News in Brief: Quality of life ‘substantially worse’ in progressive vs relapse onset MS; Prognostic value of low arterial oxygenation saturation in acute stroke; Call for Medicare to review procedural specialist incomes

12 Jul 2021

Impacts of MS HRQoL ‘substantially worse’ in progressive vs relapse onset

Patients with progressive onset MS (PROMS) report experiencing ‘substantially worse’ physical and and psychosocial impacts of their condition compared to patients diagnosed with relapse onset MS (ROMS), an Australian review has highlighted.

The findings from a sample of more than 1,570 participants in the Australian MS Longitudinal Study, persisted even when taking age, sex, disease duration and DMTs use into account. The largest difference was seen in independent living (-0.12), followed by relationships (-0.07), selfworth (-0.07) and coping (-0.04), say investigators from the Menzies Institute for Medical Research in Tasmania.

And while no significant differences were observed between the two onset types on physical health dimensions of pain investigators said mean pain scores were substantially lower than mean senses scores in both types, suggesting MS’s impact on pain is much stronger across both ROMS and PROMS

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Study defines prognostic value of low arterial oxygenation saturation in acute stroke

An arterial oxygen saturation (SaO2) around 96–97% is associated with the highest chance of functional recovery from acute stroke, according to a new analysis of the international Head Positioning in acute Stroke Trial

The well-known randomised trial looked at lying flat versus sitting up head positioning in more than 11,000 patients with acute stroke across nine countries including in Australia.

Now a post hoc analysis of the cohort, this time looking at the prognostic significance of low SaO2, showed that any change in SaO2 outside of 96–97% is associated with poorer outcome after acute stroke.

According to the international team of investigators, including from The George Institute in Sydney, patients with SaO2 desaturation were older, and had greater neurological impairment, premorbid disability and cardiorespiratory disease. Desaturation was not clearly associated with death or dependency (adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 0.95–1.48) but was with SAEs (aOR 1.34, 95% CI 1.07–1.68), without heterogeneity by head position, cardiac-respiratory comorbidity, or other pre-specified subgroups.

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Call for Medicare to review procedural specialist incomes

Procedural specialists are overpaid compared to other specialists and there needs to be a review of the inequities in the Medicare Benefits Schedule, according to two senior physicians.

The high incomes for procedural specialists are not justified by their long years of training, level of skill or the hours worked compared to other physicians or GPs, according to Dr Kerry Breen and Dr Kerry Goulston.

Writing in Pearls and Irritations, they say the imbalance in incomes between specialties has become wider and more distorted in recent years because of a flaw in the original MBS when Medicare was set up favoured procedural work over consultations.

The distortion is now deterring medical graduates from working in low income specialities, and there is an urgent need for the federal health department to commission a new study to review the 2005 Productivity Commission report on how to address  the income bias.

“Such a study should also be invited to examine whether the earning differentials between various groups of doctors are justifiable and are in the best interests of the health care system and patients,” they suggest.

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