Austin Medical Times

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Volume 5 | Issue 7

Inside This Issue

St. David’s Healthcare Facilities Recognized For Excellence In Cardiac Care See pg. 10

INDEX Oncology Research......... pg.3 Mental Health...................... pg.4 Healthy Heart....................... pg.8 Hospital News...................... pg.9

Walking Towards Healthier Knees See pg. 11

July Edition 2022

SCOTUS Sides With 340B Hospitals and Denies CMS’s Attempt To Cut Reimbursement For 340B Drugs

By Kyle A. Vasquez, J.D., LL.M. and Mary H. Canavan, J.D. Polsinelli, PC

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he United States Supreme Court recently handed down a highly anticipated, unanimous opinion, AHA v. Becerra, confirming that CMS exceeded its statutory authority when it implemented a discriminatory reimbursement structure in 2018 and 2019 that resulted in certain 340B hospitals receiving lower Part B drug reimbursement than non-340B hospitals. The opinion is welcome news for 340B hospitals that continue to face financial pressures related to the 340B Program and contract pharmacies. Now, CMS and potentially the lower court must sort through difficult matters involving payment of damages for 2018 and 2019 underpaid claims given potential Part B budget neutral constraints, but the opinion does confirm that CMS must operate within a specific set of parameters if it intends to setup up a Part B payment structure that varies by hospital group. Namely, CMS may only vary Part B reimbursement by hospital

group if it conducts a statistically valid survey pursuant to 42 U.S.C. § 1395l(t) (14)(D). Absent survey data, CMS must

policy in the Proposed Rule could shed some light into its approach to not only payment going forward, but also into its approach to remedying past underpayments. For example, it’s possible that the Supreme Court’s unanimous decision influences CMS to revisit its 340B drug payment policy in its upcoming CY 2023 Outpatient Prospective Payment System proposed rule (Proposed Rule) and reinstate its ASP plus 6% payment rate. If CMS took this step, it could shed light into CMS’s approach to payment years 2021 and 2022 where it relied, in part, on its flawed 2020 acquisition cost survey to continue its ASP minus 22.5% payment policy. Alternatively, CMS may attempt to rely on acquisition cost data obtained in its 2020 acquisition cost survey to continue its ASP minus 22.5%. If it does, there may be litigation challenging the validity of the survey itself and any resulting payment rules that vary reimbursement by hospital group. When CMS conducted its survey, it did not seek acquisition cost data from non-340B hospitals, and the

The decision does not change reimbursement for 340B drugs in the near term. However, key issues remain including how CMS will fund and pay underpaid claims... how will the Supreme Court’s decision impact payments in 2020-2022 reimburse all hospitals at the same rate. The decision does not change reimbursement for 340B drugs in the near term. However, key issues remain including how CMS will fund and pay underpaid claims to 340B hospitals for payment years 2018 and 2019, how will the Supreme Court’s decision impact payments in 2020-2022, and how will CMS change its payment policy on a go-forward basis, if at all. One key item to watch closely is CMS’s upcoming CY 2023 Outpatient Prospective Payment System proposed rule (Proposed Rule). CMS’s payment

see SCOTUS...page 14

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Austin Medical Times

Oncology Research What You Should Know About Sarcoma, A ‘Forgotten Cancer’ By R. Scott Lawson, Sarcomas are a rare and M.D., Texas Oncology– varied group of cancers and are more New Braunfels and San prevalent in children than adults. They Marcos affect the body’s connective tissue and

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ou’ve discovered an unexplained lump in your child’s knee that isn’t painful and can’t be connected to an injury or fall. Surely it isn’t cancer. Or could it be a rare form of cancer known as sarcoma? Referred to as a “forgotten cancer” due to its rarity, sarcoma accounts for about one percent of all adult cancer diagnoses but is seen more commonly in children and teens. Because it forms deep in the body, sarcoma can be difficult to detect in its early stages. With Sarcoma Awareness Month in July, here’s what you should know about the signs and risk factors associated with sarcoma. What is sarcoma?

are categorized based on whether they arise in soft tissue or bone. They can occur anywhere in the body, but most usually form in the legs, hands, arms, abdomen, head, neck, and chest. Soft tissue sarcomas typically originate from cells of muscle, fat, nerves, fibrous tissue, or blood vessels, primarily found in the arms and legs. The most common types that affect bone include osteosarcoma and Ewing sarcoma. • Osteosarcoma is found most often in the bones around the knee, and it impacts the part of the bone that gives bone its strength. • Ewing sarcoma most often occurs in the bones of the pelvis, chest wall, or the middle of long leg bones, but it can also present in soft tissue. What is my – or my child’s – risk of developing sarcoma?

