Contextualizing the first-round failure of the AHCA: down but not out

President Trump's prescription to reduce drug prices: from the campaign trail to American Patients First

Background: Drug prices in the United States are the highest in the world, restricting access to the domestic lower income population. President Trump campaigned heavily on promises to reduce drug prices.Methods: A literature review was conducted through PUBMED, EMBASE, Media and grey literature to consolidate and analyze publications addressing President Trump's promises from the campaign trail as well as the shortcomings and achievements of the Trump administration.Results: Major promises ranged from repealing and replacing Obamacare, expanding coverage, allowing cross-state insurance purchasing, and reducing drug prices. Main accomplishments of the Trump administration have been two executive orders (13765 and 13813), the proposition of the American Health Care Act, and the passing of the Tax Cuts and Jobs Act of 2017. The American Patients First blueprint further revealed the administration's strategies for lowering drug prices. The administration has also engaged in unconventional strategies, such as via bilateral leverage directly with trade partners.Conclusion: The Trump administration has not yet been able to fulfill the major campaign promises, primarily the ones requiring legislative and/or administrative action. If enough legislative action is accomplished to implement the Trump administration's promises, the effects on the pharmaceutical industry could be direct, yet minimal, unless Medicare can directly negotiate with manufacturers.

The 100 most cited articles in the Journal of NeuroInterventional Surgery

Background

The Journal of NeuroInterventional Surgery (JNIS) published its first volume in 2009. Over the ensuing years, JNIS flourished and has published a considerable number of high-profile articles. Citation analysis is a method of quantifying various metrics related to scholarly publications.

Objective

To apply citation analysis to the 100 most cited papers in the history of JNIS.

Methods

The most cited articles in JNIS were identified by using the Web of Science database. The top 100 articles were ranked according to their number of citations. Further information was obtained for each article, including citations per year, year of publication, authorship, article topics, and article type and level of evidence.

Results

The total number of citations for the 100 most cited articles in JNIS ranged from 18 to 132 (median 26.0). Most articles (75%) were published between 2012 and 2015 and originated in the USA (79%). Eighteen authors have contributed five or more articles to the top 100 list. The most common topics are related to acute ischemic stroke and cerebral aneurysm.

Conclusions

This study highlights the influence of JNIS over its first decade by providing a comprehensive list of the 100 most cited articles and their authors as well as topics covered. This study also highlights the important factors driving the growth of JNIS.

Understanding the impact of 'cost' under MACRA: a neurointerventional imperative!

The cost of providing healthcare in the United States continues to rise. The Affordable Care Act created systems to test value-based alternative payments models. Traditionally, procedure-based specialists such as neurointerventionalists have largely functioned in, and are thus familiar with, the traditional Fee for Service system. Administrative charge data would suggest that neurointerventional surgery is an expensive specialty. The Medicare Access and CHIP Reauthorization Act consolidated pre-existing federal performance programs in the Merit-based Incentive Payments System (MIPS), including a performance category called 'cost'. Understanding cost as a dimension that contributes to the value of care delivered is critical for succeeding in MIPS and offers a meaningful route for favorably bending the cost curve.

Approaching a decade since HPV vaccine licensure: Racial and gender disparities in knowledge and awareness of HPV and HPV vaccine

Purpose: Gaps remain in the public's knowledge of the human papillomavirus (HPV). We assessed racial/ethnic and gender disparities in knowledge and awareness of HPV and the HPV vaccine among US adults.

METHODS

Data from the Health Information National Trends Survey 4 Cycle 3 (September - December 2013) and Cycle 4 (August - November 2014) were analyzed for 6,862 respondents aged 18 years and older. Weighted multivariable logistic regression models were used to estimate racial/ethnic and gender disparities in HPV knowledge and HPV vaccination awareness.

RESULTS

Sixty-six percent of respondents had heard of HPV and the HPV vaccine (57% of men vs. 75% of women). In multivariable analyses, compared with men, women were 225% (95% CI: 2.60 - 4.07) more likely to have heard of HPV, and 281% (95% CI: 3.06 - 4.74) more likely to have heard of the HPV vaccine. Non-Hispanic Blacks were 33% (95% CI: 0.47 - 0.96) and 44% (95% CI: 0.39 - 0.81) less likely than non-Hispanic Whites to have heard of HPV and the HPV vaccine, respectively. Hispanics were 27% (95% CI: 0.52 - 1.02) and 53% (95% CI: 0.34 - 0.64) less likely than non-Hispanic Whites to have heard of HPV and the HPV vaccine, respectively.

CONCLUSIONS

There was evidence of disparities in HPV and HPV vaccine awareness among men compared with women and non-Hispanic Blacks and Hispanics compared with non-Hispanic Whites. To foster improvements in HPV vaccine uptake and reduce disparities in HPV associated cancers, future interventions must target men and minority populations, for whom knowledge gaps exist.