Anthem (United States)

Disclosure: H.M. Heshmati: None. N. Zameni: None.Background: Robotic surgery is quickly replacing traditional surgery performed by humans. It has significantly influenced the field of endocrine surgery. This review presents an update on the use of robotic surgery and artificial intelligence for adrenal tumors. Methods: A systematic search of literature was conducted using the search terms robotic surgery, artificial intelligence, adrenal tumors, safety, outcome, and cost. Results: Adrenal tumors are found in 10% of people who have imaging of the adrenal gland. They are typically unilateral and benign in the majority of cases. Robotic systems such as da Vinci Surgical System provide surgeons with enhanced dexterity and 3D visualization. Autonomous surgical robots can be categorized into various levels of autonomy including supervised autonomy (e.g., performance of specific tasks with human oversight), collaborative autonomy (e.g., robots working alongside human surgeons, sharing tasks and responsibilities), and fully autonomous systems (e.g., robots performing entire surgical procedures independently with human intervention when necessary). Robotic surgery allows access through tight spaces to remove adrenal tumors with small incision and minimal impact on surrounding tissues. The review of 1,162 patients who underwent adrenalectomy (robotic surgery in 747 patients, laparoscopic adrenalectomy in 415 patients) showed comparable blood loss and complications with the two techniques but patients with robotic surgery had significantly shorter hospital stay. The future of robotic surgery can be revolutionized by the integration of autonomous robots and artificial intelligence (AI), a field rapidly advancing. These innovations promise to further enhance the precision, safety, and effectiveness of surgery involving the adrenal glands. AI-powered systems provide real-time guidance and feedback to surgeons, enhancing decision-making and surgical precision. Autonomous systems can ensure consistent execution of surgical tasks, reducing variability and enhancing patient safety. AI algorithms can analyze extensive surgical data to refine techniques and predict potential complications, improving surgical outcomes. AI can customize surgical plans based on individual patient anatomy and pathology, potentially leading to better outcomes. The current high cost of these new procedures is a potential limitation for their use. Conclusion: Robotic surgery represents significant progress in minimally invasive techniques for the removal of adrenal tumors. It has improved dexterity and precision, and is associated with shorter recovery time compared to laparoscopic adrenalectomy. Collaboration between human surgeons and robotic systems can improve patient care and surgical outcomes. The precision, safety, and effectiveness of the adrenal surgery can be further enhanced by the integration of AI and robotics.Presentation: Saturday, July 12, 2025

Disclosure: H.M. Heshmati: None. H.S. Abu-Lebdeh: None.Background: Growth differentiation factor 15 (GDF15) is a peptide hormone produced by the placenta during pregnancy and by several other organs (e.g., prostate, bladder, kidney, pancreas, and endometrium). It is a member of the transforming growth factor-β superfamily. The gene encoding for GDF15 is located on chromosome 19. The mature GDF15 has 112 amino acids and binds to glial cell-derived neurotrophic factor family receptor alpha-like. GDF15 is involved in the maintenance of homeostasis and contributes to the pathogenesis of several medical conditions. This literature analysis provides an update on the relevance of GDF15 in health and few selected diseases. Methods: A systematic search of literature was conducted using the search terms growth differentiation factor 15, pregnancy, heart failure, anorexia, obesity, diabetes, and cancer. Results: In control subjects, the median serum GDF15 level is around 680 pg/mL and increases with aging. There is an increase in GDF15 secretion during pregnancy (third trimester serum levels > 20,000 pg/mL) and under other stressful conditions such as inflammation, myocardial ischemia, pulmonary diseases, diabetes, and cancer. GDF15 is involved in the maintenance of cell and tissue homeostasis. It has anti-inflammatory, immunomodulatory, and anorectic properties. The high serum GDF15 levels observed during pregnancy plays an important role in the feto-maternal immunotolerance. Low serum GDF15 levels have been reported in pregnancies with complications (e.g., preeclampsia and miscarriage). Serum GDF15 levels are negatively correlated with body mass index. Treatment with metformin in patients with or without type 2 diabetes stimulates GDF15 production, and this can explain, at least in part, the weight-loss property of metformin. In patients with heart failure or cancer, the increased serum GDF15 levels contribute to cachexia (anorexia and weight loss). Serum GDF15 level has the potential to be used as a biomarker for disease diagnosis and prognosis (e.g., biomarker for heart failure and pancreatic cancer). High serum GDF15 levels are associated with poor prognosis and predict all-cause mortality. Based on the GDF15 properties related to appetite and body weight control, GDF15 analogs and antagonists can be considered in the weight management of various conditions such as obesity (induction of anorexia with GDF15 analogs), and heart failure or cancer (reduction of cachexia with GDF15 antagonists). Conclusion: GDF15, a hormone synthesized by several organs including placenta, prostate, bladder, kidney, pancreas, and endometrium, has an important role in multiple physiological and pathological conditions. Its serum level can be considered as a biomarker for the diagnosis and prognosis of several diseases. GDF15 analogs and antagonists have the potential to be used in the weight management of obesity and cardiac or cancer cachexia.Presentation: Sunday, July 13, 2025