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While there are no definitive reasons for the development of sarcoma, risk factors include receiving high doses of radiation therapy (likely treating other cancers) or damage to the lymph system through surgery or radiation. Other risk factors include exposure to certain herbicides and individuals with inherited diseases, such as Li-Fraumeni syndrome and retinoblastoma. If your family has a history of sarcoma or other cancers that developed at a young age, you should discuss the benefits of genetic testing with your physician. What are the signs and symptoms of sarcoma? Sarcoma can go undetected for a long period of time. Often, people will notice a lump that may or may not hurt and has grown over time (weeks to months). As the tumor grows, it can cause increasing pain, swelling, bone fractures, numbness, tingling, or weakness in the affected limbs. Approximately four in 10

sarcomas begin in the abdomen. The symptoms often come from other problems caused by the tumor, such as blockage or bleeding of the stomach or bowels. The tumor can press on nerves, blood vessels, or nearby organs and may even grow large enough to be felt in the belly. How is sarcoma treated? Once sarcoma is diagnosed, treatment is based on a variety of factors including the type, size, location, and stage of the tumor, as well as the patient’s overall health. If the tumor is found at an early stage and has not spread, surgery is often an effective option, and many patients are cured. Some patients may receive additional treatments, see Oncology ...page 14

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Mental Health Major Depressive Episodes Rising in Adolescents, Especially Minorities Study shows racial and ethnic minority adolescents are more likely to experience major depressive episodes, but less likely to use mental health services By George Hale

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growing number of adolescents have been facing mental health challenges in recent years. In 2017, more than 13 percent of Americans between the ages of 12 and 17 had been diagnosed with a major depressive episode (MDE), and one study from 2019 found that nearly 20 percent of U.S. high school students reported suicidal thoughts during a one-year period. Major depression can lead to a variety of problems with adolescents’ family and social lives and academic performance. Researchers have investigated various individual risk factors for MDE, rates of diagnosis and use of

mental health services. However, fewer studies have looked into how social involvement may affect MDE rates or explored possible racial and ethnic disparities in MDE rates and mental health service use. A new study published in the Journal of Affective Disorders attempts to build on what we know about major depression in adolescents. Ping Ma, PhD, assistant professor at the Texas A&M University School of Public Health, doctoral candidate Qiping Fan and others examined MDE in adolescents from 2010 to 2018. Their analysis estimated trends in MDE prevalence over that period, looked into possible racial and ethnic disparities in MDE prevalence and mental health services use, and investigated how factors like social engagement and family structure affect MDE and mental health services use. Having experienced a major depressive episode can be defined as

having five or more of nine symptoms, including depressed mood, loss of interest in daily activities, problems with weight, sleep, energy, concentration or self-worth, or thoughts of death during a period of two weeks or more. MDE can have varying effects on life activities, with some cases causing severe disruption to school, family life and other activities. Participating in school, community and other activities may promote mental health by improving social connections and support. Getting timely help from mental health care service providers can reduce MDE-related negative effects on an adolescent’s life activities. The researchers used data from the National Survey on Drug Use and Health from 2010 to 2018. This nationally representative dataset included responses from more than 130,000 American adolescents aged 12 to 17. The study looked at weighted

percentages of adolescents receiving a major depressive episode diagnoses in the past year, the degree to which the MDE affected life activities like school, chores at home and close relationships with family and friends, and whether the respondents had seen a health professional for their MDE symptoms in the past year. In their analysis, the researchers included data on family structure, participation in youth activities, substance use, and demographic characteristics like age, gender, race and ethnicity. The analysis found that MDE prevalence in adolescents grew from

see Mental Health...page 14

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UTSW Researchers Develop Blood Test to Predict Liver Cancer Risk Protein Levels in Blood Samples of Patients with Nonalcoholic Fatty Liver Disease Reveal Those At Highest Risk Who Should Be Screened Regularly For Liver Cancer

