. This volume speaks to the approach. An extensive use of data, analytics and dashboards to support every stage of the process, from surgeon prioritization to scheduling, testing and finally surgery, he added.“Among the numerous types of surgeries performed during this challenging period, it is worth highlighting the results of our surgical volumes for two very complex surgeries,” he said.“Phoenix Children’s Hospital is nationally recognized as a center of excellence, and draws patients from all across the country for Pectus surgery, done to correct chest wall deformities, and Scoliosis surgery, to correct abnormal spine curvature.

Both are complex, long-duration surgeries that require a hospital stay, and are often planned months in advance to coincide with school summer break.”In the case of Scoliosis surgery, the hospital succeeded in performing more surgeries this year during May through August compared with the same period last year, 95 versus 91. The results for Pectus repair surgery were even more noteworthy. The surgical teams outperformed by 41% the number of surgeries performed this year from May to August compared with the same period last year, 72 versus 51.“The technology allowed for synergies across the enterprise in addressing the multifaceted challenges of resuming these operations,” Vaidya said. €œThroughout this project, given that patient and provider safety was our highest priority, it is important to point out that no surgeon or anesthesiologist has tested positive for COVID-19 since surgery restarted – a testament to extensive safety protocols that were supported by dashboard usage at every stage.”ADVICE FOR OTHERSThe success of this project no doubt depended on the collaboration and cooperation of many different teams, Vaidya said.

However, its foundation was built upon the optimum use of data analytics, and dashboard technology, to provide precise, real-time, actionable information to all the key players, he added.“Fortunately, most hospitals and health systems have developed their electronic capabilities over the last 10 years and are sitting on a trove of data,” he said.“Ensuring that the multiple, often disparate, information systems in a hospital setting all feed their data to a common data warehouse platform allows for optimum use of this data,” he explained. €œMining the data, and providing it to frontline users via intuitive interfaces, turns it into actionable intelligence that produces results.“As IT professionals, we have been promising our health providers that data can be used to produce higher quality outcomes,” he added. €œUsing technology in the resumption of surgeries is a perfect example of delivering on this promise.”Twitter. @SiwickiHealthITEmail the writer.

Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.A woman living in Woodstock, New York, has filed suit against HealthAlliance Hospital and the information management vendor Ciox Health for allegedly declining to release her deceased husband's electronic health records in a non-paper format.The lawyer for the plaintiff, Sherry Russell, said that HealthAlliance Hospital's Broadway campus (formerly known as Kingston Hospital) has repeatedly directed her to Ciox for the records, which in turn allegedly told her she will have to pay 75 cents a page for photocopied paper versions."The maximum charge for electronic medical records under federal law is $6.50," said Russell's lawyer, John Fisher, in an interview with Healthcare IT News. "But if they charge for the paper copy of the records, it could be thousands of dollars." According to a 2016 guidance from the U.S. Department of Health and Human Services, HIPAA-covered entities and business associates should either charge $6.50 to fulfill a record request or calculate fees based on the labor cost of doing so.Earlier this year, the U.S. Department of Health and Human Services lifted that cap on fees when it comes to organizations charging third parties, such as law firms, when releasing copies of electronic records.

The fee cap for patients, however, remains in place. Fisher says that Russell's alleged treatment is a violation of the HITECH Act, which – among other provisions – requires HIPAA-covered entities to provide patients with an electronic copy of their records. According to Fisher, after the death of Russell's husband, Charlie, in October 2019, she requested his electronic health records in order to file a separate malpractice lawsuit against the hospital. Without the records, said Fisher, Russell cannot identify the physician involved in her husband's care.

Ciox said that it could not comment on pending litigation. The Westchester Medical Health Network, of which HealthAlliance is a part, said it did not comment on ongoing litigation. WHY IT MATTERSAccording to Fisher, in March 2017, Charlie Russell underwent a chest X-ray as part of a routine procedure. That X-ray showed a mass in his lung, but as Fisher told Healthcare IT News, neither Russell nor his wife were informed of it.

The next March, Fisher said, Russell went in for another chest X-ray. This time, doctors found a six-centimeter mass in his lung. Further imaging showed cancer in his brain and liver.Sherry Russell believes her husband's cancer could have been treated sooner, had the mass been identified and communicated about in 2017. She is planning to file a medical malpractice lawsuit.

The deadline to sue is September 14, said Fisher, but Russell is relying on the electronic health records for her case. Fisher said he has other clients with similar experiences at HealthAlliance concerning their records, and that clients whose cases qualify could join onto Russell's class-action suit filed this past week. "We know firsthand that there are others" that have experienced problems obtaining their electronic health records, said Fisher. THE LARGER TREND The HIPAA Privacy Right Rule of Access guarantees patient access to physical or digital copies of healthcare records – and noncompliant health systems can face hefty fines.