Selenium, a trace element present in specific selenoproteins, is essential for thyroid hormone metabolism. Selenium is also an antioxidant with immunosuppressive properties and may help in managing thyroid autoimmune diseases, including Graves’ (GD) hyperthyroidism and Graves’ ophthalmopathy (GO). There were 320 clinical studies related to selenium and thyroid published in English and French between January 1, 2000, and June 1, 2023. Our focus was to identify studies reporting levels of serum selenium in patients with GD and studies that assessed the effect of selenium supplementation on outcomes of GD hyperthyroidism and GO. We also reviewed 20 systematic reviews and meta-analyses of randomized controlled trials that reported selenium levels in GD and the effects of supplementation on GD and GO outcomes. Our review showed that patients with GD had serum selenium levels lower than those of various control patients. In the short-term, a selenium supplement to antithyroid drugs showed benefit for GD hyperthyroidism in most studies, but long-term benefits and positive effects on remission rate were unclear. Some studies did not show benefit. The benefits may depend on baseline selenium deficiency. Two randomized controlled trials showed positive effects of supplementation for mild GO; however, studies about moderate and severe GO are still needed. There is evidence for benefit with short-term selenium supplementation for GD hyperthyroidism, but controlled studies are needed to assess long-term benefits, and benefits in selenium-sufficient areas.

Apply It! • Understanding the core pillars of Lifestyle Medicine (LM) • Learn how the growth of LM will impact the health and fitness professional (HFP) • Explore the elements used by the HFP in executing his or her portion of the LM prescription • Uncover responsibilities and resources required to be a trusted member of the LM practitioner's team

Purpose: Recent trends in US healthcare have seen growing consolidation of healthcare providers, including radiology groups, with fewer and larger radiology groups. We assessed recent trends and characteristics in radiology group network market share (NMS) across the US among Medicare beneficiaries. Methods: Using freely available datasets CareSet DocGraph Hop Teaming, Medicare Physician Compare, and Medicare Physician and Other Supplier Public Use File (PUF), all radiologists were identified and associated to group practices annually between 2014 and 2017. Radiology groups outside the US, not present in all three databases, or with only one radiologist were excluded. The annual frequency of radiological exams performed was determined from the PUF and used to calculate the percentage of magnetic resonance and computed tomography (MR/CT) imaging performed as well as the number of beneficiaries undergoing MR/CT per radiology group. Physician referrers without evaluation and management codes for office visits in the PUF file were excluded from the DocGraph file. Provider connections were geospatially mapped and plotted. The percentage of radiology group NMS was calculated as the number of patients a group received, divided by the total number of potential and actual connections, and multiplied by 100. Univariate analysis of radiology group NMS was performed against a variety of characteristics and compared using Kruskal-Wallis and Dunn tests, as appropriate. Univariate linear regression was used to assess the association between NMS and calendar year, as well as average wait time and calendar year. Multivariate linear regression was used to model the radiology group cumulative normalized percentile NMS, with multiple predictors for the year 2017. Results: Between 2014 and 2017, 1,764 unique radiology groups were identified, representing 17,879 radiologists in 2014, 18,143 radiologists in 2015, 20,915 radiologists in 2016, and 22,187 radiologists in 2017, with an average NMS per group for 2014 of 14.8%, 2015 of 14.5%, 2016 of 13.6%, and 2017 of 13.1%, demonstrating a small but statistically significant negative trend over four years (2014-2017), with a 0.6% decrease per year (P < 0.001). Average day weight across years (2014-2017) demonstrated a slight upward trend, with a 0.3% increase per year. The yearly percentage of MR/CT studies across all groups was 24.6-26.6%, with the most performed studies being chest radiography, mammography, and CT of the head without contrast. Univariate analysis of radiology group NMS was not significantly different between academic and nonacademic groups for all years (P > 0.05) but was significantly different for radiology-only versus multispecialty groups across all years (P < 0.05). Multivariate linear regression on 2017 data demonstrated statistically significant independent negative predictors for NMS including larger group size (50-99, >=100), higher practice MR/CT imaging percentage, and South location, while the increasing log of the number of beneficiaries undergoing MR/CT was a positive predictor, with an adjusted R-squared of 0.56 (all P < 0.01). Conclusions: Among Medicare beneficiaries from 2014 to 2017, radiology group NMS (mean 14%, median 9.0%, IQR 4-19.2%), slightly decreased over time by 0.6% per year, despite occurring during a period of widespread practice consolidation. The negative predictors for NMS at the group level included larger group size, South region, increased average wait time, and higher MR/CT imaging percentage, while the positive predictor was the increased number of beneficiaries undergoing MR/CT. Of these predictors, radiology groups are most likely to increase NMS by decreasing average wait times.