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n estimated one-quarter of adults set of 133 genes that were expressed in the U.S. have non-alcoholic at levels higher or lower than average fatty liver disease (NAFLD), an excess of fat in liver cells that can cause chronic inflammation and liver damage, increasing the risk of liver cancer. Now, UT Southwestern researchers have developed a simple blood test to predict which NAFLD patients are most likely to develop liver cancer. “This test lets us noninvasively identify who should be followed most closely with regular ultrasounds to screen for liver cancer,” said Yujin Hoshida, M.D. Ph.D., Associate Professor of Internal Medicine in the Division of Digestive and Liver Diseases at UTSW, Yujin Hoshida, M.D., Ph.D., Associate Professor of Internal Medicine a member of the Harold Credit: UT Southwestern Medical Center C. Simmons Comprehensive Cancer Center, and senior author of the paper in the livers of patients who developed published in Science Translational HCC over a 15-year follow-up period. The patients were then stratified into Medicine. NAFLD is rapidly emerging as a high- and low-risk groups based on major cause of chronic liver disease in how much these genes were expressed. the United States. With rising rates of Over 15 years after the samples were obesity and diabetes, its incidence is taken, 22.7% of those in the high-risk expected to keep growing. Studies have group were diagnosed with HCC while found that people with NAFLD have no patients in the low-risk group were up to a seventeenfold increased risk diagnosed. “This test was especially good of liver cancer. For NAFLD patients believed to be most at risk of cancer, at telling us who was in that low-risk doctors recommend a demanding group,” said Dr. Hoshida, who directs screening program involving a liver UTSW’s Liver Tumor Translational ultrasound every six months. But Research Program. “We can much pinpointing which patients are in this more confidently say now that those group is challenging and has typically patients don’t need to be followed very closely.” involved invasive biopsies. The researchers also converted Naoto Fujiwara, M.D., Ph.D., Research Scientist in the Hoshida lab, and the liver gene panel into four proteins his colleagues wondered whether whose levels could be measured blood samples from NAFLD patients in blood samples for easier risk could reveal those at highest risk of assessment. When patients were hepatocellular carcinoma (HCC), the stratified into high- and low-risk most common form of liver cancer. In groups based on these proteins, 37.6% the new study, they analyzed samples of patients in the high-risk group from 409 NAFLD patients to reveal a see Liver Cancer ...page 14

July 2022

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July 2022


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Healthy Heart

FEEL GOOD AGAIN

Lifestyle Changes, Meds Effective to Prevent or Delay Type 2 Diabetes: No Change in CVD By Megan Jameson

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lifestyle intervention program of increased physical activity, healthy eating and aiming for weight loss of 7% or more, or taking the medication metformin were effective long-term to delay or prevent Type 2 diabetes in adults with prediabetes. Neither approach, however, reduced the risk of cardiovascular disease for study participants over 21 years of the study, according to the findings of the multicenter Diabetes Prevention

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Program Outcomes Study (DPPOS), published in the American Heart Association’s flagship, peer-reviewed journal Circulation. The DPPOS evaluated 21-years of follow-up (through 2019) for the 3,234 adults who participated in the original, 3-year Diabetes Prevention Program (DPP) trial. After an average 21 years of follow-up, researchers found no significant differences in the incidence of heart attacks, stroke or cardiovascular death among the three intervention groups: • There was a continued reduction or delay in the development of T2D for up to 15 years. • The number of non-fatal heart attacks across each group was similar: 35 heart attacks occurred in the lifestyle intervention group; 46 in the metformin group; and 43 in the placebo group. • Similarities were also found in the number of non-fatal strokes: 39 incidences of stroke in the lifestyle intervention group; 16 in

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the metformin-only group; and 28 in the placebo group. • The number of deaths due to cardiovascular occurrences were low: 37 deaths among the lifestyle intervention participants; 39 in the metformin group; and 27 in the participants who took the placebo during the original DPP trial. “It’s important to note that most study participants also received treatment with cholesterol and blood pressure medications,” said Ronald B.

Goldberg, M.D., chair of the writing group for the DPPOS and a professor of medicine, biochemistry and molecular biology in the division of diabetes, endocrinology and metabolism, and senior faculty member and co-director of the Diabetes Research Institute Clinical Laboratory at the University of Miami’s Miller School of Medicine in Miami, Florida. “Therefore, the low rate of development of cardiovascular disease found overall may have been due to these medications, which would make it difficult to identify a beneficial effect of lifestyle or metformin intervention.” ”These long-term findings confirm the link between Type 2 diabetes and cardiovascular disease is complex and requires more research to understand it better,” said the American Heart Association’s Chief Medical Officer for Prevention Eduardo Sanchez, M.D., M.P.H., FAHA, FAAFP, and clinical lead for Know Diabetes by Heart, a see Healthy Heart ...page 13