In 2019, Bayfront Health St. Petersburg had to pay the HHS Office of Civil Rights $85,000 and promise remediation after failing to give a pregnant woman timely access to her medical records.Meanwhile, Ciox has been at the center of a number of lawsuits concerning the costs of electronic health records. In 2018, the company sued HHS over the $6.50 flat fee Fisher invoked, saying that it "bears no rational relationship to the actual costs associated with processing such requests." HHS, in turn, said that it couldn't actually enforce that flat fee against Ciox, because Ciox is a business associate, not a covered entity.This lawsuit eventually led to the agency lifting the cap on fees for third-party organizations' requests for records. And last year, Ciox Health and the Wisconsin-based Aurora Health paid $35.4 million to settle a class-action lawsuit that accused the companies of overcharging for records requests.Studies have shown other hospitals not complying with the HHS-recommended $6.50, with one reportedly charging more than $500 for a 200-page record.

ON THE RECORD HealthAlliance, said Fisher, is "stonewalling our client and affecting her ability to bring a lawsuit." Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication..

Global health leaders discussed the challenges of climate change and widening inequality during the closing keynote sssion, 'Climate Change, Social how does viagra work Determinants of Health i loved this. Leading Recovery and Preparing for the Future'.The speakers were Prof Jan Semenza, lead of the Health Determinants Programme, European Centre for Disease Prevention and Control (ECDC) in Sweden, Professor Prof Sam Shah, founder & how does viagra work. Director, Faculty of Future Health in the UK, Dr Hans Kluge, regional director for Europe, WHO in Denmark and Hal Wolf, president and CEO, HIMSS, US. WHY IT MATTERS HIMSS20 Digital Learn how does viagra work on-demand, earn credit, find products and solutions. Get Started >>.

It is predicted that climate change will cause around 250,000 additional annual deaths between 2030 how does viagra work and 2050. The combined effect of climate change, and increasing inequality, could lead to a more divided world. This could exacerbate how does viagra work the impact of social and environmental determinants of health, for example, clean air. Safe drinking water. Sufficient quantity and quality how does viagra work of food.

Secure shelter. And access to quality health and care services.ON THE RECORDProfessor Jan Semenza said climate change how does viagra work would impact health. €œExtreme weather events such as heat or rising sea levels are modulated by a number of vulnerabilities, or factors, such as the human capital in the human population, social capital, financial capital, fiscal capital and natural capital. Exposure can how does viagra work cause injuries, fatalities, drownings, heat- related mortality, morbidity, displacement. A whole slew of different kinds of risks”.

Semenza said a Matched Case Control Study was carried out between 1992 and 2012 in Denmark, Finland, Norway and Sweden to determine whether excess precipitation could mobilise and transport pathogens, how does viagra work leading to water-borne outbreaks. This showed there was an association between heavy precipitation events and water-borne outbreaks.Dr Hans Kluge, WHO, said. €œThe relationship between health and economic development and social cohesion, is linked how does viagra work to climate change. An economy of wellbeing is a fair and environmentally friendly society where everyone has his social safety protector and where health does not put on an economic burden but is a job creator.What citizens legitimately, and reasonably, expect from the health authorities is to guarantee the fundamental right to universal health coverage. But for how does viagra work that you need solidarity.

If solidarity does not come from the heart, it should come from the brain because no-one is safe until everyone is safe”.Hal Wolf, HIMSS, said. €œThe stark realisation from COVID-19 is that borders have nothing to with the spread of disease and no-one how does viagra work is safe until everyone is safe. We do not understand how to bring the most basic healthcare and the most basic service to each and every village, and every country, around the world. We are how does viagra work going to continue to create vulnerabilities that will start someplace else, spread across the borders and really put everyone in jeopardy, so this idea that strong economies will remain strong and invulnerable to the hardships of individuals, who don’t have the same capabilities, or luxuries, just isn’t true.”He said digital health might help. €œIt is one of the big equalisers.

We will face shortages of primary care physicians and clinicians so we have to create, through digital health, some of those equalisers, which can spread all the way down to the most basic phone in the most basic village and that’s a positive step forward.“ Professor Sam Shah, faculty of Future Health in the UK also recognised the potential impact how does viagra work of digital to help citizens access services. However, he questioned whether the right technology was reaching the right people but concluded that the digital divide was “probably just a transitory state”. However, he warned that wider society was becoming increasingly how does viagra work divided. €œCOVID-19, if anything, has exacerbated, highlighted and exposed the widening of inequalities in society. The gap between those who have how does viagra work and those who have not.

