Review: 3 prediction rules, particularly ABCD, identify ED patients who can be discharged with low risk of stroke after TIA

From Evidence-Based Medicine:

Question

In patients with transient ischaemic attack (TIA), can physicians in the emergency department (ED) reliably use a clinical prediction rule to determine which patients can be discharged because their risk of stroke is low (1–2%)?

Review scope

Included studies reported either the derivation or validation of clinical prediction rules for determining risk of stroke within 7 days after TIA in adults. Exclusion criteria were non-acute care setting and sample of patients with known history of TIA. Outcome was risk of stroke in relation to prediction rule scores.

Chuck Grassley’s Greatest Health-Care Hits

From the Wall Street Journal Health Blog:

Sen. Chuck Grassley has been following the money in health care for years now. Yesterday, he wrote to the AMA, the American Cancer Society and a bunch of other nonprofit advocacy groups to ask how much of their funding comes from the drug, device and insurance industries.

The groups, which told the WSJ they plan to respond to the letters, have plenty of company. Here’s a quick list of some of the other Grassley pen pals. (For more, including responses from the people on the other end of the letters, follow the links in the items below.)

Nonprofit hospitals: Grassley has said some facilities may be “losing sight of the public service that comes with tax-exempt status.”

Medical Schools: He’s asked questions about industry payments to high-profile docs at medical schools including Emory, Harvard and Stanford. And just yesterday he wrote to UC San Francisco about financial issues.

The FDA: It looked like a device maker was “calling the shots” at FDA, Grassley said.

Health IT companies: Among other things, Grassley asked the companies to send him copies of “complaints and/or concerns” that health-care providers have expressed about the systems.

Drug and Device Makers: On many, many, many occasions.

States safeguarding public coverage

From Modern Healthcare:

Most states in 2009 managed to preserve or expand health coverage for children and parents despite the deep recession, according to a 50-state survey from the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.

Twenty-six states bolstered coverage for low-income children, parents and pregnant women in 2009, either by expanding eligibility, simplifying enrollment procedures or reducing financial barriers, the report found.

The renewal of the State Children’s Health Insurance Program along with the fiscal relief and Medicaid enhancements provided in the American Recovery and Reinvestment Act “proved critical to enable states to continue their commitment to providing coverage to millions of low-income families,” said Diane Rowland, executive director of the commission, in a written statement. “However, even with signs of economic recovery, state revenues are still mired in a severe slump and, faced with the end of enhanced federal money after 2010, fiscal shortfalls are likely to cause states to consider significant cuts to Medicaid and CHIP,” Rowland said.

Fifteen states did scale back coverage in their SCHIP programs during 2009 by increasing waiting periods, retracting eligibility simplifications, and enacting modest increases in SCHIP premiums. Although no state reduced eligibility for children, both California and Tennessee froze SCHIP enrollment for some period of time this year.

Forty-seven states currently cover children in families with an annual income at or higher than 200% of the federal poverty level ($36,620 for a family of three), with half (24 states) covering children in families with incomes at or greater than 250% of poverty ($45,775 for a family of three), the commission report stated.