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Hospital News TCAI At St. David’s Hosted International Conference on Complex Cardiac Arrhythmias

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n June 2 and 3, 2022, the Texas Cardiac Arrhythmia Institute (TCAI) at St. David’s Medical Center hosted its sixth international symposium on complex arrhythmias, EPLive 2022. This year’s event had more than 1,250 people register, a record number, with more than 150 who attended in person. There were attendees from all over the globe, including Singapore, Thailand, Tunisia, Germany, Korea and Greece. Participants included practicing clinical cardiac electrophysiologists, electrophysiologist fellows and general cardiologists

who have an interest in treating complex cardiac arrhythmias—a condition in which the heart beats with an irregular or abnormal rhythm. The primary teaching tool was live cases broadcast from the new, state-of-the-art Electrophysiology Center at St. David’s Medical Center, with expert commentary. Live cases performed during EPLive 2022 featured new technologies pioneered by physicians at TCAI, including irreversible electroporation, which helps heart arrhythmia patients by using controlled electric fields to create tiny scars in the heart to block irregular electric signals, and thus, potentially reducing the risk

of damage to a patient’s veins, arteries, or nerves. “From the cutting-edge technology that was unveiled to our record registration numbers, this was truly our most momentous EPLive to date,” Andrea Natale, M.D., F.H.R.S., F.A.C.C., F.E.S.C., cardiac electrophysiologist and executive medical director of TCAI and EPLive course director, said. “EPLive plays a leading role in expanding the scope of electrophysiology treatment options, which we hope positively impacts the lives of patients worldwide.”

VA Develops National Standards for Health Care Professionals

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he Department of Veterans Affairs published its first of 50 draft national standards of practice in the Federal Register June 30, for Blind Rehabilitation Specialists and Visual Impairment Services Teams Coordinators. National standards of practice are a standardized set of services that all health care professionals in a given occupation can perform within VA, regardless of what is permitted by state licensure, certification or registration, per Authority of VA Professionals to Practice Health Care. “VA is undertaking a multi-year endeavor to develop national standards of practice for each of its 50 health care professions to ensure the continued safe, high-quality care for our nation’s Veterans,” said Deputy Under Secretary for Health Performing the Delegable Duties of Under Secretary for Health Steven Lieberman, M.D. “These standards will ensure VA health care professionals are able

to deliver services in regions other than where they may be licensed, registered, certified or limited by a state requirement, so Veterans can get the care they need, when they need it.” The proposed national standard of practice for Blind Rehabilitation Specialists is consistent with the four national certifications from the Academy for Certification of Vision Rehabilitation and Education Professionals; therefore, Blind Rehabilitation Specialists will continue to practice in VA as set by their national certification. There is no national or state license or certification for Visual Impairment Services coordinators. They will adhere to the national standard for the occupation in which they hold a license, certification or registration. The development of national standards of practice enables VA to move health care professionals seamlessly throughout the organization. Further, national

standards will support VA health care professionals practicing across state lines and creates standardized practice and business operations across VA medical facilities. VA is using a robust, interactive development process for these national standards that includes consultation with internal and external stakeholders, including state licensing boards, VA employees, federal labor partners, professional associations, Veteran Service Organizations, and others. VA will share all draft standards on the Federal Register. Veterans, the public, professional associations and medical leadership are welcome to provide their comments during the 60-day posting period. VA employees will have a separate, internal mechanism to provide comments during the 60-day posting period. Comments will be reviewed and considered before VA finalizes each national standard of practice. Information pertaining to timing

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of all VA national standards and hyperlinks to the appliable commenting platform can be found on the National Standards website. The final national standards of practice will be approved by VA leadership and published as an appendix into a new Veterans Health Administration policy. The policy will establish basic principles that apply across all national standards of practice, including oversight, reporting, implementation, training, and recertification. VA values input and feedback from the VA workforce and external stakeholders. Please visit the National Standards website https://www.va.gov/ standardsofpractice/ for additional information and to subscribe to the newsletter. 