The results of this are very different, in everything from life expectancy, outcomes and access to services.”Shah said that climate change could cause a range of problems such as respiratory illness, cardiovascular disease, injuries, and premature death. He also believed it would have how does viagra work an impact on mental health and wellbeing. He said the wider social determinants of health, such as education, employment and housing, could significantly affect health, particularly mental health.Access sessions how does viagra work from the HIMSS &. Health 2.0 European Digital Conference 'On Demand' and find all the latest news and deveopments from the event here.Hyland, a Westlake, Ohio-based content services and enterprise imaging technology vendor, signed a definitive agreement to acquire content services platform Alfresco this week.The move follows Hyland's acquisition of German robotic process automation software developer Another Monday this past month."We continue to grow our business and advance our platform organically and via acquisitions," said Bill Priemer, president and CEO of Hyland, in a statement.WHY IT MATTERSHyland, which provides content services for a variety of industries – including financial services, government, higher education, insurance and healthcare – has products in use at more than half of Fortune 100 companies, says the vendor.Its cloud-based, SaaS platform includes security features such as version control, data classification and at-rest data encryption, according to the company's website.Expected to close in the fourth quarter of 2020, Alfresco's entire business of cloud-native content services solutions for enterprises with large volumes of unstructured content will likely be managed under Hyland."With this acquisition Alfresco brings significant geographic and industry experience to Hyland as well as an open source community as a new source of product innovation," said Jay Bhatt, president and CEO of Alfresco. Another Monday, meanwhile, houses four complementary software products for automation, including tools for automatic process documentation, development, conduction and monitoring."The RPA market is an exciting and challenging space with rapid growth and a vast number of possible applications that organizations can easily combine and integrate for better and more flexible business processes support," said Hans Martens, CEO of Another Monday, in a statement."We see Hyland as the best fit to embed our RPA technology into their powerful automation platform, to truly implement easy, end-to-end automation for everyone," Martens continued.Hyland also this past month announced new enhancements to its platform, including updated mobile capabilities and an improved upgrade process.THE LARGER TRENDSusan deCathelineau, senior vice president of healthcare sales and services at Hyland, told Healthcare IT News earlier this year that unstructured information – such as clinical documents, narratives, consents and images – has largely been overlooked when it how does viagra work comes to interoperability concerns.

She also pointed to artificial intelligence as a needed complement to physicians overwhelmed by data and noted that moving to the cloud was an essential shift for the healthcare industry."The hesitancy that used to surround cloud adoption in healthcare now is being replaced by the realization of its ultimate inevitability. Once again, this shift in mindset largely has to do with how does viagra work data overload," she said.Hyland had at the time recently acquired the blockchain-credentialing vendor LearningMachine, another in a string of acquisitions dating back years.ON THE RECORD"This acquisition will expand our global reach, enabling us to help more organizations achieve their digital transformation goals and become more informed, empowered and connected," said Priemer in a statement. Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.With the increasing spread of COVID-19 infections, the governor of Arizona declared a moratorium on “elective surgeries” on March 19, 2020, in order to conserve hospital PPE supplies and build capacity for potential COVID-19 patients needing hospitalization.The moratorium lasted for six weeks and was finally lifted on May 1, 2020.

The end of the suspension resulted in a backlog of more than 3,000 surgical procedures at Phoenix Children’s Hospital.THE PROBLEM HIMSS20 Digital Learn on-demand, earn credit, find products and solutions. Get Started >>. “While it is true that elective surgeries are typically nonurgent, many of these are medically necessary and important for a child’s health and well-being,” explained Dr. Vinay Vaidya, chief medical information officer at Phoenix Children’s Hospital.“Besides the delay in surgery for the patient, deferring all elective surgeries put a major financial strain on hospitals across the country. The challenge we had to address was how to resume the thousands of deferred surgeries, in addition to the new surgeries that were being added each day.”These operations needed to be conducted in a timely and efficient manner while ensuring utmost safety for patients and healthcare providers.