BackgroundIt is increasingly recognized that policies have played a role in both alleviating and exacerbating the health and economic consequences of the COVID-19 pandemic. There has been limited systematic evaluation of variation in U.S. local COVID-19-related policies. This study introduces the U.S. COVID-19 County Policy (UCCP) Database, whose objective is to systematically gather, characterize, and assess variation in U.S. county-level COVID-19-related policies.MethodsIn January-March 2021, we collected an initial wave of cross-sectional data from government and media websites for 171 counties in 7 states on 22 county-level COVID-19-related policies within 3 policy domains that are likely to affect health: (1) containment/closure, (2) economic support, and (3) public health. We characterized the presence and comprehensiveness of policies using univariate analyses. We also examined the correlation of policies with one another using bivariate Spearman’s correlations. Finally, we examined geographical variation in policies across and within states.ResultsThere was substantial variation in the presence and comprehensiveness of county policies during January-March 2021. For containment and closure policies, the percent of counties with no restrictions ranged from 0% (for public events) to more than half for public transportation (67.8%), hair salons (52.6%), and religious gatherings (52.0%). For economic policies, 76.6% of counties had housing support, while 64.9% had utility relief. For public health policies, most were comprehensive, with 70.8% of counties having coordinated public information campaigns, and 66.7% requiring masks outside the home at all times. Correlations between containment and closure policies tended to be positive and moderate (i.e., coefficients 0.4–0.59). There was variation within and across states in the number and comprehensiveness of policies.ConclusionsThis study introduces the UCCP Database, presenting granular data on local governments’ responses to the COVID-19 pandemic. We documented substantial variation within and across states on a wide range of policies at a single point in time. By making these data publicly available, this study supports future research that can leverage this database to examine how policies contributed to and continue to influence pandemic-related health and socioeconomic outcomes and disparities. The UCCP database is available online and will include additional time points for 2020–2021 and additional counties nationwide.

Abstract Background: There has been a significant shift in the types of bariatric procedures being performed in the past decade, as procedures have become safer and less invasive, warranting a new data on long-term cost effectiveness. This study aims to examine the impact of bariatric procedures on a person’s long-term health care costs and compare how the impact differs by type of surgical procedure using 10-year data from 2009 -2018.Methods: This retrospective observational study compared the downstream health care cost of patients with obesity who had bariatric surgery to a matched nonsurgical cohort. Results: A total of 83 882 health plan enrollees who underwent bariatric surgery between January 2009 to December 2018, and a 1:1 matched group of health plan enrollees who were obese (body mass index≥30 kg/m2) but did not undergo bariatric surgery. The surgical group was associated with lower overall health care cost compared to the matched non-surgical group (cost ratios ranged 0.77 to 0.97, p values<.01). Lower costs were sustained during the initial six years following surgery. Majority of the cost savings came from reduced spending on prescription medications, particularly antidiabetics. However, the saving didn’t offset the initial surgery cost. Among the three most performed bariatric surgical procedures, sleeve gastrectomy was the most cost-effective.Conclusions: Post bariatric surgery cost savings have increased due to less complications and reduced medication spending, but the initial cost of bariatric surgery remains high than the savings incurred over years. This study provides recent economic data to inform policy makers and employers in designing benefits for bariatric procedures.

The integration of pharmacies with oncology practices-known as medically integrated dispensing or in-office dispensing-could improve care coordination but may incentivize overprescribing or inappropriate prescribing. Because little is known about this emerging phenomenon, we analyzed historical trends in medically integrated dispensing. Annual IQVIA data on oncologists were linked to 2010-2019 National Council for Prescription Drug Programs pharmacy data; data on commercially insured patients diagnosed with any of six common cancer types; and summary data on providers' Medicare billing. We calculated the national prevalence of medically integrated dispensing among community and hospital-based oncologists. We also analyzed the characteristics of the oncologists and patients affected by this care model. Between 2010 and 2019, the percentage of oncologists in practices with medically integrated dispensing increased from 12.8% to 32.1%. The share of community oncologists in dispensing practices increased from 7.6% to 28.3%, whereas the share of hospital-based oncologists in dispensing practices increased from 18.3% to 33.4%. Rates of medically integrated dispensing varied considerably across states. Oncologists who dispensed had higher patient volumes (P < .001) and a smaller share of Medicare beneficiaries (P < .001) than physicians who did not dispense. Patients treated by dispensing oncologists had higher risk and comorbidity scores (P < .001) and lived in areas with a higher % Black population (P < .001) than patients treated by nondispensing oncologists. Medically integrated dispensing has increased significantly among oncology practices over the past 10 years. The reach, clinical impact, and economic implications of medically integrated dispensing should be evaluated on an ongoing basis.