July 2022


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St. David’s Healthcare Facilities Recognized for Excellence In Cardiac Care By Healthgrades

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St. David’s Medical Center, Including Heart Hospital of Austin, Named to Healthgrades 2022 America’s 100 Best Hospitals for Cardiac Care

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oday, St. David’s HealthCare announced that St. David’s Medical Center, including Heart Hospital of Austin, received the Healthgrades 2022 America’s 100 Best Hospitals for Cardiac Care Award™. St. David’s Medical Center is one of just four hospitals in the state of Texas to earn this distinction from Healthgrades, the leading resource that connects consumers, physicians and health systems.

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HealthCare, said. “We are proud of the physicians, nurses and staff who deliver the highest quality patient care at these facilities.” Healthgrades compared America’s 100 Best Hospitals for Cardiac Care Award recipients as a group, to all other hospitals as a group and found that, from 2018-2020, patients treated at hospitals achieving this award had, on average, 27.8% lower risk of dying

This award honors hospitals that deliver superior patient outcomes in heart bypass surgery, coronary interventional procedures, heart attack treatment, heart failure treatment and heart valve surgery. Healthgrades evaluated nearly 4,500 hospitals nationwide for 31 of the most common inpatient procedures and conditions. “St. David’s HealthCare is able to treat the most complex cardiac cases, thanks to the best-in-class treatments offered at Heart Hospital of Austin and St. David’s Medical Center,” Ken Mitchell, M.D., chief medical officer of St. David’s

than if they were treated in hospitals that did not receive the award.* Earlier this year, St. David’s Medical Center—including Heart Hospital of Austin—received the Healthgrades 2022 America’s 100 Best Hospitals for Coronary Intervention Award™.

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To learn more about how Healthgrades determines award recipients or for more information on Healthgrades Quality Solutions, please visit Healthgrades.com/ Quality.


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Walking Towards Healthier Knees

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new study published today in Arthritis & Rheumatology led by researchers at Baylor College of Medicine reveals that walking for exercise can reduce new frequent knee pain among people age 50 and older diagnosed with knee osteoarthritis, the most common form of arthritis. Additionally, findings from the study indicate that walking for exercise may be an effective treatment to slow the damage that occurs within the joint. “Until this finding, there has been a lack of credible treatments that provide benefit for both limiting damage and pain in osteoarthritis,” said Dr. Grace Hsiao-Wei Lo, assistant professor of immunology, allergy and rheumatology at Baylor, chief of rheumatology at the Michael E. DeBakey VA Medical Center and first author of the paper. The researchers examined the results of the Osteoarthritis Initiative, a multiyear observational study

where participants self-reported the amount of time and frequency they walked for exercise. Participants who reported 10 or more instances of exercise from the age of 50 years or later were classified as “walkers” and those who reported less were classified as “non-walkers.” Those who reported walking for exercise had 40% decreased odds of new frequent knee pain compared to non-walkers. “These findings are particularly useful for people who have radiographic evidence of osteoarthritis but don’t have pain every day in their knees,” said Lo, who also is an investigator at the Center for Innovations in Quality, Effectiveness, and Safety at Baylor and the VA. “This study supports the possibility that walking for exercise can help to prevent the onset of daily knee pain. It might also slow down the worsening of damage inside the joint from osteoarthritis.”

Lo said that walking for exercise has added health benefits such as improved cardiovascular health and decreased risk of obesity, diabetes and some cancers, the driving reasons for the Center for Disease Control recommendations on physical activity, first published in 2008 and updated in 2018. Walking for exercise is a free activity with minimal side effects, unlike medications, which often come with a substantial price

tag and possibility of side effects. “People diagnosed with knee osteoarthritis should walk for exercise, particularly if they do not have daily knee pain,” advises Lo. “If you already have daily knee pain, there still might be a benefit, especially if you have the kind of arthritis where your knees are bow-legged.”

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Age Well, Live Well Health Benefits of Social Wellness By Claire Irwin, HHS Age Well Live Well

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ating a variety of healthy foods, moving more and having annual health screenings are steps to take to be healthier. However, the health of our social lives is often not considered. Positive relationships with family, friends and co-workers affect our health. Our relationships and how connected we are to the community around us gives us a social context. This social context is so important that it is one of the five key social determinants of health. According to the Centers for Disease Control and Prevention, social determinants of health are “conditions in the places where people live, learn, work and play that affect a wide range of health risks and outcomes.” Receiving community support and the comfort found in positive relationships can help alleviate or prevent social isolation, which can lead to loneliness.