The scheduling of surgeries is a complex process that involves many players and requires a series of sequential and interdependent actions. The COVID-19 pandemic added magnitudes of complexity to each step in this process.“This was an unprecedented situation that needed coordination across our entire system of care, from executive leadership to surgeons, anesthesiologists, nursing staff, operating room staff, schedulers, and ultimately patients and their families,” Vaidya said.“We needed to build a common communication highway, based on information technology, that would provide real-time visibility through the entire scheduling process, and to all stakeholders.”PROPOSALOnce the moratorium on elective surgeries was lifted, the process of rescheduling the backlog of more than 3,000 cases could begin.Clearly, what was needed was much more than simply throwing additional scheduling staff to work through the backlog one patient at a time, Vaidya said. Amidst a pandemic, staff had to rewrite the rules of how a surgical scheduling process would unfold.“Based on our previous experience of successfully using information technology in general, and data analytic dashboards in particular, it was evident at the very outset that we would need a similar approach to address the complex logistics,” he said. €œThe solution to resuming these surgeries was the development of a proprietary dashboard, which could facilitate the entire triage of operations.”MEETING THE CHALLENGEGiven the challenges posed by COVID-19, it was important to take into consideration a number of factors such as. The type of surgery, medical necessity and need for hospital/ICU stay, Vaidya explained.

These elements needed to be balanced with the availability of PPE, adequate staffing, general and ICU bed availability, and ventilator availability, while ensuring the highest standards of safety for patients and hospital staff.“Using a careful and well-planned approach, a surgical prioritization was developed and uniformly communicated to all surgical teams,” Vaidya said. €œTo support the assignment of surgical priority for 3,000-plus cases, a new dashboard was created. This technology allowed each surgeon to review all their respective cases, and rapidly assign a priority of high, medium or low to all the backlogged cases, as well as new cases.”As this data was captured electronically, it was used to feed a separate dashboard created specifically for the schedulers, who found it easy to work through the list, based on surgical priority. This significantly improved the efficiency of the process, allowing staff to schedule a much higher number of patients each day than previously possible."The technology allowed for synergies across the enterprise in addressing the multifaceted challenges of resuming these operations."Dr. Vinay Vaidya, Phoenix Children’s Hospital“For those patients who were successfully scheduled for surgery, it was mandatory to test them for COVID-19 in the 72 hours preceding the date of surgery,” Vaidya noted.“This process was also facilitated using the dashboard, which displayed the patients who were scheduled for COVID-19 testing, those who completed the test, and those who tested negative and were finally cleared for surgery.

It also identified patients who tested positive for COVID-19 and needed to have their surgeries postponed.”The entire end-to-end electronic process provided a single enterprise-wide view that allowed streamlined tracking of the patient throughout the multiple steps, not unlike that of an Amazon package, right from ordering to final delivery, Vaidya described.“This also obviated the need for inefficient and time-consuming internal communication via emails, phone calls and spreadsheets between the surgeons, operating room staff and the schedulers,” Vaidya said. €œThe dashboard thus became the de facto central hub and the single source of truth, updated in real time, and extensively used across the entire organization, from the frontline staff right up to senior leadership.”Vaidya added that it is important to point out that the hospital was able to accomplish all of this very quickly.“We already had in place an existing robust data warehouse structure that was receiving feeds from almost every information system used in the hospital, including live feeds from our EHR,” he said. €œIn addition, much of the data needed for the dashboards had already been prepackaged into ready-to-use analysis cubes that had been previously built for other surgical projects preceding COVID-19.”Finally, a couple of data analysts who were already proficient in rapidly building visually informative, interactive, actionable dashboards using Microsoft’s Power BI software, were able to deliver the dashboards in record time.RESULTSThe one success metric of this project that stands out is that the hospital was not only able to catch up quickly on the backlog of surgeries, but actually ended up performing 166 more surgeries in June and July of this year, compared with the same period last year – 4,199 versus 4,033 – Vaidya reported. This volume speaks to the approach. An extensive use of data, analytics and dashboards to support every stage of the process, from surgeon prioritization to scheduling, testing and finally surgery, he added.“Among the numerous types of surgeries performed during this challenging period, it is worth highlighting the results of our surgical volumes for two very complex surgeries,” he said.“Phoenix Children’s Hospital is nationally recognized as a center of excellence, and draws patients from all across the country for Pectus surgery, done to correct chest wall deformities, and Scoliosis surgery, to correct abnormal spine curvature.

Both are complex, long-duration surgeries that require a hospital stay, and are often planned months in advance to coincide with school summer break.”In the case of Scoliosis surgery, the hospital succeeded in performing more surgeries this year during May through August compared with the same period last year, 95 versus 91. The results for Pectus repair surgery were even more noteworthy. The surgical teams outperformed by 41% the number of surgeries performed this year from May to August compared with the same period last year, 72 versus 51.“The technology allowed for synergies across the enterprise in addressing the multifaceted challenges of resuming these operations,” Vaidya said. €œThroughout this project, given that patient and provider safety was our highest priority, it is important to point out that no surgeon or anesthesiologist has tested positive for COVID-19 since surgery restarted – a testament to extensive safety protocols that were supported by dashboard usage at every stage.”ADVICE FOR OTHERSThe success of this project no doubt depended on the collaboration and cooperation of many different teams, Vaidya said. However, its foundation was built upon the optimum use of data analytics, and dashboard technology, to provide precise, real-time, actionable information to all the key players, he added.“Fortunately, most hospitals and health systems have developed their electronic capabilities over the last 10 years and are sitting on a trove of data,” he said.“Ensuring that the multiple, often disparate, information systems in a hospital setting all feed their data to a common data warehouse platform allows for optimum use of this data,” he explained.