Addressing the issue of social isolation is important as studies have found social isolation is associated with an increased risk for mortality. Older adults are affected as well with about 43% of adults age 60 and older reporting that they feel lonely. While loneliness has been an issue for older adults for some time, the pandemic and recommendations for older adults to isolate for their protection compounded the impacts. The good news is social connection can help and there are actions that can be taken to address loneliness. A 2020 profile recommended the following tips: • Participate in social activities. Consider connecting regularly with friends, volunteering or a social club. • Invest in existing positive relationships. Spend time with people who are already in your social circle and work on strengthening those relationships.

Find local resources to address barriers to connection. Texas Health and Human Services Aging Services Coordination launched the Know Your Neighbor campaign to encourage Texans to form and maintain new connections with older neighbors to help reduce the risks of isolation and loneliness. Having a supportive neighbor can help older adults stay connected as they age, and the campaign works to strengthen those connections and grow the social networks of older adults. The campaign uses five steps to encourage engagement: •

• • •

and introduce yourself. Step 2: Invite your neighbor to a get-together. Step 3: Engage your neighbor in conversation. Step 4: Help your neighbor connect to community resources if needed. Step 5: Encourage others to engage with Know Your Neighbor.

Resources are provided to make creating connections in your own neighborhood easier Learn more by visiting the Age Well Live Well webpage.

Step 1: Reach out to your neighbor

Subscribe to Our Digital Issue Now you can get the Austin Medical Times delivered straight to your inbox. Never miss an Issue of Austin’s Leading Local Healthcare News Online.

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Study Offers Insight into Management of Patients Who Have Interstitial Pneumonia with Autoimmune Features

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nterstitial pneumonia with autoimmune features (IPAF) is a disease with many possible causes and no standard of care, making it particularly difficult to treat. While immunosuppressant drugs are primarily prescribed, they don’t work for all patients. A new study of patients treated for IPAF at UT Southwestern offers insight into the disease, which can result in a reduced quality of life and sometimes early death. Among their findings, the researchers discovered that a combination therapy of mycophenolate mofetil and prednisone was associated with a lack of disease progression. The study was published in the Journal of Clinical Rheumatology. “Some patients with IPAF don’t require any treatment at all and some seem to not respond to immunosuppression. Clinicians are now finding that a new class of medications called antifibrotics may be an appropriate treatment, but we still don’t know which IPAF patients need to be treated with immunosuppression and which need to be treated with antifibrotics or both,” said Elena Joerns, M.D., a postdoctoral fellow in the Division of Rheumatic Diseases at UT Southwestern, who led the study with Una Makris, M.D., Associate Professor of Internal Medicine and Population and Data Sciences. Drs. Joerns and Makris, working with colleagues from the Division of Rheumatic Diseases

and the Division of Pulmonary and Critical Care Medicine, sought to define features of IPAF that would predict which patients will respond favorably to immunosuppression. Una Makris, M.D. (left) and Elena Joerns, M.D. (right) Credit: UT Southwestern Medical Center Crucially, the identification of such features would help to guide to be predictive of worse mortality. pathogenesis of IPAF.” The study was limited by Other UTSW researchers who physicians on the best treatment for a small cohort of patients from contributed to the study include their patients. To this end, the researchers a single center. Additionally, Traci N. Adams, Chad A. Newton, reviewed medical records of the characteristics that could be Bonnie Bermas, David Karp, Kiran 63 patients with IPAF. They evaluated were limited to those Batra, Jose Torrealba, Lesley Davila, evaluated clinical, serologic, and in the medical records. Dr. Joerns Joan Reisch, and Craig Glazer. The study was supported by morphologic disease features, as explained that patients do not all receive the same battery of tests a Ruth L. Kirschstein Institutional well as demographic characteristics. The group did not find any when diagnosed. More in-depth National Research Service Award characteristics associated with a serologic workups of IPAF patients (T32). may be needed to improve diagnoses Dr. Bermas holds the response to immunosuppression. “Although we did not find and identify features predictive of Dr. Morris Ziff Distinguished Professorship in Rheumatology. Dr. statistically significant differences, response to immunosuppression. The study results underscore Karp holds the Fredye Factor Chair we did identify trends that could be informative for future studies. the challenges in treating IPAF in Rheumatoid Arthritis Research For example, no patient positive for and the mystery that surrounds this and the Harold C. Simmons Chair in Arthritis Research. Dr. Torrealba anti-synthetase antibody progressed newly defined disease. “There is still a lot to holds the Drs. George and Anne and there was greater progression among men and former or current learn about IPAF so that we can Race Distinguished Professorship of smokers, which aligns with findings optimally manage this patient Pathology.  from other studies,” said Dr. population,” said Dr. Joerns, who Makris. Moreover, the study found is pursuing further research. “But that immunosuppressive therapy we have an excellent collaboration with mycophenolate mofetil and at UT Southwestern between Pulmonology, prednisone was associated with Rheumatology, Radiology, and Pathology, all of lack of disease progression in immunosuppressed IPAF patients, whom are essential for classifying including those with usual and managing these patients, interstitial pneumonia pattern, a which makes our center well poised feature suggested by some cohorts to answer these questions on the