€œMining the data, and providing it to frontline users via intuitive interfaces, turns it into actionable intelligence that produces results.“As IT professionals, we have been promising our health providers that data can be used to produce higher quality outcomes,” he added. €œUsing technology in the resumption of surgeries is a perfect example of delivering on this promise.”Twitter. @SiwickiHealthITEmail the writer. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.A woman living in Woodstock, New York, has filed suit against HealthAlliance Hospital and the information management vendor Ciox Health for allegedly declining to release her deceased husband's electronic health records in a non-paper format.The lawyer for the plaintiff, Sherry Russell, said that HealthAlliance Hospital's Broadway campus (formerly known as Kingston Hospital) has repeatedly directed her to Ciox for the records, which in turn allegedly told her she will have to pay 75 cents a page for photocopied paper versions."The maximum charge for electronic medical records under federal law is $6.50," said Russell's lawyer, John Fisher, in an interview with Healthcare IT News. "But if they charge for the paper copy of the records, it could be thousands of dollars." According to a 2016 guidance from the U.S.

Department of Health and Human Services, HIPAA-covered entities and business associates should either charge $6.50 to fulfill a record request or calculate fees based on the labor cost of doing so.Earlier this year, the U.S. Department of Health and Human Services lifted that cap on fees when it comes to organizations charging third parties, such as law firms, when releasing copies of electronic records. The fee cap for patients, however, remains in place. Fisher says that Russell's alleged treatment is a violation of the HITECH Act, which – among other provisions – requires HIPAA-covered entities to provide patients with an electronic copy of their records. According to Fisher, after the death of Russell's husband, Charlie, in October 2019, she requested his electronic health records in order to file a separate malpractice lawsuit against the hospital.

Without the records, said Fisher, Russell cannot identify the physician involved in her husband's care. Ciox said that it could not comment on pending litigation. The Westchester Medical Health Network, of which HealthAlliance is a part, said it did not comment on ongoing litigation. WHY IT MATTERSAccording to Fisher, in March 2017, Charlie Russell underwent a chest X-ray as part of a routine procedure. That X-ray showed a mass in his lung, but as Fisher told Healthcare IT News, neither Russell nor his wife were informed of it.

The next March, Fisher said, Russell went in for another chest X-ray. This time, doctors found a six-centimeter mass in his lung. Further imaging showed cancer in his brain and liver.Sherry Russell believes her husband's cancer could have been treated sooner, had the mass been identified and communicated about in 2017. She is planning to file a medical malpractice lawsuit. The deadline to sue is September 14, said Fisher, but Russell is relying on the electronic health records for her case.

Fisher said he has other clients with similar experiences at HealthAlliance concerning their records, and that clients whose cases qualify could join onto Russell's class-action suit filed this past week. "We know firsthand that there are others" that have experienced problems obtaining their electronic health records, said Fisher. THE LARGER TREND The HIPAA Privacy Right Rule of Access guarantees patient access to physical or digital copies of healthcare records – and noncompliant health systems can face hefty fines. In 2019, Bayfront Health St. Petersburg had to pay the HHS Office of Civil Rights $85,000 and promise remediation after failing to give a pregnant woman timely access to her medical records.Meanwhile, Ciox has been at the center of a number of lawsuits concerning the costs of electronic health records.

In 2018, the company sued HHS over the $6.50 flat fee Fisher invoked, saying that it "bears no rational relationship to the actual costs associated with processing such requests." HHS, in turn, said that it couldn't actually enforce that flat fee against Ciox, because Ciox is a business associate, not a covered entity.This lawsuit eventually led to the agency lifting the cap on fees for third-party organizations' requests for records. And last year, Ciox Health and the Wisconsin-based Aurora Health paid $35.4 million to settle a class-action lawsuit that accused the companies of overcharging for records requests.Studies have shown other hospitals not complying with the HHS-recommended $6.50, with one reportedly charging more than $500 for a 200-page record. ON THE RECORD HealthAlliance, said Fisher, is "stonewalling our client and affecting her ability to bring a lawsuit." Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication..

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