Healthy Heart Continued from page 8 collaborative initiative between the American Heart Association and the American Diabetes Association addressing the link between diabetes

and cardiovascular disease. “However, these important results also tell us that lifestyle intervention is incredibly effective to delay or prevent Type 2

diabetes, which, itself, reduces the risk for cardiovascular disease. The CDC estimates nearly 1 of every 3 adults in the U.S. has prediabetes, therefore,

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preventing or delaying Type 2 diabetes is a public health imperative to help extend and improve the lives of millions of people.”

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Austin Medical Times

SCOTUS

Continued from page 1 data collection methods presented challenges with reporting consistent data. SCOTUS’s opinion is a much needed and clear win for 340B hospitals. Impacted 340B hospitals

should assess claims from 2018 and 2019 for separately payable, non-passthrough Part B drugs that were paid at the lower ASP minus 22.5% rate and calculate what overall reimbursement should have been had the claims been paid at

the standard ASP plus 6% rate. While CMS’s upcoming Proposed Rule could answer several unanswered questions, impacted hospitals may need to conduct a similar review for 2020-present claims at some point soon.

Director of Media Sales Richard W DeLaRosa Senior Designer Jamie Farquhar-Rizzo

Oncology Continued from page 3 such as radiation or chemotherapy, to improve the chances of eliminating all cancerous cells. While there are no known ways to completely prevent the development

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of sarcoma, regular checkups with your physician are important for early detection. If you are diagnosed with sarcoma or any other type of cancer, an early diagnosis is key to a better

outcome from treatment and an increased chance of survival.

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Continued from page 4 around 8 percent in 2010 to more than 14 percent in 2018. At the same time, use of mental health services remained low, with only about one-third of adolescents getting help from qualified professionals. The researchers also found that adolescents in racial and ethnic minority populations had higher MDE rates and lower services use than white adolescents. However, their analysis also found an association between participating in school, community or other activities and lower MDE prevalence. The reasons for the racial and ethnic disparities are unclear. The researchers identified sociodemographic factors,

discrimination, cultural perceptions of mental illness and mistrust of the health care system as possible contributing issues; however, there is a need for more research into these disparities. The disparities in MDE diagnosis and services use point to a need for further study and for improving mental health care interventions for more vulnerable populations. Developing a more diverse population of mental health professionals and training providers to be more culturally aware and responsive when working with minority adolescents could lead to improved care. In addition, future interventions that consider gender differences in mental health and

service use could be beneficial as this study found differences between male and female MDE prevalence and service use across the board. The researchers also identified a need to improve social support in depressed adolescents. The findings of this study show increasing trends in major depressive episode prevalence and the need for tailored interventions to increase use of mental health services, especially in vulnerable adolescent populations.

liver inflammation and HCC risk, including bariatric surgery, cholesterol drugs, and an immunotherapy. “This means we could actually use these panels of molecules to track how well patients are doing over time or to inform potential effectiveness of medical interventions to reduce liver cancer risk,” said Dr. Hoshida. For instance, the protein blood test, dubbed PLSec-NAFLD, is already being used to monitor the effectiveness of a cholesterol drug in reducing liver

cancer risk in an ongoing clinical trial. Dr. Hoshida’s team is planning to continue assessing the utility of PLSec-NAFLD in larger groups of patients around the world. They also say that in the future, blood tests could be developed to measure cancer risk in other major liver diseases such as hepatitis B and alcoholic liver disease

Liver Cancer Continued from page 6 were diagnosed with HCC during the 15-year follow-up period while no patients in the low-risk group were diagnosed. Most of the genes and proteins found to be predictive of HCC risk were immune and inflammatory molecules, which points toward the importance of inflammation in HCC development. Moreover, the researchers showed that levels of the molecules changed in conjunction with therapies known to decrease July 2022

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